TT.A. Hor'ci c na/i~ 
 
 -The, Occurence, Of Hemoly-ric STre.f^-t-ocoac. , 
 , hau-t~ T’hc^ 'l~6€^~th 
 
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THE OCCURRENCE OF HEMOLYTIC STREPTOCOCCI 
 ABOUT THE TEETH 
 
 BY 
 
 RALPH AUGUST KORDENAT 
 
 B. S. University of Illinois 
 1919 
 
 THESIS 
 
 Submitted in Partial Fulfillment of the requirements for the 
 
 Degree of 
 
 MASTER OF SCIENCE 
 IN BACTERIOLOGY AND PATHOLOGY 
 IN 
 
 THE GRADUATE SCHOOL 
 OF THE 
 
 UNIVERSITY OF ILLINOIS 
 
 1920 
 
Digitized by the Internet Archive 
 in 2015 
 
 https://archive.org/details/occurrenceofhemoOOkord 
 

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THE 
 
 OCCURiCTCE OF HEMOLYTIC STREPTOCOCCI 
 
 ABOUT 
 
 THI] 
 
 TEETH 
 
 Ralph A. Kordenat. 
 
 From the Department of Pathology and Bacteriology, 
 University of Illinois, College of Medicine. 
 Chicago, Illinois. 
 

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 TAELIi: OF COITTEIITS 
 
 1. Introduction 
 
 2. Literature 
 
 3. General Anatomy of I’eeth and Gums 
 
 4. Experimental data 
 Collection of material 
 Method of Culturing Organisms 
 Morphology of Organisms 
 Staining properties 
 
 Classification of Organisms hy Fermentation Tests 
 Virulence 
 
 5. Discussion 
 
 6. Conclusions 
 
 7; Table 1. Incidence of hemolytic streptococci in 
 gingival space 
 
 8. Table 2. Classification of Hemolytic Streptococci 
 
 9. Table 3. Varieties of Hemolytic Streptococci 
 
 10. Table 4. Virulence of gir^gival Hemolytic Streptococci 
 
 for rabbits 
 
 11. Table 5. Hemolytic Streptococci in Pyorrhea Cases 
 
 12. Figure 1. Gross Anatomy of Tooth and Gums 
 
 13. Figure 2. Apparatus for collecting Material from 
 
 Gingival Space 
 
 14. Figure 3. Method for obtaining Material from Gingival 
 
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 The Occurrence of Hemolyolc StreptoQOcci 
 About the Teeth. 
 
 Various investigators have shown that hemolytic 
 streptococci occur in the normal as well as in the 
 pathological oral cavity and upper respiratory tract. 
 The object of the investigative work recorded here is 
 to determine the frequency of various hemolytic strep- 
 tococci about the teeth and gums in apparently normal 
 and in pathological cases. 
 
 Literature 
 
 Davis (18o2) has shown that hemolytic streptococcci 
 occur in the crypts practically constantly and upon 
 the surface in sixty per cent of all tonsils. 
 
 Maclay (3) found in £68 cases fourteen strains of 
 hemolytic streptococci in the crypts of tonsils. His 
 examinations show a marked seasonal variation, strep- 
 tococci being fewer in the summer months, Voight (4) 
 found that thirty per cent of all oases of severe in- 
 fection of the middle ear, ethmoids and mast o ids are 
 due to some form of hemolytic streptococci and that 
 these organisms occur in eighty per cent of tonsils 
 removed. He has isolated hemolytic streptococci 
 
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 from the urine of patients suffering with an acute 
 tonsilitis. ITichols and Eryan (5) have shown that a 
 high percentage of their tonsil infections is due to 
 streptococci and confirm Davis' (6) ohser vations that 
 they may occur in great numhers in the crypts of ton- 
 sils, even when surface smears fail to reveal the or- 
 ganisms. Henrici and Hartzell (7) helieve that mouth 
 streptococci are the true parasitic organisms of the 
 mouth because they are the only ones that can live on 
 the clean mucous membrane before eruption of the teeth. 
 They observed that there is a relative decrease, but an 
 absolute increase of these streptococci in conditions 
 of uncleanliness and decay. They also believe the 
 organisms in question to be the cause of dental caries, 
 pulpitis and pyorrhea alveolaris because; first, they 
 are the only organisms, in these lesions that are patho- 
 genic as exhibited by their local invasive pov/er, 
 their ability to invade the blood and lymph stream and 
 produce metastatic infection; second, they are the 
 only organisms found in the deep advancing borders of 
 infected tissue; third, in metastatic abscesses and 
 in experimental inoculation of animals the organisms 
 produce a subacute aiid granulomatous lesion similar to 
 the inflammatory reaction found in pyorrhea and chronic 
 apical abscesses; fourth, that the true mouth strepto- 
 cocci (Streptococci salivarius) - which, according to 
 Holman's classification is of the non-hemolytic variety - 
 

 
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 will invade the dental pulp and peridental tissue. 
 
 In a later work Henrici and Hartzell (8) have fre- 
 quently found hemolytic and non-hemolytic strepto- 
 cocci in dental pulps in cases of "both dental caries 
 and pyorrhea. 
 
 The evidence that streptococci are exciting 
 factors in the etiology of many mouth lesions and 
 that their occurrence in the oral cavity as active 
 foci of infection responsible for many systemic con- 
 ditions has been further established by Hosenow (9), 
 Babcock flO), Lescohier (11), h'ldridge (12), Earl (13), 
 Grieves (14), Potter (15) and others. hosenow, in 
 his extensive studies on elective localization, lays 
 much stress upon the importance of anaerobic cultures 
 in maintaining the elective localization property of 
 the bacteria. 
 
 Eurpoean workers differ from the majority of 
 American investigators as to the exciting cause of 
 pyorrhea alveolaris. Euler (16) believes pyorrhea 
 alveolaris to be a spirochetosis, caused by the 
 "spirocheta pyorrheica” and influenced in some way 
 by Bacillus fusiformis, which is normally present 
 in the mouth, but is not pathogenic UTxless abui'dant. 
 Intensive arsenical ( salvarsan) treatment with 
 proper oral hygiene often produces beneficial re- 
 sults. Dufourmentel and Frisson (17) reported 
 two cases of mouth injuries resulting in a hypertoxic 
 
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 cellulitis of the neck, phlebitis of systemic, cranial and 
 facial veins and a third resulting in a septicemia v7ith 
 no anatomic change. fhey recovered a lor.g anaerobic 
 bacillus, similar to the hacillus bellonenses of Sacque’ 
 pe'e, that produced a fatal edematous septicemia in guinea 
 pigs. They apparently did not meet with hemolytic strep- 
 tococci in these cases. 
 
 Prom a review of the above mentioned literature it 
 is to be noted that no work has been done on the occurrence 
 of hemolytic streptococci about the teeth and gums. 
 
 General Anatomy of feeth and Gums. 
 
