hese would alone produce the disease,
but that they are only accessory causes plus the micrococcus. In
practically all our modern textbooks of medicine, rheumatism is
included under the head of infections.

This theory of causation, confessedly provisional and imperfect as it
is, helps us to harmonize the other known facts about the disease; it
has already greatly improved our treatment and given us a foothold for
attacking the problem of prevention. For instance, it has long been
known that rheumatism was very apt to follow tonsillitis or other forms
of sore throat; indeed, many of the earlier authorities put down
tonsillitis as one of the great group of "rheumatic" disturbances, and
persons of rheumatic family tendency were supposed to have tonsillitis
in childhood and rheumatism in later life. Not more than ten or fifteen
per cent of all cases gave a history of tonsillitis; but since we have
broadened our conception of infection and begun to inquire, not merely
for symptoms of tonsillitis, but also for those of influenza, "common
colds," measles, whooping-cough, and the like, we reach the most
significant result of finding that forty to sixty per cent of our cases
of rheumatism have been preceded, anywhere from one to three weeks
before, by an attack of some sort of "cold," sore throat, catarrhal
fever, cough, bronchitis, or other group of disturbances due to a mild
infection. Further, it has long been notorious that when a rheumatic
individual "catches cold" it is exceedingly apt to "settle in the
joints," and, if these cases happen to come under the eye of a
physician, they are recognized as secondary attacks of true rheumatism.
In other words, the "cold" may simply be a second dose of the same germ
which caused the primary attack of rheumatism.

This brings us to the widespread article of popular belief that
rheumatism is most commonly due to cold, exposure, chill, or damp. Much
of this is found on investigation to be due to the well-known historic
confusion between "cold," in the sense of exposure to cold air, and
"cold," in the sense of a catarrh or influenza, with running at the
nose, coughing, sore throat, and fever, a group of symptoms now clearly
recognized to be due to an infection. In short, the vast majority of
common colds are unmistakably infections, and spread from one victim to
another, and this is the type of "cold" which causes the majority of
rheumatic attacks.

The chill, which any one who is "