THE IDENTIFICATION OF THE H2EMOLYTIC STREPTOCOCCI, WITH SPECIAL REFER- ENCE TO THOSE OF THE UPPER RESPIRA- TORY

SINCE the streptococcus was first suspected as being the wetio-logical agent in acute rheumatism evidence has been gradually accumulated in support of this statement, and, since Coburn (1931) named the haemolytic streptococcus, as the causative variety, much additional work has been done. At the 1938 meeting of the British Medical Association many speakers supported this view, Green (1938) reporting a series of 200 cases of acute or subacute cases of rheumatism (58 per cent. had hsemolytic streptococci in the naso-pharynx at the onset of the rheumatic syndrome), and Gordon (1938) reported experimental work which appeared to reconcile the streptococcus and virus theories of the aetiology. In this work arthritis was produced in rabbits by a combination of vaccinia virus and haemolytic streptococci. In view of the importance of the hsemolytic streptococci, most probably as the actual cause, or as an essential contribu-tory factor, the accurate identification of the haomolytic strepto-coccus must be of great importance. Willcox (1938) stressed the importance of recent advances in bacteriological technique as a cause of the advance in the knowledge of the awtiology of acute rheumatism. In this communication methods of isolation, appearance on blood plates, hoemolysin production, fibrinolytic activity, colony appearance, and serological methods will be discussed. It will be noted that discussion of fermentative reactions has been omitted. The variability of such reactions in the case of the hawmolytic streptococcus and the difficulty of reconciling the grouping by this method with other classifications seem sufficient reason for the exclusion of the fermentative reactions as a means of differentiation