Before answering this question, it might be well to see whether we could not at first determine how this disease develops.
If you should ask your doctor what causes rheumatic fever, he may in all sincerity tell you that he doesnt know, and that while a germ has been suspected, this is a mere guess. Here is how Levine puts it: The exact etiology [cause] of this disease is not known although a streptococcus is thought by many to be the cause. The evidence, however, is very conflicting and the question is best regarded for the present as unanswered.4
MacCallum explains: Although for years many investigators have attempted to show that it is caused by one sort of bacteria or other, generally some type of streptococcus— there is no convincing evidence that any of the different bacteria occasionally found in the blood or respiratory passages have any importance as its cause.5
We can see from all this that the question of a germ being the cause is mere conjecture. Now, if the disease cannot be blamed on a germ, how does it develop ? The answer is not so mysterious as it seems. Medical literature asserts that many predisposing factors play a role in its development. Dr. Paul Dudley White states:
An important factor in the occurrence of the rheumatic infection and of rheumatic heart disease appears to be the social and economic status of the individual. These diseases are much more common, by several times at least, among the crowded poor than among the well-to-do inhabitants of almost every community. In the large American private schools, rheumatic fever, chorea, and rheumatic heart disease are uncommon, while in the large public schools they are relatively very common.
Crowding, exposure to cold and wet without sufficient protection, malnutrition and fatigue are probably all factors in producing this contrast.6
Dealing with the same subject, Dr. Normal L. Moore7 of the School of Nutrition, Cornell University, observed that the incidence of rheumatic recurrence was four times as high in a poor environment as in a good one.
It has long been suggested that economic, sociologic, and dietary factors are concerned in some way in the etiology and recurrence of the disease. The above study gives emphasis to that point.
Here then, in clear and unequivocal terms, is an indication of why rheumatic fever develops. Malnutrition or poor dietary factors, fatigue, poor environment, or any of the influences that lower the resistance of the body play an important role in the development of this disease. The reason we have a preponderance of rheumatic fever among the poor is simply because these unfavorable factors predominate in the homes of the poor.
However, since unfavorable influences are not limited exclusively to the poor and since children in well-to-do homes are often improperly nourished and exposed to influences that lead to overfatigue, they are not altogether immune to it.
Improper food, excessive indulgence in sweets, the use of rich concentrated foods or refined foods, overeating, exhaustion, and excessive emotional influences are among the many factors that affect the children of all classes.
Dr. Moore made this point clear when he stated that studies have given positive evidence of the relationship between adequacy of diet and the susceptibility of the host of rheumatic fever. He specified that one of the three factors in the genesis of the rheumatic state is conditioning of the host by a poor diet.
Dr. Moore further referred to the contribution of Jackson, Kelly, Rohret, and Duane, who have proved that the degree of deficiency of the diet was related to the incidence and degree of heart damage and that an excellent diet plus wholesome living conditions will practically eliminate the chances of recurrence with carditis [inflammation of the heart].
Dr. Moore concluded by pointing out that observations have demonstrated conclusively that an incomplete or deficient diet plays an important role in the development of this disease, and that a well-balanced diet plus wholesome living conditions will not only help toward rapid recovery but will protect the heart against damage.