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22
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 and were extended to 31st March, 1930,
from which date the disease, under further Regulations, became permanently notifiable in the Borough.
During 1936, 29 cases of acute rheumatism were notified. This figure compares with 18 cases
in 1935, 41 cases in 1934, 37 cases in 1933, 21 cases in 1932, 37 cases in 1931, and 43 cases in 1930.
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. During
the year 1936, a grant of £100 was made by the Council towards the cost of the maintenance of the
centre.
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.
Paddington Green Children's Hospital Rheumatism Supervisory Centre.
Report for the Year 1936 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge.
As foreshadowed in last year's report, juvenile rheumatism was more prevalent in Paddington
in 1936 than in 1935, 29 cases being notified as against 18 in the previous year.
The Centre held 45 sessions at which 72 Paddington children made 128 attendances. During
the year 12 new cases attended the Centre. Of these, 1 was referred by a sanitary inspector; 2
were sent by the School Medical Service; 7 were transferred from the In-patient and Out-patient
departments of the Hospital; and 2 were brought up spontaneously by their mothers. Ten cases were
discharged during the year.
On the whole the type of juvenile rheumatism during the year was mild. No child attending
the Centre suffered from a relapse serious enough to require in-patient treatment, and no case died.
Even the new cases admitted to the wards of the hospital showed for the most part only transient heart
disease, although there was one sad exception of serious heart disease when seen for the first time.
Tonsillectomy was performed in a small number of cases in the hope of warding off further rheumatism.
Mothers were instructed in the dangers of relapses and their possible prevention. Medical outpatient
treatment was provided where necessary, and arrangements for suitable convalescence and
holidays were made for some cases. The women sanitary inspectors paid 430 visits in connection
with rheumatic children and reported faulty conditions of housing, where found.
The year's work gives the impression that so long as juvenile rheumatism keeps to its present
mild form, the disease is well in hand in Paddington.
I acknowledge most gratefully the work so well undertaken by the women sanitary inspectors;
and I am again indebted to Dr. Mary Davies for her help throughout the year.