In presenting a study of 1,438 children with rheumatic heart disease whom I have had the privilege to observe at three convalescent homes outside New York City over a period of twenty years, I am mindful of the pitfalls one encounters in the analysis of records and figures and realize that any conclusions arrived at must be suggestive rather than final. Figures can often be misleading but if properly evaluated may suggest trends and help to set up an index for the formulation of criteria. My hope is that this intensive and specialized care of rheumatic children over two decades will serve to point a way toward more adequate care for these handicapped children and thus throw some light on one of the most dread diseases of childhood that still remains so obscure. Because of its high mortality in the early years of life and its crippling of boys and girls and young men and young women, rheumatic heart disease has become a public health problem of major importance. The United States Children's Bureau in Washington has already embarked on a program for the care of these children, and many states have set up state programs which are functioning at a high degree of efficiency. It is anticipated that there will be an extension of these services in other states so that a frontal attack can be made on this arch enemy of childhood, characterized in England by Lord Horder as "public danger number one of civilized mankind." At the outset the profession is confronted by a question which is on the lips of all workers in the field of rheumatic fever. "Does convalescent or sanatorial care change the course of the rheumatic child?" To this question I shall direct myself and from my experi¬ ence attempt to give an answer. It is not an easy one.The data I present are factual and have been made possible because an active follow-up has been kept on 905 of 1,007 living children, many of them now adults. The oldest is now 35.The homes (Martine Farm, Reed Farm and Nichols Cottage) in which these 1,438 children have been cared for are situated in the country about 25 miles from New York, and are readily accessible to the many hos¬ pitals from which they came. One home is near White Plains, N. Y., and the other two homes near Nyack, N. Y. All the children were transported to the home from the hospital and at the time of discharge returned to their own homes by automobile. No effort was expended, and this contributed in large measure to the total care of the child. One home with twenty-five beds took care of boys between the ages of 6 and 10 years and girls between the ages of 6 and 16 years. The other two homes, some 15 miles distant, with twenty-four beds, took care of boys from 10 to 16 years of age.At the outset it was not easy to set up criteria for admission, and children with severe carditis but in the quiescent stage of the disease were accepted. In the early years children with congenital heart disease, numbering 40, were cared for. Thirteen of this group (32.5 per cent) have died. One boy has been operated on for a patent ductus a...
