The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis.

Wharton, Henry R. (Henry Redwood), 1853-1925

Date:: 1902

Credit: The practice of surgery : a treatise on surgery for the use of practitioners and students / by Henry R. Wharton ... and B. Farquhar Curtis. 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.

63/1268 (page 49)

$SPECIAL FORMS OF INFECTION. By B. Paeqxjhak Cuetis, M.D. Erysipelas.—Definition.^-Although it is now generally ackuowledged that there is no essential difference between the coccus of Pehleisen, at one time held to be the specific germ of erysipelas, and the stre])iococcus i^yogenes, the affection known as erysipelas is so different clinically from the ordinary infection produced by the streptococcus that we must still describe it sepa- rately. Erysipelas is a circumscribed capillary lymphangitis of the skin and mucous membranes, marked by oedema and a dusky flush, which is strictly limited by a sharp edge. It begins in any part of the body, and advauces at one edge while it often subsides at another, thus wandering over the surface. The constitutional symptoms in the milder forms are scarcely perceptible, but in the severer cases they present the profoundest septic intoxication. There are two clinical varieties, phlegmonous erysipe- las and facial erysipelas, and we prefer to describe with them the erysipe- latoid lymphangitis of Eosenbach. Phlegmonous Erysipelas.—In this form, which is most frequently found upon the extremities in connection with ulcers or cellulitis, but may also appear on the trunk or head, the skin of the part becomes faintly reddened, then oedematous, the rosy hue giving way to a dusky-red flush, the skin being apparently increased to two or three times its ordinary thick- ness, and becoming dense and brawny. The edge of the affected area is sharply distinguished from the healthy skin by the color and the oedema. The disease progresses in a solid mass, and, although the edge may be very irregular, outljdng spots are very rarely seen. After a time the skin first attacked begins to grow pale again and the oedema disappears, the only trace of the inflammation left behind being the desquamation of the epithelium and the falling of any hair growing upon the part. Often, however, the inflammation of the skin is accompanied by a cellulitis, which results in the formation of extensive sloughs and abscesses, although the skin itself seldom sloughs even when this complication is added. The patient complains of heat, weight, or intense burning pain in the part, but in some cases there is no pain. The disease is ushered in by a chill, which may be very severe, followed by a sudden and great rise of temperature, often reaching 105° to 106° F. (40° to 41° C). The inflammation may progress steadily or by sud- den leaps, every extension being marked in the latter case by chills and another rise of temj)erature. The fever is of the septic type, with sudden elevations and depressions, the former sometimes not being accompanied by any visible spread of the inflammation. In these severe cases the patient soon becomes delirious or somnolent, the latter indicating perhaps the se\'erer form of the septic infection. The ui-iue is loaded with albumin, and the bacteria are found in it. The patient may fall into a typhoid delirium,$