Rheumatic fever: the way it was.

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 alone and 8% of the autopsies at the Presbyterian Hospital showed specific lesions of the rheumatic state. 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. *

E F Bland

2011

Scholarcy highlights

  • 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 alone and 8% of the autopsies at the Presbyterian Hospital showed specific lesions of the rheumatic state. 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. *
  • Special institutions took over the care of the chronically ill: the House of Good Samaritan in Boston, Irvington House in New York, Larabida in Chicago, and Taplow outside London
  • The House of The Good Samaritan in Boston with 80 beds, where 3500 children and adolescents were hospitalized with rheumatic fever between 1921 and 1961
  • The arms and the legs and especially the joints were the usual sites of discomfort, and in young children it was often mild and mistaken for "growing pains." The severe migrating polyarthritis traditionally attributed to the disease is far more characteristic in adults than in children, and of all the symptoms of rheumatic fever pain in the joints is the most satisfactory to treat; if it does not subside in a few days on salicylate therapy the diagnosis of rheumatic fever is unlikely
  • Cutler and Levine chose their first patient for valvulotomy-a 1 2-year-old girl from HGS with severe mitral stenosis who survived nearlv 5 vears after the operation
  • Six subsequent attempts failed and the procedure was abandoned; 25 years elapsed before valvulotomy became a notably successful operation. only being supplanted in part by balloon valvuloplasty

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