No abstract

The occurrence in the hospital within a comparatively short space of time of several unusual examples of sudden myocardial failure in very young children has led us to make this communication. There seems little doubt that heart failure not due to congenital cardiac malformations or to diphtheria is a rare condition in children under 5 years of age. Whereas such cases have attracted attention chiefly from an etiologic standpoint, they likewise afford considerable interest both diagnostically and therapeutically.Poynton 1 has emphasized the rarity of the first attacks of rheumatic carditis being fatal and has given brief histories of the cases of three children under 5 years of age observed in his clinic. Diagnosis did not offer any difficulties, as one or more of the usual extracardiac rheumatic manifestations were present. Death occurred within a few weeks after the onset of symptoms. He regards primary carditis with failure as one of the most fatal forms of rheumatic heart disease, and draws attention to the fact that it is more often encountered in young children.In an article on the cutaneous manifestations of rheumatic fever in children, Bass 2 has mentioned a child of 3 years who had an attack of acute myocarditis followed by myocardial failure and death. There was a history of acute tonsillitis two weeks before the onset and one week later the appearance of erythema multiforme. Autopsy showed a fresh rheumatic endocarditis and great numbers of Aschoff bodies. The child had been seen one month before death, and the results of examina¬ tion at that time were negative.