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"a decline in mortality from rheumatic fever has been
proceeding in England throughout this century. A decline in the
incidence of acute rheumatic disease among London children was
apparent before the war, and the decline accelerated during the war
years.
"The reasons for these changes offer a field for speculation and
research. The lowered mortality during this century has coincided
with a gradual rise in the standard of living. The lessening incidence
just prior to the war occurred at the same time as a considerable rise
in employment. It is tempting to think that the mass evacuation
of children from cities and towns to rural areas, which took place
at the outbreak of war, may have so reduced over crowding and the
opportunity for droplet infection as to account for the accelerated
decrease in rheumatism during the war years. The figures from
Walthamstow however show that the decline went on among children
who continued to dwell in their own homes, and spent many nights
in air-raid shelters."
Fig. 2. Walthamstow Rheumatism Clinic, 1931 -1943.