That rheumatic fever or rheumatic cardiac disease is a chronic infectious disease is now generally accepted. In children especially recurrent manifestations of an active inflammatory process are commonly observed. One or more such recurrences took place in 75 per cent of the 3,129 patients studied in this investigation during an average period of thirteen years after the onset of the illness.1 Two recurrences were experienced by 51 per cent, three by 32 per cent, four by 20 per cent and five or more by 12 per cent.
Although recurrences2 of rheumatic activity take place at all ages at which the disease is found, it appears that the largest number occurs between the ages of 5 and 14 years. A curve representing the ages at which reactivations occur shows a sharp decline beginning at the age of 11 or 12. After the age of 20 it resembles a horizontal
COHN AE, LINGG C. THE NATURAL HISTORY OF RHEUMATIC CARDIAC DISEASE: A STATISTICAL STUDY: II. MANIFESTATIONS OF RHEUMATIC ACTIVITY: RECURRENCE, SEVERITY OF INFECTION AND PROGNOSIS. JAMA. 1943;121(2):113–117. doi:10.1001/jama.1943.02840020021005
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