Atypical rheumatic fever in young adults.

Experiences gained in the armed forces have contributed much to our knowledge of rheumatic fever in adults. It has become clear that the " textbook " descriptions of the disease give a misleading picture of it's commoner features as observed in servicemen. Several large series of cases have now been reported in America (Griffith, 1947; Sokolow and Snell, 1947; Ferguson, 1943; Rosenberg, 1946); but, apart from Copemnan's description of atypical rheumatic fever in the Middle East (1944), the subject has not received the attention which it deserves in this country. This paper is an analysis of the salient clinical features of a consecutive personal series of twenty-five cases of rheumatic fever admitted to the medical wards of a military hospital in Italy during a twelve-month period. accepting set standards for the diagnosis of rheumatic fever, and twenty-four of the present series fulfil his criteria. The remaining patient differed from the others only in that he was afebrile by the time he was admitted to hospital. The most useful diagnostic criteria were the association of arthritis or arthralgia with fever and raised erythrocyte sedimentation rate, together with a history of an acute infection within the preceding five weeks. In six cases there was a history of a previous attack of rheumatic fever. Onset.-The illness commonly began with ffitting joint pains and malaise, and the patient was usually admitted to hospital within a week of the onset of symptoms (18 cases) but sometimes the onset was extremely insidious and prodromal symptoms might