View report page

69
Out of a total of 490 cases 61 per cent. were female and 39 per cent. male, or the proportion of male to female
is as 1:1.6.
Taking the chorea cases alone the proportion of male to female is as 1:1.8. The proportion of males is higher
in this series than in some others—the average has been stated to be 1:3.
It will be seen from the table and graph that it is a fact that more cases were sent to the clinic by the school
medical officers at the ages of eight and twelve than at other ages; also in a large proportion of these cases the
medical officer had discovered the rheumatic symptoms or signs when they were occurring for the first time. At
the age of eight, 17 out of 20 sent up are in group E, and at the age of twelve, 15 out of 20 are in group E; group
F, where group E cases are subtracted, is therefore a truer indication of age incidence than group C. There is
still a high peak incidence at eight; this gradually decreases until eleven years. It rises again slightly at the age
of twelve, but to a less degree than in group C.
Dr. Glover's suggestion is, therefore, correct that the age incidence is affected by the routine examinations by
school medical officers at eight and twelve. The general outline is modified; it is not, however, actually altered.
Course of two cases of Juvenile Rheumatic Carditis.
(1) Case 1 is reported to show how prolonged may be the course of even a mild case of juvenile rheumatic
carditis.
A girl, seven years old, was admitted to hospital in December, 1930. She had pains in the limbs suggesting
rheumatism and the general health was very poor. She had no definite indication of carditis although there was
a rough systolic murmur in the pulmonary area probably congenital in origin. After a fortnight in bed she
developed mild but definite chorea and had a soft apical systolic murmur. She progressed well and after three
months was allowed to get up for a short time. Immediately the pulse rate went up and there was a definite