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JAMA. 1946;130(8):488-490. doi:10.1001/jama.1946.02870080022006.
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Medical literature leads one to believe that rheumatic fever is an uncommon disease in the tropics. It suggests also that when the disease does occur it is mild and cardiac damage is slight. Manson-Bahr1 states that "as rheumatic fever is a rare disease in the tropics, rheumatic affections of the valves of the heart are correspondingly rare." J. T. Clarke2 stated that rheumatic fever is practically unknown at sea level in tropical areas. W. T. James1 has been quoted by Manson-Bahr as stating that he had not seen a case of rheumatic fever in twenty-four years of practice in Panama. Goetz3 found rheumatic heart lesions in 3 autopsies on native Panamanians. He also reported 3 cases of chorea and 5 cases of rheumatic fever among 11,000 admissions to Santo Tomas Hospital in Panama City, Chains4 gave an excellent description of rheumatic lesions found in 12


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