Rheumatic fever: the way it was.

THE RECENT OUTBREAK of rheumatic fever in Utah' brings to mind the fact that a new generation of physicians has arrived who have never seen this disease, and to today's medical students a discussion of chorea seems irrelevant. But it has not always been this way. In the 1920s, rheumatic fever was the leading cause of death in individuals between 5 and 20 years of age and was second only to tuberculosis in those between 20 and 30.2 In 1938 there were more than a thousand deaths in New York City alone3 and 8% of the autopsies at the Presbyterian Hospital showed specific lesions of the rheumatic state.4 In New England, childhood rheumatism accounted for nearly half of adult heart disease, and in Boston's crowded North End hardly a family was spared; even the well-to-do were not immune. * The only treatment was salicylates and bed rest. The majority remained at home for weeks, more often for months, with a smoldering illness while the sicker children were managed in foster homes. In several large cities, special institutions took over the care of the chronically ill: the House of Good Samaritan (locally, the "HGS") in Boston (figure 1), Irvington House in New York, Larabida in Chicago, and Taplow outside London. At the HGS, which had a capacity of 80 beds, 3500 children and adolescents were hospitalized during the four decades from 1921 to 1961. The usual stay was 3 to 6 months. In 1927 a research unit was established there under the late Dr. T. Duckett Jones (figure 1, inset) where he began his life-long study of the disease. In 1931, I joined in this endeavor and for the next two decades we followed, with the help of Benedict Massell and others, the course of the disease in this population. In particular, we set aside the original 1000 patients (admitted between 1921 and 193 1) for special