Rheumatic fever is one of a number of distressing maladies for which a really rational mode of treatment, based on known etiology, is still lacking. There is, of course, strong suggestion or perhaps even presumptive evidence that infection affords the correct explanation of the disorders to which the designation "rheumatic" has been applied. But today, as a recent writer has expressed the situation, it is surprising that, in spite of the great advance in the knowledge of the causation of most common infectious diseases, we still must recognize our uncertainty of the etiologic agent in rheumatic fever. In fact, it has even been alleged that there are two rather important features lacking in the infection picture. Although rheumatic fever does at times occur in epidemics, it is seldom transmitted to others; furthermore, one attack does not produce immunity or protect against another. To this regrettable uncertainty of causation is added
THE PATHOGENESIS OF RHEUMATIC FEVER. JAMA. 1924;82(23):1866. doi:10.1001/jama.1924.02650490040015
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