The Factor of Infection in the Rheumatic State

This interesting, timely, and somewhat unusual book is essentially a running discourse upon a series of rather unique observations on rheumatic fever, leading up to the presentation of a theory of the pathogenesis of this disease. It aims to give a comprehensive description of the many phases of rheumatic fever or what the author, in developing his conception of the disease, chooses to call, the rheumatic state. The use of the term "rheumatic state" seems quite justifiable, although to those who champion the individuality of rheumatic fever it may awaken such feelings as prompted Nathan Smith to write George Shattuck in i 8o6, "I cannot see how nosology is essentially benefitted by adding the word state to the name of diseases, as the pleurisy state, rheumatic or hydrophobic state of fever.. ." In defense of the term "state" the author has laid great stress upon the protean nature of rheumatic fever, which he characterizes as a "mosaic of disease patterns". These include the well-recognized conditions of carditis, polyar-thritis and chorea; but, he also adds, that: "bizarre lesions of the skin, strange solidified areas in the lungs, vague symptoms referable to many viscera compose the foreground of the disease picture". Such a conception reflects the important fact that the limits of rheumatic fever have yet to be defined. It also implies that the degree of underlying susceptibility is of sufficient importance to receive recognition in the descriptive term applied to the disease, as, for instance, one might regard bronchial asthma, or urticaria, as an "allergic state". As we have already stated, the subject matter gravitates rapidly toward etiologic considerations, starting with a review of previous efforts of bacteriologists , the predisposing effects of environment, and seasonal and geographic influences. From the latter viewpoint an exceedingly interesting and almost heroic experiment is described, in which ten patients suffering from active phases of rheumatic fever, were transported to Porto Rico, and subsequently back to New York, during which time observations were made upon their clinical course and throat flora. Dominating the book is the author's conception that the "Streptococcus hemolyticus is an important factor of infection in the rheumatic state". In developing this theme he has employed methods somewhat similar to those used by Longcope, et al., in the latter's work on the association of this organism with acute nephritis. His results on a large number of throat cultures taken from rheumatic patients …