 A tooth consists grossly of the corona dent is or 
 crown with its tuberculae or cusps, the colum dentis 
 or neck and the radix dentis or root. (Figure 1) The 
 detailed histology need not be considered here. The 
 roots of the teeth are embedded in the alveoli; to which 
 they are accurately adopted and firmly united by a high- 
 ly vascular layer of connective tissue, the periostium 
 alveoli (27), The periostium alveoli is continuous with 
 the gums and attached to both the root of the tooth and 
 the alveolus. This attachment is so accurate and firm 
 that the tooth is securely bound to the alveolus prevent- 
 ing any separate movement that will cause undue stress 
 and strain upon the nerves and vessels entering the 
 apex. The gingiva, however, is not always in close 
 
approxomation with the root of the tooth, hut forms a free 
 circular fold about the crown. It was from these spaces 
 that the material, to he examined for the presence of 
 hemolytic streptococci was collected. The procedure 
 of collecting this material will he described later. 
 
 The blood supply of the periosteum alveolare is 
 in part from those arteries which subsequently enter 
 the apical foramina of the roots and in part from the 
 gums. The l;^'mph vessels from the gums drain the 
 periosteum alveoli and terminate in the submental, sub- 
 maxillary, buccinator and superior deep cervical glands. 
 Noyes and Dewey, (29) by injecting certain dyes, have 
 quite definitely established the existence of lymphatics 
 in the dental pulp. It is thought that those of the 
 mandibular teeth end in the submaxillary and deep cer- 
 vical glands. Those lymph vessels of the maxillary 
 teeth pass partly by way of the infra-orbital canal 
 to the face, where they join the vessels from the 
 lateral part of the eyelids and terminate in the 
 anterior auricular and submaxillary glands. 
 
 Collection of Material 
 
 Cultures were obtained from 144 dispensary and 
 hospital patients in the following manner. At the time 
 of collecting the material from these patients, the 
 
 presence or absence of pyorrhea, gingivitis, the general 
 
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condition of the teeth, and wherever possible, the clinical 
 diagnosis were noted and recorded (Table 1). 
 
 Wooden applicators (see Figure 2) were sharpened 
 to a fine point and sterilized by means of steam* Five 
 millimeter glass tubing was cut in pieces fourteen centi- 
 meters long and one end sealed* These tubes were then 
 filled half full of ordinary dextrose broth, the wooden 
 applicators inserted and the tubes then sealed with cot- 
 ton plugs* These were then sterilized twice in the 
 autoclave* 
 
 The sharpened end of the wooden applicator was 
 then inserted into the space between the tooth and the 
 free margin of the gums* From here one can, in nearly 
 all cases, obtain a large amount of septic debris which 
 clings to the end of the sharpened point of the applica- 
 tor* The gums were in no case injured in obtaining this 
 material as the fine-pointed end of the wooden applicator 
 was softened by the broth* For this reason it could 
 be inserted quite deeply into this dento -gingival space 
 and is, therefore, considered more practicable than a 
 platinum needle which, when here used, invariably pro- 
 duces pain and bleeding* After the wooden point had 
 been deeply inserted between the gum and tooth it was re- 
 placed in the glass container half filled with nutrient 
 broth and incubated at 37° C. for eighteen hours. Then 
 sub-cultures were made from the broth* 
 

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 Method of Culturing 
 
 Serum hroth and "blood agar plates were inoculated 
 from the initial "broth cultures. Only those colonies 
 with hemolytic zones wore examined and from these the 
 hemolytic streptococci were isolated and studied. 
 
 The growth of hemolytic streptococci in no in- 
 stance was very a"bundant, often there "being only two or 
 three colonies upon the plates where a loopful of the 
 initial "broth (eighteen-hour) culture was made. Thus 
 the cultures differ markedly from those made from 
 material taken from the crypts of tonsils, which in 
 most cases gives an almost pure culture of hemolytic 
 streptococci and often in large num"bars. 
 
 From the 144 patients examined 28 (19,4 per cent) 
 were positive for hemolytic streptococci (Ta"ble 1). In 
 one case two distinctly different strains were o"btained 
 in the same patient - (Ta"ble 2), One strain fermented 
 maruiite and not lactose or salicin, while the other fer- 
 mented lactose "but not maruiite or sa.licin. 
 
 Morphology 
 
 The twenty-eight strains were isolated in pure 
 culture and studied. After the "blood agar plates had 
 "been incu"bated at 37° 0. for twenty-four hours, the 
 colonies of streptococci were removed with a wire loop 
 
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 and iDlood agar slants and tales of serum "broth inoculated. 
 Smears were made from the twenty-four-hour serum "broth 
 cultures and the morphology of the organisms o"bserved. 
 They are round cocci a"bout one micron or less in 
 diameter, arrariged in chain formation and vary slight- 
 ly in size. Often they occur singly. Frequently 
 the cocci appear pressed together, especially in "blood 
 agar cultures, Lance-shaped cocci have "been noted. 
 
 These are smaller than the typical pneumococci and 
 there is not a definite capsule. 
 
 Staining Properties 
 
 All strains stain well with the ordinary dyes 
 and are Gram positive. 
 
 Classification 
 Fermentation Tests 
 
 The twenty-nine strains of hemolytic streptococci 
 ( repressnting twenty-eight positive cases) were classified 
 according to the fermentation reactions advocated "by 
 Holman (18), After inoculating infusion "broth with 
 Bacilli coli, it was then incubated for forty-eight 
 hours, sterilized on tv/o alternate days in the auto- 
 clave and then filterec’ through cotton. To separate 
 
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portions of this sugar-free hroth lactose, maru'iite and 
 salicin were added. This hroth was then tuhed, litmus 
 added and sterilized. Tubes were inoculated with each 
 of the twenty-nine strains of the organisms and one cc 
 of blood serum added to each. The results are record- 
 ed in Table 2 and 3. 
 
 There were seventeen strains of streptococci 
 anginosus. This organism hemolyses blood and ferments 
 lactose, but it does not ferment mannite, salicin and 
 inulin. Holman found this organism prevalent in nose 
 and throat infections, especially in scarlatinal and 
 measles throats. They have also been found in 
 endocarditis; 
 
 Five strains of Streptococcus subacidus were 
 isolated. These are hemolytic but do not ferment any 
 of the carbohydrates mentioned. These, too, are of- 
 ten found in the throat, also in joint and mastoid 
 infections. 
 
 Streptococcus hemolyticus I was present in 
 three cases; This streptococcus gives biolysis and 
 ferments lactose and mannite, but not salicin. It is 
 a comparative rare strain; 
 
 There were two strains of streptococcus pyogenes 
 This organism hemolyses blood and ferments lactose and 
 salicin. This strain of hemolytic streptococcus is also 
 frequently associated with throat infections. It is 
 the common hemolytic streptococcus found in pyogenic 
 condition's where the streptococcus is the exciting 
 
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etiological factor. 
 
 Streptococcus hemolyticus II was not found. 
 
 The Streptococcus hemolyticus III was found in one in- 
 stance; it is a hemolytic streptococcus that ferments 
 only mannite. Holman found it in empyema and in the 
 "blood of pueip)eral sepsis. 
 
