The association of scarlet fever and cardiac injury has been a subject of discussion for many years. There is wide diversity of opinion concerning the frequencv of the cardiac lesions and the role which scarlet fever plays in their etiology. McCollomtT found 254 instances of cardiac damage of various sorts in a series of IOOO cases. He noted endocarditis in 3 individuals and pericarditis in 5. Broadbent3 reported the incidence of endocarditis as 0.58 per cent and pericarditis as o.o8 per cent in his series of 22,096 cases of scarlet fever. From the London Fever Hospital the percentages of I.8 and 0.I5 for endocarditis and pericarditis respectively, were estimated in their patients with scarlet fever. Hirsch12 observed cardiac disturbance in 28 of 6o cases of scarlet fever during one epidemic. Twelve of these cases showed myocarditis or endocarditis, appearing from the eighth to the fourteenth day of the disease, frequently accompanied by the onset of joint symptoms. Hirsch believes that endocarditis in scarlet fever is probably a mixed streptococcal infection. He states that the localization of lesions varies in different epidemics; in some epidemics patients develop otitis media, in others renal disease, and in still others cardiac injury, as the most frequent complication. Rosenbaum25 noted io6 cases of cardiac involvement in a series of I770 patients with scarlet fever. In 94 of these the heart disease developed during the course of scarlet fever; I 2 patients had a known cardiac lesion before the attack. Myocarditis was noted in 88 of the Io6 cases and endocarditis in 4. Three of the patients had evidences of pericarditis; two of these died. Hectorl0 presented 47 cases showing cardiac symptoms during scarlet fever, an incidence of 0.55 per cent. Seven had a history o
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