An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![Varieties.—When the virus does not confine itself to the superficial capil- hiry lymphatics, l)ut spreads to the subcutaneous connective tissue, we have the varietv known as philegmonous crvsipelas. Under these circumstances sup- puration, -which is extremely rare in ordinary erysipelas, is likely to occur. The foul, acrid, and thin pus infiltrates large areas, and there are sloughs of the connective tissue which are discharged in masses. In some of the severe epidemics of this type the muscles were attacked and the periosteum was destroyed, giving rise to necrosis. Gangrene of the skin may also occasionally occur from deprivation of blood due to death of the underlying connective tissue. The presence of a jjhlegmonous inflammation is indicated by the increased amount of local swelling and constitutional disturbance. Fluctuation or bogginess is soon felt, and if the pus is not liberated by incision it burrows freely in all directions. Pinlegmonous cellulitis, or inilammation of the subcutaneous cellular tissue, is regarded as identical with phlegmonous erysipelas by many writers. It is probable that the streptococcus rather than the staphylococcus is most frequently found in this form of inflammation, but the question must remain open until the identity or non-identity of the streptococcus pyogenes and the streptococcus erysipelatis is settled. Clinically, the two types are readily dis- tinguished by the absence of cutaneous erysipelas in phlegmonous cellulitis. There are other forms of rapidly-spreading inflammations of the skin and cellular tissue, particularly those Avhich follow infected wounds of the fingers or hand, Avhich are regarded by some authors as akin to erysipelas. These at times take the form of lymphangitis; at other times they occur as acute swell- ings of the integuments and connective tissue, extending with great rapidity, showing but slight tendency to suppuration, and frequently terminating fotally with symptoms of acute septicemia. They are probably due occasionally to infection Avith streptococci or Avith saprogenic bacilli. Facial erysipelas, which at one time was regarded as idiopathic ery- sipelas, is now supposed to be due to infection through some slight wound or abrasion on the face. It usually begins with a blush near the root of the nose or the lachrymal duct and spreads laterally toward the ears. The color is a scarlet red, and the amount of swelling is usually great and is accom- panied with oedema about the eyelids, obliterating all facial expression and causing entire closure of the lids. Vesicles and bullne also form on the cheeks. The inflammation may extend to the scalp or the neck, but the chin is rarely involved. The glands at the back of the neck are enlarged. In some forms the fever runs high, and there is usually considerable delirium. This may be due to reflex irritation of nerves or rarely to a suppurative meningitis, the result of a direct extension of suppuration in the orbit or to the meninges. Ordinarily, the delirium disappears when the fever subsides. There is more or less conjunctivitis, and some oedema in the orbital tissues. If sup- puration should occur, blindness may result, a complication which is for- tunately rare. Erysipelas neonatorum occurs usually in epidemic form in hospitals. It begins as a slight inflammation about the umbilicus, but as it s]ireads to the genitals and thighs the constitutional disturbance is great and the prognosis grave. It may be complicated w'ith phlebitis of the umbilical veins extending to the liver. Erysipelas may involve the mucous membranes. In severe epidemics of erA'-sipelatous angina the tonsils are greatly inflamed and the tongue is often swollen. Diphtheritic or gangrenous inflammation of the fauces may also occur. These epidemics are rarely seen at the present time. Erysipelas may](https://iiif.wellcomecollection.org/image/b21217014_0104.jp2/full/800%2C/0/default.jpg)
