The Pathogenesis of Rheumatic Fever in its Climatological Relationship to a Possible Insect Carrier

A short while ago a special sub-committee of the British Medical Association [1] sat to inquire into the problem of rheumatic heart disease in children, and suggested, among other conclusions, that the material for any accurate world map of the incidence of rheumatism was probably not available. My objects in presenting this paper are:-(1) To provide data for this map.(2) To show that the geographical distribution of rheumatic fever coincides with that of the common rat flea, Ceratophyllus fasciatus, and(3) To suggest that this disease is caused by a protozoön, spirochaete or allied organism, which is carried by that flea.