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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    45, after which rapid increase occurs and continues at an ever- accelerating pace throughout the rest of life to extreme old age. The reader is referred to the full discussion of this subject given in the Registrar-General’s Statistical Review, 1922, Text, p. 86. _ Occupational influences, however, seem to have less effect than geographical and environmental influence, as is shewn in the supplement to the seventy-fifth annual report of the Registrar General, Part IV. Matthew Young* has studied the geographical distribution of heart disease in England and Wales by examina- tion of standardised death rates at ages of 25 years and upwards. He concludes that ‘a definite association exists in the counties between the distribution of mortality from organic heart disease and heart diseases in the aggregate and the mortality from acute rheumatism. . . . The relative incidence of acute rheumatism appears to be the essential factor that determines the incidence of heart disease, although other factors, possibly mainly environ- mental, may have some influence on the rate of mortality in different periods.’ Geographical and racial variations in the incidence of rheumatic heart disease in the United States have recently been studied by Wood, Jones and Kimbrough,} who find that rhewmatic heart disease of all types is nearly twice as common in Massachusetts (39-8 per cent. of all cases of heart disease) as in Virginia (22 per cent. of all cases of heart disease), and that organic heart disease is almost twice as common in the negro as in the white, though in the negro hypertension (53-5 per cent.) and syphilis (21-4 per cent.) seem to be the chief aetiological factors producing heart disease. These racial differences had already been pointed out by Dublint, who said :—‘** Coloured males show rates from heart disease during the main period of lite from 65 per cent. to 80 per cent. higher than for white males of the same ages; those for coloured women are twice as high as for white women at a number of age periods.”’ In Calcutta rheumatic carditis is very rare, only one doubtful case being found in 4,800 postmortems spread over 37 years—_ “A striking confirmation,” says Rogers,§ “‘ of the practical if not complete absence of rheumatic fever in Bengal.” If. The Mortality from Heart Disease is increasing although Acute Rheumatism appears less virulent in type. It is interesting to note that the mortality from heart disease is increasing despite an apparent change in the nature of the rheumatic infection. All observers are agreed that acute * The Lancet, 19th September, 1925: Journal of Hygiene, 10th November, 1921. + American Journal of the Medical Sciences, August, 1926. t Incidence of Heart Disease in the Community, Nation’s Health, 1922, p. 453. § Rogers. Pathological evidence bearing on Disease Incidence in Caleutta. Glasgow Med. Jl., Jan.—Feb., 1925.