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may occur with no striking symptoms to account for it. Parents,
seeing their children lying in bed without pain or distress, are shocked
when they are told that convalescence must be slow and carefully
supervised. But once the parents are told that the disease is due to a
microbe which causes poisoning and that the poisoning softens the
heart muscle, they are more likely to appreciate the necessary care ;
and again, they are impressed when emphasis is laid upon the fact that
the entire future of the child depends upon the heart muscle becoming
once more firm and strong. It is necessary therefore to get at the public
somehow and warn them. The object is not to wait until some child in
the family has been stricken down, but instead to give everyone the
information now.
The following should be known to everyone:—
1. Rheumatism is caused by infection by a microbe and is a
frequent disease in large cities.
2. In children, rheumatism often attacks the heart, and is the most
frequent cause of organic heart disease.
3. Pains in the muscles and joints in children should receive
attention, as possible warnings of rheumatism.
4. Sore throats are often associated with acute rheumatism.
5. Rheumatic heart disease is often painless and requires a doctor's
examination for its detection. Shortage of breath and pain over the
heart require immediate attention.
6. The heart, when injured by rheumatism, recovers slowly from
the poisoning, and one of the greatest dangers to the child's future is
for it to resume an ordinary life before the heart is firm.
7. Chorea, or St. Vitus's dance, is rheumatism attacking the brain,
and its chief danger is the tendency of the heart to be injured by the
rheumatism at the same time.
8. Great nervousness, dreaming of school work, alteration in disposition
and slight twitchings are often seen before the Chorea has
become definite, and are warnings.
9. Rheumatism often recurs, especially in the Spring and Autumn.
10. An occupation in life for a child with heart disease requires
careful choice.
Chorea and School Teachers.
In London there is a considerable amount of chorea during school
age. Chorea is rheumatism of the brain, and it is probable that this
frequency is in part due to overstrain and lowering of the resistance of
the nervous system to infection. Hence, if we find a school child