Streptococcus Pyogenes 299 



diphtheria and pseudo-diphtheria bacilli also produce 

 hemolyzing substance, so that the test cannot be used for 

 the immediate separation of streptococci from other bacteria 

 in cultures from the throat. Colonies of the pneumococcus 

 usually appear green and without hemolysis, but Ruediger 

 finds that they sometimes also cause solution of the hemo- 

 globin. The streptococci whose colonies are green and 

 without hemolysis are called streptococcus mridans by Schott- 

 muller. They are practically without pathogenic power 

 for rabbits. 



Pathogenesis. The streptococcus has been found in 

 erysipelas, ulcerative endocarditis, periostitis, otitis, men- 

 ingitis, emphysema, pneumonia, lymphangitis, phlegmons, 

 sepsis, puerperal endometritis, and many other forms of 

 inflammation and septic infection. In man, it is usually 

 associated with active forms of suppuration and sepsis. 



The relation of the streptococcus to diphtheria is of 

 interest, for, though in all probability the great majority of 

 cases of pseudomembranous angina are caused by the 

 Klebs-LofHer bacillus, yet a number are met with in which, 

 as in Prudden's twenty-four cases, no diphtheria bacilli can 

 be found, but which seem to be caused by the streptococcus. 



There is no clinical difference between the throat-lesions 

 produced by the two organisms, and the only positive 

 method of t differentia ting the one from the other is by means 

 of a careful bacteriologic examination. Such an examina- 

 tion should always be made, as it has much weight in con- 

 nection with the treatment; in streptococcus angina no 

 benefit can be expected from the administration of diphtheria 

 antitoxic serum. 



Hirsh* has shown that streptococci are by no means rare 

 in the intestines of infants, where they may occasion enter- 

 itis. In such cases the organisms are found in large num- 

 bers in the stomach and in the stools, and late in the course 

 of the disease in the blood and urine of the child. They 

 also occur in all of the internal organs of the cadaver. 



Libman f has reported two carefully studied cases of 

 streptococcic enteritis. 



Flexner,J m a large series of autopsies, found the bodies 

 invaded by numerous micro-organisms, causing what he has 



* "Centralbl. f. Bakt. u. Parasit.," Bd. xxn, Nos. 14 and 15, p. 369. 



t Ibid., p. 376. 



t "Journal of Experimental Medicine," vol. i, No. 3, 1896, 



