Dialysis and transplantation: the national picutre over the next five years.

which seems unlikely to change radically for many years, it seems hard to believe that any major decline in the incidence or severity of acute rheumatic fever and its consequences is im minent. If anything increasing urbanization, school attendance, and group organization may aggravate the situation further. If rheumatic fever is different in the tropics it is in terms of incidence and severity, and this may be entirely a function of the streptococcus or it may, in addition, relate to host susceptibility. It is these two facets, the streptococcus and host susceptibility, which deserve a major investment in research time and public health money. The rewards may be of universal benefit and not limited to the tropics.