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rheumatism, and these germs, when injected into animals, will not
infrequently produce fever and inflammatory changes in the joints,
roughly resembling rheumatism. But the difficulty so far has been,
first, that these organisms are of several different kinds and distinct
species; and second, and even more important, that almost any of the
organisms of the common infectious diseases are capable at times of
producing inflammation of the joints and tendons. For instance, the
third commonest point of attack of the tubercle bacillus, after the
lungs and the glands, is the bones and joints, as illustrated in the
sadly familiar "white-swelling of the knee" and hip-joint disease. All
the so-called septic organisms, which produce suppuration and
blood-poisoning in wounds and surgery, may, and very frequently do,
attack the joints; while nearly all the common infections, such as
typhoid, scarlet fever, pneumonia, and even measles, influenza, and
tonsillitis, may be followed by severe joint symptoms.

In fact, we are coming to recognize that diseases of the joints, like
diseases of the nervous system, are among the frequent results of any
and all of the acute infectious diseases or fevers; and we now trace
from fifty to seventy-five per cent of both joint troubles and
degenerations of the nervous system to this cause. Two-thirds, for
instance, of our cases of hip-joint disease and of spinal disease
(_caries_) are due to tuberculosis.

The puzzling problem now before pathologists is the sorting out of these
innumerable forms of joint inflammations and the splitting off of those
which are clearly due to certain specific diseases, from the great,
central group of true rheumatism. Most of these joint inflammations
which are due to recognized germs, such as the pus-organisms of surgical
fevers, tuberculosis, and typhoid, differ from true rheumatism in that
they go on to suppuration (formation of "matter") and permanently
cripple the joint to a greater or less degree. So that there is probably
a germ or group of germs which produces the swift attack and rapid
subsidence and other characteristic features of true rheumatism, even
though we have not yet succeeded in sorting them out of the swarm. So
confident do we feel of this, that although, as will be shown, there are
probably other factors involved, such as exposure, housing, occupation,
food, and heredity, yet the best thought of the profession is
practically agreed that none of t