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35
3.—One-sixth of the industrial invalidity of the country
arises from rheumatic infections. The annual loss to the Approved
Societies is £2,000,000 and the work lost to the members equivalent
to three million weeks per year.
Among the principal causes of rheumatism may be mentioned
enlarged and septic tonsils in some 50 per cent. of cases, while
dental sepsis, damp houses and damp clothing are correlated in
the causation of the disease in a large proportion of cases.
Rheumatism is common in all low lying and damp localities,
an increased incidence of the disease in London having been shown
to follow the course of the River Thames, and explaining probably
some of the reasons for the prevalence of rheumatic affections in
this neighbourhood.
Through the kindness of Dr. Adshead, I am able to produce the
following statistics relative to the prevalence of rheumatism in
784 school children examined during the last two months:—
Of 245 "entrants," 15.1 per cent. were rheumatic. early
symptoms being present in 9.3 per cent. and heart complications
in 5.7 per cent. Among 259 "intermediates," 10.4 per cent. showed
early symptoms, while heart complications had increased to 7.7 per
cent. Among 280 "leavers" early cases had fallen to 5.7 per cent.,
while those with the more severe type of heart affection had then
risen to 13.2 per cent. Among a school population therefore of 784,
the percentage of those suffering from rheumatism may be said
to be 17.4, while those leaving school with permanently damaged
hearts would be 9.05 per cent., a state of matters in great measure
preventable.
I append the following suggested lines of prevention and
treatment of this disease.
1.—In order to gain a better supervision of the growing child,
it is necessary that the artificial barrier which now exists between
the School Medical Service and Infant Welfare Departments be
broken down, the same nurse-visitor becoming responsible for the
care of all children from birth to fourteen years. Damage to health
is most frequently done in those years immediately preceding the
child's entry to school, as, for example, in the large number of