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.

    79/114 (page 67)
    of the picture of the effects of rheumatism on child life, the following facts are striking :— (1) that there were 508 children (of up to twelve years only) attending in one department of a single hospital in one year suffering from the disease ; (2) that of these 21-9 per cent. already had cardiac damage and, in addition, 21-3 per cent. symptoms of threatened cardiac involvement ; (3) that of a sample of children whose rheumatic history was known to extend over two years or more 44:0 per cent. had had two or more relapses ; (4) that in the longer known sample, consisting of 473 children, the amount of cardiac damage was greater than in the 1926 series, which contained a greater proportion of early cases. These facts tend to show the urgency of the provision of means for the early detection of cases of rheumatism and for their prolonged treatment. The difficulty of nursing them in their own homes has been pointed out, and the impossibility of securing admission to an institution in all cases requiring rest in bed under present conditions is obvious. At present only the most urgent cases from the medical or social point of view can be sent for institutional treatment, and that only after unavoidable delay and much negotiation. These cases are not the most hopeful ones. Only when provision is made to meet the full demand will the earlier or less severely crippled cases, which cases best repay preventive treatment, have adequate facilites for treatment under conditions which will at least give them some chance of recovery. In conclusion, it is desired to express indebtedness and thanks to Dr. Jewesbury for his kind permission to utilise the medical notes of the Children’s Department, to Dr. Forest Smith, who has kindly advised as to the correct classification of the cases with cardiac involvement, to Miss Cummins, Lady Almoner, St. Thomas’s Hospital, for giving access to her case-papers and records, and to her assistant in the Children’s Department, Miss Lord, for her help in tracing out the social histories of the children. VIII. Focal Infection. There has been much discussion upon this subject into which space will not allow us to enter. The controversy arises partly from the fact that some observers have investigated series which consist entirely of cases of rheumatic fever, whilst others have included cases of rheumatic infection of much wider significance. Again, whilst some observers have used control series of healthy persons, others have used as controls series of patients with other diseases. Not unnaturally the conclusions thus arrived at have been conflicting.