On the part played by the erythrogenic (Dick) toxin of the hæmolytic streptococcus in puerperal infection

Abstract

Two practical suggestions have been frequently made in recent years with regard to puerperal fever, viz. (1) that women susceptible to Dick toxin (as shown by a positive skin reaction)-and therefore also, it is assumed, to infection by haemolytic streptococci-should be actively immunised against that toxin towards the end of pregnancy, or given antitoxic serum at the time of labour ; and ( 2 ) that treatment of the fever, when it occurs, should be by the administration of antitoxic serum, in order to neutralise the erythrogenic toxin liberated by the streptococcus in the mother's body.The assumptions involved in both these suggestions are as yet unsupported by definite evidence. They have been made too readily, perhaps, by analogy with scarlet fever. Susceptibility to that infection does appear to be in some measure related to the absence of antitoxin from the patient's blood as evidenced by the Dick test (Joe (1925) records no less than 95 per cent. of cases as Dick positive during the first five days), and there is also indirect evidence that Dick toxin is produced in the body during the infection, since the skin reaction changes from positive to negative in nearly 50 per cent. of cases within two weeks and in over 70 per cent. within three weeks (Joe).With hzmolytic streptococcus infections other than scarlet fever the situation is somewhat different. There is as yet no clear evidence that liability to these infections is intimately correlated with the patient's inability to neutralise Dick toxin (as shown by a positive Dick test), nor has there been evidence that Dick toxin is elaborated by the streptococcus in the patient's body during the course of these infections when no rash is present. The