View report page

58
APPENDIX.
PADDINGTON GREEN RHEUMATISM SUPERVISORY CENTRE.
Report for the Year 1931.
The objects of the Rheumatism Supervisory Centre which was established at the
Paddington Green Children's Hospital in October, 1926, fall under two headings :—
(1) The main object is to diminish the appalling death-rate due to valvular disease of the
heart amounting to something between 15 and 25 thousand annually in England and Wales.
This type of heart disease in young subjects is invariably due to the rheumatic infection and
in the vast majority of instances the heart disease is established in childhood although death
does not occur from it until 10, 20 or more years have passed. It is the peculiar tragedy of
rhuematic heart disease that it kills so many thousands of middle-aged people, often the
parents of young families; yet the disease of the heart which leads inevitably to premature
death is established during childhood, usually the school-age, and is due to the infection which
is termed " juvenile rheumatism."
(2) The subsidiary object is to try to solve the problem of the causation of juvenile
rheumatism. It is known that it is essentially a disease of faulty social environment, for it is
practically entirely confined to the children of the poor, and does not appear in them if they
are taken out of their homes and educated in residential poor-law schools. The exact factors
in the lives of poor children which so strongly predispose to rheumatism and rheumatic heart
disease are not known. All that can be said is that it is extremely common in, and almost
confined to, the children of the poor, living in their own homes, and attending the State
elementary day-schools under compulsion.
Scheme of work.—That a special scheme to deal with rheumatic children is necessary has
been largely accepted. There are now about 14 such Centres in London, of which the one at
Paddington Green was the first established. Two attributes of juvenile rheumatism make
special supervisory systems essential : first, that once a child is tainted with the disease
relapses are extremely frequent, and in any of these heart disease may appear or increase in
severity; and secondly, that it is often very difficult for a parent to detect that the child's
heart is getting worse, so that periodic medical examinations, irrespective of the parent's
opinion of the child, are essential.
The ideal of the Centre is, therefore, to try to get all the rheumatic children of hospital
class to attend, to obtain for them treatment in order to diminish the likelihood of further
attacks, and by repeated re-examinations to give warning of harm developing in the heart.
At the same time investigations into the social environment of the patients are made.
General review of 1931.—Of the work of the Centre in 1931 taken as a whole, two preliminary
remarks must be made. In the first place the incidence of rheumatism during the year
has been comparatively light, due probably to climatic influence. Secondly, since the
association of the Centre with the Borough authorities, the work has gained much from the
assistance of the Women Sanitary Inspectors of the Borough. Through them there has been
an improvement in getting notified cases to present themselves at the Centre, in tracing cases
whose attendance had lapsed, and in obtaining the details of the social environment of each
child. Although their assistance only began in the middle of the year's work under review,
it gives promise of being of great value in the future and has already done much for which we
are very grateful.
Sessions and attendances.—The Centre has been open every Saturday morning throughout
the year, except during the holiday periods when it is found impossible to get attendances.
The total number of visits paid by Paddington children to the Centre in the 44 sessions held
during the year was 321.*
New Cases.—During the year 42 cases from the Paddington area attended the Centre for
the first time. They were referred there by the following agencies :—
Notifications 10 cases
School authorities 24 „
Other departments of hospital 7 „
Parents 1 case
These bring the total number of Paddington children on the register (December 31st, 1931)
"to 335.
* The numbers given throughout refer to Paddington cases : these constitute rather more than half the cases
attending the Centre.