Mortality from rheumatic heart disease in children and young adults in England and Wales.

Abstract

In the last few years considerable attention has been paid to the rheumatic diseases and, in particu lar, rheumatic fever. Glover (1943, 1946) has shown that the mortality from the latter has declined considerably in the last sixty years and that recently this decline has been accelerated. On these grounds he called acute rheumatism an obsolescent disease. In contrast, Morris and Titmuss (1942), Parkinson (1945), and Ryle (1946) have called attention to the heavy toll still taken by rheumatic heart disease, and to the fact that adolescents and young adults are its main victims. Considerable local and regional differences in the mortality from rheumatic heart disease have been observed in England and Wales (and also in mor bidity), and in an attempt to determine the aetiology many workers have related these differences to social and environmental conditions. Poverty has been among the chief factors incriminated. Reports issued some twenty years ago by the Ministry of Health (1927) and the Medical Research Council (1927) agree that acute rheumatism rarely attacks the children of well-to-do parents. Morris and Titmuss hold the view that " the whole complex of poverty " is involved in the production of juvenile rheumatism, and Daniel (1943), in his study of rheumatic heart disease in Bristol, concluded that there was a significant association between its incidence and low family income. The suggestion in the Medical Research Council's report that the incidence was greatest in the artisan class is suppor ted by Wilson (1940) but denied by Morris and Titmuss. Bad housing has also been condemned as a cause of acute rheumatism, but the evidence incriminating dampness, ill-ventilation, living in basements, and other features is not clear. Overcrowding is often associated with bad housing, and some authorities have held this factor to be important. In the