PEDIATRICIANS have been cognizant for some time that there has been a change in the picture of rheumatic fever and rheumatic heart disease in children and youth. This opinion has been based upon their experience in private practice and as staff members of the larger hospitals which usually care for these patients. In spite of this general impression, however, the American literature has published few reports containing facts which substantiate or refute this clinical observation. Some of the facts describing the situation in New York City are presented herewith.
REVIEW OF THE LITERATURE
A review of the American literature from 1940 to the present time reveals 10 reports relevant to this subject. These reports are briefly summarized in chronological sequence.The Metropolitan Life Insurance Company in 19431 reported that for its industrial policy-holders between the ages of 5 and 24 years in the interval between World War I and