The Medical clinics of North America . istence ofalveolar infection in the jaws. He claims symptomatic improve-ment in many cases after removal of teeth. Elys description of Type II, as just quoted, serves to laygreat emphasis on the need for discovery of the specific causeof this disorder, so that treatment may be preventive and maybe instituted in time to save the joint from permanent bonydamage. It is possible to say clearly that this second type ofarthritis is not bacterial in origin. In reviewing possible causes,then, outside of bacterial, we are confronted with very fewpossibilities. The
The Medical clinics of North America . istence ofalveolar infection in the jaws. He claims symptomatic improve-ment in many cases after removal of teeth. Elys description of Type II, as just quoted, serves to laygreat emphasis on the need for discovery of the specific causeof this disorder, so that treatment may be preventive and maybe instituted in time to save the joint from permanent bonydamage. It is possible to say clearly that this second type ofarthritis is not bacterial in origin. In reviewing possible causes,then, outside of bacterial, we are confronted with very fewpossibilities. The pathology, as shown by Ely, does not con- 424 ALFRED C. REED, HARRY A. WYCKOFF form to that of bacterial invasion. Metabolic causes have beensuggested, but the whole nature of the disease removes thisfrom serious discussion. This theory has finally been disprovedby calorimetric studies in DuBois laboratory, where it wasfound that the metabolic rate is normal. Whatever causesthis arthritis, it is accompanied by normal basal metabolism. Fig. 103.—Photograph of section of necrotic bone from Elys case ofType II arthritis. Note area marked, where photomicrograph in Fig. 104was made. and by absence of toxic destruction of protein (Cecil, Barr,and Dubois, Arch. Int. Med., May, 1922). An invading organ-ism is strongly suggested by the nature and location of thenecrosis. Excluding bacteria, we have been led to feel thaiprotozoa offer a possibilit) worth) of careful study. Following out this idea, Ely removed the head of a femurin this type of arthritis. Sections from the necrotic areas INTESTINAL PROTOZOA IN CLINICAL PRACTICE 425 of this bone were stained with a standard hematoxylin methodand showed numerous cellular bodies identified as Entamoebahistolytica (Ely, Reed, and Wyckoff, Cal. State Jour, of Med.,February, 1922). These bodies were abundant near the per-iphery of the necrosis and especially abundant around thecapillaries. ijHH| H jfH Fig. 104.—Photomicrograph of portion o
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