The successful culture-medium consists of glycerin-agar, to which is added about 5 per cent. by weight of black garden earth, previously sterilized by discontinu ous heating. The epidermic scales re moved from a patient by a sterilized platinum loop are placed on this medium, and the tubes put in the in cubator for from two to seven days, at a temperature of about 35° C. In about two days small whitish-gray semitrans parent colonies appear. The organism does not grow on agar-agar, glycerin agar, gelatin, bouillon. or potato. W. J.
Class (Jour. Amer. Med. Assoc., Apr. S, '99).
The crescent-shaped germ described by Wynkoop and the diplococcus of Class are different forms of the same germ. Examination of 3600 to 6000 cultures from inflamed throats have shown that fully SO per cent. of the cultures contain this coccus. W. K. Jaques (Jour. Amer. Med. Assoc., May 26, 1900).
In all cases of scarlatinal angina strep tococci found, sometimes in pure culture; generally, however, accompanied by other cocci, but always overshadowing them. In all the fatal cases (forty-two) of scar latina examined, a streptococcus was found in all the organs and also in the blood and bone-marrow. From this it is safe to conclude that it is constantly present in all cases of scarlatina. The streptococcus reveals itself in its mor phological. cultural, and biological rela tions as do the streptococci of writers in general. With all methods of differ entiation hitherto used it is not capable of being distinguished. The strepto coccus is of varying degrees of virulence, and this can he increased by successive cultures. It develops a toxin in the culture-medium. Specific peculiarities of the streptococcus found in scarlatina cannot be developed by culture-methods any more than is the case with the strep tococei heretofore described. The con stancy of the presence of this strepto coccus in fatal scarlatinal cases makes this organism significant as a factor in the disease. The collective clinical mani festations of scarlatina are due to the spread of the streptococcus in the organs (infection) and the poison derived from its metabolic processes (intoxication). A. Baginsky and P. Sommerfeld (Berliner klin. Woeh., July 9, 1900).
The micro-organism discovered by Ba ginsky and Sommerfeld in the throat se cretions and blood of scarlet-fever pa tients is identical with the diplocoecus scarlatince personally discovered. The only essential difference is that they speak of it as a streptococcus growing on agar, which is not the case. W. J.
Class (Lancet, Sept. 29, 1900).
Experiments seem to show that the specific germ of scarlet fever exists in the blood, for inoculation with the serum into susceptible animals produces a ical attack of the disease. It is, also, found in the various secretions, as shown by their power to generate the disease. The micro-organism, while more tena cious of life than is that of most other diseases, either lacks the power of ing a foothold, when implanted in the sys tem, or is less readily conveyed through the air. It is at least a fact that many more children escape scarlet fever than measles, and its spread is more readily controlled.
The chief source of infection is the patient himself, but the area of con tagion is limited to a few feet. The desquamation-scales are extremely fectious. Their retention by clothing, bedding, and the walls of the rooms is one of the most common causes of fection. The purulent secretions from the throat, nose, and ear are also very infectious.
The bacteria obtained from cultures from the skin. epidermal scales, and the surface of the tonsil in eases of scarla tina are the same as those found in the same locations in health, and not one of them is constantly present except the streptococcus in the throat. Because the 1111111er011 s cocci which grow in such cultures, and which appear in groups of two and four or bunches of the same under the microscope, it is impossible to identify them, except by a complete study in pine culture. Cultures made by inexperienced persons or by those who do not fully appreciate the im portance of avoiding the tongue, are especially apt to contain large diplocoeci or sareime. The streptococcus is present upon the tonsil of scarlatinal patients in enormous numbers in almost all cases. G. II. Weaver (Amer. Medicine. April 1S, 1903).
Scarlet fever is spread by indirect in fection more frequently than any other disease except diphtheria. Its specific micro-organism is more tenacious of life than that of any other disease, except, perhaps, small-pox. Authentic cases have been reported in which it main tained its vitality for a year or more. It may be conveyed from one child to other in the fur of cats and dogs, and it is probable that these animals may suffer from the disease. The contagion clings to rooms with great tenacity, be ing usually lodged in the wall-paper or in cracks of the walls, ceilings, and floors. The conveyance of scarlet fever by milk and other articles of food is undoubted.