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98
Heart Disease in Childhood.
(1) Heart disease is one of the greatest causes of death and invalidity at the present day.
Last year 59,800 people died of this ailment in England and Wales—that is to say, one
death in every eight was due to heart disease.
(2) Many cases of heart disease commence in childhood and are frequently unnoticed at their
onset. If cases are treated properly in the earlier stages a cure can usually he effected,
but once the heart is seriously damaged complete recovery is impossible.
(3) The most frequent cause of heart disease in childhood is rheumatism. Rheumatism is
due to an organism which is liable to attack the heart and cause heart disease. In
addition, this organism is the cause of chorea (or St. Vitus' dance), which is simply
rheumatism of the brain. It may also be the cause of chronic sore throats. This
rheumatism is frequently quite mild in character in children, so mild that parents may
call it " growing-pains."
(4) Rheumatic heart disease is oTten painless and requires a doctor's examination for its
detection. Shortness of breath, loss of flesh, and pallor, are early signs that this organ
is affected.
(5) Pains in muscles and joints should receive immediate attention as being possibly the onset
of rheumatism, which may be followed by heart disease or chorea. Rheumatism frequently
recurs, especially in spring and autumn.
(6) Great nervousness, dreaming at school work, alteration in disposition, and slight twitchings,
are often evident before chorea begins, and are most important warnings.
(7) When injured by rheumatism or chorea, the heart recovers slowly from the poisoning,
and one of the greatest dangers to the child's future is for it to resume ordinary life
before the heart is cured.
(8) Three things are specially necessary to combat the present loss of life and efficiency caused
by heart disease.
(1) Education of the public in regard to heart disease in childhood.
(2) Prolonged treatment in the early stage of cases where the heart has become affected.
This must be under close medical supervision, and in the case of poorer children
can only be obtained in hospitals which are able to keep cases for a lengthened
period. Such treatment should extend over some months. The first exercise
taken must be carefully watched and graded.
(3) Choice of occupation for a child who has suffered from heart disease in school is
most important. Very many lives are wasted through such children taking
the wrong career.
The Paddington Green Children's Hospital Rheumatic Supervisory Centre has the following
injunctions for parents drafted by Dr. Reginald Miller.
On the Care of Rheumatic Children.
1. Rheumatism is caused by infection by a germ, and is a common disease of children, in whom
it often attacks the heart. This is the great danger of the disease. Rheumatism is the commonest
cause of heart disease in children.
2. Rheumatic attacks of all sorts often start with a sore throat. A sore throat in a rheumatic
child is always a dangerous symptom.
3. Common symptoms of rheumatism in children are :—
Sore throat. Paleness.
Pains in muscles. Shortness of breath.
Painful joints. Fidgetiness or nervousness.
4. Chorea, or St. Vitus' dance, is rheumatism attacking the brain. Its chief danger is the
tendency for the heart to be injured at the same time. Unusual nervousness, disturbed sleep, fidgety
movements, or a tendency to drop things, may be warnings of St. Vitus' dance
5. Rheumatic heart disease is often painless and may only be discovered by a doctor's examination.
6. If the heart has been injured by rheumatism, its recovery is very slow, and permanent harm
may be done by letting the child resume an ordinary life before recovery is satisfactory.
7. An occupation in life for a child with heart disease requires very careful choice.
8. Rest is very necessary for rheumatic children. They should always be put to bed early,
and they should be made to lie down during the day if they seem at all tired or if there is any aching
of the limbs.
9. Damp is bad for rheumatism ; basements are dangerous. Rheumatic children should
sleep in the sunniest and driest room available. If they get wet, their clothes should be taken off
and dried at once. Water-tight boots are especially important.
10. Rheumatism tends to recur, especially in the winter months.
In writing of the prevention of chorea, Dr. F. J. Poynton recommends the giving of simple
lectures on chorea and rheumatism to school teachers. The mortality from rheumatism far exceeds