The influence of climate on the prevalence, course and clinical picture of rheumatic fever has been much discussed though seldom accurately measured.1 Widespread differences in clinical concepts about this disease which exist in different places, difficulties in clinical diagnosis and the absence of specific diagnostic tests have made it practically impossible to determine its prevalence with accuracy in any given locality, much less to compare its prevalence in several localities. Despite the lack of accurate data, however, there is general agreement that the disease is common and severe in temperate zones, that it is less common in warmer and subtropical climates, and that it is rare in the tropics.2 But comparative prevalence determinations in which identical diagnostic criteria have been used in different geographic or climatologic locations are practically nonexistent. Consequently it has been the major object in this work to make such determinations under conditions that were
PAUL JR, DIXON GL. CLIMATE AND RHEUMATIC HEART DISEASE: A SURVEY AMONG AMERICAN INDIAN SCHOOL CHILDREN IN NORTHERN AND SOUTHERN LOCALITIES. JAMA. 1937;108(25):2096–2100. doi:10.1001/jama.1937.02780250010003
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