312 Suppuration 



theria and pseudodiphtheria bacilli also produce hemolyzing sub- 

 stance, so that the test cannot be used for the immediate separation 

 of streptococci from other bacteria in cultures from the throat. 

 Colonies of the pneumococcus usually appear green and without 

 hemolysis, but Ruediger finds that they also sometimes cause 

 solution of the hemoglobin. The streptococci whose colonies are 

 green and without hemolysis are called Streptococcus mridans by 

 Schottmiiller. They were at first regarded as practically non- 

 pathogenic, but it is now known that they cause endocarditis in 

 rabbits and it is thought that they may do so in man. 



Pathogenesis. The streptococcus has been found in erysipelas, 

 malignant endocarditis, periostitis, otitis, meningitis, empyema, 

 pneumonia, lymphangitis, phlegmons, sepsis, puerperal endo- 

 metritis, and many other forms of inflammation and septic infection. 

 In man it is usually associated with active suppuration and sepsis. 



The relation of the streptococcus to diphtheria is of interest, for, 

 though in all probability the great majority of cases of pseudo- 

 membranous angina are caused by the Klebs-Loffler bacillus, yet a 

 number are met with in which, as in Prudden's 24 cases, no diphtheria 

 bacilli can be found, but which seem to be caused by the strepto- 

 coccus alone. 



There are few clinical differences between the throat lesions pro- 

 duced by the two organisms, and the only positive method of dif- 

 ferentiating the one from the other is by means of a careful bacterio- 

 logic examination. Such an examination should always be made, 

 as it has much weight in connection with the treatment; in strepto- 

 coccus angina no benefit can be expected from the administration of 

 diphtheria antitoxic serum. 



Hirsh* has shown that streptococci are by no means rare in the 

 intestines of infants, where they may occasion enteritis. In such 

 cases the organisms are found in large numbers in the stomach and 

 in the stools, and late in the course of the disease in the blood and 

 urine of the child. They also occur in all of the internal organs of 

 the cadaver. 



The intestinal streptococci are often Gram-negative, when they 

 are usually non-virulent. 



Libmanf has reported 2 carefully studied cases of streptococcic 

 enteritis. 



Flexner,f in a larger series of autopsies, found the bodies in- 

 vaded by numerous micro-organisms, causing what he has called 

 " terminal infections," and hastening the fatal issue. Of 793 

 autopsies at the Johns Hopkins Hospital, 255 upon cases dying of 

 chronic heart or kidney diseases, or both, were sufficiently well studied 

 bacteriologically, to meet the requirements of a statistical inquiry. 



! "Centralbl. f. Bakt. u. Parasit.," Bd. xxn, Nos. 14 and 15, p. 369. 

 t " Centralbl. 'f. Bakt. u. Parasit.," Bd. xxn, Nos. 14 and 15, p. 376. 

 t "Journal of Experimental Medicine," 1896, vol. I, No. 3. 



