Pulmonary affections in form of pleuritis, pneumonia, or bronchitis are common complications of rheumatic fever. Adding Latham's,[73] Fuller's,[74] Southey's,[75] Gull and Sutton's,[76] Pye-Smith's,[77] and Peacock's[78] cases together, we have a total of 920 in which some one or more of the above pulmonary affections obtained in 109 instances, or 11.8 per centum. A further analysis of Latham's and Fuller's cases shows that it is especially when rheumatic fever is complicated with cardiac disease that the lungs suffer; thus, pulmonary affections obtained in 26.5 per cent. of cases complicated with heart disease, and in only 7 per cent. of cases free from that disease. It is more especially when pericarditis complicates rheumatic polyarthritis that pulmonary affections occur. Thus, these were found in only 10.5 per cent. of cases of recent rheumatic endocarditis, in 58 per cent. of cases of pericarditis, and in 71 per cent. of cases of endo-pericarditis. The tendency which inflammation of the pericardium has to extend to the pleura probably partially accounts for the more frequent association of the pulmonary affections with rheumatic peri- than with rheumatic endocarditis. (Sibson found pleuritic pain in the side twice as frequent in pericarditis, usually accompanied with endocarditis (31 in 63), as in simple endocarditis, 26 in 108.[79]) But the greater severity of those cases of rheumatic fever complicated with peri- or endo-pericarditis must also have a decided influence in developing the pulmonary affections. {37} Pneumonia and pleuritis are very frequently double in rheumatic fever, and are often latent, requiring a careful physical examination for their detection. So suddenly does the exudation take place in some cases of rheumatic pneumonia that the first stage is not to be detected either by symptoms or signs. On the other hand, in some cases the absence of the typical signs of hepatization, the want of persistence in the physical signs, and their rapid removal, and even in rare instances an obvious alternation between the pulmonary and the articular symptoms, suggest that the process often stops short of true hepatization, and partakes rather of congestion and splenization, with or without pulmonary apoplexy--a view which has been occasionally confirmed by the autopsy.[80] [Footnote 73: Latham's _Works_, Syd. Soc., i. 98 _et seq._] [Footnote 74: _Lib. cit._, 317.] [Footnote 75: _Bartholomew Hospital Reports_, xv. 14.] [Footnote 76: _Guy's Hosp. Reports_, 3d Series, xi. 434.] [Footnote 77: _Ib._ xix. 324.] [Footnote 78: _St. Thomas's Hospital Reports_, x. 12-17.] [Footnote 79: Reynolds's _System Med._, iv. 233.] [Footnote 80: Vide Sturges, _Natural History and Relations of Pneumonia_, 1876, pp. 70-78; T. Vasquez, Thèse, _Des complications Pleuro-pulmonaires du Rheumatisme Artic. Aigue_, Paris, 1878, pp. 25-31; M. Duveau, _Dictionnaire de Méd. et de Chir._, t. xxviii. p. 443.]