CLASSIFICATION OF STREPTOCOCCI 419 



explanation of these eruptions is, we cannot say. They occur in 

 fatal septicemias of many varieties, but are particularly associated 

 with fatal streptococcus infection. 



In scarlet fever, hemolytic streptococci are invariably found 

 associated with and probably the causative agents of the severe 

 angina that regularly accompanies this disease. This was observed 

 by Loeffler in 1884, and has been confirmed, since then, by many 

 observers. The regularity of these findings has been such that it 

 has led to the assumption that the hemolytic streptococci might be 

 etiologically related to scarlet fever itself. This is a problem which 

 has been much discussed, but cannot be thoroughly gone into with- 

 out an extensive review of the literature. We may say that the 

 general weight of evidence is at the present time distinctly against 

 such an assumption, and that it is most likely that the streptococci 

 in scarlet fever are the most regular and severe secondary invaders. 

 Yet, it must be admitted that no conclusive denial of the possibility 

 can be made on the basis of experimental evidence. The hemolytic 

 streptococci not infrequently invade the blood stream of scarlet 

 fever patients in the course of the disease. Baginsky and Sommer- 

 feld 50 found them in the blood at autopsy, and Anthony 51 and others 

 have confirmed this^ Anthony found them in the heart's blood of 

 ten out of eighteen autopsies. An important fact first noted by 

 Moser and Von Pirquet 52 is the apparent antigenic identity of strains 

 of hemolytic streptococci isolated from different cases of scarlet 

 fever. Bliss has recently confirmed this by the newer and more 

 reliable methods of agglutination developed by Dochez and Avery. 53 



In diphtheria and in smallpox the hemolytic streptococci are 

 frequently found as secondary invaders. Gay, 54 who has carefully 

 analyzed the literature on streptococcus infection, cites a number 

 of observers who have found the organisms in the blood streams 

 of fatal cases of smallpox, and in some of those that recovered. 



It Jias long been known that the dangerous bronchopneumonias 

 which occur in the course of measles and influenza may be of strep-, 

 tococcus origin. Eyre 53 has made particular studies of this condition 



and Sommcrfeld, Borl. klin. Woeli., 27, ]900. 

 ii, Jour. Infec. Dis., 6, 1909, 332. 

 K Moser and I'on Pirquet, Zeit, f. Bakt., 34, 1903, 500 and 714. 

 ** Dochcs and Aver;/, and Lmn-c/icltl, Journ. Exp. Mod., vol. 30, 1919, p. 179. 

 Cl (!<iii. Jour, of Lab. and Clin. Mod. 3, 1918, 721. 

 """' K I/re, Jour, of Bnctor. and Pathol., 14, 1910, 160. 



