Rheumatic Heart Disease in Philadelphia Hospitals: A Study of 4,653 Cases of Rheumatic Heart Disease, Rheumatic Fever, Sydenham's Chorea, and Subacute Bacterial Endocarditis, Involving 5,921 Admissions to Philadelphia Hospitals from January 1, 1930, to December 31, 1934. V. Distribution by Locality of Rheumatic Conditions in Philadelphia

Abstract

A review of the literature indicates a considerable lack of agreement concerning the roles of proximity to watercourses and dampness due to low altitude in the causation of rheumatic fever and chorea. The consensus of most investigations suggests that these diseases are more prevalent in areas occupied by the underprivileged than the better-to-do. Rheumatic fever, Sydenham''s chorea, and nonfatal and fatal rheumatic heart disease among hospital patients in Philadelphia tended to occur with greatest frequency in the sections of the city occupied to a large extent by the poor; but this relationship was not invariable; some of the city wards in which the rentals were lowest and the density of population greatest did not have the greatest number of hospital admissions or deaths per 100,000 population. A low rate of admissions and deaths was noted in every city ward inhabited mainly by persons living under reasonably favorable economic circumstances. This is doubtless due in no small measure to the fact that persons in the better-to-do economic brackets do not regularly seek admission to hospitals for the treatment of medical conditions. These diseases tended to occur with greatest frequency in the eastern half of South Philadelphia and in a section of the midcity near the Delaware River. These studies do not suggest that proximity to a watercourse is an important factor. The distribution of low rentals corresponded more closely to the Delaware River water front than the distribution of rheumatic fever and chorea. Low rates of admissions and deaths in hospitals from these diseases were indicated in a number of city wards occupied largely by colored persons. The distribution of Sydenham''s chorea is roughly comparable to rheumatic fever, except that a somewhat more general distribution is indicated. It is even less common than rheumatic fever in city wards occupied largely by Negroes. A more general distribution was indicated in mortality from rheumatic heart disease in hospitals than of admissions for rheumatic fever, Sydenham''s chorea, and rheumatic heart disease. This suggests that the more acute or fulminating forms of rheumatic infection occur with greater frequency among the extremely poor. An analogy is noted between tuberculosis and rheumatic infection.