Erysipelas and Puerperal 
Fever. 
1! Y 
A. GUSSEROW. 
Translated from “ Archiv f Gyndkologie\ by 
Robt, T. Wilson, M.D., 1 
AND 
Wm. B. Canfield, A.M., M.D. ERYSIPELAS AND PUERPERAL FEVER. 
BY 
A. GUSSEROW. 
Translated from reprint from “Archiv f. GyndkologieVol. 24, Part 2, by 
Robt. T. Wilson, M.D., Baltimore, Md., 
Foundation Fellow of the British Gynaecological Society; Assistant Surgeon to the 
Hospital for the Women of Maryland ; Gynaecologist to the 
Union Protestant Infirmary, 
Wm. B. Canfield, A.M., M.D., 
Baltimore, Md. 
AND 
The more the study of infectious diseases rules the medicine of the 
present time, the more our interest is directed toward the relation which 
the individual diseases bear to each other. Among the infectious diseases 
which, according to the old ideas, are said to stand in a decided change- 
able relation to each other, are, especially in England, erysipelas and 
puerperal fever, that if we are willing to designate the puerperal infec- 
tious diseases by this old name. The endeavor has been made to prove 
clinically the identity of both diseases by pointing to the fact that they 
appear simultaneously, and still further by showing that puerperal fever is 
said to be engendered from erysipelas, and vice versa in the case of lying- 
in-women. I hope I may be allowed to develop this point, since very 
exhaustive statements of the facts which belong to this subject are to be 
found in the writings of Hirsch and Zuelzer, and also Hugenberger (v. 
this Archiv., vol 13, p. 387) enters very thoroughly into this question. 
The views of the identity of both forms of disease are especially furthered 
by the opinions of Virchow, that, anatomically considered, the course of 
certain forms of puerperal infectious diseases, especially in the cellular 
tissue of the pelvis, resembled, or indeed is the same, as in erysipelas. 
On the whole, however, it must be confessed that our knowledge of the 
connection of these two diseases, though they indeed present anatomic- 
ally and clinically such a decided different picture, is to the highest de- 
gree superficial and faulty. There are cases on record in which erysipelas 
appeared to an alarming extent in cases of lying-in-women as well as in 
other patients; this is the so-called nosocomial erysipelas; and further it 
is said that septicaemic conditions and pyaemia have been engendered 
from lying-in-women with erysipelas, and vice versa, from such lying-in- 
women erysipelas has occurred with other sick persons or with well per- 
sons—physicians, nurses, etc. There are statements enough in existence 2 
Erysipelas and Puerperal Fever. 
which must make us cautious in our practice, but which are always being 
opposed by the greatest number of observers, and these, though widely 
differing, proving that there is a connection between erysipelas and septic 
infection. This subject, which has been treated in a variety of ways, has 
made great progress in recent years through the fact that Volkmann 
(Pitha-Billroth’s Chirurgie, Erysipelas, p. 161) lays.stress upon this point, 
that erysipelas as a disease, sui generis, must with all clearness be separ- 
ated just here in the puerperium from the phlegmonous conditions,—a 
view which has already been expressed by others, but not so decidedly 
(Hirsch, etc.). ('jHugenberger endeavored to show on the ground of an 
extended experience, that erysipelas in the puerperium only appeared as 
a dangerous complication and had nothing to do with puerperal fever. 
