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" Early and complete tonsillectomy stops the tendency to recurrent sore throats
and thereupon presumably reduces the chance of continued septic absorption from the
throat.

"Only 10 out of this series were thought to have normal throats, that is tonsils
either not visible or visible but not inflamed. In a previous series (Annual Report.
1927) only 17 out of 100 rheumatic children had normal throats.
"Twenty-nine out of these 84 cardiopaths had been tonsillectomised, probably
because of obvious local signs; this represents 35 per cent., a higher percentage
than is found among ordinary elementary school children in London (25 per cent.).
The throats of rheumatic children are more troublesome than those of the normal
child, but because there is no marked local hypertrophy of tonsils and adenoids,
tonsillectomy although more frequent in them is not so frequent as it should be.
"Only six out of 84 were satisfactorily operated on before the known onset of
rheumatism, 8 were incompletely tonsillectomised prior to rheumatism and 15 had
the operation subsequent to the onset, of whom 5 had tags left and all those with
fragments remaining show some signs of local inflammation. There is thus a higher
percentage of inflamed tonsils in rheumatism. Complete tonsillectomy stops
recurrent sore throats, incomplete tonsillectomy does not.
"The operation is therefore well worth while in every child with recurrent sore
throats or who shows such evidence of inflammation as is indicated above, but it
should be done before rheumatism declares itself, or alternatively, only during
definite quiescence of the illness. The tonsils should be dissected out or completely
removed ; to leave tags is more harmful than to leave the tonsils alone.
"A relatively large number of children was seen this year, without any apparent
abnormality of the heart, an encouraging sign of the increasing attention of the
parents to minor departures from good health in their children.

"Although the rheumatic infection may have long smouldered, some children
will present few signs or symptoms prior to the detection of carditis. Unfortunately,
when the heart is definitely affected recognition of the condition is too late. At the
same time the range of physiological variation in the child's heart is wide and many
apparent abnormalities are not of infective origin. Less than half of those whose
hearts were looked upon with suspicion last year are now giving anxiety ; the others
have improved and appear to be healthy and well.
" While adopting every means to better the child's condition and to increase his
resistance to infection, an optimistic attitude is best, for children showing extremes