282 IMMUNOLOGY 



phagocytic cells (elasmatocytes). While the inflammation leads 

 to a general systemic reaction, it is not as a rule accompanied by 

 suppuration. Various severe types of the disease may occur. 

 They are, according to Kaufmann, given descriptive names sucli 

 as erysipelas vcsiculosum, erysipelas pustulosum, erysipelas gan- 

 grenosum and erysipelas phlegmonosum, respectively. The latter 

 term applies to an inflammation (erysipelas) which becomes dif- 

 fuse in both the skin and subcutaneous tissues with resulting sup- 

 puration. The term indicates the transition to a phlegmon. 



Streptococci in Erysipelas. — Fehleisen (1883) not only con- 

 sistently isolated streptococci from the lesions but also experi- 

 mentally reproduced the disease in man. His work has been con- 

 firmed repeatedly. He concluded that there is a distinct species 

 of streptococcus responsible for the disease and accordingly named 

 it Streptococcus erysipelatis. This conclusion lias led to a great 

 deal of controversy. Birkhaug and othcT-s offer experimental 

 support to the concept of Fehleisen, while Wheeler, Wadsworth, 

 Williams, and others maintain that there is antigenic similarity 

 between hemolytic streptococci from erysipelas, scarlet fever, and 

 other pathological conditions. They are certain that there is no 

 definite and strict correlation between the species of streptococcus 

 and the pathological conditions it produces. Birkhaug and others 

 have studied the soluble toxins produced by hemolytic strepto- 

 cocci from erysipelas and have produced specific antitoxins of 

 definite therapeutic value. 



McCann maintains that scarlet fever antitoxin is equally ef- 

 fective in the treatment of the disease as are the antitoxins pro- 

 duced by Birkhaug and others. At the present time it seems to be 

 settled that a satisfactory antitoxin has been produced and is 

 available in the treatment of erysipelas. To be effective it niusl 

 be able to neutralize the toxin of the streptococcus involved in 

 the particular case and also supply other specific antibodies. This 

 indicates the importance of using toxins of wide antigenic valences 

 in immunizing animals to produce antistreptococcus antitoxin. 

 The other points at issue are at present unsettled. 



Puerperal Sepsis. — Puerperal sepsis or childbed fever may be 

 due to hemolytic streptococci indistinguishable from those found 

 in scarlet fever, or as Harris and Brown* (1929) and others have 



♦Harris, J. W., and Brown, J. H. : Johns Hopkins Hosp. Bull. 44: 1, 1929. 



