STREPTOCOCCIC INFECTION 155 



of streptococci cultures. The capability of dissolving red corpuscles 

 was first noted by Marmorek in 1895, and has been the subject of 

 much study since that time. If a tube of bouillon to which 0.5 c.c. of 

 blood has been added be inoculated with the streptococcus and incu- 

 bated, in a few hours the corpuscles are completely dissolved, coloring 

 the whole fluid. On prolonged standing, the color becomes brown, 

 owing to the conversion of oxyhemoglobin into methemoglobin. It was 

 at first thought that the hemolytic action is due directly to the living 

 organism, but Besredka showed that germ-free filtrates of highly 

 active cultures are hemolytic. The hemolytic substance is highly labile 

 and is destroyed by a temperature of 60 C. It must be classed as a 

 ferment. Indeed, it seems that there are two ferments, one of which 

 dissolves the corpuscles, while the other converts the soluble oxyhemo- 

 globin into methemoglobin. Although this organism is sporeless, it 

 may not only live but retain its virulence for many months in cool, 

 dark places. Before the days of aseptic surgery, certain wards in 

 hospitals became infected with erysipelas and retained the infection 

 through long periods. Puerperal fever followed, or rather, accom- 

 panied, certain midwives and obstetricians from house to house until 

 they came to believe that some dreadful fate hung over them and in 

 despair fled from those who sought their services. Holmes collected 

 cases of this kind and concluded that puerperal fever and other forms 

 of sepsis are due to a contagium. The experiences of Semmelweis in 

 the old lying-in wards at Prague led him to the same conclusion, and he 

 pointed out that the obstetrician could not, with safety to those under 

 his charge, go from the dead room to the woman in labor without first 

 making himself clean. Moreover, he demonstrated in his own work 

 that cleanliness on the part of the accoucheur resulted in the reduction 

 of the number of cases of puerperal fever. 



The streptococcus freshly taken from an infected man is not highly 

 pathogenic to laboratory animals. Large doses are necessary to fatal 

 infection and subcutaneous inoculations usually induce, at most, local 

 abscesses. When mice are inoculated at the root of the tail, the organ- 

 ism multiplies at the point, spreads through the connective tissue and 

 finally is carried by lymph and blood to various organs, and death may 

 result in three or four days, earlier with the most virulent strains. 

 With less virulent cultures a local abscess may develop and continue 



