View report page

71
Rheumatic Diseases
The seriousness with which the department views rheumatic
diseases is not new. Even as far back as 1938 a scheme had been
drawn up for the establishment in this Borough of a "rheumatism
clinic" and it had also been decided to recommend to the Ministry
of Health that manifestations of acute rheumatism in children up
to 16 years should be made compulsorily notifiable. Unfortunately
the 1939/45 war intervened and the subsequent introduction of the
National Health Services Act of 1946 rendered void the necessity
for local authority schemes.
Rheumatism in its broadest sense is one of the oldest diseases
known to affect mankind. It attacks people of all ages and is
responsible for more prolonged absences from work or school than
any other disease. Resultant heart damage or joint deformity are
often so tragically disabling that early diagnosis, prompt treatment
and well directed after-care are vitally important.
Basically, rheumatic diseases are considered to be of two types,
namely, those where the disease is essentially the result of inflammatory conditions such as rheumatoid arthritis and ankylosing
spondylitis and those in which the essential ingredient is degeneration as exemplified in osteoarthritis and intervertebral disc disease.
The pathogenesis of rheumatoid arthritis and related diseases
remains obscure. Nevertheless, increasing attention given by
research teams to this problem in recent years seems, at long last,
likely to yield results. Particles, including bacteria, absorbed by
cells are digested by lysosomal enzymes and for some time now it
has been suspected that one or more of these enzymes could be the
cause of cartilage damage in arthritic joints. Confirmation that
seepage of a particular enzyme from cells can have harmful effects
not only on the cell itself but also on surrounding tissues has been
obtained recently by a research team at Cambridge. This may well
herald a more effective approach to the alleviation of the pain and
disability of rheumatic diseases with their accompanying social
disadvantages.
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.
It is pertinent to record that out of a total of 1,412 persons
registered as physically handicapped in Greenwich in 1969, 410
or 29% are disabled due to the effects of rheumatism.