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.

    28/114 (page 16)
    the exceptions being “a streptococcus viridans and a haemolytic streptococcus.”’ With regard to her histological findings she stated :—‘‘ In the relative absence of necrosis and of polymor- phonuclear leucocytes no less than in the abundance of, and apparently large role played by, the large so-called * endothelial ’ phagocytic leucocytes, the focal lesions produced in the heart muscies of these rabbits are peculiar. These characteristics are maintained throughout all the varying phases of their development, and they are the features which have been emphasised, especially by Coombs but also by others, as distinctive of the focal lesions in the human heart in rheumatism.” She also remarked that “all of the streptococci, except the viridans, produced arthritis in rabbits.”” Her viridans was obtained from the heart valves of a man who had suffered from endocarditis for a long time. Thalhimer and Rothschild!? (1914) commenced by making a study of the nodules of Aschoff in rheumatic fever and came to the conclusion that “in rheumatic myocarditis, foci, termed sub- miliary nodules of Aschoff, are present which are characteristic of the rheumatic infection.”’ They then proceeded to devote their attention to “‘ experimental focalised myocardial lesions ”’ found in rabbits after intravenous inoculation with streptococci. They used nine different strains of Streptococcus mitis ; one of these was from the tonsils of a case of phlegmon of the neck ; the others were from blood cultures from cases of subacute endocarditis. They also employed five strains of Streptococcus rheumaticus and three strains from an epidemic of sore throat. Their results were :— “1. S. mitis produced focalised myocardial lesions which are identical with those caused by the injection of S. rhewmaticus, and with those produced by Bracht and Wachter with S. viridans. 2. The lesions differ from those which we produced by injections of streptococci from the Chicago epidemic of sore throat. 3. The lesions are not identical with Aschoff bodies and are easily differentiated from them. They also differ from the foci produced — by Jackson and Coombs, who describe their lesions as being either Aschoff bodies or similar formations.” Cecil 14 (1916) gives the following summary of his experiments. “1. Repeated injections into rabbits of non-haemolytic strepto- cocci isolated from human cases of infectious endocarditis or rheumatic fever will produce an acute arthritis in the rabbit similar in most respects to the arthritis of acute rheumatism. 2. Micro- scopical sections of the joints show a gradual transition from an acute exudative inflammation to advanced organisation. 3. Endocarditis and pericarditis occur in a small percentage of cases, and focal lesions in the myocardium consisting of necrosis and the infiltration of cells are frequent. These focal lesions differ considerably from Aschoff’s submiliary nodules.” Topley and Weir! (1921) discussed the lesions produced in rabbits by inoculation with streptococci derived from cases of acute rheumatism and stated, as the result of their experiments, that “similar lesions may be produced by inoculation with