Until recently, rheumatic fever has been viewed as a disease taking place within a short period. The newer concepts, however, emphasize that the rheumatic infection may endure through the entire life of the patient.
Mental symptoms during acute rheumatic fever have been observed since the days of Benjamin Rush, founder of American psychiatry.1
Mental disease occurring within a period of several months following the acute stage, as the result of rheumatic cerebral involvement, has been described by Winkelman and Eckel.2 A woman aged 33 had rheumatic fever. She recovered sufficiently to be able to do light house work. Several months later she began to have ideas of persecution, visual hallucinations and suicidal tendencies. When she died, shortly afterward, microscopic examination of the brain revealed proliferative endarteritis of the small cortical vessels and minute areas of partial and complete softening in the gray matter.
More recent neuropathologic studies3