Is it possible that there is a disease seen only in New York City, or is the same condition seen elsewhere classified differently? It is perhaps significant that Libman observed atypical verrucous endocarditis as early as 1911, and that all of the literature on this subject has come from New York City, being contributed by Libman, the original observer,1Libman and Sacks,2Baehr,3Baehr and Sacks4and Gross,5all from the Mount Sinai Hospital. The early descriptions are summarized as follows: Besides those cases that present the clinical picture of rheumatic fever and the typical verrucae on the valves, but not Aschoff bodies, there exists a group of cases presenting more or less the clinical picture of rheumatic fever (with perhaps a greater tendency to the occurrence of purpura and erythema), not showing Aschoff bodies at the postmortem examination, and accompanied by lesions on