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"A new dental clinic was opened in August at Cornwall Road, N.15.
It is an extension of an existing clinic. Very little space was available
and consequently the rooms are smaller than usual, but the equipment
is very good.
"At the time of writing we have nine dental surgeries in full use,
one of these being shared between the orthodontist and a part-time
dental officer. This is our whole accommodation and so far, with
existing staff, it has not been possible to provide annual inspections
for all children in all parts of the Area, though there should be some
improvement in this respect in 1955, provided we can keep all the
surgeries in full operation without any closing due to changes in
staff."
Details of the work of the dental officers are included in the Appendix
at the end of this Report.
Rheumatism Supervisory Centre
The Rheumatism Supervisory Centre has now been in operation
since August 1951, under the overall direction of Dr. I. M. Anderson,
Consultant Paediatrician, Prince of Wale's General Hospital, with the
close co-operation of the local Public Health and Area Health Departments.
The total number of cases seen in ecc'i year are tabulated here overleaf
the appropriate headings. Taking Tottenham first it can be seen that
the number of children attending for the first time has declined in each
year. There are several reasons for this.
Firstly, the number of children referred was larger in the first year
because previously no such special provision had been made for children
who had had rheumatic fever. Some of these children were not acutely
ill but merely required supervision. Once this catchment had been made
the numbers automatically declined. As can be seen this applies to
children with congenital heart disease as well as rheumatic heart disease.
There can be little doubt however that there has been a substantial
decline in the number of children newly developing rheumatic fever.
Th s trend has been noticcable in national statistics for many years but
seems to have accelerated recently. Thus it can be seen that the number
of children admitted to hospital for rheumatic fever has declined from
33 to 19 to 15 in each year since 1951. This decline is confirmed by the
clinical staff at the Supervisory Centre who have noticed the same thing
in other areas.
The reasons for the declinc are probably two-fold. The first is the
improved standard of living, and in particular improved nutrition and
housing. One of the few facts known about rheumatic fever is its association
with poverty and over-crowding.
The second is probably the decline in virulence of the Haemolytic
streptococcus, the causal organism of rheumatic fever. In this connection
it behoves us to be extremely wary as this organism tends to have a
virulence which rises and falls. At one time in this country, and that
only about 50 years ago, it caused severe epidemics of scarlet fever.
We must, therefore, be on guard in case its virulence increases.
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