Proceedings of conference on rheumatic fever : Washington, D.C., October 5-7, 1943.
- Conference on Rheumatic Fever (1943 : Washington, D.C.)
- Date:
- 1945
Licence: Public Domain Mark
Credit: Proceedings of conference on rheumatic fever : Washington, D.C., October 5-7, 1943. Source: Wellcome Collection.
15/142 (page 9)
![Dr. Dwan. I don’t know whether I got this right from your report, Com- mander Coburn, or not, but in following your cases with upper-respiratory-tract infections, did you feel that the incidence of rheumatic fever was higher in the group that had been treated with the sulfa compounds? Is that a hunch on your part? CoMMANDER Cosurn. It is hard to know what would have happened to the patients if they had not received sulfanilamide—that is the difficulty. The thing that impressed me was that a number of individuals who had passed the age of 30, had lived in an environment in which rheumatic fever was prevalent, and had had many streptococcal infections in the past without developing rheumatic fever, developed their first attack when treated with sulfonamide. Having seen that repeat itself, I have been left with a clinical impression. I do not know that it is correct, but I thought I would pass it along. DeLecaTe. Commander Coburn, you think, then, that the sulfonamides are contraindicated in upper-respiratory-tract infections. It has been my experi- ence that a great many teen-age children think they can do what they please when they are taking the drug. I wonder if the element of rest in bed doesn’t have a good deal to do with it. I don’t know what the relation is, but I think it may be wise to bear in mind the fact thateapeople who come with minor streptococcal infections should be studied before being given sulfanilamide. Dr. Van Horn. We have time for perhaps one more question. If there are none, we shall have a short recess. [Short recess.] CASE FINDING Dr. Van Horn. You will note from the agenda that our next subject is case finding. After the very interesting session this morning regarding the incidence of rheumatic fever and rheumatic heart disease among the armed forces and the findings of Selective Service, we certainly shall want to know what some of the various State people are doing and what their experiences are in regard to the case finding of children with rheumatic infection. We always feel, too, that not making the diagnosis is often quite as important as making it. What has been the experience of the States with referrals by . physicians, nurses, social agencies, and health officers? I believe that Dr. Hall of Oklahoma City has considered this problem and has worked very closely with some of the physicians and health officers in Oklahoma. I should like to have him tell us a little of his experience. Referral of Patients Dr. Hatt. When we first started, we took the records of the out-patient depart- ment of the Children’s Hospital at Oklahoma City and followed up the cases that had been diagnosed as rheumatic fever. That was our nucleus. Since then, with our main clinic in the Crippled Children’s Hospital, we get all the cases with a history of rheumatic fever that come to the general pediatric clinics. They are automatically referred to our clinic. In addition to that, we have referrals from the child-health clinics. We have 39 counties with health units, and of the total 241 patients whose records we have on file, 181 come from these counties; the other 38 counties furnish 60 patients. In our two clinics out in the State, we have a little different situation. There are good health units there, and these units refer the cases. The physicians in charge of the health units, the nurses, the social workers, and everyone else concerned cooperate well. ‘They go through the schools in their counties and refer to this 605215°—45——_2](https://iiif.wellcomecollection.org/image/b32171948_0015.jp2/full/800%2C/0/default.jpg)
