Case of acute rheumatism succeeded by chorea and affection of the heart / [J. Warburton Begbie].

  • Begbie, James Warburton, 1826-1876.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Case of acute rheumatism succeeded by chorea and affection of the heart / [J. Warburton Begbie]. Source: Wellcome Collection.

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    matic fever she had been nervous, and very easily excited and alarmed, which was different from her previous character. She could not attribute the occurrence of the disease to any par- ticular cause, indeed it had come on gradually; but she was quite sensible that it had been augmented by a fright, sustained the day previous to my visit, when a cat had somewhat incautiously attacked a favourite hawk, which was kept in the room in which my patient slept. She had given a loud scream at the time, and during the following night had awoke from sleep with the same. When I saw her, the choreic affection of the lower limbs was so aggravated as to render progression nearly impossible; the arms, especially the left, were similarly affected. The left side of the body was, on the whole, more markedly affected than the right. Articulation also was greatly impaired, and she made most singular grimaces. She had never suffered from any nervous disorder before. The tongue had become furred. On examination of the heart, I now, for the first time, noticed a deviation from the natural sounds. A distinct blowing murmur took the place of the first, as heard towards the apex of the heart, and this was accompanied by a greatly increased action of the organ. Ordered a purge of jalap, to be repeated each day for three days. The purges improved the tongue, but did not apparently influence the nervous disorder. Accordingly I ordered her to take five drops of Fowler’s solution twice daily immediately after meals. The arsenic was continued regularly, without the intermission of a single dose, from the 24th of July up to the aoth of September, when the physiological action of the mineral being induced, as represented by a very white tongue, swollen eyelids, and a somewhat irritable state of the mucous membrane of the stomach and bowels, I ordered its suspension. During that period the nervous affection had preseveringly continued, at times augmented in severity, at others apparently yielding, at one period so severe as to cause the strict confinement of my little patient to the house, at another, permitting her to walk, assisted by her mother, and even to visit me at home. On the 23rd of September I made the following note of her