Cases, with remarks illustrating the association of chorea with rheumatism and disease of the heart / by William Senhouse Kirkes.

  • Kirkes, William Senhouse, 1823-1864.
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Cases, with remarks illustrating the association of chorea with rheumatism and disease of the heart / by William Senhouse Kirkes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    5 G disappeared, was the only positive sign, in addition to the general complaint of puns in the joints, that acute rheuma tism existed: it was, however, quite sufficient to denote the fact. There was a dry black secretion about the lips; the tongue was pale, thickly furred white, with a dry brown streak down the centre, spreading out at the apex. The pulse was 84, but singu- larly irregular, — usually three beats would occur in ordinary succession, then there would be a complete inter- mission, then three more ordinary beats, followed by another intermission. She passed her evacuations in bed, but was conscious of doing so. She was a dressmaker, always deli- cate, and subject to severe headaches, especially since a violent blow on the bead six years before. She never bad rheumatism or chorea; but her mother was rheumatic, and a sister had been in the hospital with rheumatic fever. Nine days before her admission she began to be ill, chiefly with palpitation and a feeling as if “ something was amiss with her heart.” Three days subsequently she came to the hospital to have a tootli extracted; it was then noticed that her throat was inflamed. At this time her catamenia, which had hitherto been regular, were due, but they did not appear The next day her throat was worse, with increase of palpitation and pain in the chest. The twitchings of the head and face commenced two days before admission. For several nights she had had no sleep, and latterly had been delirious, and with difficulty kept in bed. On auscultation there was found to be increase of the heart’s impulse, which was perceived over a greater space than natural. The first sound was loud and ringing, with a short blowing murmur at the apex; the second sound indis- tinct. There was increased and ex- tended cardiac dulness on percussion. This auscultation was made-a few hours after her admission into the hospital; but, when first admitted, certain sounds were beard which led my friend Mr. Wood, who then examined her, to sus- pect the existence of pericarditis. These sounds, however, had quite disappeared on the subsequent auscultation. There was something in the general appearance of the patient which sug- gested the possibility of many of her symptoms being the result of hysteria, and she was accordingly treated at first with the Haust. Ammoniaci Foetidus. The day following, however, the irregu- lar movements had extended to the shoulders, and the next day both arms were affected, the general and auscul- tatory signs being otherwise unchanged, except that the pulse had become regu- lar. During the night of December 5th, which was her third night in the hos- pital, she was noisy and delirious, but when visited the following morning was. found calm and rational, though with a haggard anxious aspect. The spasmodic movements of the arms were increased in violence, and the right lower ex- tremity was now effected. The lips were dry; tongue red, glazed, and clean, hut inclining to dry; skin cool; pulse 120, small, soft, regular: the bowels, which had been relaxed, were quiet: she com- plained of thirst, headache, and a feeling of weariness and exhaustion; the heart’s impulse and action were much increased, and the first sound was prolonged, nmf fled, and accompanied with a murmur. Her hair was ordered to be cut short behind, and a blister applied to the nape of the neck, on the supposition that there was some mischief in the head. The two following nights she had a little rest, aud the involuntary move- ments of the limbs did not increase in violence, but her peculiar anxious hag- gard look remained. On the night of the 8th (five days after admission) she was again restless and delirious, and on the following day the chorea had greatly increased, the arms aud head being con- tinually tossed about, and the shoulders and chest writhing and twisting inces- santly. She got a little sleep in the morning, but was no better on awaking. The jactitation increased towards night. Chloroform was then administered, a-id quieted her for a time; but, as the effects of the reagent passed by, the movements returned with the same violence as before. On the 10th I made the follow- ing note: —With exception of an occa- sional doze, she was restless and tossing about all night, frequently uttering short spasmodic screams: is now in a state of constant restlessness and jactitation, throwing her arms about, and tossing her head from side to side, the legs being nearly still. She tries to speak, but cannot, only uttering unintelligible sounds: she also frequently attempts to cough, but fails in the effort, appa-