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Cases which were admitted to Princess Louise Hospital and St. Mary Abbots Hospital sometimes had tonsillectomy
performed during their stay in hospital when the acute stage was quiescent. Cases were admitted to
other hospitals either because they were over the age for admission to Princess Louise Hospital or because they
did not live in Kensington. The admission to convalescent homes is arranged through the lady almoner at
Princess Louise Hospital or through the Invalid Children's Aid Association.
Value of Tonsillectomy in Rheumatism Cases.
The group of cases analysed in the 1929-30 annual report has been enlarged to include 544 cases. These are
divided into three groups, namely:—
(а) Cases in which the onset of symptoms was after complete tonsillectomy. The date of cardiac
involvement in relation to tonsillectomy is often not known, but in rheumatic cases of this group there was
no history of pains before tonsillectomy, although there was often history of constant colds and sometimes
of tonsillitis;
(b) Cases in which the first onset of symptoms was after incomplete tonsillectomy ;
(c) Cases which had not had tonsillectomy or in which the first onset of symptoms was before tonsillectomy.
This group was not divided into those with healthy tonsils and those with unhealthy tonsils owing
to the difficulty of making this differentiation accurately.

Cases in group C who had complete tonsillectomy later, and who have developed further symptoms since
that date are as follows:—
2 developed more severe heart lesion.
2 developed chorea.
1 had a second attack of chorea.
14 had second attack of juvenile rheumatism with cardiac involvement.
38 continued to have rheumatic pains.
Without comparing a group of children who had had tonsillectomy and later had rheumatism or remained
healthy with a similar group who had not had tonsillectomy, it is not possible to obtain satisfactory statistics as
to the value of tonsillectomy in the prevention of juvenile rheumatism. These statistics are not easy to obtain
in hospital as the healthy children are not attending. It is difficult therefore to make any comparison between
these groups; and the 50 cases in which incomplete tonsillectomy had been performed are omitted, as in some the
throat appeared healthy, although some tonsillar remnants were present, whereas in others the throat was
definitely unhealthy. In investigating the cases which have been sent up to the rhematism clinic, it is of interest
to compare the percentage of cases diagnosed as definitely rheumatic in children who have had complete
tonsillectomy, with the percentage of definitely rheumatic children who still have their tonsils intact. It will be
seen that in the former 58 per cent. were diagnosed as juvenile rheumatism and in the latter 73.5 per cent. were
rheumatic. However, from these figures it cannot be shown that tonsillectomy is of any marked value in
preventing the onset of rheumatism in children; also it will be noted that out of 101 children who had had
complete tonsillectomy 60 developed rheumatism for the first time after the operation, and that 57 children
who had not had tonsillectomy at their first attack showed further rheumatic symptoms after the operation.
Most of the children who had definitely infected tonsils during their first attack have had tonsillectomy at a
later date, but in a number of cases such a short time has elapsed since the operation that no conclusion can be
drawn.
It does appear, however, that tonsillectomy has had some beneficial effect in modifying the severity of the
disease as far as cardiac involvement is concerned. Out of 282 rheumatic children whose tonsils were intact,
there were 18 cases, or 6.3 per cent., classified as severe, whereas in the other group only one out of 57, or 1.8 per
cent., was severe.
In chorea there is no evidence to suggest that tonsillectomy prevents the onset of the disease. Among 101
patients who had had complete tonsillectomy there are 14, or 14 per cent., cases of chorea, whereas among 393
patients who had not had their tonsils removed there are 48, or only 12 per cent., cases of chorea. On the other
hand, of the 14 patients who had chorea where onset was after complete tonsillectomy, none had carditis (although
one developed carditis during a second attack which was after tonsillectomy), whereas of the 48 cases before
tonsillectomy 11, or 23 per cent., had an associated heart lesion, so that again the severity in respect of cardiac
involvement is modified by tonsillectomy.
Summary.
There is no definite evidence that tonsillectomy is of value in preventing the onset of juvenile rheumatism.
There is some evidence to suggest that tonsillectomy may modify the severity of the disease as far as cardiac
involvement is concerned. In chorea it is less common to find an associated cardiac lesion after tonsillectomy.