Rheumatic fever is generally considered to be comparatively prevalent in the temperate zone and uncommon in subtropical or tropical climates.1 The purpose of this seminar is to report on a 5-year experience with acute rheumatic fever at the Kauikeolani Children's Hospital in Honolulu in order to emphasize the relative frequency of this disease in Hawaii. During the years 1955 through 1959, ninety-one cases of acute rheumatic fever were seen during the first attack of the disease at Children's Hospital. Although the incidence had been approximately 0.6% of the total medical admissions for the years 1955 through 1959, there was a fourfold increase in 1959 to 2.3%. The cases from 1955 through 1958 were reviewed mainly from the charts, while those of 1959 were seen personally by me.
Since the exact pathogenesis of rheumatic fever is not fully understood and since climatologic factors may play a role in precipitating or