1908] Streptococcus Infections of the Tonsils 
141 
The tonsils in the majority of cases were only slightly enlarged. 
The lymphatic glands of the neck were enlarged but this change 
was not pronounced. The inflammatory reaction of the tonsils 
consisted in the formation of a grayish white membrane which 
covered their surface, usually involved both tonsils, and in four 
cases extended up the anterior pillars of the fauces. The mem- 
brane was tough, was removed with difficulty, and after its 
removal in many instances left behind a raw bleeding surface. 
In only ten of the fifty-eight cases, was the membranous deposit 
limited around the follicular openings. 
So far as the appearance of the throat was concerned, these 
cases would have been diagnosed as diphtheritic infections. Such 
a diagnosis was made in the first four on a purely clinical basis. 
Their failure to respond to antitoxin treatment led to a bacterio- 
logical examination with the demonstration of a streptococcus 
infection . 
A series of such cases, twenty-four in number, have been 
reported by Prudden of New York in which the streptococcus 
was the organism present and not the bacillus of diphtheria. 
The existence of such cases renders the diagnosis of diphtheria 
when approached entirely from the clinical side extremely diffi- 
cult, if not impossible. All cases should be subjected to a bacteri- 
ological examination before a diognosis is made. 
The second point of interest which developed from the study of 
this series of cases was the occurrence of symptoms referable to the 
joints. Many of the patients complained of pain in one or more 
joints and in a few cases the joints were slightly swollen. Such 
symptoms lasted but a short time and did not return. 
In four of the series the joint symptoms were prominent and 
persisted. For the sake of brevity a detailed history of the cases 
will not be given. 
Case 1. — A. R. D., male, age 17. The general symptoms were 
those of an acute infection. The throat examination revealed 
a grayish membrane covering the right tonsil and sneaking up 
the right anterior faucal pillar. The lower half of the left tonsil 
was covered by a similar membrane. 
The bacteriological examination demonstrated as a streptococ- 
cus infection. 
