AGE SUSCEPTIBMLITY TO FAMILIAL INFECTION IN RHEUMATIC FEVER

One expression of our changing views with regard to rheumatic fever is the increasing importance being attached to juvenile forms of the disease. Older figures on the age incidence of this disease were based largely upon the incidence of both the primary, and recurrent attacks. Such figures minimized the importance of childhood as the period of greatest susceptibility. For instance in Rolly's monograph on rheumatic fever (1), published in 1920, he listed the age incidence of all periods of activity in a series of 1450 cases, and from these figures found, that only 4 per cent of the attacks occurred in the first decade of life; 40 per cent in the second; 39 per cent in the third; etc. The conclusion reached was that rheumatic fever found its highest inci-dence in the second and third decades of life. If, on the other hand, a series of cases is analyzed for the age incidence of first attacks, a very different result is obtained, showing that by far the greater number of initial manifestations of the disease occur in the first decade of life. This fact now seems well established among groups of patients attend-ing hospital clinics in large cities, although we have no data on rural populations. Our present views with regard to the age incidence of first attacks may now be briefly reviewed as follows: it is apparently rare, although not exceptional, to find the disease during the first year of life. Most of the cases which have been recorded in young infants were being nursed by mothers who were suffering from active phases of the disease, a fact which is of importance not only from the standpoint of age sus-ceptibility but also from that of the transmissibility of the disease. Equally important are the isolated case reports, mentioned by Rich-dorf and Griffith (2), of apparent congenital acquisition of rheumati