148 CLINICAL BACTERIOLOGY. 



culating blood must always be considered as of unfavorable 

 prognostic omen. In the small number of cases of con- 

 genital pneumonia reported the bacteria must have gained 

 entrance into the placenta, through a lesion of which they 

 have passed over into the fetal circulation. Without 

 such lesion the placenta, as is quite generally admitted, is 

 impassable to microorganisms. Like all febrile diseases, 

 pneumonia readily induces abortion. The child that has 

 been infected with diplococci can, however, suffer from 

 true pneumonia only if it has already breathed. As a 

 matter of fact, in only two of the children in the reported 

 cases was pneumonic infiltration present ; in the others 

 diplococci were found in the blood there existed a sep- 

 ticemia. 



ENDOCARDITIS. 



Endocarditis occurs usually as a secondary infection in 

 the course of various other diseases. The most important 

 of these is acute articular rheumatism, whose predominant 

 etiologic significance in the generation of endocarditis is 

 well known. The causative agents of rheumatism have 

 not yet been isolated, and rheumatic endocarditis also is 

 one of those infectious diseases whose intimate etiology re- 

 mains to be cleared up. The same statement may be made 

 .with regard to chorea, whose endocarditic manifestations 

 also are probably to be attributed to the same rheumatic 

 etiology ; and also with regard to erythema nodosum. 



In the deposits upon the valvc3 of the heart in the se- 

 quence of erysipelas the streptococcus pyogenes is demon- 

 strable both on culture and on microscopic examination. 



In the endocarditis following suppurative processes (py- 

 emia, septicemia, puerperal fever) the streptococcus or the 

 staphylococcus pyogenes has been found in the vegetations : 

 in that following osteomyelitis, generally the staphylo- 

 coccus ; and after suppuration in the abdominal cavity, the 

 bacterium coli commune. 



Endocarditis is comparatively frequent in the sequence of 

 croupous pneumonia. The lesions, which preferably involve 

 the aortic valve, contain, as a rule, the diplococcus lanceo- 

 latus Frankel. Bacteriologic examinations with reference 

 to the endocarditis following influenza are yet wanting. 



Diphtheric endocarditis is extremely uncommon. Only 

 one case of true diphtheric endocarditis (mitral valve), with 



