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The Invalid Children's Aid Association has provided two special convalescent
homes serving such children in London, and the results are claimed to be especially
favourable. There is no doubt that the lack of adequate provision for convalescence
has very unfavourable reactions upon the hospital accommodation in London. In
the first place, the rheumatic children are retained in the hospitals much longer than
those suffering from any other complaint, and they are retained so long purely for
the reason that there is no place suitable for them to be sent. This is exceedingly
wasteful, as it follows that hospital beds in London are being used for cases in the
convalescent stage, and this limits the provision for acute cases which is urgently
required, while many cases have to be treated as out-patients which should be
admitted to the wards. In the second place, although a comparatively lengthy stay
is given in the hospital, the children are, nevertheless, discharged too soon to their
homes, with the result that relapses and advancing heart disease are more frequent
than would be the case if adequate provision for convalescence existed.
In his latest annual report (1924) on the Health of the School Child, Sir George
Newman states: "There can be no doubt that children suffering from rheumatic
infection are better for early hospital treatment, and there is need for more institutional
accommodation for such children. Preferably they should not be mixed
with other invalid children, but dealt with in separate open-air hospitals or residential
recovering schools. . . . The admission to such institutions should be upon
a selection basis, and much care, skill and foresight are necessary for their proper
management."
Present
provision for
treatment of
rheumatic
children.
Acute rheumatism in its various manifestations is dealt with by the special
children's hospitals as well as the general and special hospitals in London. It is
impossible to state the total number of children admitted during a given year, but
at the five great children's hospitals which issue annual medical reports 377 children
suffering from rheumatism, or its after-effects, were admitted as in-patients during
1924.
The length of time spent in a hospital bed in the case of rheumatism is prolonged
as compared with all other diseases. Dr. Poynton gives the average length of stay
as 60 days in 1919-20, at Great Ormond Street Children's Hospital, compared with
25-30 days for other diseases. The reasons for this protracted use of accommodation
which should be available for acute and urgent cases have already been discussed.
Poor Law cases are admitted to the infirmaries, but information as to the number
of such cases cannot be given, although the number of rheumatic children admitted
to the Metropolitan Asylums Board's country hospitals was 228 in 1924.
There is very little special provision for convalescent treatment of rheumatic
children other than that provided by the Poor Law. Impressed by the urgent need
for such provision the Invalid Children's Aid Association established their two
small homes at Hartfield, Sussex, and at Willesden, but the waiting lists are very
long and the need for further accommodation is manifest. More than in any other
complaint, perhaps, is swift action imperatively called for in cases needing
convalescent care; to return a child to an unsatisfactory home, while waiting for a
convalescent bed, is to court almost certain permanent injury to the heart.
It is evident that, in dealing with a widespread problem, such as rheumatism, in
any scheme that is adopted, the necessity for co-ordination must be kept prominently
in mind, and the principle of selection, insisted upon by the Board of Education,
must be followed. The precedents which have been established in the cases of
ophthalmia, poliomyelitis and encephalitis lethargica appear to hold with special
force in the case of the rheumatic diseases of children. There is even a closer parallel
between the problem of the rheumatic child and that of the tuberculous child; and
the model of administrative action which has been worked out in the case of tuberculosis
should prove a secure guide to the action which is required in the case of acute
rheumatism and its sequelae.
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