View report page

Rheumatic
nodules.
Including this year's figures, there are 39 cases which exhibited rheumatic
nodules as recorded in the statistics of children who have been treated in hospital
under the scheme. It is not possible to give an incidence figure for the appearance
of nodules for in the discharge reports of many of the children who have been treated
the presence or absence of nodules is not stated. The variety of rheumatic infection
which these 39 children manifested at the time of the appearance of the nodules
was:—
Rheumatic fever 2 boys and 5 girls = 7
Sub-acute rheumatism 10 boys and 17 girls = 27
Chorea 5 girls ... ... = 5
Total 39
The majority of these children were either suffering from their first attack of
rheumatism or rheumatism had first made its appearance a short time before the
attack for which they came under the scheme. In many of the children the nodules
appeared in more than one part of the body but the most frequent sites in the series
were the extensor tendons of the wrists and the dorsum of the hands 7 cases ; elbows 5
cases ; occiput 3 cases. The condition of the heart in these children was : normal 11,
suspected myocarditis 8, rheumatic myocarditis 3, valvular disease of the heart 17
(mitral regurgitation 6, mitral stenosis 3, mitral regurgitation and stenosis 7, mitral
and aortic disease 1). Two of these children died while in hospital and three are still
under treatment having been admitted during the past year. On discharge from
hospital 14 of the children were judged to be fit for attendance at an elementary
school with full curriculum, 10 were allowed to attend an elementary school but drill
and games were forbidden, 8 were sent to schools for physically defective children, and
2 were thought to be unfit for attendance at any school. The history of 10 of these
children has been followed over a period of two years. Three of them remained in
schools for physically defective children their hearts being badly damaged and two
of them having had further attacks of severe rheumatism ; 5 children had been able
to continue attendance at an elementary school with limitation of games and drill
and two had been able to follow the full curriculum of ordinary school life.
Importance
of sub-acute
rheumatism.
Sub-acute rheumatism in its various manifestations is of particular concern to an
organisation devised as a preventive force. The child with acute articular rheumatism
or chorea as a rule receives medical attention either at its home or in hospital, but the
sub-acute case frequently drifts on for years without receiving any active assistance.
In these sub-acute cases one of three things may happen. The child may continue
to suffer the discomfort and handicap of its pains without complications, or the
debilitation of the continued rheumatism may reach a point at which the invading
disease is enabled to flare up in an acute attack either articular or nervous, or when
the child is medically examined by reason of the onset of other symptoms of disease
it will be found that heart disease has insidiously established itself. In 1,700 first
attacks of all forms of rheumatism the onset was indicated by sub-acute articular
rheumatism in 813 cases (48 per cent.). Out of 180 hospital cases of sub-acute
rheumatism with rheumatic heart disease, 75 of the children had never had any
other form of the disease.
Protean
character of
rheumatism
When a large number of cases is reviewed rheumatism is vividly seen as a protean
disease. A child may have a series of attacks of acute articular rheumatism extending
over some years, and when an acute phase once more makes its appearance it may take
the form of chorea. Similarly, a child with a long history of chorea will develop an
attack of acute articular rheumatism. It is the sub-acute variety which shows itself
the most ready to pass into another species of the disease. Histories were obtained
in 500 cases of rheumatism showing that an acute phase followed an intermittent