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.

    919/976 (page 899)
    between Rheumatism, and cardiac disease was also known to Dr. Wells, Dr. Baillie, and others. The heart affection, however, was regarded by these authors rather as the effect of a metastasis of the rheumatic inflammation from the joints to this organ, than as an essential part of the disease itself. Some Drench authors claim the merit of the discovery of the close relationship for M. Bouillaud, who in his work, published in 1840, called especial attention to the coincidence of pericarditis, endocarditis, and pleurisy with acute articular rheumatism. Since the above period, the relationship has been fully determined, and these diseases are now looked, upon as portions of the rheumatic affection, and not as mere accidental complications. There is considerable discrepancy of opinion among different authors as to the kind of cases of rheumatic fever in which cardiac inflamma- tion is most likely to occur. Some are of opinion that even in the slightest forms of the disease, when febrile disturbance is moderate, the structures of the heart may become seriously affected. Others think that the liability to the heart disease is far greater in the severe forms of articular rheumatism; and that even when the joints are not much implicated, still the systemic disturbance is always great, and the peculiar phenomena of the disease strongly marked. As far as my own. experience goes, it amounts to this, namely, that although the severer forms of the articular disease are very apt to be complicated with cardiac inflammation, yet even in the very slight forms, measured by the febrile and joint symptoms, serious mischief may arise in the heart, and several such cases have come under my own observation. When the heart is much influenced, this will of itself be a source of great constitutional disturbance. It is supposed by some pathologists that the vegetations which take place on the valves of the heart are not always due to endocardial inflammation, but may arise entirely independently of such, and are owing rather to an altered state of the blood itself. It is a matter of extreme difficulty to determine the relative fre- quency of the cardiac affection in rheumatic fever; in young subjects the heart is much more prone to be attacked than in adults ; the kind of treatment adopted in the early stages appears likewise, from the statistics of Dr. Dickinson, to have a considerable influence upon the result. Bouillaud thought the heart became affected in one half of the cases, but Dr. Macleod in about one fifth only. / Morbid Anatomy of Articular Rheumatism.—The opportunities of examining joints affected with rheumatic inflammation are not numerous, as the articular affection never kills, and a fatal termination, even when the heart or other important organ is attacked, is fortu- nately rare. In a few instances, where death has occurred when inflammation of the joints was actually present, I have found con- siderable redness of the synovial membrane, and increased vascularity of the synovial fringes; an augmentation of the synovial fluid and sometimes little gelatinous coagula of fibrin; under the microscope