STREPTOCOCCUS PYOGENES 343 



mouth and throat streptococci may give rise to pharyngitis and are one 

 of the most frequent causes of a form of tonsillitis often clinically indis- 

 tinguishable from diphtheria. The throat inflammation accompanying 

 scarlatina is, almost without exception, referable to streptococcus infec- 

 tion.i The occasional presence of the streptococcus in the blood of 

 scarlatina patients, moreover, has led some authors to suggest a pos- 

 sible etiological connection between this microorganism and the disease.^ 

 This, however, is at present merely conjectural. 



In diphtheric inflammations of the throat, a secondary streptococcus 

 infection is a frequent and serious complication. As incitants of disease 

 of the intestines, streptococci have been found in appendicular abscesses ' 

 and have been described as the cause of some forms of infantile diarrhea.' 

 From any of the local processes streptococci may pass into the circulation, 

 causing sepsis. The septicemia occurring during the plierperium is most 

 often caused by this microorganism. 



Secondary foci in the viscera may be established, leading to pyemia,^ 

 or, if these localizations occur upon the heart valves, septic endocarditis 

 may ensue. All such forms of general streptococcus infection, whether 

 running acute or chronic courses, present a high rate of mortality. The 

 diagnosis in these cases is usually easy if blood cultures are taken upon 

 suitable media. 



Streptococcus throat infections have recently appeared in fulmi- 

 nating epidemics. Several small epidemics were described in England, 

 and three extensive outbreaks have occurred in this country; one in 

 Boston of 1,400 cases; a second in Baltimore of about 1,000 cases, and 

 a third in Chicago of about 10,000 cases. These outbreaks were studied 

 by Winslow, Stokes, Davis,* and by Rosenow.' In each case the major- 

 ity of infections were traced to a single milk supply, though secondary 

 cases doubtless occurred by contact. Severe complications such as 

 suppurative adenitis, otitis, erysipelas, peritonitis, and septicemia 

 were not uncommon. A similar organism — a capsulated, hemolytic 

 streptococcus — was found in each epidemic. 



^Baginsky, Deut. med. Zeit., 1900. 



'^ Baginsky und Sommerfeld, Berl. kUn. Woch., xxvii, 1900. 

 'Kelly, "Pathogenesis of Appendicitis." 



* Lanz and Tavel, Rev. de Chir., 1904; Perrmie, Ann. de I'inst. Pasteur, 1905; 

 Escherich, Jahrb. f. Kinderheilkunde, 1899. 

 ^ Ldbman, Cent. f. Bakt., xxii. 

 " Cited from Capps, Jour. A. M. A., 1912, p. 1848. 

 ' Rosenow, Jour, of Inf. Dis., 1912. 



