TALKS ON HEATH

Taranaki Daily News, 9 December 1926, Page 14

TALKS ON HEATH

RHEUMATIC HEART DISEASE. PREDISPOSING CONDITIONS. (Contributed by the Department of Health.) Rheumatism is a disease 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 recurring in childhood. Again, when it is remembered that of the men medically examined in the New Zealand Expeditionary Force 15,000 were found to be 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. CAUSES OF RHEUMATISM. The importance of climate is shown by the special prevalence of rheumatism in countries within Temperate Zone and by its definite seasonal incidence, it is comparatively very rare in Tropics. The majority of cases occur in May and June, and thq fewest in the less humid months of December and January. Heredity has been long recognised 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 the disease, though statistics indicate that the incidence of infection falls mainly on the children of the moderately poor, and to a "less degree upon those of the well-to-do and the very poor. Further, it appears true that rheumatism is a disease of tlje 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 a and 15 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 in children manifests itself in a different form than 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 onset 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 is 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 affect the nervous system, producing symptoms of chorea, the disease commonly known at' 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 carefully 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. Residence in 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 after-care 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 tile disease. We wish to emphasise the fact, liowevei, 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.