WAR AGAINST RHEUMATISM

Hawera Star, Volume XLVI, 23 July 1927, Page 9

WAR AGAINST RHEUMATISM

N' OT cancer nor tuberculosis must be reckoned the chief cause of death in our country (writes “Crusader” in the “Spectator”). We rightly discuss and fight those dread diseases, but we wrongly neglect the cause which is chiefly responsible for heart disease, the deadliest of all. That cause is rheumatism, recently studied in very thorough fashion by a committee of the British Medical Association, under the chairmanship of Sir Humphrey Rolleston. We must try to define our terms. Rheumatism refers to the flow of something—a rheum, as our forefathers used to say. The word is absurdly misapplied to a large variety of disorders which, in general, are not distinguished by any flow or catarrh whatever. The Frenchman with a cold in the head says he is enrhmne, and with reason- But we use the term in reference to inflammatory conditions of the joints. We do not, however, include therein some chronic forms of arthritis, such as gout, and we also try to distinguish what we call “rheumatoid arthritis,” like rheumatism but not rheumatism. All this muddled terminology means ignorance, and will vanish when knowledge arrives. Meanwhile we should use what knowledge we have. At least we may be reasonably clear about rheumatic fever or acute rheumatism. The disease is plainly characterised and very common. The young patient, in a typical case, is attacked with joint pains, high fever, copious perspiration. The best remedies are salicyclic. We used to use salicin, actually derived from the willow bark, then sodium salicylate, and later aspirin, which is acteyl-salicyclic 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 Tining of the heart and especially of the valves, the most stressed parts of the heart. The endocarditis subsides, as does the similar condition in the joints; but often the valves are scarred and deformed as they recover. The exquisite machine is irreparably damaged; the patient has valvular disease of the heart, which will kill him sooner or later. The damage was and is irreparable. Deaths from heart disease in

CAUSE OF HEART DISEASE

B.M.A.’S INVESTIGATION

England and Waleg considerably exceeds a thousand every week. An excellent idea would be to prevent these cases; and this would not be the novelty it is if the medical profession were taught and organised for prevention instead of treatmentIn such an instance as this, the student might surely receive five minutes' teaching on prevention as against weeks of systematic and clinical lectures on the treatment, which, at best, is pitifully futile. Prevention, on the 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 associated with damp; it attacks the children of the less fortunate classes in especial, and must be correlated with the quality of their housing and their footwear. It is therefore largely preventable, and our 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 tactus eruditus of the great heart specialist who feels the pulse and tells the astonished class what .kind of valvular lesion will be 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 service, the teaching profession, to protect our children, especially from the hibernal damp and darkness which favour the spread of rheumatic fever. . The facts are not clear, but there is a connection between 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 rheumatism, we can at least assert that children’s throats and mouths should be scrupulously cared for. No child should live in a damp house; no child should sit in damp clothes; no child should be 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 1 per cent, of the cost of heart disease.