Streptococcus

“ Now, if you can think of any possible chink through which a wandering streptococcus can, by any possibility, sneak into that wound, please suggest it, and it shall be closed immediately!
The intruders against whom all these preparations are made are two in number: Streptococcus pyogenes and Staphylococcus pyogenes—cousins, as you see, by their names. Their last (not family) name really [Pg 340] means something, and is not half so alarming as it sounds, as it is Greek for "pus-making." ”

“ B. THE RELATION OF THE TYPE OF ORGANISM TO PLEURAL INVOLVEMENT The hemolytic streptococcus has been found frequently in association with purulent pleural effusions in influenza, Thomas (146) , Stone and Swift (138) , Ely et al (37) ; and Goodpasture (48) has suggested an etiologic relationship between the type of effusion and the infecting organism in influenza, as has been brought forward for the similar post-measles empyema in the army camps. At the New Haven Hospital the Streptococcus hemolyticus was found frequently in non-fatal empyema. ”

“ It is easily killed by boiling, and can be destroyed by carbolic acid and by corrosive sublimate. The streptococcus of erysipelas is thought to be identical with the streptococcus pyogenes, but their difference in action is believed to be due to difference in virulence induced by external conditions and by the state of the tissues of the host. The coccus of erysipelas is larger than the ordinary form of streptococcus pyogenes, and infection takes place through a wound, often a very trivial one, or through a mucous membrane. The organism multiplies in the small lymph channels. ”

“ The common inflammatory bacteria—staphylococcus and streptococcus—cause suppuration in the majority of cases, but there are a few organisms such as streptothrix, spirochaete pallida, and in many instances the tubercle bacillus, which set up an inflammation of an extremely chronic type, rarely progressing to the formation of us, but leading rather to the development of a hard, solid mass of very slow growth, that may persist for months or even years. ”

“ During the 1889 epidemic Prudden examined by current bacteriologic methods seven cases of influenza and six cases of influenza-pneumonia. In them he found staphylococcus pyogenes aureus, streptococcus pyogenes, diplococcus pneumoniae, and in other cases he found a streptococcus. He concludes that the use of culture methods and media commonly employed has brought to light no living germ which there is reason to believe has anything to do with causing the disease. He emphasizes the probable importance of streptococcus pyogenes in particular in inducing the various complications. ”

“ Congested swollen kidneys, epithelial degeneration, casts, streptococcus. Congested, consolidated bronchioles, alveoli, lungs, with microbe. Meningeal congestion, exudate. Bacteriology: Streptococcus, pure cultures in lesions, size, chains, tetrads, staining qualities, culture media, colonies, action on sugars, acid, no gas, on milk no 394coagulation, on gelatine no liquefaction. History: Stagnant water; no evident source of infection, buzzards, etc. Pathogenesis: Inoculation, intravenous or intramuscular, feeding. On duck, pigeon, rabbits, mice, dogs. Guinea pigs and sheep immune. ”

“ Pure blood will not allow the development of the streptococcus erysipelatis in sufficient numbers to cause trouble. First the disease develops and then the germ comes along and multiplies in great numbers, giving it type. ”

“ The streptococcus abounds in the local phlegmons and abscesses, in the exudate of the submaxillary, pharyngeal or other glandular swellings, in the pustular eruption on the skin, and in the catarrhal discharge from the air passages. It further exists in the alimentary canal, in the ingesta and in the blood to a limited extent. In the bowels of an immunized animal it may remain virulent for months. Thus it comes that the manure is a source of infection, and that soiled fodder, litter and water may prove dangerous. ”

“ The virulence of the streptococcus of erysipelas, as pointed out by Fehleisen and Coley, is greatly exalted when the coccus is grown alongside the Bacillus prodigious and certain other saprophytic organisms which flourish at the body temperature. It is an easier matter to control the action of a non-multiplying poison, even though exceedingly active, than of one capable, under favourable conditions, of producing an indefinite amount of even a weaker poison. ”

