We present in this report clinical observations on the fatal course of rheumatic fever and its sequelae in 306 young patients. Our purpose is twofold. First, there are important aspects of the natural course of the disease which are best displayed by this special group, and, second, certain clinical features which characterize the disease in its more severe form are not generally recognized as important manifestations of rheumatic fever. The significance of these less well recognized manifestations becomes increasingly evident from a consideration of these fatalities.
The material dealt with is in some respects unusual. During the past sixteen years (since 1921) approximately 1,500 children and adolescents under the age of 21 years have received prolonged care in bed at the House of the Goòd Samaritan during the course of active rheumatic fever and chorea. The subsequent course of these patients has been followed by frequent examinations and, when