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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    pletely recovered and it is very difficult to tabulate in any way the improvement or otherwise in the state of the heart. These cases, unless there has been a history of an acute attack of arthritis or of chorea in addition to the heart condition, have, therefore, been shewn as having one attack only, which of course, is no index to the severity of the disease. 3. Cases of Chorea. There are some cases of Chorea with well-defined attacks (often occurring at the same season every year, or coincident with some emotional upset), but there are also a large number who continue to attend for prolonged periods with fluctuating conditions as regard the severity of the symptoms and intervening periods of latency accompanied by rheumatic pains. In this type of case it is hard to say when the original attack has ended and a relapse set in. The records of this type have been carefully scrutinised and relapses have been recorded only when the chorea has become apparent after the movements have been noted as absent. It is possible that the numbers arrived at are an under- statement of the number of relapses, as some may have occurred during periods of absence from attendance. In all cases, for the purpose of estimating the number of relapses, the history of each has been examined from the first manifestation of the presence of rheumatism, and any further manifestation of a different: form of the disease has been counted as a relapse. Thus, if a child originally attended for rheumatism with marked pains and stiffness in the joints, and after a period of treatment developed chorea, rheumatic fever or carditis, these further developments, if they occurred at separate times, are noted as relapses. With the reservations described above, the number of relapses suffered by the 257 cases who have been known for over two years is shewn in Table 4. | TABLE 4. Shewing the number of relapses sustained by 257 children under observation for a minimum period of two years (average 3°2 years) at St. Thomas’s Hospital. Number of Relapses | Boys | Girls Both Sexes No further manifestation or | acute attack re 2 Soaghe aaa 19 38 or 14-7 per cent. One relapse... os £5 42 54 A Wir ls Be ee Two relapses .. i me 28 41 Oe 45 20'S Se ; Three relapses ee ea 11 27 Oo yg Le Feet oe Four relapses .. ae nea 4 9 LS gt aD gary Five relapses .. a fa — 3 ioe FiBolbetpiews Total number under observation .. be 104 | 153