A study of rheumatic fever and streptococcal infection in different social groups in Melbourne

Abstract

1. Hospital records of 1469 cases of rheumatic fever (including chorea) up to the age of 14 years were used to study the social distribution of the disease in Melbourne. On this evidence the incidence of rheumatic fever was three times greater in low than in high rental districts.2. The results of throat-swab surveys and Dick tests on schoolchildren living in different districts showed that children in the poor districts contracted streptococcal infections more frequently than those in well-to-do districts.3. One factor associated with the carrier rate ofStreptococcus pyogenesin the various social groups was the incidence of tonsillectomy. In the better class districts where the tonsillectomy rate was high (60%) theStr. pyogenescarrier rate was 12.5%, whereas the rates in poor areas were 35 and 25.3% respectively.4. Differences in social incidence of rheumatic fever might therefore be explained by differences in social incidence of streptococcal infection, which, in turn, might be influenced by the incidence of tonsillectomy.We wish to thank the many persons who so willingly assisted in the collection of data for this study, particularly Dr H. L. Stokes and Dr M. M. Wilson, and Dr R. E. O. Williams for advice on presentation. This work was supported by a grant to one of us (Dr M. C. Holmes) from the Commonwealth Research Fund from the University of Melbourne.