STILL A PROBLEM

Ashburton Guardian, Volume 56, Issue 68, 2 January 1936, Page 8

STILL A PROBLEM

RHEUMATIC FEVER. MICROBE SUSPECTED. Though the nature of many diseases is now known, quite a number still require elucidation. It is one of the fascinations of medical investigation to review from time to time what may he called the natural history of some particular disease in the hope that light may thus be thrown on its nature through some new avenue of approach, says a writer in, the “Melbourne Age.” Acute rheumatism fever is a complaint whoso etiology is still unsettled, and many lines of investigation have been explored in an endeavour to find out its true nature. To prevent misconception, it must he remembered that rheumatic fever is quite distinct from those chronic joint conditions, whose nature also baffles us, that we usually refer to as rheumatism. Acute rheumatic fever frequently, though not invariably, affects children. Though redness and swelling over the joints often occur, subsiding without permanent disablement, the chief danger lies in the liability of the heart to be affected. Changes may occur in almost any part of this organ, but those most to be feared are located in or near the valves which prevent the regurgitation of the blood. It these .situations are attacked, scar tissues may slowly develop and in the course of years, lead to such contraction of these delicate flaps that they fail to carry out their function. Other parts of the body may ho affected, and one of the forms of shoiea or St. Vitus’s dance is due to minute lesions in the brain. Specific Microbe*. The whole behaviour of the disease suggests that it is due in some way to invasion of susceptible persons by some? specific microbe. Though most are agreed on this point, opinions differ as to how such a microbe acts. Thus the germ, whatever it is, may be actually present wherever the lesions are to be found, its actual presence there being responsible for the reactions. Or the invading entity may in one place—say, the throat —and frequently the attack of rheumatic fever is preceded by a sore throat —the results elsewhere may be due to toxins or poisins absorbed from this site. Or, again the presence of the germ in one situation may eventually lead to a conditions of undue susceptibility or sensitisation of other parts to the material of which the germ is composed, ‘ much as pollen causes many of ns to become sensitised in the shape of hay fever. Time and again attempts have been made to grow ordinary bacteria from the sites of the disease. Some workers have been successful at times in growing organisms from such situations, but many have failed, and in any case the number of bacteria present has been small. For many years the organism known as the diplococcus rheumaticus of Poynton and Paine has been looked on by some as the agent sought. The general verdict on it, however, is one of “not proven.” Another school of thought considers that certain streptococci to he found in the throat are probably responsible, acting in one of the three ways mentioned above. In some cases the net of investigation has been thrown wide. There is a supposed rarity of cases of acute rheumatic fever in the tropics. Is it possible that the disease is dependent on conveyance of a virus by some insect which is rare in the tropics but common in the temperate regions—quite a reasonable hypothesis to put up? False Hopes. One writer points out that a special kind of flea on rats is found in colder climates, but is uncommon in the tropics, and might thus fill the bill. A suggestion such as this must not he lightly dismissed as fantastic. The reactions to the unknown cause of the fever are not. unlike those met with in typhus fever (the germs of which in animals may affect the brain, and the typhus group of diseases .is spread by body-lice, mites, etc. A little while ago, it was averred that bodies resembling the Rickettsias of the typhus group had been found in rheumatij fever, hut our hopes were destroyed when it was pointed out that the supposed organism had another explanation. Quite recent work suggests that a minute filterable virus may he the real cause of the disease. But even though such a virus may play an essential part in the causation, it is possible that it may he reinforced by the association with it of such, bacteria as streptococci.

Many other aspects lieve received attention. Thus housing and living conditions may facilitate in some way tile acquirement of the disease, and jt is recognised that, in general, more cases occur where these conditions are bad than among the well-to-do. By following up clues such as those, the investigators hope that, eventually the key to the situation will bo found. By the steady accumulation of reliable information covering as will be seen, a very wide field, and by the careful sifting and co-ordinating of the data, and by following up every likely avenue of exploration, success will be in the end achieved. The triumph may not Jest with one man, but may be the culmination of the efforts and thinking of many, or on the other hand some new and unexpected approach to the solution may be stumbled on or may be brilliantly worked out by a single investigator. Even the by-pro-ducts of some other line of work may to a capable mind furnish the clue. These are indeed fascinating problems, and who can tell what the morrow may bring forth?