London's Pulse: Medical Officer of Health reports 1848-1972
View report page
Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1927
[Report of the Medical Officer of Health for London County Council]
This page requires JavaScript
82
Rheumatic fever is used to denote an acute definitely febrile attack, often
ushered in by a sore throat with marked pain and swelling (rarely redness in children)
in one or other joint, often moving to another joint, or, again, during such an acute
febrile attack, the heart rapidly becomes involved, the acute stage lasting from a few
days to a fortnight or longer, and when the child is so acutely ill that bed has to be
resorted to.
Chorea is so familiar, as regards clinical appearances, that it requires no detailed
description.
There is, of course, considerable overlapping of these three classes. Many subacute
cases exhibit intermittent attacks of rheumatic fever and chorea. It is because
of this fact that the inclusive term acute rheumatism has been so widely adopted,
but in so far as a large number of sub-acute cases never show major attacks this
term is unsatisfactory, as it leads to confusion in discussion, in statistical surveys,
in notification, and in the practical assignment of rheumatic children to hospital
beds.
A simple tabulation of the cases is as follows, the figures in brackets showing the number of attacks.
| Classification. | Number of cases. | |
|---|---|---|
| Sub-acute cases | 20 | |
| Attacks of rheumatic fever with no history of previous or subsequent sub-acute phase | 6 | |
| (1) 2 | ||
| (2) 2 | ||
| (3+) 2 | ||
| Attacks of chorea with no previous or subsequent sub-acute phase | (1) 2 | 9 |
| (2) 4 | ||
| (3 + ) 3 | ||
| Sub-acute phase with rheumatic fever | 37 | |
| Sub-acute phase with chorea | 19 | |
| Rheumatic fever, chorea and no sub-acute phase | 1 | |
| Rheumatic fever, chorea and sub-acute phase | 6 | |
| No previous history | 2 | |
At first an attempt was made to tabulate the choreic cases separately, but the
whole history and clinical appearances (apart from the obvious choreic movements)
was so similar to the other rheumatic cases that they have been included, since it
is obvious that the twitchings of chorea are but a part of the whole clinical picture
of rheumatism. It will be observed that chorea figures either as a separate entity
or combined with other manifestations in 35 cases, that is, in over a third of this
series, but this group of 100 patients is unduly weighted with advanced cases complicated
by cardiac lesions, and in any random sample of early rheumatic cases it
is possible that this proportion of chorea would be much reduced. In most of the
nine cases of chorea and six cases of rheumatic fever there was a history of periods
of ailing with occasional sore throats, headaches, night sweats, and other minor
symptoms, but no history of pains.
Thirty-seven of the cases were boys and 63 were girls. Choreic symptoms
were present in 23 girls and 11 boys. This table shows 20 cases of accepted rheumatism
in which no history of major attacks could be gathered, and also shows the
marked overlapping of minor and major symptoms and signs, also of major attacks