ACUTE RHEUMATISM. 203 



which appears to have strongest claims is a small diplococcus 

 ■observed by Triboulet, Westphal and Wassermann, Meyer, and 

 Allaria, the characters and action of which have been investi- 

 gated especially by Poynton and Paine. These latter observers 

 found this organism in eight successive cases of acute rheuma- 

 tism, and obtained pure cultures both from the blood during hfe 

 and also from some of the lesions after death ; they also found 

 it, on microscopic examination, in all the important lesions of 

 the disease. The organism is a minute coccus about .5 /i* in 

 •diameter ; in the tissues it usually occurs in pairs, in fluid 

 cultures it forms short chains, whilst on solid media it is irregu- 

 larly arranged in masses. It stains readily with the ordinary 

 basic dyes, but loses the stain in Gram's method. For isolation 

 the best medium was found to be a mixture of bouillon and 

 milk, rendered slightly acid by lactic acid ; from growths on this 

 medium sub-cultures may be made on blood agar, on which the 

 organism produces small circular, yellowish-white colonies, show- 

 ing under a low magnification a slightly granular appearance. 

 On intravenous injection of pure cultures in rabbits they found 

 as results, polyarthritis and synovitis, valvulitis and pericarditis — 

 without any suppurative change ; along with these there were 

 also marked symptoms referable to the lesions of the heart, 

 joints, etc. These results are of a definite nature, and it remains 

 to be seen to what extent they receive confirmation at the hands 

 of other observers, especially when the experimental inquiries are 

 made with animals naturally susceptible to disorders resembling 

 human rheumatism. 



Singer, as a result of a study of five fatal cases of acute 

 rheumatism and two of chorea rheumatica, isolated a strepto- 

 coccus in pure culture from five cases ; streptococcus and 

 staphylococcus aureus, in association, from two cases ; and 

 staphylococcus aureus, alone, from one case; and sections of 

 the various tissues and of the cardiac vegetations upon staining 

 showed streptococci and diplococci in more or less abundance.. 

 He believes , that there should not be any claim allowed for 

 specificity, such as Wassermann, and Poynton and Paine hold 

 for their micrococci, but is of the opinion that acute rheuma- 

 tism is only one of the many expressions of the variable activities 

 of the ordinary pyogenic cocci. Menzer also inclines to Singer's 

 views, as a result of a study of two cases of acute rheumatism. 



