Acute Rheumatism.

Damp, chill, and exposure have always been considered prime factors in rheumatic fever. The conditions of modern war-the trench or fox-hole filled with water, icy exposure, sleeping in wet clothing, and the crowded dug-out or shelter-seem to make an environment favourable to rheumatic fever, and one might expect it to be outstanding among those diseases which crowd in the train of war. Yet it finds no place in Hurst's Diseases of War, and the various bulletins of war medicine hardly notice it. Even in times when the disease in civil practice was far more common and severe than to-day, its incidence in war was much below expectation. " Certain it is," says Lehlbach in 1863, " that we often see regiments exposed to damp, wet, cold, sudden and violent changes of temperature, and obliged to sleep on wet ground with but scant protection and no cases of acute rheumatism." Then it was-as it still is-a disease of recruits, occurring in training establishments (in war always overcrowded), rather than a scourge of armies in the field or fleets at sea. In the American Civil War we find that " acute rheumatism shows in its monthly rates a greater prevalence in that period of the war during which new levies were sent to the field than later when the levies have become inured to the hardships of active service." This preferential incidence on recruits and training establishments often takes the form of " barrack epidemics." But rheumatic fever, if not outstanding as a war disease, is important for the following reasons: it causes no small proportion of medical casualties (who require long treatment in bed); in " barrack epidemics " it may ruin for active service previously healthy recruits; it causes invaliding, and pension claims for consequent heart disabilities; as the main cause of organic heart disease in children it diminishes manand woman-power for recruiting; and, lastly, it seems often to be the precursor of those more chronic forms of rheumatic disease to which armies in the field are particularly prone-fibrositis, lumbago, and sciatica.