Rheumatic Heart Disease in the Bombay Deccan

By L. B. CARRUTHERS, b.a., m.d., c.m. American Presbyterian Hospital, Miraj, S. M. C. ' he conception that rheumatic fever and its concomitants are rare or entirely unknown within the true tropics has long been in favour. Seemingly it received strong confirmation when Clarke (*1930) published his notable paper on the geographical distribution of rheumatic fever. Rogers and Megaw (1930) in India and Swift (1931) and Longcope (1931) in America have supported this view. However, in the same year that Clarke published his paper, Hughes and Yusuf (1930) reported 25 cases of heart disease ?f rheumatic origin from Lahore, while Stott '1930) at Lucknow reported 20 cases of mitral stenosis. Two years later, Hodge (1932) reported six cases of rheumatic disease from Jalpaiguri, Bengal. Nevertheless, in each of these cases the objection can be made that they were not from within the true tropics. More recently, Kutumbiah (1935) from Vizagapatam and Banerjea (1935) from Calcutta have published series of cases of rheumatic heart disease which this objection cannot be taken. It is 0llr purpose to help further to clarify this object by reporting our experience at Miraj. Miraj is situated in the Bombay Deccan, 160 Utiles south of Poona at an elevation of about 1,800 feet and well within the true tropics. The Presbyterian Mission Hospital is an institution ?f 270 beds caring for about 5,500 outpatients and approximately 3,200 inpatients yearly, the majority of the latter, namely 70 per cent, being surgical. In the period under discussion, from 1st November, 1933, until 1st November, 1935, there were 6,248 admissions to the hospital, 4,281 (68.52 per cent) being surgical and 1,967 (31.48 per cent) being medical. During this Period of time there were 100 cases of cardiac disease admitted, distributed according to diagnosis as shown in table I. These formed 1-60 per cent of the total admissions and 5.08 per cent of the medical admissions. In this group there were 47 cases of rheumatic origin, forming 0.75 per cent of the total admissions and 2.44 per cent of the medical admissions. In reference to the temperate climates, Tice (1920) ates that about 5 per cent of all patients met 10 (10 per cent)