418 PATHOGENIC MICROORGANISMS 



septicemia accompanying endocarditis. Hemolyticus septicemia, 

 secondary to wound infection, puerperal septicemia or other lesions, 

 are usually initiated by grave symptoms of fever, chill and general 

 depression, and the organisms can be isolated in blood cultures 

 taken in agar plates or in hormone broth. It is an important 

 thing to remember that in all of these septicemias the presence of 

 the organisms in the blood may not signify that they are actually 

 multiplying in the blood. It is, in our opinion, more likely that 

 the organisms at first simply enter the blood stream from the lesion, 

 and are destroyed in the circulation. If, during this period, the 

 focus can be surgically cleaned out, rapid recovery may follow. 

 We have seen cases, in which the surgical lesion was accessible to 

 recover promptly after operation, although blood cultures taken 

 before had shown numerous organisms in the blood stream. In 

 cases dead of streptocococcus septicemia, the organisms may be cul- 

 tivated from all the organs and from the heart's blood. 



In dealing with other streptococcus lesions in man, it will be 

 convenient for us to differentiate sharply between those caused by 

 the hemolyticus and those due to the viridans strains. Since normal 

 human beings harbor hemolytic streptococci in the mouth and 

 pharynx in a large percentage of individuals examined, it is natural 

 that inflammations of the upper respiratory tract should frequently 

 be due to streptococci. Thus, the hemolytic streptococci are fre- 

 quently the causative agents in pharyngitis, and are often associated 

 with the more severe forms of follicular tonsilitis. Some of these 

 tonsillar infections may be accompanied by high fever, and severe 

 illness, and the local inflammation may be so severe that it cannot 

 be clinically differentiated, with certainty, from diphtheria. From 

 such throat infections, septicemia does not often follow, but occa- 

 sionally severe generalized infections may ensue. MacCallum 

 describes the case of a physician, one of our colleagues, who had 

 repeated attacks of throat infection caused by streptococci. In one 

 of these he developed glands of the throat which were incised and 

 streptococcus pus was found. A year later there was a sudden 

 recurrence with a rapidly developing general septicemia, and a 

 scarlatiniform rash. He died within a few days. In connection 

 with this, it is interesting to note that we have seen three -or four 

 cases which occurred among soldiers in France who, in the course 

 of severe streptococcus throat infections developed rashes Hint were 

 difficult to distinguish from those of scarlet fever. Just what the 



