458 DISEASES OF THE SKIN. 



by some hours, and still more often by some days, of general disturb- 

 ance of the health, accompanied by more or less fever. As the pro- 

 dromic stage is not constant, and as sometimes the general derange- 

 ment of health and the fever do not appear until after the local symp- 

 toms, the precursory signs of erysipelas are not to be compared with 

 the fever of the acute exanthemata, but are rather to be regarded as 

 analogous to that which often, for several hours or days, precedes a 

 severe coryza, or the stitch and cough of a pneumonia. The first local 

 symptom of the disease which is developing, is a sense of heat, ten- 

 sion, and pain in the skin, which is not as yet reddened or swollen 

 The neighboring lymphatic glands are already enlarged and sensitive 

 to the touch. Soon the skin, begins to redden and to swell. At first 

 the redness is speckled and clear, but it soon becomes diffuse and 

 dark. The swelling increases and soon becomes extreme, especially 

 where the skin is attached to the parts beneath by loose connective 

 tissue (as in the eyelids), where it renders the skin smooth and 

 shining from the tension. With the swelling, the sense of burning 

 and fulness also increases. At this period there is almost always a 

 violent fever, which grows worse toward evening. The pulse is usu- 

 ally full, beating from a hundred to a hundred and twenty times a 

 minute, and the temperature rises to 105 F., or even higher. The 

 thirst is increased, the appetite lost. As in facial erysipelas, the mu- 

 cous membranes of the mouth and tongue sympathize with the inflam- 

 mation of the skin ; there are also signs of violent oral catarrh. The 

 tongue is heavily coated and dry from the effects of fever, while a 

 fetid odor proceeds from the putrefying epithelium which covers it. 

 There is a slimy or bitter taste in the mouth. 



Although facial erysipelas may also be accompanied by symptoms 

 of dyspepsia, yet, from this, we are not justified in assuming that the 

 disease proceeds from a saburral condition, or from " biliousness," as 

 nearly all fevers are accompanied by more or less gastric derangement, 

 the patient sleeps badly, and his rest is troubled by dreams. Some- 

 times there is delirium, which, however, but rarely depends upon 

 implication of the meninges, and is due to the fever alone. At this 

 stage of facial erysipelas the patient is much disfigured and scarcely 

 recognizable. The epidermis is usually elevated here and there 151 

 small vesicles, or even in large blisters, while elsewhere the blisters 

 have burst, and their contents, with the debris of the epidermis, are 

 dried into yellow scabs. It is quite useless to give special names to 

 the unimportant variations observed in different cases of erysipelas, 

 caused by the degree of the swelling, the presence or absence of vesi- 

 cation, the size of the blisters, the nature of their contents, such as 

 erysipelas Icevigatum s. erythematosum, miliare, vesiculosum, bullo 



