Rheumatism, gout, and some allied disorders / by Morris Longstreth, M.D.
- Longstreth, Morris, 1846-1914
- Date:
- 1883
Licence: Public Domain Mark
Credit: Rheumatism, gout, and some allied disorders / by Morris Longstreth, M.D. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
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![mation—severe as evidenced by the quantity of the valvular murmur—be comparatively comfortable and the pain due to the heart-lesion be infinitely less than the articular suffering. The patient may not know of the new malady, although the physician recognizes, from the physical signs, the grave peril threatening the valvular structures. This relation of affairs to the condition of the patient is explainable on an anatomical basis. The space over which the lesion extends in endo- carditis is excessively limited, while in pericarditis it is usually coextensive with the large area of the 2)ericardiao sac. It is natural for the more widely extended inflammation to be attended with effects more perceptible to the patient. It is not infrequent to discover an endocarditis unexpectedly, by its phj-sical signs. A ]Dericarditis makes itself known by its symptoms. In respect to inflammation of the muscular substance of the heart, in connection with acute rheumatism, our information is quite scanty and wholly incomj)lete for the purpose of its clinical recognition. In a severe form, or occurring independently of the other two lesions, it is certainly infinitely more rare than either of them. As already said, its api^earance coexistently with these lesions, to a gi-eater or less degree, nearly always takes place. Post-mortem evidence shows that the inflam- mation of the pericardium extends to and affects the muscular substance of the heart; in endocarditis it does likewise, though much less frequently. The cases are very rare—in fact, I have only met with one or two un- doubted instances—where the inflammation could be looked upon as a primary disease of the muscular tissue. The myocarditis, coexistent with the serous inflammations, must un- questionably intensify the symptoms of those lesions, but to precisely what degree is uncertain, since the symptoms of the muscular inflamma- tion are themselves unknown. Time of their Occurrence and Concurrence.—A question of very great im- portance is the time which these lesions manifest themselves in the course of acute rheumatism. It is now a general belief that the cardiac localiza- tion does take place, in certain cases of rheumatism, prior to the advent of the articular inflammation. In fact, some writers hint at cardiac disease of a rheumatic character, unattended throughout with joint manifestations, and even without any general symptoms. If this were true it might serve to explain the origin of many cases of valvular heart disease, or of pericar- dial alterations from which can be elicited no history of acute cardiac symptoms or of other acute disease.](https://iiif.wellcomecollection.org/image/b21445333_0138.jp2/full/800%2C/0/default.jpg)
