CIRCULATION I 2 5 



kindling already laid in a stove or fireplace, so an attack of a disease caused 

 by germs of the streptococcus family — for example, tonsillitis, scarlet 

 fever, or streptococcal cold— often lights up rheumatic fever in a child 

 or young adult who is susceptible to it. What makes an individual suscep- 

 tible seems in most cases to be an inherited tendency to rheumatic fever, 

 which may be increased by poor diet, inadequate protection from cold 

 and damp, and crowded living conditions that give germs a chance to 

 spread easily from throat to throat. Unfortunately, one attack of rheumatic 

 fever makes a child more susceptible, rather than immune, to further at- 

 tacks, and repeated attacks are more likely to damage the heart. 



The earliest symptoms of rheumatic fever may be slight fever, nose- 

 bleeds, loss of appetite, failure to gain weight, and pain (often vague and 

 fleeting) in joints and muscles. The uncontrollable twitching or jerking 

 of the face, arms, or legs, commonly known as St. Vitus's dance, is some- 

 times a sign of rheumatic fever. This disease may attack all parts of the 

 heart and, in some cases, clear up with little or no trace. But commonly it 

 leaves scars in the endocardium which interfere more or less with the work- 

 ing of one or more of the valves of the heart. By following the advice of 

 the physician with regard to work and play, individuals with rheumatic 

 heart disease, whose hearts have not been too severely scarred, may lead 

 productive and normal or near-normal lives. 



Prompt and continuing medical care during attacks of rheumatic fever 

 is essential, and good nursing care is of prime importance. The child must 

 be kept in bed during the active stage in order to give the heart the rest 

 it requires to make as good a recovery as possible. The doctor is the one 

 to say when the child may get up and how active he may be as he returns 

 to normal living. 



The best, but not absolutely certain, protection against recurrences is 

 periodic medical supervision, with emphasis on the proper balance be- 

 tween rest and activity, good nutrition, and protection from respiratory 

 infections. The use of sulfa drugs under medical supervision to ward off 

 the streptococcus infections which so often light up rheumatic fever is 

 giving promising results in preventing recurrences in susceptible chil- 

 dren. 



Syphilis of the Circulatory System. Syphilis continues to be a common 

 cause of infectious disease of the heart and blood vessels. This disease does 

 more damage to the aorta than to other arteries or to the heart itself. Prob- 

 ably the germs (spirochetes) of syphilis invade the heart and aorta soon 

 after they first enter the body, but as a rule actual disease of these organs 

 does not appear for many years. Fortunately syphilis of the heart and 

 arteries is now a preventable disease, since the spirochetes can be destroyed 

 before they damage the aorta or heart if treatment is begun in the first, or 

 chancre, stage. 



Bacterial E7ido carditis. This serious infection of the endocardium, or 

 heart lining, is caused in most cases by an invasion of bacteria of the coccus 



