Rheumatic Fever in Warm Climates

To the Editor.— In reading the article of Barnert et al (232:925, 1975), I was surprised by the first sentence: "Acute rheumatic fever (ARF) is considered a disease of decreasing incidence, less common in warm climates, and rare in adults. 11 The following four references amply confirm that the above statement is incorrect: Suarez R: Incidence of heart disease in Puerto Rico. Am Heart J 29:339, 1945. Francisco R: Rheumatic heart disease in the tropics with special reference to its incidence in Puerto Rico. Clinics 5:971, 1946. Garcia-Palmieri MR, Costas R Jr, Diaz-Rivera RS: Rheumatic fever in the tropics. Am Heart J 63:18, 1962. Garcia-Palmieri MR: Rheumatic fever and rheumatic heart disease as seen in the tropics. Am Heart J 64:577, 1962. In the fourth reference, 44 references are cited to add strength to our claim; multiple articles confirming our claim have been published since 1962.