Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    914/976 (page 894)
    the amount of effused fluid is large, there is increased dulness of the percussion note over the cardiac region, and the heart’s sounds are diminished in intensity, and heard as if from a distance. When, on the other hand, the endocardium is implicated, abnormal heart sounds are produced usually at the aortic or mitral valves, giving rise to basic or apex systolic murmurs; or, if the closure of the aortic valve becomes imperfect, a basic diastolic murmur is also developed. These various phenomena are due to the pouring out of lymph and serum upon the surfaces of the pericardium, or the secretion of plastic lymph or fibrinous coagula upon the valves of the heart. When the cardiac substance is involved, great irregularity and extreme feebleness of the action of the heart ensue, often leading to sudden and fatal collapse. For further details concerning the physical signs and symptoms which occur in pericarditis and endocarditis, the reader is referred to the articles devoted to the diseases, as these affections when they arise from rheumatic inflammation, follow the same course and exhibit the same phenomena as when due to other causes. Pleurisy of a true rheumatic nature sometimes occurs during the progress of rheumatic fever, and the phenomena are the same as in the ordinary forms of acute pleuritis. More rarely the peritoneum becomes affected by rheumatic inflam- mation. When the heart is implicated, delirium is usually present, especially at night; but in some few cases, the rheumatic inflammation may attack the membranes of the brain, and then all the symptoms of cerebral meningitis are produced. Sometimes the membranes of the spine are involved, and spinal meningitis is set up. Chorea is apt to supervene in young subjects after the cessation of the febrile disturbance in rheumatic fever, where the heart has been implicated. Description of Sub-acute Articular Rheumatism.—At times from various causes, as the nature of the patient’s constitution, or the presence of cardiac complication, articular rheumatism assumes a form to which the name sub-acute may be properly applied; the joint symptoms remain, but in a much less severe degree, and there is an almost, complete absence of febrile disturbance. Such a condition may continue for weeks or even months, at one time relieved, at another aggravated, and the disease may then be compared to a similar sub-acute form not infrequently seen in gout, and to which the term chronic is applied. In sub-acute rheumatism there is often some tenderness of the joints, slight swelling, and heat, but the disease differs from both chronic gout and rheumatoid arthritis, inasmuch as it may continue for a long time without leading to any great deformity or permanent injury to the articulations. , . It will be seen that the statements above made are at variance with those commonly met with in works on this disease, in which the results ascribed to the sub-acute affection are so formidable. This