The discovery of Fehleisen, which made an epoch in the study of erysip- 
elas, recalls involuntarily to our recollection the question, how far erysip- 
elas stands in connection with septic infection in the puerperium 
(Frankel, Deutsche Med. Wochenschr., 1884, No. 14; Lomer, Zeitschrift 
f Geburtsh. u. Gyndk. x). While I formerly had had opportunity to ob- 
serve an occasional case in the institutions under my charge or in my 
private practice, there appeared in the spring of 1879 a relatively larger 
number of erysipelas cases with lying-in-women, while at the same time 
many cases of puerperal fever appeared in the obstetrical ward of the 
Charite Hospital. From the course of the cases of nosocomial erysipelas, 
if we are willing thus to designate the coincidence of about nine cases of 
genuine erysipelas, I was thoroughly convinced that there existed no con- 
nection between puerperal sepsis and erysipelas. These observations 
were made at a time immediately after the appearance of Hugenberger’s 
communications, and at that time I could not have added anything ma- 
terially new to them by publishing the cases observed by me. Since 
through the erysipelas coccus, the specific principle of erysipelas, the pe- 
culiarity of the disease has been so beatifully proven, it seems to me that 
now is the time to emphasize again from a clinical standpoint the individ- 
uality of erysipelas in the puerperium, and to endeavor to prove that this 
disease has nothing in common with puerperal sepsis. In the next place 
the history of a large number of erysipelas cases during pregnancy can 
be brought forward to substantiate this view. Medical literature contains a 
sufficient number of observations on the course of erysipelas in pregnant 
women, and I myself could quote a still larger number of cases; but 
partly because I have not the full notes of these cases, and partly because 
a large number of histories of cases would only be tiresome, I shall con- 
fine myself to the following : 
I. C. A., from Alsace, 23 years old, in the last month of pregnancy, 
is taken ill on the 15th of Nov. with erysipelas of the right cheek, with 
I v. this Archiv, vol, 13, p. 389. Erysipelas and Puerperal Fever. 
3 
chill and fever. The erysipelas extending to the left cheek with increase 
of temperature. 
On the 19th of Nov. the pains began, and on the 20th a matured 
child was born. 
While on the 19th and 20th the erysipelas was abating and corres- 
pondingly the temperature had dropped to 38.2° C., it rose on the 21st, 
the first day of the puerperium to 39.2° C., because the erysipelas had ex- 
tended to the forehead and neck. On the 24th, the fourth day of the 
puerperium, temperature sinks to normal. The patient is convalescent, 
and is dismissed on the 2d of December, well. 
11, L. Stoll, 25 years old, primipara; she noticed in the Bth month 
of her pregnancy a painful redness on the left leg in the region of a 
small abrasion; this redness increased the next few days. The left leg 
is cedematous, and the anterior surface of the leg is intensely congested. 
At the same time there is high fever (4o°C.). 
The redness and swelling increase considerably in the next few days, 
in such a way that the disease extends to the upper leg [thigh] as far as 
the groin and decreases on the leg. Large blisters appear on the thigh, 
while the process extends to the left buttock. The erysipelas, with con- 
tinued high fever (40.7° C.), creeps over the posterior surface of the ab- 
domen to the right thigh and the genitalia. 
On the nth day the erysipelas descends on the posterior surface of 
the right thigh, but upon the back [body] it ascends to some extent. The 
left extremity is again of normal color up to the knee; the epidermis 
peels off in large pieces. 
Slight pains [labor] began on the 10th day of the disease, and the 
foetal heart sounds distinct. 
On the 12th and 13th days the disease extends along the back up to 
the back of the neck and to the sides of the thorax. The patient begins 
to cough, and rales are heard on both sides below [behind thorax], and 
there is also some dulness on percussion. The patient is in a stupid state, 
takes no nourishment, temperature 39.2° C. Foetal heart-sounds no 
longer heard. 
14th day, patient in a collapse; great dyspnoea. Dulness on both 
sides of the thorax up to the angle of the scapula (Angulus Scapulae) ; 
labor pains present. 
15th day, the condition of patient worse, pulse 138; on the inner side 
of the left leg there is a gangrenous spot as large as a silver dollar. 
On the 16th day the birth of a macerated male foetus of eight months 
takes place with violent labor pains. A few minutes afterwards the 
death of the patient occurs. 
Postmortem (v. Recklinghausen); Thickening of the left lower ex- 
tremity, with peeling off of the epidermis. On the back part of the ex- 
tremity are observed red spots, and the skin is also infiltrated; on the 4 
Erysipelas and Puerperal Fever. 
thigh the subcutaneous tissue is rich in fat, with localized infiltration; the 
lymph glands of the inguinal region are enlarged and the lymph vessels 
leading to them filled with pus; the skin of the back of the foot oedemat- 
ous. In the deepest layers of the subcutaneous tissue of the leg there is 
a moderate infiltration of pus; there is no change of the bone. On the 
right side there is only oedematous infiltration in the subcutaneous tissues. 
