There have been striking changes in the incidence of rheumatic fever in the United States over the past 50 years. Rheumatic fever was a serious health problem for young people during the 1930s and 1940s. This may be appreciated best by briefly sharing with you my own experience in 1946 when I worked for a year in a rheumatic fever convalescent hospital on the outskirts of New York City.

The hospital was filled with 90 children and adolescents, and there was even a waiting list. Almost all of the patients had heart disease and were convalescing from 6 months to 1 year after one or more attacks of acute rheumatic fever. This experience had a deep and lasting impression on me, and nurtured my interest in this disease over the last half century. There were a number of such convalescent hospitals near cities with large urban populations. For example, the...

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