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to the importance of tonsillar sepsis and dental caries as aetiological
factors in Rheumatic Fever; and as Rheumatic Fever is in the
majority of instances associated with Heart Disease, any means
which will reduce the incidence of Rheumatic diseases must ultimately
react upon the frequency of Heart Diseases.
In regard at least to acute rheumatism there is some evidence of
the disease becoming less virulent as well as less common. Dr. Miller
has pointed out in a recent paper that the percentage of hospital
in-patients suffering with acute rheumatism has been almost halved
in recent years.
In addition to the work in the School Clinics and other centres
there is a necessity to emphasise the importance of rheumatism,
especially in children, and the desirability of prolonged rest after
an attack of rheumatic fever.
In a recent work issued by the Ministry of Health it is pointed
out that permanent damage to the heart is much more likely to
occur in second or recurrent attacks than in first attacks of rheumatic
fever. Recurrence is much less likely to occur in those
patients who have been able to have a prolonged convalescence from
their first attack. Medical opinion has recently advised in favour
of what amounts to bed sanatorium treatment for convalescent
patients in special homes of recovery. These special homes of
recovery, which differ entirely in their regime from the ordinary
convalescent home, have been instituted in Birmingham, Liverpool,
and in some other towns in this country. In New York, a society
has been formed for the prevention and relief of heart disease. One
curious fact has emerged from the activities of this society, viz., that
Chorea or St. Vitus's Dance in its liability to leave permanent
effects upon the heart was more difficult to control than ordinary
rheumatic or throat cases.
The subject of chorea in the schools is well worth the most
serious consideration.
Deaths in Public Institutions.—212 of the deaths of residents
outside the district occurred in public institutions. In addition, 15
deaths of residents occurred in public institutions in the district.
These numbers are exclusive of the deaths which occurred in
nursing homes.
227 out of a total of 599, or 38 per cent. of the total deaths
occurred in public institutions.
SPECIAL CAUSES OF SICKNESS.
Fur Rashes.—Mention should be made of the complaints
received in the early part of the year from persons who had suffered
from rashes on the face and neck, caused ostensibly by the wearing
offurs.