ERYSIPELOID¹

Synonyms.—Erythema migrans; Erythema serpens (Morrant Baker).

This affection, first clearly described by Morrant Baker, and later
studied clinically and bacteriologically by Rosenbach, is rare, and
clinically bears a slight resemblance to erysipelas, lacking the constitu­
tional and the more violent local symptoms of the latter. It is observed
in those who handle putrid or spoilt meats and fish, such as butchers,
fish-dealers, poultry-dealers, and cooks, and occasionally with those who
handle animal products. For obvious reasons it is almost invariably
seen on the fingers and hands, although Elliot refers to a case in which the
disease was conveyed from the hands to the toes by scratching. It is,
as a rule, observed to follow some slight traumatism or break in the con­
tinuity of the skin, the disease starting from this point. It consists, at
first, of a dull red or purplish spot or zone, scarcely elevated, which tends
to spread; as it spreads the first part involved usually clears up. If
infection takes place at several points, many zone-like erythematous
areas may merge into each other, presenting then an eruption of a fes­
tooned character. The advancing border of the erythema is sharply
defined against the surrounding skin, and is slightly elevated, and com­
monly purplish red or even livid in color. Sometimes some swelling and
pufriness are noted. There may be itching and burning, and these
symptoms are sometimes marked. Its progress is slow, and it rarely
involves much area, remaining limited to a finger or small part of the
hand. Subsiding, it changes to a yellowish color, and finally disap­
pears. There is no scaliness.

The disease is, according to Rosenbach, due to a micro-organism

¹ Literature: Morrant Baker (under the name “Erythema serpens”; based upon 16
cases, with colored plate), St. Bartholomew's Hospital Reports, 1873, vol. ix, p. 198;
Rosenbach, Verhandl. der Deutschen Gesellschaft für Chirurgie, 1887, vol. xvi, p. 76
of part ii; Elliot, Jour. Cutan. Dis., 1888, p. 12; Tilbury Fox, under the title “Ery­
thema of the Hands from Dyes” (Brit. Med. Jour., 1870, p. 132), described 2 cases
which seem to be examples of this disease, one in a patient who handled kid shoes, and
the other in a clothing dealer; Gilchrist, New York Med. Rec, 1896, vol. xlix, p. 783,
and Jour. Cutan. Dis., 1904, p. 507 (“Erysipeloid,” with a record of 329 cases, of which
323 were caused by crab-bites or lesions produced by crabs), reviews the literature,
with references.

DERMATITIS GANGRÆNOSA INFANTUM                427

which is found in dead or decomposing animal matter, and probably
of the family of cladothrix, from cultures of which the malady has been
experimentally produced. Gilchrist found no organisms; experiments
with smears were negative, and attempts to produce the disease by ex­
perimental inoculation were likewise negative. He believes that the
disease is probably produced by a special ferment. In almost all of his
cases the disease had followed crab-bites. It is to be distinguished from
erysipelas and ringworm, but the absence of the more inflammatory and
the constitutional symptoms of the former and the elevated and often
vesicopapular and subsequent scaly border of ringworm will serve to
differentiate. It could scarcely be confounded with dermatitis repens
or erythema multiforme; in the former there is serous undermining, the
upper epidermis separating from the rete, and in the latter the eruption
presents other symptoms and is usually extensive.

The disease tends to spontaneous disappearance in from one to several
weeks, but its course may be influenced by treatment, which is usually
rapidly successful, as the nature of the affection would indicate. Treat­
ment consists of antiseptic dressings, of which those employed in ery­
sipelas are the most satisfactory, especially the ichthyol applications.

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