STREPTOCOCCAL INFECTIONS 



relevance to the pathology and control of rheumatic fever, 

 we may submit the following : 



In children of appropriate genetic constitution suffering 

 streptococcal infection of appropriate type and intensity, the 

 internal environment of the lymphoid accumulations around 

 the pharynx is modified. Amongst the thousands of clones 

 represented, some mutation to a forbidden pattern occurs, 

 the antigenic determinants in question being present in the 

 inflamed region. In the absence of normal homeostasis the 

 forbidden clones flourish along with other antibody-pro- 

 ducing clones of normal type. It is probable that there is 

 only a limited breakdown of control in some way dependent 

 on the nature of the streptococcus since by no means every 

 type of forbidden pattern is produced. The 'forbidden' cells 

 gradually overflow into blood and body fluids and find 

 regions where they can interact with the corresponding 

 antigenic determinants {XT). One would postulate that the 

 lymphocytic and inflammatory accumulations characteristic 

 of the rheumatic process will arise where the carrier of the 

 XT determinants is to some extent accessible and can be 

 made more accessible or produced as a result of inflammatory 

 action. In this way one can conceive of contact of forbidden 

 cell with Z resulting in damage to the ceH and to immediately 

 adjacent tissue, resulting in greater liberation of X and in- 

 creased opportunity for entry of forbidden cells into the 

 region. The result will be the rapid build-up by 'vicious 

 circle ' principles of areas of acute inflammation. 



With the waning of the streptococcal infection one would 

 postulate a gradual reorganization of the missing control, 

 with the elimination or inactivation of the forbidden clones 

 and a break in the local vicious circle. 



Acute nephritis might be accounted for in similar fashion 

 but it should be noted that it is exceptionally rare for one 

 streptococcal pharyngitis to initiate both rheumatic fever and 

 acute glomerulonephritis. The implication is obvious that 

 the forbidden clone which can emerge depends very much 



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