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This classification follows that of Dr. E. Miller. It appears
the most useful, as in it a place is found for all cases irrespective
of situation or character of symptoms. Grouping of Rheumatic
cases, in spite of the ever increasing advance in diagnostic methods,
still remains a matter of difficulty and one requiring considerable
experience in all the diseases of childhood.
Perhaps the earliest signs and those which in particular led
to the diagnosis of a case as mild and potential were "growing
pains" in highly strung children, in association with slight irregularities
of cardiac sounds or rhythm.
Where these signs were present in a case, who also showed
some cardiac dilatation accompanied by breathlessness on exertion,
the diagnosis became more certain and passed into the definite and
quiescent group.
In these cases anaemia was almost constantly present being
recorded in 123 cases out of a total of definite cases of 130.
Malnutrition was frequently noted, and an expression of
nervous tension completed a clinical picture whose only counterpart
may be seen in children the subjects of glandular, mesenteric
or other forms of tuberculosis. The mistake of diagnosing some
of these rheumatic cases as tuberculous must be constantly guarded
against.
The definite and active group comprised cases of frank
Rheumatic carditis, as shown by well marked physical signs with
a history, or the presence of rheumatic fever or chorea.
Some cases of organic heart disease, whose origin could not
be otherwise accounted for, were placed in this group.
(4) Rheumatic manifestations.