A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy.

Date:: 1877

Credit: A handy-book of forensic medicine and toxicology / by W. Bathurst Woodman and Charles Meymott Tidy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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$1060 ERYSIPELAS AND PYA5MIA. night, or in the early morning. It is a late result of wounds or other injuries, and usually occurs when there are large abscesses or large and profusely suppurating wounds, such as compound fractures, gunshot wounds, amputations, or resections. It is often associated with the tuberculous or phthisical diathesis, and is thus met with in scrofulous and scorbutic patients, and those who are consequently often the subject of joint-diseases, or caries of the spine, Ac. Erysipelas, sometimes called phlegmonous inflammation, “ St. Anihoirtfs fire,” or “ the rose,” is an unhealthy form of inflammation, which generally commences with a rigor or rigors, attacks first the skin, usually in the neighbourhood of a wound or sore of some kind; spreads into the con- nective tissue beneath the skin; and may finally involve the connective tissue and fascise of muscles and other deeper structures, and invade the peritoneal or pleural cavities; or in the head, the membranes of the brain, and the sheaths of nerves. It hangs about old hospital wards, old workhouses and ancient ships, and is the scourge of camps and fleets iu time of war. It infests lying-in hospitals chiefly in the form of puerperal peritonitis, with which it seems interchangeable. Old sponges, dirty dressings, dirty towels and bedding, and the unwashed hands or dirty nails of surgeons and dressers, of midwives and nurses, appear to be active in spreading it. Under certain circumstances it appeal's to change into, or be exchanged foi’, hospital gangrene. On the other hand, some new hospitals, where every precaution is taken, appear infested with it. In a few cases the proximity of drains, sewers, or of a dead-house, have been shewn to be associated, if not chief factors. Some old hospitals again, such as the Glo’ster Infirmary, where the boards are dry-rubbed, instead of being scrubbed, are remarkably free from it.* It is sometimes, though less frequently, met with in private practice when all the surroundings are favourable. One form of this disease wanders all over the body, and is then called erratic. If erysipelas be slight, and almost confined to the skin, it is called simple or cutaneous. The severer and deeper forms are known as cellulo-cutaneous or phlegmonous. Overcrowding, unhealthy situations, a large number of extensive and open suppurating wounds, dirty dressings, and foul sponges, want of cleanliness in other ways, the presence of septic poisons, and, as some say, of bacteria, micrococci, and other germs in the air, the prevalence of certain winds (as those from the north-east), and other circumstances, have been alleged as the true or proximate causes of this disease. It is well known to be both a dangerous and uncertain disease as regards its termination. Pyaemia again, which derives its name from the supposed presence of pus in the blood [irvov, pus, alga, blood], also spelt pyohoemia, is a diseased state of the blood, doubtless caused by the presence of septic, or un- healthy materials in the blood, which cause the coagulation of fibriue, and effusion of this and of blood; as well as stasis and arrest of the red blood-discs, in various organs and cavities (such as the lungs, liver, heart, Ac.), and in the interior of joints. Thus secondary or metastatic abscesses are formed iu various parts. Usually the immediate wound (which generally involves the cancellous tissue of some bone more or less immediately) suppurates less freely, or even becomes almost dry, and the patient has severe rigors at odd times, perhaps several in an hour. His * This statement refers to some six or seven years ago. The authors have no recent statistics on this point.$