Reiter's disease.

Reiter's disease is characterized by a clinical syndrome consisting of a primary abacterial urethritis of venereal origin, bilateral conjunctivitis, polyarthritis, frequently balanitis, and sometimes keratodermia blennorrhagica; cardiac and other manifestations have also been described.The itiology is unknown. There is an almost identical syndrome associated with the various types of dysentery (the primary focus of infection in these cases is the bowel and not the urethra) which is probably the same disease. There are also certain other diseases and reactions due -to treatment which may simulate the syndrome very closely. In my experience true Reiter's disease is one in which the primary focus of infection is an abacterial urethritis of venereal origin with blood-borne complications. (In none of my cases have I observed dysenteric symptoms nor have any of them shown a previous history of dysentery.) The syndrome may be complete or incomplete. It is commonly pyrexial, sometimes runs a protracted course, and often recurs after short or long periods of remission. In my series two separate attacks occurred in twenty-four patients, three in four, and four in one: the syndrome was never complete in more than one attack. It has frequently been reported to me by my male nurses at St. Charles's Hospital that patients with the syndrome, including those acutely ill, invariably have voracious appetites. From the many references to Reiter's disease which have appeared. recently in the literature, it seems that several misconceptions exist on the subject. Much of the confusion would' appear to be due to the fact that the disease bears Reiter's name. In his case, reported in 1916, the illness was ushered in with severe abdominal pain, diarrhoea and blood-stained stools, followed eight days later by a purulent -urethral discharge with bilateral conjunctivitis. On the ninth day there was an acute polyarthritis, and six weeks later numerous pustules were noted in the region of the left hip