Rheumatic heart disease in East Pakistan.

Since the beginning of this century rheumatic fever has been studied more thoroughly and various theories have been postulated, ascribing the disease to non-specific streptococcal infection,’ allergic to non-specific allergen2, virus hypothesis , and streptococcal beta-haemolyticus infection with abnormal antigen-antibody response.4 With advance in the field of bacteriological investigations, especially those of Lancefield and Griffith, it is now apparent that epidemiology of rheumatic fever is related closely to the incidence of preceding streptococcal illness. More informative and interesting researches have been made recently by Rammelkamp and others,7 in their studies on “the Epidemiology of Rheumatic Fever in Armed Services.” The variation in the incidence of rheumatic fever in these studies has been shown to be independent of season, and indicated to have little direct effect of altitude, climate or humidity. They conclude that overcrowding, dampness, economic factors, effect the incidence of rheumatic fever only because they are related to the incidence of streptococcal infection in general. Why a certain section of the population under similar environmental condition suffers from rheumatic fever has not yet been settled excepting the indication that “host factor” plays a significant role either by their susceptibility or by their exaggerated antibody response. In the field of experimental medicine recent works of Murphy and his colleagues8 denotes a great advance in the pathogenesis of rheumatic fever. At last myocandial Aschoff bodies have been produced in rabbits after focal cutaneous infection with group A streptococci. Exaggerated antistreptococcal antibodies (antistreptalysin 0) have been noted in their blood, and in addition an interesting observation on the hypertrophy of adrenal contices with histopathological changes has been observed. The peculiarity of host factor has once more been substantiated by the experimental method. However no proper study of rheumatic fever has been done in tropical countries. Price9 avoids the subject by stating that it is more prevalent in temperate and humid climate than in others. Boyd1#{176}states “in the tropics, where Haemolytic streptococci are rarely found in the throat, scarlet fever is unknown and rheumatic fever is very uncommon.” Paul White” says “permanent residence in the tropics is preferable if a ‘rheumatic family’ can readily arrange it.” In “The Symposium of Rheumatic Fever” edited by Thomas Lewis in which the subject has been dealt with exhaustively, it has been asserted that this disease is “rare in the tropical countries” but as the autopsy record on the people of Guam during World War II by Zimmerman showed