142 
Journal of the Mitchell Society 
[ December 
Four days after the patient was first seen the right shoulder 
joint became swollen, red, tender and painful. The following 
day the left knee became involved. The joints remained swollen 
for about one week and gradually returned to the normal. Dur- 
ing the time the joints were effected the temperature ranged 
around 103 degrees., occasionally falling to 101 degrees F., follow- 
ing profuse sweats. At no time was there a leucocytosis. 
Case 2— L. A., male, aged 21. This case was very similar to 
case No 1, with the exception that the changes in the tonsil were 
those of a follicular tonsilitis. The exudate was more or less con- 
fined to the surface immediately around the follicles. From the 
exudate streptococci were isolated. A few days after the tonsilitis 
the right shoulder and knee joint become involved. 
Case 3. — R. L. W., male age 19. When the patient was first 
seen he was just recovering from a severe sore throat. His chief 
complaint was soreness in the left shoulder joint, which he attri- 
buted to an injury. Temperature 100 degrees F., pulse 75. The 
following day the joint was decidedly enlarged and very painful. 
Five days from this the right ankle joint became swollen and pain- 
ful, then the left ankle and right shoulder. Within two weeks all 
the joints had returned to their normal size, except the first joint 
affected. This joint remained slightly swollen and the move- 
ments greatly restricted. 
One month from the time the patient was first seen he suddenly 
complained of intense pain in the left shoulder joint. Within 
twenty-four hours the joint had increased perceptibly in 
size and gave evidence of a rapid accumulation of fluid. The 
joint was opened, liberating a few old tarry looking clots, fresh 
clots and some pus. Immediately following the operation the 
patient became profoundly shocked from which condition he failed 
to rally, 
Case !{.. — A. H. B., male, aged 19. Mr. B. was seen early in 
the course of an acute tonsilar infection of streptococcus origin. 
The local condition had the same characteristics as previous cases. 
A membranous deposit over both tonsils and extending to both 
anterior pillars. During the early stage of the infection his tem- 
perature remained constantly elevated, ranging between 101 and 