 One strain of streptococcus infrequens was 
 found. It is a hemolytic streptococcus that fer- 
 ments lactose, mannite and salicin. This is also a 
 comparatively rare organism and is usually found in 
 throat conditions, Kuediger (19) isolated it from 
 otitis media, pericardial fluid, suppurative adenitis 
 and conjunctivitis ; Holman describes a case of 
 chronic arthritis where this streptococcus was har- 
 bored in the tonsils and after removal of the tonsils 
 the symptoms improved; 
 
 The hemolytic streptococcus equi was not found 
 among the twenty-nine strains; 
 
 Virulence 
 
 Generally the virulence of hemolytic strepto- 
 cocci varies considerably. Passage through animals 
 increases the virulence, while continued growth on 
 artificial media reduces the virulence. The cell 
 substance possesses little toxicity (19). The 
 

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cells yield a streptolysin that hemolyses "blood cells - 
 a true toxin containing a haptophore and a toxophore group 
 which, upon injection, will produce specific antibodies 
 (EO-21). This hemolytic substance, however, is not 
 the dangerous endotoxin of the streptococci. In 1918 
 Clark and i^'elton (23) produced a filterable, non-hemolytic 
 streptococci which would kill rabbits in doses of 0.5cc 
 per 1000 grams of body weight of the rabbit. This work 
 has not been confirmed. 
 
 Eleven rabbits were each injected intravenously 
 with 2cc of t\7enty-f our -hour serum broth cultures of the 
 hemolytic streptococci. These were selected at random. 
 
 Of the eleven strains used, two proved to be fatal. (Table 4). 
 One of the rabbits (ITo. 2) died four days after inoculation. 
 The lung was found hemorrhagic ; otherwise there was no 
 anatomical change. The organisms were not recovered 
 from the body fluids. This was believed to be due to 
 faulty incubation. The second rabbit died ten days after 
 injection of the organisms. There were no s\70llen joints; 
 the lung was hemorrhagic and the organism was recovered from 
 the hearts, blood and bile, but not from any joint, nine 
 of the rabbits remained alive showir^g no ill effects v/ith 
 one exception. Rabbit ITo. 10, which was injected with 
 a strain of streptococcus pyogenes, had distinctly swol- 
 len and painful joints. 
 
 It is to be noted that only two strains were 
 fatal to the rabbits. The pathogenicity of hemolytic 
 
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streptococcus is varialDle for different animals. Battits 
 and mice as a rule are quite susceptible. It is knoTTn, 
 however, that strains of streptococci are being passed 
 through one animal, thus Increasing the virulence, will 
 not be so highly virulent for another species (E3). Some 
 varieties of hemolytic streptococci (those often found in 
 mastitis in cows) may be of low virulence for rabbits, 
 though the organisms themselves are markedly hemolytic 
 (24). Animal tests may not, therefore, be a reliable 
 index of the virulence or pathogenicity for man. . 
 
 Discussion 
 
 It has frequently been shown that hemol^iiic strep- 
 tococci occur in various parts of the body, as upon the 
 tonsils, in the crypts of the tonsils (26), the hairy 
 parts of the bodies of filthy individuals (25), the 
 ethmoid and mastoid cells (4), in carious teeth and 
 apical abscess (7 and 8), the appendix (26) and in 
 various other localities without producing acute clin- 
 ical manifestations. In other words these localities 
 may be considered as frequent habitats for hemolytic 
 streptococci. 
 
 Because of the fact that the gingival space 
 (between the gingivae and the teeth) is anatomically 
 suitable for the collection of debris and because of 
 
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14 . 
 
 the above experimental data, it is reasonable to suppose 
 that the gingival space may occasionally act as a focus 
 of infection. In the 144 cases examined fewer hemolytic 
 streptococci were found about those teeth and gums to 
 which a tooth brush had been recently applied. The 
 majority of the individuals were dispensary and Cook 
 County Hospital patients, most of whome were grossly 
 negligent concemirig oral hygiene. Henrici end 
 Hart z el believe, as was previously mentioned, that the 
 "Mouth” streptococci produce, in metastatic infections 
 and in e^iperimentally inoculated animals, subacute and 
 granulomatous lesions similar to the inflammatory re- 
 actions seen in pyorrhea and chronic apical abscesses. 
 This may account for the fact that the strains of strep- 
 tococci injected into the series of rabbits mentioned 
 did not all prove fatal; It is to be noted that the 
 virulence of the twenty-nine strains of hemolytic strep- 
 tococci recorded here doss not appear to be as high as 
 that of the hemolytic streptococci harbored in the crypts 
 of tonsils, adenoids and upon the pharyngeal mucous mem- 
 brane. The latter are often highly virulent organisms. 
 The possibility of some of the organisms from the crypts 
 of the tonsils or from the pharyngeal mucous membrane 
 becoming disloged and subsequently finding their way 
 to the gingival spaces to reside there merely as tran- 
 sients must, of course, be considered. If this were 
 
 true the decreased virulence might be explained 
 
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15 . 
 
 In the 144 patients examined nineteen or 13.1 per 
 cent showed distinct clinical manifestations of pj^-orrhea. 
 Of these, seven or 36*8 per cent, gave positive cul- 
 tures for hemolytic streptococci (Table 5), Three 
 were of the suhacidus and four were of the anginosus 
 varieties. Many of these individuals had other clin- 
 ical manifestations, and it should be remembered that 
 the majority were hospital cases. 
 
 Because of the great invasive power of the hemo- 
 lytic streptococci it is highly probable that they can 
 penetrate, not only the fibrous gingivae, but the al- 
 veolar periosteum as v/ell. Here they can be taken up 
 by the numerous lymph vessels and thence carried on into 
 the blood stream producing metastatic lesions elsewhere. 
 There is certainly a possibility tha,t from this favorable 
 habitat, in the deep dento- gingival spaces, the various 
 hemolytic streptococci may at times act as secondary and 
 terminal invaders. 
 
 Conclusions 
 
 The method of obtaining material for examination 
 from the gingival spaces, as described, is advantageous 
 because it is a clean, painless procedure and does not 
 cause hemorrhage. 
 
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16 . 
 
 The data presented. show$ that 19.4 per cent of a 
 series of 144 patients gave positive cultures of hemolytic 
 streptococci in material taken from the d.anto -gingival 
 spaces. 
 
 Of those patients with well d.efined. clinical 
 manifestations of pyorrhea 31.1 per cent gave positive 
 cultures of hemolytic streptococci. Of these three 
 strains were of the Streptococci suhacid.us and. four 
 of the Streptococci anginosus groups. 
 
 Hemolytic streptococcus ?/ere found, hetwaan the 
 teeth and. gums in three out of fifteen cases of gingivitis. 
 
 Of the various strains of hemolytic streptococci 
 found, seventeen were streptococcus anginosus, five strep- 
 tococcus suhacid.us, three streptococcus hemolyticus I, 
 two streptococcus pyogenus, one was streptococcus in- 
 frequens and. one was streptococcus hemolyticus III. 
 
 Of eleven strains selected, at random, from 
 twenty-nine strains of hemolytic streptococci isolated 
 from the gingival spaces of patients, two proved to he 
 fatal to rahhits in doses of 2cc of a hroth culture. 
 
 Both were of the. anginosus t3rpe. 
 
