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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. In one case last year boots were provided by the Public Assistance Committee.
Condition of the Nose and Throat.
In forty-two children the condition of the tonsils was normal.
Forty-three children had their tonsils removed, twenty-two of these also had adenoids
removed.
In seven cases tonsillectomy was advised, two of the seven also requiring removal of
adenoids.
In the remaining four cases the tonsils were enlarged at the time of examination but no
special treatment was recommended.
Of the forty-three children referred to above, in eleven 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 twenty tonsillectomy had been performed at varying periods considerably
before the symptoms of rheumatism were observed (from seven of these also adenoids had
been removed); in twelve 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 seven others treatment had been given.
Heredity.
As a result of enquiries of parents it was found that there was a family history of varying
degrees of rheumatism in 36 families. In sixteen of these the mother was reported to have
Buffered, in eight the father, in two both parents; in ten cases there was a more or les6
definite history of rheumatism in other relations.
Contacts.
Twenty of the notified cases had no contacts.
A history of rheumatic pains was reported in the contacts of ten cases. Eleven of the
contacts were examined at the Rheumatism Supervisory Centre, and as a result two are 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 1932 one patient ceased to attend school and is occupied as follows: —
(1) Girl (D. L., æt 14) is a clerk.
Five patients who ceased to attend school in 1931 continue occupation as follows : —
(1) Girl (G. A., æt 14) is a needlewoman.
(2) Girl (I. A., æt 14) is a needlewoman.
(3) Boy (R. B., æt 14) is a shop assistant.
(4) Girl (V. B., æt 14) is a cracker maker.
(5) Boy (R. C., æt 14) is a goods stamper.
One child (P. M.), reached the age of 16 during 1932 and still continues in her previous
employment.
Obviously the nature of employment to be followed by any child who has suffered from
heumatism requires careful consideration from all concerned.