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The Human Comedy
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Heart Disease In Children And During Pregnancy
Source: Disturbances Of The Heart
A common characteristic in a large proportion of middle-aged or old
patients with heart disease is the presence of degenerative changes
in the myocardium, the valves, or the arteries of the heart. In
children, on the other hand, the most common disturbances of the
heart are acute inflammations affecting its different structures,
and due in most instances to acute infections. Myocarditis and
endocarditis occur frequently, and pericarditis occasionally. As in
adults, rheumatism is the most common cause of inflammation of the
structures of the heart, but rheumatism causes inflammation of the
heart much more frequently in children than in adults. Besides this
infection, the most frequent causes of inflammation of the heart in
children are diphtheria, scarlet fever, typhoid fever, measles and
influenza, with the frequency, perhaps, in the order named.
Diphtheria frequently gives rise to myocarditis, which results in
dilatation of the heart. This may occur in the second or third week
of the course of the disease, and even up to the eighth and tenth
week from the beginning of the disease. The myocarditis due to
diphtheria is not always the cause of sudden death occurring during
the disease, as such a fatal result may be due to paralysis of
nervous origin. In scarlet fever, inflammation of the heart may be
due directly to the poison of the disease, or it may be secondary to
a nephritis which is so frequent a complication of scarlet fever. It
is probable that the inflammation of the skin in scarlet fever,
preventing normal secretion, may be a cause of a sometimes increased
blood pressure and also of the nephritis, both of which conditions
may predispose to the cardiac complication. Erysipelas may cause
acute inflammation of the heart, perhaps for the same reason.
A certain proportion of cardiac diseases in children, especially
endocarditis, seems to be due to a general septic infection which
results in the so-called septic, infectious or malignant
endocarditis. There is sometimes a tendency in certain children, and
perhaps in certain families, for the heart to become readily
infected during an infectious disease, more than in other children
who suffer from the same disease. Sometimes the heart becomes
inflamed in rheumatic children without any joint affection
occurring; the inflammation in the heart may be the only
manifestation of the disease.
This etiology of cardiac affections of children indicates the
directions in which therapeutic efforts should be aimed. In children
who are under the more or less constant care of the family
physician, the possibility of the occurrence of some cardiac
affection should be borne in mind, especially in children in
families which are known to be affected with what may be called a
rheumatic diathesis--families in which several members have suffered
from rheumatism. It is reasonable to suppose that children who are
delicate and feeble, who do not have sufficient fresh air, who do
not take sufficient exercise, and who are not properly fed are more
liable to be affected with cardiac complications in the presence of
infectious diseases than children who have had plenty of fresh air,
an abundance of exercise and a sufficient amount of proper food.
At the present day it is hardly necessary to insist on the
importance of giving every child an adequate amount of fresh air. It
is possible, however, that this gospel has been overworked, and it
is not infrequently necessary to caution some parents that there is
danger of impairing their children's health by too much exposure.
The old ideas of the influence of exposure to cold and dampness in
the production of rheumatism have not yet been so far abandoned that
we can entirely neglect the possibility of rheumatism being
developed, at least, by the exposure to cold winds and dampness of
children who are otherwise predisposed to this disease. It is
possible that the enormously increasing number of children with
adenoids and enlarged tonsils, who need operative measures for their
removal, may have these conditions aggravated by too much exposure
to the inclemency of variable, harsh weather.
It is not necessary to state that proper exercise develops the
heart, as it does all the other muscles; but at the same time it is
necessary to caution parents against allowing their children to
indulge in too violent and too prolonged exercise. Young children
probably stop often enough in their play not to overwork their
hearts. Older boys and girls, especially boys, are inclined to take
too severe athletics, such as long-distance running, competitive
rowing, violent football and rapid cycling. It should be emphasized
to school-masters, gymnasium teachers and athletic trainers that a
boy who is larger than he should be at his age has not the
circulatory ability that the older boy of the same size has. The
overgrown boy has all he can do to carry his bulk around at the
speed of his age and youth. The addition of competitive labor
overreaches his reserve heart power, and he readily acquires a
strained, injured heart. On the other hand, moderate indulgence in
walking, baseball, swimming, rowing and golf should be commended. It
is not exactly the exercise that does him the harm, it is the
competitive element in it. Until a boy is well developed in his
internal reserve strength, he should not compete with other boys who
are better developed. His pride makes him do himself injury.
Dietetic fads are so prevalent today that there is danger that many
children will not receive an adequate amount of nutriment, that they
will be fed an excess of such foods as are likely to produce damage
to their constitutions, or that they will be given food which does
not contain all the different elements of nutrition to satisfy their
economy and their growth. While it is now generally acknowledged
that an excess of meat is not beneficial to any one, on the other
hand a moderate amount is necessary for individuals who are working
or are mentally active, especially for growing children. Also a too
great limitation of the child's diet to farinaceous foods, and
especially the allowance of too much sugar and sugar-producing food,
is liable to encourage the development of rheumatism. A mixed diet,
not excessive in amount, and prepared so that it will be digested
without difficulty, is most useful, and it should include in
suitable proportions meat, milk, eggs, vegetables, starches and
fruit. These should all be taken at regular intervals, thoroughly
chewed, and should not be taken in excess.
If a child has had an attack of heart inflammation, a myocarditis or
an endocarditis, greater care should be taken of him not only when
he is well but especially when he becomes ill of any other disease.
If the child has had a rheumatic inflammation of the heart, or has
had rheumatism without such a complication, it is considered by some
clinicians wise to give a week's treatment with salicylates at
intervals of three or four months, for two or three years, perhaps.
It is hard to determine how much value this prophylactic treatment
has. If the child's surroundings cannot be changed and lie is
subjected to the same conditions of possible reinfection, it may be
a wise precaution, much like the prophylactic administration of
quinin in malarial regions. If a child has developed a cardiac
inflammation during any disease, the treatment is that previously
An important part of prophylaxis and treatment of a cardiac
affection during the course of any disease is the prevention of
serious anemia. During sickness the patient is liable to become more
or less anemic, but the administration of iron, in the manner
previously suggested, during the course of the disease, and
especially during rheumatism, will prevent the anemia becoming rapid
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