422 PATHOGENIC MICROORGANISMS 



paper 62 declares the organism to be indistinguishable from other 

 hemolytic streptococci. 



VIRIDANS INFECTIONS. The non-hemolytic or so-called green, 

 streptococci are, as stated above, more likely to be associated with 

 the less severe and subacute lesions. These organisms are usually 

 harmless saprophytes. 



They are associated frequently with tooth abscesses, may be 

 present in middle ear disease and infections of the accessory sinuses 

 of the nose. They are not infrequently found in the tonsillar crypts 

 and have been known to cause mild forms of tonsillitis. 



The viridans is frequently associated with subacute vegetative 

 endocarditis. In such cases the organisms cause relatively firm 

 vegetations, usually on the mitral, but sometimes also on the aortic 

 valves, extending occasionally along the walls of the auricle. The 

 organisms can be readily cultivated from the blood stream where 

 they may remain for weeks and months. Often, in such cases the 

 resistance of the patient is unusually high for a long time, the 

 bacteria probably being disposed of in the blood stream, but are 

 passed either constantly or intermittently into the blood stream 

 from the infected valves. Death may ensue after weeks or months. 

 Death usually follows by a gradual wearing down of the patient's 

 resistance. Cerebral or renal embolism may occur, and joint con- 

 ditions may develop secondarily. 



It has been suggested that the frequent association of rheumatism 

 and cardiac lesions may be due to the fact that the green streptococci 

 are responsible for both conditions. An enormous amount of rather 

 confusing work has been done upon the etiology of rheumatism 

 from this point of view. It is a fact that many coccus infections, 

 and, for that matter, other forms of general infection, may lead 

 to secondary joint lesions in both animals and man. Poynton and 

 Paine 63 in 1900 described a diplococcus not very dissimilar from 

 viridans strains which they obtained from eight cases of acute rheu- 

 matic fever, and with which they claimed that they could produce 

 lesions in rabbits which they considered typical of rheumatism. 

 The organism was recovered from the blood and pericardial fluids 

 of their patients. They describe them as minute diplococci, grown 

 best in acid media under anaerobic conditions, but capable of growth 



62 Davis, Amer. Jour. Pub. Health, 8, 40, cited after Gay, loc. cit. 



63 Poynton and Paine, Lancet, London, 1900, 860 and 932. 



