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.

    48/114 (page 36)
    centages of diseased tonsils are found in young adult patients.* R. Miller, whose admirable summary of this matter deserves careful study,+ found a history of “ sore throats ” in 33 per cent., and diseased tonsils in 83 per cent. In addition to recurrent attacks of tonsillitis serving as “‘minor manifestations”’ or “warning signals’’ of rheumatic infection, a sharp attack of tonsillitis is, in about 10 per cent. of cases of acute rheumatism, a prodromal symptom (Bertram? 5 per cent. Poynton§ 12:8 per cent., Wyckhoff{ 12-7 per cent.). Not uncommonly carditis may follow directly upon an attack of tonsillitis without any arthritis or chorea. Still|| sums up the matter thus: “ Tonsillitis so fre- quently occurs just before the onset of rheumatic pains in children that it is difficult to escape the conclusion that it bears some direct relation, possibly as medium of infection, to rheumatism.” This question and the value of tonsillectomy are further discussed on page Nodules. We come to the third of our minor manifestations. Here is a tangible manifestation so important from its being the homologue of the submiliary nodule of Aschoff in rheumatic carditis, and so diagnostic that many authorities (e.g., Carey Coombs and the Medical Research Council Committee) class it as a major manifesta- tion. Init surely we may hope we have a reliable index of the rheumatic infection. Yet as a statistical guide to the incidence of the rheumatic infection in children, the presence of nodules seems as disappointing as growing pains or tonsillitis. The varying percentages given by reliable observers are most puzzling. Taking only child in-patients with severe and un- doubted infections, Poynton (London) found nodules in 19 per cent. in one series** of cases, 28 per cent. in another{+; Bertramt | (Glasgow) in 7 per cent. of child in-patients, Ingerman§§ and Wilson 11 per cent. in 185 cases under observation for an average period of three years, whilst Vincent Coates and Thomas have found them in 80 per cent. of children considered rheumatic on other criteria. The two latter observers also consider them as a definite objective physical sign, which can be elicited in a large number of children who present themselves as out-patients suffering from subjective symptoms suggesting rheumatic infection prior to clinically demonstrable cardiac lesions. Cheadle, Barlow, and Warner * Ministry of Health Report 23, ‘‘The Incidence of Rheumatic Diseases, 1924, p. 60. + Part III of the British Medical Association’s Report of Special Sub-Committee on Rheumatic Disease in Children. t Brit. Med. Jl. 1925, March 14. § Lancet, 1920, II, p. 1086. 4] American Heart Journal, 1926, April. || Common Disorders of Childhood, G. F. Still, 1924, p. 519. ** Proceedings Royal Soc. Medicine, Oct., 1921. tt Lancet, 1920, IT, p., 1026: §§ Journal Amer. Med. Ass., March 8, 1924.