 Because of the occurrence of hemolytic strep- 
 tococci in the deep dento -gingival spaces, these spaces 
 may he considered as potentially dangerous foci of 
 infection. 
 
 There is a possibility that those organisms may 
 
 from the above mentioned site act as secondary and 
 
IC-W. 
 
 
 
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 terminal invaders. 
 
 The fact that hemolytic streptococci v/ere found 
 in only a small proportion of the cases of pyorrhea 
 examined and in these not in great numbers indicates that 
 they are not the primary etiological factor in this 
 condition. 
 
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18 . 
 
 Eilliography 
 
 1; Davis and Pilot, -Jour. Inf .Dis . , 1919-24-386. 
 
 2. Davis, D;J., -Jour.Inf .Dis . , 1912-10-148. 
 
 3. Maclay,Otis H., -Laryngoscope, -1919-28-598. 
 
 4. Voight, 'JiC.R., -Jour.Ophth.Otol.Laryngol. , -1917-23-87. 
 
 5. llioliols&Byron, -Jour; A.M.A. , -1918-71-1813. 
 
 6. Davis, D.J;, -Jour. A;M.A;, -1919-72-319. 
 
 7; Hartaell&Herarici, - Jour. Hat .Dent. Asso; , -1917-4-477. 
 
 8. Henrici&Hartzell, -Jour. Dent .Research, -1919-1-419. 
 
 9. Rosonow, ii.G., -Jour. Hat .Dent. Asso. , -1919-3-205. 
 
 10. Bahcock,R.H; , -IT.Y;Med. Jour . , -1916-104-1086. 
 
 11. Lescohniar, A.Y7., -Jour. A;M.A;, -1917-68-414. 
 
 12. Sldridge,I7atson 17, , -Dent .Dig. Chi . , -1919-25-12. 
 
 13. George, Bari, -Lancet, -1919-n.s. 39-78. 
 
 14. Grieves, Clarence J., -Dent, Cos., -1919-61-819. 
 
 15. Potter, Hath. B., -H.Y.Med. Jour . , -1917-105-243. 
 
 16. Euler, Therap. Monatsch., Berlin - 1919-4-133. 
 
 17. Dufourmental & Frisson, Presse.Med. Paris, -1918-26-415. 
 
 18. Holman, -Jour .Med. Research, -1916-34-377, 
 
 19. Ruediger, -Jour .Inf .Dis . , 1906-3-663. 
 
 20; Jordan, Edwin 0. ,-Gen.Bact .IT.B.SaundersCo. ,Phil. ,Pa.-1916- . 
 
 p . 19 2 . 
 
 21; Ruediger, -Jour. A;M;A. , -1903-41-962. 
 
 22. BesreJJia, Ann; de 1' Inst;Past , , -1901-15-r880. 
 
 23; Clark & Felton, Jour. A.M.A;, -1918-71-1048. 
 
 24. Knorr, -Ztsch. fur Hyg;, -1893-13-427. 
 
19 . 
 
 25. Jones, F.S;, -Jour ;l2xp. Med. -1918-28-253. 
 
 26; Schachter, Proc;, Ghi ;Path;Boc ; , -1918-10-301. 
 27; Kraft, A.,- Experimental data to "be pullished. 
 
 28. Cunningham, Text, of Anat., V/m. Wood & Go; 
 
 29. IToyes & Dewey, -Dental Cosmos, -1917-59-436. 
 
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TABLE I 
 
 Incidence of hemolytic streptococci in the gingival space. 
 
 CASE 
 
 HEM 
 
 PYORR 
 
 GIEGIV 
 
 DEET 
 
 BRIDGES , 
 
 
 EO 
 
 STREP 
 
 mA 
 
 IT IS 
 
 CARIES 
 
 GROrmS,ETC 
 
 REMARKS 
 
 1 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 Wire hrace 
 
 B 
 
 
 0 
 
 0 
 
 0 
 
 + 
 
 Tor^sillitis 
 
 3 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 
 4 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 5 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 
 6 
 
 + 
 
 0 
 
 + 
 
 + 
 
 + 
 
 Undergoing dental 
 treatment 
 
 7 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 Chronic rhino- 
 pharyngitis 
 
 8 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Chronic rhinitis 
 
 9 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Chronic rhinitis 
 
 10 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 11 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 2 strains of 
 strep, recovered 
 
 12 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 "Rheumatism” 
 
 13 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 14 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 15 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 16 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 17 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 18 
 
 + 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 19 
 
 + 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 20 
 
 + 
 
 + 
 
 0 
 
 + 
 
 0 
 
 Chronic pha.ryn- 
 gitis 
 
 
 
 
 
 
 
 

 
 i 
 
 [»*■ 
 
 V «■' 
 
 r,. ■ 
 
 K ' 
 
 »< 
 
 r- 
 
 (S 
 
 
 hT 
 
1-2 
 
 CASE 
 
 NO 
 
 HEM 
 
 STREP 
 
 PYORR 
 
 HEA 
 
 GIIIGIV 
 
 ITIS 
 
 DENT 
 
 CiiRIES 
 
 BRIDGES , 
 CROATS, & 
 
 REM/J?ES 
 
 21 
 
 •f 
 
 + 
 
 0 
 
 + 
 
 + 
 
 
 22 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 23 
 
 0 
 
 0 
 
 + 
 
 + 
 
 + 
 
 
 24 
 
 0 
 
 0 
 
 + 
 
 + 
 
 + 
 
 Lower plate 
 Neurasthenia 
 
 25 
 
 + 
 
 0 
 
 + 
 
 + 
 
 + 
 
 Upper plate-arterio- 
 sclerosis 
 
 26 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Tuho tympanal catarrh 
 
 27 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 ■ 28 
 
 0 
 
 + 
 
 0 
 
 + 
 
 0 
 
 Varicose ulcer 
 
 29 
 
 0 
 
 0 
 
 + 
 
 + 
 
 0 
 
 Chronic Septic 
 arthritis 
 
 30 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 31 
 
 + 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Neuritis 
 
 32 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 33 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 34 
 
 0 
 
 0 
 
 0 
 
 -r 
 
 0 
 
 
 35 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 36 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 37 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 38 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 39 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 40 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 41 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 42 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 43 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 
 44 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 45 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Neuritis 
 
 — . » . - 1 ..1 
 

 
 'sim vmic’ .m^ aiko '\, 
 iTxaxr^ <am '■ im ,t 
 
1-3 
 
 CASE 
 
 NO 
 
 HEM 
 
 STREP 
 
 PYORR 
 
 HEA 
 
 GIITGIV 
 
 ITIS 
 
 RENT 
 
 CARIES 
 
 BRIDGES , 
 CROHIIS. & 
 
 RELLIRKS 
 
 46 
 
 0 • 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Pulmonary T, B. 
 
 47 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 Chorea 
 
 48 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Otitis media 
 
 49 
 
 + 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 50 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 51 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 52 
 
 + 
 
 0 
 
 + 
 
 + 
 
 + 
 
 Undergoing dental 
 treatment 
 
 53 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 54 
 
 0 
 
 0 
 
 + 
 
 + 
 
 0 
 
 
 55 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Chronic laryngitis 
 
 56 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Recurrent tonsil- 
 litis 
 
 57 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Gonorrheal vagin- 
 itis 
 
 58 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 59 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Chronic pharyn- 
 gitis 
 
 60 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 61 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Lues ? 
 
