THE pattern of distribution of rheumatic heart disease in the general population is of particular interest not only to those studying the natural history of rheumatic fever but also to those concerned with the pre-eminence of heart disease as a cause of disability and death. Studies of the epidemiology of rheumatic fever have helped to establish the association between that disease and streptococcal infections as well as to describe the familial aggregation of cases of rheumatic fever1 , 2 and its predilection for northern latitudes.3 However, data on the epidemiology of the late cardiac sequelae of rheumatic fever have been largely restricted . . .