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Acute Rheumatism And Rheumatic Heart Disease

E.T. Conybeare

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Although there has been a substantial decline in its prevalence during the last twenty years, acute rheumatism remains one of the most important diseases of the rheumatic group. Infection with hæmolytic streptococci of Group A is at present the only factor in the aetiology of acute rheumatism which can be identified with confidence. Until other aetiological factors, which almost certainly exist, have been defined the prevention of acute rheumatism rests upon general measures such as diminution of overcrowding which will control the frequency, weight and variety of upper respiratory tract infections among children and young adults. Prompt detection of acute rheumatism, especially of the forms which have an insidious onset, rest in bed during the stages of acute illness and convalescence, together with special clinical arrangements for after-care extending over many years remain the only satisfactory measures for the prevention and limitation of the chronic heart disease caused by acute rheumatism. The chief responsibility for this now lies with the hospital and specialist section of the National Health Service. Research at present in progress may serve to uncover some of the hitherto unknown factors in the aetiology of acute rheumatism and hence lead to better methods for its prevention. The use of penicillin to control upper respiratory infections in rheumatic individuals and of hormones in the treatment of the initial illness which are now being investigated may prove to be valuable in the prevention of chronic rheumatic heart disease.