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110
The Gravity of Rheumatic Heart Disease.
Heart disease caused by rheumatism is very frequent and very
constant in its occurrence, particularly in London. The major part of
the heart disease we meet with in children arises from infection, and it
is the infection in particular which causes rheumatism that leads to
serious damage to the heart valves, to the heart bag, or to the muscular
heart walls in so many young children. Is it not possible to take
preventive measures ? Look for a moment at The Gravity of Rheumatic
Heart Disease.
Acute rheumatism is a disease of children of the "hospital class,"
and not to any extent of children living in better circumstances. In the
year 1919-20 a bad outbreak occurred, and 172 cases were admitted to
Great Ormond Street Hospital, the average stay in hospital being 60
days, whereas, as a rule, the average stay in hospital for a medical case is
28 days, and the cost of each case is £2 9s. per week. In maintenance,
this outbreak of 172 cases cost the hospital £4,589. But what of the
damage to the children arising from the disease? 66 per cent. of these
children had signs of organic disease of the heart, 22 cases died and 38
became complete invalids. Twelve is the age limit for admission to
Great Ormond Street, and of the 172 cases mentioned above, some were
two years of age, whilst 30 first-attacks occurred at seven years of age.
As soon as the school age is reached a steady increase in the incidence
occurs.
Cardinal Pathological Facts.
If the infection, the poison, attacks the muscles and nerves of the
heart, these cannot be replaced if destroyed; it is only if the damage is
slight or partial that complete recovery can be looked for. When the
poison attacks the heart's framework, that is, the fibrous tissue (not the
muscle) found in the valves and heart bag, then this fibrous tissue is
replaced by scar tissue which may thicken and contract if the irritation
be prolonged.
The chief cause for a heart breakdown in a child is active infection.
If the pericardium (the heart bag) becomes the seat of a chronic rheumatic
infection, it becomes thickened and densely adherent to the heart
and possibly to the surrounding tissues. Serious then is the condition,
the outlook, when the poison of rheumatism affects the muscle and
fibrous tissue alike, of a child's heart. How can the heart, the mechanical
pump, work when the valves are scarred?