MEDICAL NOTES.

New Zealand Herald, Volume XXXI, Issue 9401, 6 January 1894, Page 3

MEDICAL NOTES.

; RHEUMATIC FEVER. 1 This is a very serious disease, more especially in childhood. It; is also a very painful one, and may either rapidly prove fatal, or may pass off and leave i the patient apparently recovered, bub really marked for life by organic heart mischief. Sickly children are very liable to this form of fover, which is neither infectious nor contagious, but seems to depend largely on a form of inherited constitutional taint. Catching a cold is . usually assigned as the starting cause of the complaint, but something more than this must be present, because a dozen children may all get wet and catch cold in the same rainstorm* bub only one may develop this fever. Another important characteristic is the liability to repeated attacks ; if a child has had one attack he is more liable than other children to an attack of rheumatic fever; in i this peculiarity the disease differs, especially from the acute infectious fevers, one attack of which seems to protect against further attacks. The patient then, generally a delicate child, after catching cold, becomes ailing for a day or two, with loss of appetite, lassitude, headache, and vague pains about the limbs then shivering fits come on, and , heat of skin is recognised, thirst and still worse pains in head and joints become noticeable. After an uncertain number of hours it is apparent that some of the joints are painful and tender to touch. They are swollen, and the skin is reddened. The fever tends to continue, and the joints remain tender and painful and swollen, sometimes one more than the other; the inflammation in fact tends to move from one joinb to the other. All the general symptoms of fever are present, but there is no rash of pimples, pustules, or scales apart from the joint redness. Lung symptoms ■are generally absent. There is a tendency to profuse acid perspirations, and great debility comes on, and the fever may run very high. Before the invention of the use of the stethoscope and clinical thermometer the above were the only very obvious symptoms, and having reached a climax they either ended in death or else gradually subsided, often leaving some chronic joint weakness or some unexplained shortness of breath and tendency to palpitation. The introduction of the use of the registering thermometer enabled the medical adviser to recognise and measure the intensity of the fever, and to estimate the risk involved to life, for the amount of imminent danger largely depends on the number of hours that the beat remains excessive. The ■" information afforded by the stethoscope is even more important, for ib led to the discovery thab rheumatic fever, while attacking the joints outwardly, is very often also inwardly affecting the heart, both its outside surface, and also the valves in its interior; and the stethoscope has further shown that rheumatic inflammation inside the hearb is the cause of a very great proportion of the heart mischiefs which cause illness and death at and after middle age. The moral is, never neglect for a moment) a feverish attack accompanied by swollen joints; medical advice is urgently required ; a few hours' delay may work irretrievable mischief, and may lead to a whole life of inability to take any exercise, or do any duty requiring serious exertion.

MENTAL DEPRESSION AND SUICIDE.

! In spite of some pessimistic utterances in its favour, suicide still ranks with us (says the Lancet) as an indictable offence. This is but natural, if we allow that self-destruc-tion is incompatible either with mental or moral health. We are all familiar with the verdict so often heard at the close of a coroner's inquiry, " committed suicide whilst of unsound mind." Without doubt ib describes with more or less accuracy every case of the kind. Ib certainly applies to such a case as that of a young practitioner who lately died from taking an overdose of morphia. *Ib does not, however, as a rule, exclude the operation of moral forces, and there is abundanb proof to show that these are active at every stage in the pitiful transaction. We would claim for them a predominating influence. The mind which connives at self-destruction is ab variance with the most elementary instinct of self-preservation, a sentiment which is fully justified both by the proved possibility of present existence and by our ignorance as to future events. It is, therefore, unhealthy. It is in an even greater degree immoral, since possessing within itself a sense of duty and of relationship with others in their lives, labours, and attainments, ib ignores all for the sake of a present gain of personal relief. No one can rid himself of this relationship without at the same time casting on others the burden of responsibility which he abandons. We cannot, therefore, bring ourselves to agree with some who go the length of excising suicide and even of advocating the creation of facilities for its accomplishment Of more practical importance, as bearing upon the causes and course of this essentially morbid condition, is a brief analysis of 100 cases lately published in tho pages of a contemporary. From this article we gather, among other interesting details, that, according to the evidence obtained, men destroy themselves with much greater readiness than women. The proportion is about two to one. Middle age is the period at which the tendency is most marked, and j the middle class holds tho same position in the social scale. Mental influence is more active than any physical inducement, and pecuniary and related social difficulties fill a larger space than any other group of! motives. As regards the question of treatment, it is to our mind perfectly clear that the evil of suicide is not to be disguised by resorting to a lethal chamber or other permissive method, however plausible its description, bub by cherishing a simpler, stronger, and more impersonal senso of human fellowship and mutual duty. In the presence of innumerable evidences of providential design we would equally impress the necessity of remembering that the divine order still prevails, and still for each and all men furthers, though sometimes obscurely, thoir best interests. Lot us not forget physical considerations. Mental depression is often the' outcome of mere bodily illness, especially of fatigue and of indigestion. Some judgment in treating those, some consideration on tho part of employers of labour, may disperse _ a thundercloud of despair which otherwise would settle in perpetual gloom. We have heard enough, at all events, of the modern pessimism with its latest miserable canon of self-destruction. We would substitute for it the plain, old-fashioned but eminently wholesome and courageous precept, Never say die." DIPHTHERIA IN LONDON. According to the Times diphtheria is at the present time very prevalent in the metropolis. Up to 1888 it had never caused as many as 1000 deaths in a single year, but in 1892 that number was nearljy doubled and as in the last ten months ib has made about 2500 victims, it is assumed that tho total mortality from it will amount to at least 3000 by the end of; December. About 400 new cases have been reported weekly for the last two months, and instead of the usual ■ average of something under thirty deaths a week there have been from eighty to ninety. The disease is terribly fatal—much more so, indeed, than most others; and ib is found that, whereas scarlet fever, for example, kills less than five per cent, of those it attacks, the proportion in the case of diphtheria is from 20 to 25 per cent.