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* D = Definite.
† S = Suspected cases.
Dr. Dobbie's
report on
heart disease.
Dr. Nairn Dobbie has kept careful notes of all children presenting heart symptoms
met with at his school inspections and has reported as follows:—
" Recognising that rheumatism in its various manifestations plays an important
part in injuriously affecting the heart in school children, a record was kept of all
children showing cardiac abnormalities and their past histories were investigated.
About 10,000 children were seen as entrants and in the age groups examined at
ordinary routine inspections.
Definite evidence of acquired carditis in children under 5 is comparatively
rare, 1 in 1,000—the percentage gradually increases with the age—at 7 years the
percentage was 25 (5 in 2,000), and at 12 years .7 (36 in 5,000). These figures are
probably a low estimate of the condition amongst the poorer school population as
many of the worst cases either do not attend school or are early admitted to special
P.D. schools and so do not appear at routine examinations.
In 90 per cent. of all these cases of acquired structural alteration of the heart—
definitely present—there was a history of rheumatic fever, definite chorea, recurrent
pains and repeated tonsilitis either singly or combined. In some areas rheumatism
appeared to be endemic and the number of cardiopaths whose parents gave a
rheumatic history rather indicates a familial susceptibility to the virus. In the
remaining 10 per cent., the only illnesses recorded were scarlet fever, diphtheria,
influenza, measles or whooping cough. In these acute illnesses the infection is
short-lived and not recurrent while the resistance and recuperative powers of the
young heart are very great.
The virus of rheumatism has a selective action on the heart. The percentage
of children showing definite cardiac involvement is greater in those with a history
of two or more attacks of rheumatic fever, viz., 30 per cent. (14 out of 40). In 83
cases having had one attack of rheumatic fever, followed by "growing pains,"
there were 15 with acquired valvular disease of the heart (18 per cent.) and amongst
211 children who had suffered from recurrent tonsilitis, 12 were definite cardiopaths
(5.7 per cent.). Chorea is a rheumatic manifestation in those of the unstable
nervous type. The percentage of choreic cases resulting in developed heart
disease was not obtained, but 35 cases of valvular disease gave a history of
chorea, though many of these also gave a history of either rheumatic fever,
tonsilitis or pains.
The time elapsing between the initial onset of rheumatic fever and definite
recognisable signs of carditis varies from under a year to many years, excluding,
of course, cases of acute pericarditis and acute malignant endocarditis, which
11908 F