Henry Baird Favill, AB, MD, LL.D., 1860-1916, a ... - University Library

156 HENRY BAIRD FAVILL
coincidence is not ready, and when one considers that the
various morbid outbreaks in a number of these cases were
separated by long intervals, it is with hesitation that one
concludes that there is
a causal relation.
Let us digress for a moment and observe what is true of
endocarditis. That it may be due to infective invasion, in
the course of various diseases, there is no question; that it
may be due to participation in the reaction to the morbific
agent of rheumatism there is no question. Whether, in
pursuance of the suggestions therein contained, rheumatism
is an infection is beside the point. We see that endocarditis
is associated with rheumatism. Is it a complication? By
no means. It is rheumatism. Nothing is more important
than that we divest ourselves of the idea that endocarditis
is a sequel of rheumatism. Often, very often, in children,
it is the only manifestation of rheumatism, and more often
the arthritis that coexists or precedes is so slight as to escape
attention. Likewise, with enormous frequency, the endocarditis
escapes attention in the absence of arthritis.
The observation is well verified that endocarditis is essentially
the rheumatism of the young. Yet what is the relation
between the cardiac and arthritic manifestations?
Gradually evidence is accumulating that rheumatism is a
septic process; whether of one form of coccus or another
does not matter to us at this time. The fact, if established,
will serve to simplify and harmonize the relationship between
the joint and cardiac lesions.
The known relation of cardiac disease to septic and infective
processes has logically demanded such a nature for
rheumatism as a causal antecedent or collateral process.
The toxic foundation of rheumatism, though by no means
disposed of by such demonstrations, receives an important
coordinate factor. Manifestly, if it is demonstrated that
the arthritis as well as the endocarditis is of infective
origin, the problem will still be open. Is there an underlying
toxemia? Clinical observations, it seems to me,