Acute rheumatism in children in its relation to heart disease.

Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: Acute rheumatism in children in its relation to heart disease. Source: Wellcome Collection.

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    7. Though many experienced observers consider the bacterio- logical cause of acute rheumatism to be a streptococcus of the Viridans group, and though no rival theory has so far made substantial headway, we have as yet no certain knowledge as to the causal organism. Attempts to identify rheumatic strains by serological tests have failed. More research work, including the elaborate methods of combined chemical and serological analysis, which have been employed in connection with pneumococci, is urgently needed. 8. In the absence of certain knowledge as to the causal organism, it follows that our efforts at prevention must still be empirical, and that we must grope our way more or less in the dark until the new light comes. Nevertheless clinical experience indicates which way the road to prevention lies. As regards the many minor manifestations of the rheumatic infection, Haven Emerson* says, that prevention lies in “ Cleaner mouths, fewer diseased tonsils, fewer neglected decayed teeth, earlier recognition of sore throats, and quick care in their treatment as serious infections, the considered and skilled attention to the little child with aching muscles and joimts—‘ too young to have rheumatism,’ kept up and about with ‘growing pains — repeated examinations of the heart after attacks of any acute infectious fever in childhood, always separation of the sick from the well; by such means will the number of acute rheumatic hearts be reduced.” We may fairly say that one child in every fifty attending public elementary schools in cities and towns requires observation and periodic examination on account of manifestations of rheumatic infection and the danger they imply to the heart. In some the attack is obvious, in others insidious. 9. With regard to the major manifestations of the disease, 7.e., when once the child has sustained an attack, clinical experience again has clearly shewn us that to minimise the risks of permanent damage to the heart and of recurrence at some future date the child requires : (a) full in-patient hospital treatment for a period of six to twelve weeks during the acute stage of his illness, and (b) special convalescent treatment and after-care for a further period of at least six months. The child may also require surgicai treatment for the removal of foci of septic infection. 10. Special institutional treatment is intended to prevent the carditis almost invariably present in rheumatic cases from causing permanent damage, by furnishing, first, a period of complete rest, and secondly, after a period of complete cessation of symptoms, a slowly graduated resumption of activity, both periods being spent in an environment as favourable as possible so that the patients’ resistance may be raised to the highest of which it is capable. Special education is required for convalescent rheumatic children at these institutions. 11. The removal of focal sepsis is essential to success in pre- * Survey Graphic, VI, November 2nd, 1924.