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.

    49/114 (page 37)
    considered this manifestation as ominous of severe concurrent and progressive carditis. Poynton states that nodules may occur in cases which follow a benign course and even in patients free from heart disease, but that this does not in any way affect the general truth that their appearance is a grave sign. He gives the following incidence in one of his series of 172 cases in children under 12, all in-patients seen within 12 months, 33 patients (19 per cent.) showed nodules, and. of these 33 cases 12 were fatal, 15 gave rise to severe crippling heart disease, 4 gave rise to carditis, which later became compen- sated, and in two cases carditis did not develop. Subcutaneous nodules appear to be less common in America although Brennemann* considers that they are as common in Chicago as in England. Even in England there are variations which can scarcely be explained by the individual views of observers. They appear to be more frequent in Bath and Bristol than in London, whilst in Birmingham they are rare. Although their adequate discussion is beyond the scope of this report, which is not concerned with clinical matters, the other minor manifestations of the acute rheumatic infection must be briefly reviewed, as, like growing pains, they may often afford us that period of warning (of six weeks or six months) in which our therapeutic measures (e.g., tonsillectomy) may be taken with the fairest hopes of success. Such minor manifestations or pre- monitory symptoms include epistaxis, erythema multiforme, persistent headache unexplained by eyestrain, and a category of nervous symptoms which may be signs of “latent ”’ chorea.y ‘he latter include nightmare, talking or doing sums during sleep, habit spasms, acquired enuresis, “‘ exaggerated fidgetiness,”’ clumsiness, and deterioration of the handwriting. The fact that these may each or all be indications of acute rheumatic infection increases the difficulties, already seen in connection with growing pains, recurrent tonsillitis and nodules, which lie in the path of the investigator who would estimate the number of “ potential cardiacs ’ in a child population. Some American authorities would place the proportion of “ potential cardiacs ”’ high—as high indeed as 14 per cent.{ a figure which has recently been suggested by K. Simpson§ at Barking in Essex and by Vercoe at Chelmsford. ] VI. Major Manifestations. Rheumatic Fever.—Arthritis, though not in the child the predominant sign of acute rheumatic infection which it is in the adult, nevertheless occurs in some 60 to 70 per cent. of all children * Amer. Jl. Diseases Children, 1919, XVIII, p. 179. + R. Miller, Lancet, 1909, Dec. 18. t Health of 1,000 newsboys. § Brit. Med. Jl., Jan. Ist, 1927. § Annual Report of the Medical Officer for Chelmsford Borough, 1925.