Major advances in pediatric cardiology in the 20th century: I. Diagnostics

Abstract

Although the observation that endocarditis, arthritis, and chorea often followed scarlet fever was made in the 19th century, it was not until the middle of the 20th century that the “link between the throat and the heart” was clearly established. Epidemiologic studies in the 1930s demonstrated that in closed communities such as boarding schools, multiple cases of rheumatic fever followed outbreaks of tonsillitis or scarlet fever. Rebecca Lancefield4 differentiated streptococci into distinct groups and demonstrated that group A was responsible for most streptococcal infections in humans, including scarlet fever and pharyngitis. Todd’s development of a method for measuring an antibody against a streptococcal hemolysin (streptolysin O) in 1932 provided a means to establish evidence of a previous streptococcal infection in patients suspected of having rheumatic fever.5 In 1944 T. Duckett Jones6 described the clinical and laboratory criteria that, with surprisingly few modifications, are used today for establishing the diagnosis. By the 1970s, rheumatic fever was uncommon in most To appreciate the major advances in pediatric cardiology in the past century, it is necessary to consider the state of medicine in 1900: only a few physicians limited their practice to cardiology (general, not pediatric); although many congenital cardiac anomalies had been described at autopsy, diagnosis in a living patient was virtually impossible. Laennec had invented an early stethoscope by 1816,1 and a burst of technology at the end of the century saw the introduction of the sphygmomanometer, the electrocardiogram, and the chest radiogram. What follows is a summary of the most important contributions to pediatric cardiology in the 1900s, with emphasis on the understanding of disease processes and diagnostic techniques. Treatment of cardiac disorders will be covered in a separate review.