INFECTIONS OF THE DIGESTIVE TRACT 189 



more grave manifestations of alterations in the blood 

 and loss of muscular power. 



It is now well known that there are occasional instances 

 of phlegmonous gastritis due to streptococcal infec- 

 tions. I have observed instances of extreme hyper- 

 chlorhydria which showed in the vomited material during 

 a seizure of protracted vomiting large numbers of Gram- 

 positive streptococci and many leucocytes. 



The relation of streptococcus infections to appendicitis 

 is still unsettled despite the considerable work that has 

 been done on the etiology of this affection. In many 

 instances the dominant flora in the diseased appendix 

 are streptococci, but the question arises whether they 

 are primarily or secondarily concerned. I have obser- 

 vations on two fatal cases of appendicitis in which the 

 intestine between the appendix and the anus contained 

 enormous numbers of streptococci and diplococci at all 

 points. It appears to me probable that the careful 

 microscopical and cultural study of the intestinal con- 

 tents will prove an aid to diagnosis in some obscure 

 forms of local intestinal infection by streptococci. 



Of the position which should be assigned to infections 

 of the intestinal tract by staphylococci there is little to 

 be said at present. One sometimes observes in the sedi- 

 ments of the fermentation tubes or bouillon flasks which 

 have been inoculated from mixed faecal flora numerous 

 clumps of Gram-positive cocci. The biochemical char- 

 acters of these organisms have not been studied and their 

 classification is at present uncertain. It is noteworthy, 

 however, that in two cases of severe staphylococcus acne 



