248 SYPHILIS. 



pyogenes. He believed that this microbe had entered the body 

 through an open pemphigus blister, the umbilicus, or had been 

 derived from the furuncles. In another case in which he found 

 the same microorganism in the liver, he obtained a pure culture of 

 the streptococcus pyogenes from blood taken from the liver. 



Chotzen ( Vierteljahrsschrift f. Derm. u. Syphilis, 1887, S. 109) 

 states that in searching for the same microbe, in Neisser's clinique, 

 it was found once in bone, five times in the skin, four times in the 

 liver, once in the mucous membrane of the intestine; in the last- 

 mentioned organ the microbe was found in great abundance, not in 

 the vessels, but in the paravascular and lymph spaces. In bone it 

 was found where syphilitic lesions are usually met with. As the 

 result of his observations he looks upon the streptococcus only as 

 an accidental, and not as an essential, condition of hereditary syph- 

 ilis. In cases of acquired syphilis it was never found. As this 

 streptococcus must be different from the microbe of erysipelas and 

 of suppuration, it still remains an open question as to its relation 

 to syphilitic infection. From a hypothetical standpoint he regards 

 the presence of the streptococcus as an evidence of a mixed infec- 

 tion, and believes that it produces death by giving rise to sepsis. 

 The presence of the coccus in the medullary tissue of the epiphy- 

 seal extremities of the long bones would furnish an explanation 

 regarding the frequency with which lesions are found here in chil- 

 dren suffering from hereditary syphilis. As points of entrance of 

 the streptococcus he enumerates coryza and inflammation of the 

 naso-pharyngeal space. 



Doutrelepont (" Streptokokken und Bacillen bei hereditarer Syph- 

 ilis,' 7 Centralblatt f. Bad. u. Parasitenhmde, B. ii.. No. 13) agrees 

 with Chotzen in regard to the character and etiological significance 

 of the streptococcus found in children suffering from congenital 

 syphilis. He has found it in the papular eruptions of the skin, 

 and believes that it enters the lymph spaces here, and through these 

 channels reaches the general circulation and distant organs. The 

 frequency with which suppuration in bones and other organs is met 

 with in children soon after birth, and sometimes in utero, would 

 suggest that the secondary infection results from the introduction, 

 sometimes through the maternal circulation, at others through 

 lesions after birth of pus microbes, which become localized in 

 organs the seat of syphilitic lesions, where, in the course of time, 

 suppuration takes place. The presence of an abundance of pus 

 microbes may destroy life by sepsis before a sufficient length of 

 time has elapsed for them to manifest their specific pathogenic 

 properties on the tissues. 



