PYOGENIC BACTERIA. 387 



dred elements may be found in a single chain, and some of these are distin- 

 guished by their size ; occasionally whole chains are made up of these large 

 cocci, and when closely observed some of these may present indications of 

 division transversely to the axis of the chain. Subcutaneous inoculation of 

 cultures into mice results in the death of a considerable number of these ani- 

 ma l s more than half ; and the streptococci are found in the spleen and other 

 organs. Inoculation into the ear of rabbits causes an erysipelatous inflam- 

 mation. When injected into the circulation of these animals through a vein 

 joint affections are developed in from four to six days, and a purulent ac- 

 cumulation occurs in which the streptococci are found. In two rabbits in- 

 oculated in the same way with a culture of the streptococcus of erysipelas, 

 Loffler has observed a similar result." 



Numerous researches indicate that infection by Streptococcus 

 pyogenes through the endometrium is the usual cause of puerperal 

 fever. Thus Clivio and Monti demonstrated its presence in five 

 cases of puerperal peritonitis. Czerniewski found it in the lochia of 

 a large number (thirty-five out of eighty-one) of women suffering 

 from puerperal fever, but in the lochia of fifty-seven healthy puer- 

 peral women he was only able to find it once. In ten fatal cases he 

 found it in every instance, both in the lochial discharge during life 

 and in the organs after death. Widal carefully studied a series of 

 sixteen cases and arrived at the conclusion that this was the infect- 

 ing microorganism in all. Bumm and other observers have given 

 similar evidence. Eiselsberg and Emmerich have succeeded in de- 

 monstrating the presence of the streptococcus in hospital wards con- 

 taining cases of erysipelas. That puerperal fever may result from 

 infection through the finger of the accoucheur, when he has previ- 

 ously been in contact with cases of erysipelas, has long been taught, 

 and, in view of the facts above recorded, is not difficult to under- 

 stand. But in view of the fact that the streptococcus of pus has been 

 found in vaginal mucus and in the buccal and nasal secretions of 

 healthy persons, it may appear strange that cases of puerperal fever 

 not traceable to infection from erysipelas or from preceding cases 

 do not occur more frequently. This is probably largely due to an 

 attenuation of the pathogenic power of the streptococcus when it 

 leads a saprophytic existence. Widal asserts that, when cultivated 

 in artificial media for a few weeks, the cultures no longer have their 

 original virulence, and Bumm has made the same observation. On 

 the other hand, in " streptococcus-peritonitis " occurring as a result 

 of puerperal infection Bumm states that the thin, bright-yellow, 

 odorless fluid contained in the cavity of the abdomen is extremely 

 virulent ; a very slight trace, a fragment of a drop, injected into the 

 abdominal cavity of a rabbit, is sufficient within twenty-four hours 

 to cause a general septic inflammation with a bloody serous exuda- 

 tion, quickly terminating in the death of the animal ; injected sub- 

 cutaneously it gives rise to an enormous phlegmon which also 