In the lower portion of the skin of the abdomen there is a distinct infil- 
tration of pus in the connective tissue layers which are imbedded in the 
fatty tissue. In each pleural sac there is about a litre of purulent fluid. 
In the lungs on both sides exists atelectasis in the lower parts. Spleen 
unchanged. The kidneys show cloudiness of the corticle substance and 
hypersemia of the medullary portion. And there are no deposits of 
tubercle to be found. The uterus extends above the pelvis. The peri- 
toneal cavity and Douglas’ cul-de-sac are free from disease and there is 
nothing pathological in the uterus or its appendages. 
In both of these cases the erysipelas occurred as an accidental dis- 
ease during pregnancy, just as it might attack any other person. It is, 
to say the least, doubtful if the birth in the first case took place under 
the influence of the disease (des Fiebers) or not, because the fever was 
not high enough, nor did it last long enough to make this probable, and 
again, because the patient was in the usual health of a woman at the end 
of a normal pregnancy. At all events, the birth took place while the 
erysipelas was going on, the latter taking its course in the usual way with- 
out having any influence on the puerperium at all; not to mention the 
fact that septic conditions had appeared in the puerperium. 
The history of the second case is entirely different. A pregnant wo- 
man, in the Blh month, is suddenly taken sick with erysipelas, and in its 
long duration and high fever, the child is born dead. Immediately after, 
the patient dies, and the post-mortem shows with certainty that the puer- 
peral fever is only an accident in the course of the erysipelas, and that in 
spite of the fact that the patient was sick with erysipelas and finally died 
of it, that there were no post-mortem changes present to point to a puer- 
peral sepsis. 
The appearance of erysipelas as an accidental complication in the 
puerperium is no less characteristic and clear in a number of cases, from 
which I cite one as an example. 
111. A. 8., after an easy labor, gave birth, in April, 1883, to a liv- 
ing child, and was taken sick on the fourth day of the puerperium with 
an erysipelas faciei, with correspondingly high fever. At the same time 
she had a cough, with rust colored sputum. A decided dulness on per- 
cussion could not be found. The fever continued until the Bth day, and 
the crisis occurred on the morning of the 9th day, when the fever fell,— 
at the same time the abdominal signs in the lungs gradually disappeared, Erysipelas and Puerperal Fever. 
5 
the erysipelas quickly disappeared, and she was completely cured. There 
was not the slightest disturbance to be found in the genitalia. 
Here we have the case of a healthy lying-in-woman who is taken 
sick on the 4th day of the puerperiura with erysipelas faciei, which takes 
the same course as with any other person, leaving the puerperium en- 
tirely unaffected. The height of the fever keeps pace with the intensity 
of the skin disease, both dropping together; there being no disturbance 
in the genital tract. Another set of cases helps to prove that erysipelas 
and puerperal sepsis have nothing in common. Of these cases I have 
only noted one, which belongs to the above mentioned epidemic of nos- 
ocomial (?) erysipelas. 
IV. A. 8., after a light case of labor, was delivered of a living child 
on June 21st, 1879. Up to the eighth day the puerperiurn was normal 
without fever. On the eighth day there appears with high fever (39.0° 
C., pulse 102; evening, 40.50 C., pulse 120), an erysipelas which started 
with an abrasion on the right mammary gland. This erysipelas extends 
gradually over the whole breast, reaching posteriorly to the back and up- 
ward to the neck, thus involving the whole thorax. Later, it extends to 
the skin of the abdomen below the umbilicus; at the same time there is 
very high fever with an irregular and extremely frequent pulse. The 
patient, from the beginning, was very restless, and tried to jump out of 
the window. On the fourteenth day of the puerperiurn and the sixth 
day of the disease, coma set in; appearances of pneumonia having al- 
ready been observed on the fourth day of the disease. On the fifteenth 
day of the puerperiurn, and the seventh of the disease, the patient died. 
The post-mortem showed a bright redness of the skin on the depend- 
ent parts of the trunk and upper extremities, the remaining parts being 
colorless. On making an incision, there was found everywhere corres- 
ponding to the red places, a succulent somewhat cedematous condition of 
the fat tissue, and nowhere pus or cloudy infiltration. The interstitial 
cellular tissue of both mammary glands were in the same condition. 
