History.—S. P., male, aged 20, entered the Har Moriah Hospital, Feb. 4, 1913. He had measles when 3 years old and typhoid when 10; otherwise there was no history of any previous illness. He was not addicted to tea, coffee, tobacco or alcohol. Five days before admission he developed a typical attack of acute articular rheumatism involving the ankles, wrists, knees and elbows. The attack was accompanied by fever ; there were no chills or gastric disturbances.
On admission, except for swelling and redness of the inflamed joints, the physical and neurological examination revealed nothing abnornal. There was no urethral discharge. The complement-fixation test for gonococci was negative. The cardiac outline was normal to percussion, the apex beat was in the fifth interspace, 8.5 cm. from the midsternal line ; the heart sounds were normal ; the pulse was rhythmical. The systolic and diastolic blood-pressures were within normal limits.