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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    before G. A. Sutherland* had recommended six months’ rest in bed or longer if necessary, followed by sanatorium treatment. for one or two years. Undoubtedly, whilst there is any evidence of active infection or progressive involvement of the heart, and for a period of at least three weeks subsequent to the cessation of any such evidence, complete rest in bed is essential. But if proper facilities are available at the end of this time, if adequate supervision and all the surroundings are favourable, recent opinion is in favour of substituting “ graduated rest ’’ for complete rest, and so gradually allowing the child to resume carefully graduated and supervised minor activities. But in any case “ complete ” rest should be continued for three weeks after (1) the pulse rate and temperature have returned to normal, (2) anemia has disappeared and (3) the heart signs are unchanged. The essentials of treatment then appear to be :— (1) Complete rest until three weeks after symptoms have ceased. (2) Removal of focal sepsis if not already carried out. (3) Graduated resumption of activity “ graduated rest.” (4) Country air and perfect environmental conditions. (5) Constant medical and nursing supervision. (6) Special educational arrangements. For such a regimen for children of the elementary school class, institutional treatment is obviously necessary, and we must now consider the various types of hospitals and schools and the part they play in the treatment of convalescent and sub-acute rheumatism, and in the prevention of cardiac complications. They will be dealt with under the following headings : (a) Special Homes for Rheumatic and. Cardiac Children. (6) Ordinary Convalescent Homes, (c) Day Open-Air Schools. (d) Residential Open-Air Schools. (e) Physically Defective Schools. Special Residential Schools for Rheumatic and Cardiac Children. The need for special residential schools where rest and recreation are strictly controlled, and where expert medical advice and periodic supervision are available has been suggested for some time past, though it is only during recent years that such institutions have been opened. . The Chief Medical Officer, in his Annual Report for 1913 to the Board of Education, wrote: “‘ Perhaps the best method of dealing with children with heart disease is to send them to a residential * “* Diseases of Children,’’? 1907.