That simple cardiac hypertrophy may occur in childhood without other heart le sion must be considered settled. As the result of raclioscopic investigations, IIoch singer found hyperplasia of the thymus gland regularly associated with cardiac hypertro phy (Fig.101). 'Fhe thyroid heart is also found in later childhood, with all the symptoms so well known from the pathology of exophthalmic goitre in adults. The so-called eccentric hypertrophy of the heart, athlete's heart, is noted in children who began early to spend hours in arduous ath letic exercises. Cardiac hypertrophy also occurs in children from frequent and violent nervous excitement. Masturbation certainly plays a prom inent part in the production of this hypertrophy (masturbator's heart). Only exceptionally do both the last-mentioned forms of cardiac hyper trophy lead to insufficiency of the heart muscle in childhood; yet they may be given in later life as the cause of the early appearance of this unfavorable condition. Congenital narrowness of the arterial system (Virchow) can predispose to hypertrophy in early life by giving rise to insufficiency of the heart muscle.
It would be difficult to support the idea of hypertrophy of the heart in later childhood, due to growth, which, as was mentioned, has been advanced by Germain See. Much more probably this symptom complex, in which nervous conditions also play an important part beside the usual symptoms of cardiac hypertrophy, depends upon me chanical or nervous overstinaulation of the heart, in whieli case the possibility of congenital narrowness of the arterial system should not be overlooked as the predisposing cause.
As the result of cardiac hypertrophy in the child a visible forward bulging of the anterior chest wall appears, together with a weakening of the respiratory murmur at the apex of the left lung, while gallop-rhythm and arterial vibrations are observed only exceptionally-.
A. Neumann has described as dilatative heart weakness (coeur forc6) in childhood a sx-mptom-complex which develops in anamnic children from dilatation of the heart, to which congenital, debility and chronic nutritive disturbances predispose. The characteristic symptoms are palpitation, dyspncea, general weakness after overexertion, displace ment of the apex-beat, and horizontal increase in the heart dulness.
Diagnosis.—The differential diagnosis between pericardial exu date and cardiac dilatation may be difficult in early childhood. Re traction of the left lung or infiltration of its peripheral portions may also simulate cardiac hypertrophy. In the former case the pulsation of the
pulmonary artery would be visible; in the latter, pathologic respiratory murmurs would appear; in both cases, in spite of the great increase in the dulness, the other symptoms of hypertrophy of the heart, heaving apex-beat and accelerated heart action, would be absent.
According to Blaehe and See physiologieal hypertrophy should be recognized by palpitation, dyspmea. migraine attacks, displacement of the apex-beat to the sixth or seventh intereostal space, irregular pulse and a systolic murmur at the apex, which can always be extra cardial only in simple cardiac hypertrophy and represents a cardio pulmonary murmur.
rapid and early appearance of eardiac hyper trophy, peeuliar to childhood, acts as a protecting mechanism for the circulatory apparatus. This hypertrophy may completely- disappear if the causes of it, obstacles to the circulation, overexertion or nervous excitement, are no longer present. Dilatation is always a sign of cardiac weakness (insufficiency of the heart muscle) and, after continued injury to the heart, may follow hypertrophy, on account of which the prognosis of simple cardiac hypertrophy, orig,inally favorable, becomes unfavor able. Acute dilatation of the heart with nephritis and the toxi-infectious diseases of childhood is a serious disease with a very doubtful prognosis.
simple hypertrophy of the child's heart, the cause of the condition should be treated, as the hypertrophy itself can not be overcome. Subjective symptoms are obviated by the application of cold, rest of mind and body, and simple, non-irritating diet. Acute dilatation of the heart needs energetic treatment. Stimulants must be given, such as camphor, caffeine and ether hypodermatically, and especially' full doses of digitalis, if there is sufficient time (see later p. 527). Steffen advises extract of ergot in the treatment of acute dila tation of the heart in scarlet fever, as follows: R Extract. ergot 1.0 gr. xv Syrup. cinnamond 90 0 f Aqua. dem SO 0 chs. ad .3 iii M. Sig.—One teaspoonful every 2 hours.
Chronic dilatation of the heart is treated as described in the treat ment of insufficiency of the cardiac musculature, on page 518.
Smith advises strychnine and iron together for dilatation of the heart in anaimic children and for the dilatation remaining after the infectious diseases. The most judicious preparation of strychnine for this is the tincture of nux vomica. Thyroid therapy- is effective for the thyroid heart.