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59
The number of children referred to us by the School Medical Officers shows a considerable
increase on former years. This is very welcome to us as the efficient combing out of the schools
of cases of heart disease is essential to the plan of the anti-rheumatism campaign.
Notifications.—During 1931 there were 37 cases of juvenile rheumatism notified as such.
Of these, 12 cases have already attended the Centre. Doubtless, many more will do so in time,
as there is always a considerable delay in attendance, pending recovery from the acute attack
for which the patient was notified. Owing to legal difficulties notification can only be made
during an acute attack of rheumatism, a fact which very severely limits the use of this process.
Classification.—On admission to the Centre the new cases were classified as under :—
f with heart disease 6
Rheumatism with suspected heart disease 15
without heart disease 8
Suspected rheumatism 13
Non-rheumatic 0
Social environment.—Inquiries have been made in each case into the social environment
of the rheumatic children received at the Centre. Particular care has been taken in the matter
of general financial status, questions of crowding, and the character of the housing, especially
as regards damp. As during the last months of the year under review these details have been
given us by the Sanitary Inspectors of the Borough instead of by our own visitor as formerly,
we have no comparable figures to cover the whole year of work. The figures given here refer
therefore only to the new cases investigated for us by the Sanitary Inspectors; they are
as follows :—
Number of new cases investigated 38
Circumstances comfortable 19
Circumstances poor 15
Circumstances very poor 4
Overcrowding 12
No overcrowding 26
Rooms damp 5
Rooms not damp 33
Living in basements 7
The total number of visits paid for us by the Sanitary Inspectors since taking over the
work was 38 first visits and 50 re-visits.
Supervision and treatment.—By the method of regular re-examination every few weeks
the effort is made to detect as early as possible any recrudescence of active rheumatism such
as might endanger the heart. Where such evidence is found the child is either admitted
to the wards of the hospital, or in milder cases is referred for treatment to its original private or
hospital doctor. Sometime, unfortunately, serious relapses occur without our knowledge,
the child being moved into some other hospital : of this we only hear later.
Special attention is paid to the condition of the throat, particularly of the tonsils, since
chronic disease in them is well recognised as predisposing to acute rheumatic attacks. Many
cases have their tonsils removed at hospital : some as out-patients, but where the condition
of the heart demands it, they are admitted to the wards for the operation. Other cases,
again, are operated on by the L.C.C. School throat clinic at St. Mary's Hospital.
In certain cases we report unsatisfactory hygienic conditions in the home to the Medical
Officer of Health and gratefully acknowledge the ready assistance given to us in matters of this
kind.
We make very considerable use of the Special Day Schools for Physically Defective
Children, and our experience of their value for cases of rheumatic heart disease is extensive
and most encouraging. In many cases we have seen great improvement in the general physical
condition of the children : this tends to heighten their resistance to further attacks, and to
allow the damaged heart to become as strong as its valvular disease permits. At present, we
think it preferable to keep these children under supervision at home and get them admitted
to the P.D. Day School, rather than send them to special " heart-homes." Whether the
attendance at the P.D. School is itself of positive value, or whether the good accrues by escaping
the compulsory attendance at an ordinary Elementary school, is a difficult problem; both
factors probably are at work.