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49
the bronchial tubes and lungs. A low standard of
environment has been proved to be an important predisposing
factor in rheumatism and damp houses and
sites are especially blamed. Doubtless other defects
in houses have an indirect influence either by giving
opportunities for infection or by lowering the resistance.
It is essential to secure the co-operation of sanitary
inspectors in the districts for the purpose of improving
the housing conditions. Maternal care was found
to be less in the rheumatic cases investigated by the
Medical Research Council's Committee than in nonrheumatic
cases. Exposure to wet was more common
and clothing less satisfactory.
The education of parents and others by leaflets
and propaganda generally is recommended with the
object of instructing them regarding the prevention
and early signs of rheumatic infection, and health
visitors, teachers and members of voluntary care
committees have many opportunities to help in the
propaganda work. Rheumatism may be difficult to
detect in the early stages as pain may not be very
severe. The symptoms may not be localised, but may
consist of general languor, malnutrition and slight
feverish attacks. Home treatment is unsuitable for
children suffering from rheumatism, because faulty
environment is one of the chief predisposing causes
of the disease, and early treatment necessitates special
care, which is unobtainable in a small house. A
sufficiency of hospital beds is not available at present,
and it has been suggested that special wards should be
set aside in Poor Law Hospitals for the purpose just
as special wards are provided for tuberculous cases.
It has been found that ordinary convalescent homes
are unsuitable for children with rheumatism and
special convalescent homes or country hospitals are
required.
Rheumatic children are now being treated under
open air conditions very similar to those in a tuberculosis
sanatorium, with abundance of fresh air, sunlight
and good food. The patients' rest and exercise,