HEALTH NOTES

Greymouth Evening Star, 16 July 1928, Page 9

HEALTH NOTES

RHEUMATISM. (Contributed by the Department of Health). In its various forms rheumatism is one of the most insidious, disabling, and mortal of all diseases. It is well known in temperate climates, and in New Zealand we are by no means exempt from it. An investigation of all cases of rheumatism with involvement of the heart, irrespective of the ages of the patients, in one of our larger Dominion hospitals for the period 1923 to July, 1926, showed a total of 186 cases. Of this number 44 cases occurred in children and youths up to 21 years, but without doubt a number of the other cases had their origin in a rheumatic infection occurring in childhood. Again when it is remembered that of the men medically examined in the New Zealand Expeditionary Force, 15,000 were found to bo affected'by disease of the heart, the importance of rheumatism, one of the commonest causes of heart disease, cannot be over-estimated. Further investigation on the question, therefore, has recently been carried out, and though much remains to be learned, the influence of certain factors in its causation has been clearly demonstrated.

The importance of climate is shown by the special prevalence of rheumatism in countries within the Temperate Zone and by its definite seasonal incidence; it is comparatively very rare in the Tropics. The majority of cases occur in May or June, and the fewest in the less humid months of December and January. Heredity has been longrecognised as a factor and an imperfect dietary has been held for many years to be associated with it. Poverty and overcrowding and dampness of dwelling houses aggravate poor, and to a less degree upon those of the well-to-do and the very poor. Further, it appears that rheumatism is a disease of the inhabitants of industrial towns rather than of rural districts Investigations into the exciting cause of rheumatism point to the existence of a micro-organism or germ. Apparently scarlet fever may act as a strong predisposing cause. The predisposing causes which favour the development of the disease are of outstanding importance. The disease is emphatically one of school years, the onset as a. rule being between five and fifteen years. There is a reasonable amount of evidence to show that infection generally occurs through the throat. Unhealthy throats caused by diseased tonsils, adenoids, and decayed teeth are common in childhood, and provide an entry through which the micro-organism of rheumatism invades the body. Rheumatism l in children manifests itself in a different form to that in older people. In adults, the typical acute rheumatic attack is accompanied by painful joints, fever, profuse perspiration, and is liable to be associated with various complications, especially in connection with the heart. In children in fully half the cases there is little or no joint affection, and fever may be comparatively slight, In many cases the only symptoms noticed during the outset of a serious rheumatic attack in a child are languor, pallor, and wasting, although extensive changes in the heart may have already occurred. It is this characteristic of the rheumatic poison to do serious damage before being recognised that makes it essential not to minimise the' importance of minor rheumatic manifestations in children. For instance, the popularly named “growing pains” are rheumatic in origin and indicate the necessity for care. Though muscular and ligamentous structures are most readily attacked, rheumatism in children often affects the nervous of chorea, the disease commonly known as St. Vitus Dance. •

PREVENTION.

Every child who suffers from “growing pains” should be medically examined and careful supervision of all slight ailments is advisable. Defective teeth, discharging ears, enlarged tonsils, frequent sore throat, and any form of catarrh should be carefu'ly treated. The clothing of children, especially those with rheumatic tendencies, is very important. 'Such children, especially in winter, should wear woollen garments next to the skin, care being taken to cover the extremities; warm stockings and watertight shoes in bad weather are essential. .Undue exposure to wet and cold should be avoided. It is inviting trouble for women to go out in winter wearing thin shoes and silk stockings or to clothe their children with short inadequate socks and thin shoes. Residence m a dry climate, when possible, is beneficial. The importance of rest and fresh air for all children cannot be exaggerated, and for the rheumatic child they are doubly necessary if the weakened heart and nervous system are to become strong. It is inadvisable to enforce the habits of an invalid upon ,a child convalescing from rheumatic fever, but strenuous exercise whether physical or mental should not be taken ’until recovery is complete. The details of the child’s life should be regulated by medical advice. Competitions whether athletic or intellectual should be avoided. The need for the aftercare of the rheumatic child is as yet imperfectly realised. Every large city should be provided with the means for the institutional treatment of rheumatic children in the course of which they can receive controlled rest, with plentiful sunlight and fresh air concurring with education over periods of months.

It can be laid down definitely that a child suffering from an attack of rheumatic fever should be confined to bed for a period of at least six weeks and should be under strict medical supervision for some months. A periodic health examination by the’family medical practitioner or by the school doctor is a valuable safeguard against the recurrence of the disease.

We wish to emphasise the fact, however, that it is unnecessary in considering the future of any child suffering from rheumatic manifestations to hold too gloomy a view, as early recognition of the disease and appropriate treatment hold out great prospects of definite amelioration and even of absolute cure. RHEUMATISM IN CHILDREN. The following is a copy of instructions issued to parents by the Paddington Green Children’s Hospital on the care of rheumatic children: — 1. Rheumatism is caused by infection by a. germ, and it is a common disease of children, in whom it often attacks the heart. This is the great danger of the disease. Rheumatism is the commonest cause of heart disease in children. 2. Rheumatic attacks of all sorts often start with a sore throat. A sore throat in a rheumatic child is always a dangerous symptom. 3. Common symptoms of rheumatism

in children are:—Sore throat, pains in muscles, painful joints, paleness, shortness of breath, fidgetiness or nervousness.

4. Chorea, or St. Vitus’s dance, is rheumatism attacking the brain. Its chief danger is the tendency for the heart to be injured at the same time. Unusual nervousness, disturbed sleep, fidgety movements, or a tendency to drop things may be warnings of St. Vitus’s dance. 5. Rheumatic heart disease is often painless and may only be discoverable by a doctor’s examination.

6. If the heart has been injured by rheumatism, its recovery is very slow, and permanent harm may be done by letting the child resume an ordinary life before recovery is satisfactory. 7. An occupation in life for a child with heart disease requires very careful ch'oice.

8. Rest, is very necessary for rheumatic children They should always be put to bed early, and they should be made to lie down during the day if they seem at all tired or if there is any aching of the limbs. 9. Damp is bad for rheumatism; basements are dangerous; rheumatic children should sleep in the sunniest and driest room available. If they get wet their clothes should be taken off and dried at once. Water-tight boots are especially important. 10. Rheumatism tends to recur, especially in the winter months.

In cold weather all children should wear long woollen stockings so that the legs, including the thighs, are well covered.