“ He was playing with cultures isolated from various dairies and various people, thinking mostly of Klopchuk and streptococcus. Accidentally he discovered the lavish production of hemolysin in sheep’s blood as compared with the blood of other animals. Why should streptococcus dissolve the red blood corpuscles of sheep more easily than those of rabbits?
It is true that a busy health-department bacteriologist has no right to waste the public time in being curious, but the irresponsible sniffing beagle in Martin drove out the faithful routineer. ”

“ Marigold was coughing badly, for already a large area of her lungs had become involved and consolidated. Hence the doctor carried a portion of the sputum to his surgery, and that afternoon discovered the presence of the deadly streptococcus. On establishing the actual disease he at once telephoned for some anti-pneumococcic serum, and this he injected into the patient early next morning.
Having done so, he turned to her sister, and said:
"I am extremely sorry to tell you that this is our last hope. She is, I fear, collapsing fast. ”

“ Now, of course, the presence of a foreign substance in the human body will not necessarily produce inflammatory action, it must become septic, and we must at once admit the possibility of an adult worm becoming affected with a streptococcus and thus produce an abscess and secondary lymphangitis, though the streptococcus might produce it without the dead worm. ”

“ The invading organism is usually one of the staphylococci, less frequently a streptococcus, and still less frequently one of the other bacteria capable of producing pus, such as the bacillus coli communis, the gonococcus, the pneumococcus, or the typhoid bacillus.
So long as the tissues are in a healthy condition they are able to withstand the attacks of moderate numbers of pyogenic bacteria of ordinary virulence, but when devitalised by disease, by injury, or by inflammation due to the action of other pathogenic organisms, suppuration ensues. ”

“ Specific cause, streptococcus. Pathogenesis, to lambs and kids through sucking, drinking, feeding; inoculable on Guinea-pig, not rabbit. Lesions: like thrush, congested patches, with curd-like concretion; epithelium, leucocytes, microbe; in bad cases gastro-enteritis, hepatitis, or pneumonia. Symptoms: hyperthermia, refusal of teat, froth on lips, dulness, debility, emaciation, death in 15 days; in mouth, concretions and red raw sores; cough, hurried breathing, diarrhœa; subacute cases have little fever, or infection. Mortality 8 368per cent. in acute cases, none in subacute. ”

“ Serumtherapy.—Marmorek's original antistreptococci serum has been on the whole disappointing in its results, but polyvalent serums have been much more successful. Dr Besredka prepared a serum from the blood of fatal cases, and in the serum prepared at the Pasteur Institute no less than twenty separate strains of streptococci are used. In using serums, early and large dosage is necessary. Palmirski and Zebrowski have also prepared a serum from the streptococcus conglomerulatus, which has been used with considerable success in the children's hospital at Warsaw. ”

“ Certainly the obstetrical patient cannot be well cared for unless the nurse has this fear in her heart.
396Puerperal infection, then, in the light of present information, is regarded as a wound infection caused by the streptococcus, gonococcus, colon bacillus, gas bacillus or any other pus producing organism. Of these, the streptococcus infection is the most frequently seen and is also the most serious, about 10 per cent. of such infections resulting fatally; while the gonorrheal infection, though seldom ending in death, usually causes sterility. ”

“ The streptococcus shows a special disposition to enter and advance along the lines of the lymphatic circulation. The paucity of the germ in the blood and its abundance in the lymph plexuses, vessels and glands show that its election is preëminently for the lymphatic system. Then the ordinary primary lesions in and around the upper part of the air passage (nose, pharynx, submaxillary, parotidean and pharyngeal lymph glands) bespeak infection by inhalation, rather than with the ingesta. Primary solitary lesions on or near stomach or intestine are almost unknown ”

“ Most cases are due to the staphylococcus pyogenes aureus and a few to the streptococcus. Typhoid bacilli may cause suppuration. The infecting organism is present in pure culture but sometimes a mixed infection occurs, and such cases are said to be severe.
In cases of chronic osteomyelitis with open sinuses and exposed bone, a great variety of organisms, pathologic and saprophytic, may be present. ”

