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Skin sensitivity of rheumatic subjects to streptococcus filtrates
Department
of Reviews Selected
and Abstracts
Abstracts
Palmer, Robert S., and White, Paul D.: A Note Murmur Heard in the Supra and Infraclavicular brium Sterni in Children. New England J. Med.
on the Continuous Fossae and Over 199: 1297, 1928.
Humming the Manu-
Fourteen cases showing the eontinuous humming murmur best heard on the right side of the neck also heard in the infraclavieular fossae over the manubrium sterni and sometimes on the left side of the neck, have been reviewed In this in order to call attention to a common physical sign in childhood. series of fourteen cases, patent ductus arteriosus was wrongly considered three times and aortie regurgitation was wrongly considered twice. When the chin is raised and turned to the left this murmur will often be heard in children when otherwise it is not present. It may be heard by this maneuver in some adults. Although most writers hold that the murmur arises in the veins, this theory is not yet proved. The fact that it is like the murmur of patent ductus arteriosus, the observation that it does, in some cases, persist in spite of occluding the vein, and its great variability in intensity with respiration require further study and observation to determine the exact mechanism of the production. It is possible, as Laennec first thought, that the murmur may arise in the arteries. At any rate the air spaces probably play an jmportant rXe, whatever the vascular origin. Lawson,
George
Endocarditis
M.,
and
At the Massachusetts bacterial endocarditis has years, a third case is age A very unusual case of valvular damage in a of the colonies cultured to the subacute bacterial Irvine-Jones, coccus
Palmer,
in Childhood.
Edith, Filtrates.
New
Robert S.: Occurrence England J. l\led. 199:
of Subacute 11’05, 1928.
Bacterial
General Hospital, the earliest age at which subacute occurred is six years and the next earliest is eight ten years. of Streptococcus viridans septicemia without evidence child twenty-one months is reported. The appearance from the blood of this cast suggests that it belongs group.
I. &I.: Skin Sensitivity of Rheumatic Arch. Int. Med. 42: ‘754, 19%.
Subjects
to
Strepto-
The author based her study on a varied group of streptococci obtained from the upper respiratory tract of rheumatic subjects and contrasted the findings with the culture group from nonrheumatic individuals. The organisms were classed according to their reactions on blood agar, according to their fermentation tests and according to the skin reactions obtained when filtrates of the strains were injected intradermally into rheumatic and nonrheumatic subjects. Correlation with the Dick test enabled the strains to be differentiated from scarlatinal forms of streptocoeei. It was found that the series of organisms from rheumatic sources were very similar culturally and immunologically to those from normal individuals but 369
370
THE
dMERICAN
IIEhRT
JOURNAL
that skin sensitivity to filtrates from either series of strains was very much This inmore marked in rheumatic individuals than in the control subjects. creased sensitivity of rheumatic subjects was more clearly demonstrated with the anhemolytie than with the hemolytic forms. The skin sensitivity was most marked in subjects during the acute phases of rheumatism, negative reactions frequently occurring as convalescence was established. The author followed certain rheumatic subjects for a considerable period of time and was able to correlate the changes in the intradermal injection with the clinical condition of the subject and analogy could thus be drawn between her findings and those of Dochez and Stevens on experimental allergy. The author concludes that rheumatic fever is an allergic manifestation due to streptococci occurring in predisposed individuals. The evidence would point to a heterogeneous group rather than one particular strain of streptococcus as being responsible for rheumatic fever. Clawson,
B. J.:
Experimental
Rheumatic
Arteritis.
Arch.
Path.
6: 947,
1928.
In this paper a description is given of certain arterial lesions that were produced experimentally. Streptococci had been repeatedly injected into monkeys in an effort to produce glomerulonephritis. Microscopic examination showed in the kidneys of two of the monkeys vascular changes which bore a resemblance to the lesions described by Iilotz and Pappen.heimer and von Glahn. The t!vo monkeys had receive4 intravenous inject,ions of strains of Streptococcus viridans, isolated from the blood of patients having acute rheumatic fever. In another series of experiments in which many rabbits had had streptococci injected intravenously or subcutaneously in the effort to produce, experimentally, Asehoff bodies and subcutaneous rheumatic nodules, similar examples of arteritis were noted. This artcritis was commonly found in the hearts of rabbits into which streptoccocci had been injected intravenously, and practically always in the subcutaneous tissues of rabbits into vvhich the streptoeeocci had been injected subcutaneously. The result of these experiments show-cd that by injecting streptococci into rabbits and monkeys lesions could commonly bc produced in man which morphologically appeared similar to the rheumatic lesions in many. The morphology of the cellular reaction in this experimental arteritis was similar to that found in the Asehoff nodule and in rheumatic inflammation in other parts of the body. Clawson, B. J.: 6: 565, 19’8.
Experimental
Subcutaneous
Rheumatic
Nodules.
Am.
J.
Path.
In this paper a microscopic study is made of human subcutaneous rheumatic nodules and of the nodules produced experimentally in the subcutaneous tissue in rabbits by injecting streptococci. The purpose is to compare the structure of a known rheumatic lesion with that of a lesion which has been produced experimentally to arrive at further conclusions concerning t,he casual relation of streptococci to rheumatic injections. The nodules were produced in the subcutaneous tissues of rabbits by inin varying amounts and at different jecting different strains of streptococci Five different strains of streptococcus intervals under varying conditions. were used. Two of these were isolated from the blood of patients having acute rheumatic fever, one from the blood of a patient with subacute bacterial endocarditis and two from pus from sinuses in cases of sinusitis. Ten rabbits were injected intracutaneously and subcutaneously in many places with these organisms. Most of the animals had been previously injected
of Reviews Selected
and Abstracts
Abstracts
Palmer, Robert S., and White, Paul D.: A Note Murmur Heard in the Supra and Infraclavicular brium Sterni in Children. New England J. Med.
on the Continuous Fossae and Over 199: 1297, 1928.
