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13
JUVENILE RHEUMATISM:
A COMPARATIVELY RARE DISEASE IN HORNSEY.
A condition of early life which is attracting much attention
in recent years is rheumatic infection, with its occasional
disastrous sequel in heart disease.
Formerly the concern of the family physician and the
paediatrist (children's specialist), juvenile rheumatism has now
become the subject of special supervisory schemes by public
authorities—chiefly education authorities, because school age is
the age of highest incidence of the disease. In these circumstances
it is desirable to call attention to the favourable position
of this district in regard to rheumatic infection of young people.
The Nature of Juvenile Rheumatism.
The cause of this infection is not known with the same
certainty as is the cause of some other infections of childhood,
e.g., diphtheria, meningitis, etc., but it is believed to be caused
by hæmolytic streptococci, which gain entrance to the body by
the throat. The initial illness may be a tonsillitis, followed,
after a period of two to three weeks, by signs of acute rheumatism
or rheumatic fever.
If the cause is obscure, the same cannot be said about the
clinical manifestations of this infection. The signs and symptoms
make one of the most striking pictures seen amongst the acute
specific infections of childhood. They may be classified under
five headings:—
(1) Constitutional.—The raised temperature (100° to 105° F.),
coated tongue, thirst, perspiration, anaemia and loss of
flesh all testify to the general constitutional effect of the
rheumatic poison.
(2) Articular (Joints).—The most characteristic feature of
acute rheumatic infection is the inflammation of one
or more of the joints, which become swollen, tender and
hot to touch, and painful when moved.
(3) Cardiac.—On account of the permanent damage sometimes
done, the most important manifestations of acute rheumatic
infection are those affecting the heart. Any or
all of the tissues of the heart may be involved in
rheumatic cavities—the sac in which the heart lies
(pericarditis), the muscle wall of the heart (myocarditis),
or the lining membrane of the heart (endocarditis). This