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SUPPURA TION.                          193

years without any particular precautions and found its
virulence unchanged.

Probably the virulence and attenuation are peculiarities
of the organism itself.

Dried streptococci are said by Frosch and Kolle to re-
tain their energies longer than those growing on culture-

lyike the staphylococci, the streptococcus is frequently
associated with internal diseases, and has been found in
erysipelas, ulcerative endocarditis, periostitis, otitis, men-
ingitis, emphysema, pneumonia, lymphangitis, phleg-
mons, sepsis, and in the uterus in cases of infective puer-
peral endometritis. In man the streptococci occur in the
most active forms of suppuration. Its relation to diph-
theria is of interest, for, while, in all probability, the
great majority of cases of pseudomembranous angina are
caused by the Klebs-Loffler bacillus, yet an undoubted
number of cases are met with in which, as in Prudclen's
24 cases, no diphtheria bacilli can be found, but which
seem to be caused by a streptococcus exactly resembling
that under consideration.

There is no clinical difference in the picture of the
throat-lesion produced by the two organisms, and the
only positive method of diagnosticating the one from
the other is by means of a careful bacteriologic examina-
tion. Such an examination should always be made, as it
has much weight in connection with the treatment. Of
course, in streptococcus angina no benefit could be ex-
pected from the diphtheria antitoxic serum.

Hirsh2 has shown that under pathological conditions
streptococci are by no means rare organisms in the in-
testinal canal of infants, and may cause a streptococcic
enteritis. In these cases the organisms are found in large
numbers in the stomach and in the stools, and later in
the course of the disease in the blood and urine of the
living child and in the internal organs of the cadaver.

1  Flugge's Die Mikroorganismen.

2  Centmlblfur J$akt. und Parasitenk.> Bd. xxii., Nos. 14 and 15, p. 369.