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Notifications.—During 1934 notifications of 41 cases were received.
Sessions and Attendances.—The number of sessions held during 1934 was 42, and the total number
of attendances of Paddington children amounted to 270. Twenty new cases attended for the first time
during the year; of these 9 were referred to the Centre by other departments of the hospital, 6 by
the Public Health service, 4 by the School Medical service, and 1 was brought by the mother of the
child.
Social Standard.—Of the 20 new cases seen in 1934 the home conditions were reported as comfortable
in 11 cases, and poor in 7 cases; while in 2 instances the families had moved before they could
be visited. Of the 18 cases visited 15 lived in dry rooms and 3 in damp ones. In these 3 cases one
house was repaired, one condemned, and in the third instance the family removed.
Discharges.—During the year 26 cases were discharged for the following reasons:—
Removed 14
Recovered 2
Reached age limit 9
Died 1
Children are only discharged as "recovered" when they have been under observation for a long
while and have kept not only free of rheumatism, but in robust health.
Treatment.—The main line of treatment adopted at the Centre is the close supervision of the
children and their periodic re-examination, with a view to preventing further attacks of rheumatism
or of detecting fresh symptoms of the malady early. In 36 instances fresh infection was detected;
in 7 cases this was of sufficient moment to require in-patient treatment, and the children were admitted
to my beds in the hospital wards. Twenty-seven other cases were referred for out-patient treatment,
and 2 were referred back to their own doctors for further treatment. It is impossible not to presume
that in such cases as these, the Centre is really fulfilling a most useful part as tending to prevent the
development of truly serious relapses amongst the children attending.
Tonsillectomy.—With the opening of the new throat ward at the hospital, all children who are
to undergo an operation for the removal of tonsils are now admitted. But in the case of the rheumatic
children in whom valvular disease of the heart is already present, they are admitted to the medical
ward and so given more prolonged pre-operative treatment and longer convalescence than would be
possible in the routine of the throat ward itself. All this makes for greater safety, and in these circumstances
the removal of infected tonsils, which may be of great importance, can be undertaken
with a minimum of risk.
In addition many letters of advice have been written to patient's doctors, and numerous reports
have been sent to school doctors, headmasters and mistresses, and sanitary authorities. Arrangements
for extra milk and free dinners have been made and advice on a choice of careers for the patients with
heart disease is frequently given.
Home Visiting.—The prompt co-operation of the Women Sanitary Inspectors has again proved
most valuable. In addition to their reports on home conditions, they have helped in many other ways
to aid the effectiveness of the Centre. They have made 359 visits in 1934 in connection with this
work, and for all their help the Centre is most grateful.
I beg to express my indebtedness to Dr. M. Llewellyn Davies for her able and willing assistance
during 1934.
CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE,
RELAPSING FEVER, TYPHUS FEVER.
One case of dysentery was notified during 1934, but there were no cases of the other diseases
included in the heading.
WHOOPING-COUGH.
This disease is notifiable in only three London Boroughs and not in Paddington. Since both the
cause of the disease and effective means for treating it are unknown it would not appear that notification
could assist very much in checking it. Whooping-cough is very infectious in the catarrhal stage,
before the characteristic whoop develops, and this adds to the difficulty in dealing with the disease.
In 1934, 11 persons died of whooping-cough, all being children under the age of 5 years. The
number of deaths in 1933 and 1932 were 5 and 13 respectively.
FOOD POISONING.
Section 7 of the London County Council (General Powers) Act, 1932, requires medical practitioners
to notify cases of food poisoning or suspected food poisoning. During 1934 45 cases of illness,
suspected to have been caused by food poisoning, were notified in the Borough. In no case was action
considered necessary as regards the source of the food supply. In most of the cases there was no doubt
that the illness was not "food-poisoning," but was due to personal idiosyncracy or to the results
of some dietetic indiscretion.