Streptococcus Pyogenes 321 



ferentiating the one from the other is by means of a careful bacterio- 

 logic examination. Such an examination should always be made, 

 as it has much weight in connection with the treatment; in strepto- 

 coccus 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 enteritis. In such 

 cases the organisms are found in large numbers 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. 



The intestinal streptococci are often Gram-negative, when they 

 are usually non-virulent. 



Libmanfhas reported 2 carefully studied cases of streptococcic 

 enteritis. 



Flexner,J in a larger series of autopsies, found the bodies in- 

 vaded by numerous micro-organisms, causing what he has called 

 " terminal infection," and hastening the fatal issue. Of 793 autop- 

 sies at the Johns Hopkins Hospital, 255 upon cases dying of 

 chronic heart or kidney diseases, or both, were sufficiently well 

 studied bacteriologically, to meet the requirements of a statistical 

 inquiry. Tuberculous infections were not included. Of the 255 

 cases, 213 gave positive bacteriologic results. "The micro-organ- 

 isms causing the infections, 38 in all, were Streptococcus pyogenes, 

 16 cases; Staphylococcus pyogenes aureus, 4 cases; Micrococcus 

 lanceolatus, 6 cases; gas bacillus (Bacillus aerogenes capsulatus), 

 three times alone and twice combined with B. cpU communis; the 

 gonococcus, anthrax bacillus; B. proteus, the last combined with B. 

 coU; B. coU alone; a peculiar capsulated bacillus, and an unidentified 

 coccus." 



It is interesting to observe in how many cases the streptococcus 

 was present. All the streptococci found may not have been Strepto- 

 coccus pyogenes, but for convenience in his statistics they were re- 

 garded as such. 



The presence of streptococci in the blood in scarlatina has been 

 observed in 30 cases by Crooke, by Frankel and Trendenburg, 

 Raskin, Leubarth, Kurth, and Babes. In 11 cases of scarlatina 

 studied by Wright§ a general streptococcus infection occurred in 

 4, a pneumococcus infection in i, and a mixed infection of pyogenic 

 cocci in i. 



Lemoinell found streptococci in the blood during life in 2 out of 

 33 cases of scarlet fever studied. Pearce * * studied 1 7 cases of scarla- 



'Centralbl. f. Bakt. u. Parasit.," 1897, Bd. xxn, Nos. 14 and 15, p. 369. 

 t 'Centralbl. f. Bakt. u. Parasit.," 1897, Bd., xxii, Nos. 14 and 15, p. 376. 

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

 § 'Boston Med. and Surg. Jour.," March 21, 1895. 

 |"Bull. et M6m. Soc. d'Hop. de Paris," 1896, 3 s., xiii. 



'Jour. Boston Soc. of Med. Sci.," March, 1898. 



21 



