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70
An analysis of Group II shows that the carditis associated with chorea only is less severe than when arthritis
is also present or is the only other manifestation. In Group II twenty-eight cases are analysed, and only one is
placed in a subdivision below B. In the four cases tonsillectomised before the onset of chorea none had a permanent
heart lesion. The progress is satisfactory in all groups, though it is again slightly better in divisions
16 and III.
In this group of chorea only it would seem also that tonsillectomy may modify the disease as far as cardiac
involvement is concerned.
In division la 65 per cent, of the cases are in subdivision P.A. and 35 per cent, in B. and C.
In division lb 80 per cent, of the cases are in subdivision P.A. and 20 per cent, in B. and C.
In division III 100 per cent, of the cases are in subdivision P.A. and 0 per cent, in B. and C.
Two of the thirteen cases of division la, who had been tonsillectomised after the onset of chorea, had had
second attacks ; neither had a further carditis, but in one of them the general health was very poor. Ten of
these cases, however, had had no further attacks of chorea during the two years or more following tonsillectomy,
and in all the general health was greatly improved.
GROUP III.
Arthritic and
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
tomised
later.
Improved.
Unchanged-
Deteriorated.
Improved.
Unchanged.
Deterlorated.
I. Non-tonsillectomised
before onset of
arthritis and chorea.
(а) Requiring
tonsillectomy.
(б) Not requiring
tonsillectomy.
II. Tonsillectomised
incompletely before
onset of arthritis and
chorea.
III. Tonsillectomised
before onset of arthritis
and chorea.
IV. Cases from division
la tonsillectomised
before
(а) 2nd attack
(б) 3rd attack
V. Cases from division
la. No further
attacks of chorea 2
years after tonsillectomy.
23
3
2
I 1st
attack
4 arthritic
only
2nd
choreic.
1st
2 attack
choreic
2nd
arthritic
only
1st and
, 2nd
1 attack
arthritic
3rd
choreic.
All
attacks
arthritic
and
choreic.
5
1 had 2
attacks
chorea
before
tonsillectomy.
P 4
A 3
B 5
C 10
D 1
P 1
A 1
B 1
C -
D -
P 1
A -
B -
C 1
D -
P 3
A -
B 1
C 2
D -
P
A
B -
C 2
D -
P 1
A 1
B 1
C 2
D -
P 2 P 2
A3 A -
B 7 B I
C 4 C 3
D - D 1
P 1
A 1
B 1
C
D -
I p 1
A
B
C 1
I D -
P 3
A -
B 2
C 1
D -
P
A
B 1
ci
D1
A 1
B 2
C 1
D -
3 20 — 6 15 2
13% 87% 26% 65.3% 8.7%
3 3
100% 100%
2 1 1
100% 50% 50%
15 5 1
17% 83% 83% 17%
1 1 2
50% 50% 100%
1 4 5
20% 80% 100%
An examination of Group III again suggests that the progress of the disease is best in division lb. In division
III the figures are not so good as in Group I, but there are only two cases in this group, one showed a very
satisfactory progress, the other had a fairly severe cardiac lesion and the condition did not change. Divisions IV
and V are interesting. The progress of 13 of the 16 cases from lb which had been tonsillectomised later is