London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1925
[Report of the Medical Officer of Health for London County Council]
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suffered or are suffering from rheumatic symptoms. The great majority of these
of course, are not in need of any special treatment other than that they are already
receiving, but they require careful watching. They are mostly attending school,
and under the observation of the school medical service, and are known to the school
care committees, who give the parents such advice and help as is, from time to time,
desirable. There are about 1,000 of these children attending special (physically
defective) schools whose hearts have been seriously and permanently injured; and
there are from 600 to 700 children absent from school for long periods on account
of rheumatism. These last represent 25 per cent. of the chronic invalidity amongst
children, and include all, or almost all, the children for whom special arrangements
are still necessary.
A census is taken each year, in November, of the number of children reported chronically out of school, and the numbers of these for the past four years are set out in the following table in which those absent on account of rheumatism are also shown separately.
| 1922. | 1923. | 1924. | 1925. | |
|---|---|---|---|---|
| Total chronically absent | 2,902 | 2,726 | 2,686 | 2,485 |
| Rheumatic cases | 682 | 652 | 672 | 614 |
| Percentage due to rheumatism | 23.5 | 23.52 | 25.02 | 24.71 |
The 614 rheumatic children absent in November, 1925. are classified as follows:—
| Boys. | Girls. | Total. | |
|---|---|---|---|
| Rheumatism | 51 | 93 | 144 |
| Heart disease | 86 | 138 | 224 |
| Chorea | 75 | 171 | 246 |
This table demonstrates the greater incidence of rheumatism generally upon
girls (65 per cent.), and the very special incidence on the nervous system in school
children shown by the very high proportion of chorea to the total (40 per cent.).
This is especially to be noted, as it illustrates a point which is to be emphasised,
that rheumatism often steals in upon children like a thief in the night and does not
come as a sudden acute illness, for the onset of chorea is generally very insidious,
and it is usually first noticed at school.
Children with chorea are largely treated as outpatients at the hospitals, but it
is highly desirable that all children with active chorea should be treated by rest in
bed, as the development of rheumatic endocarditis in these patients is a frequent
occurrence. The relief to the hospitals, which further convalescent provision for
rheumatic children would afford, might result in a number of choreic cases receiving
adequate treatment with a corresponding reduction of the incidence of cardiac
complications. About 11 per cent. of the children admitted on account of heart
disease to the physically defective schools gave a history of previous chorea.
It is obvious that special consideration will be required for the choreic child as
part of the whole problem of rheumatism.
The deaths in London in 1924 from rheumatism at ages below 25 were:—
| 0-5 | 5-15 | 15-25 | |
|---|---|---|---|
| Rheumatism and rheumatic fever | 4 | 65 | 41 |
| Heart disease | 13 | 147 | 257 |
| Chorea | 1 | 5 | 4 |
| Total | 18 | 217 | 302 |
The annual number of children admitted for heart disease to the Council's special
schools is at present between 250 and 300. This number has increased during the
past few years largely because the hospital physicians have become better acquainted
with the facilities, and in consequence of the very close co-operation, which has grown
up between the hospital authorities and the Children's Care Organisation of the
Council, in regard to the after-care of rheumatic children.