The Lævulose Test in Rheumatic and Choreic Children.

hi a I)aper rCceily I)iil)lished in TIHE ARCHIIVE.s OF DISEAs;E IN CHILDHOOD Traylor Chadwiclk i gave the results of ani investigation of the behaviour of the -vtullose test in the rheumin<atic chil(l. From the results he coiicliided that in certaiin stages of the rheumlatic infection the efficiency of the liver is impaired, andl lhe expressed the opinion that this might be (lile to the result of toxic absorption from sonie rheuimatic focuts. In childreni completelv recovered from rheumatism. an(d in those suffering from uincomplicated chorea, he found that the ingestioin of levtlose gave a blood-sugar curve not differing from that obtained in the inormiial individuial. In children presenting active rheumatisin, with or U-ithout heart affectioIl and in the examples of chorea with evidence of carditis there was. on the other hand, an appreciable intolerance to loeviilose as inidicated b)v a rise in the blood sugar. This rise in the blood sugar varied betw-een 18 per cent. anid( 113 per cent., with ani average increase of 49 per cent. A suirvey of the details in Chadwick's paper raises a suspicioin that the dimiinished hepatic efficiency as indicatedl by the lavuilose test is dependent on passixve congestion of the liver seconidarv to cardiac involvement rather thaii oni soniie toxic actioni. Of the number of cases in which there was cardiac involvement 54 per cent. reacted abnormally to lakevulose. If, however, there be excluded the five cases (Nos. 12, 16, 30, 31 and 34), in which the cardiac invol-ement was admittedly transienit, theni the percenitage of abnormial finldinigs in Chadwick's cardiac cases rises to 73. OIn the other hand, of the four rheumatic cases without apparent heart disease, oiily one (No. 11) gave an abniormnal curve. IIn tlhe text of his paper Chad-wick drew attention to the cases with and(i -without heart disease, adl uwhile he remarked that the abnormal blood-sugar curve followving l.mPvulose blears no relatiolnship to the valvular lesioni, he admittedl thcat it (lid bear a certaini relationslhip to the state of tolne, of thle cardiac muiscle. It is, therefore, (lifficult to appreciate oIn what grounids lie bases h1is ultimate (olcluision. that active rheumatism, w%-ith or without heart disease, is accompanied by ati abnormal blood-sugar cuirve after the iIIgestiol) of hevulose. In a previouis commuinicationl2 also published in this Journal, I recorded the resuilts of a studY of the value of the levidlose test as an index of efficiency of thte liver. I concluded that a rise of 30 per cent. in the blood-sugar content after the admninistration of 1ev-ulose should be considered as evidence of hepatic