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The effect of scarlet fever upon the heart
562
THE
AMERICAN
HEART
JOURNAL
was noted that the murmur usually disappeared when the children were reexamined over a period of years. When the parents and the child were convinced that the symptoms were not due to organic heart disease, the child quickly became symptomfree; when the symptoms had been greatly impressed on the child, it was necessary to increase physical activity slowly and to overcome gradually the fear of symptoms. During the adolescent period, the too frequently on uncertain data. the careful evaluation and analysis a definite opinion should be given Averbuck, dren.
diagnosis of early organic heart disease is made The differential diagnosis can be made only by of all the data obtained, and in some instances only after several years of careful observation.
Samuel H., and Friedman, Am. J. Dis. Child. 49: 361,
William: 1935.
Circulation
Time
in Normal
Chil-
With the use of the saccharin method, the circulation time was determined in 100 normal children ranging in age from eight to sixteen years. The technic employed is described. The average circulation time was 8.6 seconds. The range was from 5 to 13.5 seconds. In 83 of 100 tests, the limits were from 6.5 to 10 seconds. This is shorter than the circulation time in adults, determined either by the saccharin or the sodium dehydrocholate method. The increased eireulation time in children as determined by this test is due yrobfirst, the actual distance to be traversed from the arm to the ably to two factors: second, the execution of the test in children intongue is less than that in adults; duces excitement and an acceleration of the heart rate. Von
Glahn,
William
Rheumatic
C.,
and
Pappenheimer, Alwin Endocarditis.
and Subacute Bacterial
M.: Arch.
Studies based on observations on a series of twenty-six acute bacterial endocarditis suggest that active rheumatic who have had rheumatism, a necessary and practically the implantation of bacteria. The
evidence
for this
conclusion
is summarized
as follows
Relationship Int. Med. 55:
Between 173, 1936.
consecutive cases of subvegetations are, in persons constant prerequisite for :
1. Vegetations histologically identical with those in rheumatic endocarditis and not containing bacteria are found (a) on the same valve as the bacterial vegetations, (b) on other valves on which there are no vegetations containing bacteria, and (c) on the aurieular wall. . 2. As&off bodies in the myoeardium that are taken to indicate active disease are found in practically the same proportion of cases of subacute endocarditis as of uncomplicated rheumatic cardiac disease.
rheumatic bacterial
3. Types of bacterial endoearditis other than that due to nonhemolytic streptococci This is a cogent argument may be engrafted on active rheumatic vegetations. against the view that the two types of lesions are a response of different intensity to the same infective agent, unless the current views as to the histological specificity of the rheumatic reaction are dispensed with. Faulkner,
James
M.,
Place,
Edwin
let Fever Upon the He’art.
H.,
and Ohler,
W. Richard:
The
Effect
of Scar-
Am. J. M. SC. 189: 352, 1935.
An electrocardiographic study was made of 171 cases of scarlet fever during and following the acute infection. Abnormal electrocardiograms were noted’ in The abnormalities consisted of prolongation of the P-R interval in eleven cases. five cases and flattening or inversion of the T-wave in six cases and .did not appear before the thirteenth day from the onset of the scarlet fever in a single instance.
A foihv-up study of 600 cases of scarlet fecer wa.3 ~uu~ie JI~JL~~ .&d Lo tiirec yzacu It was found that sew31 of these individuals had dere?opcd after the acute infection, heart disease in the interval. The type of heart disease found was indistinguisbabis &nieally from rheumatic heart disease.
Mc;Mahon, tensiorr).
