This was not a case of puerperal erysipelas in the mother, for the dis ease had not only preceded labour but had completely disappeared by the time the child was born. It seems probable that the poison was com municated by the mother to the infant through the milk from her breast. At any rate, it is difficult to say in what other way the infant could have contracted the disease.
Morbid Anatomy.—In the skin the inflamed surface is red, hard, and brawny, with a well-defined margin. The redness disappears on pressure, and the hardness is due to accumulation of serum, lymph, and corpuscles in the substance of the cutis and tissue beneath it. If the oedema be co pious, the part is dull red in colour, soft to the touch, and pits on pressure. The area of inflammation rapidly extends to neighbouring parts, and as it spreads the skin first attacked becomes less tense and browner in colour. Sometimes the skin affection disappears from one part of the body and reappears on another without spreading along the surface. Thus, it may attack one limb, then fade in its first situation and break out on the cor responding limb of the opposite half of the body.
As a result of the inflammation, abscesses may form in the subcutane ous tissue ; and sometimes sloughing may occur in the skin or areolar tis sue. Often vesicles or bullm form on the inflamed surface, especially in the severe cases where there is subcutaneous sloughing.
In most instances of erysipelas in the infant, adjacent parts share in the inflammation of the skin. Peritonitis is common, even when the dermatitis does not occupy the abdominal parietes. There may be also inflammation of other serous membranes—the pleura, the pericardium, and the cerebral meninges. Sometimes the inflammation spreads from the skin to other parts by direct continuity. Thus, it may pass into the ear by the auditory meatus, into the nose and throat by the mouth, nares, and lachrymal ducts. In other cases, the disease begins in these deeper parts and extends to the skin by the same channels. In addition to the above morbid appearances, evidence of phlebitis, pneumonia, and enteritis is often observed. Lately micrococci, arranged in clusters, have been discovered by Fehleison in the lymphatic vessels of the affected portions of the skin. This observer has even succeeded in artificially cultivating the organisms on gelatine, and in the course of two months reared fourteen generations of micrococci. Some of these cultivated micro-organisms he inoculated into animals and others into the human subject. In almost all cases a typical erysipelas followed
the operation in the person or animal experimented upon.
disease presents different characters according to whether it arises as a consequence of puerperal infection or is induced by other causes.
In the first case the general symptoms are usually violent from the first. A patch of bright redness appears on some part of the abdomen, usually about the pubes. The part looks somewhat swollen, feels hard and brawny, and has a well-defined margin. The patch may be of limited extent, but there is high fever, and the infant looks ill, is restless, cries frequently, and is evidently in great pain. By the next day the area of redness has become widened ; the fever continues ; the fontanelle is de pressed, and the patient sleeps little and is very restless and feeble. The erysipelas continues to extend. It passes downwards to the lower limbs and upwards over the trunk ; the belly usually becomes fuller and may be tympanitic ; vomiting and diarrhoea come on, and a jaundiced hue of the skin may be observed. After a few days, the child falls into a state of collapse and death may be preceded by convulsions and coma. In this form of the disease the duration is sometimes very short. A child who appears to be healthy and vigorous when first attacked rapidly falls into a state of prostration and may die in a few days. The illness may, however, last for a longer time. The colour of the inflamed surface then becomes deeper and more purple, bullm appear on the surface, abscesses form in the subcutaneous tissue, or gangrenous sloughs may destroy considerable portions of the skin. Infants attacked by the puerperal form of erysipelas are usually under two weeks old, and the illness is almost invariably fatal.
When erysipelas occurs as a result of other causes than puerperal in fection the early symptoms are less violent. The local affection generally begins about the genitals, the pubes, the anus, or the lower part of the abdomen, and spreads thence in various directions. it extends widely, the parts of the skin first affected become paler, but are liable at any time to a return of the redness. The child has a pale pinched face, but may continue to take his food, and his digestion is often fairly good. In other cases, he refuses the bottle or breast, and may be troubled with frequent vomiting or looseness of the bowels. The temperature is high, at night it rises to 103° or 105°, sinking to 101° or 102° in the morning.