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75
RESIDENTIAL TREATMENT.
St. Mary Abbots Hospital—Limitation of the Number of Beds Occupied.
The inpatient accommodation for rheumatic children at St. Mary Abbots Hospital
(Kensington Infirmary) has been of great value in the second as in the first year. Nevertheless,
we take the view that the prolonged treatment required for severe rheumatic cases is more
suitably provided at convalescent hospitals and specially organised convalescent homes out
of London, the proper function of the hospital beds in London being to accommodate cases
awaiting transfer to the special institutions for the treatment of rheumatism.
Pressure on the beds at St. Mary Abbots Hospital has been at times so great that the
Medical Superintendent was forced to suggest that the number of beds allotted for rheumatic
cases should be reduced. This suggestion was agreed to and at present accommodation
is provided for twelve cases.
Two beds are now reserved at the Princess Louise Kensington Hospital for Children.
Convalescent Treatment: Recommendations.
Under the present arrangements in this Borough, all rheumatic children developing
heart disease immediately before coming under supervision, or while under supervision, or
children in whom relapses of rheumatism or chorea have occurred, are put on waiting lists
for one or other of the special residential institutions for the treatment of rheumatism. At
certain times, and for certain children, the period of waiting has been excessive, the accommodation
for the residential treatment of rheumatic children being quite inadequate. Owing
to the pressure on this limited accommodation we have to pick our cases very carefully before
recommending them, choosing only those cases for whom any less elaborate treatment is out
of the question. This practice, forced on us as on other physicians responsible for the care
of rheumatic children, leaves no provision for a large number of rheumatic children for whom
home treatment is not sufficient.
For such children, it has been our practice to arrange that an opportunity is provided
for them to go to a convalescent home out of London for a period of a few weeks. During
the year 1928-1929, twenty children were sent away by the Invalid Children's Aid Association
working through the Centre. All children bad enough to be admitted to hospital were
afterwards either placed on the waiting lists for the special residential institutions or offered
convalescent treatment as outlined above.
Expert opinion regarding the duration of the treatment required in cases of severe
rheumatism in general, and rheumatic heart disease in particular, is becoming almost unanimous
that a period, comparable in length to the time recognised as necessary for the treatment
of tuberculosis of bones and joints, should be spent in a suitable institution, always excepting
the cases in which home conditions make domiciliary treatment possible for a corresponding
period. A term of a few weeks as a hospital inpatient, followed by four to eight weeks at a
convalescent home (which accommodates other children recovering from a variety of illnesses)
is inadequate. Often such a course of treatment is all that can be provided and in
such circumstances relapsing cases are frequently encountered, each relapse adding to the
danger of cardiac involvement. Therefore, we urge that adequate residential accommodation
organised on proper lines should be provided. The expense of such provision will be great,
but without it our efforts will be little more than a scratching on the surface. Progress on
these lines during the last five years under the London County Council and the Metropolitan
Asylums Board has been considerable,* and the Invalid Children's Aid Association have also
been developing similar plans. The establishment of a country hospital at Tadworth by The
Hospital for Sick Children provides for a number of their rheumatic cases, while others are
treated at a special convalescent home at Lancing.
Experience has shown that the Kensington Rheumatism Supervisory Scheme could be
very considerably enhanced in value as a measure of public health organisation if arrangements
were entered into with a suitable institution outside London, and it would be advantageous
if such arrangements could be made in concert with the Princess Louise Kensington Hospital
for Children. If several of the neighbouring Boroughs combine for the purpose, even more
satisfactory arrangements could be made.
THE RHEUMATISM SUPERVISORY CENTRE.
During the two years (1927-1929) that the Centre has been in existence, 370 cases of
rheumatism or potential rheumatism have been supervised. Although the Centre was primarily
established to deal with cases from Kensington, it has been our custom to accept cases from
other Boroughs whenever our advice was required.
*A large number of new beds will be available when the extension of Queen Mary's Hospital, Carshalton,
is completed and it is hoped that these will be ready before next winter.