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(i) Heart Diseases and Reumatism.
The Rheumatic Clinic is held once monthly at Croyland Road for
the purpose of examining children suffering from rheumatism and diseases
of the heart.
The specialist reports as follows :—
"During the year 1947 altogether 251 children attended the Rheumatic
Clinic, of which 187 were old cases and 64 new.
It is interesting to note that only 3 of the number of children seen
were of the arthritic type, thus emphasizing the important truth, that childish
rheumatism differs essentially from the adult form.
It is not surprising that in past years the absence of joint involvement
in children led to the failure to detect the presence of juvenile rheumatism,
with the result that many young people did not receive proper treatment
and guidance until they presented cardiac symptoms and signs—the too often
dramatic results occurring in missed childish rheumatism.
The picture of the rheumatic child, is as already stated, different from
the arthritic form seen in adults. In children rheumatism may assume many
guises—as for example—listlessness, irritability, pallor with or without real
anaemia, nervous twitchings and vague aches and pains in different parts of
the body, more particularly in the lower limbs. Such types of rheumatism
are common, and are best designated as "subacute cases," ninety-five of these
being diagnosed at the Clinic during the year.
A considerably large group of cases, namely, 36 in our series came
under the heading of "Fascial type." The word, fascia, denotes a sheet
or band of tissue which invests and connects the muscles. Inflammation of
this band of tissue is prone to occur in rheumatic infection, and gives rise
to an ache or even severe pain in such places where fascia exists, e.g., the
thighs or the abdomen. In the latter situation, if the pain be located chiefly
to the right lower region of the abdomen, the diagnosis of appendicitis may
wrongly be made.
Apart from the irritability and muscle twitchings already referred to
in connexion with the subacute cases, a more severe and haphazard type
of jerky movements are often met with in rheumatic children, and denote
either a choreic tendency or a definite chorea.
Forty-five chorea examples were noted in our cases. The importance
of recognising chorea at an early stage of the disease, lies in the fact that
this form of juvenile rheumatic trouble leads more often to heart complication
than any other variety of rheumatism.
I am convinced that the early recognition of those somewhat indefinite
nervous symptoms as manifestations of childish rheumatism, and the appropriate
advice given to the parents, and the limiting of the patient's activities,
must have resulted in the lesser incidence of rheumatic heart disease in later
life
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