Acute rheumatism in children in its relation to heart disease.

Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: Acute rheumatism in children in its relation to heart disease. Source: Wellcome Collection.

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    illustrating his remarks by dissections. Carditis seems at first only to have included pericarditis, endocarditis being discovered later, some say by Baillie in 1797. In 1780 subcutaneous nodules on the extensor surfaces in subacute rheumatic infections were described by Haygarth of Manchester*, and confirmed thirty years later by Wells at St. Thomas's Hospital. Scudamore in 1827 divided acute rheumatism into acute and subacute, distinguishing the latter from chronic rheumatism. ‘There is not,’ he wrote, “‘ probably a more dangerous form of disease than a sudden seizure of the heart during the inflammatory state of the system in acute rheumatism.”’ In 1831 Bright pointed out the close relationship of chorea to acute rheumatism, and the frequent occurrence of heart murmurs in chorea. In 1836 Jean Baptiste Bouillaudt published his Law of Coincidence between the occurrence of heart disease and acute rheumatism. Sir Thomas Watson? in 1843 almost states the modern opinion with regard to acute rheumatism. He lays stress upon the greater liability of the young to cardiac complication in the following words: “‘ One law respecting the connexion between the cardiac and the arthritic symptoms may be stated with confidence, namely, that the younger the patient is who suffers — acute rheumatism (and I have seen it so early as the third or fourth year) the more likely will he be to have rheumatic carditis. The chance of the combination appears to diminish after puberty as life advances.” Watson gives a very high incidence of carditis in rheumatic children. “‘ I have known,” he says, “ oniy three persons pass through acute rheumatism with an untouched heart prior to the age of puberty,” and he also appears to have observed, what has been subsequently confirmed,§ that second and third attacks are more likely to cause heart disease than the first attack. “ T have observed also,” he writes, ‘‘ that when a patient has come under my care who has had repeated attacks of acute rheumatism in him I have generally found reason to believe that some organic affection of the heart was present.”” He suggests that the seat of the latent infection in patients who have repeated attacks may be the heart. “ Probably the disposition to such repetitions of the disease, so remarkable in some individuals, may be kept up by the cardiac complication.” He agrees with Latham’s opinion, expressed in 1845, that “carditis is incident to all the degrees and all the stages and all the forms of acute rheumatism. It is not more to be looked for when the disease is severe than when it is mild.”’ It is in Watson’s lectures that we get the first suggestion of the period for which it is necessary to keep the patient with acute rheumatism in bed, for he quoted :—‘‘ the dictum of the first Dr. Warren, who, when asked what was good for acute rheumatism, * A Clinical History of Acute Rheumatism. {+ Nouvelles Recherches sur le rheumatism articulaire. { Practice of Physic (1848), II, p. 294. § See for example Ministry of Health Report No. 23, 1924, ‘‘ The Incidence of Rheumatic Diseases,” page 77,