Acute rheumatism in children in its relation to heart disease.

Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: Acute rheumatism in children in its relation to heart disease. Source: Wellcome Collection.

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    What, then, is the nature of this insidious infection ? Is the infecting organism of one specific kind ? or is acute rheumatism, like septicaemia or food poisoning, a diseased condition which can be produced by an association of organisms or by more than one specific bacterium? If the causa causans be single, is it an infection of purely streptococcal origin? If so, is it a highly specialised strain of streptococcus of the viridans group? If not, and if the streptococcus be only a secondary invader, what is the primary invader? Is it a filter-passer ? If it be a filter-passer, is not its comparatively low grade of infectivity exceptional for infective viruses of this type? If, again, the infection be due to a streptococcus of the viridans group, why do the salicylates, which are not known to be selectively antibacterial for these organisms, have an action so nearly specific upon the arthritic form of the disease—an action unparalleled in any other strepto- coccal infection ? That we should be driven to ask ourselves a series of questions like this indicates the degree of our ignorance as to the aetiology of this wide-spread infection. Dr. Eastwood’s analysis of the many attempts to give consistent answers to these difficult. questions properly occupies a primary place in this Report, for a clear knowledge of the causal agent would probably lead us to the essentials of preventive action. The present position seems to be that :— (a) we have no certain knowledge of the causal agent of this infection, although the theory that a streptococcus of the viridans group is the bacteriological agent, without being fully proven, provisionally holds the field : (6) no rival theory has so far made substantial headway : (c) attempts to identify rheumatic strains by serological methods have failed : (qd) further work is urgently needed, especially on blood cultures and including the elaborate methods of com- bined chemical and serological analysis which have been employed in connection with pneumococci. Whilst the bacteriologists are exploring the field and con- tinuing their investigations, the predisposing conditions of infection. are being studied. There is good ground for believing that the social condition and environment of the patient is a potent influence. This social aspect of the disease has recently received the attention of the Medical Research Council, and their report: appeared but a few weeks ago, in March, 1927.* In his intro- duction, Dr. Still shows how much more common is the disease in hospital practice than in private practice, mentioning that. in 1,000 consecutive children under 10 years of age seen at the Children’s Out-patient Department at King’s College Hospital, 229 children (or 13-1 per cent.) showed evidence of acute . Medical Research Council. Special Report Series, No. 114, Report. of Committee on Child Life Investigations, ‘‘ Social Conditions and Acute. Rheumatism,”’ 1927.