Volume 3

A system of medicine / by many writers ; edited by Thomas Clifford Allbutt.

Date:
1896-1899
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / by many writers ; edited by Thomas Clifford Allbutt. Source: Wellcome Collection.

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    463] is accompanied by severe arthritic pains; hence cases not truly rheumatic may be included in the statistics and raise the average. Un- fortunately the military returns during the Crimean War do not afford data for comparing the proportion of cases of rheumatic fever with those of rheumatism. Our troops in the Crimean War were exposed to damp and great cold as well as fatigue. The only information I find bearing on this point is the statement by Dr. Lyons : Rheumatic pericarditis seems to have been very rare during our army's occupation in the Crimea, not- withstanding the rigour of the climate. The influence of fatigue and exposure in a dry and otherwise salu- brious climate is shown very prominently by the military returns during the Egyptian and Cape Wars. In Egypt, during the years that our troops were on active service in the field, the average number of admissions for rheumatic fever reached the high ratio of 2968 per 1000 men; and in the Cape during the years of the Kaffir War an increase of over 5 per cent in the cases of rheumatic fever was seen. The United Kingdom, and England in particular, is regarded by many writers, especially on the Continent, as pre-eminently the country of acute rheumatism. It is almost impossible to form any opinion as to the fre- quency of its occurrence in the United Kingdom. I have arranged in the Appendices V. and VI. all the returns that I have obtained from the metro- politan and provincial hospitals. The returns are very imperfect, and of less value than I had hoped; whether as indicating the proportion rheumatic fever bears to other diseases, or as showing the effect of position, climate, nature of the soil, or character of the population on the occurrence of the disease. How little reliance can be placed on these returns as giving information regarding the frequency of the disease in different localities may be seen from the returns of hospitals in the same town, which differ widely in the proportionate number of cases to the sum total of the medical cases treated: for instance, there is a difference of 2-40 per cent between the returns of the Koyal Infirmary and the Eoyal Southern Hospital, Liverpool; and a still greater difference between the returns of the Salford Royal Hospital and the Manchester Royal Infirmary. The population of our large manufacturing centres, appears to suffer more than that of our rural districts; but this may be due to the larger proportion of cases in country districts treated in their own homes The returns from the East Coast are lower than those from the \Y est j but with the exception of Newcastle there are no returns from large towns, such as Hull and Hartlepool. The prevalence of the disease in the Isle of Man and Whitehaven is remarkable. _ Scotland suffers less than England, corroborating the evidence given by the military returns; and there is no proof that the disease is less fre- icnt, as has been stated, in Cornwall/ Guernsey, and the Isle of Wght than in many other parts of the United Kingdom of equal s.ze. Senator i i c,„i tw in ttia ten vears 1882-91, 235 deaths in Cornwall are ascribed to rheumatic ^^ tSa^oSn^; and a correspondent who practises at Redruth says: Cases of acute rheumatism are not infrequent in my own practice.