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Rheumatic heart disease continues to be one of the most important and perplexing diseases of man. Although information acquired and correlated in the last 80 years has led to the knowledge that group A hemolytic streptococci play a major role in the pathogenesis of this disease, many of the most important aspects of the pathogenesis are poorly understood. How interaction of the streptococci with the host results in rheumatic heart disease in a certain small proportion of the numerous human beings who are repeatedly infected with these micro-organisms has not been established. Inasmuch as we know that in many children and adults active rheumatic disease of the heart occurs insidiously and sometimes in protracted form without fever and beneath the clinical horizon, the incidence of this disease is probably greater than usually reported. Indeed, a large proportion (probably 50% or more) of adults with severe chronic rheumatic heart disease do
NATURE OF RHEUMATIC HEART DISEASE. JAMA. 1961;175(3):230–231. doi:10.1001/jama.1961.03040030054011