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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    in rheumatic children than in their non-rheumatic brothers and sisters, and than in children of normal families. The Value of Tonsillectomy. This question must be considered as two different, though closely related, questions :— (1) does tonsillectomy tend to reduce the risk of the rheumatic infection ? (2) does tonsillectomy after the first attack tend to prevent. recurrence, and after the heart has been affected does. it tend to prevent the heart affection from becoming a permanent condition ? Of these questions the first is perhaps the harder to answer, as by the time the tonsils are sufficiently large or suspicious to be. operated upon, the infection has probably travelled beyond them. A large number of cases have been recorded where the onset of rheumatic fever has occurred some years after an apparently satisfactory enucleation of the tonsils. Thus among 907 rheumatic members of rheumatic families in the Medical Research Councils. series 60 had developed rheumatism at varying periods after apparently satisfactory enucleation. Chorea was the predominant subsequent manifestation (66-7 per cent.). There seems little doubt that the operation has less protective value against chorea than against acute rheumatism. Poynton* has summarised the answer to the first question thus— ‘““(1) I believe the tonsils to be an important site of infection. (2) I know that skilled enucleation will not prevent a first attack of rheumatism and acute carditis of extreme severity occurring some years later. (3) I know also that an acute and crippling attack of carditis may directly follow removal of the tonsils in the rheumatic. (4) I hold that the successful removal of unhealthy tonsils is a valuable prophylatic step if, undeterred by excep- tions, we view the problem on broad lines. (5) I believe every case must be considered as an entity, and do not favour routine action. Millert believes that ‘‘ Probably still more favourable would be the group operated on in the prodromal stages, before an acute rheumatic attack has declared itself. ‘To my mind the early operation is probably one of the many factors making rheumatism rare in private practice as opposed to hospital practice.”’ Kaiser,t working on two precisely parallel series of 1,200 children each, both series consisting of children over 5 who * Brit. Med. Jl., 1925, October 3lst, p. 790. + Brit. Med. J1., 1926, July 3rd, Supplement, p. 20. t Jl. Amer. Med. Assocen., 1924, 82, p. 759.