272 THE TREATMENT OF DISEASES. 



Usually the disease begins with malaise, aching of the limbs, loss of appetite, 

 thirst, nausea or vomiting, diarrhoea, sore throat, increased heat of skin, frequency 

 of pulse, headache, giddiness, depression of spirits, and perhaps bleeding from the 

 nose. There are, in fact, all the ordinary symptoms of fever ; but there is no such 

 special prominence of any symptom as would enable us to give an opinion as to the 

 probable nature of the complaint. After a few hours, the patient may suffer from a 

 well-marked rigor, or he may experience only a little feeling of chilliness. 



After a few hours, or it may be a day or two, of these undefined symptoms, the 

 special phenomena of erysipelas make their appearance. The inflammation usually 

 first attacks some part of the head or face. It is most frequently seen about the 

 nose, or ear, or mouth, or eyelids. 



To the patient the part affected feels hot and burning, and on touching it, it is 

 found to be sore, stinging and smarting. It is of a red and shining aspect, and is 

 usually hard and swollen. The inflammation gradually extends, most commonly in 

 only one direction, but sometimes in several different directions. At the advancing 

 edge the skin is so distinctly hard and swollen, that it can be not only seen but felt, 

 whilst at the receding margin it is far less distinct. Sometimes the amount of 

 swelling is not considerable, but at others it is enormous. Sometimes the lips swell 

 enormously, the cheeks enlarge, the eyes are closed by the pufiiness of the eyelids, 

 and all traces of the natural countenance are effaced. A medical writer says : " I 

 know no disease, except perhaps confluent small-pox, by which the human face 

 divine is so completely and speedily deformed and disguised. A stranger seeing a 

 young female in the height of the disorder, and revisiting her after her recovery, 

 is astonished at the change. It seems as if, by some magic process, such as we read 

 of in our nursery tales, a hideous monster has been metamorphosed into a comely 

 damsel." In some cases, in addition to the redness and swelling, little bladders are 

 formed, like those produced by a blistering fluid, or a scald. These bladders may 

 attain a large size, and when they burst they leave dry and thick crusts, which 

 render still more hideous the face they have covered. Very frequently the inflam- 

 mation is quite superficial, but sometimes it dips, as it were, through the skin, and 

 affects the subjacent tissues, giving rise, perhaps, to the formation of matter. This 

 is often the case in the loose tissue of the eyelids, and it is more common on the 

 scalp than on the face. 



There is considerable variety in the course of the symptoms. In some cases there 

 is a speedy diminution in their severity, both locally and generally ; whereas in 

 others the reverse is observed. The amount of swelling about the face may be suffi- 

 ciently great to give rise to the most annoying, and even alarming complications ; 

 such, for example, as temporary blindness, deafness, and impossibility of breathing 

 through the nose. Sometimes the sufferer lies patiently still, yet apparently con- 

 scious and rational, till the tumefaction diminishes, and he is once more able to open 

 his eyes. In many cases, however, the result is less fortunate, and the patient 

 becomes first delirious and then comatose, and may die at the end of a few days. 

 Sometimes the disease extends to the throat, and the patient may die suddenly from 

 suffocation. In all cases of erysipelas of the head and neck it is necessary to 

 carefully examine the throat, count the number of respirations, and note the tint o 



