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47
the opening paper of a discussion at the sixth Congress on
Rheumatism held at Oxford in March, 1938 The following is
taken from that communication:—
" 'During the last six years a scheme of prevention has been
introduced at Walthamstow, where the Medical Officer of Health
has examined all patients under 15 years of age who have been
discharged from the local fever hospital after scarlet fever and
diphtheria Those who showed any abnormal cardiac signs were
referred to the Walthamstow Rheumatism clinic, firstly for a
more precise diagnosis, and then for treatment and supervision
The results have been as follows:—3,050 children have been
examined after leaving the fever hospital; 153 children with
abnormal cardiac signs were referred to the Rheumatism clinic
and of these, 33 (1 per cent, of those originally examinedl) were
accepted as showing signs of rheumatic carditis Those in whom this
diagnosis was not accepted were found to be suffering from a
variety of cardiao abnormalities, such as congenital heart disease,
nervous tachycardia, and functional bruits These were kept
under observation for a period varying from 3 months to 4 years,
but evidence of rheumatic carditis did not materialise in any of
them'
"Turning to the 38 children with early involvement of the
heart, in 22 there was evidence of dilatation, and in 26 there was a
systolic murmur at the apex conducted to the axilla A short,
sharp first sound but no murmur was present in 5, and 5 had a
mitral diastolic as well as a systolic murmur Treatment at home
or in hospital, or in the special country heart homes, was arranged
for these, followed by supervision at the rheumatism clinic on their
return to school
"The after-history of these children is as follows : a follow-up
could not be maintained in 7, either because the parents had left
the district, or from difficulty in obtaining oo-operation Of the
remaining 26 no fewer than 15 are regarded as having recovered
completely, that is to say, there is now no clinical evidence of any
abnormality in the heart Even if we assume that carditis has
persisted in the 7 cases not followed up, we are left with a recovery
rate of 45 per cent, which, I submit, supports the contention that
the early diagnosis of rheumatic heart disease combined with prompt
treatment and prolonged supervision makes for a much improved
prognosis
"As would be expected, the prognosis was least satisfactory in
those cases showing a diastolic as well as a systolic murmur The
after-history of these children has been as follows : one child after
4 years is developing signs oif mitral stenosis; another was under
observation for 2 years and then left school, at which time it was
noted that there was a long mitral systolic murmur and shortness