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47
Regarding the question of environment, living in
damp houses, especially in low-lying districts or on
clay soils which retain moisture and the wearing of
damp clothes. or defective shoes have long been considered
to be predisposing causes of rheumatism, and
there is little doubt that they have a considerable
influence. Part I. of the report of the British Medical
Association by Dr. Miller states: (1) "that 62.2
per cent. out of 196 rheumatic patients were living in
damp houses when first attacked by the disease," and
(2) "it would appear that the proximity to water,
the subsoil, and the altitude of site have all some predisposing
power towards rheumatic infection, but their
importance should not be over emphasized. If there
is anything in the connection between damp houses
and rheumatic infection it is the dampness of the home
itself, which is primarily of importance. Its site is
only of secondary importance as tending towards a
damp house. That it is perfectly possible to live in a
low-lying district close to water without the slightest
fear of rheumatic infection is proved beyond criticism
by the experience of Eton and Beaumont Colleges.
Both these lie close to the Thames, and between them
account for 1,350 boys, and yet I am told by Dr. W.
Attlee that he has seen only one case of rheumatic
fever at Eton in 17 years, and by Dr. L. O'Ferrall that
he has met with no case at Beaumont College during
his eight years as medical officer of the school."
The possibility of overcrowding, uncleanliness,
dust and vermin (e.g., rats, lice, fleas, bugs) being concerned
in the production of the disease has been the
subject of various investigations, but the available
evidence indicates that they have no influence. Although
rheumatism in childhood is a single disease
caused in all probability by a specific microbe it shows
itself in many forms according to the part of the body
mainly affected. Thus Drs. Ingerman and Wilson
describe: (1) "Growing pains and joint pains," in
the tendons of the hamstring muscles behind the knee
and rheumatism of the muscles of the neck (rheumatic
wry-neck), (2) rheumatic tonsillitis or sore