134 ERYSIPELAS. 



Gusserow (" Erysipel u. Puerperalfieber/'^lrc/Mv. f. Gryncikologie, 

 1887, p. 169) asserted upon the basis of aa extensive experience, 

 that no direct etiological relations exist between the contagion of 

 erysipelas and puerperal fever. He had under his care puerperal 

 women suffering from erysipelas of the skin without any serious 

 disturbances following in the genital tract. In ten other cases, one 

 of them occuriug during an epidemic of puerperal fever, the ery- 

 sipelas was observed as a complication of septic affections of the 

 genital organs. Gusserow asserts that, in this case, it cannot be 

 claimed that the erysipelas could have caused the puerperal affec- 

 tion, as the latter preceded the former. But another point could 

 be raised, as it might be claimed that the septic processes should be 

 made answerable for the occurrence of erysipelas. The author has 

 studied this subject also by way of experiment. A pure culture of 

 the streptococcus erysipelatosus, which had been tested and found 

 reliable in producing erysipelas by the usual methods of inocula- 

 tion, was injected into the peritoneal cavity of two rabbits ; in two 

 others it was applied to an open wound of the abdomen, and in the 

 last two animals it was injected into the subserous connective tissue 

 of the peritoneum. In all of these animals no effect was produced, 

 and no pathological changes were detected at the point of injection 

 when the animals were killed some time after the inoculation. 

 Gusserow looks upon the results of these experiments, if not as 

 positive proof, nevertheless as strong evidence against the claim 

 that erysipelas can cause puerperal sepsis. 



Winckel (" Zur Lehre von dem internen puerperalen Erysipel," 

 VerTi. der Deutschen Gesellschaft f. Gyndkologie, 1 Congress, p. 78), 

 an equally reliable and able observer, has come to entirely opposite 

 conclusions. He cultivated from a parametric abscess which had 

 developed after childbed, Fehleisen's streptococcus. Injections of 

 this culture in rabbits produced typical erysipelas. The same 

 author also observed erysipelas following, in a puerperal woman 

 suffering from suppurative peritonitis, pleuritis, and metro-lymph- 

 angitis. The patient died on the thirteenth day. The starting- 

 point of the erysipelas could be traced to an ulcer of the vulva. 



Blood taken from the right side of the heart soon after death was 

 inoculated upon a solid nutrient medium and produced a culture of 

 the streptococcus of erysipelas. The same culture was obtained by 

 inoculations with fluids taken from the peritoneal and pleural cavi- 

 ties, the uterus, kidneys, and liver. In three cases a culture thus 

 obtained was injected into the peritoneal cavity of rabbits and no 

 peritonitis followed. In one experiment it produced suppurative 

 peritonitis. Guinea-pigs proved less susceptible to infection than 

 rabbits. In white mice the inoculations were invariably followed 

 by a fatal disease. From the results of these experiments, the 