H. E., and Pratt, Am.
J. W.: Malignant J. &I. 8c. 189, 221, 1935.
Mephrosclerosis
~~al~~na~~
H$~er-
‘Fhr clinical and anatomical findings in a consecutive series of 100 patients with Essential l~io~:s irmiign&nt nephrosclerosis, who came to autopsy, are described. occur in t.he blood vessels t.hroughont the body, especially in the heart and kidneys. The authors believe that malignant nephroae!erosis should not be lo&e6 u!aon as but rather as a distinct and sepnrR:ti: nterely a progression of benign nephrosclerosis, I! isease. It may occur alone or as a terminal complication of the benign &WSSZ. fn the very early stages, when only the cardiovascular signs and symptoms are [Jresent, it may be impossible not only to say diether one is dealing with 2.~1 earl3 case of benign or malignant oephrosclerosis, bat also it may be equally impossibis to predict into which of these diseases the case will ultimately fall. As the disoa~e progresses, the renal component becomes more and more conspicuous, and in. the late stages it may be impossible to differentiate this disease from chronic. glomerdo nephritis. The etiology of benign and malignant nephrosclerosis has probably muclr in common, for one sees cases of chronic lead poisoning, pituitary haso&ilinm, toxemias of pregnancy, and so on, which on tke one hand may show benign nephro sclerosis and on the other, the much less frequent malignant diseese. ‘l!ho Oourse ar:tl prognosis depend not alone on the quality 2nd quantity of the exciting agent hut If the response is of :L also in the manner in which the vessel wal! responds. simple degenerative nature, the disease progresses slowly, the prognosis is good, If the vascular response is and such cases are classed 2s benign nephroselerosis. characterized by inflammatory changes of the intima, necrosis, and hemorrhage, t&e t’cnme is more rapid, the prognosis is poor; and such cases are classed as mciignant nophrosclerosis. Bsam& S,amuel, and Alexander, .Ben@min: Duroziez’s and in Patients With Arterial Hypertension With Relation to Capillary Pulsation and the Forward piow J. clin. Investigation 14: 285, 1935.
Siga in Normal Special Reference
SXbjeci;s tu Its
of
The purpose of this investigation was to study in heal& and vascu1a.r dise;rar tI?c rneidence of Duroziez’s sign artificially produced by immersing the arm in w2ter at 114” I?.; to correlate this sign with other peripheral vascular signs suah XL; -atpillary pulsation, blood pressure, and pulse pressure ; to evaluate Duroziez’s sign as an index of the dilatability of the peripheral vascular bed. In sixty-three subjects with no evidence of cardiovascular disease, the in-ldenct .,~f Dutoziez’s sign decreased with aiIvan&g years. This indicakes a progressive inability of the peripheral minute vessels to dilate sufficiently as age advances tc~ provide the increased diastolic forward flow of blood necessary to produce %e sign. The incidence of the sign was studied in forty-one subjects with clinical ltypertension. Compared to normal subjects of similar age groups, the incidence was in general lower, particulariy with advancing age. This is in accord with the theory aha; arteriosclerosis is associated with arterial hypertension. Subjects with wide pulse pressures generally showed a low incidence of DurOeic~‘r;i sign of the peripheral type. This probably is due to the general eoexis+ncs o: ;Lrterial and arteriosclerosis.
THE
AMERICAN
HEART
JOURNAL
was noted that the murmur usually disappeared when the children were reexamined over a period of years. When the parents and the child were convinced that the symptoms were not due to organic heart disease, the child quickly became symptomfree; when the symptoms had been greatly impressed on the child, it was necessary to increase physical activity slowly and to overcome gradually the fear of symptoms. During the adolescent period, the too frequently on uncertain data. the careful evaluation and analysis a definite opinion should be given Averbuck, dren.
diagnosis of early organic heart disease is made The differential diagnosis can be made only by of all the data obtained, and in some instances only after several years of careful observation.
Samuel H., and Friedman, Am. J. Dis. Child. 49: 361,
William: 1935.
Circulation
Time
in Normal
Chil-
With the use of the saccharin method, the circulation time was determined in 100 normal children ranging in age from eight to sixteen years. The technic employed is described. The average circulation time was 8.6 seconds. The range was from 5 to 13.5 seconds. In 83 of 100 tests, the limits were from 6.5 to 10 seconds. This is shorter than the circulation time in adults, determined either by the saccharin or the sodium dehydrocholate method. The increased eireulation time in children as determined by this test is due yrobfirst, the actual distance to be traversed from the arm to the ably to two factors: second, the execution of the test in children intongue is less than that in adults; duces excitement and an acceleration of the heart rate. Von
Glahn,
William
Rheumatic
C.,
and
Pappenheimer, Alwin Endocarditis.
and Subacute Bacterial
M.: Arch.
Studies based on observations on a series of twenty-six acute bacterial endocarditis suggest that active rheumatic who have had rheumatism, a necessary and practically the implantation of bacteria. The
evidence
for this
conclusion
is summarized
as follows
Relationship Int. Med. 55:
Between 173, 1936.
consecutive cases of subvegetations are, in persons constant prerequisite for :
1. Vegetations histologically identical with those in rheumatic endocarditis and not containing bacteria are found (a) on the same valve as the bacterial vegetations, (b) on other valves on which there are no vegetations containing bacteria, and (c) on the aurieular wall. . 2. As&off bodies in the myoeardium that are taken to indicate active disease are found in practically the same proportion of cases of subacute endocarditis as of uncomplicated rheumatic cardiac disease.
rheumatic bacterial
3. Types of bacterial endoearditis other than that due to nonhemolytic streptococci This is a cogent argument may be engrafted on active rheumatic vegetations. against the view that the two types of lesions are a response of different intensity to the same infective agent, unless the current views as to the histological specificity of the rheumatic reaction are dispensed with. Faulkner,
James
M.,
Place,
Edwin
let Fever Upon the He’art.
