Die Prophylaxe der rheumatischen Herzkrankheiten

  • F. Küster
Part of the Ergebnisse der Inneren Medizin und Kinderheilkunde book series (KINDERHEILK. NF, volume 16)

Zusammenfassung

Eine erfolgreiche Prophylaxe können wir nur bei Krankheiten treiben, deren Ätiologie uns bekannt ist. Das rheumatische Fieber ist ein neuer Beweis für diese These. Jahrzehntelang wurde die Streptokokkenätiologie diskutiert, und schon vor 55 Jahren erschien in England eine Statistik über die Sterblichkeit an Scharlach, Erysipel, Kindbettfieber und rheumatischem Fieber, die das Zahlenmaterial der gesamten zweiten Hälfte des 19. Jahrhunderts umfaßt (Longstaff). Der Herausgeber war von dem verblüffenden Gleichlauf der vier Sterblichkeitskurven so beeindruckt, daß er dieser Statistik den Titel „Beitrag zur Ätiologie des rheumatischen Fiebers“ gab und eine gemeinsame Ursache für alle vier Krankheiten annahm. Die Streptokokkentheorie konnte sich jedoch viele Jahrzehnte hindurch nicht gegenüber den vielen anderen Hypothesen durchsetzen. Einen Wendepunkt in der Geschichte der Erforschung der Ätiologie des rheumatischen Fiebers bildet die Monographie “The Factor of Infection in the Rheumatic State” von Coburn (1931). Von nun an wurde in rascher Folge Material von verschiedenen Seiten her (Epidemiologie, Serologie und Bakteriologie) zusammengetragen, die den Grundstein zu einem festgefügten Fundament ergänzten. Einen wichtigen Beitrag lieferte das riesige Material der U.S.-Marine aus der Kriegszeit, das Coburn und Young mit einer bewunderswerten Energie gesammelt und ausgewertet haben. Es war wiederum Coburn, der den entscheidenden Schritt zur praktischen Auswertung der gewonnenen Erkenntnisse vollzog, und bereits im Jahre 1936 die Sulfonamide zur Prophylaxe verwandte.

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