144 
Journal of the Mitchell Society [ December 
ism has been isolated from the synovial fluid of patients with 
acute rheumatism, has been cultivated on special media where it 
grows characteristically, and lastly an acute arthritis has been 
produced by various investigators by giving intravenous injections 
of the organism to rabbits. This diplococcus is Gram negative, 
the streptococcus is invariably Gram positive. 
The question of the specific nature of acute rheumatism has 
been well summed up by Cole of the Johns Hopkins Medical 
School. His views are certainly conservative. They are as 
follows : 
“I greatly fear we are not as yet in a position to make any 
positive statements as to the etiology of this disease. It seems to 
me that there are at least three possibilities. First, that acute arti- 
cular rheumatism is a definite, acute, specific infectious disease, 
the cause of which we do not know, and that the cocci which 
have been isolated were secondary invaders. Second, that there 
is no such specific disease as acute articular rheumatism, but that 
the cases grouped under this term are those of a mild and moder- 
ately severe case of general streptococcus infection, in which the 
joints and heart are generally involved. Third, that acute artic- 
ular, rheumatism is due to a specific form of streptococcus, which 
at present we have no accurate method of distinguishing from 
Streptococcus Pyogenes, but which, owing to the specific character 
of the lesions induced in man, must possess special characteris- 
tics.” 
Lastly, in regard to the treatments of these cases a point of 
interest develops. It is well known that the salicylates have a 
more or less specific influence in cases of acute rheumatism. In 
all of these cases of streptococcus infections of the tonsils the sali- 
cylates were of great service in relieving the subjective symptoms. 
This relief might be produced through the general action of the 
salicylates on the nervous and circulatory systems, or, on the 
other hand, it might be explained through a germicidal action of 
the salicylates on the specific cause of the disease. 
University of North Carolina, 
Chapel Hill, N. C. 
