PATHOGENICITY FOR MAN 229 



tion of pneumonia cases is also apparent from the work of Christie 

 in England (1932), 232 who found pneumococci in approximately 

 57 per cent of the blood samples cultured. Christie emphasized the 

 importance of positive blood cultures as a prognostic measure, 

 since all the fatalities in the series occurred in the positive group, 

 whereas, in the case of the patients who had bacteriemia and recov- 

 ered, convalescence was prolonged or complicated with empyema. 

 Heffron discusses this feature of pneumococcal infection in 

 greater detail. For the purposes of the bacteriologist the foregoing 

 discussion may suffice. The presence of active bacteriemia and the 

 development of infected foci in the deeper tissues bears witness of 

 the ability of pneumococci at times to surmount the natural obsta- 

 cles in the body and to migrate to parts distant from the original 

 site of infection. 



Excretion of Pneumococci 



From diseased foci pneumococci pass into the sputum in cases 

 of sinusitis, parotitis, gingivitis, and pneumonia ; into the spinal 

 fluid in meningitis ; into all purulent exudates in pericarditis, em- 

 pyema, peritonitis, and arthritis. The urine in approximately 38 

 per cent of the cases of lobar pneumonia studied was found by 

 Mathers (1916) 868 to contain pneumococci. The organisms ap- 

 peared in the urine usually just before or immediately after crisis, 

 and Mathers advised precautions to avoid the possible danger of 

 passing on the infection, particularly in hospitals, by careless han- 

 dling of the excreta of pneumonia patients. The intestinal tract is 

 another exit by which pneumococci pass from the infected body. 

 Rutz (1912) 1198 isolated virulent pneumococci from the feces of 

 the majority of patients ill with lobar pneumonia, the organisms 

 appearing as early as the second or third day of the disease. No 

 pneumococci were discovered in the feces of the normal individuals 

 tested. 



In studying the distribution of pneumococci throughout the 

 body a word of warning may be said against placing reliance on 



