ACUTE ARTICULAR RHEUMATISM 219 



followed by gradually appearing and progressing 

 paralyses. It may be sporadic or appear in epidemics. 

 The infective agent and its mode of transmission are 

 not known. It probably enters by the nose and 

 throat. The virus is present in the blood, lymph 

 glands, and especially in the central nervous system. 

 It is so small that it will pass through porcelain filters 

 such as are used for water purification. The disease 

 may be reproduced in monkeys by injecting this virus 

 by almost any route and it is strictly comparable to 

 that seen in human beings. It is not known how 

 the virus leaves the body. There is as yet no reliable 

 specific treatment. The only laboratory test consists 

 in finding an excess of clear cerebrospinal fluid in 

 which there is a slight excess of a certain organic sub- 

 stance called globulin and a very small number of cells. 



Mumps. This is an acute inflammatory infectious 

 disease of the salivary glands, the cause of which is 

 not known. It is disseminated by direct contact, and 

 the virus is in the saliva. 



Acute Articular Rheumatism. The modern concep- 

 tion of this disease is that it is an acute infection. 

 Many bacteria have been described as its cause,^ but 

 their defenders have not built up unanswerable argu- 

 ments in their support. The theory now holding 

 the stage is that a streptococcus called Streptococcus 

 rheumaticus enters by the tonsils, penetrates to the 

 blood stream, and settles in the joints. Certain it is 

 that we frequently have streptococcus sore throat 

 associated with acute rheumatism, and that the 

 inflammations of the heart lining after this disease 

 are frequently streptococcal. 



