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It has to be remembered that there are early and late
heart lesions in diphtheria, and that the former having been
successfully combated, the latter may supervene when convalescence
seems in process of being reasonably well
established. The earlier circulatory failure is due to toxie
degeneration of heart muscle and the later circulatory failure
is a consequence of damage sustained in the early period.
Then there are the grave forms of diphtheria which are
desperate from the onset and despite massive dosage of antitoxin
proceed rapidly to a fatal issue, or if surviving for a
time, seldom give any hopeful sign of recovery. But even
here the making of a prognosis is a hazard, for it has been
one's experience that cases of this nature do recover after a
period of grave and prolonged illness during which for a time
all hope was abandoned.
The selective action of the toxins of diphtheria on the
heart muscle gives rise to anxiety when the decision has to
be made as to whether or not a child is fit to leave the
hospital and also whether his normal activities should be
limited and for how long. This assessment is made mainly on
the history of the illness and on general clinical grounds but
in this connection an electro cardiographic examination, which
gives a more precise estimate of the condition of the heart
muscle, would in certain cases prove a valuable adjunct. It
is certain that a proportion of heart conditions in later life
owe their origin to one or other of the acute specific fevers
of childhood.
An advance in treatment for the more prolonged cases
of diphtheria would be provided by the part-time employment
of a masseuse, as after a prolonged period in bed suffering
from a disease which is always markedly debilitating, there is
in many cases a marked lowering of muscular tone which in
turn prolongs convalescence.