Chorea gravidarum / by Herbert French and H. T. Hicks.

  • French, Herbert Stanley, 1875-1951.
Date:
1906
Catalogue details

Licence: In copyright

Credit: Chorea gravidarum / by Herbert French and H. T. Hicks. 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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    different sources in the literature. It is natural that the milder cases escape from such statistics, because they would not seem to be of sufficient interest to be published indi- vidually. We think that cases from the same hospital, taken consecutively, afford a better basis for determining the mor- tality, even though the numbers dealt with are much smaller than those in some previous papers. Even with hospital patients, it must be remembered that all the more serious cases will be admitted, whereas some of the milder ones may be seen only in the out-patient depart- ment. This would tend to render the mortality amongst our cases, who were admitted to the wards, higher than it ought to be. Even so, we have only 3 deaths out of 29, or 10 per cent. In our last case it will be seen that there was evidence of the chorea being possibly a post-hemiplegic condition from already existing fungating endocarditis and cerebral embolism. The clinical condition was one of fungating endocarditis. If this exceptional case be excluded, the mortality is 2 in 28, or only 7 per cent. The Importance of Pyrexia. There is one point which we think very important, and one to which we cannot find attention drawn in the litera- ture ; and that is the significance of pyrexia in the prognosis of chorea gravidarum. As will be seen, on referring to the abstracts of cases, not a single one of the 26 patients who recovered had temperatures above 990 F. In the majority, indeed, the temperature was slightly subnormal. In all the fatal cases, on the other hand, there was marked pyrexia (vide charts) ; in one case persisting for over four weeks ; in another for one week ; and in both cases preceding the birth of the foetus. That the intra-uterine death of the child need not be the cause of pyrexia is shown by cases 20 and 21, where there was no pyrexia, although the foetus had been dead in utero, and in one case was macerated. Our cases are too few to generalise upon, but so striking is the presence of pyrexia in our fatal cases, and its absence in those which recovered, that we consider that a rise of tempera- ture above ioo° F. in a patient suffering from chorea gravidarum