Although rheumatic fever has been the subject of numerous and extensive studies, many aspects of its natural history still remain open to scientific investigation. This is particularly true with reference to rheumatic fever and rheumatic heart disease in adults, since the greatest number of investigations have been made on patients during their childhood and adolescence. The number of adults with rheumatic fever is not negligible. According to Cohn and Lingg1 the percentage of these cases occurring in early maturity is 42, embracing, of course, the survivors from childhood (23 per cent) and adolescence (9 per cent) plus the new cases which occur at this age period (10 per cent).
The present paper submits an analysis of 100 unselected fatal cases of rheumatic heart disease over the age of 20 years at death and examined post mortem. They were collected from the records of the Massachusetts General Hospital and include patients from 1927 to 1943 inclusive. On looking at the figures one should take into account the cause of death. Since any one of two, three or four factors may be the cause of death, it is often difficult to ascertain which is the main determinant factor. Nevertheless we have made an effort to determine the cause of death as precisely as possible. The myocardium was examined for active rheumatism.