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Erysipelas

child, mother, affection, conditions, operation and time

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ERYSIPELAS is not often seen in childhood after the age of infancy has passed. For a short time after birth, however, there appears to be a special tendency, under favouring conditions, to suffer from this serious affection ; and in lying-in hospitals the disease is a not unfamiliar one. Amongst well-to-do families erysipelas but rarely attacks the infant, and in chil dren's hospitals, even in those where quite young infants are admitted, it is exceptional to meet with an example of this form of illness.

Causation.—Erysipelas is in all cases a general disease of which the dermatitis and its consequences are merely the local expression. The malady most commonly affects new-born babies at a time when puerperal' fever is prevalent, and is most liable to happen during the first six weeks. of life. It is then apparently the result of a similar affection to that which attacks the mother ; and the illness almost invariably has a fatal issue. According to Trousseau, besides erysipelas, purulent ophthalmia and in fective peritonitis are common under the same conditions, and the three diseases must be regarded as various manifestations in different subjects of the same morbific principle.

But besides special puerperal infection, other agencies will act as pre disposing causes of the affection. Unhealthy conditions generally will do this ; and the complaint has been known to follow exhausting derange ments and diseases, such as chronic digestive troubles and the acute spe cific fevers. In some cases, however, no such influences can be discovered to have been in operation. Such a case came under my own observation in my student days. A healthy infant of a week old had great difficulty in relieving his bladder, owing to a very narrow preputial orifice. The operation for circumcision was performed (not very wisely) by a young surgeon. Extensive erysipelas followed, starting from the wound, and in a few days resulted in the death of the patient. The child was being suckled by a healthy mother. The parents were of the poorer class, but seemed comfortably circumstanced ; and their residence was clean, and certainly presented no obvious insanitary conditions. Possibly in this

and similar cases the erysipelas owed its origin to the use of imperfectly cleansed instruments in the operation.

The exciting cause of the affection is usually traumatic. The erysipelas may follow the operation of vaccination, inflammation set up about the umbilicus, a burn, or the incautious application of a blister. It may de velop around an intertrigo or attack a surface excoriated by the irritation of excreta. Some time ago a local outbreak of erysipelas occurring in a par ticular London district was traced to the use of a violet powder extensively adulterated with white arsenic. Apparently idiopathic cases do, however, sometimes occur. Thus, Mr. Strugnell has reported the case of a male in fant, aged eight weeks, in whom a patch of erysipelas appeared on the scalp and thence spread to the face, arms, and trunk. The child had suf fered from no bruise or other injury, and nothing objectionable was dis covered in the sanitary state of the house in which his parents were living. Other cases of a similar kind are on record.

It seems possible that the milk of a mother who has lately suffered from erysipelas may communicate the disease to her sucking child. Dr. Schole field has reported a case in which a woman during a sharp attack of ery sipelas of the face, neck, and scalp, gave birth to a son. As the labour progressed the erysipelas gradually faded, and when the child was born no trace of redness remained. The mother was warned not to nurse her child ; but on the fourth day, as the secretion of milk was copious, she put the infant to the breast. Twelve hours afterwards a red blush ap peared on the child's thumb and spread to the arm. This faded and the opposite arm became affected in the same way. Afterwards the same symptom appeared on one of the lower limbs, and in the end a large ab scess formed over the sacrum and the child died. The mother had no re turn of the erysipelas after delivery.

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