ERYSIPELAS. 521 



Not all streptococci are able to cause erysipelas, 

 and a streptococcus cultivated from a case of ery- 

 sipelas is not able to cause the disease in all indi- Erysipelas. 

 viduals. Furthermore, cultures obtained from 

 other sources (phlegmon) may produce the dis- 

 ease (Koch and Petruschky). Koch produced an 

 erysipelatous inflammation with staphylococcus. 

 It has been suggested that streptococci which 

 cause erysipelas, rather than some other process, 

 do so because of some peculiarity in their virulence 

 or in the resistance of the individual, or perhaps 

 both. Another suggestion is that this type of in- 

 fection depends on some peculiarity in the skin 

 and subcutaneous tissue of the susceptible. The 

 conditions are obscure. The infection atrium is 

 not always known. In facial erysipelas entrance 

 probably is gained through the mucous membrane 

 of the nose in many instances. Erysipelas is a 

 wound infection in most or all instances, although 

 the atrium often escapes observation. The cocci 

 lie principally in the lymph spaces and interspaces 

 of the connective tissue. They are rarely to be 

 cultivated from the scales or the fluid of blisters, 

 but may be obtained from skin which is excised 

 from the border of the inflamed area (Fehleisen). 

 They probably are not excreted through the un- 

 broken skin. 



Erysipelas is an inflammation of the superficial 

 lymphatics of the skin, while in lymphangitis the 

 deeper lymphatics are involved. Thrombosis of 

 the lymphatic vessels, congestion of the adjacent 

 blood vessels, causing reddened streaks and local 

 hemolysis (?), are distinguishing local features. 

 Metastases occur to adjacent lymph glands and 

 the infection may become general. In this process, 



