GASTRIC ULCER AND STREPTOCOCCI 6 1 



other organism is pathogenic in a given infection, is to examine smears from the pus 

 or other material in a Gram-stained specimen for information as to abundance and, 

 in particular, phagocytosis of any organism, before plating out. 



Streptococci are commonly the cause of diffuse phlegmonous inflam- 

 mations, while the staphylococci cause circumscribed lesions. Strepto- 

 cocci cause necrosis and do not characteristically produce pus. The 

 importance of the Streptococcus as a secondary infection in diphtheria, 

 tuberculosis, small-pox, and even in typhoid fever must always be kept 

 in mind. It is this infection which does not respond to diphtheria 

 antitoxin, and not the diphtheria one. 



Rosenow has reported on the rather constant presence of streptococci in gastric 

 and duodenal ulcers removed at operation, under which circumstance the number and 

 variety of bacteria present are comparatively few. The strains from 27 chronic 

 ulcers gave grayish-green colonies on blood plate, were in short chains and diplococci, 

 produced much acid and turbidity in dextrose broth and showed a low-grade virulence. 

 When injected into dogs, rabbits and guinea-pigs they showed a tendency to localize 

 in the mucosa of stomach and duodenum, causing ulceration in a large percentage 

 of cases. 



Streptococci as well as colon infections are always to be thought of in connection 

 with cholecystitis and appendicitis. 



It has been claimed that scarlet fever is a streptococcal infection (S. anginosus). 

 Klimenko found streptococci only n times in the blood of 523 cases of scarlet 

 fever. The Dohle inclusion bodies of the disease suggest chlamydozoal virus. 

 Mallory has very recently claimed that scarlet fever is due to a diphtheria-like 

 bacillus. It is found in the same locations as the diphtheria organism and also 

 produces a toxin which, however, is less virulent and only produces inconspicuous 

 lesions. The membrane formation in the throat in scarlet fever is due to streptococci. 



When freshly isolated from human lesions streptococci often show only a slight 

 virulence for animals. Hence massive doses are indicated and intravenous or intra- 

 peritoneal injections. The guinea-pig is not very susceptible to streptococci; the 

 rabbit and white mouse being the animals of choice. 



In nondiphtheritic anginas, puerperal fever, ulcerative endocarditis 

 and coccal enteritis it is the Streptococcus which is usually the cause. 

 It has been claimed that acute articular rheumatism is due to a short- 

 chain streptococcus (M. rheumaticus), which is best isolated from 

 material from an acute joint infection, but may also be isolated occa- 

 sionally from the blood. It produces much acid and clots milk in two 

 days. The growth is described as being more luxuriant than that of 

 S. pyogenes. It is about 0.5^ in diameter. 



The majority of investigators have reported streptococci from acute joint inflam- 

 mations and bacilli from chronic infectious joint affections. Goadby has considered 

 a streptobacillus, somewhat resembling Ducrey's bacillus of chancroid, which ex- 