The right lunu was slightly cloudy on the surface of its middle lobe, and 
in the middle lobe there was also a small number of lobular hepatizations 
which are situated near the surface of the lung, and these are hard and 
resistant. The remainder of the right lung is hyperaemic, otherwise nor- 
mal. The spleen was swollen, hyperaemic and soft. The kidneys were 
very much swollen, the corticle substance was very large and cloudy; 
and the medullary was congested. The abdomen was entirely normal. 
Uterus was gradually gaining its normal size, its internal surface dark red 
and covered with a thin grey mucous coat. The broad ligaments were 
not diseased, both ovaries, as well as the other appendages of the uterus 
and vagina, were in a normal condition. There was oedema of the pia- 
mater and brain. 6 
Erysipelas and Puerperal Fever. 
The child, a healthy boy, was taken sick two days before the death 
of the mother, with erysipelas of the face, which began with a small abra- 
tion on the nose. On the third day of the disease the child died. 
At the post-mortem there was found only a hyperseraia of the brain 
and an infiltration of the subcutaneous cellular tissue of the parts where 
erysipelas had occurred during life. 
This case resembles, to a certain extent, case 2. In both cases a 
typical erysipelas, beginning with an abrasion of the skin, occurred after 
pregnancy, in an entirely healthy lying-in-woman, on the eighth day of 
the puerperium. Case 4 takes a serious turn with violent appearances, 
and ends fatally on the seventh day of the disease and the fifteenth of 
puerperium, although during life every appearance was wanting to point 
to a disease of the genital apparatus, the course of the disease could be 
diagnosed a puerperal septic infection, because at the same time there 
were cases of the same kind of disease in the department. 
If there had been no post-mortem this observation might have been 
sufficient to prove the connection between erysipelas and puerperal fever, 
the discovery of the erysipelas coccus had not been made or else the 
proofs and attempts at cultivating might have been able to confirm the 
diagnosis during life. The post-mortem showed that it was only a bad 
case of erysipelas. 
If all the cases of erysipelas which have been recorded scarcely admit 
of a doubt that during pregnancy and the puerperium occurs an acciden- 
tal disease which stands in no relation to septic infection, that will not 
appear clear, very likely, without further explanation in the following 
group of cases. The question here, on the contrary, is of cases of ery- 
sipelas which set in at the same time that puerperal sepsis existed, and 
which by a superficial observation could be regarded as proving the con- 
nection of both conditions. Observations of such kind have been made 
which have led to the widely disseminated opinion of the connection be- 
tween erysipelas and puerperal fever. 
V. C. Bassler, 19 years old, entered the hospital and gave birth after 
an easy labor to a female child. She did well up to the tenth day, when she 
was taken sick with appearances of perimetritis and parametritis, the fever 
running high (40° C., pulse 120). 
On the sixth day of the disease, and fifteenth of the puerperium, there 
appeared an erysipelas of the abdominal walls, starting from some leech 
bites on the abdomen. This quickly spread over the entire abdomen, 
back, and to the external genital parts. This lasted ten days. The par- 
ametritis brought on a pelvic abscess which burst into the rectum. The 
patient was dismissed, entirely cured, after a long illness. 
The eight cases which briefly follow came (together with case 4) at a 
time when puerperal sepsis was quite prevalent in the Obstetrical Depart- Erysipelas and Puerperal Fever. 
7 
ment of the Charive. Runge has already reported three cases (?>. Zeit- 
schriftficr Geburtskulfe und Gyudkologie, Bd. V., S. 165). 
VI. A. Klisch was delivered of a macerated tee"us on Nov. 12th, 
1878. At this time there occurred a rupture of the perineum which was 
sewed up. Until the tenth day of the puerperium, there were only slight 
febrile sensations, with moderate pain over the uterus. From this day 
on, the fever reached 39.8° C.; the appearance of septic parametritis 
with offensive lochia became more evident. 
On the eighteenth day of the puerperium, and the eighth of the dis- 
ease, there set in an erysipelas faciei, starting from the tip of the nose. 
