A research upon combined mitral and aortic disease of rheumatic origin : a contribution to the study of rheumatic malignant endocarditis / by F.J. Poynton and Alexander Paine.

  • Frederic John Poynton
Date:
1912
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Licence: In copyright

Credit: A research upon combined mitral and aortic disease of rheumatic origin : a contribution to the study of rheumatic malignant endocarditis / by F.J. Poynton and Alexander Paine. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    18/40 (page 478)
    Escaw.ple HE Again, a girl of nine years had been ill four months with moderate and persistent fever. Polyarthritis had developed early in the illness and passed off; then severe mitral and aortic disease developed, with an enlarged spleen and multiple embolisms. After death, malignant aortic and mitral endo- carditis was present. We are quite aware, as one of the cases we have chosen has illustrated, that a polyarthritis in a child need not he rheumatic. A transient affection of the joints such as occurred in the above case is, however, much more suggestive of acute rheumatism than any other disease. When a series of cases of this kind is studied and all the evidence we have put forward deliberately weighed, we believe that we are justified in asking that those who dispute the nature of such an arthritis and endocarditis should produce definite facts in support of their contention, and not generalize from the well-known fact that there are many causes of arthritis. We repeat that the preceding cases have been quoted in order to show that now that we are dealing with examples of malignant endocarditis which have not been completely investigated we have not assumed that they are necessarily rheumatic, but have balanced the evidence both for and against this view. The appended list from our series given in brief will enable the reader to form his own opinion upon the value of our evidence. We may add that nine examples of malignant endocarditis have been excluded because they were obviously the result of other infections, and fifteen were of uncertain nature and open to grave criticism. It is very interesting to find in the list below all grades of virulence in the rheumatic process, and there are some cases which lead us to the next group. This is, we admit, quite an artificial one and called by us transitional because it bridges over the gap between the certainly malignant and the third group, which contains examples of acute rheumatism showing damage to the mitral and aortic valves of the simple type. As we pass to the transitional group the conclusive evidence becomes more and more difficult to obtain, because recovery is more likely to occur, and among these examples it may well have been that some were in reality of the malignant type and others of the simple. It is, if our view is correct, much more scientific to abandon these two terms simple and malignant and to substitute for them active rheumatic endocarditis. Such a term is much more satisfactory from every point of view, for it is less alarming to the patient; it represents more accurately^ the true pathology and in no way blinds our eyes to the meaning of this activity when it reaches the degree in which the embolic phenomena and consequent systemic poisoning show that life is clearly threatened. Possibly the objection may be raised that such a condition of malignancy is utterly unlike any other manifestation in rheumatism, but we would point out that no other severe lesion in this disease could run a parallel course, however malignant it might be, for no other rheumatic lesion stands in the same x-elation to the general blood stream. Thei’e is a statement that has been made about the relation of an attack of malignant endocarditis to previous rheumatic heart disease which we would