RELATION OF ERYSIPELAS TO PUERPERAL FEVER. 133 



size of a pea. A multiple fibre-sarcoma was greatly benefited, 

 while an orbital sarcoma was not improved. 



In view of the uncertainty of the result, and the danger which 

 attends the intentional form of erysipelas, the danger of the dis- 

 ease being as great as in the accidental form, it is safe to predict 

 that no further inoculations will be made in man until we shall 

 have found a certain antagonistic action of the streptococcus of 

 erysipelas against some pathogenic microbes which are the cause of 

 some grave disease not amenable to less heroic measures. 



MANNER OF INFECTION. As the streptococcus of erysipelas 

 produces its pathogenic effects in the lymphatic vessels and diffuses 

 itself through these channels in the tissues, it becomes obvious that 

 infection takes place as soon as localization is effected in the lym- 

 phatic structures, or in the spaces contributory to them. Before 

 antiseptic surgery was practised, infection frequently occurred 

 through accidental or intentional wounds. Even before the 

 microbic cause of erysipelas was known, one of the closest of clini- 

 cal observers (Trousseau) claimed that infection with the virus of 

 erysipelas is only possible through some wound or abrasion of the 

 skin ; the latter may be so insignificant as to be unnoticeable, and 

 entirely overlooked by the patient and physician. Inoculation 

 experiments have shown that the time of incubation is from fifteen 

 to sixty-one hours, so that we can estimate the time quite accurately 

 in a case of beginning erysipelas when the infection occurred. 

 In most instances infection takes place through some wouud, a 

 slight abrasion of the skin, which may, perhaps never have attracted 

 the patient's attention, and which has become invisible at the time 

 the disease is first noticed. Infection, however, may also take 

 place through a mucous surface, through which the microbes enter 

 the tissue in the same manner, and under the same conditions as 

 when infection takes place through the skin. One of the severest 

 cases of erysipelas that ever came under my observation commenced 

 in the pharynx, or tonsils, and as the symptoms subsided here, a 

 typical and severe facial erysipelas developed. The patient was 

 suffering at the time from secondary syphilis. 



Relation of Erysipelas to Puerperal Fever. 



Obstetricians recognized the danger of exposing puerperal 

 women to the infection which might emanate from erysipelatous 

 patients, long before the tangible contagion of erysipelas was 

 known. Since the discovery of Fehleisen, this subject has attracted 

 renewed attention, and positive knowledge has accumulated both 

 from accurate clinical observation, and from the fertile, and more 

 positive field of experimentation. 



