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23
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 1937, 24 cases of acute rheumatism were notified. This figure compares with 29 cases
in 1936, 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.
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.
Owing to the fact that the number of attendances of Paddington children had decreased considerably,
the Council in June, 1937, decided to make, as from the 1st October, 1937, a quarterly grant
to the Hospital on the basis of £50 per annum, instead of £100, as formerly.
Paddington Green Children's Hospital Rheumatism Supervisory Centre.
Report for the Year 1937 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge.
During the year 1937, 24 cases of acute (juvenile) rheumatism were notified in Paddington.
The Centre held 45 sessions, at which 56 Paddington children made 145 attendances. There were
9 new cases, of which 3 were transferred to the Centre by other departments of the Hospital, 3
were referred by the Sanitary Inspectors, 1 by the School Medical Service, 1 by a private doctor,
and 1 was brought direct by its mother. Twelve cases were discharged from further attendance.
The type of acute rheumatism was, as in previous years, mild. Evidence of active infection,
either primary or in the form of recrudescences, was dealt with by appropriate in- or out-patient
treatment. Tonsillectomy was performed in suitable cases in the hope of diminishing the dangers
of relapses. In addition the mothers were given instruction on the points requiring special care
in rheumatic children. Arrangements were made for attendance at the special schools for physically
defective children or for convalescence where desirable.
The women Sanitary Inspectors paid 355 domiciliary visits in connection with rheumatic children,
and reported faulty housing conditions where found.
The year's work again gives the impression that, as long as the disease keeps its present mild
form, it is well in hand in the Borough.
I acknowledge gratefully the work undertaken in connection with the Centre by the Sanitary
Inspectors, and am again indebted to Dr. Mary Davies for her help throughout the year.