Medicine: Young Heart’s Doom

At present we know nothing of rheumatic fever whatsoever, except that it is infectious, that the average age at which it occurs is twelve, and that if the sufferer contracts the heart weakness which it so often causes he or she has small chance of living much more than 15 years longer. That is the average age at which death comes.

I don’t know how many school children there are in New York at present. I believe the figure is a million and a half. One percent of them have rheumatic hearts, so that means that there are 15,000 children and adolescents in the city this afternoon who will die while they are still very young people.

When one day last week at the New York Academy of Medicine Dr. Alfred Einstein Cohn of the Rockefeller Institute for Medical Research uttered the latest known thought on the subject of hearts’ crippled by rheumatic fever. The subject is one of the major research problems of the Rockefeller Institute,* and Dr. Cohn, 56, has been perfecting his knowledge of its fugitive aspects for the past 30 years.

The normal symptoms of rheumatic fever are unmistakable. A sore throat, particularly tonsillitis, usually precedes the attack. Within 24 hours fever jumps to from 102° to 104° F. The tongue be comes moist and covered with white “fur.” Sweating is profuse, and has a peculiar sour odor. The mind usually remains clear. The joints swell; the skin around them flushes, is hot, almost bursts; pain is agonizing. The joints are not attacked together, but one after another, usually beginning with the knees and passing on in order to the ankles, shoulders, wrists, elbows, hips, hands, and ending with the feet.

For treatment a doctor’s whole object is to bring the child through the attack, which lasts two to three weeks, with an undamaged heart. He can do that with only every other case. Fifty percent of children who contract rheumatic fever, said Dr. Cohn last week, develop some sort of heart trouble, if not after the first attack, then after recurrent attacks.

Most often the valves of the heart are affected. They get nubby and warty, can not close tightly. Consequently, after a chamber in the heart contracts, expels its content of blood and relaxes for a succeeding beat, some of the blood which should be coursing through the body seeps back into the flaccid chamber of the heart. As that happens, blood refreshed by the lungs comes spurting from the opposite direction. Spurting blood meets seeping blood. They churn. They jolt the heart. The heart can stand the repeated shocks for just about 15 years. Then it stops altogether.

Until that last flutter the cardiac child must be protected from overexertion. In a tremendous number of cases that means being kept in bed month after month. Sunshine does such children a great deal of good. Hence Boston sends a dozen or so of its poor cardiac children at a time to St. Francis Hospital, on a Miami Beach island. On the hospital roofs are topless cubicles where the frail children loll.

Poor New York City children, 150 at a time, go to Irvington House’ on the Hudson River, founded by Mrs. Irma B. Levy of Manhattan. It is the biggest establishment of its kind in the country. Some 3,000 children have already recuperated there, and left their medical records. It was to help raise $75,000 which Mrs. Levy needs to keep Irvington House going full tilt that Dr. Cohn last week made his gloomy statement concerning the inevitable doom of every other child who contracts rheumatic fever. Said Dr. Cohn further, and more hopefully: “If we can . . . have 3,000 more case records in another ten years … we may find some way of giving these children a normal span of life on earth.”

*Last week Dr. Simon Flexner, 72, let it be known publicly that he is looking for an able pathologist to succeed him as director of the Rockefeller Institute’s laboratories. Quickly recommended was Dr. George Hoyt Whipple, Nobel Prizeman, dean of the University of Rochester’s School of Medicine & Dentistry. When Dr. Flexner will yield the general directorship of all the Rockefeller Institute’s activities he did not indicate.