Modern trends in acute rheumatism.

The last few years have witnessed a marked decline in the incidence of acute rheumatic infection in childhood, but it "is still a dangerous menace demanding the continued attention of paediatricians, public health officers, and laboratory workers" (Annotation, 1955). The serious nature of the disease was revealed in a follow-up of children in the United States: after 10 years approximately one in three had died, and after 20 years more than half (Ash, 1948); in general, a rheumatic child has but a fifty-fifty chance of surviving to the age of 40 years (Wilson and Lubschez, 1948). Rheumatic heart disease is probably responsible for the deaths of one in ten of all heart sufferers and for practically all the deaths from heart disease of persons below the age of 40 years; in the under 40s it takes second place only to tuberculosis.