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especially the adult population, in health matters
would have considerable influence in this respect by
inducing people to lead active and healthy lives free
from overstrain and excesses of all kinds.
The third class, due to syphilis, is more common
in men, and the symptoms do not show themselves
until 10 to 20 years after the onset of the syphilis.
The arrangements for co-ordinating the treatment of
venereal disease in London is under the authority of
the London County Council, and much propaganda
work is being done by the British Social Hygiene
Council.
It is difficult to ascertain which class of heart disease
accounts for the largest number of cases, and also
whether the gradual increase in the death-rate is due
to any particular type of heart disease. It is generally
considered in this country that rheumatic heart disease
is commonest. Dr. J. Wyckoff and Miss C. Lingg
writing in the American Heart Journal in April, 1926,
however, state, " about one-fourth of the cases presented
rheumatic heart disease, about two-fifths were
arterio-sclerotic, about one-tenth syphilitic, and about
one-tenth heart disease of unknown origin. Other
factors, such as scarlet fever, hyperthyroidism,
nephritis, etc., comprised less than one-tenth of the
total."
Rheumatic Heart Disease.—Much pioneer work has
been done by English physicians on heart disease, and
especially on rheumatic heart disease. Recently reports
have been issued by the British Medical Association
and the Medical Research Council on the causation
of rheumatism and rheumatic heart disease in children
and much of the following statement has been obtained
from these sources. Rheumatism in children is prevalent
in temperate climates, and occurs most frequently
during winter and spring. It is a disease essentially
of school life (five to fifteen years), and although
affecting principally the children of the working
classes is relatively less common among the destitute