A benign type of rheumatic fever.

A diagnosis of rheumatic fever conjures in the minds of most physicians a serious disease demanding prolonged rest in bed, suggesting the likelihood of cardiac damage, and producing subsequent invalidism to a varying degree. Copeman (1944) described 42 cases of febrile polyarthritis of acute onset which he states were " non-epidemic, of short duration, and probably not uncommon." None of his cases developed cardiac damage, and all occurred in patients whose previous resistance to disease appears to have been exceptionally high. For this benign syndrome he suggests the name " acute febrile myalgia" as being better than " benign rheumatic fever" for several reasons, in spite of the prominence of the arthritic manifestations. Ferguson (1944), in reviewing 243 such cases occurring in the Canadian Army, suggested the appellation " acute febrile polyarthritis " for a condition in adults simulating rheumatic fever, but which has not the gloomy prognosis of this disease as seen in children. The diagnosis of rheumatic disease was usually followed in the Canadian Army by discharge from the Service (162 out of 243). In his opinion at least half of those who developed the condition and were discharged could continue in military service. W. Tegner (1944), the reviewer of Ferguson's article, could not agree that a change in nomenclature is needed. He, however, agreed that a diagnosis of rheumatic fever should not automatically entail'discharge from the Army. The 47 Service patients discussed in this paper suffered with this " benign type " of rheumatic fever and have been seen within the last 2! years. They showed an acute febrile illness with non-suppurative polyarthritis simulating classical rheumatic fever, yet with features which differentiated them from this serious disease, and enabled a shorter period away from duty to be imposed, and a more optimistic prognosis to be given, which within the limits of a relatively short follow-up proved to be justified. During this period only 7 cases of classical rheumatic fever with endocarditis were seen, and in none of these was the attack the primary one.