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111
Diphtheria.
This is a disease which can kill the heart muscle and nerves, but it
does not produce scarring. Diphtheria is notifiable and is under
supervision. We know that from about the third to the fifth weeks of
attacks of diphtheria, troublesome heart symptoms may become
manifest. But in diphtheria the heart condition is well supervised ; it
is anticipated, whereas the rheumatic heart of the child may work havoc
before medical aid is sought. Heart disease from tuberculosis is
uncommon, but in the case of heart disease from scarlet fever, this is an
event which, where it occurs, tends to arise after the child has left the
hospital, and so supervision of scarlet fever "recoveries" (as is done
in Deptford) is imperative.
Rheumatic Heart Disease.
Acute rheumatism is not notifiable and perhaps should not yet be
made notifiable, as some doctors doubt whether the disease is infective
and so they dispute its cause. Others again believe (including Dr.
Poynton) that it is a definite infection and a definite disease.
Prevention can often be only Partial.
When sufferers from acute rheumatism come under the doctor's
care, the damage, frequently, has already been done; thus one can but
strive to stave off further attacks. There is a limitation at present to
our control over rheumatic heart disease, notwithstanding the value of
the salicylates in treatment. But there is a someth0ing wanting in the
general management of rheumatic children. If this can be defined and
applied, much severe heart disease will be prevented, and many lives
will be made more useful to the State and happier to the patients.
Defects in the Management of Heart Disease in Infants.
1. Imperfections in Medical Education. Greater opportunities
are required for students to see cases of acute rheumatic conditions in
the child. It is one thing to see the closing chapter of heart disease in
the adult, but the dawn of heart disease in the child is that which the
student requires to familiarise himself with.
2. Public Ignorance. Propaganda and instruction are necessary,
because the public do not appreciate the gravity of heart disease in
childhood. The disease may commence insidiously, no pain, perhaps,
nothing to alarm or strike the warning note. A serious organic change