ERYSIPELAS. 4.59 



*um, crustosum, ind the like. The redness usually begins to fade 

 about the third or fourth day, the swelling subsides, the pain abates, 

 and the tension of the blisters, which still remain, diminishes, part of 

 their contents undergoing absorption, another portion drying up into 

 a crust. It nearly always happens, in facial erysipelas, that the disease 

 spreads beyond the region first attacked, and that while the inflamma- 

 tion is subsiding at one point it is still at its height elsewhere. Hence, 

 patients often suffer more after the tumefaction of the face has sub- 

 sided, and they have again become able to open their eyes, because the 

 disease has invaded the scalp, which, being firmly attached and but 

 slightly distensible, is much more sensitive when in a state of inflam- 

 matory tension. 



Excepting the " wandering erysipelas," to be described presently, 

 the disease does not generally spread over more than a moderate area 

 of skin. Facial erysipelas almost always involves the eyes, ears, hairy 

 scalp, and a portion of the throat, but scarcely ever attacks the back 

 of the neck or the trunk. Hence, as it also has to run its course upon 

 the region last attacked, its whole duration is usually about a week, or 

 somewhat longer. The process terminates in the peeling off of the 

 cuticle in large pieces, even where there were no blisters. If the scalp 

 has been inflamed, the hair always falls out soon afterward, for the 

 hair follicles have also been the seat of an exudation which loosens 

 the hair and detaches it from its matrix. Erysipelas, however, does 

 not cause any permanent injury of the hair follicles, hence the baldness 

 which it occasions soon disappears completely. In the somewhat rare 

 instances in which erysipelatous dermatitis passes into suppuration, 

 fluctuation appears at one or more points of no great magnitude (and 

 most frequently in the eyelids). Generally speaking, this is not ob- 

 served until the redness and swelling of the surrounding parts have 

 begun to subside. Puncture of the abscess or its spontaneous open- 

 ing, which is apt to be somwhat delayed, is usually followed by a dis- 

 charge of yellow laudable pus, and by speedy recovery. Reddening 

 of the contents of the vesicles by effusion of blood is not always an 

 unfavorable sign, although it is sometimes due to a gangrenous stasis 

 of the capillary circulation in the inflamed skin. Upon the appearance 

 of gangrene of the skin (which is not rare in the malignant forms of 

 symptomatic erysipelas, but which is of quite exceptional occurrence in 

 the true, or exanthematic form of the disease), the contents of the ves- 

 icles assume a dark color, and the skin beneath is converted into a 

 grayish discolored slough. The general condition of the patient 

 changes. The fever becomes asthenic ; the temperature is very high : 

 the pulse very small and frequent, and there is an intense prostration 

 which may be fatal to life. Even the most favorable cases of gan 



