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It will be observed that about 37 per cent, have a definite history of acute
arthritis or chorea (A and B) ; 8 per cent, have definite carditis but give no history
of acute illness (C) ; 20 per cent, are considered to be definitely not rheumatic (E);
whilst 35 per cent, give a history of symptoms related to rehumatism but having no
sign of cardiac involvement (D); probably many of these cases are not rheumatic ;
11 cases gave a definite history of acute arthritis and chorea. Of these 8 had carditis.
Increasing experience has shown that many of the definitely rheumatic cases,
even those with carditis, are capable of leading active lives with progressively
decreasing restrictions, but it is felt that a child known to be definitely rheumatic is
never free from a risk of further manifestations and therefore it is the present practice
at the three centres under discussion never to discharge these cases until they leave
school. If the children are well, the mothers are told that no treatment is necessary
but that it would be desirable for the children to be seen in 6 or 12 months to make
sure that they are still well.
The most difficult cases are those which come under Classes C and D. Under
Class C are 49 children thought by their mothers to be healthy but found at some
routine examination to have serious carditis. When did these children develop
carditis ? At these three centres the mothers of all children reputed to be suffering
from " insidious carditis " have been subjected to a searching examination and it is
surprising to find that a certain number of mothers who, on first enquiry, avow that
their children have never been ill will subsequently let slip some remark about
"... when he was in-hospital " ; and on enquiring why he had been taken to
hospital, " Why, when he had St. Vitus Dance, of course! " In this way quite
a number of cases which were originally classified under " C " have been subsequently
found to belong to " A " or " B." Of the 49 cases finally left in Group C, there was
some evidence in 14 that the carditis may have been the result of some acute illness,
and in 6 others the mothers seemed so casual or unintelligent that it was felt that little
significance could be attached to the negative history. In submitting these figures
it is not intended to suggest that carditis of insidious onset does not occur, but it is
suggested that a grave valvulitis should not be assumed to have developed insidiously
merely because the mother says the child has never had rheumatic fever.
In an attempt to prevent these tragic cases from developing, a large number of
children having symptoms of a rheumatic nature are referred to the centres ; these
cases constitute about 35 per cent, of those seen (Table 6) (Group D). How many of
these cases are potentially Group C ? In the present state of our knowledge there
seems to be no reliable method of diagnosing the muscular pains of true rheumatism