The first volume of the New England Journal of Medicine and Surgery, which appeared in 1812, contained this succinct description of congenital cyanotic heart disease in a young girl:
S.R. when born was for a considerable time supposed to be dead-did not cry, or evince any living actions. The lungs were artificially inflated for several minutes and life at length appeared, but very feebly.-A livid countenance, with frequent syncope took place.-With great maternal care the infant was kept alive, and as she grew became remarkably sprightly and active. When two years old (she) was unusually intelligent and fond of exercise.-As she advanced in age her fondness for violent exercise in playing often exposed her danger, as these efforts never failed to produce syncope and a kind of convulsion, laughing, crying, any emotion of mind, also brought on the syncope, from which after falling into a horizontal position, she generally soon recovered.-Her countenance, all times blueish and livid, was in these fits extremely extremely so. Her nails were always of the colour of litmus, or perhaps a little nearer to violet.
After death the thorax was examined-it was of an unusual shape, being more cylindrical than common, and the lungs having less the form of a cloven hoof, when inflated, than they usually assume.-The heart was very small. In place of a right auricle was observed a small appendage like the edge of that portion of the heart, not capable of containing more than one fourth its usual contents.
Hypertrophic osteoarthropathy (HOA) in a child with congenital cyanotic heart disease - a case report