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In the same way the number of children with cardiac involvement also shows a
steady decline, which seems to indicate that the disease, in addition to being less widespread,
is also becoming less severe and that the cardiac complications are becoming
milder. The percentage of children with cardiac involvement on admission during recent
years has been :
1947 1948 1949 1950 1951 1952 1953 1954
67.7 70.2 51.7 60.8 49.1 43.7 41.2 34.5
Chemotherapy and the wider use of antibiotics has probably been a factor in speeding
up a process which in part seems due to an attenuation in virulence in the infecting
organisms, but the use of cortisone and its congeners does not seem to prevent the onset
of carditis in cases of established disease. The condition on admission of the cases
admitted during 1954, was as follows:
Boys Girls
Articular Rheumatism
Number admitted 64 38
Percentage with :
Carditis 28.1 31.5
Valvular damage:
Mitral 9.4 10.5
Mitral and aortic 3.1 —
No cardiac involvement 59.4 58.0
Chorea
Number admitted 12 17
Percentage with :
Carditis 8.3 23.5
No cardiac involvement 91.7 76.5
Articular Rheumatism and Chorea
Number admitted 4 4
Percentage with:
No cardiac involvement 100.0 100.0
N.B. seven children were diagnosed ' not rheumatism .
An analysis of the figures available for the past year suggests that, whereas the
numbers of boys and girls developing carditis as a result of acute rheumatic infection
are almost equal (boys 28.1 per cent.—girls 31.5 per cent.) and the numbers with mitral
involvement are similar (boys 9.4 per cent.—girls 10.5 per cent.), the boys have been
more liable to aortic disease. When the cases of chorea are considered, however, it is
noticed that the girls are more frequently affected and that the percentage of carditis
amongst them is considerably higher (boys 8.3 per cent.—girls 23.5 per cent.).
Unfortunately it cannot be claimed that these figures are complete as it has not
been possible to follow up all the cases. Changes at Queen Mary's Hospital, Carshalton,
during the past two years have ended the 'Acute Rheumatism Unit' as a separate
entity. No longer are the children under the care of a single consultant in separate
wards; they now come under the care of three separate consultants in general wards.
This seems to cause considerable delay before discharge reports reach the County Hall,
and makes the correlation of reports somewhat arbitrary and the follow-up more
difficult. A solution of these difficulties should not prove insuperable and should
certainly be attempted, for with reasonable co-operation it is thought that re-entry
into school life at a satisfactory level of activity could be expedited. In the past year
88 per cent. boys and 84.5 per cent. girls were considered fit for ordinary school or
employment; 8.4 per cent. boys and 8.6 per cent. girls suitable for school for the
physically handicapped or light employment; 3.6 per cent. boys and 6.9 per cent. girls
unfit for school or work:
Fit for ordinary Fit for P.H.
Sex school or ordinary school or light Unfit for school Total
employment employment or work
No. Percentage No. Percentage No. Percentage
Boys 73 88.0 7 8.4 3 3.6 83
Girls 49 84.5 5 8.6 4 6.9 58
Total 122 86.5 12 8.5 7 5.0 141
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