Heart Disease in Children. A Survey of School Children in Nashville, Tennessee †

Heart disease in children, and in particular, rheumatic heart disease, is not generally reported to public health departments; therefore, estimates of its prevalence in different geographic and climatologic areas, in specific age groups, in varying socioeconomic levels, and in other diverse environmental and familial conditions must be made on the basis of surveys. Prevalance surveys of heart disease have been conducted in some geographic divisions of the United States, and these surveys, along with clinical experience, are gradually adding to our knowledge of the prevalance of rheumatic fever and rheumatic heart disease. One of the earliest of these, in American Indian school children, was done by Paul.1 Unfortunately, very few surveys of heart disease have been made in the southern states, too few, in fact to settle the question as to whether rheumatic heart disease is or is not less common in the southern United States when compared to the North. The hemolytic streptococcus, considered to be the agent factor in the etiology of rheumatic fever, has long been thought to be more frequently a cause of disease in children in the northern rather than southern states. However, recent studies of the prevalence of the hemolytic streptococcus have challenged this impression.2" The methods usually employed in determining the prevalence of heart disease, including questionnaires, health surveys, autopsy studies. hospital or clinic admissions, and actual examination of children, leave much to be desired. Probably the most commonly used method is that in which groups of children have been examined for evidence of heart disease, but even with this method, there are certain inherent inaccuracies which need