ERYSIPELAS Erysipe as is a wound infection, which leads to a rapidly spreading inflammation of the skin and mucous membranes. It arises at times from large wounds and at times from insignificant breaks or excoriations of the skin. In the newborn the infection gains entrance as a rule at the umbilical wound, only very rarely elsewhere and then usually through the skin of the genital organs. Since the vogue of anti- and a-sepsis in obstetrical practice, the occurrence of erysipelas. as of the other wound infections of the newborn, has become much less frequent. Older children are subject to the infection under the same conditions as adults.
Symptoms. In case erysipelas occurs in a newborn infant the um bilical region, at the end of the first or beginning of the second week, shows a slight redness which spreads quite rapidly downward over the lower part of the abdomen. The affected parts are very (edematous and feel warm; at times pale-red spots are seen in their vicinity. In sonic of the cases the affected area has a rampart-like boundary which ad vances with the spreading of the disease. Within a few hours or clays the disease advances over the pubic region and the lower extremities. Only in a small percentage of the cases does erysipelas of the newborn spread upwards to reach the chest, head and upper extremities. (The author observed this only once in ten eases). As a rule the lower part of the body is the first and most severely affected. The disease is not always accompanied by fever. Chills are not observed in the new born: the fever rises gradually, in many eases is very high, remains high or falls before death; in other cases the disease runs its course without fever. The wall-like boundary and the redness are often not pronounced in the newborn. The (edema, however, is always very marked and tense; it may persist long after the disappearance of the redness and the healing of the erysipelas; then it is gradually absorbed. Blebs are formed in the skin just as with erysipelas in the adult. Not uncommonly the formation of necrotic areas in the skin is seen in cases which last several days; these usually affect the scrotum or the extremities and especially the skin over the small bones or on the dorsum of the foot.
In one ease observed by the author there was necrosis of the skin of the penis as well as of the scrotum. ID such cases circumscribed areas of the skin varying in color from dark-blue to black occur, which, gradu ally becoming necrotic, forni rapidly spreading ulcers with a lardy sur face. Phlegmonous processes leading to suppuration are rare.
Virehow saw develop, in the pharynx of a child with erysipelas, an acute phlegmon which caused attacks of suffocation.
Etiology.—The disease is caused by the entrance of streptococci into the skin. We owe the knowledge of this fact to the investigations of Fehleisen. The streptococcus of erysipelas differs in no way, how ever, from the streptococcus pyogenes. Earlier clinical facts had al ready supported this, von Eiselsberg produced erysipelas in animals by using streptococci from the pus of phlegmons. Koch and Petruschky furnished the experimental proof that erysipelas in man can be pro duced by using streptococci cultivated from abscesses. The strepto cocci enter the and wander further in them. Infection of the newborn probably takes place from the hands of the midwife, the nurse, possibly also of the physician, through the dressings and clothes. Children of mothers suffering from puerperal diseases are attacked with relatively greater frequency. In this connection the assumption is justified that the infection takes place from the infected lochia of the mother, through a third person or through the dressings.
In one case coining under the author's observation a physician who had dressed a patient. with erysipelas assisted at a delivery on the same day. The mother became septic and the child infected \ vith erysipelas on the fifth day. In another case a nursing baby was infected from a purulent mastitis and developed an erysipelas starting on the skin of the hp.