At the same time there were appearances of pneumonia of the left side, 
without any material change in the fever (39—40.50 C.). After four 
days the fever had entirely disappeared. After a still longer sickness of 
this septic disease, the lying-in-woman died on the thirty-third day. 
The post-mortem showed a left-sided phlegmonous inflammation of 
the ligamenta lata, and starting from here there were purulent decom- 
posed thrombi of the venae iliacae, femoralis and saplena sinistra. Bron- 
cho-pneumonia of both lungs, with pleurisy of the left side, also pres- 
ent. 
VII. Mrs. B. gave birth, on March 17th, 1879, to a living child at 
full term. A rupture of the perineum was united with several sutures. 
On the second day of the puerperium a high fever set in (39.20 C) with 
tenderness about the uterus and with offensive lochia.. The perineal 
sutures were removed and the uterus washed out. 
On the sixth day of the puerperium, erysipelas showed itself at the 
perineal rupture and extended to the right thigh, and, with increasing 
high fever, gradually spread itself, step by step, from the right thigh to 
the back, then to the left thigh, and from there to the abdomen and to 
the chest. 
At the same time there appeared, on the tenth day, a pneumonia of 
the right lung. 
On the twenty-fifth day of the puerperium, the erysipelas entirely dis- 
appeared and the patient was considered, on the thirty-second day, as 
entirely cured. 
The child died of erysipelas. 
VIII. M. J., on the 14th of April, 1879, was delivered of an unde- 
veloped living child. The patient came into the Hospital with marked 
oedema of the labia, legs and abdominal walls, showing symptoms of the 
albuminoid kidney of pregnancy. At the delivery she had several ec- 
lamptic convulsions. The lying-in woman had fever beginning with the 
first day of the puerperium, and there was also offensive lochial discharge 
and tenderness over the whole abdomen. On the ninth day of the puer- 
perium an erysipelas of the inner part of the right thigh set in; on the 
tenth day this extended to the whole thigh. On the eleventh day the pa- 8 
Erysipelas and Puerperal Fever. 
tient died. The post mortem showed slight diphtheritic kolpitis, throm- 
bophlebitis of the site of the placenta, anaemia and fatty degeneration of 
both kidneys, hypostasis and oedema of the lungs. In the veins and in 
the subcutaneous cellular tissue of the right thigh, there were no anato- 
mical changes to be found. 
IX. Mrs. L. was delivered on the 6th of April, 1879, of a living 
child at full term, and was taken sick on the second day of the puerper- 
ium with high fever (40-1° C.), tenderness over the uterus and annexes. 
An offensive lochial discharge began on the eighth day. On the eleventh 
day of the disease there appeared a decided erysipelas of the right thigh, 
starting from a ulcus puerperale of the labiae. On the 3d of March the 
patient died. The post mortem showed kolpitis et endometritis diphther- 
ica, thrombophlebitis uterina, phlebitis spermaticae sinistrae, embolia art. 
pulm. dextrae, infarctus lobi inferioris dextri, pneumonia lobi inferions 
sinistri, nephritis, hyperplasia lienis. 
X. M. G. gave birth 19th of April, 1879, to a living female child at 
full term and was taken sick on the second day of the puerperium with 
fever (39-1° C., pulse 112), with offensive lochial discharge, with tender- 
ness over the left uterine region. A parametritis of the right side ap- 
peared. On the twelfth day erysipelas which started at a leech bite ap- 
peared on the abdomen, with high fever (39-4° C.); the fever lessened 
and the erysipelas grew better, and the patient after experiencing a short 
relapse was dismissed cured after three weeks’ illness. 
XI. T. tv., on the 6th of March, 1879, while being transported to 
the Hospital, was delivered of a child and entered the Hospital with a 
perineal-vaginal rupture which necessitated the introduction of nine sut- 
ures. On the third day a violent fever set in with tenderness about the 
right parametrium. The sutures had to be removed and on the sixth 
day erysipelas began at the perineal wound and extended to the left but- 
tock and thigh without any marked rise of temperature, and by the fifth 
day it had completely disappeared. The prtient was discharged on the 
fourteenth day cured of the parametritis. 