 62 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Postoperat. 
 
 adhesions 
 
 63 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Aortitis 
 
 64 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 65 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 66 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 67 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 68 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 69 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 T uh 0 - t ymp anal 
 catarrh 
 
 70 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Pharyngitis 
 
CASE 
 
 NO 
 
 HEM 
 
 STREP 
 
 PYORR 
 
 HEA 
 
 GINGIV 
 
 ITIS 
 
 PENT 
 
 C/iRIES 
 
 BRIDGES. 
 
 CR0\71TS,& 
 
 REMARKS 
 
 71 
 
 0 
 
 0 
 
 + 
 
 + 
 
 4 - 
 
 
 72 
 
 0 
 
 0 
 
 0 
 
 0 
 
 4 
 
 
 73 
 
 0 
 
 0 
 
 0 
 
 0 
 
 4 
 
 
 74 
 
 0 
 
 0 
 
 0 
 
 0 
 
 4 
 
 Undergoing dental 
 treatment 
 
 75 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Undergoing dental 
 treatment 
 
 76 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 77 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 78 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 79 
 
 0 
 
 0 
 
 0 
 
 
 0 
 
 
 80 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 
 81 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 TaBio Pareses 
 
 82 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Multiple sclerosis 
 
 83 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 84 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 85 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 86 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 87 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Struma 
 
 88 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Myocarditis 
 
 89 
 
 0 
 
 0 
 
 + 
 
 + 
 
 + 
 
 Struma 
 
 90 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Arthritis deformani 
 
 91 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 Chronic bronchitis 
 
 92 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Neuritis 
 
 93 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 
 94 
 
 0 
 
 0 
 
 + 
 
 + 
 
 4 
 
 Struma 
 
 95 
 
 0 
 
 + 
 
 0 
 
 + 
 
 4 
 
 
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 afcues: *,8rRC’«-j-, tsiaio siii 
 
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 4 
 
 X- 
 
 Der Qiit'i Qlifs^ 
 
 
 
 flaii;i7C 
 
 J;t4o^’sd otao^HO' 
 nli}lxtr<»Z 
 
 I 
 
 m 
 
 '■I 
 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Q 
 
 -« 
 
 t 
 
 1 
 
 * 
 
 0 
 
 O'’ 
 
 
 0 
 
 0 
 
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 0 
 
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 at 
 
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 0. 
 
 0 ■'*■: 
 
 
 'v 
 
 9T 
 
 '■'^■K - ■ i 
 
 « 
 
 f 
 
 f'= 
 
 .0 * 
 
 0 ■ 
 
 o' J 
 
 , 1 
 
 1^'s- 
 
 
 0 
 
 0 
 
 t 
 
 0 
 
 
 * 
 
 0 
 
 0 
 
 O' ■;:. 
 
 V 
 
 ♦ 
 
 jO 
 
 0 ii 
 
 
 'ee 
 
 • ’*V . " 
 
 0 
 
 0 
 
 0 
 
 w t 
 
 
 0 
 
 0 
 
 O.y 
 
 ae 
 
 " X 
 
 0 ^ 
 
 t» 
 
 0 . 
 
 6 • 
 
 ■ *'*• rf 
 
 as i 
 
 -<L 
 
 ■ ir 
 
 0 . 
 
 0 
 
 0 *.1 
 
 ^t8 
 
 4- 
 
 - "* 
 
 0 
 
 
 0 ■ 
 
 BS 
 
 t 1 
 
 4f 
 
 0-^ 
 
 0.2 
 
 ' 98 1 
 
 
 0 
 
 0 
 
 % 
 
 0 1 
 
 o« ■ 
 
 « 1-ia' 1 
 
 ^ " * - 
 
 
 0 ■ ’ 
 
 0 ‘ 
 
 X9 
 
 eg 
 
 
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 0 
 
 Q 
 
 0 
 
 0 
 
 0 
 
 4 
 
 -Sr • 
 
 ^ Jl 
 
 
 0 
 
 - I 
 
 •J 
 
 
GIITGIV mm BRIDGES, 
 IT IS C.-UilES cRO\ras,& 
 
 RELilARKS 
 
 
 CASE HEM 
 NO STR.EP 
 
 96 
 
 0 
 
 + 
 
 0 
 
 + 
 
 + 
 
 97 
 
 0 
 
 0 
 
 0 
 
 0 
 
 4- 
 
 98 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 99 
 
 * 
 
 0 
 
 0 
 
 0 
 
 0 
 
 100 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 101 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 102 
 
 0 
 
 0 
 
 0 
 
 0 
 
 + 
 
 103 
 
 + 
 
 0 
 
 0 
 
 + 
 
 0 
 
 104 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 105 
 
 0 
 
 0 
 
 0 
 
 
 •f 
 
 106 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 107 
 
 + 
 
 + 
 
 0 
 
 
 0 
 
 108 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 109 
 
 + 
 
 + 
 
 0 
 
 + 
 
 0 
 
 no 
 
 + 
 
 + 
 
 0 
 
 + 
 
 0 
 
 111 
 
 + 
 
 + 
 
 0 
 
 H- 
 
 + 
 
 112 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 113 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 114 
 
 + 
 
 0 
 
 0 
 
 
 0 
 
 115 
 
 + 
 
 0 
 
 0 
 
 0 
 
 + 
 
 116 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 117 
 
 + 
 
 0 
 
 0 
 
 + 
 
 + 
 
 118 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 119 
 
 0 
 
 + 
 
 0 
 
 + 
 
 0 
 
 120 
 
 0 
 
 
 0 
 
 + 
 
 0 
 
 Dental abrasion 
 
 Lower plate 
 

 
 A.SL^iio 8s:mo eifx 
 
 HflO'iX ii&io 
 
 .'.“•;4H m.fS OK T 
 
 
 e^itXq xoVTC^X 
 
 •• 
 
 V 
 
 w 
 
 Ifw — !■... - . — 
 
 0 - 
 
 - 4 
 
 0 
 
 3 
 
 ’ 
 
 
 
 
 
 
 1", 
 
 <4 
 
 
 a 
 
 '>■ 
 
 
 0 
 
 
 0 
 
 
 0- 
 
 0 
 
 0 
 
 0 
 
 ’ 0- V 
 
 8C * 
 
 
 .rj 
 
 0 
 
 ■ 'H 
 
 ■ 
 
 0 
 
 ♦ 
 
 2 
 
 Iji 
 
 
 ♦ 
 
 
 0 
 
 0 
 
 ' t^x 
 
 0 
 
 •»■“ “ 
 
 ■t 
 
 . 0 • ^ 
 
 0 
 
 c 
 
 '^XOI 
 
 # 
 
 
 0 ■ 
 
 0 *•!> 
 
 0 
 
 0 
 
 ■’ «0X ' 
 
 0 
 
 
 
 0 
 
 0 
 
 ♦! 
 