H.,
and Ohler,
W. Richard:
The
Effect
of Scar-
Am. J. M. SC. 189: 352, 1935.
An electrocardiographic study was made of 171 cases of scarlet fever during and following the acute infection. Abnormal electrocardiograms were noted’ in The abnormalities consisted of prolongation of the P-R interval in eleven cases. five cases and flattening or inversion of the T-wave in six cases and .did not appear before the thirteenth day from the onset of the scarlet fever in a single instance.
A foihv-up study of 600 cases of scarlet fecer wa.3 ~uu~ie JI~JL~~ .&d Lo tiirec yzacu It was found that sew31 of these individuals had dere?opcd after the acute infection, heart disease in the interval. The type of heart disease found was indistinguisbabis &nieally from rheumatic heart disease.
Mc;Mahon, tensiorr).
H. E., and Pratt, Am.
J. W.: Malignant J. &I. 8c. 189, 221, 1935.
Mephrosclerosis
~~al~~na~~
H$~er-
‘Fhr clinical and anatomical findings in a consecutive series of 100 patients with Essential l~io~:s irmiign&nt nephrosclerosis, who came to autopsy, are described. occur in t.he blood vessels t.hroughont the body, especially in the heart and kidneys. The authors believe that malignant nephroae!erosis should not be lo&e6 u!aon as but rather as a distinct and sepnrR:ti: nterely a progression of benign nephrosclerosis, I! isease. It may occur alone or as a terminal complication of the benign &WSSZ. fn the very early stages, when only the cardiovascular signs and symptoms are [Jresent, it may be impossible not only to say diether one is dealing with 2.~1 earl3 case of benign or malignant oephrosclerosis, bat also it may be equally impossibis to predict into which of these diseases the case will ultimately fall. As the disoa~e progresses, the renal component becomes more and more conspicuous, and in. the late stages it may be impossible to differentiate this disease from chronic. glomerdo nephritis. The etiology of benign and malignant nephrosclerosis has probably muclr in common, for one sees cases of chronic lead poisoning, pituitary haso&ilinm, toxemias of pregnancy, and so on, which on tke one hand may show benign nephro sclerosis and on the other, the much less frequent malignant diseese. ‘l!ho Oourse ar:tl prognosis depend not alone on the quality 2nd quantity of the exciting agent hut If the response is of :L also in the manner in which the vessel wal! responds. simple degenerative nature, the disease progresses slowly, the prognosis is good, If the vascular response is and such cases are classed 2s benign nephroselerosis. characterized by inflammatory changes of the intima, necrosis, and hemorrhage, t&e t’cnme is more rapid, the prognosis is poor; and such cases are classed as mciignant nophrosclerosis. Bsam& S,amuel, and Alexander, .Ben@min: Duroziez’s and in Patients With Arterial Hypertension With Relation to Capillary Pulsation and the Forward piow J. clin. Investigation 14: 285, 1935.
Siga in Normal Special Reference
SXbjeci;s tu Its
of
The purpose of this investigation was to study in heal& and vascu1a.r dise;rar tI?c rneidence of Duroziez’s sign artificially produced by immersing the arm in w2ter at 114” I?.; to correlate this sign with other peripheral vascular signs suah XL; -atpillary pulsation, blood pressure, and pulse pressure ; to evaluate Duroziez’s sign as an index of the dilatability of the peripheral vascular bed. In sixty-three subjects with no evidence of cardiovascular disease, the in-ldenct .,~f Dutoziez’s sign decreased with aiIvan&g years. This indicakes a progressive inability of the peripheral minute vessels to dilate sufficiently as age advances tc~ provide the increased diastolic forward flow of blood necessary to produce %e sign. The incidence of the sign was studied in forty-one subjects with clinical ltypertension. Compared to normal subjects of similar age groups, the incidence was in general lower, particulariy with advancing age. This is in accord with the theory aha; arteriosclerosis is associated with arterial hypertension. Subjects with wide pulse pressures generally showed a low incidence of DurOeic~‘r;i sign of the peripheral type. This probably is due to the general eoexis+ncs o: ;Lrterial and arteriosclerosis.