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rate 120-140. Liver enlarged and tender on palpation. Blood pressure: 110 mm. Throat
culture : hemolytic streptococci, type ii. Blood culture: aerobic staphylococci, anaerobic nonhemolytic
streptococci. Blood urea: 22 mgms. per 100 c.c. 30 c.c. anti-scarlet serum and 30 c.c.
glucose, 50 per cent, given intravenously. Digitalin given orally.
12th day.-—Heart condition showed no change. 20 c.c. anti-scarlet serum and 30 c.c. glucose,
50 per cent, given intravenously.
13th day.—Marked improvement, fairly rational. Heart: rhythm more regular, A.B.
V.N.L. occasional extra-systoles heard. Blood culture: sterile. 40 c.c. glucose 50 per cent,
given intravenously.
14th day.—Quite rational and very much improved. Profuse general desquamation.
Heart: regular, sounds normal, rate 84.92. Blood pressure: 115 mm.
17th day.—Blood culture: sterile. Patient continued to improve and was discharged
fit on the 39th day, 29 days after admission.
Case 2.—Lilian C., aged 12. Admitted 3rd October, 1934.
Previous history.—Measles in infancy. No previous heart trouble.
Present illness.—Commenced 1st October with headache and sore throat. On admission:
typical scarlet fever with heart sounds normal. 40 c.c. anti-scarlet serum given intramuscularly.
4th day.—Heart: rhythm irregular with frequent extra-systoles. Temperature 101°.
Pulse 128. The temperature settled to normal within twenty-four hours, but the cardiac
irregularity persisted until the 35th day, when the heart was found to be normal upon
examination. Patient was then allowed up for short periods.
40th day.-—Attack of praecordial "aching," with temperature 99.8°. Pulse rate 110.120.
Heart examination revealed irregular rhythm with frequent extra-systoles and slight dilatation.
The patient was returned to bed and the heart was examined daily. The heart was found to
be normal on the 60th day, and the patient was discharged fit on the 75th day.
Case 3.—Stanley E., aged 8. Admitted 30th December, 1934.
Previous history.—Measles in infancy. No previous heart trouble.
Present illness.—Commenced with headache and sore throat, 30th December.
Admitted 1st day.—Well marked scarlet fever rash present. Temperature 102°. Heart:
rhythm and sounds normal. 40 c.c. anti-scarlet serum given intramuscularly. The temperature
became normal and the rash cleared up within 48 hours.
9th day.—Sudden attack of praecordial pain with temperature 100.2°. Heart: rhythm
irregular with frequent extra-systoles present. Pulse irregular in rhythm with rate 124. Blood
pressure: 100 mm. Patient treated with quinidine sulphate, an initial dose of gr. iiss., followed
after twelve hours by gr. iii every three hours for six doses, and by Nativelle's digitalin. The
heart was examined daily, and on the 20th day the heart sounds were found to be pure with no
extra-systoles, and the rhythm was regular. From now onwards the heart remained normal
and the patient got up on the 39th day. He was discharged on the 53rd day. He was then
quite fit and no cardiac abnormality could be detected.
Case 4.—Thomas M., aged 4. Admitted 4th May, 1934.
Previous history.—Measles in infancy. No previous heart trouble.
Present illness.—Vomiting and sore throat 3rd May.
Admitted second day of disease with bright rash present. Heart: normal. 5 c.c. antiscarlet
serum given intramuscularly. Patient made a quite normal progress until the 21st day,
when he was permitted to get up.
22nd day.—The pulse was found to be irregular. Heart: rhythm irregular, with very
frequent extra-systoles. In spite of all forms of treatment, the cardiac irregularity persisted,
with frequent extra-systoles, until the 80th day, when upon examination the heart was found
to be normal. Subsequently the rhythm remained regular, there were no extra-systoles and
the patient was discharged on the 87th day.
The above cases were the only examples of arrhythmia in the series. In a
number of cases symptomless murmurs were audible. These appeared during
the course of the disease, and were heard most frequently at the pulmonary area,
but their transient nature suggested that they were the result of a temporary cardiac
dilatation. The murmurs all disappeared before the patients were discharged.
Commentary.
Brelet (1920) stated that, in scarlet fever, tachycardia was frequently found
in children, and bradycardia quite commonly in adolescents. Examples of tachycardia
were not infrequent among my cases, but with the exception of one case,
which had a tachycardia (110-140) persisting until the 40th day, this symptom does
not appear to be associated with a definite carditis. Bradycardia was not met with.
There was also one instance of cardiac irregularity, in which extra-systoles
occurred in association with a pulmonary systolic murmur, but as there was a history
of previous cardiac damage, this case has not been described.
In each case the onset of arrhythmia was sudden, in a heart previously regular
with normal sounds. The rate of the cardiac apical beat—by auscultation—varied
Clinical signs.