416 PATHOGENIC MICROORGANISMS 



tion is followed by rapidly spreading edema, lymphangitis, and 

 severe systemic manifestations with the development of a grave 

 cellulitis, often threatening life and requiring energetic surgical 

 interference. 



The particular significance of streptococci in surgically infected 

 wounds and the effect of their presence upon therapeutic procedures 

 is considered in another section dealing with the bacteriology of 

 infected wounds. 



Suppurations of bone may be caused by streptococci, and con- 

 stitute a severe form of osteomyelitis. Such lesions when occurring 

 in the mastoid bone are not infrequently secondary to streptococcus 

 otitis and may lead to a form of meningitis which is in most cases 

 fatal. 



Streptococcus meningitis fortunately does not occur very often, 

 but when it does occur is usually fatal. Most cases are probably 

 secondary to such lesions as otitis and mastoiditis mentioned above, 

 but occasionally primary streptococcus meningitis may occur in the 

 course of bronchopneumonia. We have seen a number of cases 

 in which streptococci were associated in the spinal fluid with in- 

 fluenza bacilli. 



As mentioned above, erysipelas is a streptococcus hemolyticus 

 disease. It was first isolated from such lesions by Fehleisen 46 who 

 believed that the organism obtained by him was a particular variety, 

 specific in erysipelas. He named it, for this reason, streptococcus 

 erysipelatis. Subsequently, however, it was shown by Marbaix 47 

 and Petruschky 48 and others that erysipelas-like lesions could be 

 produced in animals with streptococci from many other sources. 

 The production of the peculiar erysipelas lesion seems to depend, 

 on the one hand upon the relative virulence of the strain and upon 

 the infection of the lymphatics of the skin. The streptococci in this 

 disease are, according to MacCallum, 49 located in the crevices of 

 the tissues and the lymph channels of the skin. A peculiarity is 

 that, unlike streptococcus lesions in other places, in this disease the 

 inflammatory exudate consists very largely by mononuclear cells. 



48 Fehleisen, Aeriol. d. Erysipelas, Berlin, 1883. 

 47 Marbaix, La Cellule, 1892. 



PetrusMy, Zeit. f. Hyg., 13. 



49 MacCallum, Textbook of Pathology, Second Edition, 1920 Monograph of the 

 Eock. Inst., No. 10, 1919. 



