A report on 235 cases of erysipeloid in Aberdeen.

For some time it had been thought locally that the incidence of erysipeloid of Rosenbach among fish workers was much higher in Aberdeen than elsewhere. For this reason we began a systematic study of the disorder, and our findings over the period June 1, 1952, to September 30, 1953, are presented in this paper. Doctors generally are not familiar with the lesion known as erysipeloid. Because of its strong occupational association it is well known in localities where there is a risk of infection and, at least in Aberdeen, the skin picture is so easily recognized that fish workers sometimes make their own correct diagnosis of "fish hand" or " fish poisoning ". Price and Bennett (1951) reporting on 51 cases, stated that "casualty officers working near meat and fish markets, slaughter-houses, and hotel districts, are quite familiar with the disease and regard it as being by no means uncommon". Because the clinical picture has been adequately described by many authors only a brief description is given here. The infection first appears as a reddish-blue swelling on the finger or hand, varying in size from 1 to 10 sq. cm.; the edge is raised, well demarcated, and slowly advances. The patient feels a burning, itching pain at the site and often there is a sensation of tightness in the inflamed area. Some stiffness and slight pain are common in the interphalangeal joints near the lesion. In almost all cases the occupation of the patient is a useful guide to diagnosis. The infecting organism is a strain of Erysipelothrix rhusiopathiae, the causal organism of swine erysipelas, and though the natural history of erysipelothrix is uncertain, it is widely distributed in nature. The source of infection in man is invariably animal or vegetable matter, and the occupations commonly associated are those in which contact with fish, meat, or poultry is entailed; thus fish workers, slaughtermen, butchers, cooks, and housewives have been the commonest reported sufferers (Klauder, 1938; King, 1946; Price and Bennett, 1951). In a very high proportion of patients there is a history of injury-a prick from fish scale or bone, a knife cut or other minor breach of the skin followed a few days later by the typical appearance of the infection. After one to three weeks the lesion disappears spontaneously. It is essentially a localized infection, general symptoms being unusual and complications rare. Suppuration does not occur and surgical interference is unnecessary. Diagnostic biopsy has been performed, but Price and Bennett (1951) found that the proportion of positive cultures was not high enough to make the procedure of great value in diagnosis. We agree with Goodwin (1950) that " In view of the ease in diagnosing the condition clinically, biopsy of the lesion is not justifiable ". A striking feature of erysipeloid is its seasonal incidence. Numerous writers have noted the increased frequency of cases in summer and early autumn and its virtual disappearance in winter and spring.