158 STREPTOCOCCIC INFECTION 



In other cases the organism in the tonsils of the child may pass into 

 the intestine and induce a serious enteritis. From the intestine the 

 organism may pass into the blood and a systemic infection may result. 

 In such cases the streptococcus has been found not only in the stools, 

 but in the blood and urine also. 



The secretions of the vagina, in both pregnant and non-pregnant 

 women, often contain streptococci, but for the most part, at least, these 

 are not numerous and are non-virulent. This is due to the fact that 

 under normal conditions the vaginal tract is self-cleaning and its 

 secretions are bactericidal. In the puerperal state, when bits of pla- 

 centa or membrane are left in the uterus, the streptococci normally 

 present may become virulent and may lead to a septic condition. It 

 is possible, therefore, for puerperal fever to develop without extrane- 

 ous infection. That this is not the usual way in which puerperal fever 

 originates is quite certain. A virulent strain is introduced shortly 

 before, during or after labor. It may happen before labor by vaginal 

 examination, by improper douches or by coitus. It may happen during 

 labor by some fault of the accoucheur. It may happen after labor by 

 improper douches or handling the parts. The obstetrician must guard 

 against both autogenous and exogenous infection. He must avoid 

 those conditions which tend to increase the virulence of organisms 

 normally present and he must prevent the introduction of virulent 

 cocci. Puerperal fever is not confined to the human species, but 

 occurs in cows and other domestic animals. Contagious coryza, the 

 pleuropneumonia of horses, and certain inflammatory diseases of the 

 udders of cows, are results of streptococcic infection. Moreover, 

 wound infection and sepsis are -frequent causes of death among all the 

 higher animals. 



The streptococcus does not produce a soluble toxin in the sense 

 of that elaborated by the diphtheria bacillus. Its hemolytic product 

 is a soluble toxin, but the poisonous agent in the cellular substance of 

 streptococci is the protein poison. Filtrates from old cultures in large 

 doses kill animals, but there is nothing specific in this. Marmorek grew 

 cultures in blood serum for three months and found that the filtrate 

 killed animals, but the same result may be accomplished with many 

 non-pathogenic organisms. Baginsky and Sommerf eld grew the organ- 

 ism in strongly alkaline bouillon cultures for many weeks and found 



