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20
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.
The above Regulations remained in force for a year but have been extended up to
March 31st, 1930.
During 1928, 76 cases of acute rheumatism were notified. This compares with 34 cases
for the ten months of the year 1927, during which the disease was notifiable.
Acute rheumatism is defined in the Regulations 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 (October 1927-1928), some 119 new cases attended the Centre, but of
76 Paddington cases notified as "acute rheumatism" only 15 attended the centre. The
remainder were under the care of private medical practitioners.
INFECTIVE ENTERITIS.
This disease is notifiable in some eight other Metropolitan Boroughs. On May 2nd, 1927,
the Council made the disease known as "Infective Enteritis" or "Summer Diarrhoea"
notifiable for a period of two years. This Order was made by virtue of the Public Health
(London) Act, 1891, and is only applicable to children under the age of five years.
Twenty cases of the disease were notified during the year.
The number of deaths under the age of 5 years was 23 as compared with 16 in the year
1927 and 52 and 22 in the years 1926 and 1925 respectively. In no case was it found necessary
to provide for home nursing by the district nurses, all severe cases being treated in institutions.
Provision was available in the hospitals of the Metropolitan Asylums Board but no case of
the disease was removed from Paddington to such institutions.
It will be noticed that the number of deaths was in excess of the number of cases notified.
This is explained by the fact that some deaths occurred outside the Borough (not notifiable)
and other deaths were from causes classified for the purpose of the death returns as diarrhoea
and enteritis but not coming within the meaning of the terms "infective enteritis" or
"summer diarrhoea."