Erysipelas of the newborn is often a.ccompanied by convulsions and somnolence, vomiting and liquid stools. In some cases there are symptoms of sepsis; inflammatory processes of the navel (arteritis, etc.) arc often demonstrable. In occasional cases the abdomen becomes very tense and tender to the touch, the oedema over it being especially pronounced and highly distended veins being visible in the skin of the thorax and upper part of the abdomen. In such cases one must keep in mind the possibility of an acute peritonitis which sometimes (proba bly as a result of the general septic infection) accompanies erysipelas neonatorum. This complication I have observed in two cases. Erysip elas in older children varies in no way from that in the adult. High fever accompanying it is the rule. Glandular swellings are usually demonstrable. It remains only to call attention to the now rare occur rence of vaccination erysipelas. Formerly, in the days of humanized virus, this appeared as veritable epidemics.
Course and neonatorum spreads very rapidly, as a rule, and with few exceptions results in death with manifestations of cardiac weakness. In older children the course is usually less violent and recovery takes place much oftener. With them also we not uncom monly encounter relapses and recurrences.
the diseased areas besides the hyperaemia, an extensive oedema of all the layers of the skin is found with small round celled infiltration of the skin and subcutaneous tissues. Also lymph node swellings, enlarged spleen and parenchymatous degeneration of the glandular organs. In many cases in the newborn diseases of the
umbilical vessels and sometimes sepsis can be anatomically demon strated. In uncomplicated cases innumerable foci of streptococci outside of the blood vessels in the affected area may be detected.
treatment of erysipelas in general, promises no brilliant results. The treatment with antistreptococcus serum as inaug urated by Mar morek, though theoretically well grounded, has completely failed in practice. Attempts to prevent the spreading of the erysipelas, by sealing the affected area and vicinity, have had, in the main, no definite results. For this purpose oil-paints, varnish, shellac, (siccative, Gersuny) and gutta-percha tissue have been recommended. Wolfler applies strips of adhesive plaster at a short distance from the boundary of the affected area, for the purpose of compressing the lymph-spaces and thus furnishing a hindrance for the migration of the streptococci. As a rule moist dressings are employed and compresses of liquor alum inii acet. (P. G.) diluted S times, or alcohol 50 per cent., sublimate 1-1000, boracic acid 1-2 per cent., salicylic acid 1 per cent., or lead water. The use of cold applications is often satisfactory as they usually at least relieve the pain. Others apply ichthyol ointment and recommend painting with tincture of iodine (a procedure to be avoided in the infant). The artificial hyperaemia of Bier seems to promise results.