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Rheumatic Fever and Streptococcal Infection
Unraveling the Mysteries of a Dread Disease
Benedict F. Massell, M.D.
Harvard University Press, 1997

This is a historical review of the development of our knowledge of the clinical picture, etiology, pathogenesis, and prevention of rheumatic fever and rheumatic heart disease over the past four centuries. Benedict Massell examines the major contributions of both clinicians and investigators to our current understanding of rheumatic fever as a separate disease form.

Elucidating many facts about this dread disease, Massell examines the frequent epidemics in training camps during World War II, discusses our growing understanding of the pathogenesis and mechanisms by which streptococcal infections cause the disease, and shows the important progress made in prevention through the use of penicillin and other antibiotics. He includes a discussion of the many problems which can hinder our understanding and control of this disease, as well as recent promising developments in the clarification of the molecular structure of the streptococcal protein and the possible application of this information to the development of a safe and effective vaccine for the prevention of streptococcal infection.

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Rheumatic Fever in America and Britain
A Biological, Epidemiological, and Medical History
English, Peter C.
Rutgers University Press, 1999

Rheumatic Fever in America and Britain is the first book to examine comprehensively a disease that has been a moving target for physicians and health care workers. A disease of skin, brain, heart, connective tissue, blood, tonsils, and joints bound to a member of the streptococcus family of bacteria, this illness has practically disappeared from the present-day scene. Yet in 1940 more than one million Americans suffered from the heart disease that followed the ravages of rheumatic fever. It struck nearly 2 percent of all school-aged children, filling hospitals, convalescent homes, and special schools.

Rheumatic fever rose in prevalence throughout the nineteenth century, reaching its peak in that century's last decades, and then steadily declined-both in occurrence and severity-throughout the twentieth century. In the nineteenth century, acute rheumatic fever was largely a disease of children and young adults. Another remarkable epidemiological change occurred during the twentieth century; rheumatic fever shifted its character, became milder, and in doing so allowed its victims to live longer, if disabled lives. As this disease so altered, adults increasingly became its victims.

Dr. Peter C. English explores both the shifting biological nature of this disease and the experiences of physicians and patients who fought its ravages. Using insights from biology, epidemiology, and social history, Dr. English-both a physician and medical historian-is uniquely suited to unravel this disease's epidemiological and cultural complexities.

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