 0 w 
 
 . "i L-"^ 
 
 0 
 
 
 
 0 
 
 1 
 
 0 
 
 
 
 ► 
 
 0 - .V 
 
 a 
 
 \ 
 
 0 
 
 ddX 
 
 
 
 # .' 
 
 0 . 
 
 0> i 
 
 0 
 
 ’^vdb-r 
 
 c 
 
 
 
 0 ,. 
 
 . 1 
 2? 
 
 4- 
 
 iJtOX 
 
 C ■ 
 
 
 • 
 
 ' • * 
 
 0 
 
 0 
 
 s 0 
 
 mi 
 
 c 
 
 
 » 
 
 ♦• ' 
 
 0 
 
 m 
 
 «- 
 
 ^ BOX 
 
 0 
 
 
 #- 
 
 0 
 
 s 
 
 
 Oil 
 
 ♦ 
 
 
 
 0 
 
 • If 
 
 ♦ 
 
 * 
 
 f' -t XXX 
 
 0, 
 
 
 ^5, 1/ 
 
 ' 
 
 1 0 
 
 0 
 
 . 0 
 
 ^Eai:i: 
 
 %£■ 
 
 a 
 
 
 'if 
 
 
 T 
 
 
 ,0 '■ 
 
 0 
 
 -0*4 
 
 til 
 
 '? 
 
 
 0 
 
 0 
 
 * u 
 
 ^IX 
 
 « 
 
 0 
 
 0 
 
 0 
 
 ■ 
 
 SIX 
 
 0 
 
 ' 0 •:■ 
 
 Q 
 
 0 , - 
 
 . i 
 
 an 
 
 
 o,^. 
 
 (# , 
 
 0 
 
 .-. ■'* t.iC ^ 
 
 - 0 
 
 » 
 
 vxx 
 
 
 0 
 
 .. * 
 
 0 
 
 0 
 
 0 
 
 0^" 
 
 0 
 
 
 0 
 
 ♦* 
 
 ✓ 
 
 0 
 
 all 
 
 f 
 
 c 
 
 ♦ 
 
 0 
 
 ♦ 
 
 0 
 
 OSS 
 
 s> 
 
 I 
 
 •-• Ti 
 
1-6 
 
 CASE 
 
 HO 
 
 HEM 
 
 PYORR 
 
 HRA 
 
 GIHOIY 
 
 ms 
 
 RRHT 
 
 CARIES 
 
 BRIDGES , 
 GROWTHS, & 
 
 H2UAEES 
 
 lEl 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 
 122 
 
 + 
 
 + 
 
 0 
 
 + 
 
 0 
 
 
 123 
 
 0 
 
 + 
 
 0 
 
 + 
 
 + 
 
 Undergoing dental 
 treatment 
 
 124 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 
 125 
 
 0 
 
 + 
 
 0 
 
 + 
 
 0 
 
 
 126 
 
 0 
 
 + 
 
 0 
 
 + 
 
 + 
 
 
 127 
 
 0 
 
 0 
 
 0 
 
 + 
 
 + 
 
 Lower plate 
 
 128 
 
 0 
 
 0 
 
 + 
 
 + 
 
 + 
 
 
 129 
 
 0 
 
 0 
 
 0 
 
 -f 
 
 + 
 
 Mitral stenosis 8o 
 regurgitation 
 
 130 
 
 0 
 
 + 
 
 0 
 
 
 0 
 
 Acute catarrhal 
 jaundice 
 
 131 
 
 0 
 
 0 
 
 + 
 
 + 
 
 0 
 
 Carcinoma of 
 Esophagus 
 
 132 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Pulmonary tuber- 
 culosis 
 
 133 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Cardiac decompen- 
 sation 
 
 134 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Auricular fibril- 
 lation 
 
 135 
 
 0 
 
 0 
 
 + 
 
 
 0 
 
 Gastric ulcer 
 
 136 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Hyp emephr oma 
 
 137 
 
 + 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Gastric ulcer 
 
 138 
 
 0 
 
 0 
 
 0 
 
 + 
 
 0 
 
 Pulmonary tuber- 
 culosis 
 
 139 
 
 + 
 
 0 
 
 + 
 
 0 
 
 0 
 
 Gonorrheal arthri- 
 tis 
 
 140 
 
 0 
 
 0 
 
 0 
 
 0 
 
 0 
 
 Hydro-pneumo-thoras 
 
 141 
 
 0 
 
 0 
 
 + 
 
 + 
 
 + 
 
 
 142 
 
 0 
 
 + 
 
 0 
 
 + 
 
 0 
 
 Chronic nephritis 
 

 
 aTM, V'IO W 
 
 saiLO 
 
 ASM . OH 
 
 
 ”„t?^ r< 
 
 .' €ji>CT34*al* 
 
 -■ 
 
 
 tt u UJC<? J 
 
 I eSeo^b^M Lsn^ttK 
 
 *0 /icAoafj'cftO' 
 staoIXTO 
 
 -rro ^ocei^ 
 
 ttoi:>j8T2 
 • £ittJ|5- -si^rXrsii'jLai 
 S02 .tci 
 iso/y oi^jfaa-? 
 
 AJirci xri;q» ma ^S 
 
 •reoXj? Ql*^t:e»s 
 
 dl80i</0 
 -Yri4'*ia IstBifvxomif 
 «i!# 
 
 : - 0<J**D Oflij- - o\i 
 
 J 
 
 ♦ 
 
 >♦■ 
 
 p 
 
 ^ 0, 
 
 0 
 
 XSI 
 
 0 
 
 
 0 
 
 'i 
 
 * 
 
 isi* 
 
 W , 
 
 
 ♦ 
 
 0 
 
 •v'*? n.”’ 
 
 0 
 
 iVj 
 
 0 
 
 0 
 
 0 
 
 ,0 j 
 
 0 1 
 
 w 
 
 0 
 
 ■i'-" 
 
 e 
 
 m ^ 
 
 
 i,»i. > 
 
 H&t 
 
 
 i4n 
 
 0 
 
 ■ :i 
 
 Q 
 
 d&i 
 
 1 % 
 
 ,vv 
 
 
 '•4l 
 
 y» * 
 
 • 
 
 V- 
 
 0 
 
 0 
 
 0 
 
 7!tC 
 
 1 
 
 4 
 
 
 iM 
 
 0 , 
 
 jm . 
 
 
 ♦ 
 
 # * 
 
 ♦ 
 
 0 " 
 
 ‘eax 
 
 br' 
 
 
 r -..iT '*n» 
 
 u 
 
 0 
 
 0 
 
 0 
 
 i»'; 
 
 0 
 
 0 
 
 o 
 
 0 
 
 0 
 
 Q 
 
 0 
 
 •*' 
 
 c 
 
 •IP. 
 
