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.

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    A RESEARCH UPON COMBINED MITRAL AND AORTIC DISEASE OF RHEUMATIC ORIGIN. A CONTRIBUTION TO THE STUDY OF RHEUMATIC MALIGNANT ENDO- CARDITIS By F. J. POYNTON and ALEXANDER PAINE With Plates 27-29 Section I. (a) Object of the communication. We return in this investigation to the consideration of the second statement that we made in our paper upon the causation of acute rheumatism published in the Lancet in September, 1900. This statement was to the effect that acute rheumatism produces a malignant as well as a simple endocarditis. At the outset we would insist upon the exact wording of this assertion in order to avoid the mistake being made that we are thought to maintain that rheumatism is the only cause of this condition. It has been repeatedly proved that there are many causes of malignant endocarditis, and we would venture to make the generalization that any infection which attacks the valves of the heart may produce this lesion, and to express our belief that when an infection which only produces endocarditis exceptionally does happen to attack the valves then the malignant form of endocarditis is prone to result. On many previous occasions we have commented upon the peculiar attitude that has been adopted to rheumatism, in that it has been almost universally taught that it is a cause of simple or healing endocarditis, but needs the assis- tance of a secondary infection to produce the malignant form. Surely this is a curious example of seeking a difficult path, when the plain and easy one lies before us. In this paper we are approaching our subject from a somewhat different point of view to that from which we dealt with it in a former paper (‘ A con- tribution to the study of malignant endocarditis,’ Medico-Chirurgical Transac- tions, Yol. 85, 1903), for we are here studying a form of heart disease which we believe every one must allow may be the result of the rheumatic infection itself and not of any added infection. In the course of this communication we shall quote from our former paper which established certain facts that may be lawfully utilized to illustrate our present contention, which is to this effect: That from a study of severe heart [Q. J. M., July, 1912.]