War Against Rheumatism 1TOT cancer nor tuberculosis must be reckoned
the chief cause of death in our country. 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 Humphry 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 enrhuine, and with reason. But we use the term in reference to inflammatory conditions of the joints. We do not, however, include therein sonic -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 charac- terized and very common. The young patient, in a typical case, is attacked with joint pains, high fever, copious perspiration. The best remedies are salicylic. We used to use salicin, actually derived from the willow bark, -then sodium 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 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.
Meanwhile he will be examined and treated, in clinics and special or general hospitals. Students will learn to use. the. stethoscope upon him. His murmurs will be defined, his pulse tracings correlated therewith : and he will swallow what must ultimately become vast quantities of digitalis. Volumes are written about heart disease, and the "great heart specialist" ranks, for entirely ridiculous reasons, as the supreme physician. All this is very interesting and satisfactory to many people, but it is not treatment in any adequatesense. The damage, I repeat, was and is irreparable. Deaths from heart disease in England and Wales consideqtbly exceed a thousand every week.
Au excellent idea would be to prevent these cases: and this would not be the novelty it is if the medical profession were taught and organized for prevention instead of treatment. In 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 immediately practical -possibility.
Rheumatic fever is a disease of Northern Europe rather than the sunny lands which border the Mediter- ranean; 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 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. Vire need the architect and the town planner, the school .medical service, the teaching profession, to protect our .children especially from the hib.ernal damp and darkness .which favour 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 the germs become specially favoured by some unknown factor.which augments their virulence ; -perhaps the defences of the body become lowered by a -pair of leaky boots,. in -which, on a rainy _day, the child sits at school, whilst, Heaven pity him, he is taught the names of-Henry VIII's hapless wives or odious daughters .—and the microbes, .from their. focus, are able to spread, reaching. the delicate lining membranes of the joints and the heart, wherein, for unknown bie-chemical reasons, 'they are particularly able to flourish, or which their 'poisons are particularly able to injure.
The facts are --not • clear, • but there • is la connexion • between the state of • the throat • and the -so-called " rheumatic " state. Without complicating our discussion further by reference to subacute rheumatism or enquiry as to the relations between rheumatic fever and the other kinds of 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 one hundredth part of one per cent, of the cost of heart disease.
CRUSADER.
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