The changing pattern of rheumatic fever in childhood.

The manifestations of acute rheumatic fever were compared in 231 children admitted to hospital from 1937 to 1940 with those in 252 children admitted from 1957 to 1960. Of the 178 in the early group seen during an initial attack, 82 had cardiac involvement; of these, 12 died early. Of the 218 patients in the later group with an initial attack, 96 had cardiac involvement; of these, two died early. Despite this decrease in early mortality, the incidence of isolated mitral value involvement (73% in the early group and 62% in the later group) and the incidence of congestive failure (20% and 13%) were similar. This reduction in the number of early deaths may be due to lowered virulence of the streptococcus, improved socioeconomic conditions, or therapy with penicillin and corticosteroids. The incidence of chorea and the frequency of recurrences were also less in the later group.