KELATION TO PHLEGMONOUS INFLAMMATION. 135 



author claims that the virus of erysipelas is one of the most viru- 

 lent puerperal poisons, and believes that they prove the causal rela- 

 tions of erysipelas to puerperal sepsis. 



Doyen (British Medical Journal, 1888, ix. 93, has also found, both 

 in mild and severe cases of puerperal fever, a streptococcus similar 

 to the one described by Rosenbach and Fehleisen. He made some 

 inoculations to determine their relationships. The streptococcus 

 found in the lesions of puerperal fever caused erysipelas, and the 

 streptococcus found in erysipelas developed puerperal fever. The 

 author believes that the microbe of puerperal sepsis is the same as 

 that of erysipelas. 



Puerperal sepsis from the virus of erysipelas can only be feared 

 when the virus is brought in contact with an absorbing surface in 

 the genital tract, but when this takes place and the streptococci 

 reach the enlarged lymphatic vessels of the puerperal uterus, the 

 most violent and fatal form of puerperal sepsis is almost certain to 

 follow. 



Relation of Erysipelas to Phlegmonous Inflammation and 

 Suppuration. 



Some difference of opinion still exists among pathologists with 

 regard to the question whether the streptococcus of erysipelas pos- 

 sesses pyogenic properties. The majority of those who have studied 

 this subject experimentally deny this, and assert that when suppura- 

 tion takes place in cases of erysipelas it is the result of a secondary 

 infection with pus-microbes, and, on this account, look upon phleg- 

 monous inflammation as a complication, and not as a condition 

 belonging to the erysipelatous process. 



Hajeck (" Das Verhaltniss des Erysipels zur Phlegmone," Deutsche 

 med. Wochenschrift, 1886, No. 47) has made careful investigations 

 to show that the streptococcus of erysipelas is neither in form nor 

 culture materially different from the streptococcus pyogenes, but he 

 showed, also, that in fifty-one cutaneous or subcutaneous inocula- 

 tions with a pure culture of the streptococcus of erysipelas in rab- 

 bits, the result was always a superficial migrating dermatitis which 

 resembled to perfection erysipelas in man, while similar injections 

 with the streptococcus pyogeues produced a more intense and deeply 

 seated inflammation, which in almost every instance terminated in 

 suppuration. The difference in the action of the two microbes on 

 the tissues plainly demonstrated their non-identity. Microscopical 

 examination of the inflamed tissues showed a still more important 

 difference as far as the localization and local diffusion of the microbes 

 were concerned. The coccus of erysipelas was always found with 

 the products of inflammation within the lymphatic vessels, and only 



