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64
INVESTIGATIONS CONCERNING ETIOLOGY.
Contact Cases.
In view of the statement in the Medical Research Council's report on acute rheumatism in children that
"there is at least a ground for suspecting that rheumatism can be conveyed in some way from person to person,
and that, as might be expected, closeness of contact favours its transmission," investigations are being made into
the sleeping accommodation of rheumatic children.

In group 1, therefore, the question of the spread of rheumatic infection by close contact during sleeping
hours between one child and another does not arise.
In group 2, there is no evidence that sleeping in the same bed as compared with sleeping in the same room
gives a higher incidence of contact cases.
An analysis of group 2 cases.
(а) In 14 + 10 = 24 (or 18.5 per cent.) rheumatic cases, the child attending the clinic sleeps in a single
bed, but one or more other children occupy the same room.
In 11 + 9 = 20 cases (or 83. 3 per cent.) the other child or children show no evidence of rheumatism.
In 3 + 1 = 4 cases (or 16.7 per cent.) there is evidence of rheumatism in the children occupying the
same room.
(b) In 45 + 22 = 67 (or 51.5 per cent.) rheumatic cases attending the clinic the child shares his or her
bed with another child or other children.
In 37 + 19 = 56 cases (or 83.5 per cent.) there is no evidence of rheumatism in the children occupying
the same bed.
In 8 + 3 = 11 cases (or 16-5 per cent.) there is evidence of rheumatism in the children occupying
the same bed.
Thus in group 2(a), the possible contact cases are 16.7 percent., and in group 2(b), where the chance of infection
is greater the possible contact cases are 16.5 per cent. In the first series alone in group 2(a) the possible contact
cases were 21.5 per cent., and in group 2(b), they were 18 per cent. The addition of the second group slightly
alters the percentages, making them almost equal in the two groups. The number of cases analysed is still very
small and no definite conclusion can be drawn from them. Up to the present there is no evidence that the very
close contact of sleeping in the same bed as opposed to the less close contact of sleeping in the same room, but in
separate beds, has caused a greater spread of rheumatism.
Taking group 2 as a whole, it appears that in 15, or 16.5 per cent., there was more than one case of
rheumatism in the family, but it is not possible to draw any conclusion from this observation alone, as so many
other factors such as heredity, clothing, feeding and lack of maternal care must be considered.
Environmental Factors.
Careful comparisons have been made between a map showing the distribution in the borough of notified
rheumatism cases during the four years 1927-1931, and maps showing:—
(a) damp areas;
(b) rat-infested areas;
(c) various soils;
(d) poverty.
In the first three cases, no definite connection can be shown.
Evidence of Dampness.
Information concerning the presence of dampness in the rooms occupied by the rheumatic children notified
during the year 1930-1931 shows that the health visitors reported dampness to be present in 14 instances,
while in 52 instances no dampness was found.
Dampness present 14 (20 per cent.)
Dampness absent 52 (80 per cent.)
In pursuance of the policy of the two previous years, the houses reported by the health visitors to be damp
were reinspected by the sanitary inspectors.
Dampness confirmed by the sanitary inspectors 6
No dampness remediable under the Public Health (London) Act,
1891 8
14
During the year, the proportion of damp houses reported by the health visitors has decreased from 39 per
cent, in 1929-1930, to 20 per cent., and thenumber confirmed by the sanitary inspectors reduced the figure still
further.