ACUTE RHEUMATISM 221 



medium ought to be distinctly acid. In such a medium after 

 three or four days' incubation at 37° C. small whitish colonies 

 appear, which when examined under a low magnification are 

 seen to have a lenticulate shape. The organism shows con- 

 siderable jJeomorphism, — coccoid, diphtheroid, and filamentous 

 types being present, as 

 'well as irregular bizarre 



forms. Some observers * ' v 



have also obtained sur- _ \ J 



face growth on ordinary «^ » f <" 

 agar, especially after the K^ 



organism has been culti- j f. \. i\ •*?? ".-*» 



vated for some, time under ''w^jk ..Jfe «*Br" '* "^ 

 anaerobic conditions. Its i . * 

 relation to the suppura- ; \ » 

 tion in acne has been a .'"• '%£ 

 matter of dispute, some 

 holding that it is the cause '\: • ' v ,. 

 of the suppuration, whilst 

 others maintain that this 

 is due to pyogenic cocci. : . ■ /„ '' 



There seems, however, to .„ „., x . , 



V> Tttl A K+ +1, \\, — preparation of conjunctival 



be little doubt tnat tne secretion, showing the Morax diplo-bacillus 

 bacillus is sometimes pre- of conjunctivitis. xlOOO. 

 sent alone. 



Acute Rheumatism-. — There are many facts which point to 

 the infective nature of this disease, and investigations from this 

 point of view have yielded important results. Of the organisms 

 isolated, the one which appears to have strongest claims is a 

 small coccus observed by Triboulet, and by Westphal and 

 Wassermann, the characters and action of which were first 

 investigated in this country by Poynton and Paine. It is now 

 usually known as the micrococcus rhenmatieus. The organism 

 is sometimes spoken of as a diplococcus, but it is best described 

 as a streptococcus growing in short chains ; in the tissues, how- 

 ever, it usually occurs in pairs. It is described as being rather 

 smaller than the streptococcus pyogenes, and although it can be 

 stained by Gram's method, it loses the colour more readily than 

 the streptococcus pyogenes. In the various media it produces a 

 large amount of acid, and usually clots milk after incubation for 

 two days ; on blood agar it alters the hsemoglobin to a brownish 

 colour. Its growth on media generally is more luxuriant than 

 that of the streptococcus, and it grows well on gelatin at 20° C. 

 Injection of pure cultures in rabbits often produces polyarthritis 



