THE PREVENTION OF RECURRENCES IN RHEUMATIC SUBJECTS

Abstract

Rheumatic fever is a recurrent disease, and the danger of developing permanent organic heart disease increases with every recurrence. These considerations have stimulated a wide search for measures to prevent the recurrent attacks. For years it has been recognized that infections of the nasopharynx, especially sore throat and tonsillitis, frequently precede exacerbations of rheumatic fever. On this account it has been almost universal practice to perform tonsillectomy and adenoidectomy on rheumatic patients in the quiescent stage in the hope of decreasing the frequency and intensity of such infections of the upper respiratory tract and avoiding rheumatic flare ups. However, this hope has not been fulfilled; tonsillectomized patients continue to have rheumatic recrudescences nearly as often as before, although Allan and Baylor¹ have shown that there seems to be less likelihood of rheumatic heart disease developing after tonsillectomy in those who had escaped it up to the time of the