5 249 Rheumatism
Mortality Statistics Of Insured Wage Earners And Their Families © 1919
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242 MORTALITY STATISTICS OF INSURED WAGE EARNERS.
As in the case of acute bronchitis, we are not justified in compar-
ing the above figures with those for the expanding Registration Area
of the United States. The rates, as we have seen, are important
only after age 65, and it is at these ages that the proportion of
policyholders to total persons insured is much lower than in the
general population.
There has been a marked decline in the death rate in the insur-
ance experience from chronic bronchitis since 1911 in each one of
the color and sex classes. The same condition is to be observed
in the figures for the expanding Registration Area. It is probable
that the same cause has been at work to bring about this result,
namely, improved reporting of causes of death by physicians.
Many vital statistics offices in the country have for a number of
years made a special effort to advise physicians against the use of
the term “chronic bronchitis” when tuberculous bronchitis was
meant. Undoubtedly the effect of this effort is shown in the rap-
idly reducing figures for this cause of death.
RHEUMATISM.
Deaths from rheumatism are classified, according to the detailed
International List of Causes of Death, under two distinct headings.
The first is acute articular rheumatism and the second chronic
rheumatism and gout. Unfortunately so many deaths are still re-
ported as due to “rheumatism,” without any qualification, that it is
impracticable to determine which of these two conditions actually
caused the deaths. The report of “rheumatism” is frequently
made in cases where the deaths were due to the acute infection,
rheumatic fever, a disease which has epidemic prevalence. This is
the condition which the present title No. 47 of the International
List (acute articular rheumatism) was intended to cover. Unfor-
tunately, however, the same term “rheumatism ” is also returned
for many cases of arthritis deformans, which is a disease of the
joints of doubtful etiology, but which ordinarily pursues a chronic
course. It is also used in cases in which physicians intended it
as the equivalent of “chronic rheumatism,” a term used loosely
for all sorts of long standing painful conditions of the joints,
nerves, bones and other parts of the body. Any attempt at this
time to show separately the mortality actually due to acute rheu-
matic fever on the one hand and to chronic rheumatoid arthritis
