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Particulars of cases of acute rheumatism in children coming to our knowledge
are recorded in a register under the following headings:—
Tonsils, Adenoids and
Name, &c. Classification and Symptoms Teeth.
Surname Rheumatic tendency Condition of tonsi's
Christian name Sub-acute rheumatism Presence of adenoids
Sex Acute rheumatism Teeth including oral
Date of birth Post-rheumatic sepsis
Address Arthritis accompanied by
School rise of temperature
Source of information Rheumatic chorea
Rheumatic carditis
Treatment. Home Conditions. Sleeping Conditions.
Private doctor — date of Position of rooms in Separate room
first attendance house Separate bed in room
Out-patient at hospital— Evidence of Dampness Room shared with—
name of hospital and Lighting Adults (number)
date of first attendance Ventilation Children (number)
In-patient at hospital— Overcrowding Bed shared with—
name of hospital and Adults (number)
date of first attendance Children (number)
Convalescent home—name
of home and date of admission
Hours of Sleep. Clothing. Food.
Time of getting into bed Condition of clothing and Quantity
Time of rising boots Suitability