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for by increased longevity and consequent proclivity to the disease, and by more accurate
diagnosis on the part of doctors.
ACUTE RHEUMATISM.
This widely prevalent disease was made notifiable as from the 1st March, 1927, by virtue
of the Paddington (Acute Rheumatism) Regulations, 1927. Paddington was the first area
in Great Britain to make acute rheumatism notifiable and in view of this it may be considered
appropriate for the Regulations to be reprinted below.
It was found necessary to define the disease "acute rheumatism" as being the following
conditions, occurring separately or together in a child under the age of 16 years:—
(1) Rheumatic pains or arthritis, if accompanied by a rise of temperature;
(2) Rheumatic chorea;
(3) Rheumatic carditis.
The Regulations enjoin the medical officer of health to make such enquiries and take
such steps as are necessary or desirable for investigating the source of disease, for removing
conditions harmful to the patient and arranging for the treatment of the patient.
All these enquiries and any necessary action have been delegated to the "Rheumatism
Supervisory Centre" which was opened at Paddington Green Children's Hospital on October
9th, 1926.
The objects of this voluntary centre are:—
(1) To meet the need shown by rheumatic cases for careful supervision during periods
of apparent quiescence to prevent the development of heart disease.
(2) To supervise rheumatic children when apparently well by periodical examinations,
and to instruct the parents to consult their usual doctor or hospital should fresh
symptoms of rheumatism develop. Treatment at the Centre itself is only given
in urgent cases.
(3) To instruct parents in the care of rheumatic children and to make investigations
in Paddington into the causation of rheumatism.
The Centre is under the personal supervision of one of the Honorary Physicians to the
Hospital and there is also a salaried medical officer who devotes her whole time to visiting
cases of the disease and making such enquiries as may elucidate the causes thereof.
The work of the Centre lies with children who are suffering from rheumatism in any of its
forms, whether slight or "acute" as defined in the Regulations. During the year some 175
children attended the Centre and a full report by the physician-in-charge has already appeared
in the medical press.
Thirty-eight children were notified under the Regulations during the year. All children
notified are given an opportunity of attending the Supervisory Centre, and 27 did so.
No great value would be served in describing the conditions found in the 27 children who
attended the Centre after being notified. They only form a small group artificially delimited
in the large mass of rheumatic children.