London's Pulse: Medical Officer of Health reports 1848-1972
View report page
Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1927
[Report of the Medical Officer of Health for London County Council]
This page requires JavaScript
81
Rheumatic Children.
The arrangement by which the Council has become the organising authority
for the care of rheumatic children was described in last year's report, and reference
to subsequent and imminent developments is made in a later section of this report
dealing with crippling defects in school children.
From the commencement of the scheme in November, 1926, up to 31st December, 1927, a total of 535 nominations had been received for institutional treatment for rheumatism in childhood, and the following table shows how they have been dealt with up to 3rd January, 1928, in the face of, as yet, inadequate provision.
| Hospital. | At present in hospital. | Discharged from hospital | Removed by parents against advice. | Died in hospital. | Total. | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Boys. | Girls. | Boys. | Girls. | Boys. | Girls. | Boys. | Girls. | Boys. | Girls. | |
| Queen Mary's Hospital, Carshalton (sub acute beds) | — | 16 | — | 12 | — | 2 | — | 1 | — | 31 |
| Do. (rheumatic fever unit) | 6 | 4 | — | 5 | — | — | — | — | 6 | 9 |
| High Wood Hospital, Brentwood (sub-acute beds) | 26 | 30 | 17 | 19 | 9 | 21 | 1 | 1 | 53 | 71 |
| Cases treated | 32 | 50 | 17 | 35 | 9 | 23 | 1 | 2 | 59 | 111 |
| Refusal by parents after admission had been arranged | 4 | 6 | ||||||||
| Children placed by I.C.A.A. and other organisations | 40 | 92 | ||||||||
| Children nominated but considered unsuitable under the scheme | 41 | 61 | ||||||||
| Cases on nomination list at present | 39 | 82 | ||||||||
| Total number of nominations received | 183 | 352 | ||||||||
Careful enquiry is made not only into the medical aspects of each case, but also
into the social and environmental conditions. Dr. J. Nairn Dobbie has made a
minute and searching analysis of the particulars in 100 of the first cases, and the
results are given in the following report.
The immediate cause of rheumatism in children is not yet known, although its
disastrous effects are painfully evident. While definitely affected rheumatic children
must be treated, it is obvious that preventive measures must be adopted to control
this menace which maims, cripples and cuts off so many young lives. Such measure
can only be framed when the conditions surrounding the inception of the disease
are known and clearly recognised.
At the present time it is difficult, if not, indeed, impossible, definitely to diagnose
rheumatism in the early stages. It would, therefore, seem reasonable to take a
series of frankly declared cases and analyse the signs and symptoms, and then
retrace them back along the paths of progression to their immediate beginnings,
and at the same time attempt to evaluate the influences and observe the effects of
heredity and of the sufferer's personal, social, and environmental standing, and by
so doing arrive at some tentative conclusions. Such conclusions may be proved
or disproved by applying them later to children showing prodromal features. For
clarity and uniformity it is well to use terms which more or less define the various
conditions seen.
Sub-acute rheumatism will cover the insidious type in which there may be
periods of minor febrile attacks or of indefinite pains and aches accompanied by
weakness in the limbs with recurrent sore throats, headaches and night sweats,
occasional swellings of the joints, fleeting skin rashes and emotional upsets, during
which the child is capricious both in behaviour and in appetite, but seldom so ill
as to be confined to bed.
Dr. Nairn
Dobbie's
report on the
analysis of
100 cases of
rheumatism
in children
admitted
under the
Council's
scheme.