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97
The reasons for the decline are probably two-fold. The first is the
improved standard of living, and in particular improved nutrition and housing.
One of the few facts known about rheumatic fever is its association with
poverty and over-crowding.
The second is probably the decline in virulence of the haemolytic
streptococcus, the causal organism of rheumatic fever. In this connection it
behoves us to be extremely wary as this organism tends to have a virulence
which rises and falls. At one time in this country, and that only about 50
years ago, it caused severe epidemics of scarlet fever. We must therefore be
on guard in case its virulence increases.
While the Supervisory Centre was not set up for children with congenital
heart disease, inevitably some with an unexplained heart condition are seen
there. Some of these have been found to have remediable congenital heart
disease and after admission to hospital have been operated upon, giving them,
in more than one sense of the word, a new lease of life.
The same trends can be seen in the statistics for children coming from
other areas, but these statistics are less reliable because of the fact that
they rep resent a smaller selection of the children involved.