The virtual disappearance of rheumatic fever in the United States: lessons in the rise and fall of disease. T. Duckett Jones memorial lecture.

lished his paper entitled "The Diagnosis of Rheumatic Fever."' Jones had the foresight to recognize the im- portance of standardized diagnostic criteria from three points of view. He wrote: "(1) Otherwise, without standardized criteria the incidence of rheumatic fever may be interpreted as varying greatly whether the data are collected by surveys, the development of a rheu- matic fever register, making the disease reportable, or the study of hospital records. ( Jones' third point dealt with the importance of standardized diagnostic criteria if valid information regarding ultimate prognosis were to be obtained and provided to patients and their families. It is noteworthy that the primary benefits he described were not so much the improved clinical management of individual patients with rheu- matic fever, but rather facilitation of the collection of meaningful incidence data and evaluation of the effectiveness of prevention programs. In this article I would like to discuss the dramatically changing incidence of rheumatic fever and its relation to our preventive ef- forts. The studies I will present were possible only because of the broad acceptance and utilization of the diagnostic criteria promulgated by Dr. Jones 40 years ago.