Haemolytic streptococcal infections and acute rheumatism

Abstract

The investigations described in the thesis gave strong support to the latter theory with certain reservations. Thus the evidence of streptococcal infection was obtained in the majority of cases and an abnormal response was demonstrated. Furthermore, the survival of haemolytic streptococci in the absence of a pyogenic focus was discovered in the post-mortem studies in sections G and H. The two points upon which further investigation are required were the following. Firstly, there was no evidence of streptococcal infection nor of an abnormal response in a minority of cases of acute rheumatism. Admittedly a similar absence of response was seen in a proportion of cases of streptococcal pharyngitis in non -rheumatic subjects (section E), but Coburn (1936) has stipulated that rheumatic symptoms appeared only when a definite increase in antistreptolysin 0 titre was produced. Secondly, the toxin-like component in the joint fluid in the stage of acute arthritis finds no place in the sensitisation theory unless it represents a form of secondary antigen.In conclusion then, it is essential that haemolytic streptococcal infection should be placed first and foremost in all questions relating to the spread and reactivation of acute rheumatism, but the problem of aetiology cannot be considered as finally solved.