ABDOMINAL MANIFESTATIONS OF RHEUMATIC FEVER: DESCRIPTION OF A RIGHT

T H E abdominal manifestations of rheumatic fever have been known since Andral, in 1839, called attention to the presence of abdominal pain in cases showing other evidences of rheumatic fever. The French, who were the first to study this problem, found signs and symptoms of peritoneal irritation in rheumatic fever, manifested chiefly by attacks of abdominal pain at the onset of rheumatic activity, and found that when the arthritic pains began the abdominal pains stopped and vice versa. This important association of abdominal pain and rheumatic fever has largely escaped the attention of the internist and the surgeon. Poynton,1 in 1925, was the first to describe a chronic peritonitis in a fatal case of rheumatic fever with most of the exudate around the liver and spleen. A loud peritoneal friction rub had been heard during life. Poynton felt that no fatal case of rheumatic fever ever had acute rheumatic changes in the appendix. Paul,2 in 1930, described the autopsy findings in a rheumatic with polyarthritis, pericarditis, pleurisy, endocarditis and pain in the abdomen