CEDEMATOUS ERYSIPELAS. 37 



and reappears immediately on its removal. In some instances, 

 small miliary vesicles appear, in others bullae or phlyctense are ob- 

 served. The most favourable termination is in resolution, in which 

 case the epidermis is thrown off in small scales. It occasionally 

 assumes an erratic form, and sometimes it terminates by metastasis 

 to some of the internal organs. 



PHLEGMONOUS ERYSIPELAS. 



In this form the redness is very vivid, and diminishes in intensity 

 from the centre to the circumference. The cellular tissue being im- 

 plicated in this affection, produces swelling, hardness, and a burning 

 pain. This affection may terminate in resolution ; but should it pro- 

 ceed to suppuration, and measures are not employed to allow of the 

 exit of the pus, abscesses will form, and the cellular tissue between 

 the muscles will become implicated. The abscesses and sinuses 

 thus formed, will gradually burst externally, when a quantity of 

 gangrenous masses, mixed with foetid pus, will be discharged. The 

 constitutional symptoms in this case indicate that much mischief is 

 going on. The pulse becomes quick and hard, and the tongue 

 brown ; encephalitis, meningitis, or gastro-enteritis, may come on, 

 and the patient sinks under diarrhoea, with low muttering delirium 

 and coma. 



EDEMATOUS ERYSIPELAS. 



This is the name given to simple erysipelas affecting loose cel- 

 lular parts. The skin is smooth and shining; and pits on pressure. 

 This affection often induces gangrene, the skin being deprived of its 

 supply of blood through the distension of the cellular tissue; the 

 accession of this is announced by acute pain, a red and shining 

 skin, with sometimes a livid or leaden hue. The genitals in women, 

 the scrotum in men, and the infiltrated limbs of hydropic patients, 

 are the most usual seats of the oedematous erysipelas. Erysipelas 

 of the head and face is generally of the simple or oedematous 

 variety ; and is the form which the disease assumes, when there is 

 no wounded part for it to fix upon. It is very dangerous, as the 

 contiguous irritation is liable to cause inflammatory excitement, or 

 effusion within the cranium. 



Treatment. — When the surface of the inflamed part is of a deep 

 or florid red, tense, and very hot; the pulse hard, full, or strong; 

 the head much affected, and the papillse of the tongue erect and 

 excited, both general and local bloodlettings are requisite, especially 

 in unbroken constitutions, in persons not addicted to drinking to 

 excess, and very early in the disease. Local depletion by leeches or 

 incisions, will often be sufficient, except the patient be of a phlogistic 

 habit. 



At the outlet,, an emetic may often be administered with advantage ; 



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