Separately, gangrene caused by the streptococcus and infection limited to subcutaneous tissue are well known entities. The combination of the two is not widely understood. This combination, whether or not one chooses to call it a disease, does follow a distinctive course, has predictable possibilities of complication, and is benefited by a particular treatment.
Meleney has written an excellent, and apparently the original, account of hemolytic streptococcal subcutaneous gangrene.1 The essential lesion is gangrene of the subcutaneous tissue. Secondarily, this kills part of the overlying skin, possibly by vascular interference. The subcutaneous lesion is broader than the cutaneous lesion, that is, it undermines. Both are surrounded by cellulitis. Deep tissues are rarely involved unless a preceding wound has penetrated them. Meleney showed that the cause is a hemolytic streptococcus. In nineteen of the cases he reported, there were four deaths.
In Peking, where the condition is not uncommon, Meleney