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The brief results are as follows : Of 70 children who have passed through the school and who
left more than a year ago I have managed to keep in touch with 58. For statistical purposes
1 have classified these 58 cases into groups.
A—Good (with normal hearts or with signs of slight cardiac damage which persists unchanged)
36 cases (62 per cent.).
B—Deterioration of the heart condition or relapse of rheumatism. 15 cases (26 per cent.).
C—Deaths. 7 cases (12 per cent.).
These results will, I am sure, improve in the future in consequence of wider experience in the
handling of these cases and of the recognition of the value of early complete tonsillectomy."
Three other special residential schools for Rheumatic children are thus described in their " Report on the
Organised After-care of Rheumatic Children," by Drs. G. A. Allan and A. P. Thomson. The Invalid Children's
Aid Association have been pioneers in the provision of recovery hospitals for rheumatic cases.
Edgar Lee Home, Willesden, is scheduled as a residential open-air school, and is under the management
of the Invalid Children's Aid Association (London). It has accommodation for 22 boys. There is a local medical
officer, and consulting physicians visit from London. The average period of residence is 119 days, and the cost of
each patient per week is £1 8s. 0½d. The boys live indoors, but are taught in the open-air. Since 1918, 327 cases have
been treated with encouraging results. The boys have simple games and a modified school curriculum.
Kurandai Home School of Recovery, Hartfield, Sussex, is scheduled as an open-air school, and is under the
management of the Invalid Children's Aid Association (London). It has accommodation for 50 girls and small boys.
The children are housed in open-air shelters during summer and winter. This place was opened as an experiment
and as a temporary home.
The results have justified the plan, and a more permanent home is at present being sought. During the
first year 123 cases were admitted for periods varying from one to twelve months (average five months), and only
2 cases had rheumatic relapses. There is a medical officer (Dr. Prince) in the village, and a consulting staff of London
physicians. The average total cost of each patient per week is £1 is. 3½d.
St. Mary's Home, Broadslairs. The Horsfall Hospital wards in St. Mary's Home have been set aside for the
treatment of rheumatism, carditis, and chorea, under the care of Dr. M. O. Raven. During three and a half years
92 cases were admitted. Since October, 1925, education has been given by a fully certificated mistress. The average
residence is about ten months. Out of 75 patients discharged, 6 had died, being severe and advancing cases of cardiac
rheumatism. Of the remainder, 46 were re-examined, 31 had had no relapses, while 15 had shown active rheumatism,
chorea, or carditis. Dr. Raven considers that the longer the stay the better is the progress, and that tonsillectomy
is an important factor in controlling the recurrence of acute rheumatism, and rheumatic pains ; it is less effective in
chorea.
" Reports from these institutions prove their value in minimizing the severity of the after-effects of the
disease, and diminishing the chances of recurrence." (Sir George Newman.)
The Beneficial effects of removal of the Tonsils in Rheumatism.
In the past removal of the tonsils has been largely practised in Rheumatism, and since parents
and others are entitled to a confident opinion when an operative procedure is recommended and
since tonsillectomy is one of the most definite elements in the treatment of rheumatism now currently
proposed the matter will be summarised.
Sir George Newman, in 1926, is able to conclude that whilst some have doubted the efficiency
of removing enlarged tonsils after the occurrence of the first rheumatic attack as a preventive means
against subsequent and recurrent attacks, the removal of enlarged and septic tonsils, and the improvement
of oral hygiene forms perhaps the most important prophylactic measure we can take against the
rheumatism of childhood.
The statistical proof of the prevalent view thus voiced is based upon such recent researches as those of Miller
in London and Thomson in Birmingham.
Doubt of the efficiency of the operation had depended upon the subsequent occurrence in certain cases of
the first rheumatic manifestation after removal, and also the failure of the operation at times to prevent relapses
In studying this question most investigators have based their conclusions upon the proportion of cases which
shewed recurrence after operation. Miller has attributed their contradictory results to a lack of detail in the findings.
It is unreasonable to suppose that tonsillectomy has the same possibilities for benefit in a case after repeated attacks
of carditis as it may be a case taken in the stages of rheumatism. He attacked the problem by studying the manifestations
of rheumatism in children where tonsils had been removed. Analysis of his cases produces evidence strongly
in favour of the value of the operation.
Miller studied the rheumatic symptoms of 45 children after tonsillectomy, over periods of one to five years.
These were compared with the symptoms of the same children before operation and controlled by an analysis of the
symptoms of 133 children with tonsils.
Sore throats, joint pains, and heart involvement in all its forms were found to be greatly diminished following
operation. Muscular pains remain frequent, but tend to disappear gradually after operation. Chorea, on the other
hand, appears to be totally uncontrolled by previous operation ; the great majority of first and later in-patient
attacks of rheumatism occuring in such children consist of chorea, usually uncomplicated.
Thomson, from a study of 100 consecutive cases admitted to the Baskerville Home, Birmingham, has shewn
quite clearly that the children who had had the operation were far less prone to slight attacks of fever, which for lack
of other cause he considered to be a rheumatic manifestation. More important still, they were far less likely to
develop permanent cardiac injury as judged by the physical signs.