THE ACTION OF THE SALICYL COMPOUNDS IN THE HEART COMPLICATIONS OF RHEUMATISM.
In its general pathology, rheumatism of the heart is identical with rheumatism of the joints. The poison is the same ; the textures which chiefly suffer are the same; and there is no difference in the mode in which the poison acts. The morbid process is, therefore, fundamentally the same in both.
Such being the case, it is natural to suppose that both should yield to the same treatment, and that the beneficial results which fol low the administration of the salicyl compounds in rheumatic inflam mation of the joints should equally follow their administration in rheumatic inflammation of the heart. And such no doubt would be the case, if the heart were in all respects similarly situated to a joint. But it is far from being so; for though in their general pathology the two are identical, there exist between them several important differ ences, the recognition of which is essential to the formation of a just estimate of the respective value of the salicyl compounds in the treat ment of each.
In both heart and joints it is the fibrous textures which suffer first and chiefly. In both heart and joints these textures have the same duties to perform—they regulate movement and resist strain. The chief difference to be noted between them is in their relative func tional activity. A joint acts only occasionally, never for more than a few hours in succession, and gets complete rest for many hours every day. The heart gets no rest, but beats on by day and by night.with out cessation or repose. This physiological difference exercises a vast and important influence in disease, and especially in such acute inflammation as that which now engages our attention.
To an inflamed organ rest is of the utmost importance. If a joint is inflamed it becomes painful; motion increases the pain; instinc tively we give it rest, and its function is in abeyance till the inflam mation is at an end. If a man suffering from rheumatic inflamma tion of the knees and ankles were to persist in going about as usual (supposing such a thing to be possible), he would thereby prevent recovery. The salicyl compounds might be given so as to destroy
the rheumatic poison, but the continued exercise of the inflamed tex tures would keep up the inflammation, independently of the cause which originally set it agoing, and they would probably not recover till they got rest.
When the heart is inflamed it gets no rest; no matter what the consequences to itself, its work has to be done; and clone it is, so long as life lasts. The fever of the accompanying joint affection, as well as the inflammation of its own textures, causes increased excita bility and increased frequency of action, so that instead of rest there is greater activity—instead of its function being in abeyance it is exalted. This it is which makes the chief difference between the results of rheumatic inflammation of the heart and similar inflamma tion of a joint; and this it is which makes the heart trouble so much less amenable to treatment.
In considering the question of their respective amenability to treatment it is essential that this should be borne in mind, and that the results of the inflammatory process should be distinguished from those directly due to the action of the rheumatic poison. The de struction of the rheumatic poison must put a stop to its direct action on the heart as well as the joints. But to do this is quite a different thing from removing the morbid products resulting from that action. It is a step, and a very important one, toward that end; but some thing more is requisite to its complete attainment. For this the in flamed textures should have rest. In the joints this is easily got; in the heart it is unattainable. The inflamed valves continue to be strained, their roughened surfaces continue to nib, the friction keeps up the irritation, and restoration to the normal is thus rendered very difficult.