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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    rently from inability to combine the requisite muscular movements. Face pale and haggard; lips covered with sordes; tongue brown and dry; skiu cool, moist: pulse small, feeble, about 120 in the minute, her restlessness pre- venting its being accurately counted. The like cause also interfered with a proper auscultation of the heart. Her head was again shaved, and a blister applied to the vertex. She also took chloroform again with temporary cessa- tion of the movements, followed by a little sleep. She appeared to like the remedy, and occasionally asked for it, as well as she could. In the evening and early part of the night she had a little sleep, but after two o’clock the following morning the choreic move- ments became more violent, involving the lower limbs, and increased to such a degree that it became necessary to tie her in bed to prevent her being thrown out. Between nine and ten o'clock she was lifted out of bed to have her bed made and her blister dressed. On being returned to her bed, she took eagerly about half a pint of beef-tea, then lay quiet, and in a quarter of an horn- was dead. Five hours after death the brain and heart were examined. In the former, nothing unusual was noticed beyond a peculiarly soft condition of the cerebel- lum. In the latter was found the pro- bable source of all the mischief. The two surfaces of the pericardium were universally and rather firmly adherent to one another through the medium of a thin layer of soft, reddish, rather dry granular lymph. The heart was rather large: its muscular tissue presented ex- tensive fatty degeneration, large buff- coloured blotches being abundantly scattered through the walls of both ven- tricles, while the interior of these cavities exhibited in an extreme degree the pe- culiar streaky, freckled aspect, so charac- teristic of fatty disease of the heart. Moreover, there was abundant evidence of recent endocarditis, the tricuspid, mitral, and aortic valves being more or less thickly set near their free borders with clusters of minute, soft, reddish, ' loosely adherent granules. The objections of friends prevented the spinal cord and other organs from being examined. The liver, however, was noticed to be extremely fatty. Here we have a case in which a deli- cate girl, inheriting a tendency to rheu matism, and having a sister formerly affected with that disease, becomes out of health just at a period when the cata- menia are expected, but do not appear, suffers a slight attack of articular rheu- matism, with a severe inflammation of the investing and lining membranes of the heart, and then has violent chorea, which terminates in death, dissection disclosing, moreover, extreme fatty de- generation of the muscular tissue of the heart. Abundant matter for general comment is here offered, but into this we must not now enter. Case II.—Ann Holt, aged 13, a thin, light-haired child, admitted under Dr. Roupell, October 18, 1849, with rheu- matic inflammation of various joints, of five days’ standing, and pain in the chest of one day’s duration. The heart’s action was accelerated, and there was a prolonged soft systolic murmur at the apex, faintly heard also at the base, where the second sound was clear. So far the mischief seemed to be only endo- cardial. She was treated by leeches to the region of the heart, and small doses of calomel and opium every four hours. The next day (the 19th) the first sound at the apex was confused, while at the base a peculiar creaking sound was audible with the systole, the second sound still remaining clear. On the 20th, the joints being still very bad, the first sound continued rough and crack- ling at the base, while a somewhat simi- lar sound was occasionally audible with the diastole. Little doubt now remained of pericarditis being superadded to the endocarditis, and this little was removed by the pericardial friction becoming more distinctly marked during the next three days, and then it disappeared, leaving an endocardial systolic murmur both at apex and base. The rheuma- tism now rapidly subsided, and the child got so much better, that I took no further note of her until the 29 th, five days after the disappearance of the pericar- dial sounds. On this day I learnt that the preceding evening she was observed to be very strange and foolish in man- ner, and that subsequently twitchiugs ensued in the face and arm: she passed a restless night, and in the morning she had frequent spasmodic movements of the muscles of the face, with involun- tary knitting of the brows, while the left hand and arm were constantly in movement. Her thin, wan, feeble as-