Acute Rheumatic Fever in Young Men

Since the turn of the century, acute rheumatic fever has become increasingly uncommon (Glover, 1930; Hitchens, 1956). Penicillin treatment of upper respiratory tract infections and the increasing use of antibiotic prophylaxis have contributed to this decline in recent years, but improved social and economic conditions and the changing pattern of streptococcal illness are probably more important. Nevertheless, rheumatic fever remains a serious problem which may become a menace during epidemics of streptococcal infection (Coburn and Young, 1949; Winblad, Malmros, and Wilander, 1947). Leff (1956) estimates that 4,000-5,000 school children in England suffer from an attack of acute rheumatic fever each year, and Knowelden (1949) has shown that the mortality from rheumatic heart disease has not paralleled the declining mortality from acute rheumatic fever, particularly in adults. Epidemics of streptococcal infection are particularly common in institutions, so that rheumatic fever would be expected more often than in the general population. The barrack conditions of Army units in the United Kingdom form typical closed communities which provide epidemiological information not readily available from civilian sources. This paper describes a clinical and epidemiological study in young soldiers, which was undertaken to ascertain the incidence of initial and recurrent attacks of acute rheumatic fever (as diagnosed by predetermined criteria); the pattern, frequency, and persistence of heart damage; and the importance of the preceding upper respiratory tract infection. Epidemiological data, based on the notification rate of rheumatic fever in the Army, has already been reported (Rosenbaum and Slater, 1957) and the present investigation extends this, using strict criteria for the diagnosis of the disease.