Sunday, December 6, 2015

Rheumatic Fever (Excerpt)

Lowell A. Rantz, M.D.

Rheumatic fever has been a problem to the U.S. Army in all of its wars for which historical data are available, although it attracted little attention before World War II. Enteric infection and malaria in earlier wars, and influenza and its complications in World War I, overshadowed all other acute diseases. Inadequate diagnosis also prevented the recognition of the military importance of this disorder.

The recorded experience of the U.S. Army in the American Civil War1 reveals that acute rheumatism occurred with remarkable frequency. In 5.2 years, 146,000 cases were reported among white troops at a rate of 61 per 1,000 per annum. Certainly, not all of these were acute rheumatic fever, but examination of the case records that have been preserved in the history of that war indicates that a substantial number of them was certainly this disease. This impression is confirmed by 642 deaths caused by rheumatism, endocarditis, and pericarditis. Furthermore, the disease occurred principally in the winter among fresh levies of troops, an epidemiological pattern which resembles that of rheumatic fever during World War II. In retrospect, it is impossible to define the magnitude of the problem of rheumatic fever in the Civil War, but it must have been great.



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