II
A Suggestion in Regard to Preventive Treatment of Valvular Disease
I have referred to certain facts, mostly of recent discovery, bearing on the existence of our profession in the remote past and in reference to the partial knowledge to which the priests of I-em-hotep attained as to the circulation of the blood, a subject not without a certain interest, but the advances of that knowledge made subsequently, which have on more than one occasion been dealt with in this room, those now making, and those yet to be made in the future are of more practical importance to us.
The genius and the marvellous industry of Harvey first clearly unfolded the great secret of the course of the circulation, thus opening a wide door for the work of others, physiological and therapeutic. A recognition of the principles of blood pressure, and of the action of vasomotor nerves, and other advances have followed. We have attained to a larger, though I believe as yet only to a partial and provisional, hold of truth in these matters. As such we shall regard our knowledge if we are wise. The great mistake in all times has been that of believing that the truth already attained is the whole and that nothing remained behind.
Our Egyptian and our Greek predecessors seem to have believed that they had attained to absolute and final knowledge on these subjects. While we smile at their error, let us be humble in estimating our own position and ever remember that we ourselves may be yet barely on the threshold.
Our father, Harvey, has exhorted us ever to search and to study out the secrets of nature by the way of experiment. Will you pardon me if I devote the remainder of this paper to an account of a humble attempt to carry out his mandate, if I narrate briefly an experiment dealing with a yet unsolved problem in the pathology of the circulation, to which I have devoted twenty-five years of my life?
I may plead the usage of speakers and writers who follow a tale or narrative by a moral or practical application, and perhaps I may also be allowed to say that the discovery that ancient Egyptian physicians advocated rest in certain forms of heart disease suggested to me the propriety of supporting this doctrine by a brief narration of my own experience in the same direction.
As the Egyptians were probably ignorant as to the action of the valves of the heart, they can only have known the fact that rest was beneficial, but not the reason.
Valvular defect is one of the most important and perhaps the most common of circulatory diseases. It is one which probably we shall never be able to cure, and is thus likely to remain one of the opprobia of medicine. Is it possible to treat it by prevention? This is the problem upon which I wish to speak a few words. I am the more encouraged to do this because I know that various Fellows and Members of this College hold similar views to those which I desire to unfold.
Joints recover: Why does the Endocardium fail to do so?
There are in this audience many who have treated cases of acute rheumatism and cases of valvular disease in hundreds of instances. We are all aware that in acute rheumatism, however severe the joint lesion may be, however great the swelling, the pain, the local pyrexia, and the effusion, in the large majority of cases, after the usual treatment all these grave symptoms subside, or if they linger in any joint many of us know how certainly they will vanish if we stimulate the trophic and vasomotor nerves by small blisters applied to the adjacent skin, the final issue in most cases being the restoration of every joint to a normal condition. But, alas, we also know that when the endocardium covering the mitral or aortic valve cusps is in like manner attacked, a like restoration does not take place spontaneously excepting in few and rare instances. When regurgitation through the valve, shown by an apex bruit with accentuation of the second pulmonary sound, has occurred in acute rheumatism, if after treating the rheumatism we leave the affected heart to its own course, and the patient to his, persistent bruit, persistent pulmonary accentuation, hypertrophy, dilatation—in fact, life-long heart disease and its train of attendant evils follow in a large majority of cases, and mar or shorten life. Why should the rheumatic heart be so much more intractable than the rheumatic joint?