ERYSIPELATOUS DERMATITIS ERYSIPELAS. 457 



and then attacks the most trifling wounds, even leech-bites, is, that the 

 material which excites inflammation in the lymphatics, when absorbed 

 by them, needs not absolutely to be inoculated, nor to have been 

 generated by the decomposition of the secretion of a wound, but that 

 it may be contained in the surrounding air or in the dressings which 

 cover the wound. Although, however, I regard it as almost certain 

 that many forms of erysipelas proceed from the extension of an inflam- 

 mation from the walls of the lymphatics to the skin, yet I do not be- 

 lieve that all forms of the disease arise in this way ; and, in the so- 

 called erysipelas verum sen exanthematicum in particular, I believe 

 this mode of origin to be improbable. This primary idiopathic form 

 of dermatitis, which attacks persons previously in good health, and 

 which appears most commonly upon the face and scalp, bears some 

 analogy to pneumonia, pleurisy, laryngitis, bronchitis, angina, etc., 

 which also occur primarily and idiopathically, and which likewise ap- 

 pears in previously healthy subjects. We have no reason for looking 

 upon true erysipelas as one of the acute exanthemata, or of regarding it 

 as infectious ; indeed, the great tendency which the complaint shows 

 to recur again and again, in the same individual, may be advanced as 

 an argument against its analogy with scarlatina, small-pox, measles, 

 etc., and against the supposition of its infectious origin. The causes 

 of exanthematic erysipelas are as obscure as are those of pneumonia 

 and the other inflammations above alluded to. In both forms of dis- 

 ease it cannot generally be ascribed to local irritation, nor to cold, to 

 errors of diet, nor to other pernicious agents. Violent mental emo- 

 tion, however, seems to have an influence in producing the disease, 

 especially in persons who already have suffered from it. Like pneu- 

 monia, angina, and the other inflammations, erysipelas sometimes pre- 

 vails without assignable cause, under the influence of a so-called 

 genius epidemicus stationarius. We are unable to determine whether 

 these inflammatory disorders are secondary local manifestations of 

 some primary general disease, or whether the affection is of a local 

 character from the outset. Erysipelas also resembles pneumonia and 

 the other inflammations, by its tendency to attack persons who have 

 already suffered from the disease in preference to those who never 

 have had it. It occurs most often during middle age, and is seen 

 somewhat more frequently in women than in men. The disease is 

 more common in warm weather than in cold. 



SYMPTOMS AND COTTKSE. Erysipelas proceeding from external 

 causes belongs to the province of surgery. In this work we shall 

 only consider the symptoms and course of the erysipelas verum seu 

 exanthematicum. 



In many cases of true erysipelas, the local symptoms are preceded 



