RELATION OF DURATION OF BED REST IN ACUTE RHEUMATIC FEVER TO HEART DISEASE PRESENT 2 TO 14 YEARS LATER

Abstract

THE MEDICAL management of children with acute rheumatic fever has undergone remarkable changes in the past decade. It is no longer considered "radical management" to mobilize a patient promptly upon disappearance of the acute signs and symptoms of rheumatic activity instead of imposing prolonged periods of bed rest. A few investigators have recently advocated permitting ambulation and physical activity to tolerance within the first few days after the onset of the acute attack even in the presence of myocarditis. There are very few data available in the literature, however, to support the clinical impression that prolonged bed rest is not necessary to secure optimal myocardial healing. For this reason it seems desirable to record clinical studies designed to test the validity of this impression. In 1946 when Herrick House was converted from a summer residence for children convalescing from rheumatic fever to a year-round convalescent home, it became one of the first institutions to abandon prolonged bed rest. Detailed description of the Herrick House program has been published previously. A long-term study was undertaken by the medical staff at that time to determine whether abandonment of prolonged bed rest was harmful. The cardiac status of children who had been treated at Herrick House was determined by periodic examinations. All the children in the study were examined by at least one of the authors. The medical care, however, was not provided by the physicians who performed these follow-up examinations. Observations made during the first 4 years after the initiation of the study have been reported. The conclusion was reached that abandonment of prolonged bed rest and restriction of activity did not appear to affect the heart adversely and may have benefited it. The purpose of this paper is to present further observations on the same and additional children followed from 2 to 13 years.