17,1 Johnson: Streptococcus Hemolyticus — 93 
the usual treament of elimination, and alkaline and glucose per 
rectum were started. In addition, Parke Davis polyvalent anti- 
streptococcus serum was given in 100 cubic centimeter doses 
every four hours, both intravenously and subcutaneously. About 
this time the patient was again searched for a possible focus other 
than in the throat, but none was found. The genitourinary 
tract and rectum were very closely studied, but found apparent- 
ly free from disease. 
The administration of the serum was continued at four-hour 
intervals for some days, and persisted in at longer intervals 
throughout the disease. 
Blood cultures were taken every other day, and the second 
culture showed a diminution in the amount of growth. The 
leucocyte count on the fifth day was 22,000, with polymorpho- 
nuclear cells, 82 per cent. Here was recorded the first metastatic 
involvement. The metatarsophalangeal joint of the great toe of 
the right foot became very red and swollen, and on the follow- 
ing day presented signs of pus. The joint was opened and a 
small quantity of seropurulent fluid obtained. This was sent 
for culture. 
The same day the left knee became involved, and this went 
on rapidly to suppuration. The joint was opened and the pus 
evacuated. This also was sent for culture. Other joints fol- 
lowed in rapid succession. Nearly overnight, a previously well 
joint would give signs of pus and have to be opened. The 
right knee, left ankle, left elbow, left knee, right wrist, right 
elbow, and right sacroiliac joints were all involved, and were 
opened and the pus cultured. A pure culture of streptococcus 
was obtained from the exudate from all the diseased joints. 
At first the exudate was of a thin seropurulent material, but 
this soon changed to a thick bloody pus. 
All the incised joints were irrigated with Dakin’s solution. 
Involvements followed each other so rapidly that after the 
eleventh day no new involvements occurred. The joints all 
continued to drain pus, and in those first affected distinct crepi- 
tation was obtained. On the twelfth day, the right parotid 
gland became involved and progressed rapidly to a suppurative 
parotiditis, draining spontaneously through the external ear. 
During this time the blood cultures showed less and less 
growth until only a faint growth was obtained. Each culture 
showed the same organism. The temperature dropped and 
hovered around 102°. The general condition of the patient was 
