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(i.e., something more than a simple alteration of the heart sounds) occurred apart from
the susceptibility to rheumatism noted at the time of the examination or at some
subsequent period, in the form of pains of typical location and character.
Order of appearance of symptoms. In 6 cases where evidence was available it
appeared that the cardiac signs had preceded any subjective symptoms of rheumatism.
In 3 others it appeared that the rheumatic pains came first. In the remaining cases
there was no evidence to show which variety of symptom preceded the other.
Rheumatism and chorea. Six children in all showed signs of chorea, of whom
5 showed heart murmurs but no rheumatism, and the sixth complained of.pains and
showed severe anaemia, but had no abnormality in the heart sounds or rhythm. No
nodules were found. Two of these children were only 2 years of age when the
symptoms developed ; one was 3 and three were 4. Three of the rheumatic children
also complained of symptoms as early as 2 years of age and 15 at 3 years of age.
Persistence of symptoms. Six only of the rheumatic children were re-examined
some time after the examination at which symptoms were first noted. Of these,
3 reported improvement in the pains (all cases with cardiac murmurs), 2 were as before
and 1 was reported to be worse. The period covered by this observation varied from
6 months to 2 years.
Summary of rheumatic cases.
(1) 2.5 per cent of the total children examined showed signs that were possibly
those of early rheumatism.
(2) One third of the cases showed fairly definite signs, including some cases of
acute rheumatism or (reported) rheumatic fever; the remaining two thirds
showed fleeting pains that, combined with other symptoms, might signify
rheumatism.
(3) Anaemia was a concomitant symptom in half the cases.
(4) Sixty per cent of the cases showed some minor cardiac disturbance; 40 per
cent showed definite murmur; 10 per cent suggested some degree of actual
carditis. There was no clear indication of whether the rheumatic symptoms
ordinarily preceded the carditis or the heart disturbances the rheumatism.
(5) Six children in all, or .3 per cent of the total, showed signs of choreic disturbance
but only 1 had rheumatic pains and that case had apparently a normal
heart.
(6) The results of re-inspection were not sufficient to show whether the rheumatic
symptoms were cumulative or not, or whether they responded to general
hygienic or dietetic treatment.
(7) It would appear that the watch for rheumatism (in view of its liability to affect
the heart from its early stages) must begin at an earlier age than has been
customary, since the cases observed were found to start from 2 years of age.
(8) The number of cases was not sufficient to allow of any inquiry into other
conditions such as housing, economic status, etc., as factors in the causation
of rheumatism.