Editors: JOHN P. HUBBARD, M.D..
THE pediatrician plays an important role in the care of children with rheumatic fever or rheumatic heart disease. As a clinician, his primary concern is with the diagnosis and treatment of the individual case. Adequate care, however, of a child with this long-term disease is much more than a pediatric problem. Its solution requires the services of many other professional individuals and agencies.
The integration of these skills and services necessitates planning and organization. Ideally, the person to call attention to the many needs of children who have rheumatic fever or rheumatic heart disease is the pediatrician. He should take leadership in working with others in the community to plan and develop a program.
Survey of the Council on Rheumatic Fever and Congenital Heart Disease
A survey of rheumatic fever programs undertaken by a special committee of the Council on Rheumatic Fever and Congenital Heart Disease in 1950 and 1951 revealed that in those communities visited, pediatricians, internists, and cardiologists had taken the initiative in developing services for rheumatic children. By and large, these services met the need for a thorough diagnostic study and for institutional care during the active and convalescent phases. Home nursing, educational, and other social needs, however, were being used on an organized basis in only a handful of communities. The survey made by the Council was essentially a study of medical care. The conclusions and recommendations of the study were based on observations in 13 communities. Some of these communities were urban; some were rural; others, part of a state-wide program. As a working guide for the study, the following definition of a community rheumatic fever program was used:
"A community rheumatic fever program covers a community or an administrative area including several communities. It promotes the development, integration, and periodic evaluation of services and facilities in the community, and is designed (1) to find individuals who have rheumatic fever or heart disease; (2) to remove the label of falsely diagnosed rheumatic fever from children and adolescents, and (3) to ensure that individuals receive adequate and continuing care."