A research upon combined mitral and aortic disease of rheumatic origin : a contribution to the study of rheumatic malignant endocarditis / by F.J. Poynton and Alexander Paine.

  • Poynton, F. J. (Frederic John), 1869-1943.
Date:
1912
Catalogue details

Licence: In copyright

Credit: A research upon combined mitral and aortic disease of rheumatic origin : a contribution to the study of rheumatic malignant endocarditis / by F.J. Poynton and Alexander Paine. 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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    coming, seeing that few physicians look upon the malignant types from our point of view, and that no bacteriologist, unless devoting himself to such a special study, will be likely to have made more than the routine investigation of the blood or vegetations. Then again, in the non-malignant cases the lesions have often been considered as examples of heart disease and no particular stress laid upon them as phases in a prolonged rheumatic infection. Our evidence must then be of necessity fragmentary, but it is lawful for us, we think, to build up our thesis upon the carefully prepared basis of our complete investigations—that is, upon the four claims set out at the beginning of this section, strengthening the position by the aid of numerous other important fragments of evidence. It remains for any opponent to demolish the structure by bringing forward equally clear evidence that cases of this type are due to some other cause which is clearly of a different nature to the one we claim. In order to avoid any suspicion that we are now trying to evade a plain issue, we will illustrate the character of our evidence by concrete examples of malignant endocarditis. The first case we quote is for the purpose of showing that we have weighed our evidence in every incomplete case. A child, aged 4 years, had been ill ten days with arthritis of the shoulder, hips, and wrist joints; high fever and mitral disease. Pneumonic signs developed and death occurred. In our opinion, if we published such a case as this as an example of a virulent first attack of rheumatism we should deserve the most drastic criticism. The necropsy showed periostitis of the right femur, multiple suppurative arthritis, suppurative pericarditis, abscesses in the muscles, and early mitral disease. The Staphylococcus pyogenes aureus was isolated and was the cause of the illness. On the other hand, a girl aged 11 had an attack of acute rheumatism at 9 and again at 10 years. Her final illness showed active carditis with persistent fever; no infarctions were observed. A strepto-diplococcus was isolated from the blood and at the necropsy malignant aortic disease was dis- covered with acute mitral of the simple type. Both valves showed former disease. The other viscera accorded with the diagnosis of a rheumatic infection. Such a case we claim to be rheumatic, until others can bring moi’e convincing evidence to the contrary. There is a very close clinical and pathological similarity in many of these cases of malignant endocarditis which becomes apparent from the short details of twenty-five examples that occurred in our series, and we feel justified in claiming some cases upon such clinical or clinical and pathological evidence, admitting at once that the proof is not complete, but believing the explanation as by far the most probable. Case I. A man aged 27 years had chorea as a boy, and an attack of rheumatic fever at 26. He never laid up during the attack, but struggled on with his work, gradually losing ground. Compelled at last to give in, nine months after the neglected illness, he was found to have aortic and mitral