A decline in the incidence and severity of rheumatic fever has been reported from several centers in the past 2 decades.1-11 It is the purpose of this report to document this trend as it has occurred on the Children's Cardiac Service at Bellevue Hospital over a 24-year period from 1935 through 1958.
Case Material and Methods
A total of 792 initial attacks of acute rheumatic fever form the basis for this study. The patients, ranging in age from 2 to 15 years, fulfill the following requirements: (1) They were hospitalized atBellevue during their first attack, and (2) a definite diagnosis of acute rheumatic fever was made in each. Cases in which the diagnosis of acute rheumatic fever was considered to be questionable at the time of review for the study were not included. A definite diagnosis required at least one of the major criteria of Jones12,13 (arthritis,