1908 ] Streptococcus Infections of the Tonsils 143 
104 degrees F. At the end of the first week several points became 
involved, the swelling and pain presisted for several days and 
gradually subsided, following the subsidence of the joint changes. 
The joints at this stage of the infection gave no trouble but severe 
pain was complained of in the muscles and tendons. This dis- 
turbance continued sixteen weeks at the end of which time the 
patient entered on a tedious convalescence which terminated in 
complete recovery. 
A fifth case recently seen, presented nothing in general 
different from the cases reported, except the development of a dry 
pericarditis followed by quite an extensive effusion. 
The streptococcus in an organism which varies much in its 
morphological and biological characteristics as well as in the type 
of infection which it produces. In some instances it rapidly 
causes a septicaemia while in other cases it is content to remain a 
circumscribed infection producing an abcess, or at other times to 
extend to the adjacent structures without entering the general cir- 
culation . 
The frequency with which the tonsils act as an avenue for the 
entrance of an infection has long been recognized. The develop- 
ment of a tonsilitis before or during an attack of acute articular 
rheumatism, first suggested the possibility of the disease being of 
microbic and of metabolic origin. 
Taking into consideration the ease with which a local infection 
of the tonsil could become generalized, the frequency with which 
joint complications follow streptococcus infections of these struc- 
tures, and lastly, the variety of changes this organism is capable 
of causing, it is not improbable that a modified streptococcus or 
or an organism clasely related to it, is the specific cause of acute 
articular rheumatism. 
The specific cause of acute rheumatism, is at the present time, 
receiving much attention. There practically remains no doubt 
that the disease is an acute infection and that in many of the 
cases the tonsils are the portals of entry. The question which is 
at present under much discussion is whether the disease should 
be considered as a condition produced by one specific organism, 
the Diplococcus Rheumaticus of Poynton and Paine. This organ- 
