460 DISEASES OF THE SKIN. 



grenous erysipelas are very tedious in their course, as the loss of sub- 

 stance resulting from the separation of the sloughs is repaired very 

 slowly. 



Erysipelas is sometimes complicated with bronchial or with intes- 

 tinal catarrh, sometimes with intense hyperasmia of the kidneys, and 

 with catarrhal or croupous inflammation of the uriniferous tubules. 

 A far more serious but less common complication is the extension of 

 the inflammation from the scalp to the meninges. There is no me- 

 tastasis in such cases, however. The so-called " striking-in " of 

 the erysipelas is a consequence of the malignant character of the 

 disease, and of incipient collapse, and is not to be regarded as the 

 cause. 



Wandering erysipelas (erysipelas ambulans s. migrans) generally 

 attacks the extremities, and spreads toward the trunk and head. It 

 usually advances steadily, so that the disease, while subsiding in one 

 place, is commencing in the immediately adjoining one. Much more 

 rarely it advances by skips, so that there are intervening regions of 

 sound skin between the inflamed surfaces. The hyperaemia and swell- 

 ing are not generally so severe in the wandering erysipelas as in the 

 stationary ; and while in the latter the redness and tumefaction are 

 most intense at the centre and gradually fade toward the edges, in 

 the former the seat of the greatest swelling and reddening is close to 

 the healthy skin. This form of erysipelas is usually accompanied by a 

 more moderate fever. However, as the disease often continues for 

 weeks and even for months, during which time the inflammation some- 

 times reverses the direction of its progress, and even goes back to its 

 original point of departure, even this lesser degree of fever is capable 

 of so exhausting the patient as to endanger life. 



TREATMENT. A large number of so-called "sympathetic reme- 

 dies " against " the rose " are in popular use ; even intelligent and 

 educated people often carry amulets to protect them from its attacks, 

 and submit to conjuration of the disease if the amulet fail. Owing to 

 the short, cyclical, and almost invariably favorable course of the dis- 

 ease, therefore, every new attack of erysipelas is a fresh proof, in the 

 eyes of superstitious people, of the efficacy of their sympathetic cures. 

 Hence, as one seldom receives any thanks for attempting to combat 

 such superstition, and as it usually is labor lost ; moreover, as the " in- 

 vocation of the rose " has this advantage, that the patients, confident 

 in the efficacy of the procedure, accommodate themselves to their dis- 

 tressing position with patience, and without longing for superfluous 

 medication, I deem it advisable to allow patients, who believe in such 

 remedies, to do as they like. At all events, they do much better thus 

 than when (as often happens) the physician commences the treatment of 



