ON THE SIGNIFICANCE OF THE SUBMILIARY MYOCARDIAL NODULES OF ASCHOFF IN RHEUMATIC FEVER

Abstract

1. In rheumatic myocarditis, foci, termed submiliary nodules of Aschoff, are present which are characteristic of the rheumatic infection. 2. They are most frequently found in the walls of the left ventricle, the auricles usually escaping. 3. The nodules were found in three cases of chorea without joint manifestations, proving the close relation of this condition to rheumatism. 4. They were absent in fourteen cases of subacute bacterial endocarditis due to Streptococcus mitis. 5. They were not found in infections of the endocardium with the gonococcus, staphylococcus, streptococcus, or pneumococcus. 6. Even in the absence of a rheumatic history we believe, in accordance with Fraenkel, that the presence of Aschoff bodies signifies a previous rheumatic infection. 7. Aschoff bodies are not always found in rheumatic carditis, where the infection antedates death by a long period, but the healed remains, represented by sclerotic patches ("Schwielen"), are present. 8. We suggest that the cases of arthritis characterized by the presence of the submiliary nodules of Aschoff in the myocardium be placed in one group and called for the time being "rheumatism"; and the cases with articular manifestations, yielding positive bacteriological findings and no Aschoff bodies, should be classified according to the infecting microörganisms concerned, and not as rheumatism.