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51
his future welfare. Without such visiting, the poor health of the child might be accepted
as inevitable and no special effort might be made to sccure for him the best conditions within
the reach of the parents. The value of fresh air, of sufficient rest and especially of the
"early to bed" habit are insisted upon, as well as the meaning and importance of good
nutrition.
In Central London, where facilities for obtaining good fresh food at reasonable prices
abound, the provision of a suitable diet is a matter of knowledge and mean. There are,
however, many difficulties in the way of providing adequate sleeping accommodation for
children. High rents must be paid for even few and small rooms and flats, and thus the
condition which is frequently most harmful to the child, namely, a crowded sleeping room,
is the most difficult to remedy. Children are not infrequently found sleeping two or three
in a bed, because there is not enough floor space to allow of another bed being put up; spare
beds, which could be used if there were room for them, must sometimes bo stored. A separate
bed is especially desirable for a rheumatic child, but if this can be secured only by placing
the bed in the living room, the child will go to bed too late and get up too early, and this
may bo worse for him than sharing a crowded bedroom. Where the father must either live
near his work or run the risk of losing it, it is no solution of the difficulty to suggest that
the family shall remove to the Greater London area. At the same time, it is occasionally
found that a child for whom ample and separate accommodation is provided is kept up until
the parents' bedtime because the parents do not understand the vital importance
to the child of sleep during the early hours of the night.
Heredity.
As a result of enquiries of parents it appeared that there was a family history of varying
degrees of rheumatism in forty-three families. In twenty-three of these the mother was
reported to have suffered, in nine the father, in two cases both parents; in thirteen cases there
was a more or less definite history of rheumatism in other relations.
Condition of the Nose and Throat.
In fifty-one children the condition of the tonsils was normal.
Fifty-six children had their tonsils removed, thirty-one of these also had adenoids removed.
In nine cases tonsillectomy was advised, three of the nine 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 fifty-six children referred to above, in twelve 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-eight tonsillectomy had been performed at varying periods considerably
before the symptoms of rheumatism were observed (from fourteen of these also adenoids had
been removed); in fifteen others the children were found to have had tonsils removed as part
of treatment for rheumatism.
Teeth.
In seven children dental caries was still present: in nineteen others treatment had been
given.
Contacts.
Twenty-four of the notified cases had no contacts.
A history of rheumatic pains was reported in the contacts of eleven cases.
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 bo observed and examined if necessary.
History of Patients after leaving school.
During 1933 nine children censed to attend school and are occupied no follows:—
(1) Boy (F. A., æt. 14) is an optical lens maker.
(2) Girl (F. B., æt. 14) is engaged in a tobacoo factory.
(3) Girt (W. C., æt. 14) assists in a laundry receiving office.
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