Erysipelas occasionally attacks an operation wound that has become septic; and it may accompany septic infection of the genital tract in puerperal women, or the separation of the umbilical cord in infants (erysipelas neonatorum).  After an incubation period, which varies from fifteen to sixty hours, the patient complains of headache, pains in the back and limbs, loss of appetite, nausea, and frequently there is vomiting.  He has a chill or slight rigor, initiating a rise of temperature to 103, 104, or 105 F.; and a full bounding pulse of about 100 (Fig. 25).  The tongue is foul, the breath heavy, and, as a rule, the bowels are constipated.  There is frequently albuminuria, and occasionally nocturnal delirium.  A moderate degree of leucocytosis (15,000 to 20,000) is usually present.

Around the seat of inoculation a diffuse red patch forms, varying in hue from a bright scarlet to a dull brick-red.  The edges are slightly raised above the level of the surrounding skin, as may readily be recognised by gently stroking the part from the healthy towards the affected area.  The skin is smooth, tense, and glossy, and presents here and there blisters filled with serous fluid.  The local temperature is raised, and the part is the seat of a burning sensation and is tender to the touch, the most tender area being the actively spreading zone which lies about half an inch beyond the red margin.

[Illustration:  FIG. 25.—­Chart of Erysipelas occurring in a wound.]

The disease tends to spread spasmodically and irregularly, and the direction and extent of its progress may be recognised by mapping out the peripheral zone of tenderness.  Red streaks appear along the lines of the superficial lymph vessels, and the deep lymphatics may sometimes be palpated as firm, tender cords.  The neighbouring glands, also, are generally enlarged and tender.

The disease lasts for from two or three days to as many weeks, and relapses are frequent.  Spontaneous resolution usually takes place, but the disease may prove fatal from absorption of toxins, involvement of the brain or meninges, or from general streptococcal infection.

#Complications.#—­Diffuse suppurative cellulitis is the most serious local complication, and results from a mixed infection with other pyogenic bacteria.  Small localised superficial abscesses may form during the convalescent stage.  They are doubtless due to the action of skin bacteria, which attack the tissues devitalised by the erysipelas.  A persistent form of oedema sometimes remains after recurrent attacks of erysipelas, especially when they affect the face or the lower extremity, a condition which is referred to with elephantiasis.