226 BIOLOGY OF PNEUMOCOCCUS 



was any claim advanced that pneumococcal disease of the meninges 

 could occur as a primary infection. Many references to clinical re- 

 ports must necessarily be passed over in this review, but Harkavy's 

 (1928) 589 is cited because from the one patient mentioned Type I 

 Pneumococcus was isolated from the spinal fluid and in the case of 

 this patient the administration of specific immune serum effected a 

 cure. 



Endocarditis and pericarditis are not unusual concomitants of 

 pneumonia, but the condition is nearly always secondary to the 

 pneumonic process and the same organism may be responsible for 

 both lesions. Thomas and O'Hara (1920) 1395 described a case of 

 endocarditis in which Type I Pneumococcus was found in a vegeta- 

 tion on the tricuspid valve, but the authors disclaimed that the un- 

 usual site of the infection was due to any special selective affinity 

 of that pneumococcal type. 



Such infections as sinusitis, parotitis, gingivitis, and otitis 

 may accompany but are rarely independent of lobar pneumonia. 

 Zaufal 1568 " 9 was probably the first to report primary infection of 

 the ear by Pneumococcus. Arthritis is a metastatic manifestation 

 of pulmonary infection and has been described by Nauwerck, 944 " 6 

 Weichselbaum, 1503 " 5 and Herzog, 639 but it is improbable that ar- 

 thritis or nephritis occurs except as a result of pneumococcal in- 

 fection elsewhere in the body. To the list of non-pulmonary infec- 

 tions caused by Pneumococcus, Neufeld and Schnitzer added 

 osteomyelitis and appendicitis (Ungermann), epidydimitis and or- 

 chitis, cystitis, fibrinous enteritis (Flexner, Curio), cholecystitis 

 (Lenharz and others), phlegmon (Robbers), ulcus serpens and 

 conjunctivitis (Axenfeld and others), erysipelas (v. Leube, and 

 Reiche and Schomerus), and pyosalpinx and puerperal sepsis 

 (Jacob). 



Of the several specific complications of pneumonia, infections of 

 the pleura and pericardium are the most common. Endocarditis 

 and meningitis are grave sequels, while, in addition to the affec- 



