136 ERYSIPELAS. 



exceptionally in the connective-tissue spaces, which anatomically 

 are only a part of the lymphatic system. The streptococcus pyo- 

 genes penetrates the tissues more deeply ; it is not only found in 

 the lymphatic vessels, and connective-tissue spaces, but it migrates 

 beyond the lymphatic system and infects different kinds of tissue, 

 thus giving rise to a more deeply seated and more intense inflam- 

 mation. The cocci of erysipelas are found only exceptionally in 

 the immediatete vicinity of bloodvessels, while the streptococcus of 

 suppuration can always be seen arranged in radiate lines around 

 vessels entering the adveutitia, the muscular coat, and often even in 

 the lumen of the vessel. In man, the same histological differences 

 can be seen in erysipelas and phlegmonous inflammation as in the 

 artificial conditions in animals subjected to experiment, and the 

 same pathological differences are also constantly found. The author 

 asserts that Fehleisen was in error when he claimed that the forma- 

 tion of abscesses occurred independently of the erysipelatous infec- 

 tion. He affirms that, in rabbits inoculated with the virus of 

 erysipelas after the acute inflammation has subsided, circumscribed 

 small nodules which remain may suppurate, but the suppurative 

 process remains circumscribed, while after injection with cultures 

 of the streptococcus pyogenes the inflammation assumes a phleg- 

 monous type, and the suppuration is always more diffuse. Under 

 certain circumstances, a circumscribed subcutaneous suppuration 

 can also take place in erysipelatous inflammation in man. When 

 suppuration in a joint takes place, however, it is not caused by the 

 erysipelatous infection, but is due to the presence of pus-microbes. 

 Death following erysipelas is caused by the introduction into the 

 blood of ptomaines in sufficient quantity to produce fatal intoxica- 

 tion, or by the entrance of the cocci into the circulation, which 

 seldom takes place, or it results from complications incident to the 

 disease occurring independently of it. In the discussion on this 

 paper Eiselsberg said, from the knowledge he derived from his own 

 personal experimental work, he would agree with Passet in that the 

 streptococcus erysipelatosus and pyogenes do not differ in their 

 pathogenic effects. They are not different species of microbes, but, 

 at the most, only varieties of the same species. Passet found that 

 the streptococcus which he cultivated from a phlegmonous abscess 

 was different from the one described by Rosenbach, inasmuch as in 

 culture it resembled the coccus of erysipelas. 



Von Noorden ("Ueber das Vorkommen von Streptococcen im 

 Blut bei Erysipel," Milnchener med. Woehenschrift, No. 3, 1887) 

 records an observation which tends to prove that the coccus of ery- 

 sipelas occasionally enters the circulation, and that, when it localizes 

 in distant parts of the body, it can produce suppuration. In the 

 course of a severe attack of erysipelas which proved fatal, suppura- 



