ERYSIPELAS NEONATORUM GANGRÆNOSUM. E. NOHL. (_Münch. med.
Wochenschr._, September 13th, 1904, p. 1648.)
The child was born on February 29th, and was apparently healthy at
birth; she developed diarrhœa on the fourth day, and redness and
swelling of the genital region on the sixth.
Seen for the first time on March 7th, the labia majora were much
swollen, red and shining and painful. Both thighs presented a firm œdema
and looked blue and marbled. There were frequent motions like pea-soup.
On March 9th the temperature rose above normal for the first time and,
with the exception of the first two evenings, when it sank below normal,
it remained elevated till the child died, reaching 40° C. on March 11th,
and 40·5° C. on March 15th.
On March 12th a large ulcer appeared on each labium following a bullous
upheaval and casting off of the epidermis, and at the same time the skin
over the trochanteric region on each side commenced to necrose. The
œdema had involved the whole of the lower extremities, the affected
parts being pale and flecked with blue; small bladders filled with
yellow serum appeared on the dorsal surface of each foot.
Fresh areas of necrosis developed. The ulcers on the labia turned black.
On March 15th the child died, with symptoms of meningitis. A post-mortem
examination was not allowed.
The author discusses the differential diagnosis between erysipelas and
œdema neonatorum. He quotes a passage from Strümpell, as well as a case
of his own, to show that fever sometimes appears after the eruption in
erysipelas. He further records the fact that there had been a great deal
of infectious illness in the house before the birth of this child—severe
measles, whooping-cough complicated by empyema, ulcerated throats with
otitis media—whilst the mother developed parametritis on the second day.