Etiology. 805 



all the external influences which cause chills and colds may be 

 considered as causes. Consequently the illness is observed 

 most frequently in the spring and autumn. 



Cows may fall ill with symptoms of articular rheumatism 

 a short tmie, 5 or 6 days, after calving. The disease occurs 

 especially after calving or after the retention of the afterbirth. 



The course of articular rheumatism and its close connec- 

 tion with various diseases which at present are known to be 

 decidedly infectious (endocarditis, sero-fibrinous inflammation 

 of the serous membranes) seem to point to the fact that the 

 actual cause of joint rheumatism is some infection. In ad- 

 dition, it must be mentioned, that in connection with infectious 

 diseases of certain organs (uterus, udder, and so on) an in- 

 flammation arises clinically, corresponding A\ith articular rheu- 

 matism, concerning the infectious source of which there can 

 be no doubt. 



The view that articular rheumatism is an infectious disease re- 

 ceives still more support from the recent bacteriological investigations 

 on sick persons (Guttman, Petron, Buday) which repeatedly gave posi- 

 tive results, and according to which the pus producing microorgan- 

 isms, especially streptococci, play an important role in the production 

 of articular rheumatism. Wassermann and Meyer express the same 

 view, while von Striimpell found staphylococci as well, and Thiroloix & 

 Rosenthal attributed the disease to the bac. perfringens var. rheuma- 

 tismi._ Considering the great similarity of the symptoms in animals to 

 the disease in man bearing the same name, there can now scarcely be a 

 doubt but that joint rheumatism of man is also caused by an infection. 



In man articular rheumatism is usually preceded by catarrh of the pharynx. 

 Meyer cultivated streptococci from the tonsils of persons suffering from articular 

 rheumatism, and with their cultures he succeeded in producing not only a sero- 

 hemorrhagic inflanimation of the joints, but also an inflammation of certain serous 

 membranes, and in some cases even a verrucous endocarditis. Giirich expressed it as 

 his opinion that a connection between articular rheumatism and angina can no longer 

 be disputed. ^ 



Lenhartz indeed claims that in man he has always found the exudate in diseased 

 joints free from bacteria and considers those cases where streptococci are found in 

 the joints as not belonging to the category of articular rheumatism. But the negative 

 findings of Lenhartz do not argue against the infectious nature of articular rheuma- 

 tism, since bacteria growing in any internal organ can exert an inflammatory effect 

 m the joints through toxins circulating in the blood stream, or it may be that the 

 bacteria imprisoned in the articular cavities disappear soon after the onset of in- 

 flammation. 



The results of investigations in man, further the observation that cows fall ill 

 with symptoms similar to articular rheumatism a short time after parturition, after 

 an abortion, or if the afterbirth is retained, support the view that articular rheuma- 

 tism in animals is, in most cases, if not in all, a secondary disease, in such manner 

 that the infectious material itself or its toxins reach the joints from any, even 

 slightly diseased, organ by way of the blood stream, possibly with the stimulation of 

 predisposing causes, and set up an inflammatory process therein. This view is 

 strengthened all the more by a case of typical articular rheumatism which was recently 

 observed by Knabe and which had developed in association with a pharyngitis. There 

 is therefore no ground for separating diseases similar to articular rheumatism from 

 this disease in so far as they do not represent the partial symptoms of specific infec- 

 tious disease. Such affections are inflammation of joints, arising bv metastasis after 

 parturition, in connection with a mastitis, or with other internal disease. Yet many 

 authors (Hess, Guillebeau, Ehrhardt. Strebcl, Moussu, Loblanc & Bitard and others) 

 still deem such a separation necessary. It would not have a proper basis even if it 



