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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    answered ‘six weeks,’’’ an opinion also held by Osler: ‘‘ The patients are kept in bed for about six weeks.” In 1864 Hirsch announced his conjecture that rheumatic fever was a specific infective disease,* and in the following year Trousseau described rheumatic sore throat. In 1876, just one hundred years after the discovery of the - cardiac action of digitalis, the treatment of acute rheumatism received enforcement of great value in the publication by Maclagan of his results obtained by the use of salicin derived from willow bark. Almost at the same time Buss and Stricker were using salicylic acid, which had been discovered by Kolbe some years earlier, and in 1877 See introduced the treatment by sodium salicylate. In this year, too, Francis Sibson made what appears to be the first suggestion that a longer and more particular convalescence than Warren’s “six weeks’? was the way of avoidance of permanent heart damage. Sibson found that a much larger proportion of patients (more than two to one) treated by rest escaped the permanent heart mischief as compared with those allowed free action. “‘ The whole chain of evidence points then, I think, irresistibly to the conclusion that the extent, severity ‘and permanent ill-effects of the endocarditis were much greater in the series of cases that were not rigidly treated by rest than in the series that were so treated.”’ 3 Garrodf in 1890 emphasised the protean forms which rheumatic infection may assume, and so for the first time pointed out the extreme complexity of the problem which lies before those who would prevent rheumatic heart disease. “‘ If it be once granted,” he says, “that an attack of chorea with endocarditis, or an eruption of a cutaneous erythema, may constitute as truly a rheumatic attack as the most severe forms of articular lesions, it is obvious that arthritis must be deposed from the position of the essential rheumatic lesion, and must be looked upon merely as the most constant and conspicuous of the manifestations of the disease.” From this time forward it was apparent that we had to deal not merely with frank acute rheumatic fever and chorea, but also with a large number of much less definite clinical conditions, such as tonsillitis, myositis, erythemata, and indefinite “ growing pains ”’ from which so many children suffer. In 1898 Singer claimed that the disease was an attenuated pyaemia due most frequently to a streptococcus. In 1899 Westphal, Wassermann and Malkoff produced non-suppurative polyarthritis in rabbits by inoculation with streptococci isolated from a case of acute rheumatism. In 1900 Poynton and Paine described a diplostreptococcus isolated from pericardial exudates, blood cultures and valve lesions, which they named the ‘* Diplococcus rheumaticus.”’ These last three events are recorded. * Newsholme in his Milroy Lectures of 1895 (Lancet i. p. 664) con- sidered Rheumatic Fever as an acute infectious disease with an epidemic . prevalence of irregular periodicity, epidemics usually occurring in years of exceptional drought. + A Treatise on Rheumatism.