Transactions of the international Medical Congress : seventh session held in London, August 2d to 9th, 1881. Diseases of children / prepared for publication under the direction of the Executive Committee by Sir William Mac Cormac ; assisted by George Henry Makins and H. B. Donkin, R. W. Parker.

  • International Medical Congress 1881 : London)
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Transactions of the international Medical Congress : seventh session held in London, August 2d to 9th, 1881. Diseases of children / prepared for publication under the direction of the Executive Committee by Sir William Mac Cormac ; assisted by George Henry Makins and H. B. Donkin, R. W. Parker. Source: Wellcome Collection.

    124/258 (page 104)
    Finally, I believe that from the analysis of these cases the following con- clusions may be drawn :— 1. —That a murmur was present in more than half the cases of chorea. 2. —That the murmur, in all except one case, was due to endocarditis affect- ing almost exclusively the mitral valve. 3. —That in GO per cent, for certain (and in over 80 per cerft. possibly) the heart lesion persisted. 4. —That absence of murmur is no proof of absence of organic heart disease. 5. —That rheumatism had pre-existed in nearly half the cases, and that there are strong grounds for believing that it had been an antecedent in a very much larger proportion of cases. G.—That no other very frequent exciting cause of endocarditis is shown to have pre-existed, or to have been more frequent amongst the non-rheumatic than the rheumatic. 7. —That the form of heart disease is that seen in connection with rheuma- tism. 8. —That rheumatism is in nearly all cases the cause of the heart murmur which so frequently attends chorea. APPENDIX. Cases of Chorea examined with reference to the condition of the heart at periods of from one to five years subsequent to the attack for which they were in the London Hospital. Left Hospital in 1876— (Five Years). No. Name. Age. Condition of Heart on Leaving. Present Condition of Heart. I M. L. . . 29 Systolic at apex. Occasional reduplication of first sound, which is rather prolonged at apex; soft blow over pulmonary artery. 2 A. L. . . 12 Mitral diastolic. No bruit; reduplication of first sound at apex. 3 A. W. . . 15 Mitral systolic. No bruit ; apex beat in 5th space, dif- fused, moderately strong. ^ 4 F. A. . . 16 Mitral systolic. First sound murmurish, occasionally developing into bruit; apex in nipple line. 5 G. F. . . 9 Systolic at apex. Sounds normal, beat normal. 6 K. A. . . 8 Mitral systolic. i Left Hospital in 1878- Systolic at apex, second sound intensi- fied at base; beat in 4th and 5th spaces nipple line. [Three Years). 7 S. N. . . 14 Systolic at apex. Soft systolic at apex, intensified on ex- ertion ; apex beat in 4th space and nipple line, slightly heaving. 8 A. W. . . 10 Mitral systolic. Murmurish first sound at apex, especi- ally on exertion; accentuated second sound. 9 C. W. . . 16 Systolic at apex. Died of heart disease in 1881. Had subcutaneous nodules. 10 H. B. . . 9 Mitral systolic, which disap- peared. Died of heart disease in 1881. 11 M. A. W. . 10 Systolic and (?) presystolic at apex. Loud systolic at apex ; maximum in- tensity in 3d space; second sound intensified and occasionally redupli- cated.