Rheumatic fever historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Lance Christiansen, D.O.; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Historical Perspective
Rheumatic fever, and therefore Streptococus pyogenes infections, are endemic in all areas of the world. In countries affected by the industrial revolution, domestic living conditons became less crowded, due to the development of larger homes and families had fewer children. In addition, living conditions became, generally, more hygienic. The introduction of antibiotics, first sulfonamide in the early 1930's and then penicillin in the 1940's, further caused Streptococcus pyogenes infections to become less common and less severe in economically developed countries although they never disappeared.
Rheumatic fever was a scorge of society for hundreds of years, until the post WW II era, for in the text, Rheumatic Fever and Streptococcal Infection (Massell, B., Harvard Press, 1997)the author indicates, "For the period 1939-1943, statistics published by the Metropolitan Life Insurance Company indicated that rheumatic fever was the leading cause of death among policy holders for persons from five to nineteen years of age and the second leading fatal disease among twenty to twenty-four year olds."
The indicence of rheumatic fever had been decreasing, as society became more wealthy, as the industrial revolution progressed and by the late 1960's it seemed that rheumatic fever has nearly disappeared. Rheumatic fever became so undommon in economically developed countries that physicians, in general, lost their clinical knowledge of the disease.
Rheuamtic fever has been a puzzling disease for a long period and it was not until 1931 that Alvin Coburn, MD determined, for sure, that Streptococcus pyogenes infections caused its development. It was not until the 1950's that all physicians agreed that Streptococcus pyogenes was its cause. Even T. Duckett Jones, MD, the physician who first developed the Jones Criteria, did not accept the fact that Streptococcus pyogenes was the sole cause of rheumatic fever.