W. L. HOLMAN 109 



Babtchinski, Similar results were obtained by Barbier^ and Schreider.* Funck^ found 

 the fact to be true but did not consider it as striking as had previous workers, and 

 showed that the presence of the streptococci in no way affected the specific action of 

 the diphtheria toxin. Klein^ also showed that streptococci enhanced the effect of B. 

 diphtheriae. Arnold^ found httle or no evidence of any increased virulence in the he- 

 molytic streptococci isolated from diphtheria throats, but that there was a decided in- 

 crease in hemolytic streptococci during diphtheria. These strains showed limiting 

 H-ion concentrations like pathogenic strains, but he believed this change was merely 

 environmental. Gate, Papacostas, and Billa,'' although they found that filtrates of 

 avirulent streptococci stimulated diphtheria-toxin production, reported that the in- 

 creased virulence was not retained on further transfers. Zoeller^ showed it was possi- 

 ble to produce in his cumulative cultures a diphtheria-streptococcus altero-toxin by 

 growing a scarlet fever streptococcus in a diphtheria toxin to which had been added 

 a little horse serum. Stovall, Scheid, and Nichols* reported that the presence of 

 staphylococcus in mixed cultures changed the morphology of virulent B. diphtheriae 

 so that they stained more solidly and that the non-virulent pseudo-diphtheria strains 

 became more beaded. Streptococci had no such effect. 



The well-known overgrowth of B. diphtheriae by Staphylococcus aureus in cultures 

 led many workers to try such cultures in patients following the report by Schiotz.' 

 Among these, Lorenz and Ravenel'" had good results in nine carriers and eight clinical 

 cases of diphtheria although nasal furuncles developed in some of them. Rolleston" 

 found it helpful in ten carrier cases but ineffective in two cases of nasal infection. He 

 considered it should only be used in chronic cases. There were also a number of un- 

 favorable reports such as that of C, M. Davis'^ who reported the development of ton- 

 sillitis following the use of the staphylococcus spray. Nicholson and Hogan'-' were 

 encouraged by the results on nine acute cases, using sprays of B. bulgaricus and sour 

 milk. Papacostas and Gate''' studied the question of the antagonism between the 

 pneumobacillus of Friedlander and B. diphtheriae following the observation that clini- 

 cal cases of such mixed infections were usually mild. Mixed cultures of these two bac- 

 teria showed a progressive predominance of the former on serial transfers and the 



' Barbier, H.: Cenlralbl. f. Bakteriol., I, Orig., 11, 382. 1892. (Ref.) 



^ Schreider, M. von.: ibid., 12, 289. 1892. 



3 Funck, E.: Zlschr.f. Hyg. u. Infektionskrankh., 17, 465. 1894. 



1 Klein, E.: Thirty-third Ann. Rep. Loc. Gov. Bd., p. 431. 1903-4. 



5 Arnold, L.: /. Lab. df Clin. Med., 8, 387, 389. 1923. 



^ Gate, J., Papacostas, G., and Billa, M.: Compi. rend. Soc. de biol., 90, 500. 1924. 



' Zoeller, C.: loc. cit. 



» Stovall, W. D., Scheid, E., and Nichols, M. S.: Am. J. Pub. Health, 13, 748. 1923, 



' Schiotz, A.: see Diphtheria, p. 367. London: Medical Research Council, 1923. 



'"Lorenz, W. F., and Ravenel, M. P: J.A.M.A., sg, 690. 1912. 



" Rolleston, J. D.: Brit. J. Child. Dis., 10, 298. 1913. 



" Davis, C. M.: J. A. M.A., 61, 393. 1913. 



••i Nicholson, S. T., and Hogan, J. F.: ibid., 62, 510. 1914. 



'■» Papacostas, G., and Gate, J.: Compt. rend. Soc. de biol., 85, 859, 1038. 1921. 



