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June 23, 1900


JAMA. 1900;XXXIV(25):1611-1613. doi:10.1001/jama.1900.24610250023003i

This paper has been prepared on such short notice as to give me no opportunity to consult medical journals and text-book literature. What I have to say is, therefore, purely the result of my own experience with affections of the heart in children.

The first question which naturally arises in diagnosis is, is heart disease present, and if so, is it congenital or postnatal?

Let us take up first the study of congenital heart disease. The principal diagnostic symptoms of this condition are: cyanosis, clubbing of the fingers, thrill, characteristic murmurs, the absence of any great enlargement of the heart.

Cyanosis is peculiarly marked in congenital heart disease; in fact, I do not know of any other condition in which it is so intense. Even in severe forms of postnatal heart disease, with entire lack of compensation and decided blueness of the lips, I never have seen the blue-red tongue,

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