PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK
FROM his earliest writings on rheumatic fever, Hugh McCulloch recognized the importance of geographic variation in incidence and prevalence of the disease. What was behind this variation was not clear then and is not clear now. Other problems have, perhaps, been easier to attack, [SEE TABLE I AND II IN SOURCE PDF] since multiplicity of factors impedes definitive analysis of geographic influences, but it is clear that elucidation of the specific reasons behind variations from one locality to another, may go far in promoting effectiveness of preventive measures. As collaborative international efforts in the field of health have progressed, data on the subject are becoming available from more and more nations. Despite difficulties in interpreting the data, to be pointed out later, there are presented herewith information on [SEE FIG.1, FIG.2 AND TABLE III IN SOURCE PDF] the current world-wide situation as reflected in reports to official agencies. It has been repeatedly pointed out that any analysis of incidence of rheumatic fever and chronic rheumatic heart disease is subject to difficulty because of lack of a specific diagnostic test. Clinical advances have gone far towards clarifying the criteria for establishing the diagnosis, but, in the great majority of cases, decision rests on the clinical acumen of the physician, in terms both of alertness to the possibility that a case is rheumatic fever, and in critical appraisal of the evidence before accepting the diagnosis in doubtful cases.