522 INFECTION AND IMMUNITY. 



as well as in wound infections, thrombosis of the 

 adjacent vessels may occur, which may be the first 

 step in the production of pyemia with multiple 

 points of infection. 



Cellulitis may also be caused by the staphylo- 

 coccus alone or infection with the latter may be 

 superimposed on a primary streptococcus cellulitis. 

 Pneumonia. Pneumonia produced by the streptococcus may 

 either be primary or secondary to infection in 

 other parts of the body. It is mostly of the lobular 

 type in the occurrence of multiple foci, which pre- 

 sent a smooth surface on section and are very rich 

 in cells. It occurs less frequently in the form of 

 lobar consolidation, and very frequently as a mixed 

 infection in pneumonias caused by the pneumo- 

 coecus and other organisms. 



Streptococcus infection of the lungs in pul- 

 monary tuberculosis is a serious and frequent com- 

 plication of the latter disease. It produces a septic 

 condition, involves adjacent healthy tissue, and its 

 role in causing consolidation and liquefaction of 

 the tissues predisposes of hemorrhages. In cul- 

 tures, the streptococcus is said to inhibit the 

 growth of the tubercle bacillus. 



Meningitis. Primary streptococcus meningitis is rare or of 

 doubtful occurrence. It frequently is secondary 

 to otitis media, to injuries, and has been noted 

 following tonsillitis, facial erysipelas, pneumonia, 

 endocarditis and as part of a pyemic process. 

 Enteritis. Streptococci are at times the cause of enteritis 

 in children, the inflammation often being mem- 

 branous and accompanied by desquamation of the 

 epithelium and by hemorrhages. It is not infre- 



