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In the remaining five cases the tonsils were enlarged at the time of examination
but 110 special treatment was recommended.
Of the twenty-two children referred to above, in seven cases the removal of
the tonsils coincided with the reported onset of rheumatism, in that the diagnosis
of the rheumatic condition was made in connection with the attendance of the
children at hospital on account of tonsilitis. In ten tonsillectomy had been
performed at varying periods considerably before the symptoms of rheumatism
were observed (from three of these also adenoids had been removed); in five others
the children were found to have had tonsils removed as part of treatment for
rheumatism.
Teeth.
In three children dental caries was still present: in five others extractions
had been made as part of the treatment for rheumatism.
Heredity.
Based on information derived from the parents (notably untrustworthy seeing
that they include all forms of rheumatism including fibrositis) the following has
been compiled:—
In six the mother had suffered from rheumatism.
In three the father.
In one both mother and father.
In one the brother.
In two cases, the father, mother, brother and other relations.
In one family the mother and her relations.
In one family there was a history of rheumatism in the mother's relations
only.
Contacts.
Nine of the notified cases had no contacts.
A history of rheumatic pains was reported in the contacts of six cases. Seven
of the contacts were examined at the Rheumatism Supervisory Centre, and as a
result one is being kept under observation.
The names of all the other contacts going to school were passed on by the
London County Council district organiser to the Divisional School Medical Officer
in order that they might be observed and examined if necessary.
History of Patients after leaving School.
Five of those notified, one boy and four girls, have ceased to attend school
and are at work. A boy (A.M., æt, 15) works as a lift attendant at a large store,
one girl (G. H., set. 14 years) as a clerk, one (G.M., set. 14 years) as a relief
stamper, one (M.C., æt. 14 years) as a box folder, and one (Q.W., set. 14 years)
as a checker in a laundry receiving office.
Two of these (A.M. and Q.W.) reached 16 years of age in the early part of
1930 and are no longer under supervision as notified cases nor as "children"
under any children's care organisation. At the moment all these children are
keeping well but would probably benefit by attendance at a Rheumatism Supervisory
Centre for adults.
Obviously the nature of employment to be followed by any child who has
suffered from rheumatism requires careful consideration by all concerned.