Observations ON THE NATURE AND SYMPTOMS OF CARDIAC INFECTION IN CHILDHOOD

Abstract

THE MITRAL VALVE. THE commencenment of rlheuinmatic endocarditis of the mitral valve is botind up witlh the early acute dilatation of the heart, and the symptoms are very few. There need be no pain, and fever is not essential. An increase in the rate of tlle pulse, sonme breatlhlessness and possibly palpitation, if thie chiild is not confined to bed, are suspi-cious, but these are duie to the myocardial weakness rather than to the valvular disease. We lhave only to picture the minute lesions that constitutp an early endocarditis to realize this lack of symptoms, and it is amply borne-out clinically by tlle ease with whiclh a primary cardiac rheumatism can be overlooked. I am nevertheless opposed to any attempt to iinimize the importance of' valvular disease, for though, no doubt, in former years overmiiuclh attenltion was paid to it as the agent in cardiac failure, wve calnnot neglect its