XII. A. N. sustained at her confinement, 16th March, 1879, a bad 
rupture of the perineum, was taken sick on the third day of the puer- 
perum with signs of septic infection; fever reached 39*5° C., there was 
tenderness on pressure over the uterus with offensive lochia. On the 
fifth day there began at the perineal rupture an erysipelas which extend- 
ed to the abdomen, lumbar region, both buttocks, and upper and lower 
limbs. This erysipelatous condition was not cured until the twenty-third 
day of the puerperium, signs of septic infection had already disappeared. 
The child was also taken sick with erysipelas (fourth day after the moth- 
er). This erysipelas began with a small abrasion in the right axilla. The 
erysipelas extended to the head, back and breast, and the child died in a 
few days. Erysipelas arid Puerperal Fever. 
9 
XIII. J. was delivered of twins 6th of May, 1879, and was taken 
sick on the third day with fever (39 0 C.) and offensive lochia. On the 
sixth day she experienced tenderness over the left parametrium, which 
on the seventh day was markedly swollen. On the eighth day her temp- 
erature was 40-2° C., with swelling of the left labium. On the tenth day 
there appeared a diphtheritic ulcer of the right labium from which ery- 
sipelas extended to the right buttock. On the eleventh day the erysipelas 
was better but the patient had a cough with red-brown expectoration. 
Above and behind on the right of the thorax there was dulness with 
crepitant rales, fever reached 400 C. and was remittant in type. On the 
16th day bed sores, profuse diarrhoea, tympanites, tremors, cyanosis, and 
finally unconsciousness. There was swelling of the right knee joint. 
Death occurred on the 23d day. 
Post mortem showed endometritis ulcerosa and a purulent lymphan- 
gitis of the left parametrium, extending to the cervix. Corresponding to 
this on the inner surface of the uterus was a discolored ulcer, up to which 
the lymph vessels could be traced. There is also myocarditis, hyper- 
plasia of the spleen, and parenchymatous inflammation of the liver and 
kidneys. The parts which were invaded by the erysipelas showed no 
longer changes. 
XIV. W. J., delivered on the 17th of July, 1879, of a living child 
at full term after an easy labor, and was taken sick on the third day of 
the puerperum with rigors and high fever (39.70 C., pulse 148) the loch- 
ial discharges were somewhat offensive, the uterus sensitive upon press- 
ure, and both parametriums very painful. On the fifth day a second at- 
tack of rigors occurred. On the sixth day there appeared on the inner 
side of the right thigh an erysipelas which extended to both thighs, both 
buttocks, accompanied with fever. The patient became derilious and 
died on the eleventh day of the puerperium. Post mortem showed slight 
cedematous infiltration in the subcutaneous tissue in the parts attacked 
with erysipelas. The uterus showed a gangrenous endometritis on the 
placental site. There is also a phlebitic parametritis of the right side and 
pelvic phlegmonous inflammation of the left side. There is a slight pur- 
ulent exudation of the pelvic peritoneum. Metastatic pleurisy of the left 
side and cloudy parenchymatous swelling of kidneys and liver. 
All of the cases of erysipelas which have been enumerated, with the 
exception of case V., occurred at the time of a so-called epidemic of 
puerperal fever, and constituted only isolated cases in contradistinction 
to the number of those who were taken sick with puerperal sepsis under 
other conditions, so that for this reason it would be a greatly exaggerated 
supposition to seek for a causal connection in the statement that erysipe- 
las had been the cause of the puerperal infection. But a more decided 
contradiction to this kind of supposition is to be found in the history and 
course of the disease in every case. For there were always evident signs Erysipelas and Puerperal Fever. 
