RHEUMATIC FEVER

New Zealand Listener, Volume 37, Issue 949, 18 October 1957, Page 18

RHEUMATIC FEVER

This is the text of a talk on health, broadcast recently from ZB, ZA, YA and YZ

stations of

H. B.

TURBOTT

Deputy Director General of

Health:

\V HEN you hear of somebody having a "wonky" heart, the majority of ‘you will have a mental picture of leaky valves in an all important pump. In a great many cases you will be right. |Very commonly it is the’ mitral valve, the one on the left side between the upper and lower chambers’ of the heart, that is damaged. Its delicate membrane is damaged and scarred by some disease of septic origin or by theumatic fever. The scarring spoils its shape and elasticity, and no longer can it close properly, Blood in the upper chamber seeps back to the lower instead of all being propelled out into the arteries to circulate and nourish the body. There is a leaking valve. The heart tries to compensate for this by enlarging in an attempt, by greater muscle action, to drive the proper amount of blood onwards. Sometimes this succeeds, sometimes it doesn’t, and -you have a failing heart, you feel unduly tired even without exertion, and on trying to do things, become very short of breath. As you know, heart surgery is on the "up and up." For some time surgeons have been able to operate on, -and repair, a valve that is damaged so that it won’t open properly. They -haven’t been so successful with the valve that leaks, because it can’t close tightly. A team of research surgeons in the U.S.A. have been working on this problem of the leaking heart valve. Now they have come up with a tiny, artificial, flexible flap that does not damage the passing blood. It is fashioned from a special alloy watch spring metal and’ nylon. After several years’ trial in animals it has now been tried in humans. Last year a mother of five children, with a heart valve so leaky that she could barely stand the exertion of walking, was fitted. with this device. Now, a year later, the artificial flap is doing its up and down action correctly, and the woman is doing full housework and climbing stairs. There will need to be further testing, of course, but heart surgery is marching on. How much better if we could avoid the need for such repair "work. Rheumatic fever is one of the great destroyers of héart valves. While the surgeons of the new world were devising advances in repair, in the old world, at Geneva, at much the same time as they applied their ideas to the first human test, a group of experts were gathered together by the World Health Organisation to consider how rheumatic fever could be prevented. Rheumatic fever is still followed in our land by far too much chronic rheumatic heart disease -that is, leaky valves and __heart muscle damage. About a third of all New Zealand deaths from heart and blood vessel disease are due to rheumatic fever or chronic rheumatie heart disease. ; Infection with a particular family of germs (Group A_ haemolytic strept®cocci) is now recognised as the only established inciting factor in acute rheumatic fever, says the W.H.O. Expert Committee. The practical problem of rheumatic fever prevention is therefore one of the prevention and treatment of streptococcal infection. Not all sore throats are due to streptococcal germs, and of those that are, they will not always be caused by the special type of streptococcus that induces fever. What is the risk when you are carrying this dangerous germ in a sore throat? Possibly three people ih each 100 so infected will develop rheumatic

fever and run the risk of heart damage, How can this risk be minimised? Attacks of rheumatic fever may be prevented, says the W.H.O. Expert Committee, if all infections with the haemolytic streptococcus are recognised and treated promptly and effectively so that the germ is eradicated with as little delay as possible. Sore throats with much redness and swelling and surface discharge, with a high temperature, and with large tender glands at the angle of the jaw, may be dangerous, and the Expert Committee gives guidance to doctors, in this and other upper respiratory infections, as to diagnosis and treatment. It is suggested that, to ‘prevent recurrences so common after a first attack of rheumatic fever, known rheumatic patients should be given penicillin treatment for 10 days from the earliest appearance of a sort throat, without waiting to determine whether the, particular criminal -streptoccoci are present or not. To prevent first attacks, when the. dangerous type of sore throat is suspected, or proven if laboratory diagnosis of swabbing is possible, curing the sore throats in two to four days will not bé enough to be sure of avoiding rheumatic fever. Penicillin treatment for 10 days is the suggested recipe.