STUDY OF A CASE OF ERYSIPELAS GENITAL1UM 
DUE TO THE USE OF INFECTED OINTMENT. 
BY 
ADELAIDE WARD PECKHAM, M.D., 
OF PHILADELPHIA*—.-™ 
FROM 
THE MEDICAL NEWS, 
February n, 1893. [Reprinted from The Medical News, February 11, 1893.] 
STUDY OF A CASE OF ERYSIPELASG EN IT ALIU M 
DUE TO THE USE OF /NFECTED/o/NTMENT} 
By ADELAIDE WARD PECKHAM, M.D., 
OF PHILADELPHIA. ' ' ~ 
M. D., born October 7, 1892, was a plump, 
healthy babe, with fair, sound skin. The navel 
healed quickly. The mother seemed free from dis- 
ease, convalesced without rise of temperature, and 
there was a history of preceding normal pregnan- 
cies. 
On November 12th, five weeks from the date of 
birth, I saw the child after an illness of twenty-four 
hours. The mother said that for a slight “chafing” 
of the genitalia she had applied an ointment that 
she had in the house, and that during the following 
day and night the child had become alarmingly ill. 
On inquiry, the mother stated that the ointment 
had been used by a woman in the family on a sup- 
purating gland in the neck, application having been 
made by dipping the fingers in the ointment. This 
woman gave a history of having fallen through a 
hatchway, striking the side of the neck upon a pro- 
jection in the wall; a large abscess had formed, 
which suppurated very freely, leaving a long and 
angry-looking cicatrix. 
On examining the child, the following conditions 
were found : Temperature, 103.8° F.; pulse full and 
very rapid, all food vomited, bowels constipated, 
1 From the Laboratory of Hygiene, University of Pennsylvania. 2 
extremities cold, convulsive twitchings of the mus- 
cles of the face and limbs, fingers and toes flexed, 
the pupils contracted. The child was in a state of 
coma. Locally there was a small excoriation on 
the left labium, intense redness and swelling of the 
skin over the pubic region, which was sharply de- 
fined, and did not extend to the anus. On Novem- 
ber 13th, the second day, the erythema had extended 
to the anus and creases of the thighs; the labia 
were so infiltrated that the skin seemed tense enough 
to rupture; the temperature was 103.40 F. On 
November 14th, the inflammation had extended 
over the lower third of the abdomen and lower half 
of the back, making a shining, inflamed surface so 
sensitive that the child had a slight spasm when 
moved; temperature still 103.40 F. On Novem- 
ber 15th, there was no extension of inflammation 
upward, but it had reached the left knee and half- 
way down the thigh on the right side, the parts 
being swollen to nearly twice the normal size; the 
skin over the genitalia was slightly paling ; tempera- 
ture, 103° F. On November 17th, both legs were 
very much swollen, and of a dusky red color. The 
convulsive movements and insomnia, which had 
lessened, returned again ; the tongue was coated ; 
there was intense thirst and slight diarrhea. The 
temperature was now 102.40 F. On November 22d, 
the right foot was swollen, the inflammation on the 
right side reaching a point two days later than on 
the left; the cuticle was flaking on the parts first 
attacked, and on the labia it came off in casts; tem- 
perature, 990. On November 25th, the left foot 
was nearly normal, and the right improving; tem- 
perature, 990 F. On November 29th, there was 
noticed a swelling on the top of the left foot, and 
another on the inner malleolus of the right ankle 
showed beginning abscess-formation : there was also 3 
edema of the left labium. The temperature was nor- 
mal. On December 2d, there was slight cough, the 
first symptom of the broncho-pneumonia that fol- 
lowed. Both abscesses were lanced. On Decem- 
ber 8th, the respirations increased in frequency, 
and an area of dulness was found by percussion on 
the right side posteriorly; large and small mucus 
rales were heard over both lungs; there were fre- 
quent spells of coughing, with cyanosis around the 
mouth and nose, relieved by vomiting. On Decem- 
ber 13th, another large abscess on the right ankle 
and a small one on the top of the left foot were 
lanced. A swelling, the size of a walnut, was found 
in the anterior axillary line between the fifth 
and sixth ribs. On December 14th, the rattling 
respiration and severe cough still continued. The 
skin over the abscess on the chest began to redden, 
and the temperature was ioo° F. Two small abscesses 
were lanced, one on each foot. On December 18th, 
an abscess on the chest was lanced; the lungs were 
much clearer. 
