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55
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 bring
home 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 are,
however, many difficulties in the way of providing adequate sleeping accommodation for
ohildren. 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
beda, which could be used if there were room for them, must sometimes be 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 6ame 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.
Condition of the Nose and Throat.
In fifty-four children the condition of the tonsils was stated to be normal.
Seventy children had their tonsils removed, forty-three 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 seventy 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 thirty-four tonsillectomy had been performed at varying periods considerably
before the symptoms of rheumatism were observed (from seventeen of these also adenoids had
been removed) ; in twenty-one others the children were found to have had tonsils removed as part
of treatment for rheumatism.
Teeth.
All children are reported to be under dental supervision, with treatment if required, as
part of the school organisation.
Contacts.
Twenty-seven of the notified cases had no contacts.
A history of pains in limbs 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 be observed and examined if necessary.