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are in fact a great testimony to the efficacy of the administrative measures possible
in the case of tuberculosis and the thoroughness with which they have been applied.
In reviewing the individual records of chronic invalidity, the majority of the
cases of tuberculosis are "satisfactory," that is, the medical officer is satisfied that
the best possible measures are being exerted for the children; if a tuberculous case
is not "satisfactory," he knows exactly what to do, the machinery is there ready at
hand, he has only to press a button, so to speak, for it to be set in motion and the only
sand likely to get into the machine is parental objection due, in the majority of
cases, to affection blinding the mother to the best interests of the child. Even in
these cases there is a "second best" line of administrative action which is open.
But in rheumatism the case is quite the reverse. In only a small proportion of the
children can the individual cases be written off as "satisfactory." Case after case
is revealed of sub-acute rheumatism, chorea or rheumatic heart disease, which the
medical officer cannot mark "satisfactory." He knows that the best possible is
not being done for the child, but he is helpless. There is no button to push; there is
no machinery to work; there is no provision in existence adequate to the needs.
There remains the duty of providing special school accommodation for children
who are crippled with heart disease on account of earlier rheumatism. Out of
1,083 children seen for admission to physically defective schools in London in 1926,
327 were suffering from non-congenital heart disease. As rheumatism is almost
the only cause of acquired valvular heart disease in childhood, it is thought that
many, if not the majority of these children could be saved from crippling if adequate
means existed for dealing with rheumatism similar to those available for tuberculosis.
Fortunately instructed opinion is now alive to the necessities of the case. As the
result of conferences among the Ministry of Health, the Metropolitan Asylums
Board and the Council, additional provision was established for rheumatic children
at Queen Mary's Hospital, Carshalton, in November, 1926. The scheme provided
for the provision of a rheumatic unit of 60 beds, and embraces five clauses, as
follows:—
(а) That in admitting cases to these 60 special beds, preference will be
given to children received directly from out-patient departments of selected
London Hospitals or from the homes of the children. This restriction is
important if research work of the kind proposed, and for which the unit is
instituted, is to be undertaken.
(b) That the final decision as to the suitability or otherwise of cases for
admission shall rest with the medical superintendent of the hospital or his
representatives.
(c) That the London County Council will be promptly informed of the
admission and of the discharge of each patient and will be furnished with
particulars as to the condition of each patient od discharge.
(d) That the London County Council will be informed in writing by the
medical superintendent of the clinical character and type of case suitable for
the specific purpose of the unit, in order that if the County Council know of
such cases, at home or elsewhere, they may be in a position to recommend them
for examination by the medical superientendent or by one of his representatives
for decision as to admission.
(e) That, apart from the 60 beds of this unit, the Board will do all that
is practicable by the special allotment of other convalescent beds at Queen
Mary's and the Downs Hospitals to accommodate (if desired by the London
County Council) cases of acute rheumatism at a later stage of the disease.
It was decided that cases of primary acute rheumatism, with temperature and
acute local manifestations and excluding chorea were suitable for the "unit."
Under clause (e) 16 more beds were placed at the Council's disposal at Queen
Mary's Hospital for sub-acute cases (including chorea) but confined to girls only.