of puerperal sepsis, as we know from the history of the cases, before the 
erysipelatous affection attacked the skin, and the course of the sepsis was 
in most cases as if no new disease had appeared, or at the most that the 
fever was higher and more irregular, or that pneumonic symptoms were 
added. In the cases which ended fatally the post mortem showed that 
severe forms of sepsis were present, and that further it was not the ques- 
tion of phlegmonous inflammation, such as indeed more often occur in 
the puerperium, and such as indeed undoubtedly stand in genetic con- 
nection with puerperal fever, but the question is actual, genuine ery- 
sipelas. It is very likely, therefore, that there is not the slightest ground 
for supposing, even from these cases, in my opinion, that erysipelas is 
able to cause puerperal sepsis. If, therefore, from a clinical standpoint, 
the theory that erysipelas does not lead to puerperal sepsis could with 
certainty be announced before the discovery of Fehleisen, this view is 
very materially supported now by the discovery of a special micrococcus 
of erysipelas. But there was a great temptation to prove this question 
experimentally. Through the great courtesy of Dr. Fehleisen, whom I 
again thank in this place, I obtained in the course of the summer a large 
supply of the erysipelas coccus in beautiful culture. The fact that the 
cultures were obtained from the hands of Dr. Fehleisen goes to show that 
the material was free from objection, moreover I made conclusive experi- 
ments by first inoculating two rabbits in the skin of the ear with the 
smallest qnantity possible of the micrococci. Each time there appeared 
an evident erysipelas which was especially severe and typical in one of 
the cases. The animals had fever and recovered when the skin trouble 
disappeared. I then inoculated six rabbits with the same material, by 
introducing in the case of two a small quantity into the cavity of the per- 
itoneum, with the second two I simply opened the abdomen, scratched 
the peritoneum, and introduced the matter into the small wound. In the 
last two I introduced small quantities of the erysipelas coccus in the 
subserous cellular tissue of the peritoneum and abdominal walls. 
Not one of these animals was taken sick in any way worthy of men- 
tion, but all lived days and weeks. After some time I killed them all 
and in not one of them d’d I find a pathological change traceable to sep- 
tic processes. The matter which had been introduced had either disap- 
peared without leaving a trace behind, or there were seen on the points 
of inoculation small, white caseous deposits, such as are so often found 
under the conditions after wounds m animals. 
I may say here that I of course undertook these experiment under 
strictly antiseptic precautions, but guarded of course against bringing 
this material while inoculating into contact with the antiseptic fluid, to 
prevent the objection being brought forward that the infectious property 
of the micrococcus was perhaps destroyed during the inoculation. 
Although these experiments are capable of many modifications, and Erysipelas and Puerperal Fever. 
perhaps may not be considered as absolutely conclusive, still at all events 
they support in such an excellent manner the conviction that we have 
obtained by clinical study, that erysipelas cannot cause sepsis or puer- 
peral fever. 
There remains also the other side of the subject to be investigated, 
that is, whether the septic virus or the fluids such as the lochia which 
contain this virus can cause erysipelas when it is brought in contact with 
wounds of the skin. 
Apart from the fact that this question has no such practical import- 
ance as the one just considered, still I can only briefly point to the fact 
that in my clinical observation there is no case known to me which could 
make this mode of infection appear probable. If erysipelas could be 
easily produced from a lying-in-woman who has puerperal fever, the 
number of observations ought to be very large. But in the literature of 
this subject the cases on record are by no means large, and those which 
do exist admit of the supposition that they are not genuine erysipelas but 
phlegmonous inflammation whose connection with sepsis is known, as 
has been already repeatedly shown. 
Experimental investigations in this direction would promise very lit- 
tle so long as the micrococcus of the different septic and pysemic conditions 
are not yet better known than formerly. On the contrary, the erysipelas 
coccus has been confirmed by Fehleisen’s discovery as a specific cause 
of disease, and we have no right, therefore, to call redness, swelling of 
the skin, or, indeed, of the subcutaneous cellular tissue as they occur in 
inoculating with septic material, as erysipelas, so long as we cannot find 
the erysipelas coccus there, or prove its presence by further inoculations 
and cultures. If, indeed, an actual erysipelas could occur by inoculat- 
ing with septic material, then we are, in my opinion, forced, in accord- 
ance with the present condition of the teaching of erysipelas, rather to 
believe in a contamination with the erysipelas coccus, than to believe 
that the micro-organisms of sepsis can lead to erysipelas. We can only 
deal with this question further when, as I said, the micrococcus of sepsis 
is so well known and so clearly defined as that of erysipelas. 
CINCINNATI: 
Reprint from The Obstetric Gazette, September, 1886.