RHEUMATISM, ETC.

Its Increase daring the last Thirty or Forty (Tears, owing to change of diet and clothing—Dyspepsia, its increase, owing to excessive use of tea—Its Treatment—Hypochondriasis.

ALTHOUGH not the most fatal, probably the most wide-spread disease is chronic rheumatism. So common was this ailment reckoned in former times, that Dr Edmondston, writing in 1809, says:—“This disease is perhaps of the most frequent occurrence of any. Indeed, there is scarcely an individual who has attained the age of sixteen who has not been affected by it.” The extent of its prevalence must have been greatly exaggerated by the doctor, for at the present day, the disease, though common, is by no means universal; and there is reason to believe, from popular tradition and otherwise, that it is now much more frequent in its occurrence than formerly. And for the people of an extensive district to be seized with chronic rheumatism at the age of sixteen, as regularly as they attain to puberty, and yet continue a healthy, robust race, is not only contrary to all pathological experience, but a “physical impossibility.” According to my observation, while assistant to a practitioner who has 400 or 500 paupers under his charge, chronic rheumatism generally appears after the prime of life, and is gradual in its onset, being very seldom preceded by an attack of the acute disease. As age advances, it assumes more of an athritic form, producing often much deformity at the larger joints, with acute local pain, but no constitutional febrile symptoms. The intervertebral cartilages also frequently suffer in this way, producing in the aged much bending forward of the vertebral column, and an intensely stooping gait. No doubt the articular cartilages of the various joints are much altered, and often absorbed, but this has never been investigated, from the extreme rarity of post-mortem examinations, which are only had recourse to in cases such as attract the suspicions of the authorities, and these cases seldom occur. Cardiac lesions are also not uncommonly produced by chronic rheumatism. In 1862, six persons were reported in the Registrar-General's returns as having died of heart-disease, but only two of rheumatism ; thus showing a small mortality from the disease itself, but a greater from its complications. The heart affection is also chronic in its course, acute pericarditis or endocarditis very seldom occurring. Which form of valvular disease is generally produced I have never ascertained; but it is probable the semilunar valves of the aorta are the seat of the lesion, since death is often sudden, and the slow form of fatal termination, accompanied by respiratory and dropsical symptoms, characteristic of mitral disease, rare. This extensive prevalence of chronic rheumatism is by no means difficult to account for, when we remember that the Shetlanders live chiefly on amylaceous food (potatoes and oat or barley meal), together with fish, that their houses are damp and floored with earth, their fields ill drained, their commons boggy, and their climate somewhat moist.

Unfortunately, for chronic rheumatism little can be done, and what palliative treatment we can employ is seldom received by the poor Shetlanders, either because they are far from medical aid, or because antiquated prejudicies forbid them to have faith in any remedies save strong liniments applied locally. From their familiarity with this disease, it is customary for these people to speak of all chronic ailments, attended with pain, as rheumatism. Thus we often hear them speak of “windy rheumatism in the stomach,” i.e., dyspepsia, accompanied with flatulency.

Rheumatism is said to have increased very much within the last thirty or fifty years, in consequence of a change of diet, and the substitution of cotton for woollen garments. To the very extensive use of tea, which now prevails, much of the blame is attached by the landlords, and other intelligent persons. Mr Umphray of Reawick, a county gentleman of great intelligence, acute powers of observation, and no ordinary medical skill, informs me that, in a small district on the borders of his estate, twenty-five or thirty years ago, the people were perfectly healthy; but that now the most of them are generally ailing in some way or another, rheumatism being the most common complaint.* He agrees, with others, in ascribing the change to tea and cotton. Of course, in estimating its influence, we are to consider not merely the injurious effects of too frequently drinking strong tea, but the change from a plain and nourishing to a less substantial system of diet, which its use represents. But this will be fully discussed under the head of dyspepsia, of which I propose next to treat.

DYSPEPSIA

or, as the natives call it, “Rheumatism of the stomach,” is even more common than the above. I say more common, because it manifests itself at an earlier period of life, and, therefore, has a wide area over which to extend, if it may be so expressed. Dr Cowie informs me that this disease has always, within his memory, extending over upwards of thirty years, been common in Shetland. But it appears to have increased of late years, particularly amongst females, no doubt owing very much to the strongly concentrated potions of tea, which they take repeatedly, and at short intervals. Probably the tannin in such cases proves injurious to

the stomach, while the thein acts on the nervous system. Toothache, which evidently depends in a great measure on gastric derangement, was thirty or forty years ago very rare amongst the young women of Shetland; but it is now very common. I fear this is to be ascribed to the same cause. These cases of dyspepsia, of which I have seen many, are characterised by anoraxia, foul and furred tongue, flatulency, sometimes heartburn, vomiting, often a sense of fulness in the epigastrium, and constipation. * Great benefit, I find, to result from the exhibition of compound rhubarb powder, followed by chalybeate tonics, or, sometimes, the mineral acids. Dietetic treatment is, unfortunately, impossible with these people, who think drugs can do everything.

Amongst young women a form of gastro-intestinal irritation, indicated by a glazed appearance of the tongue, is very common. This is usually accompanied with a form of hypochondriasis, which leads the patient to imagine her ailment much more severe and unbearable than it really is. This is quite characteristic of Shetland females. Those of them who find their way to the Edinburgh Royal Infirmary frequently puzzle the physicians, who endeavour in vain to ascertain the cause of the numerous symptoms they describe. Dr Sanders has remarked that Shetland girls, complaining of slight dyspepsia, are so hypochondriac, that it is generally impossible to make out what is the matter with them; and I have been told by an elderly practitioner, now retired, that Dr Spence, a physician in the Infirmary thirty or forty years ago, made the same remark. All ages and both sexes of Shetlanders “suffer from imaginary ailments.” The causes of this hypochondriac condition, I shall endeavour to trace when speaking of diseases of the nervous system, and also under the head of their mental qualities.