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THE KING’S HEALTH.

THE LANCET.

LONDON: SATURDAY, JANUARY 26, 1929.

THE announcement on Tuesday last by HisMAJESTY’S doctors that the time was approaching’when the patient might be removed safely to the South-Coast has been regarded widely as a landmark in thelong story of the illness. Although the public has been’expressly warned that the period of convalescencecannot yet be regarded as having set in, it is highlyreassuring to note that the KING’s medical adviserscan contemplate for him a somewhat lengthy journeyby road or rail in the immediate future. The place ofTesidence has been chosen for its close proximity tothe sea, its southern exposure, and its protection- from wind, while the location is associated with ameasure of privacy and provides reasonable accessto London. Bognor-is regarded as one of the sunniestof the South Coast health resorts. Its rainfall averagesunder 26 inches in the year, and there is but little fogor frost, while in the commencing Spring the north-easterly winds are kept off the seaboard by thenearness of the South Downs. The mean temperatureof the winter months is about 42° F.’, and there is anaverage of 2-8 hours of sunshine a day, being about-30 per cent. of the possible hours during which thesun is above the horizon. Craigweil House, which hasbeen lent for the reception of the KING by Sir ArthurDu Cros, has been extensively altered since it wasused by the late Dr. A. H. Stocker as a convalescentstation for his London patients, and the large grounds,gently falling to the strand, afford ample scope forexercise and for the assistance to convalescence under- conditions of perfect privacy. Craigweil House notonly enjoys a full South exposure, but has beenequipped with rooms specially designed for sun

treatment. The stimulating quality of the sea air islikely to be helpful, both in its generally invigorating-qualities and in its special aid to the restitution of- damaged tissues. The empyema wound is now statedto be small and steadily healing, and the relative

unimportance of this complication may be gaugedby the fact that twice during the past week Sir HughRigby has not been asked to sign the official bulletin.Under such conditions we may reasonably hope thatconvalescence may soon be reached. Especiallyencouraging is the announcement that solid food is-now being enjoyed, for it is an open secret that for along time it required HER MAJESTY’S constant

- assistance to ensure that nourishment of any kindwas taken.

Once again we may congratulate the KING’s medical"advisers on the fruition of their devoted labours, andon having found in the Royal household so ready anacceptance of the measures which they considereddesirable to employ. It is generally believed thatnowhere can better treatment be found than in one-of the large general teaching hospitals of London, butHis MAJESTY’S wonderful recovery may lead to ajustifiable suspicion that in one household theseconditions have been bettered. The EiNG’s healthwill still take the central place in the interest of hissubjects, though all the indications are that the story-will now be uneventful even if prolonged.

TONSILLECTOMY FOR ARTHRITIS.

production of chronic disturbance in distant-lyingorgans is being closely studied in this country and inAmerica. In setting out recently 1 some of the

evidence for this belief, it was remarked that the

culpability of the tonsil is not easy to establish in

the group of conditions generally called rheumatic.A. D. KAISER, of Rochester, N.Y., in examining therecords of 48,000 school children, found that theincidence of rheumatic fever and joint pains wasslightly less in the 20,000 whose tonsils had beenremoved than in the remainder in whom they hadnot been removed, and some earlier work at the MayoClinic aimed at assessing the effect of tonsillectomyperformed after subacute joint trouble had alreadyset in.. This week, in our own columns, Mr. A. B. PAVEY-SMITH, of -Harrogate, records an analysis of theresults of tonsillectomy performed at the Royal BathHospital there. Of the 7000 cases of arthritis andallied diseases treated at this hospital in the six yearsunder review, some 400 were sent to Mr. PAVEY-SMITH on account of conditions falling under thethree headings of subacute rheumatism, chronic infec-tive (focal) arthritis, and fibrositis. From these hechose about 200 of -ages ranging from 10 to 64 assuitable for tonsillectomy, which was accordinglyperformed. His observations on them lead him tothink that a probable tonsil focus can be found in alarge number of cases falling into these three groups,and he says that when the tonsil is removed theresults are so good in one group-namely, subacuterheumatism-that tonsillectomy should become a

routine part of its treatment if only as a prophylacticagainst recurrence and cardiac complication. Heclaims that even when septic tonsils have causedchronic inflammation in joints improvement fromtheir excision may be expected in 80 per cent. ofcases, provided that the tonsil actually shows oneor other of the stigmata of infection. He admits,however, that systemic infection can never be deducedfrom the appearance of the tonsil itself ; it can onlybe inferred. We regard Mr. PAVEY-SMITH’S obser-vations as worthy of record and his figures as distinctlyfavouring the conclusions which he draws. Hiscases had the merit of being taken serially, althoughthey lack comparison with a control group of similarcases treated without operation and watched for asimilar length of time. It may be that no such validcontrol is obtainable, but it would be of interest tofollow up the 200 other patients who were referredto him on account of focal sepsis and in whom hefailed to find enough evidence to justify tonsillectomy.The class of case included in the series is so commonand so distressing in its disability and chronicitythat the success of so simple a remedy would be veryheartening to the practitioner who may be over-

whelmed by the number of such cases and his com-parative helplessness in the face of them. Apartfrom the clinical evidence in his paper, llr. PAVEY-SMITH adduces evidence which increases the suspicionunder which the Streptococcus viridans already liesas the primary infective agent in chronic focalarthritis. The occurrence of the organism is, in

fact, so frequent as to imply that it must eitherbe an active agent or count for nothing at all. Inthis matter any effective control might be still moredifficult to devise.

1 THE LANCET, 1928, ii., 1248.2 Jour. Amer. Med. Assoc., 1927, lxxxix., 2239.