Researches on rheumatism / by F.J. Poynton and Alexander Paine.

  • Poynton, F. J. (Frederic John), 1869-1943.
Date:
1914
Catalogue details

Licence: Public Domain Mark

Credit: Researches on rheumatism / by F.J. Poynton and Alexander Paine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    In this case, when the area of cardiac dullness was most extensive, the pericardial friction was loudest and most general. This suggests that there was probably no great excess of fluid in the pericardial cavity. The suggestion is supported by the post-mortem records of fatal cases of rheu- matic heart disease. In only 12 out of 150 cases (see Appendix C) is it definitely stated that more than two ounces of fluid were found in the pericardial cavity. By actual experiment on the cadaver we have ascertained that this quantity will not produce anything like the enlargement of the cardiac area often observed during life. Dr. Sibson found that six ounces of fluid were required to distend the pericardium in a boy of nine. If to these facts we add the clinical observation that the area of pulsation, in these cases, is usually extensive and the cardiac sounds fairly loud, we are driven to the conclusion that in the great majority of cases of rheumatic pericarditis the increase in the area of cardiac dullness is mainly due to dilatation. At first sight it might seem that the dilatation is secondary to the pericarditis, but it is much less marked in suppurative than in rheumatic pericarditis, and it is often marked in rheumatism in which no pericarditis exists. We conclude, therefore, that^the enfeeblement of the cardiac wall is mainly due to a direct toxic action of the rheumatic poison. However brought about, the dilatation is a most serious addition to the valvulitis or the pericarditis which may accompany it, and takes a very large share in the production of the dangerous symptoms usually attributed to them. Group IV. The more chronic forms of chorea and rheumatism. Careful observation of the clinical course of these more chronic cases, and comparison with the results revealed by post-mortem examination, prove that in them also dilatation of the heart is one of the most important factors. A moderate valve lesion in a child is easily and effectually compensated if no fresh incidence of rheumatism occurs. On the other hand, grave symptoms of cardiac failure in a rheumatic child are almost always accompanied by fresh rheumatic manifestations. In 100 such cases ending fatally (Appendix C) there was evidence (apart from endocarditis) of fresh rheumatism in 86. We lay special stress on this fact, for it indicates that in children the