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The opinion is widespread and of good founda- tion that acute articular rheumatism, or acute rheu- matic fever, is of infrequent occurrence in the tropics and in China. Chalmers and Castellani state that among tropical diseases rheumatism is distinctly uncommon. Anders gives it as a disease of temperate climates, and rare in both cold an»i hot latitudes. Poynton (i) admits that rheuma- tism is ubiquitous, but says it is more frequent and severe in temperate and changeable climates. Leon- ard Rogers (2) marks the almost complete absence of rheumatic fever on the plains of India. To this and the Micardis Plus 80 25 Mg coincident absence of scarlatina, he attributes a wide difference in Buy Micardis Hct India in the inci- dence of cardiac disease. Jeflferys and Maxwell, in their standard text on Chinese practice, note the nearly total absence of acute rheumatic fever in Chinese chiklren, in whom they have never ob- served the disease. They comment on the still greater rarity of chorea in Micardis Mycard Program Chinese children. ' Cantlie (.3). in Micardis Generic Equivalent an admirable address before the Society of Tropical Medicine and Hygiene, in Lon- don, discussed the subject of acute rheumatism in the tropics with the thesis, "I have for many years spoken and written to the effect that rheumatic fe- ver was a disease which gradually diminished as one Micardis Substitute passed from temperate to warm climates, and that in the tropics the disease was practically Micardis Hct Generic un- known." Cantlie was perplexed to account for the large number of cases of acute rheumatic fever re- ported in the British Colonial Reports, but this was explained by the inclusion of all forms of so callcl rhemnatism under the single term. In an experi- ence Is There A Generic For Micardis of ten years in Hong Kong, Cantlie saw but one case of acute Micardis Mycard rheumatic fever, and that was a second attack Generic For Micardis Hct in a European recently arrived from England. In discussing Cantlie's paper, T. M. Atkinson stated that in a term of twenty-five years in Hong Kong, lie had not seen six cases of rheumatic fe- ver. W. O. Pon, contiiuiing the discussion, noteii the observation of but one ca.se of rheumatic Micardis Alternatives fever in his term of nine vears in the Federated Malay KEED: ACUTE RHEUMATISM. States, with an inpatient service of from 600 to 700 per Micardis Plus 40 Mg annum. In closing the discussion, the pres- ident of the society. Sir R. Havelock Charles, cited his experience in Afghanistan and Turkestan, Micardis Plus 80 Mg where in two years Micardis Hct 40mg 12.5mg he saw two cases in natives. He stated also that in the British army in India, in 191 1, with a strength of 72,371 men, 310 cases of acute rheumatic fever were diagnosed. Among the 4,248 women there were eighteen cases, and among the 7)656 children tliere were six cases with one death. There were eleven cases among the 5,259 British officers. In the Indian army during the same period, with a strength of 130,441, there were 633 cases of acute rheumatic fever with one death. In the jail population of 109,099, 655 cases were reported with five deaths. He concludes : "So you have a very great number of medical officers of various services, and they can not all be wrong in the diagnosis. I think that you might say Generic Micardis Hct that the position with reference to rheumatic fever in the tropics is still sub judice." Thus it is apparent that the last word has not been said on the ques- tion of the influence of tropical climates on the de- velopment and prevalence of acute rheumatic fever, although the prevailing views are expressed in the opinions selected. On experimental and clinical evidence it may be accepted that acute rheumatic fever is a systemic infective disease, and that it has certain major man- ifestations which may be grouped primarily under the headings of cardiac lesions, arthropathies, Micardis Plus 80 12.5 Mg ton- sillar infections, and chorea. The term, rheuma- tism, is an inexact appellation whose connotations are misleading, and which might well be replaced by a scientific descriptive title. The composite and undoubtedly heterogeneous disease entities which have been grouped vmder this term, are gradually being separated out and specifically de- scribed. So acute rheumatic fever has left the rheumatic fold of a century ago, even though it is but now receiving clear definition. We are not at present concerned with the specific cause of the disease, but with stating the problem of its preva- lence in hot latitudes and the reasons for its infre- quency there. Taking rheumatic fever as a specific disease due to a Micardis 40 Mg Price systemic infection with some morbific agent, the predisposing causes seem to play a Micardis Telmisartan 40 Mg most impor- tant role in its development. Among the weighti- est predisposing factors, common clinical experi- ence joins in placing the influence of climate, sea- son, and locality. The fact stands that a climate with minimal seasonal variations, particularly if it is hot, does not favor the development Micardis Telmisartan 80 Mg of acute rheumatic fever- There is room for Micardis 80 Mg Price study of the relationships borne by hot climates or constant temperatures to the development of this disease. A somewhat analogous case is that of the rarity of

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