STREPTOCOCCUS PYOGENES. 167 



A 1 : 2500 bichloride solution is fatal in two hours ; 1 : 300 

 carbolic acid, in two hours; 1 : 50 peroxide of hydrogen, in 

 two hours. 



Pathogenesis : The streptococcus is the cause of all severe 

 and rapidly fatal inflammations, especially those of the lym- 

 phatic system, the so-called " spreading " inflammations. The 

 germ has been found in hospital wards and in operating- 

 rooms, in the mouth, nose, pharynx, intestinal canal, vagina, 

 on the skin, and in the lesions caused by it. Infection occurs 

 in the same manner as with the staphylococcus. 



The streptococcus pyogenes is the specific cause of erysip- 

 elas (St. Anthony's fire), an acute inflammation involving 

 especially the subcutaneous tissues, and it is always found in 

 the erysipelatous patch, particularly at its periphery. It 

 occupies the lymph-spaces and lymph-vessels of the skin, and 

 subcutaneous tissues, in great numbers. The streptococcus 

 found in erysipelas was formerly known as the streptococcus 

 erysipelatis of Fehleisen ; the term has been abandoned, as it 

 is no longer recognized as a variety of streptococcus. 



It is always found on the heart valves in ulcerative endo- 

 carditis ; and sometimes in the blood in pneumonia, otitis 

 media, meningitis, phlegmons, and the secondary infection in 

 pulmonary tuberculosis. 



It is always present in the uterus in puerperal fever, of 

 which it has been said by some to be the specific cause. 

 Puerperal fever is so extremely liable to follow infection with 

 the streptococcus that physicians who have a "pus case" 

 under their care, or any streptococcus infection, always refuse 

 to take charge of obstetric cases during that time. 



It is found very commonly in the diphtheritic membranes 

 in the throat, and in non-diphtheritic angina, especially that 

 of scarlet fever ; in the blood of scarlet fever patients, and in 

 the suppurative sequelae of scarlet fever. 



The streptococcus can alw r ays be obtained in pure cultures 

 from the bleb or blister over an erysipelatous patch ; or by 

 introducing a fine needle into the subcutaneous tissues and 

 withdrawing a small quantity of serum. 



Serum : Marmorek has succeeded in obtaining an anti- 

 streptococcus serum which possesses a decided specific action 



