Rigid Rest in Rheumatic Carditis

Rheumatism in childhood has been calculated by Dr. Gordon Pugh1 in a report to the Metropolitan Asylums Board as being " eventually responsible for one-twenty-fourth of all deaths." It is a good many years since (in 1910) I first tried the effect of prolonged rest in bed for a child in a first attack of rheumatic fever. There was evidence of carditis, for which he stayed in bed for close on a year and improved remarkably. It seemed to me that a heart whose apex beat was for many months displaced outwards, and whose action was unduly rapid, rather suddenly became, after many months, markedly quieter in its action and smaller. There was a systolic bruit that became less audible.