ACUTE RHEUMATISM 229 



usually clots milk after incubation for two days ; on blood agar 

 it alters the haemoglobin to a brownish colour. Its growth on 

 media generally is more luxuriant than that of the strepto- 

 coccus, and it grows well on gelatin at 20 'C. Injection 

 of pure cultures in rabbits often produces polyarthritis and 

 synovitis, valvulitis and pericarditis, without any suppurative 

 change lesions which are not produced by the ordinary 

 streptococci (Beattie). In one or two instances choreiform 

 movements have been observed after injection. The organism 

 is most easily obtained from the substance of inflamed synovial 

 membrane where it is invading the tissues ; a part where there 

 is special congestion should be selected as being most likely to 

 give positive results. It is only occasionally to be obtained 

 from the fluid in joints. It has also been cultivated from the 

 blood in rheumatic fever, from the vegetations on the heart 

 valves, and from other acute lesions ; in many cases, however, 

 cultures from the blood give negative results. Beattie in a 

 recent paper has shown that in rabbits the arthritis produced 

 reproduces the main features of acute or subacute rheumatism 

 in man, namely, the rapidity with which the affection passes from 

 joint to joint, the tendency to relapses, the contributory effects 

 of exposure to cold, and the absence of gross anatomical changes 

 in the joints. Poynton and Paine cultivated the streptococcus 

 from the cerebro-spinal fluid in three cases where chorea was 

 present, and also detected it in the membranes of the brain. 

 They consider that this disease is probably of the nature of a 

 slight meningo-myelitis produced by the organism. The facts 

 already accumulated speak strongly in favour of this organism 

 being causally related to rheumatic fever, though this cannot 

 be considered completely proved. Andrewes finds that the 

 organism has the same cultural characters and fermentative 

 effects as the streptococcus fsecalis, a common inhabitant of the 

 intestine. Even, however, if the two organisms were the same, 

 it might well be possible that rheumatic fever is due to an 

 infection of the tissues by this variety of streptococcus. The 

 clinical data, in fact, rather point to rheumatic fever being 

 due to an infection by some organism frequently present in the 

 body, brought about by some state of predisposition or acquired 

 susceptibility. Beattie and Yates have recently brought forward 

 important evidence to show that the joints do not become infected 

 post mortem with the streptococci of the alimentary canal as a 

 terminal phenomenon, and that accordingly the finding of the 

 micrococcus rheumaticus in the joints has an important etio- 

 logical significance. 



