BACTERIA IN INFECTIOUS DISEASES. 611 



affected joints, the fibrinous exudate upon the pericardium, the endo- 

 cardial vegetations, and the swollen bronchial glands. It is evident 

 that in this case there was a general infection, and it seems probable 

 that the joint inflammation was due to the same microorganism as 

 that of the other tissues involved in the infectious process. It is pos- 

 sible, however, that the so-called complications of acute rheumatism 

 result from a mixed infection. Saint-Germain (1893), in inoculation 

 experiments made with attenuated cultures of staphylococci into the 

 circulation in young animals, was able to produce joint inflamma- 

 tions with effusion of serum into the joint cavity, but this serum 

 proved to be sterile. In cases of subacute or chronic articular rheu- 

 matism Bouchard and Charrin report (1891) that they have fre- 

 quently obtained cultures of Staphylococcus pyogenes albus from fluid 

 drawn from the affected joints. Sacaze (1894) calls attention to the 

 fact that acute rheumatism is sometimes preceded by a lesion through 

 which general infection may have occurred, and he records a case fol- 

 lowing a suppurating wound, from the pus of which Staphylococcus 

 pyogenes albus was obtained in pure culture, also several cases occur- 

 ring in individuals with hypertrophy of the tonsils, in which he 

 supposes that this was the channel of infection. 



If, as appears probable, acute rheumatism is due to infection by 

 the ordinary pus cocci, we may suppose that this occurs in conse- 

 quence of a loss of the natural immunity which in a normal condi- 

 tion of health protects man from invasion by these micrococci, which 

 are constantly present (especially Staphylococcus pyogenes albus) 

 upon the surface of the body and of mucous membranes. In the 

 writer's work on " Immunity, Protective Inoculations, and Serum- 

 Therapy " (1895) the following conclusion is reached with reference 

 to the explanation of natural immunity : 



" The experimental evidence submitted considered in connection 

 with the extensive literature relating to "phagocytosis," leads us to 

 the conclusion that natural immunity is due to a germicidal sub- 

 stance present in the blood serum which has its origin (chiefly at 

 least) in the leucocytes and is soluble only in an alkaline medium." 

 Now, in acute rheumatism there is an excess of acid in the system, 

 and it seems quite probable that, as a result of this, the natural im- 

 munity against infection by these micrococci is neutralized. 



RHINITIS FIBRINOSA. 



In a considerable number of cases of fibrinous rhinitis, reported by vari- 

 ous authors, the Klebs-Lb'ffler diphtheria bacillus has been demonstrated to 

 be present Baginsky, Park, Abbott, Stamm, Concetti, Gerber, and Podack 

 (1895), and others. V ery curiously the diphtheritic process, as a rule, does 

 not extend to the fauces, and the disease runs a favorable course, although 

 virulent diphtheria bacilli may be obtained from the fibrinous exudate. 



