1920 Archives of internal medicine (Chicago, Ill. : 1908)  
The presence of the hemolytic streptococcus in the blood preceding and during the eruptive stage of a case of hemorrhagic smallpox led us to inquire whether this was a common finding in this form of smallpox. A search through the literature failed to give any information on this point. The close association of the streptococcus with variola is well known. In forty necropsies, practically all of which were in severe cases of smallpox, Perkins and Pay 1 found streptococci in the heart's blood and
more » ... viscera of thirty-eight, or in 95 per cent. of the cases. Of these forty cases three were of the purpuric type, nine of the so-called secondary hemorrhagic type (variola hemorrhagica pustulosa), twenty-four of the confluent type, one discrete, two varioloid and one desiccating. The streptococcus was present in all of the cases except one purpuric and one varioloid case. These same workers examined the blood of twenty patients, before or just after death, and found streptococci present in eleven, or 55 per cent. If we consider only the sixteen more serious cases in this group, streptococci were present in 69 per cent. Ewing 2 examined the blood after death in twenty-nine cases of smallpox and demonstrated the streptococcus in all. The abundance of the growth was found to be uniformly proportional to the severity of the disease, and in the primary hemorrhagic cases the cultures were remarkably profuse. In five cases cultures of the circulating blood were examined with a negative result. Only one of these cases was fatal. Ewing was greatly impressed by the early appearance and enor¬ mous development of the streptococcus infection in variola, especially in the primary hemorrhagic cases. It seemed to him that the smallpox virus "annihilates resistance" to the growth of the streptococcus. Arnaud 3 found streptococci in the. blood during life in two cases of hemorrhagic smallpox. From
doi:10.1001/archinte.1920.00100050087006 fatcat:mz2qc4mn7veehh5zv4k2ooeo7a