 0‘ 
 
 J 
 
 0 
 
 :>i 
 
 
 •«SX 
 a- 0 
 
 le#" 
 
 
 + 
 
 .rP 
 
 • 6.. 
 
 i 0 
 
 
 
 
 1 
 
 
 ' G 
 
 
 
 0 ' 
 
 0 
 
 & 
 
 " 0 
 
 
 ■■-*■, 
 
 • 
 
 0 
 
 0 
 
 4^ 0 
 
 
 ’f*' 
 
 t 
 
 * 
 
 j -sr • 
 
 0 
 
 , • t 
 
 '■I^' 0 1 
 
 dSX' 
 ^ a 
 
 ^iL’i 
 
 0 
 
 ij 
 
 0 
 
 
 dSI 
 
 g J 
 
 0 
 
 0 
 
 0 
 
 7BI 
 
 : 41 
 
 
 
 
 -1 
 
 
 i 
 
 ♦ 
 
 O' 
 
 0 
 
 
 
 
 0 
 
 ■ 
 
 0 
 
 I ♦ 
 
 ♦ . 
 
 o ' |j 
 
 0 
 
 o 
 
 0 
 
 0 
 
 d 
 
CASE mu PYORR GIIIGIV lEiTT BRIlXtES, 
 EO STREP HEA IT IS CARIES GROWTHS, & 
 
 143 
 
 0 
 
 0 
 
 0 
 
 144 0 
 
 0 
 
 0 
 
 TOTAL 
 
 28 
 
 19 
 
 15 
 
 91 
 
 74 
 
 or 
 
 or 
 
 or 
 
 or 
 
 or 
 
 19.4 
 
 13;1 
 
 10 ;4 
 
 63.1 
 
 51 
 
 per 
 
 per 
 
 per 
 
 per 
 
 per 
 
 cent 
 
 cent 
 
 cent 
 
 cent 
 
 cent 
 
 RELIARKS 
 
 Carcinoma of stomac 
 
 Lethargic ence- 
 phalitis 
 
 Total 
 
TABLE II 
 
 Glass if ic ati on of Hemolytic S trept ococci 
 
 (Holman) 
 
 CASE 
 
 NO 
 
 LACTOSE 
 
 immiTE 
 
 SilLICIN 
 
 Vj\RISTY 
 
 2 
 
 + 
 
 0 
 
 0 
 
 Str. anginosns 
 
 6 
 
 0 
 
 0 
 
 0 
 
 Str. suLacidus 
 
 7 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 11 
 
 0 
 
 + 
 
 0 
 
 Str. hemolyticiis 11 
 
 IIB 
 
 + 
 
 0 
 
 0 
 
 Str, anginosus 
 
 18 
 
 + 
 
 0 
 
 0 
 
 IT 
 
 19 
 
 + 
 
 0 
 
 0 
 
 n 
 
 20 
 
 0 
 
 0 
 
 0 
 
 Str, subacidus 
 
 21 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 25 
 
 + 
 
 0 
 
 0 
 
 Str. ” 
 
 27 
 
 + 
 
 0 
 
 0 
 
 Str. 
 
 31 
 
 + 
 
 0 
 
 0 
 
 Tl 
 
 49 
 
 + 
 
 0 
 
 + 
 
 Str. pyogenes 
 
 52 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 56 
 
 + 
 
 0 
 
 + 
 
 Str. pyogenes 
 
 99 
 
 0 
 
 0 
 
 0 
 
 Str. subacidus 
 
 103 
 
 + 
 
 + 
 
 0 
 
 Str. hemolyticus I 
 
 107 
 
 0 
 
 0 
 
 0 
 
 Str. subacidus 
 
 109 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 

 
 
 . ■*‘•1 -. 
 
 " ■'.•I,; ,,| 
 
 ■f\ ■-• 
 
 «Y5#^X^ Vt 
 v^. -Si,' 
 
 tU : 
 
 V I ii ' * 1 
 
 ■j?' sppl»^^ - 0 
 
 ^ . _■ y. 
 
 k ' 
 
 UUt'^ViC.T 
 
 f , 
 
 
 9 
 
TT-2 
 
 C/iSE 
 
 NO 
 
 LACTOSE 
 
 MKITE 
 
 S.\LICIII 
 
 VARIETY 
 
 110 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 111 
 
 + 
 
 0 
 
 0 
 
 TT 
 
 114 
 
 + 
 
 0 
 
 0 
 
 TT 
 
 115 
 
 + 
 
 + 
 
 0 
 
 Str. hemolyticus I 
 
 116 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 117 
 
 + 
 
 0 
 
 0 
 
 Tt 
 
 122 
 
 0 
 
 0 
 
 0 
 
 Str. suLacidus 
 
 136 
 
 + 
 
 0 
 
 0 
 
 Str. anginosus 
 
 137 
 
 + 
 
 + 
 
 0 
 
 Str. hemolyticus I 
 
 139 
 
 + 
 
 + 
 
 + 
 
 Str. infrequens 
 
4 
 
 V. 1 
 
 t 
 
 
 
 '*• f >ii.' 
 
 ■WS 
 
 
 ■■■ ft . ,\ 
 
 I 
 
 %i 
 
 r-. '.i , ' 
 
 , =J 'V. .■ . *•■' 
 '■>< ' . _ 
 
 • * 
 
 ■ ^ ■* '* 
 
 ♦• "* 
 
 r-F ' - 
 
 I? ^ <1^ < k ''!>** 
 
 ^ ,-r 
 
 ‘Wi 
 
 t 
 
 /j ■ 
 ir\^ - ■ 
 
 •.©•' 
 
 y. *■ 
 
 Vb- 
 
 rf 
 
 •TV 
 
 h 
 
 
 0 
 
 ^-4'> .t . 
 
 0 
 
 
 
TABLE III 
 
 ® ies of H emol yt ic St r ept ococci 
 
 Variety of Humber of 
 
 Hemolytic Streptococci Strains Per Cent 
 
 Streptococci Anginosus 
 
 17 
 
 5B.6 
 
 Streptococci Subacidus 
 
 5 
 
 17. E 
 
 Streptococci Hemolyticus I 
 
 3 
 
 10.3 
 
 Streptococci Pyogenes 
 
 E 
 
 6.8 
 
 Streptococci Hemolyticus III 
 
 1 
 
 3.4 
 
 Streptococci Infrequens 
 
 1 
 
 3.4 
 
 Streptococci Hemolyticus II 
 
 0 
 
 0 
 
 Streptococci Equi 
 
 0 
 
 0 
 
^-ndtmSz 
 
 
 
 
 
 
 *■ ■ ■% 
 
 -ST——**'* — *Hsrr- ■ 
 
 jr p 
 
 "'I 
 
 ' *. r ■ 
 
 *1V . ^ 
 
 C 
 
 ►’.a 
 
 A,.-; 
 
 H"s» • * 
 
 
 :t.ajp 
 
 At 
 
 f . ?■ ?«Liyi:'%'r 
 
 -f*|L(*lfV 
 
 SilW'l 
 
 •• . •- :■ .^rfSK --..^M 
 
 >'. '.'2-.a 
 
 
 
 r. 
 
 j 
 
 c 
 
 M' 
 
 ja 
 
 >JiKVt»:£^ 
 
 ra 
 
 « wEi 
 
 «-— ‘ ■ ^1 
 
 E Vp. 
 
