PHLEGMONA DIFFUSA

Synonym.—Phlegmonous cellulitis.

Phlegmona diffusa is a somewhat rare, more or less extensive inflam­
mation of the cutaneous and subcutaneous tissues, which is similar to

¹ Woods, Toledo Med. and Surg. Jour., 1880, p. 446; Taylor, Austral. Med. Gaz..,
1881-82, p. 34; Manley, Med. Record, June 18, 1898.

² Schleich, Methode der Wundheilung, Berlin, 1899; Riedel, Deutsche med. Wochen-
schr., 1891, p. 845; Parker, Brit. Med. Jour., Nov. 26, 1898, p. 1604.

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or closely allied to cellulitis and to erysipelas. It is of a rather ill-defined
character, presenting a conglomerate symptomatology of deep erysipelas
and later of extensive flat carbuncle. There are often prodromal symp­
toms akin to those observed in erysipelas: feeling of malaise, followed by
a decided chill or by repeated rigors, with subsequent febrile action.
There is usually sharp or dull pain at the site of the disease. It begins,
as a rule, as a hard infiltration of lumpiness somewhat deeply seated, and
is attended by a good deal of swelling and edema, which may involve
considerable area. In the course of five to ten days some softening is
observed, and the indurated swollen area gives place to bogginess and
fluctuation. Or before this stage is so clearly reached there may be
retrogression and a gradual disappearance of the swelling. In other
cases a melting away or necrosis takes place. The purulent matter may
burrow its way into surrounding tissues, involving those in the process;
or there may be a gradual working toward the surface, and one or more
openings may present, and discharge pus and the necrotic tissue. In
favorable cases the disease then gradually declines. In severe and grave
instances septic poisoning may ensue, the patient rapidly succumbing
or sinking gradually from exhaustion. In these severe forms the con­
stitutional symptoms continue from the very beginning. In favorable
cases as soon as there is cessation of pus-formation, febrile action, as a
rule, ceases, and the patient gradually recovers. Depending upon the
amount of surface necrosis, the scarring may be slight or extensive.

The malady is of a somewhat obscure nature. It is, as judged by
kindred diseases, due to a micro-organism. It may be the ordinary
pus coccus, with some unknown favoring conditions added. It is
really a phlegmonous cellulitis, and is probably to be regarded, as
suggested by some writers, as a deep form of erysipelas. It is similar
or closely allied (Hyde and Montgomery) to the gangrene foudroyante
of the French and to the acute purulent edema of English authors.
Unna‘s investigations would indicate that the process is due to infection
by the erysipelas coccus and pyogenic staphylococcus.

The disease varies in severity from comparatively mild form to a
rapidly fatal variety. With cases of mild or moderate severity in healthy
and vigorous subjects the result is almost invariably favorable; and even
in some of the more extensive cases in such individuals the outlook is
not hopeless. It is always to be considered, however, a dangerous affec­
tion. Constitutional treatment is to be of supporting character, as in
erysipelas; local measures are essentially surgical, consisting of incision,
thorough drainage, and the free use of antiseptics.

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