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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    child is difficult. Both require the most careful medical super- vision, and the so-called pre-rheumatic child is too often in reality already the rheumatic child. V. Relative Frequency of these Manifestations. The early recognition of the rheumatic infection, as may be inferred from what has already been said, is a matter as difficult as it is important. But upon early recognition prevention may depend and it seems proper therefore for us to discuss first the minor manifestations, as they are often the first to appear. Minor Manifestations. Growing Pains, These may be mild and evanescent for a few days, or may even cause a limp or stiffness on rising. They are usually described as most noticeable in the hamstrings behind the knees, but H. P. Newsholme* found that in 50 per cent. of his cases pain was referred to the front of the thigh compared with 10 per cent. referred to the hamstring muscles. Stiff neck in a child should be regarded with suspicion. Information as to growing pains depends for elicitation upon the accuracy and memory of the child patient and upon the method and personality of the inquirer. Avoidance of leading questions is essential and yet the information must be obtained. Thus we must expect and do indeed find the widest variations in the recorded incidence of growing pains in school children, variations which have naturally affected the estimates of the incidence of the rheumatic infection in school children. The following instance illustrates the immense difficulty of assessing their true value. ‘Two experienced school medical officers each examined about 2,500 elementary school children in attendance at school between the ages of 5-13 years (except about 200 younger and 49 older in the case of the second observer), with special reference to rheumatic infection. The first observer worked in the Kastern part of the County of Middlesex, the second amongst children of similar social circumstances in the N.E. central part of London one or two years later. The firstt reported that of the Middlesex children nearly 25 per cent. had had growing pains (in addition to 2 per cent. who had a definite history of rheumatism). The second{ reported that of the London school children only 1-4 per cent. had growing pains. (Nevertheless this observer considered 5-2 per cent. definitely rheumatic ‘“‘ merely suspicious * ‘Thesis for M.D. Oxford quoted by Kerr. Fundamentals of School Health, p. 277. + Annual Report Chief Medical Officer Board of Education, 1912, - D. LOU, t London County Council Medical Officer’s Report, 1910, p. 135.