Rheumatism in childhood

?Jl of -cne individuals were in good health on March :.. .?i severe epidemic of influenza began on March 22. l&ii but six &ii&err w;? ‘raeted the disease. The filterable virus responsible for Tunis outbreak was recovered. This agent did not activate the rheumatic process. It was followed by an outbreak of streptococcus infection and appeared to facilitate its spread. The source of these infections was not traced. They were due to a single t.ype Its eu1tura1, bio.xZ hemolytie streptococcus which was a strong toxin producer, chemical, and serological characteristics were different from those of the carrier strain. Of seventeen individuals proved bacteriologically to be infected with the epidemia rtrain, fourteen rheumatic subjects developed acute rheumatism; two rheumatic subjects and one patient with congenital heart disease escaped. These fourteen rheumatic attacks were accompanied by a rise in antistreptoiysin titer coincident with the onset of symptoms. In four of these attacks is was possible to exclude influerrza as a causative factor. tZ?oburn, A. F., and Pauli, R. IX: Studies on tire Immune response 5f the fheramatic Subject and Its Relationship to Activity of the Rheumatic Process: sensations on the Reactions of a Rheumatic Group to an, Epidemic Infec%ioa With H.emolytic Streptococcus of a SingIe Tglpe, J. Exper. Bed. 62: 159, I.935 This study of an isolated colony showed that of seven children who escaped the epidemic streptococcus infection, none ,developed rheumatic symptoms; and that of seventeen children who contracted the epidemic streptococcus infectioq fourteen developed acute rheumatism, and three showed no recognizable rhemnatie manifestations. The seven children who failed to contract infectiou with Streptococcus r2emol@C~s showed clearly that susceptible individuals may live iri dose association with an epidemic of acute rheumatism, develop no rise in autistreptoiysin titer, and maintain excellent health. The patient with congenital heart disease demonstrated that a nonrheumatic subject may be infected with a highly effective strain of hemolytie streptococcus, develop a typical antibody response, and yet escape all rheumatic manifestations. The two patients who, although infected with the epidemic strain, failed to show aqy antibody response, also failed to develop rheumatie recrudescenees. Environmental, dietary, age, and the other factors investigated did not appear to oe significant in this outbreak of acute rhenmatism. Three factors appeared to determine the development of the fourteer* rearudeseences: (I) infection with a highly effective agent; (2) the disease pattern, pe&iar io eaeh rheumatic subject; and (3) the intensity of the immune response of the p2tknt as indicated by the rise in antistreptolysin titer. Kutumbiah,

P. :

Rheumatism

in

Childhood,

Indian

3. Pediat.

2: 215,

1935.

1. A short summary of the literature on rheumatism in India is given. 2. The contention that there is no rheumatic fever in the tropics is shown to he no longer tenable. 3. Evidence is adduced to show that rheumatic infection in childhood is common In Yizagapatam, a city situated in the tropics. 4. A brief resume of the salient features of juvenile rheumatism as it oec,urs in the temperate climates is given. 5. An analysis of fifty cases of juvenile rheumatism from King George I&spit Vmagapatam, is given. 6. The various phases of cardiac rheumatism are illustrated by typical ca.ses from this series.

1124

THE

AMERICAN

HEART

JOURNAL

7. The age and sex incidence and incidence of polyarthritis, ehorea, and nodules are discussed. 8. The frequency of cardiac rheumatism in children suffering from tonsillitis is noted. 9. Few typical radiographs and electrocardiograms of mitral disease are given. 10. It is concluded that rheumatism in childhood is very common in the Vizagapatam district, and in its essential manifestations it closely resembles juvenile rheumatism in the temperate climates. Bland, ing

Edward f., and Jones, T. D.: the Appearance of Rheumatic

Clinical Observations on the Events PrecedFever, J. Clin. Investigation 14: 633, 1935.

1. There appears to be no significant clinical difference between the recurrences or recrudescences of rheumatic fever following (1) respiratory infection, (2) other forms of infection, (3) accidents or operative procedures, and (4) a single intravenous injection of typhoid-paratyphoid vaeeine sufficient to cause a slight febrile reaction and chill. It is 2. The probable significance of these observations has been discussed. evident that various events precede and apparently influence the appearance of the signs and symptoms of recurrent rheumatic fever. 3. It seems desirable, in view of the observations presented, to consider the r8le of such events as nonspecific until more definite information is available concerning the etiological agent.

David, Seegal, E. B. C., and Jost, E. L.: A Comparative Study of the Scarlet Fever and Acute Geographic Distribution of Rheumatic Fever: Glomerulonephritis in North America’, Am. J. M. Se. 190: 383, 1935.

Seegal,

1. A comparative study has been made of the geographical distribution in North America of acute glomerulonephritis, rheumatic fever, and scarlet fever. 2. The case rate for scarlet fever diminishes progressively from latitude region 50 to 45 degrees to 34 to 29 degrees. 3. The yearly hospital medical admission rate for rheumatic fever in twenty-four hospitals shows a similar decrease in the same latitude regions. 4. In contrast to ‘the diminished case frequency of scarlet fever and rheumatic fever in southern latitudes as compared ‘with northern latitudes, the yearly hospital medical admission rate for acute glomerulonephritis does not vary significantly in the four latitude regions studie.d. 5. The failure of acute glomerulonephritis to diminish in frequency in southern latitudes might be interpreted as supporting the hypothesis that agents other than the hemolytic streptococcus play the chief etiological role in this disease. This does not seem likely, however, since considerable evidence is available incriminating the hemolytic streptococcus as the main incitant of the disease. 6. Since evidence is available ascribing streptococcus in all three diseases studied distribution of these diseases based upon specific host and bacterial interaction.

etiologieal here, the the limited

significance to the hemolytic variation in the geographical ,data presents a problem in

Baker, B. M., Thomas C. B., and Penich, R. M., Jr.: Experimental Carditis: Changes in the Myocardium and Pericardium of Rabbits Sensitized to Streptococci,

1. When pericardially results.

J. Clin.

Investigation

a heat-killed into rabbits

14:

465,

1935.

culture of beta hemolytic sensitized to the same

streptococcus organism, an

is injected extensive

intracarditis