Social and psychological aspects of Sydenham's chorea

Abstract

It was decided to make an attempt to study the soil in which chorea developed. For this purpose the mother (and sometimes also the father) or guardian_of each child treated for chorea in the principal medical ward of the Royal Aberdeen Hospital for Sick Children, or in the outpatient department, was interviewed on one or more occasions. The object of the interview was to determine in addition to the usual history of birth, feeding, previous illness and family history, the presence of any factors which might adversely affect the child's mental and emotional stability. A pro-forma (Appendix - 1) was used to guide the investigation and explains the type of information that was sought.It was felt that such adverse factors were most likely to be found in the circumstances of the home or of the school. In this connection it is interesting to note that while most authors refer to the possible aetiological influence of school life, comparatively little has been said of the part played by home circumstances. It is indeed hardly surprising that school life should have attracted attention in the aetiological study of a disease of which the incidence is over 80% in the normal school age. An attempt was made to estimate the mental and emotional attributes and make -up of the parents. Relations with other children in the family, with other relatives and with neighbours were enquired into and an endeavour made to assess the Physical and economic conditions of the home. Once the object bf the enquiry had been explained, most of the mothers were readily co- operative: sometimes so enthusiastically so that their contributed information had to be accented with a certain reserve. Information regarding school possibly suffered in accuracy by being obtained at secondhand through the parents but in a number of cases the parents had already discussed the situation of the child with the teacher, or did so after the first hospital interview.Originally, 53 cases were studied. These repre- sent for practical purposes an unselected series. During the years 1935 to 1939 inclusive, 72 cases diagnosed as chorea were treated in the hospital. n some of these cases it was not possible to arrange he necessary interview; and the whole enquiry had to be abandoned on 1st September 1939. It has been necessary to discard seven cases on account of the incompleteness of the hospital records, and four others in which the diagnosis of chorea was not sustained (3 habit spasm, i hysteria). 42 cases, therefore, remain and form the basis of this study.Ten of the children were referred to Mr Rex Aright, Lecturer on (now Professor of) Psychology at Aberdeen University, who is specially interested in Child Guidance. The only selection applied was that for the purpose of this reference town children were chosen to save expense to the parents from the country. One of the ten (Case No.15) had started her chorea when living in the country. A summary of Mr Knight's conclusions is contained in Appendix 4.