512 J. H. RICHARDS 



Associated with bacteria in origin 



a. Acute rheumatic fever 



b. Acute suppurative arthritis, e.g., acute pyogenic joint 



infection. 



c. Chronic suppurative arthritis, e.g, tuberculosis of joint. 



d. Acute non-suppurative arthritis, e.g., that acute exacerba- 



tion which occurs frequently during the course of a chronic 

 non-suppurative arthritis. These attacks are usually mildly 

 febrile, and present a local picture not unlike that of acute 

 rheumatic fever. The joint involved may be one previously 

 diseased, or may be a newly involved one. 



e. Chronic non-suppurative arthritis 



1. Syphilitic. This condition is much more common than is 

 recognized and is frequently found complicating other 

 types 



2. A type of arthritis probably not representing a disease 



entity, but rather a group of diseases which have been 

 variously termed: 



Arthritis deformans, Virchow 

 Rheumatoid arthritis, Garrod 

 Osteo arthritis, Garrod 

 Rheumatic gout, Fuller 

 Chronic rheumatic arthritis, Adams 

 Nodosity of the joints, Haygarth, etc. 

 The dominant features of this type are the tendency to in- 

 volve many joints especially the smaller ones, the disposi- 

 tion to the destruction of the articular and periarticular 

 tissues resulting in exostoses and ankylosis, and the usual 

 progressive chronicity of the disease. 



It is this latter type that was selected for this study. It re- 

 mains for investigators to determine by etiologic studies whether 

 this type represents a chronic form of acute rheumatic fever, or 

 whether in this type there is included a group of diseases. Also 

 if a constant bacterium is found associated with the disease, it 

 must be determined whether the arthritis is the result of the 

 activity of the bacteria themselves in the articular or periar- 

 ticular tissues, or the result of toxines elaborated by these bac- 

 teria in some remote focus. This work makes no pretense of 

 clearing up these questions, for the streptococcus studied is not 