 ■' ., W* 
 
 ' ■I .a: 
 
 M ■ ■' '■ 
 
 U 
 
 [pits 
 
 ijiti 
 
 iu 
 
 % 
 
 m- 
 
 
TABIE IV 
 
 Virulence of gingival hemolytic streptococci for Rabbits 
 
 Rabbit 
 
 No 
 
 Strain 
 
 Variety of Clinical 
 
 Streptococci Manifestations 
 
 Animal 
 
 Inoculation 
 
 1 
 
 52 
 
 Str. anginosus 
 
 - 
 
 Multiple 
 
 arthritis 
 
 2 
 
 19 
 
 TT 
 
 
 head 14 days 
 (cause unde- 
 ( termined) 
 
 3 
 
 27 
 
 tl 
 
 
 Multiple 
 
 arthritis 
 
 4 
 
 114 
 
 TT 
 
 gonorrheal 
 
 arthritis 
 
 head 10 days 
 (Strep. Sep- 
 ( ticemia) 
 
 5 
 
 49 
 
 Str. pyogenes 
 
 - 
 
 ho symptoms 
 
 6 
 
 20 
 
 Str. subacidus 
 
 pyorrhea- 
 
 pharyngitis 
 
 n n 
 
 7 
 
 139 
 
 Str. infrequens 
 
 - 
 
 TT TT 
 
 8 
 
 18 
 
 Str. anginosus 
 
 - 
 
 TT TT 
 
 9 
 
 21 
 
 tt 
 
 pyorrhea 
 
 TT n 
 
 10 
 
 56 
 
 Str. pyogenes 
 
 tonsillitis 
 
 Arthritis 
 
 11 
 
 107 
 
 Str. subacidus 
 
 pyorrhea 
 
 ho symptoms 
 
■'•mi ' 
 
 
 
 aoMii i''/t>o-aI 
 
 - f./ >X*I.U5 : to MttWrif lv '[ 
 
 af?oi,j£;f 33%XDi‘H ' ;:a ' . > . 
 
 .4-tA 
 
 ,.,5 >’'X *1^ 
 
 via. t<iX!&c) 
 il'- T alsf'^3^ ) 
 ^•.vj.U IffZ 
 t ' ^: *f ' i-ii* 
 
 .■r?>' ) 
 
 L?^ir<x:a^a da; 
 
TABLE V 
 
 
 Hemolytic 
 
 streptococci in Pyorrhea Cases . 
 
 CASE 
 
 HEM 
 
 VARIETY OP 
 
 OTHER CL III I CAL 
 
 no 
 
 STEEP 
 
 HEM. STREP. 
 
 MNIPESTATIONS 
 
 20 
 
 + 
 
 Str. subacidus 
 
 Chronic pharyngitis 
 
 21 
 
 + 
 
 Str. anginosus 
 
 - 
 
 2B 
 
 0 
 
 - 
 
 Varicose ulcer 
 
 95 
 
 0 
 
 
 - 
 
 96 
 
 0 
 
 - 
 
 - 
 
 107 
 
 + 
 
 Str. subacidus 
 
 - 
 
 109 
 
 + 
 
 Str. anginosus 
 
 - 
 
 110 
 
 
 TT 
 
 - 
 
 111 
 
 + 
 
 TT 
 
 - 
 
 119 
 
 0 
 
 - 
 
 - 
 
 120 
 
 0 
 
 - 
 
 - 
 
 122 
 
 + 
 
 Str. subacidus 
 
 - 
 
 123 
 
 0 
 
 - 
 
 - 
 
 125 
 
 0 
 
 - 
 
 - 
 
 126 
 
 0 
 
 - 
 
 - 
 
 130 
 
 0 
 
 - 
 
 Catarrhal jaundice 
 
 142 
 
 0 
 
 - 
 
 Chronic nephritis 
 
 143 
 
 0 
 
 - 
 
 Carcinoma of stomach 
 
 144 
 
 0 
 
 - 
 
 Lethargic encephalitis 
 
a^rsr-JWreaa 
 
 W . 
 
 , ul 'c>U :y, X<;h^ 
 
 Hi 
 
 iv 
 
 • «4*** 
 
 % ■ ,, J.’. ^ijiirv.; I'ijCl*'!’-- 
 
 .ufiSffi 
 
 
 *!5r -".T ■ 
 
 
 
 ■■ - ., 
 
 
 
 
 
 
 
 _ •• ^S 
 
 i:' i) ' tr 
 
 V 
 
 la ‘-uiaaV* ’■'. 
 
 
 , -"■ 
 
 - 
 
 
 
 - 
 
 •' « 
 
 * : VC ^ 
 
 'C- 
 
 
 • - v3**^ 
 
 tJ-' 
 
 - 
 
 ;^;'i,t*.cULrt .'iJ'i. a" 
 
 \ 
 
 
 
 
 " ■'■■ •■' -^.e' /■ 
 
 
 
 r* ■> Ik » 
 
 
 
 
 
 <«• 
 
 
 
 
 ' . •'■*.». 4< » .xfe 
 
 
 
 
 
 
 Ni?4|.-:;'’ 
 
 
 - , nk. 
 
 ■ "• *■ , ‘tJ 
 
 
 - ^ 
 
 ‘>i.A ' ^ 
 
 VijtU^jRifrrli -> ■ 
 
 
 
 
 > ■ -■ 
 
 t 
 
 4T< 
 
 V . 
 
 i-<i>fc 
 
 * 
 
 - ** 
 
 #■ 
 
 (??'•' 
 
 «? 
 
 ? c i' tftc^ ^ r < , 1 ' *' *t t-4 tL It 
 
 
 ii .t i T/ 5*1 oi <a<^^ 
 
 lyctjf.f (a**jt ^ 
 
 ■ •0T 
 
 -^ ' * 
 
 A ' 
 
 . -V. ’,; ^ 
 
 ‘0^ 
 
 A 
 
 ...J 
 
 ■iK- 
 
 
 Si < 
 
 A 
 

 Per/o^team (^/veo/^re-~^ 
 
 £0/7 
 
 ■~I?Gr7t^J Pu/p 
 
 ~~y e<3se/>s ^/?c/ Perves 
 
 Figure 1- Gross Anatomy of Tooth S Gums 
 
Figure 2- Showing tube of Serum broth containing .-ih£rpened 
 
 wooden applicator. 
 
V 
 
Cot 1 0/7 plug 
 
 -Appt/'cgtor 
 
 -iBrot/? 
 
 Se<5>/ec/ er?c/ of tube 
 

 
 
 ' J'-' : 
 
 
 s 
 
 
 Y' • 
 
 
 
 
 *■ ;f. 
 
 ' ♦' 
 
 f 
 
 ) i 
 
 . ■-- ,v . 
 
 V ■ . 
 
 > ’^c . 
 
 ,w. - ■• 
 
Figure 3 
 
 Method of obtaining material from gingival space. 
 
f 
 
 Til 
 
 
 
 j'io I'j .50iiwC2; - ■ ^ 
 
 o'u/gjt'a 
 
/^et/?oc/ o 6^(^//7)/7^ /77o>ter/c?/ 
 
 ro/77 
 
 cSpc9ce