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the disease is initiated by an exogenous antigen but that its continuance
is the result of a secondarily induced auto-immune
response. If this is substantiated then there are grounds for anticipating
more effective methods of treatment and a reduction in
the alarming disability rate occasioned by these diseases.
With osteoarthritis it is estimated that the incidence ranges from
20% in all men and 30% in all women over the age of 15 years
but radiological evidence indicates that, over the age of 65 few
people, if any, are free from intervertebral disc degeneration. In
these cases much can be achieved by reducing or abolishing excessive
physical stresses and strains in industry by increased
mechanisation, the application of anthropometry and the education
of workers in the correct methods of handling and lifting of heavy
loads. An increasing number of patients are benefiting from the
replacement of joints by modern techniques which, in many
instances, results in a return to a useful degree of function.
Osteoarthritis and similar degenerative rheumatic diseases seem
to be tolerated surprisingly well even when there is gross involvement
of major joints. Perhaps this is because, more often than not,
the onset tends to be gradual and occurs later in life. It is the more
extreme inflammatory conditions such as Still's disease which give
rise to the greatest concern for such explosive types of rheumatic
disease are apt to render persons disabled at a very early age with
all its distressing implications.
Improvement in the treatment and rehabilitation of the rheumatic
groups is of great concern to local authorities for it becomes their
responsibility to sustain individuals and their families when they
become registered as disabled. It should be the authorities' aim,
whenever possible, to ensure that after-care is such as to improve
the functional state and so maintain morale which is so essential
in such cases.
Furthermore, because immobility in the elderly often results in
a regimen of "tea and bread-and-butter" it falls to the vigilance of
the geriatric visitor, in her preventive role, to assess the situation
and, accordingly, to arrange for supportive services (including the
use of nursing and medical aids) to avoid the development of avitaminosis
and anaemia arising from such a deficient diet.
It is pertinent to record that out of a total of 1,269 persons
registered as physically handicapped in Greenwich in 1968, 387
or 30.5% are disabled due to the effects of rheumatism.
Venereal Diseases
The term "venereal" is given to a group of diseases acquired
during sexual intercourse of which, in England, syphilis and gonorrhoea
are the most important. Other complaints, usually acquired