DIFFERENTIAL DIAGNOSIS OF RHEUMATIC FEVER IN OFFICE PRACTICE

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Abstract
This discussion is based chiefly on experience gained in the examination of 2,639 children seen in consultation for the presence of active rheumatic fever and heart disease; it represents problems encountered by over 250 physicians in their practice. The errors in the early diagnosisof rheumatic fever and heart disease frequently result in labeling normal children rheumatic or cardiac. It is partly in hope of sparing some children needless invalidism that these observations are presented. The value of penicillin in the prevention of rheumatic fever also makes it important to accurately identify the rheumatic child so that he may be carefully maintained on long-term prophylaxis. HEART MURMURS AND HEART SOUNDS Systolic Murmur.— The finding which most often raises in the mind of the physician the question of the presence of rheumatic fever is the discovery of a systolic murmur. Eleven hundred fifty-one of the 2,639 children seen were referred for this

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