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.

    6/10 (page 24)
    condition :—Chorea almost entirely disappeared; walks well’ and steadily, though she still complains of occasional sinking at the knees; slight twitches of the muscles of the face. The cardiac murmur continues distinct, clearly heard over the whole cardiac region; it is most distinct towards the [apex, and is not propagated in the cervical vessels. November 17th.—Is quite^free from all choreic movements; expresses herself as well, except for the beating at the breast. The palpitation is at times inordinate. No decided increase of precordial dulness exists. The murmur continues as before. Remarks.—This case is similar to many others which have been placed on record, and is, with one point of difference, the same as more than one ease alluded to by Dr. Kirkes in his most interesting papers^ on this subject, the only dissimilarity being that the evidence of the affection of the heart, though looked for during the rheumatism, was not detected, but became established about the time of the recurrence of the chorea. I had indeed come to the conclusion, that happily the heart had escaped implication in the disease. The case is interesting from the speedy manner in which the choreic affection succeeded the declension of the rheumatic. There is one question of great interest to which I should wish to draw the attention of the Society, and that is—The association of disease of the heart, unattendant on rheumatism, with the nervous disorder. I think that the evidence of some affection of the heart will be found in many cases of chorea. In Dr. Kirkes’ analysis of thirty-six cases, three were of this nature. In some cases the cardiac affection will no doubt be found to be inorganic—functional derangement merely—attended by a murmur with the heart’s first sound, heard most distinctly over the upper sternum, propagated in the cervical vessels, and in all probability asssociated with the so-called venous murmur in the neck. Further, the general appearance and symptoms of such patients point to the probable dependence of both nervous and cardiac affection on a disordered state of the blood, in short, on ansemia, But apart from these, there is another class of cases, in which the evidence of organic disease of the heart, independent alto- > ‘Medical Gazette,’ 1850.