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
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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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    5. Bacteriological evidence is necessarily incomplete, for in the majority of cases none was made. 12 positive results were obtained in the 25 malignant cases and 6 were reported negative. The comparative success in this group is entirely in accord with the view of the pathology we have put forward. Negative results in the simple rheumatic cases (Group III) are the rule, but there are exceptions. We would repeat that a single or even two such examina- tions of the blood are but little evidence of the presence or absence of an infective process when the result is negative, and that in our opinion far too much weight has been laid upon the occurrence of these negative results when the morbid processes in acute rheumatism are thoroughly realized. 6. The relation of the final illness, when fatal, to the last attack of rheumatism can be readily studied from our lists. The facts thus obtained are only relative, for, when a patient has been the victim of repeated attacks of acute rheumatism, the more closely the history is investigated the more frequently will be found evidence of some activity of the rheumatic processes between the definite attacks: these minor attacks are frequently not recorded and not mentioned by the patients. 7. All the observations upon the duration of the illness are also only approximate, but they serve to illustrate how prolonged the illness may be and how difficult it is to ascertain the commencement or the end of the active processes. 8. We would lay special stress upon the following histories from the groups of the malignant cases. First, three in which the malignant process dated from the first illness ; two in which it followed upon an attack of rheumatism six months before, from which illnesses the patients had never really recovered ; one in which there was a continuous history of failing health for twelve months after the fourth attack of acute rheumatism ; one in which the patient neglected a previous attack of rheumatism which had occurred less than a year before and after which he had been ill fed and had kept at work; one in which there had been failing health following a rheumatic polyarthritis five months previously. These 8 cases out of a series of 25 show the close relationship of the rheumatic process to malignant endocarditis. 9 more illustrate the malignant endocarditis emerging from other and transitory symptoms of acute rheumatism. Thus 17 of these 25 cases show a close relationship to the occurrence of acute rheumatism. Group No. I. Mitral and Aortic Cases Malignant in Type. No. 1. Male, aged 10. History of acute rheumatism at 9 years. Main symptoms of final illness : Admitted with mitral and aortic disease—developed transient polyarthritis and pericarditis. Later infarctions, persistent fever, &c. Approximate duration: 18 weeks. Bacteriology: Strepto-diplococcus isolated from valves. Result: Death. Malignant mitral and aortic, recent pericardial adhesion, white infarctions in spleen and kidneys. No. 2. Male, aged 13. History of acute rheumatism at 10 years. Main symptoms of final illness : Mitral and aortic disease, transient pericarditis. Infarctions and persistent