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Epidemiology.
As in previous years, an effort has been made, both at home visits and at the supervisory centre, to ascertain
factors in the causation of the disease. Particular attention has, during the year, been paid to the question of
diet. Details of this investigation will be found in part II of this report.
Co-operation of the public.
During the National Health Campaign, which opened in September last, great stress was laid on the necessity
for co-operation on the part of the public in order that the fullest use might be made of the various health services.
In this connection, it is pleasing to be able to report that the parents of rheumatic children are taking increasing
advantage of the facilities for diagnosis and treatment provided at the supervisory centre. In the past, they
have brought their children to the centre only when asked to do so, but recently, many, realising the importance
of intercurrent symptoms, have returned before the date appointed, thus helping to prevent the serious consequences
which, in this disease, so often result-from neglect of minor symptoms.
Residential treatment of rheumatism.
Hospital accommodation.
Four beds are reserved at the Princess Louise hospital for the treatment of rheumatism, and extra beds are
available when required. In addition, cases are admitted for treatment to other hospitals in the borough.
Convalescent homes.
Adequate facilities for convalescence have again been available ; the necessary arrangements being made
through the Invalid Children's Aid Association, or under the London county council's rheumatism scheme.
Report on the Social Work of the Centre
by Mrs. G. JACOBSON., Honorary Secretary.
The staff of the centre cpnsists of one paid part-time social worker—Miss Hilda Caton—who is in charge of
the social work; one honorary secretary—Mrs. Gerald Jacobson ; three voluntary workers—Miss Dudley Baxter,
Miss Greer and Miss Reitlinger; and another voluntary worker—Miss Hazel Kahn—who is in charge of the filing
of case papers, entering up of weights and temperatures, etc., at the centre on the days that the children attend.
One of the questions most frequently asked by visitors to the Kensington rheumatism supervisory centre is
" Why is such a large staff needed to run the centre ? " The answer can be stated briefly—" The centre attempts
to deal with every phase of the rheumatic child's life."
There is a large amount of home visiting to be performed. All first visits to children notified to be suffering
from acute rheumatism are paid by the council's health visitors, but the remainder are paid by the staff of the
rheumatism supervisory centre. Altogether 895 visits were paid to families in Kensington during 1937. The
visits paid may be divided into the following categories :—
1. Visits paid to inform the parents that the child is due to attend the centre. It is one of the aims of the
centre that every mother should be visited before bringing her child for examination, so that the situation
may be discussed, and valuable information may be obtained which would not be ascertained if the
mother was not interviewed until in the presence of the doctor.
2. Visits paid when home treatment has been ordered by the physician. Frequently a rheumatic child is
ordered to spend a week in bed, or just resting at home. It is the visitor's duty to see that the child is
not made use of by the parents to run errands, and to do the housework or shopping—an unfortunate
occurrence which has been discovered several times.
3. Visits paid to investigate social conditions. The centre attempts to inv estigate the social conditions of
every family that comes under its care. Much has been done with the assistance of the public health
department to remove families from damp and overcrowded homes to better conditions where therheumatic
child will have a chance. The social workers are also responsible in many cases for assisting
the parents to get extra nourishment for these children—i.e., dinners at school, milk, etc.
4. Visits paid in regard to convalescence, tonsillectomies, etc. In cases where these have been advised.
visits to the home are necessary to make arrangements with the parents.
Another duty undertaken by the visitors may be best described as that of " liaison officer." Amongst others,
school teachers and school care committees send children to the centre—these children may need special care at
school, and yet not be ill enough to warrant sending them to a special school for physically defective children.
It is the visitors work to make contacts with the school-teachers, and so enlist their sympathy and help in dealing
with these cases, explaining the need for extra rest during the day, and why they must not do drill, play games,
swim, etc.
Another branch of the work done by the centre is to find suitable work for cardiac cases. In many cases
contact has been made with the local labour exchanges, explaining the need for finding sedentary work. Much
time is spent discussing with the parents the future of these children, and the best way of setting about the difficult
task of finding suitable work. In some cases the centre has been instrumental in getting children apprenticed.
Although the centre is open to children up to the age of 16, it is often difficult to get them to attend once
they have commenced work, as they are afraid of losing their employment through taking time off. These patients
are in their adolescent stage—one of the most important in their lives—when serious breakdowns are liable to
occur unless checked by supervision. The visitor discusses with the parents the child's state of health, and is
often able to notice early signs of trouble and get the mother to use her influence in making the child take the
necessary time off to attend the centre. At 16 years of age the child leaves our care, but whenever possible the
physician in charge of the centre communicates with the panel doctor and transfers all details of the case to him.
In this report no mention has been made of the work done in dealing with cases attending the centre from
other boroughs. As no visits are paid by our workers outside the Kensington area, all following up, etc., has
to be done by correspondence, which takes up a considerable amount of time.
There is much secretarial work to be carried out in dealing with cases. All work done has to be recorded on
special case sheets, which are kept apart from the medical records. These are invaluable in checking up past
events in the family life.