London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
Kensington 1938
[Report of the Medical Officer of Health for Kensington Borough]
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Apart from these admissions, forty-two patients were sent home to bed, and the district nurse was sent in.
•Of these, thirty-five had pains or tachycardia or slight fever which was suggestive of juvenile rheumatism, and
seven had a definite cardiac murmur originating from a previous attack of rheumatic fever. All these cases
responded to a short rest at home, their symptoms having subsided when next seen.
During the year no cases with nodules, which are in our opinion a sign of a severe rheumatic infection, have
been seen. In fact, during the last four or five years nodules have become a rarity.
Cases admitted to hospital from Clinic, October, 1937—October, 1938. I. Chorea—Eight cases.
| Case Initials. | Reason for Admission. | Remarks. |
|---|---|---|
| R. C. | Early chorea | Very mild. General health poor. |
| C. H. | Chorea | Very mild. |
| E. D. | Chorea | - |
| W. J. | Chorea | - |
| P. W. | Chorea | Very mild. Growing pains severe. |
| J. A. | Chorea and carditis | - |
| A. B. | Chorea and carditis | - |
| J. G. | Chorea and carditis' | - |
II. Active Juvenile Rheumatism—Thirteen cases.
| Case Initials. | Reason for Admission. | Remarks. |
|---|---|---|
| R. C. | Arthritis, tachycardia, extra systoles | - |
| P. H. | Rheumatic pains, canter rhythm | - |
| E. P. | Pains, pyrexia, tachycardia | Old case of mitral regurgitation. |
| J. P. | Tachycardia, rheumatic pains, restless | Old case of mitral regurgitation. |
| J. G. | Active carditis | Old case mitral stenosis. Abnormal electrocardiogram. |
| R. G. | Infective endocarditis | Old case rheumatic mitral stenosis. |
| M. H. | Rheumatic pains and carditis | - |
| M. L. | Tachycardia | Old case mitral regurgitation, severe scabies. |
| W. W. | Pyrexia, joint pains | - |
| M. W. | Persistent pains | Old case mitral stenosis. |
| A. Y. | Severe debility. No definite evidence active carditis. | Old case mitral regurgitation. |
| R. B. | Arthritis | Old case mitral stenosis. |
| R. W. | Pains and carditis | Old case mitral stenosis. |
III. Doubtful Juvenile Rheumatism—Three cases.
| Case Initials. | Reason for Admission. | Remarks. |
|---|---|---|
| B.C. | Persistent tachycardia | Later tonsillectomy. |
| P. B. | Pyrexia | Later tonsillectomy followed by persistent tachycardia. |
| G. W. | Rheumatic pains—tonsils infected | - |
| IV. General—Six cases. | ||
| E. G. | Otitis media | Old case mitral regurgitation. |
| E. T. | Erythema nodosum | - |
| W. S. | Pneumonia | - |
| S. M. | Pneumonia | Old case rheumatic mitral regurgitation. |
| G. B. | Investigation subclavicular mass | - |
| W. T. | Tubercular peritonitis | - |
V. Admitted into Medical Ward with a view to Tonsillectomy—Nine cases.
Six were cases of quiescent rheumatic carditis.
Two had congenital heart disease.
One general health very poor.
Owing to the educative value of a supervisory clinic such as this, private and school doctors, school teachers,
and parents themselves now send children to the clinic for observation if they suspect juvenile rheumatism in
any form. This has led to an increased knowledge of early diagnosis and of preventive treatment. It is, however,
impossible to prove that this has caused the present milder manifestations already discussed. Certain diseases,
notably scarlet fever and smallpox, are known to have natural cycles of severity, and as juvenile rheumatism is a
disease the incidence of which increases directly with poverty, the decrease in its severity may in part be due to
the improvement in general hygiene initiated by the public health authorities. However, the fact remains that
the comparative rarity of gross cardiac disabilities is co-incident with the increased interest aroused in this subject,
and we feel sure that some of this striking difference must be attributed to the increased care and supervision
now given.
During the year under review a statistical research has been begun into the significance of what are commonly
called growing pains. These pains vary and are certainly not all due to rheumatism. Is it possible to make a
clear differential diagnosis? How seriously must one view their incidence? The material at the clinic is extensive
and nearly a thousand cases are being considered. Various avenues of investigation have been opened up, but
the statistics required are not yet complete, so that no conclusion can be published in the report of this year.