Crippled Hearts

No. 1 killer of U.S. children is rheumatic fever. It is not only one of the biggest mysteries in medical science; it is one of the most neglected. Last week one of the most thorough campaigns yet mapped against the disease got under way at Baltimore's Johns Hopkins University. Directing the work were two well-matched experts: Dr. Francis Schwentker, 42, new head of the Hopkins pediatric staff who has just finished eight years of research on strep infections, and Dr. Helen Taussig, 48, head of the Hopkins Children's Heart Clinic and a famed authority on "blue babies."

Every year rheumatic fever kills far more children than polio. Dramatic publicity has led the public to chip in over $94 per polio patient for research and treatment, but for every rheumatic fever victim, only 3-c- has been spent. For such work as the new Hopkins program, 146 U.S. insurance companies recently set up a joint research fund. Said Dr. Schwentker last week: "They have begun to realize that a crippled heart is worse than a withered arm."

Research Mystery. The researchers are up against a deceptive and insidious disease. In its first stage it looks like an ordinary respiratory infection, perhaps a mere sore throat, and is often overlooked or mistaken for another disease. Recent research has shown that the infection is usually group A streptococcus (but not streptococcus of other groups), and occasionally scarlet fever.

The second stage follows two to six weeks later. Typical symptoms: swollen joints, fever, rheumatic nodules at the elbow, knee and other joints. "When it is typical, the disease is easy to diagnose," says Dr. Schwentker, "but the big majority of cases are not typical. The patient may suffer from vague, fleeting pains in the joints and have a low fever." Mistakes in diagnosis are again common until the heart's valves and blood vessels become inflamed.

In the third stage, damage to the heart may be prevented by good care (mostly a long rest in bed). But, says Dr. Schwentker, "sometimes damage occurs even under the very best of care. More often it occurs because the very best care is not available."

Murkiest problem is how the infection affects the heart, and in what form. Working on rabbits, Dr. Schwentker is now testing a theory that the antibodies which form in the blood to fight the infection also attack the heart.

Look to the Family. While Dr. Schwentker studies his rabbits, Dr. Taussig will continue her clinical work with child victims of the disease. She will also study the sociological factors which seem to be important in the spread of rheumatic fever. It tends to run in families, for example, and is far commoner in big cities than in the country, most often hits poor and underprivileged children.

Daughter of the late, famed Harvard economist, Helen Taussig was a Radcliffe tennis champion, still eats and swims heartily, lavishes her affection on a large, undisciplined mongrel named Spot. She took over the Johns Hopkins Children's Heart Clinic in 1930, is so deeply absorbed in her work that she seldom gets home until 9 p.m. A major aversion: the press, ever since she felt that the recent wave of publicity on her work with blue babies had hurt her professionally (to the medical mind, publicity often ranks high among the more loathsome diseases).

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