. The diseases of children : medical and surgical. cardiac dulness extends from nipple to nipple,and the apex beat occupies perhaps the fifth, sixth, and seventh spaces outsidethe nipple fine, while the whole of the precordial region is bulged forward Chronic Heart Disease 411 by the hypertrophied heart. Often the left bronchus is pressed upon and thelower lobe of the lung becomes collapsed. During the last stages, whichmay be short or prolonged intermittently for many months or even years,the liver becomes congested and enlarged, there is albuminuria from con-gested kidneys, while the belly,
. The diseases of children : medical and surgical. cardiac dulness extends from nipple to nipple,and the apex beat occupies perhaps the fifth, sixth, and seventh spaces outsidethe nipple fine, while the whole of the precordial region is bulged forward Chronic Heart Disease 411 by the hypertrophied heart. Often the left bronchus is pressed upon and thelower lobe of the lung becomes collapsed. During the last stages, whichmay be short or prolonged intermittently for many months or even years,the liver becomes congested and enlarged, there is albuminuria from con-gested kidneys, while the belly, scrotum, and legs become of dyspnoea with pain resembling angina pectoris are not un-common towards the last. Such cases may be very chronic, and evenrepeated attacks accompanied by much orthopnoea, cardiac distress, bron-chitis, and dropsy may be recovered from and the patient once more bepatched up. In such cases, however, probably no fresh endocarditis occurs,and the attack is due more to the engorged state of the lungs and a. Fig. 79.—Acute Endocarditis of Mitral Valves In a case of Chorea.(See Fatal Case of Chorea.) temporarily overworked heart, the latter recovering by rest in bed, and thesymptoms disappearing as the bronchitis passes off. Should, however, peri-carditis occur in a case of old-standing heart disease, the end is not far off,as the muscle becomes damaged and further work is imposed on an alreadyburdened heart. In order to illustrate the lesions most commonly found in chronic heartdisease in children, we have analysed the results of forty-one post-mortemsmade at the Childrens Hospital, Manchester, during the last few years, onpatients who have been under the care of our colleague Dr. Hutton or oneof ourselves. The youngest was three years and eight months at the timeof death, and the oldest fourteen years. With one exception all died from 412 Diseases of the Circulatory System the results of chronic heart disease—that is, the heart disea
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