The work reflects the author’s great experience and that of his collaborators at the Research Institute of Paediatrics in Sofia. It also contains the most modern medical achievements on the problem of rheumatism.
The book consists of four main parts:
- Etiology and pathogenesis of rheumatic fever.
- The nature of rheumatic disease.
- Diagnosis and differential diagnosis.
- Treatment and prophylaxis.
Chapter «Etiology and Pathogenesis of Rheumatic fever»
In the chapter «Etiology and Pathogenesis of Rheumatic fever», the connective tissue structure and some of its fundamental processes are examined in a present day light. The biochemistry of the ground substance, permeability regulation and the role of the two basic enzyme systems — the mucolytic and proteolytic have received a particular attention.
The study on the three humoral rheumatic syndroms: dysfermentia, dyscorticia and dysproteinemia are extensively developed, and widen by the results of some personal research.
The role of the allergic aspect in the pathogenesis of rheumatism is looked into the light of the latest research, and anlarged by personal research illustrating the role of the streptococcal antigens.
Side by side with the indisputable pathogenic role of the streptococci there are problems in the etiology of rheumatism which are still unsolved. They require, that research for additional etiologic factors should be made more thorough and estended. The participation of the viral infection as a factor is worth examining. The latter problem has been discussed in the works of Soviet writers.
Chapter «Nature of the Rheumatic Disease»
The chapter «Nature of the Rheumatic Disease», deals with there fundamental aspects of the disease:
- The systematic aspect of the rheumatic process. The author proceed, from the assumption that the disease involves all human organs. The histologic and functional changes in each organ and their clinical appraisal are described considering at the same time personal experience and literary data.
- The interrelation between rheumatic process and additional infections. By numerous data, the role of the rheumatic process as conffring a tendency to disease caused by different additional infections as well as their more peculiar course is elucidated. The great significance of such infections on the nature of rheumatic disease and its dynamics is underlined. The author explains the clinical aspect of rheumatic disease as a complex relation between the disease and additional infections. A number of rheumatic disease symptoms (persistent subfebrile condition, skin and annular eruptions, hematuria, etc.), are determined by the accompanying focal and intercurrent infections developing on a rheumatic background.
- The development of rheumatic disease. Two peculiarities of the rheumatic process dynamics are pointed out: a) its chronical, and b) its undulant course. So these specify rheumatism as a chronical and long time disease of different phases of development. The nature of the attack, the period between two attacks as well as the period after the attack, is described. In contrast to the majority of writers, the latter, is defined as a tranquil period. The uneven course of the disease observed during this phase in a great number of cases is considered out of the way, and it is caused by various additional agents - for the most part chronical (focal) and intercurrent infections.
The author examines the changes of recent years in the rheumatic clinical manifestations, emphasizing at the same time on the following peculiarities:
- a relative increase in the number of sick children of the younger age group;
- decrease in the relative portion of the polyarthric tic types and an increase in that of cases with rheumatic heart disease heart;
- a more favourable course of the rheumatic disease.
Chapter «Diagnosis and Differential Diagnosis»
In the chapter «Diagnosis and Differential Diagnosis», the author considers in detail the diagnostic potentialities of various clinical and laboratory signs. The attempts of certain writers (Jones and others) to reduce the complicated and varied rheumatic clinical picture to a simplified schematizing is criticized. The «major» group indices are analyzed and the decrease in their value during recent years as related to changes of the rheumatic clinical picture is underlined. Underestimating of the «minor» group, especially those of the biochemical indices, is disputed. A number of diagnostic errors ensuing as a result of underestimating some symptoms and overestimating others are pointed out.
Chapter «Treatment and Prophylaxis»
In the chapter «Treatment and Prophylaxis», the most modern achievements on the subject of rheumatism are advanced. A critical attitude is taken against many authors one-sided enthusiasm by accepting certain methods of treatment and prophylaxis which have acquired great popularity in medicine (hormonal treatment & penicillin prophylaxis). The important role of physical factors like curative exercises, physiotherapy and physioprophylaxis is emphasized. The author maintains that in solving the rheumatic problem, the only proper methods are - the complex treatment and complex prophylaxis.
A number of organizational undertakings are recommended for the most proper daily regimen of the sick child as well as the most useful school activity organization for the rheumatic student and utilizing of both physical and resort factors. A number of well-tried methods of curative exercises, balneotherapy and physiotherapy are applied.