262 INFECTIVE DISEASES. 



These changes appear to be clue to the poison which is in the blood, 

 and is excreted by the kidneys. The epithelium is in a state of 

 cloudy swelling, a condition found in other febrile diseases and in 

 septic poisoning. 



Bacteria in Scarlet Fever. The occurrence of micro-organ- 

 isms in cases of scarlet fever has been observed by several investi- 

 gators Coze and Feltz, Crooke, Loftier, Babes, Heubner and Bahrdt, 

 and notably by Frankel and Freudenberg, and more recently by 

 Klein, the author, Raskin, and others. 



Coze and Feltz found cocci in the blood, and Crooke, in cases of 

 scarlet fever with severely affected throat, found bacilli, cocci, and 

 streptococci in the organs of the throat, and cocci in the internal 

 organs. Crooke left it an open question whether these cocci were 

 the specific organisms of scarlet fever, or were to be regarded as 

 diphtheritic or septic associates. He inclined, for clinical reasons, 

 to the latter view. 



Loffler, in cases of scarlatinal diphtheria, found the same chain - 

 forming micrococcus which he had found in typical diphtheria. 



Babes was able constantly to prove the presence of a strepto- 

 coccus in inflammatory products secondary to scarlatina. 



Heubner and Bahrdt, in a fatal case of scarlet fever in a boy, 

 complicated with suppuration of the finger and knee-joints, and 

 with pericarditis, found a streptococcus identical in form with Strepto- 

 coccus pyogenes, but cultivations were not made. The secondary 

 infection started from diphtheritically affected tonsils, which were 

 followed by retro-pharyngeal abscesses. 



Frankel and Freudenberg examined, for micro-organisms, three 

 cases of scarlatina with well-marked affection of the throat. In all 

 three cases they obtained cultivations of cocci from the submaxillary 

 lymphatic glands, spleen, liver, and kidney. These cocci could not 

 be distinguished from Streptococcus pyogenes derived from pus, nor 

 from the undoubtedly identical streptococcus which one of them 

 (A. Frankel) had repeatedly cultivated in large numbers from 

 puerperal affections. In two of the cases Streptococcus pyogenes 

 was the only organism present, and in all three cases it was far in 

 excess of other colonies which developed. The organisms were also 

 found in sections of the organs by microscopical examination. 

 Frankel and Freudenberg could in no way distinguish the strepto- 

 coccus in scarlatina from the streptococcus in pyaemia and septi- 

 caemia. The identity of this streptococcus with Streptococcus pyogenes 

 and Streptococcus puerperalis was established by comparison of their 

 macroscopical and microscopical appearances in cultivations on 



