STUDIES IN CHRONIC ARTHRITIS AND CHOREA 513 



always found, and it has not been determined that the disease 

 is produced by the inoculation of the streptococcus or its toxins. 

 Further work on this subject is now under way. 



The literature of this subject is not satisfactory on account of 

 the variations of classification. Very little bacteriologic work has 

 been done on this type. D. J. Davis (1913) found that in this 

 class of case streptococci could rarely be demonstrated excepting 

 at autopsy, but he did occasionally obtain this organism from the 

 regional lymph glands. E. C. Rosenow (1914) found that by 

 making cultures directly from the glands draining the inflamed 

 joints in 54 cases there could be isolated 



Cases 



Modified Streptococcus viridans 32 



Staphylococcus 5 



Bact. mucosum 3 



Neisseria catarrhalis 1 



Gonococcus 1 



Moon and Edwards (1917) in 83 cases of chronic arthritis took 

 blood cultures using the technique described by Rosenow and 

 obtained 



Cases 



Negative cultures 58 



Non-hemolytic streptococcus 18 



Bact. mucosum 3 



Diphtheroid bacillus 3 



Unidentified 1 



In acute rheumatic fever much work with not at all uniform 

 results has been done, notably by Poynton and Paine (1913), 

 Beattie and Yates (1912-13), R. I. Cole (1914), H. K. Faber 

 (1915), Swift and Kinsella (1917), E. C. Rosenow (1914), Moon 

 and Edwards (1917) and others. It is difficult to determine 

 what types of cases have been included in these studies. Very 

 frequently cases of typical chronic deforming arthritis at the out- 

 set present the picture of acute rheumatic fever; and acute rheu- 

 matic fever may extend for months with a low grade fever relapsing 

 into a severe type for a few hours or days at each new focal ex- 

 tension, and terminating either in death, complete recovery, or 

 recovery with damaged tissues and a tendency to relapse. On 

 account of the frequency of these border line cases, the blood 



