WAR AGAINST RHEUMATISM

Evening Star, Issue 19519, 29 March 1927, Page 8

WAR AGAINST RHEUMATISM

- [By Crusader, in tho ‘ Spectator.’] Not cancer nor tnbcrculjsis must bo reckoned tho chief cause of death in onr country. Wo rinhtly discuss and fight those dread diseases, hut we wrongly neglect tho cause which is chiefly responsible for heart disease, tho deadliest of all. That cause is rheumatism, recently studied in very thorough fashion by a committee of tho British Medical Association, under tho chairmanship of Sir Humphry llollcston.

\Vo roust try to define our terms. Rheumatism refers to the flow of something—:i rheum, as our forefathers used to say. The word is absurdly misapplied to a largo variety of disorders which in general are not distinguished by any flow or catarrh whatever. The Frenchman with a cold in ilio head ravs ho is enrhuroo, and with reason. But wo use the term in reference to inflammatory conditious_ of the joints.. We do not, however, include therein such chronic forms of arthritis, sucha-s gout, and wo also try to distinguisii what wo call ‘‘rheumatoid arthritis,” like rheumatism, but not rheumatism. All this muddled terminology means ignorance, and will vanish when knowledge arrives Meanwhile wo should use what knowledge wc have. At least we" may he reasonably clear about rheumatic fever or acute rheumatism. The disease is plainly characterised and very common. The young patient, in a typical rase, is attacked with joint pains, high fever, copious perspiration. The best remedies are salicylic. Wo used to me saliein, actually derived from ihe willow bark, then sorjium salicylate, and later aspirin,, which is acetyl-salicylic acid. They are valuable, relieving the pain and the joint swelling. But they do not cure. As the disease progresses there often ensues a common and terrible complication. The poison, a microbe of still doubtful identity, attacks not only the linings of the joints, but the lining of the heart, and especially of the valves, the mast stressed parts of the heart. The endocarditis subsides, as docs the similar condition in the joints; but often (lie valves aro scarred and deformed as they recover. The exquisite machine is irrenarably damaged, the patient has valvular disease of the heart which will kill him sooner or later. Meanwhile ho vvi 11 ho examined and treated in clinics and special and general hospitals Students will learn to use the stethoscope upon him. His murmurs will ho defined, his pulse tracings correlated therewith; an:l ho will swallow what must ultimately become vast quantities of "Volumes are written about heart disease, and the “ great heart specialist ” ranks, for entirely ridiculous reasons, ns the supremo physician. All this is very interesting and satisfactory to _ many people, but it is not treatment in any adequate sense The damage, I repent, was and is irreparable. Deaths from heart disease in England and Wales considerably exceed 1,000 every week. An excellent idea would be to prevent these eases; and this would not be the novelty it is if the medical profession were taught and organised for prevention instead of treatment. In such an instance as this the. student might surely lecoivo five minutes' teaching on prevention, ns against weeks of systematic and clinical lectures on tne treatment which at best is pitifully' futile. Proventiotw on ihe other hand*, is not a dream, but an immediate practical possibility. Rheumatic fever is a disease of Northern Europe rather than the sunny lands which border the Mediterranean; it is a winter rather than a summer disease; it is in part one of my “ diseases of darkness ”; it is associated with damp; it attack tho children of the less fortunate classes in especial, and must he correlated with tho quality* of their housing ana their footweir. It is therefore largely preventable, and cur bounden duty is to declare war on it forthwith. Like tuberculosis and the venereal diseases, this is one which belongs to the terribly neglected realm of medical sociology The stethoscope and the vactns ernditus of tho great heart specialist who feels the pulse and tells the astonished class what kind of valvular lesion will he discovered suffice nothing at all. They avail even less, if that were possible, than the lung specialist who can hear ominous sounds at one apex or other and diagnoses consumption. We need the architect and the town planner, the school medical servL-o, the teaching profession, to protect our children, especially from the hibernal damp and darkness which favor the spread of rheumatic fever. Also we have another piece of knowledge—not too explicit by any means, but’ indicative and helpful. It is an application of the modern pathological doctrine of focal infection. Thus if a child, for instance, has diseased tonsils, in the crypts of which, certain germs are permanently lodged, or has carious teeth, with invaded root membranes, the enemy has already established a post within, his gates—a focus whence infection may" spread. ' .Perhaps, tho germs become specially favored by

seme unknown factor which augments their virulence; perhaps the defences of Die body become lowered by a par of leaky hoots, in which on a rainy day the child sits _at school, while, heaven pity him, he Is taught tho names of Henry VUJ'.’s hapless wives or odious daughters—and the microbes, from their focus, are able to spread, reaching tho delicate lining membranes of ,thc joints and the heart, wherein, Tori unknown bio-chemical reasons, they are particularly able to flourish, or which their poisons are particularly able to injure. Tin- facts are not clear, but there is a connection hot,ween the state of the throat and the so-called “rheumatic state. "Without complicating our discussion further by reference to subacute rheumatism or inquiry .as to the relations between rheumatic fever and the other kinds or rheumatism, we can at least assert that children’s throats and mouths should bo scrupulously cared for. No child should live in a" damp house;, no child should sit in damp clothes; no child should ho ■allowed to go about with chronic disease of the tonsils and teeth. Expense? Yes, there will be some expense in seeing to these things—perhaps even as much as one hundredth part of 1 per cent, of the cost of heart disease.