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18
FIRST ANNUAL REPORT ON THE RHEUMATISM CLINIC:
Although the causes of rheumatism of childhood are not completely known, early diagnosis and the
supervision of cases can prevent crippling and the development of permanent heart damage.
The problem is quite serious and widespread, and it has been estimated that 200,000 children suffer
from rheumatism in England and Wales and that at least one-quarter of the prolonged absences from school
are due to this disease.
An important function of the clinic is to exclude the diagnosis of rheumatism in children with aches
and pains and thus avoid unnecessary restriction of their activities or their schooling.
A Rheumatism Clinic is held once weekly at each clinic and is conducted by the Senior Assistant Medical
Officer of Health. A full environmental history is taken by the health visitor and a complete medical
examination is made by the doctor. The child is referred to the paediatrician of the Central Middlesex Hospital
if further investigations or hospital admission is required.
All children discharged from hospitals with rheumatism are followed up and special sessions are held
at the physically handicapped school for the rheumatic children who attend there.
The parents are given general advice on the care of the child, insanitary conditions are remedied as far
as possible, and arrangements are made for hospital admission, convalescence, special schooling or special
treatment as required.

27 of the rheumatism cases had been discharged from hospital or convalescent home with a diagnosis
of the disease.
Family History:
This appeared to be of no significance in this series, as of the 37 children who gave a history of the disease,
only 14 were suffering from rheumatism.
Environmental Conditions:
These did not appear to be of any significance in this series.
Of the 45 children where there was dampness in the home, only 24 actually had rheumatism. Of the
42 children who shared a bed, 21 had rheumatism.
74 cases were investigated for economic status:
Under a week 2 No. with rheumatism 0
„ £5 „ 8 „ „ „ 4
„ £6 „ 25 „ „ „ 12
Over £6 „ 39 „ „ „ 19

Treatment of Cases:
Admitted to Hospital 3
Sent for Convalescence 16
Sent to Lower Place School 8
Already at Lower Place School 4
To Orthopaedic Surgeon 5
To Ear, Nose and Throat Department 7
To Dental Department 6
Medicinal Treatment 25
CLO + malt or malt + iron 16
Although there is a close liaison between the Rheumatism Clinic and the Central Middlesex Hospital,
a paediatrician attached to the clinic would be of great benefit to the service. There is also need for more
hospital beds for observation and treatment, for the provision of hospital schools and convalescent places for
these children, and for the provision of clothing and shoes for the poor children.