History of Present lllness.—The patient was a 13-year-old white boy who was in good health until five weeks prior to his first admission to this hospital on June 2, 1967. At this time, he complained of a sore throat which lasted one to two days. Two and one-half weeks prior to admission he had "flu" and nine days prior to admission, his temperature rose briefly to 40 C (104 F). Two days later, he was seen by a physician who told the parents that the child had a heart murmur. He was hospitalized elsewhere five days prior to admission, and the parents were told that he had rheumatic fever. He was treated with penicillin, 400,000 units intramuscularly every six hours, and aspirin. There was no history of arthralgia, erythema marginatum, joint swelling, subcutaneous nodules, or neurological changes. He was then transferred to this hospital.
Physical Examination at the Time