The Bradshaw Lecture on the prevention of acute rheumatism : delivered at the Royal College of Physicians, London, November 4th, 1924 / by F. John Poynter.

  • Poynton, F. J. (Frederic John), 1869-1943
Date:
1924
Catalogue details

Licence: In copyright

Credit: The Bradshaw Lecture on the prevention of acute rheumatism : delivered at the Royal College of Physicians, London, November 4th, 1924 / by F. John Poynter. Source: Wellcome Collection.

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    2. The next difficulty is concerned with the etiology of acute rheumatism considered as an infective disease. This view of the causation has a most important hearing upon the possibilities of prevention, but is at present in a state of uncertainty. When, in 1898, 1 first became associated with my faithful and valuable colleague Dr. Alexander Paine, Dr. Cheadle had already enunciated the clinical reasons for suspecting that acute rheumatism was due to some infective process. At the moment the whole question is being reinvestigated, anti I believe I shall not be wrong if 1 put the present position somewhat thus: that many of those who have given the most attention to the subject recognize the importance of the strepto-diplococcus, but do not think that it affords a complete explanation of the etiology, and would look elsewhere for this—to some filter- passer, for example. Neither do 1 look upon this micro¬ coccus as a complete explanation, but I do not anticipate the discovery of another infective agent. I look for help from the unravelling of the tangled skein of the secondary factors which combine with the micrococcus to produce this specific disease. Until the solution is revealed 1 feel, with the utmost respect for my able opponents, that l have caught something of the spirit which inspired Giordano Bruno to reply to the sentence of his inquisitors: “ Majori forsitan cum timore in me sententiam dicitis quam ego accipiam.” 3. In any case, even if we admit that acute rheumatism is due to a specific infection, we find ourselves confronted by further problems, among which are the many factors predisposing to the infection—such as heredity, environ¬ ment, and nerve strain. 4. Again, our conception of the disease is still deficient in two particular directions: we have very little accurate knowledge either of the life-history of such an infection when once it has gained access to the human frame, or of the influence of the tissue characteristics and habits of the patient upon its course. On this account I have always connected with any scheme for the prevention of acute rheumatism the provision in such for opportunities for research. 5. The varied symptoms of the disease dependent upon the various important organs attacked constitute yet another difficulty, though one which must steadily diminish with increasing knowledge, and which will be met by care¬ ful medical instruction and by the gradual education of the public. 6. Then there is the difficulty of treating this disease with success, and upon this point, so far as children are con¬ cerned, I unfortunately find myself at variance with many able physicians. Except for the relief of pain, my expe¬ rience as to sodium salicylate and other members of that group has been so unsatisfactory that I have no hesitation