A treatise on the nature, causes, and treatment of erysipelas / by Thomas Nunneley.

  • Nunneley, Thomas, 1809-1870.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the nature, causes, and treatment of erysipelas / by Thomas Nunneley. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    James,rof the skin being primarily involved, and the disease from thence affecting the cellular tissue ; the difficulty is not overcome. Moreover, as'there is no difference in the organization of the sub- cutaneous cellular membrane, and in that which is so universally diffused on the exterior surface of all membranes, both mucous and serous, and which also enters so largely into the composition of the abdominal and thoracic viscera ; there can be no reasonable objection to the assumption that, if in one situation it is obnoxious to any form of diseased action, so it may be in the other. As to the identity of the peculiar signs of erysipelas, during life or after death, in the part affected, which Mr. Lawrence would admit as proof of the existence of it; as far as the nature of the case will allow, they certainly are manifested. With regard to the four predominant signs of heat, pain, redness, and swelling; the increase of heat is of itself so uncertain that no one would think of relying upon it alone ; it depends upon the natural temperature of the part, and the distance of this from the centre of circulation ; the lower the temperature usually is, the greater is the increase during an inflamed condition ; so that in every species of inflammation, there is always less change in the temperature where an internal part is affected, than when the surface or extremity is attacked. The degree of pain, taken alone, is a very uncertain sign, and depends upon many circumstances; but it will, without hesitation, be ad- mitted, that there is at least as much tenderness in most cases of diffused peritonitis as there is in external erysipelas. That there is increased redness, with preternatural injection of the blood- vessels of a membrane diffusely inflamed, is undeniable. As to the last sign, swelling, it must be borne in mind, that when the skin alone is affected there is very little swelling, and that when the cellular membrane is affected, the swollen condition does not so much depend upon engorgement of the vessels of the part, or actual thickening of the tissue itself, as upon the effusion of serum into its cells where it is confined, and thus the swelling is mechani- cally produced. If the part affected be an expanded membrane, which does not contain these cells but presents a free surface, we should, a priori, expect that the effusion would be thrown off and escape ; accordingly we find it so ;-jone characteristic of erysipeloid inflammation of the membranes is the quantity of effused fluid. The objection, that the vesications of erysipelas are not found in these inflammations, is valueless, or worse, for it proves too much ; because, if vesications are essential to erysipelas, there are many cases which are, both by Mr. Lawrence and everybody else, allowed to be decided cases of the complaint, but which must no longer be considered so, for they want the passport of vesication. In a great number of cases of phlegmonous erysipelas of an extre- mity, there are no vesications ; they are not essential to the disease ; they are mechanical products, and can only exist when the in- flamed tissue is covered by an epithelium or cuticle, which is k James on Inflammation, p. 372.