The symptomatology of diphtheritic myecarditis (carcliac death from diphtheria) deserves a brief special description. After the local symp toms of diphtheria have Tisappeared, rapid pulse, pallor and dyspncea appear, with bodily and mental excitement, a condition of nervous vomiting and a tendency- to fainting even with slight movements of the body. Examination of the heart shows diffuse precordial undulation (trembling of the heart), frequently dilatation of the. heart with systolic murmurs. Death occurs either slowly, with gradual diminution in strength, or suddenly.
Prognosis.—Diphtheritic myocarditis is fatal in more than half of the cases. The appearance of conditions of collapse and fainting dur ing convalescence from the infectious diseases is always unfavorable and depends upon diffuse myocarditis. Myocarltis in childhood is always a dangerous affection, whether because it predisposes to sudden death, or because it causes contraction of the interstitial connective tissue of the wall of the heart, the effect of which is only noticeable in later life.
Diagnosis.—Functional heart symptoms are differentiated with difficulty from myocarditic symptoms, in the febrile infectious diseases. The persistence of cardiac symptoms for a long time, sometimes longer than the period of fever, points to myocarditis. The symptom-complex of diphtheritic myocarditis is sometimes hardly to be distinguished from that of a diphtheritic vagus paralysis.
Myocarditic heart collapse occurs in typhoid fever, but frequently the diagnosis is made incorrectly-, when the collapse depends upon intes tinal hiemorrhage or perforation.
Myocarditis due to scarlet fever is rare and is not to be mistaken for dilatation of the heart from nephritis, which has already repeatedly been mentioned as occurring in scarlet fever.
all the infectious diseases, great stress should be laid frowt the very beginning upon the condition of the heart; modern antipyretic drugs and the administration of alcohol are to be absolutely avoided, while on the other hand hydrotherapy and measures for as abundant nourishment as possible are to be used. When symptoms of myocarditis appear, every superfluous movement and every psychic excitement should be prevented, while the ice bag or other cooling apparatus should be constantly applied to the cardiac region. Cam phor should be given for attacks of fainting and collapse. Calamet advises the subcutaneous employment of caffeine sodiobenzoate or sodiosalicylate [0.25-1.0 Gm. (4 to 15 gr.) daily] or sparteine sulphate [0.4 Gm. (6 gr.) to 10 c.c. (21. dr.) aq. clestill., given hypodermatically once or twice a day] for the myocarditis of typhoid fever. Treatment with digitalis continued for some time should be begun when symptoms of chronic myocarditis appear. After myocarclitis has run its course, it is urgently adyised to carefully' watch the children, to prevent excessive bodily and mental exertion.