Humming the Manu-
Fourteen cases showing the eontinuous humming murmur best heard on the right side of the neck also heard in the infraclavieular fossae over the manubrium sterni and sometimes on the left side of the neck, have been reviewed In this in order to call attention to a common physical sign in childhood. series of fourteen cases, patent ductus arteriosus was wrongly considered three times and aortie regurgitation was wrongly considered twice. When the chin is raised and turned to the left this murmur will often be heard in children when otherwise it is not present. It may be heard by this maneuver in some adults. Although most writers hold that the murmur arises in the veins, this theory is not yet proved. The fact that it is like the murmur of patent ductus arteriosus, the observation that it does, in some cases, persist in spite of occluding the vein, and its great variability in intensity with respiration require further study and observation to determine the exact mechanism of the production. It is possible, as Laennec first thought, that the murmur may arise in the arteries. At any rate the air spaces probably play an jmportant rXe, whatever the vascular origin. Lawson,
George
Endocarditis
M.,
and
At the Massachusetts bacterial endocarditis has years, a third case is age A very unusual case of valvular damage in a of the colonies cultured to the subacute bacterial Irvine-Jones, coccus
Palmer,
in Childhood.
Edith, Filtrates.
New
Robert S.: Occurrence England J. l\led. 199:
of Subacute 11’05, 1928.
Bacterial
General Hospital, the earliest age at which subacute occurred is six years and the next earliest is eight ten years. of Streptococcus viridans septicemia without evidence child twenty-one months is reported. The appearance from the blood of this cast suggests that it belongs group.
I. &I.: Skin Sensitivity of Rheumatic Arch. Int. Med. 42: ‘754, 19%.
Subjects
to
Strepto-
The author based her study on a varied group of streptococci obtained from the upper respiratory tract of rheumatic subjects and contrasted the findings with the culture group from nonrheumatic individuals. The organisms were classed according to their reactions on blood agar, according to their fermentation tests and according to the skin reactions obtained when filtrates of the strains were injected intradermally into rheumatic and nonrheumatic subjects. Correlation with the Dick test enabled the strains to be differentiated from scarlatinal forms of streptocoeei. It was found that the series of organisms from rheumatic sources were very similar culturally and immunologically to those from normal individuals but 369
370
THE
dMERICAN
IIEhRT
JOURNAL
that skin sensitivity to filtrates from either series of strains was very much This inmore marked in rheumatic individuals than in the control subjects. creased sensitivity of rheumatic subjects was more clearly demonstrated with the anhemolytie than with the hemolytic forms. The skin sensitivity was most marked in subjects during the acute phases of rheumatism, negative reactions frequently occurring as convalescence was established. The author followed certain rheumatic subjects for a considerable period of time and was able to correlate the changes in the intradermal injection with the clinical condition of the subject and analogy could thus be drawn between her findings and those of Dochez and Stevens on experimental allergy. The author concludes that rheumatic fever is an allergic manifestation due to streptococci occurring in predisposed individuals. The evidence would point to a heterogeneous group rather than one particular strain of streptococcus as being responsible for rheumatic fever. Clawson,
B. J.:
Experimental
Rheumatic
Arteritis.
Arch.
Path.
6: 947,
1928.
In this paper a description is given of certain arterial lesions that were produced experimentally. Streptococci had been repeatedly injected into monkeys in an effort to produce glomerulonephritis. Microscopic examination showed in the kidneys of two of the monkeys vascular changes which bore a resemblance to the lesions described by Iilotz and Pappen.heimer and von Glahn. The t!vo monkeys had receive4 intravenous inject,ions of strains of Streptococcus viridans, isolated from the blood of patients having acute rheumatic fever. In another series of experiments in which many rabbits had had streptococci injected intravenously or subcutaneously in the effort to produce, experimentally, Asehoff bodies and subcutaneous rheumatic nodules, similar examples of arteritis were noted. This artcritis was commonly found in the hearts of rabbits into which streptoccocci had been injected intravenously, and practically always in the subcutaneous tissues of rabbits into vvhich the streptoeeocci had been injected subcutaneously. The result of these experiments show-cd that by injecting streptococci into rabbits and monkeys lesions could commonly bc produced in man which morphologically appeared similar to the rheumatic lesions in many. The morphology of the cellular reaction in this experimental arteritis was similar to that found in the Asehoff nodule and in rheumatic inflammation in other parts of the body. Clawson, B. J.: 6: 565, 19’8.
Experimental
Subcutaneous
Rheumatic
Nodules.
Am.
J.
Path.
In this paper a microscopic study is made of human subcutaneous rheumatic nodules and of the nodules produced experimentally in the subcutaneous tissue in rabbits by injecting streptococci. The purpose is to compare the structure of a known rheumatic lesion with that of a lesion which has been produced experimentally to arrive at further conclusions concerning t,he casual relation of streptococci to rheumatic injections. The nodules were produced in the subcutaneous tissues of rabbits by inin varying amounts and at different jecting different strains of streptococci Five different strains of streptococcus intervals under varying conditions. were used. Two of these were isolated from the blood of patients having acute rheumatic fever, one from the blood of a patient with subacute bacterial endocarditis and two from pus from sinuses in cases of sinusitis. Ten rabbits were injected intracutaneously and subcutaneously in many places with these organisms. Most of the animals had been previously injected