The left leg was red and swollen to the knee on 
December 21st. The temperature was ioo° F. The 
redness of the leg had disappeared on December 23d, 
and a swelling involving two lymphatic glands was 
found in the left groin ; these two glands coalesced 
into a single abscess-cavity. On December 24th, 
an abscess in the groin was lanced, and two ounces of 
pus were discharged. On December 26th, an abscess 
was forming under the right knee, and two enlarged 
glands were found in the left axilla. On December 
27th, the abscess under the knee was lanced ; tem- 
perature, 99.20 F. On December 30th, the inci- 
sion made under the knee had become occluded by 
the dressing; temperature 106° F., but it fell to 
101.20 F. in three hours after drainage was reestab- 
lished. A gland in the left groin was much enlarged. 4 
On December 31st, the temperature was 100. i° F. A 
small abscess on the left ankle was lanced. On 
January 18th, two abscesses in the left axilla and 
one in the right groin were lanced. 
During the whole period of abscess-formation the 
temperature seemed remarkably low. The test was 
made at different hours and on each day, and at no 
time did the temperature exceed 990 F., with the 
exception mentioned in the history. 
Treatment.—During the first forty-eight hours hot 
fomentations were appl ed to the inflamed parts. 
Calomel, gr., with 2 grains of sodium bicarbonate 
was given every hour until the bowels moved. 
An ointment containing one dram each of ichthyol 
and zinc oxid to an ounce of cosmolin was used 
during the remainder of the attack of erysipelas. 
During the pyemia, brandy and syrup of iron chlorid 
were given in suitable doses, and elixir of calisaya 
whenever there was rise of temperature. 
BACTERIOLOGIC STUDY OF THE CASE. 
The following experiments were made with the 
blood, pus, and sputum taken from the child, and 
with the ointment used during the first twenty-four 
hours of its illness. The latter was that variety of 
petroleum ointment named “Lucilline. ” 
Experiment I.—On November 16th, from the 
advancing margin of the disease on the leg two 
drops of blood were drawn by puncture with a ster- 
ilized needle, the skin having previously been thor- 
oughly washed in a solution of carbolic acid of 
approximately 2 per cent, strength. From the drops 
of blood six slanting tubes of nutrient glycerin 
agar-agar were inoculated by smearing the blood 
upon the surface of the culture-medium with a 5 
sterilized platinum-wire needle. These tubes were 
placed in the incubator for twenty-four hours; they 
then showed a growth of isolated colonies differing 
in size and color, a pin-point pearly growth being 
very plentiful. From the different colonies on these 
tubes a series of Petri plates, four in number, was 
made, and from single colonies on these plates tubes 
were inoculated, and pure cultures obtained. By 
their growth on different media, and by micros- 
copic examination of cover slip preparations, these 
proved to be the streptococcus erysipelatis, the 
staphyloccus pyogenes aureus, and a nondescript 
bacillus 
Experiment II.—Inoculations were made from 
the ointment by smearing fifteen tubes of glycerin 
agar agar with it, using the amount taken up in a 
looped platinum wire for each tube. Mixed growths 
were found on twelve tubes after exposure to a tem- 
perature of 370 C. for twenty-four hours. Petri 
plates were made as before, and from single colonies 
pure cultures of a streptococcus and the bacillus 
pyogenes fluorescens were obtained. 
Macroscopic comparison was then made of the 
streptococci obtained from these two sources, regard- 
ing their growth on different media and their reac- 
tions. Two sets of tubes of the different kinds of 
media were inoculated, the one with the streptococcus 
from the child, the other with that from the oint- 
ment. The inoculations were made in the same 
hour and kept in the incubator an equal length of 
time. The streptococci from both sources were 
found to be identical in every respect, and we feel 
justified in thinking the streptococcus in the oint- 
ment to be the streptococcus erysipelatis. It pre- 
sented the following characteristics: 
On Petri plates of ordinary nutrient agar-agar, 
glycerin agar-agar, and gelatin, pin-point, pearly- 6 
white colonies are found, which under a low power 
of the microscope are round, finely granular, of a 
yellowish-brown color, with even edges. Smears 
on agar-agar, glycerin-agar and gelatin, show macro- 
scopically a delicate, pearly growth, with many.iso- 
lated colonies, growing most luxuriantly on glycerin 
agar-agar, and least on gelatin. They do not liquefy 
gelatin. On potato the growth is invisible, but 
after a short time there is an increase ot moisture 
about the point at which the organisms were de- 
posited. In neutral or slightly alkaline litmus milk 
it causes a very faint pink color in twenty-four 
hours; this change in color is not due, apparently, 
to any production of acid, as the reaction of the 
milk, even when this color is present, is shown by 
litmus and curcuma paper to be slightly alkaline, 
and remains so for several weeks. In none of a 
number of experiments bearing on this point was 
there any coagulation of the milk, or any deviation 
from the change in the reaction described. In 
deep stab-cultures (8 cm. deep) there is a growth 
along the entire track of the needle, as well as upon 
the surface. This growth is most luxuriant at the 
temperature of the incubator, 370 C., and also de- 
velops, but less rapidly, at ordinary room-tempera- 
ture.- This organism stains readily with the ordi- 
nary anilin dyes. 
