THE PYOGENIC COCCI 161 



Erysipelas, a spreading inflammatory condition of the skin, is 

 almost invariably due to streptococci. The organisms are found 

 in large numbers in the underlying tissues and lymphatics; they 

 may extend to serous and synovial cavities and give rise to peri- 

 tonitis, meningitis, and synovitis. As a rule in erysipelas the 

 cocci are not present in the central portion of the inflamed area, 

 but may be isolated from the swollen edge by excising a small 

 piece of the skin. 



The fact that puerperal fever might be caused by infection 

 from an erysipelas case was noticed long before it was discovered 

 that the same organism could produce both conditions. 



Observers have noted that patients suffering from malignant 

 tumor seem to improve, and in some cases the tumor has diminished 

 after an attack of erysipelas. Fehleisen, accordingly, inoculated 

 hospital patients suffering from inoperable growths with cultures 

 of streptococci and produced in them typical erysipelas and often 

 a favorable influence on the growth. Later Coley modified the 

 treatment by using a mixture of dead streptococci and bacillus 

 prodigiosus or their products. The sarcomatous tumors are most 

 favorably affected by " Coley's mixture " ; carcinomatous growths 

 slightly or not at all. Many observers, however, have failed to 

 note any favorable results following its use. 



Suppurative conditions in different organs of the body may 

 result from streptococcus invasion. Ulcerative endocarditis, 

 bronchopneumonia, pleurisy, empyema, otitis media, enteritis, 

 are included in the list of diseases of which they may be the primary 

 cause. 



In throat affections of all kinds they play an active role ; their 

 constant presence on the mucous membranes and tonsils make 

 possible a speedy invasion whenever there is a lowering of the 

 local vitality. 



In smallpox and scarlet fever streptococci can be isolated from 

 the internal organs in a large number of the fatal cases. Certain 

 authorities regard the streptococcus as the causal agent of scarlet 

 fever ; the view, however, is not generally accepted. 



Isolated from the blood of rheumatic fever cases they have pro- 

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