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69
In this group 117 cases have been analysed, and, in division IV, thirteen of the 55 cases who required tonsillectomy
which were tonsillectomised before a second attack have been re-grouped. It will be noted that the
percentages which improved or deteriorated both as regards the cardiac condition and as regards the general
health do not vary very markedly in each group.
In division la twenty per cent, improved as regards the cardiac condition ; these were nearly all cases which
when first seen were placed in sub-division C and which when last seen were placed in sub-division B, that is to
say, the signs of heart disease remained but the symptoms disappeared. On the other hand 7 per cent, definitely
deteriorated. The general health in this group is the least good.
Division 1& shows the best progress as none deteriorated both as regards cardiac condition or general health.
Only one or 10 per cent, improved as regards cardiac condition, but it must be noted that it was hardly
possible for any of the others to improve in this respect as they are all in the first three subdivisions—that is, cases
with no carditis, or cases with transitory signs only which cannot improve their cardiac condition. The others
were cases with signs of rheumatic carditis which are not limited to the acute phase and these do not commonly
disappear.
Similarly the progress in division III is satisfactory—only 9.5 per cent, improved as regards their cardiac
condition, but again there were only three which were not in subdivision P.A.B. and two of these improved. In
this group, however, one deteriorated.
The analysis seems to show; therefore that the progress in those cases which did not require tonsillectomy
and those which were tonsillectomised before the onset of juvenile rheumatism is rather more satisfactory than
in those who required tonsillectomy at the onset of juvenile rheumatism. The analysis also confirms my previous
findings that tonsillectomy may modify the disease as far as cardiac involvement is concerned, for when last
seen
In division la 65 per cent, of the cases are in subdivision P.A.B. and 35 per cent, in C. and D.
In division 16 100 per cent, of the cases are in subdivision P.A.B. and 0 per cent, in C. and D.
In division III 95 per cent, of the cases are in subdivision P.A.B. and 5 per cent, in C. and D.
In division IV 54 per cent, of the cases are in subdivision P.A.B. and 46 per cent, in C. and D.
From this point of view also cases which had not been tonsillectomised but which did not require tonsillectomy
are the most satisfactory, but those which have had complete tonsillectomy before the onset of the disease are
nearly as good. That the cardiac condition in division IV is less good than the tonsillectomised cases in
division I a does not suggest that tonsillectomy before a second attack is disadvantageous, for in division IV all
the cases have had second attacks; whereas division I a includes these, and also a number of cases which have
had only one attack. It is not very common for a carditis to occur in a second attack if the heart has escaped
in the first, but a second attack will commonly aggravate an existing carditis. Discussion of division II is
omitted, as it is often impossible to be sure whether tonsillar remnants are infected or not.
GROUP II.
Choreic
cases.
Number
of
cases.
Classification
when
first
seen.
Classification
at least two
years later.
Progress in
reference to
cardiac
condition.
Progress in
reference to
general
health.
Tonsillectomised
later.
Nontonsillec
tomiseJ
later.
Improved.
Unchanged.
Deteriorated.
Improved.
Unchanged.
Deteriorated.
I. Non-tonsillectomised
before onset of
chorea.
(a) Requiring
tonsillectomy.
(b) Not requiring
tonsillectomy.
II. Tonsillectomised
incompletely before
onset of chorea.
III. Tonsillectomised
before onset of chorea
IV. Cases from division
I a tonsillectomised
before 2nd
attack.
V. Cases from division
la. No further
attacks of chorea 2
years after tonsillectomy.
17
5
2
4
2
10
1 had 2
attacks
before.
P 3
A 8
B 6
C —
D —
P 3
A 1
B 1
C —
D —
P —
A —
B 2
C —
D —
P 1
A 3
B —
C —
D —
P —
A 1
B 1
C —
D —
P 4
A 1
B 5
C —
D —
P 2
A 5
B 6
C —
D—-
P 3
A I
B 1
C —
D —
P —
A —
B 1
C 1
D —
P 1
A 3
B —
C —
D —
P —
A 1
B 1
C —
D —
P 4
A 1
B 5
C —
D —
P 13 attacks
A 3
B
C
D
17
100%
5
100%
1
50%
4
100%
2
100%
10
100%
15 1 1
88% 6% 6%
5
100%
1 1 1
50% 50% 50%
4
100%
1 1
50% 50%
10
100%