View report page

50
Social Conditions.
Seven children live in one-room homes. In fourteen homes there is a history of chronic
poverty, but without acute distress; in three of these the mother has been many years widowed;
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.
Value of Notification of Rheumatism in Children.
The notification of rheumatism in children enables research to be made into conditions
which may possibly influence the incidence of the disease; it also calls attention to
rheumatism as a disease of childhood.
The periodic visiting which follows upon notification enables the health visitor to bringhome
to the parents the need of intensive care for the child and of giving consideration to
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 secure for him the best conditions within
the reach of the parents.
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 means. There arc,
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 be 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-four children the condition of the tonsils was stated to be normal.
Sixty-one children had their tonsils removed, thirty-four of these also had adenoids
removed.
In eleven cases tonsillectomy was advised, four of the eleven 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 sixty-one 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