Streptococci : their toxins and antitoxins lecture delivered at St. Mary's Hospital, May, 1927 / by R.A. O'Brien.

  • O'Brien, Richard Alfred, 1878-1970.
Date:
[1927?]
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Licence: In copyright

Credit: Streptococci : their toxins and antitoxins lecture delivered at St. Mary's Hospital, May, 1927 / by R.A. O'Brien. Source: Wellcome Collection.

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    interesting and valuable, that the disease so produced is infectious to others and therefore in every respect resembles natural scarlet fever. It is further reasonable to believe that most of the symptoms at least of uncomplicated scarlet fever are due to the “ toxin ” of the S. scarlatince, for, by the injection of sterile filtrate made from a culture of the streptococcus, subcultured perhaps hundreds of times since its isolation from the human subject, one can produce pyrexia, headache, “ strawberry tongue,” the characteristic throat condition, albuminuria and rash followed by peeling—in other words, a pathological condition indistinguishable from naturally ocurring scarlet fever. It is practically certain that this so-called “ scarlatinoid syndrome ” is non-infectious. It appears to be established beyond doubt that the response to the Dick test is related to immunity against scarlet fever, and that scarlet fever antitoxin is effective in the treatment of uncomplicated scarlet fever ; it is probably without effect on the late septic or pyogenic conditions occurring in scarlet fever. Further, by immunising with Dick toxin one can make positive reactors negative to the Dick test, and this negative reaction indicates a reasonably high immunity against scarlet fever. When we consider the more recent work, we find a distinct suggestion that the toxins and antitoxins of all the heemolytic streptococci are so closely related as almost to amount to identity. But whether this view will be entitled to a “ land mark,” time and further experience alone can tell. Current clinical views may be summarised under some such headings as the following:— (a) Experimental evidence.—(1) S. pyogenes when injected has caused at least local septic conditions. (2) S. erysipelatis when injected has caused erysipelas. (3) S. scarlatince when rubbed on the tonsils has caused scarlet fever. (b) Conclusions reasonably based on much clinical observation.—Streptococci, usually haemolytic, are the cause of puerperal fever, mastoiditis, septic pneumonia, &c. S. viridans is the usual cause of subacute infectious endocarditis. (c) Current hypotheses.—Truth dependent on experience in the future. Because streptococci occur in demtal septic
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