The Natural History of Rheumatic Fever: ? Incurable, Fatal Pancarditis: Forty Years Later

RECENT REPORTS from Puerto Rico emphasize that rheumatic fever occurs among the children¹ and adults^2,3 of this tropical island. Furthermore, the manifestations now being observed are similar to those seen in colder climates. Moreover "carditis seemed to have been at least as frequent and severe in this series as in those reported from temperate zones."¹ Whereas rheumatic fever was known to be both severe and prevalent at high altitudes, it has long been a rarity at sea level in tropical areas of the Carribean. This matter was summarized in 1886 by Hirsch⁴ as follows:

Of the area and frequency of rheumatic fever in North America we are unable to judge, owing to the extreme scantiness of our geographical information; but, if we may infer from the number of communications made about it to medical societies, particularly in the Northern and Central United States, it should be