Acute rheumatism in children in its relation to heart disease.

Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: Acute rheumatism in children in its relation to heart disease. Source: Wellcome Collection.

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    almost every malady is to begin at the beginning. Whether it be poliomyelitis, or venereal disease, or diphtheria, or tuberculosis, or cancer, or acute rheumatism, the most potent factor in effective treatment is to commence as promptly as possible after the first signs have manifested themselves. Partly by a process akin to that of denudation in geology, that is by a reduction of the general mortality, the great peak of heart mortality stands out each year more boldly than before. It is becoming steadily more prominent. In 1926, of every 1,000 deaths in England and Wales, 142 were ascribed to heart disease, and if other diseases of the circulatory system be added, the figure is 188. In other words, no less than 85,20.) deaths occurred last year which were attributed to this cause. Here are the five principal contributors to the mortslity-tax in England and Wales in 1926, per 1,000 deaths :— 1. Disease of the Heart and Circulation .. oe 188 2. Bronchitis, pneumonia and other respiratory diseases os 149 3, Cancer of all forms .. ; ‘ti rs ae hd tHe 4. Disease of Nervous System ia ig ing pF 102 5. Tuberculosis ni a tog! me ne: o 4 82 It is clear therefore that heart disease has a pre-eminence among “‘ the captains of the men of Death,” and its relative, if not its real, mortality is steadily rising. Much of this heart mortality is, as we should expect, concentrated upon the age groups of later life and of old age, for much of it is due to degenerative processes and to senile changes, to the wearing out, in short, of pumping machinery incessantly at work, a wearing- out which may perhaps be hastened or deferred, but which cannot in the end be averted. But even if we assumed that half the total heart mortality be accounted for by processes of senile decay, it nevertheless means that the other half of this mortality, which falls upon childhood, adolescence, young adult life, and early middle age, and some of that of later middle age, is due to | infective processes such as acute rheumatic fever. These infective processes are caused by diverse organisms, such as the various pyogenic organisms causing infective endocarditis, or those causing diphtheria, scarlet fever, syphilis, or influenza. The most important, however, of these infective sources of cardiac disease and death is probably the rheumatic infection. 'To this may be due some 40 per cent. of the total cardiac mortality, and even a higher proportion of those cardiac deaths which are due directly to infective causes, If we turn from mortality statistics to study the sickness records we find that of all patients in hospital with cardiac disease, the cause is definitely acute rheumatism in approximately 90 per cent. of those who are under ten years of age, in 80 per cent. of those between ten and twenty, mn 60 or 70 per cent. of those between twenty and forty years of age. After the age of forty syphilis becomes an appreciable factor, and the proportion of cardiac disease of unknown origin increases. After fifty years of age the degenerative Sos stich as arterio-sclerosis, Bright’s