Erysipelas

Young Dr. Konrad E. Birkhaug smiled modestly last week in his biological laboratory of the University of Rochester School of Medicine and Dentistry. He had succeeded in developing a cure for erysipelas.

Erysipelas. This disease, popularly called the Rose or St. Anthony's* Fire, is a highly contagious infection caused by the streptococcus pyogenes. This germ resembles a minute seed and grows in long chains, like a string of beads. It gains entrance to the human body usually by some abrasion, sometimes by way of the tonsils. Then it spreads first through the lymphatic system, later through the blood to every part. It gives off a toxin (poison) which diffuses through the system even more quickly than the germ itself. The peculiar effect of the streptococci pyogenes is to cause fever, although in some cases, especially in wounds, it forms pus. If they get into the lungs by way of the blood they clog the bronchioles, the tiny air passages, and so give one form of bronchopneumonia. They frequently are secondary invaders in diphtheria, scarlet fever and smallpox. In septicemia, bacterial blood poisoning, these germs may snake along to the heart, where they fasten themselves to the inner heart membranes; or they may grow to the lips of the heart valves, causing thereby valvular troubles. The toxins may cause rotting of the lobules of the liver and of certain passages of the kidneys. They are the causative agents of erysipelas.

Everyone knows the hideous aspects of erysipelas. From a tiny red blotch at the nose or on the cheek near an eye, an angry red spreads out into a wide, fiery stain. The skin tingles. It burns. When the stain reaches the spongy cheek or lip tissues, these swell into a horrible, puffy, burning mass. Sometimes the disease works into the scalp and down the neck. The toxins are filtering through the lymphatic fluids. The patient is feverish and drowsy. Heretofore the only cure has been to let the disease run its course, to ease the pain by hot fomentations, by the application of powdered starch, and by giving nourishing, easily digested foods. After a few days the beginning edges of the stain fade to a sickly yellow, which follows after the wave of red. The skin scales off in tiny flakes. The fever subsides. Later the skin resumes its normal tone. One attack of erysipelas does not furnish unaided immunity against future ones. This is the treacherous aspect of this disease.

Mortality. Few grownups die from erysipelas alone. But the mortality of children is very great. Among infants under one year of age 75% to 90% attacked die. Among children under five years 15% to 20% die. Adult mortality is 3% to 5%.

Antitoxin. Two years ago when Dr. Birkhaug was working at Johns Hopkins in Baltimore,** a friend suffering from erysipelas came to him. The doctor had been working on scarlet fever. But he decided to concentrate on erysipelas. He knew, as had long been known, that streptococcus pyogenes was the cause, that of this germ there are several strains, of which one is streptococcus erysipelatis. The problem was to isolate this particular strain and to develop from it a serum. He succeeded.

Immunity. There is no autoimmunity to erysipelas. Therefore Dr. Birkhaug advises that a person subject to this disease should take a prophylatic injection of the antitoxin serum to counteract a future sickness.

*St. Anthony of Padua (1195-1231) was the most celebrated follower of St. Francis d'Assisi (1182-1226), whose seventh centenary will have world-wide celebration this year. St. Anthony is patron saint of Padua and of Portugal, the places respectively of his teachings and death and of his birth. His eloquence was so great that fishes were reported to jump out of the water to hear him. Devout clients appeal to him for the finding of lost articles. Miraculously he could cure erysipelas.

**He was born at Bergen, Norway, in 1892; educated there and in London and Berlin ; in Russian hospital service 1917-19, prisoner of war. In 1923-24 he was interne in infectious diseases at Sydenham Hospital. Baltimore, and later went on the staff of Johns Hopkins. In 1925 he went to Rochester University.