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Management of convalescence in rheumatic heart disease
The second group was of 133 children with a history of rheumatic fever or acute articular rheumatism. These children are rarely seen before the age of three years. The author describes the well-known characteristics of rheumatic fever in young children. He believes that the relnt,ionship bctmeen rheumatic fever and heart disease is well recognized. In tllis group, 93 children (70 per cent) showed evidence afterward .of cardiac involvement; of the remainder, the rheumatic fever was follow&l by chorea in 5 cases. Only 23 children had brcn entirely free of rheumatic symptoms since their attack of rheumatic fever. The third group was of 197 children with choren. Of this group, rheumatic heart disease occurred in 52; rheumatic fever preceded the choren in 5 cases, and :~ccompnnied or followed the in 1.5 instances rheumatic pains in the limbs either Children with chorea are apt to he quick and intelligent and keeo on their cshorea. school work. The fourth group was The author centage of 44. ticularly the differentiation and functional disturbances. this group of children.
of 266 childreu with rheunlatic heart disease, a perdiscusses the early diagnosis of the heart disease, parof murmurs associated with organic valvulnr lesions Aort,ic regurgitation ins present in 6 per cent of
The question of tonsillectomy in chilihm with rheumatism is discussed briefly. In this group of children tonsillectomy has been performed on 90 per cent. Three hundred ninety-three were operated on before admission to the clinic. Cases in which visible tousil remnant remained after the operation have not been included in this st,udy. Approximately one-third of the cases of rheumatic pains, ehorea, and rheumatic fever begin these symptoms of rheumittic infection after the tonsils have been removed. The author believes that unless it can be shown that tonsillectomy has a definite influence in the prevention of cardiac disease there seems small justification for the operation merely on the ground that the child is n rheumatic suspect. It seems more. probable that the value of tonsillectomy in rheumatic children is in proportion to the degree of impairment of the general hmlth attributable to the tonsils. Buffnm, ease.
William Rhode
P.: Island
Management M. J. 13:
of 127,
Convalescence 1930.
in
Rheumatic
Heart
Dis-
The author discusses the many criteria that can be used in watching individuals convalescent from active rheumatic fever and heart disease. Usual points to be noted are the temperature, pulse rate, general appearance, and color of the child, weight curve, and the physical signs noted ou examination of the heart. Furthermore, subcutaneous nodules should be looked for; the leucocyte count should be followed, and occasionally the determination of vital capaeit,y may serve as a guide to satisfactory progress. The vital enparity cnn be used as au index of the functional capacity of the heart. He points out that the determination of whether or not the active disease has ceased is at times very difficult and that it is not possible to rely entirely on auy one of the above signs. During further convalescence, after the patient is up, any recurrence of these signs of active disease shows that the patient should be put to bed again. The author makes the important statement that in general it is better to consider the child as a whole rather than to focus the attention too much on the heart. He discusses the regulation of exercise and the general care that should he provided these patients. He also discusses the value of tonsillectomy in the control of further attacks of rheumatic fever.
of 266 childreu with rheunlatic heart disease, a perdiscusses the early diagnosis of the heart disease, parof murmurs associated with organic valvulnr lesions Aort,ic regurgitation ins present in 6 per cent of
The question of tonsillectomy in chilihm with rheumatism is discussed briefly. In this group of children tonsillectomy has been performed on 90 per cent. Three hundred ninety-three were operated on before admission to the clinic. Cases in which visible tousil remnant remained after the operation have not been included in this st,udy. Approximately one-third of the cases of rheumatic pains, ehorea, and rheumatic fever begin these symptoms of rheumittic infection after the tonsils have been removed. The author believes that unless it can be shown that tonsillectomy has a definite influence in the prevention of cardiac disease there seems small justification for the operation merely on the ground that the child is n rheumatic suspect. It seems more. probable that the value of tonsillectomy in rheumatic children is in proportion to the degree of impairment of the general hmlth attributable to the tonsils. Buffnm, ease.
William Rhode
P.: Island
Management M. J. 13:
of 127,
Convalescence 1930.
in
Rheumatic
Heart
Dis-
The author discusses the many criteria that can be used in watching individuals convalescent from active rheumatic fever and heart disease. Usual points to be noted are the temperature, pulse rate, general appearance, and color of the child, weight curve, and the physical signs noted ou examination of the heart. Furthermore, subcutaneous nodules should be looked for; the leucocyte count should be followed, and occasionally the determination of vital capaeit,y may serve as a guide to satisfactory progress. The vital enparity cnn be used as au index of the functional capacity of the heart. He points out that the determination of whether or not the active disease has ceased is at times very difficult and that it is not possible to rely entirely on auy one of the above signs. During further convalescence, after the patient is up, any recurrence of these signs of active disease shows that the patient should be put to bed again. The author makes the important statement that in general it is better to consider the child as a whole rather than to focus the attention too much on the heart. He discusses the regulation of exercise and the general care that should he provided these patients. He also discusses the value of tonsillectomy in the control of further attacks of rheumatic fever.