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95
" In view of the question of the influence of colour, this has been specially
investigated : 60 per cent. of our cases had fair hair, 39 per cent. had brown or dark
hair and 1 per cent. had 'red' hair. The combination of blue eyes and fair hair
occurred in 50 per cent. of cases. Blue eyes with dark hair in 20 per cent., while
30 per cent. had dark eyes and dark hair. These figures do not suggest any marked
colour propensities to rheumatism
" From a study of the histories, the following facts emerged. Of the cases in
group A, 41 per cent. gave a definite history of arthritis, 10 per cent. a definite history
of chorea, 3 per cent. a history of chorea and arthritis, while 46 per cent. had a vague
history of joint pains, twitchings, etc. In group B 18 per cent. gave a definite
history of arthritis, 9 per cent. a history of arthritis and chorea, 18 per cent. a history
of chorea only, and 55 per cent. gave only a vague history. In group C, 5 per cent.
gave a definite history of arthritis, none a history of arthritis and chorea, and 15 per
cent. gave a definite history of chorea. In 80 per cent. the history was vague.
Hence it can be concluded (1) a definite attack of acute arthritis is very often
followed by cardiac involvement; (2) chorea is far less constantly a precursor of
cardiac involvement than acute arthritis ; (3) half the cases of serious heart disease
have been preceded by no recognisable serious illness, but had vague signs of tiredness,
pallor, vague ill-health.
As regards the type of heart disease in Group A, 84 per cent. had mitral disease
and myocarditis, of which 17 per cent. were mitral regurgitation ; 30 per cent. had
combined mitral disease ; 25 per cent. had mitral stenosis ; 12 per cent. were unclassified
; 8 per cent. had both aortic and mitral disease. There were 7 cases of
congenital morbus cordis of which 3 were associated with mitral disease. These figures
show the striking preponderance of a mitral lesion. Of cardiac irregularities, only
sinus arrhythmia and extra systoles were observed, but sinus arrhythmia was not
often noted in the cases with myo-endocarditis, which lends stress to the statement
that sinus arrhythmia is a normal event.
The pulse rate.—The average rate for each group showed no striking differentiation.
A, 98'4 ; B, 100 ; C, 89'5 beats per minute, and for this reason a sub-classification
was adopted :—
A (a) A (b) B. C.
Resting Active Healed
Pulse rate. myo-endocarditis. myo-endocarditis.
Over 100 46 81 40 80
Under 100. 54 19 60 20
Hence it may be concluded that tachycardia is compatible with a normal heart;
but tachycardia in a child with a rheumatic history indicates the need for a careful
and searching examination. It seems that a majority of children with normal
hearts shows a moderate increase in pulse rate after exercise, but in the majority
of healthy hearts it rapidly returns to normal. The following observations result
from examinations of many hundreds of blood pressures taken. The system of
marking adopted is fully set out in the Annual Report for 1928 (p. 81). Eight
marks is the minimum allowed for efficiency :—
Cardiac efficiency.
Per cent.
Over 8 marks. Vnder 8 marks.
Definite cases of myo-endocarditis
Active 27 73
Inactive 75 25
Group B 40 60
„ C 80 20
These figures prove the usefulness of the cardiac efficiency taken in conjunction with
other signs. The next table shows the effect of standing on the pulse rate (percentage
of cases examined).
17710 G 2