Enterococcus and Sydenham's Chorea

IF Onle examines the literature on the bacteriology of chorea, one finds that as far back as 1894 a cliplococcus was isolated by Dana from the brain of a fatal case.1 and others have isolated differenit cocci as being the cause of rheutmiatic infectioni, anid some have injected streptococci into rabbits anid prodluced clhoreiform coniditions. In a paper publislhed elsewvhere in this Journal,2 Sir TIhomas Houstol (Iraws attenition to the role of the eniterococcus or streptococcus faecalis, and its relation to rheumatism. He has endeavoured to correlate his work with the findinigs of other observers, and suggests that all recorde(d varieties of cocci may be eniterococci livilng in symbiosis with a virus or 'phagc.' For example, the coccus of Beattie gives all essential ch1aracteristics of an1 enterococcuLs. Sir Thomas Houston's experiments also shoxv that some varieties of streptococcus viridans may be a 'phage'-infected enterococcus; hiis owxln words on this point are important. He says thlat his 'phage'-infection "would explain whly, wllhen the str-eptococcus has beeni isolated, it may grow out in different antigenic and biological forms, at onie time the coccus of Clawson, at another time the coccus of Small or Birhaug, or eveni the atypical streptococcus described by Cecil, Nicholls, or Stainsby, or, to go inlto past history, the diplococcus of Poynton and Painie anid Beattie." One of his co-workers (Haslett), working with the three types of enterococcus A, B, and C, has found that thie first two types produce a soluble specific substance. TIype A is the purest form, and makes a file emulsion. TIvpe B dloes not contain so much specific soluble substance, and is not so good in emulsion; while Ivpe C has no specific soluble substanice at all. It has been the custom for the last five or six years in the laboratory of the Royal Victoria Hospital to dlo agglutination tests with these cocci ill many rheumatic conditions, chiefly of a chronic nature. A great number of these gave an agglutina-tion, while cases which appeared to be normal controls did not give this reaction. These results have not as yet been published. If one accepts the view that Sydenham's chorea is rheumatic in origin, and that the patlhology is "a diffuse or disseminated encephalitis affectinig chiefly the corpus striatum an(l inivolving the cortex andl pia arachnoid,"3 it occur-redl to me that one might get aggglutination of the blood-serum from choreic cases to the organism …