Microscopic examination of fresh cultures, espe- 
cially in bouillon, show the cocci arranged in long 
chains. Similar long chains are also to be found 
in blood-serum cultures; upon other solid media 
chains are likewise to be found, but they are usually 
shorter. 
Experiment III.—Experiments upon animals 
gave the following results: 
Two rabbits were inoculated, one intra-venously, 
the other by scarification on the ear, with pure cul- 7 
tures of the streptococcus of the fifth generation. 
An area of slight inflammation found at the point 
of inoculation on the third day soon disappeared, 
and no further result was obtained. Two rabbits 
were again inoculated in the same manner with a 
culture of the first generation. The experiment 
proved negative. 
Experiment IV.—To determine whether the oint- 
ment was free from bacteria when procured, the 
outer portion was removed, and from the deep part 
ten tubes of glyc&rin agar-agar were inoculated as 
before. The tubes were inoculated December ist, 
and have remained sterile up to the present time 
(January 15th). 
Experiment V.—To prove that the bacteria would 
live in the ointment, test-tubes containing ointment 
were sterilized for two hours, the ointment allowed 
to harden in slants, and inoculated with the strepto- 
coccus erysipelatis, the staphylococcus pyogenes 
aureus, and the bacillus pyogenes fluorescens, the 
cultures used being of the fifth generation from the 
patient. From these tubes inoculations on glyce- 
rin agar-agar were made every third day, and cul- 
tures of the organisms introduced obtained for 
twenty-one days. Cultures of streptococci were 
obtained from the box of ointment for forty days, 
and the bacillus pyogenes fluorescens is still easily 
obtained after sixty days. 
Experiment VI.—In the first stages of the 
broncho pneumonia, tubes were inoculated from 
the sputum. The staphylococcus pyogenes aureus 
was obtained, but the streptococcus, if present, was 
not found. 
Experiment VII.—After the twelfth abscess, 
tubes of glycerin agar-agar were inoculated with 
blood taken at a point farthest from any abscess; 
no growths were obtained. Tubes were then inoc- 8 
ulated with blood taken from near an enlarged gland, 
and colonies of the streptococcus appeared in 
twenty-four hours. Cover-slip preparations of blood 
from the same point showed a very few diplococci 
and marked leukocytosis. 
The pus from the first abscess was examined mi- 
croscopically. A stained cover-slip preparation 
(Loffler’s blue) showed streptococci in short and 
in long entwined chains, and, throughout the speci- 
men, solitary scattered diplococci. Some of the 
leukocytes contained short and entwined chains of 
streptococci, as shown in accompanying illustration. 
The cells were mostly polynuclear leukocytes, some 
of which showed various stages of nuclear division. 9 
A few cells contained small stained granules of a 
purplish tint. No other bacteria were found by using 
different stains, and from Petri plates inoculated 
with pus only pure cultures of streptococci were 
obtained. The pus from each large abscess was 
tested in the same manner with the following result: 
Pure streptococci were obtained in every case, with 
one exception, in which a skin coccus, the staphy- 
lococcus epidermidis albus, was isolated. 
Summary.—The points of interest in studying 
this case are the following : 
1. That bacteria were conveyed from one person 
to another through the intermediation of an oint- 
ment. 
2. That the streptococcus erysipelatis lived forty 
days in an ointment. 
3. That streptococci taken directly from the point 
of suppuration lived longer in ointment than those 
which had passed through several generations on 
media. 
4. A typical case of erysipelas genitalium, having 
been caused by a streptococcus from a suppurating 
gland, with no known preceding lesion, tends to 
confirm the opinion that the streptococcus pyogenes 
and the streptococcus erysipelatis are identical. 
5. Streptococci were found in the blood. 
6. The necessity of antisepsis, even in pyemia, is 
shown by this case. The abscesses were due to 
streptococci only, and precautions were necessary 
to prevent mixed infection by the introduction of 
the staphylococcus pyogenes aureus found in the 
skin and sputum. 
Note.—The condition of the child at the time of writing points to recovery. The fourteenth abscess 
has just been lanced. Those that have formed within 
the past two or three weeks have matured slowly, 
and the child has gained in flesh and strength. The 
digestion, which has been fairly satisfactory during 
the entire sickness, is good. Anticipating a fatal 
issue, promise of autopsy was obtained, and should 
death finally occur, a protocol of the autopsy will 
be added to this article. 
In conclusion the writer extends thanks to Dr. A. 
C. Abbott and Dr. A. A. Ghriskey for direction 
and verification of work. The Medical News. 
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