View report page

24
ACUTE RHEUMATISM.
This 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 1938, 25 cases of acute rheumatism were notified. This figure compares with 24 cases
in 1937, 29 cases in 1936, 18 cases in 1935, 41 cases in 1934, 37 cases in 1933, 21 cases in 1932, and
37 cases in 1931.
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 were 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.
In May, 1938, the Secretary of the Hospital gave notice to the Council that the Rheumatism
Supervisory Centre would be closed at the end of the year, as the number of children who attended
did not justify the cost of the establishment. Facilities, however, exist in the out-patient department
of the hospital, and elsewhere, for the necessary supervision of children requiring to be examined.
Paddington Green Children's Hospital Rheumatism Supervisoby Centre.
Report for the Year 1938 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge.
During the year 1938 the Centre held 45 sessions. New cases from the Borough numbered
only 4, although 25 cases of acute (juvenile) rheumatism were notified during the year. The total
number of attendances by Paddington children amounted to 94. The Women Sanitary Inspectors
paid 254 visits and reported faulty housing conditions when found.
With the small number of Paddington cases now being admitted to the Centre it was decided
to close the Centre to new cases on 31st December, 1938. The supervision of old cases is being
maintained and earlier cases are being followed up as far as possible.
The diminution in the number of Paddington cases is partly due to the fact that cases of juvenile
rheumatism notified in the Borough have not of recent years attended the Centre. A more welcome
cause for the falling-off in the number of cases is, it is hoped, the diminution in frequency and severity
of juvenile rheumatism in the Borough. Attention has been called to this in my reports for the
last few years, and if the Centre has contributed to this improvement all the work undertaken in
connection with it since it was first opened in October, 1926, has been well worth while.
I am greatly indebted to Dr. Mary Davies, who has assisted me in the work of the Centre for
the last eleven years.