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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    the 7 rheumatic strains, 7.e., agglutination tests failed to effect any differentiation. The third endocarditis strain produced a serum which agglutinated itself alone. Clawson noted that “ all strains in the homogeneous group are mannite fermenters, while those in the heterogeneous group fail to ferment mannite.”’ In 5 cases, the patient’s serum was examined for antibodies. “In 4, agglutinins were found in a dilution of 1:50 or more. In one, they could not be detected. The serum of 3 rheumatic patients agglutinated a streptococcus isolated before death in a case of subacute bacterial endocarditis. This case was found to be typical at necropsy.”’ For the purpose of studying experimental lesions, he injected 35 rabbits with 12 of his rheumatic strains. Well-marked polyarthritis is mentioned as occurring in two instances and in both of these he recovered from the affected joints large numbers of organisms which were identical with those injected. Endocarditis was found in 13 rabbits. The results were irregular. For example, the same strains produced endocarditis in one or more animals but not in others; all four rabbits inoculated with one strain were negative ; another strain, inoculated into 5 rabbits, produced no endocarditis but three of the animals died from septicaemia within two days; and in one, which received injections over a period of 2 months, there was pronounced arthritis. When endocarditis occurred, the lesions, including the myocardial lesions, “were essentially the same as the human rheumatic Jesions.”’ | As controls, he injected rabbits with three strains from subacute bacterial endocarditis. Two of these strains produced no lesions ; the lesions produced by the third were similar, both to the naked eye and microscopically, to those produced by the rheumatic strains. He suggested that the two conditions might be due to the same agent and might represent different degrees of the same — process, 7.e., “that subacute bacterial endocarditis may be the stage in which there is a development to the extent of an infected thrombus, while in rheumatic endocarditis there is only a stage of mild valvulitis.”’ Clawson’s investigation, which I have taken as a sample from the recent literature, exemplifies the need of further information on many points of interest. Why have some bacteriologists obtained invariably negative results and some only an occasional positive ? Clawson does not state if he had any failures; he certainly seems to have been successful as a rule. To what extent does success depend on cultural technique ? What corroboration is there of the view that haemolyticus may occasionally be the causal agent ? What further evidence is available about the serological classification of strains of viridans derived from rheu- matic fever? The question of demonstrable antibodies in the serum of patients is also of considerable importance. What is the significance of the comparison between experimental lesions produced by viridans and the lesions of human rheumatic fever?