TOXINS AND ANTITOXINS 281 



While the rasli may have faded, tliey have a high, septic tempera- 

 ture (103° to 105° F.), the tonsils and fauces are extensively 

 inflamed and covered with membrane, and there is a persistent 

 cervical adenitis. 



This group also responds to antitoxin and convalescent serum 

 or blood. Park states that whole normal blood has been used by 

 Zingher in the treatment of eight cases belonging in this group. 

 He found it to be of definite therapeutic value. Its administra- 

 tion leads to a distinct lowering but not to a striking critical 

 drop in tlie temperature and to a definite improvement in symp- 

 toms. 



Immune-Transfusion. — In addition to the use of antitoxin, nor- 

 mal and convalescent sera in the treatment of scarlet fever with 

 sepsis, there has also been employed the blood of individuals 

 actively immunized with bacterial vaccines. This procedure 

 called immuno-transf\isio7i was originally recommended by Wright 

 (1919) for the treatment of typhoid fever. It has not been used 

 extensively. 



For a more extensive discussion of scarlet fever streptococci, 

 their toxins and antitoxins, the student is referred to Zinsser and 

 Bayne- Jones (1939) or some other standard textbook of pathogenic 

 bacteriology. 



Erysipelas. — Another interesting disease caused by the beta 

 hemolytic streptococci is erysipelas. It is an acute infection of the 

 skin appearing as a red, swollen, inflamed area, diffuse at first 

 and later showing a sharp line of demarcation. General febrile 

 changes usually occur. Within a few days the redness and in- 

 filtration may disappear and tlie skin appear normal or perhaps 

 rcddisli brown, dry and desquamating. The disease lasts usually 

 for one or two weeks. Except in debilitated individuals, the 

 prognosis is usually good. 



The bacteria in the lesion are present in the lymph spaces of 

 the corium. As the former advance, the area of inflammation 

 follows. For an excellent discussion of the minute lymphatics of 

 the living skin the student is referred to the work of Hadack and 

 MacMaster (1933). 



Types of Lesions in Erysipelas. — A study of the inflammatory 

 exudate in erysipelas shoM^s that it is rich in large mononuclear 



