Max S. Marshall

Skin Infection in Salmon Fishermen in Alaska.

The occurrence of various types of skin infection among commercial fishermen has frequently been noted. Minute abrasions from the teeth or the spines of fish open the way frequently to infection. Fellers 1 has isolated a pyogenic streptococcus associated with fish and Klauder and his associates 2 , 3 have noted on the east coast a specific skin infection due to the bacillus of swine erysipelas. While giving medical assistance to the commercial fishermen at Bristol Bay, a part of the Bering Sea, one of us (H.N.M.) noted a type of skin infection which was typical and had uniformly constant symptoms. Although the fishermen do not distinguish between this and other infections, the disease has apparently been known to them for some time. The disease appears to have a short incubation period. Pain, swelling, and a dark red discoloration develop simultaneously. If, at this stage, the area is examined closely, a tiny break in the skin may be noted from which a drop or two of clear or slightly cloudy serum can be expressed. There is general malaise, often a slight headache, and a temperature between 99 and 100. Swelling, or pain, or both may become quite marked, so that a lesion starting on a finger produces edema of the whole hand and sometimes of the wrist. Epitrochlear and axillary lymph nodes are commonly enlarged or tender. Lymphangitis is rarely visible. The infection spreads locally between the epidermis and the dermis, separating the two layers to form a lesion resembling a collapsed blister, containing a few drops of turbid serum. Improvement usually begins in 2 or 3 days, but the blister may spread for 5 or 6 days, with more or less burning and pain, the pain frequently extending up the arm.