The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
=Symptoms.=--With the exception of the local appearances, they
are essentially the same in both of the above-mentioned forms.
The characteristic feature of the disease is a _dermatitis_ with
its peculiar _roseate_ hue, which it is impossible to describe in
words. In tint it differs slightly from that noted in certain cases
of erythema. It is, however, accompanied by an infiltration of the
structures of the skin, so that the area which is reddened is at the
same time elevated above the surrounding surface. Its edges are often
irregular. As exudate takes the place of blood in the tissues, the
red tint merges into a yellow. At this time there is more induration
of the skin and tendency to pit on pressure. Vesication of this
involved area is now frequent, the vesicles often coalescing and
forming large blebs and bullæ, which fill with serum that may become
discolored or purulent. When exposed to the air, unless the tissues
become gangrenous, this serum usually evaporates and forms scabs. This
disturbance of the skin is always followed after a number of days by
desquamation. This infectious dermatitis shows a constant tendency
to spread in all directions. Its most characteristic appearances are
limited to the margin of the enlarging zone, while in its centre there
may be evidences of recession of the disease. If it commences in the
vicinity of a wound it will probably spread in all directions from it.
Beginning in the face, it usually spreads upward; in the trunk, in all
directions; if on the extremities it tends to migrate toward the trunk.
_Wandering erysipelas_ is a term often applied to these phenomena. The
_metastatic_ expressions of the disease have been described.
When this affection attacks a recent wound the local appearances are
not essentially distinct from those mentioned under Septicemia. The
wound margins separate to a greater or less extent, the surfaces
slough, and a characteristic seropurulent discharge occurs. Granulating
surfaces usually become glazed--often covered with a membrane
resembling that of diphtheria; deep sloughs may occur, undermining of
wound edges, even hemorrhages from destruction of vessel walls. In rare
instances, however, under the influence of the microbic stimulation
granulations proceed faster than normal.
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