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in another the mother has been rearing the illegitimate family of a man who also supports
his wife and his own legitimate family on a moderate income; two are living on widows'
pensions. In all these homes difficulty of providing proper clothing, and more especially
sufficient boots, may arise at any time, and if this does occur we hope to be able to solve
the difficulty.
Condition of the Nose and Throat.
In thirty-four children the condition of the tonsils was normal.
Thirty-five children had their tonsils removed, fifteen of these also had adenoids
removed.
In five cases tonsillectomy was advised, two of the five also requiring removal of
adenoids.
In the remaining five cases the tonsils were enlarged at' the time of examination but no
special treatment was recommended.
Of the thirty-five children referred to above, in ten oases the removal of the tonsils
ooincided 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 fifteen 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 nine others the children were found to have had tonsils removed as part
of treatment for rheumatism.
Teeth.
In five children dental caries was still present: in five others extractions had been made
as part of the treatment for rheumatism.
Heredity.
As a result of enquiries of parents it was found that there was a family history of varying
degrees of rheumatism in 32 families. In fourteen of these the mother was reported to have
suffered, in seven the father, in two both parents; in nine cases there was a more or less
definite history of rheumatism in other relations.
Contacts.
Fifteen of the notified cases had no contacts.
A history of rheumatic pains was reported in the contacts of eight cases. Nine 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.
During 1931 six patients have ceased to attend school and are occupied as follows;—
(1) Girl (P. M., set 15) is an embroidercss.
(2) Girl (G. A., set' 14) is a needlewoman.
(3) Girl (I. A., set' 14) is a needlewoman.
(4) Boy (R. B., set 14) is a shop assistant.
(5) Girl (V. B., set 14) is a cracker maker.
(6) Boy (E. C., Bet 14) is a goods stamper.
Five children (R. O., M. C., G. H., G. M., and R. P.), reached the age of 16 during
1930 and still continue in their previous employment.
Obviously the nature of employment to be followed by any child who has suffered from
rheumatism requires careful consideration from all concerned.