“ Undue weight should not be given to this objection, as the essential accessory conditions of plethora, etc., are usually largely modified in cases of dystokia.
The microbiology of the affection leaves much to be desired. Coureur and Pottiez and later Van de Velde found a streptococcus in the blood. Trinchera, Nocard, and Cozette found the common pus cocci (staphylococcus pyogenes aureus, citreus and albus) a streptococcus and a colon bacillus in the liquid squeezed from the cotyledons, and in the liquid debris on the uterine mucosa. These microbes were not found in other organs. ”

“ The pus microbes, cocci, streptococci, staphylococci, and bacilli, have been found and adduced as causes, also diplococci, the bacillus hæmorrhagicus of Kolb, the streptococcus of strangles, the microörganism of contagious pneumonia and that of influenza, with a variety of others too great and too inconstant to be accepted as proof of cause. The fact that rarely more than one animal suffers in the same stable at the same time might be held to oppose the idea of contagion and of a definite organized germ. ”

“ Like septicæmia, this condition is due to pyogenic bacteria, the streptococcus pyogenes being the commonest organism found. The primary infection is usually in a wound—for example, a compound fracture—but cases occur in which the point of entrance of the bacteria is not discoverable. The dissemination of the organisms takes place through the medium of infected emboli which form in a thrombosed vein in the vicinity of the original lesion, and, breaking loose, are carried thence in the blood-stream. ”

“ An example of increasing virulence from changing environmental conditions, is the experience in the United States Army camps in 1917 and 1918 with the streptococcus. This microorganism, which at first was but a secondary invader, particularly to measles, became so exalted in virulence that it soon became the cause of primary disease. This is likewise true of the various secondary invaders of the influenza epidemics. They become so highly virulent that they dominate the picture in the later stages. ”

“ I have seen a patient walk into the hospital on Sunday with a temperature of 100 and a pulse of 99, and when the abdomen was opened on Monday morning a most virulent form of general streptococcus peritonitis was found, from which the patient died the next day. It is said that it is much better to depend on the pulse and its variations than on the temperature. ”

“ Erysipelas occurs on various parts of the skin. It is caused by the inoculation through an abraded surface of a virulent form of the same streptococcus that commonly causes suppuration. It occurs chiefly in debilitated subjects. Some persons are specially prone to it, and may have many attacks. Erysipelas, like scarlet fever, occurs most in years in which there is deficient rainfall; and is probably conveyed by dust. It may spread, though exceptionally, from case to case. ”

“ Mathers reported that coincident with the epidemic among humans there was an epizootic of so-called influenza among horses. The symptoms are very similar to that of the disease among humans. He isolated a streptococcus as the predominating organism in the horses. The streptococci from human and equine sources, although similar in many characteristics, differed widely in pathogenicity, and seemed to be highly parasitic for the specific hosts.
Capps and Moody found that in man most cases began rather abruptly, with coryza, pharyngitis, laryngitis, or bronchitis. ”

“ Infection with the staphylococcus albus, the streptococcus, or the pneumococcus also causes a mild form of osteomyelitis which may go on to suppuration.
Necrosis without suppuration, described by Paget under the name “quiet necrosis,” is a rare disease, and would appear to be associated with an attenuated form of staphylococcal infection (Tavel) . It occurs in adults, being met with up to the age of fifty or sixty, and is characterised by the insidious development of a swelling which involves a considerable extent of a long bone. ”

“ Bacterial ferments have an equally bad reputation. Bastin records the poisoning of five foals by fermented rye; Dieckerhoff describes an acute gastro-enteritis with congestion and swelling of liver, spleen and kidneys, as the result of microbes and their products in the fodders. Galtier traced a pneumoenteritis in the horse to two cocci, a motile diplococcus and non-motile streptococcus. ”