he War of 1812 might be paraphrased into,
"Once rheumatic, always rheumatic." The disease appears to be lost to
all sense of decency and reason; and to such unprincipled lengths may it
go, that I have actually known one luckless individual who had the
unenviable record of seventeen separate and successive attacks of
rheumatic fever. As he expressed it, he had "had rheumatism every spring
but two for nineteen years past." Yet only one ankle-joint was
appreciably the worse for this terrific experience.

Obviously, the picture of acute rheumatism carries upon its face a
strong suggestion of its real nature and causation. The high
temperature, the headache, the sweats, the fierce attack and rapid
decline, the self-limited course, the tendency to spread from one joint
to another, from the joints to the heart, from the heart to the lungs
and the kidneys, all stamp it unmistakably as an infection, a fever. On
the other hand, there are two rather important elements lacking in the
infection-picture: one, that, although it does at times occur in
epidemics, it is very seldom transmitted to others; the other, that one
attack does not produce immunity or protect against another. The
majority of experts are now practically agreed that _acute_ rheumatism,
or _rheumatic fever_, is probably due to the invasion of the system by
some microoerganism or germ. When, however, we come to fixing upon the
particular bacillus, or micrococcus, there is a wide divergence of
opinion, some six or seven different eminent investigators having each
his favorite candidate for the doubtful honor. In fact, it is our
inability as yet positively to identify and agree upon the causal germ
that makes our knowledge of the entire subject still so regrettably
vague, and renders either a definite classification or successful
treatment so difficult.

The attitude of the most careful and experienced physicians and
broad-minded bacteriologists may be roughly summed up in the statement
that acute rheumatism is probably due to some germ or germs, but that
the question is still open which particular germ is at fault, and even
whether the group of symptoms which we call rheumatism may not possibly
be produced by a number of different organisms, acting upon a particular
type of constitution or susceptibility. There is no difficulty in
finding germs of all sorts, principally micrococci, in the blood, in the
tissues about the joints, and on the heart-valves of patients wit