Pemphigus Neonatorum 



531 



264 (2224) 



Observations on the epidemiology of pemphigus neonatorum. 

 (Impetigo contagiosa bullosum?) 



By RALPH R. MELLON, WILLARD S. HASTINGS and DOROTHY 

 W. CALDWELL. 



[From the Highland Hospital, Rochester, New York.] 



On account of recrudescences of this condition in obstetric 

 wards following long periods of quiescence the presumption 

 obtains that the infection has never been completely eradicated 

 from the institution. In order to verify this conjecture, atten- 

 tion has been concentrated on the sporadic case, especially that 

 one occurring after months of freedom from the disease. 



Careful study of such a case reveals the interesting fact that 

 the origin of the disease in the infant was apparently by way of 

 the mother's milk, which was heavily infected with pure hemoly- 

 tic staphylococcus aureus and albus, the former predominating. 

 The lesion on the infant's skin followed forty-eight hours after 

 a rather generalized rash on the mother. It was of note that 

 aside from this macular type of rash the mother was quite nor- 

 mal. The rash itself resembled that often caused by drugi*. 

 Cultures of the cervix blood and stool were negative for the in- 

 fecting organisms, but the urine contained a few colonies. The 

 first and last portions obtained by completely emptying the breasts 

 with a sterile breast pump contained approximately equal num- 

 bers of the organisms, which were quite abundant, although no 

 evidence of mastitis was present, either clinical or from exam- 

 ination of the milk. 



Although ingesting large numbers of the organism in the milk, 

 the infant's stools were negative for the specific germ, which 

 ruled out the possibility of the initial thigh lesions being the 

 result of direct contamination from the stool. Many lesions 

 appeared on the baby's face and head about seventy-two hours 

 after those on the thighs. All this evidence points to a mild 

 systemic infection via the upper respiratory or intestinal tracts. 



Successful feeding experiments of young guinea pigs rather 

 confirms this idea. A certain per cent, of these animals fed with 

 cultures of the organism in milk developed a pneumonia, the 



