A clinical experiment in subacute streptococcus endocarditis.

Abstract

Permission having been obtained, an attempt was made to study the effect in a patient with Subacute Streptococcus Endocarditis of inoculation with autogenous, living organisms. Without previous observations, and without knowing whether the effects would harm or benefit the patient the utmost caution was used with regard to dosage. Four inoculations were made within a period of four weeks. The first two injections were intracutaneous, the second subcutaneous and the fourth consisted of infected agar injected subcutaneously. The first injection consisted of about two cubic millimeters of broth culture attenuated by freezing and melting five times so that the resulting culture yielded weakly growing subcultures. No reaction followed this injection up to six days.

The second injection consisted of four cubic millimeters of broth culture that had remained in the ice box four days. No reaction followed during the same interval.

The third injection consisted of five cubic millimeters, injected subcutaneously, of twenty-four hour broth culture. No reaction followed.

A moderate clinical improvement could not certainly be ascribed to this procedure and all inoculations were discontinued one month before death.

Following these clinical observations, rabbits were inoculated with cultures intradermally and with infected agar subcutaneously, using the same streptococcus. No reaction followed immediately or at any time up to ten days after inoculation.

Although it is easy to reproduce the disease in dogs by using a non-hemolytic streptococcus obtained from a case of Acute Rheumatic Fever, attempts were unsuccessful in three dogs when strains from two cases of Subacute Streptococcus Endocarditis were used.

It is further interesting to note that in the experiments in dogs in which the more virulent streptococcus was employed, the animals suffered a rapidly rising bacteriemia while patients displayed a constant number of colonies in culture.