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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    From this table it will be seen that in 38 cases, or 14-7 per cent., no relapse as such was observed. Among these were 13 cases of rheumatic carditis of varying severity where the question of relapse, as already stated, does not arise, 6 cases of first attacks of chorea who had had no further manifestation, and 19 cases of rheumatism who were apparently controlled by treatment. 96 children, or 37:3 per cent., had had one relapse and 123, or 44-0 per cent., had two or more relapses, during a minimum period* of two years and an average period of 3-2 years. Of the final result of treatment it is not possible to say anything as yet. In order to estimate the ultimate prognosis it would be necessary to re-examine the entire series at some future date. Three girls and 4 boys in this series are known to have died as a result of the disease, but it is possible that some deaths may have occurred which have not been notified to the hospital, so that no figures of the actual mortality can be given without further investigation. In the 400 families under review 216 cases were not under observation for any definite length of time. Some ceased to attend, others have been drafted to other departments of the hospital on account of age and a few cannot be traced to their last attendance. 22 boys and 28 girls, in all 50 children, had one or more relapses during the time they were under observation. The remaining 166 cases were of the following types :— 57 of chorea, first attacks with no further manifestation while known. 36 of rheumatic carditis with no other manifestation while under observation. 20 of rheumatic fever, first attacks who did not return for treatment after the acute symptoms had disappeared. 54 cases of rheumatism with subacute symptoms (some with dilation of the heart and suspicious murmurs) who ceased, to attend but were not discharged as well. It is impossible to be definite as to the progress of the disease in these cases. Their failure to attend might be ascribed to recovery ; on the other hand they may have gone to other hospitals or to private doctors. They have, at all events, not re-appeared in the Children’s Department at St. Thomas’s Hospital up till January, 1927, and it is noteworthy that 54, or nearly one-third, are now over age for the Children’s Department and could not return there. VII. SumMMARY AND CONCLUSIONS. OUT-PATIENTS. lst Series—Cases of 1926. The incidence of rheumatism in the Children’s Department, which deals only with children up to twelve years of age, during * Mackie has shown that only 57 per cent. of relapses were found to develop in a period of four years following the first attack of rheumatic fever. A.M. Jl. Med. Sci., 1926, Aug., p. 220.