CLASSIFICATION OF STREPTOCOCCI 417 



This disease is particularly dangerous in infants in whom it may 

 spread over the entire surface of the body. 



It was formerly supposed that a number of different forms of 

 acute enteritis might be due to streptococci, but this has never been 

 positively demonstrated, and is doubtful. However, streptococcus 

 infections of the walls of the intestines by passage into the sub- 

 mucosa may occasionally occur. 



The inflammation which is known as Ludwig's angina is usually 

 of a streptococcus hemolyticus nature. In this condition the origin 

 is usually from a focus in the teeth, tonsils or pharynx, or perhaps 

 a peritonsular abscess, and consists of a violent, acute inflammation 

 of the areolar tissues of the submaxillary region of the neck. 



Superficially, infections through the skin, through abrasions and 

 injuries are among the most frequent and dangerous infections 

 caused by the hemolytic streptococcus. These are particularly fre- 

 quent among surgeons and pathologists, and their course and out- 

 come is determined entirely by the relationship between virulence 

 of the strain and resistance of the individual. Given a sufficiently 

 virulent strain, a very minute abrasion or injury with the inocula- 

 tion of a small quantity of the organisms only, may suffice to result 

 in a rapid and fatal infection. We know of one autopsy infection 

 in which a minute pin prick through a rubber glove, hardly visible 

 to the eye, resulted, within twelve hours, in high fever, and within 

 twenty-four hours, in delirium with little red lymphatic lines run- 

 ning up the arm from the source of the lesion. In such cases, the 

 local lesion may look relatively innocent, since, with sufficient 

 virulence, the point of inoculation may show nothing more than a 

 small red swelling which is soggy and edematous and looks quite 

 different from the slower processes, with central abscess formation, 

 caused by the less virulent streptococci and staphylococci. 



Puerperal sepsis is one of the most dangerous of the infections 

 caused by the hernolytic streptococci, but with the advent of more 

 perfect obstetrical methods, this grave infection of the uterus is 

 becoming more and more rare. 



From all of the streptococcus lesions a general infection of the 

 blood stream may arise, if the infection proceeds with sufficient 

 virulence. Although both the viridans and the hemolyticus strains 

 may be responsible for such septicemic conditions, the most fre- 

 quent and dangerous ones are those caused by the hemolyticus. 

 We will devote a separate paragraph to a description of the viridans 



