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Up to the end of February, 1927, the number of children admitted to the
rheumatic unit was 17. The beds for sub-acute cases were all filled by December
14th, 1926; since that date there have been 17 urgent applications for admission
of sub-acute cases in girls lor whom it has been possible to provide for only two by
an extension of the 16 beds at Carshalton to 18. In November, at the time the
additional provision was made at Carshalton, an index of children suffering from
rheumatism reported to the public health department was commenced, and at the
present date (25.2.27) the index contains 1,314 names.
The need for further accommodation is now fully recognised and measures
are being concerted for the provision of further beds on a substantial scale with
the least possible delay. Measures for concerted action in cases of rheumatism
between the Council's care organisation and various hospitals are mentioned in
the section in co-operation with the voluntary institutions. Notice should here
also be taken of the establishment in Paddington under Dr. Reginald Miller of a
"Rheumatism Supervisory Centre" at the Paddington Green Children's Hospital.
The centre is intended to meet the need shewn by rheumatic cases for careful supervision
during periods of apparent quiescence to prevent the development of heart
disease.
"The plan adopted is to supervise the care of the children when apparently
well by periodical examinations, and to instruct the parents in writing to consult
their usual practitioner or hospital should fresh symptoms or rheumatism supervene.
Treatment at the centre itself is only given in urgent cases. In this way it is hoped
that the centre will form a useful link between practitioners, the school medical
service and the hospitals, for the benefit of the patients. Further, instruction is
given to parents in the care of rheumatic children."
As a development of the Paddington system, the Ministry of Health has agreed
to the making of acute rheumatism in childhood a "notifiable disease" in the
Borough of Paddington under the Public Health Act.
The experience of the year has demonstrated anew how small a part in relation
to the whole problem of rheumatism in childhood is played by the onset of acute
rheumatic symptoms. There is a very large number of children in the schools
with a rheumatic tendency. They suffer from symptoms too slight to be noticed,
or for alarm to be aroused, if noticed by the parents. They have recurrent attacks
of sore throat, complain of vague growing pains and present unusual pallor; that is
all. In a great number of cases nothing further supervenes. In others the jerky
movements of chorea come on, especially in the spring time. In still others the
school doctor is shocked to find at a routine examination that there is a heart murmur
showing that the valves of the heart have been quietly attacked by the disease and
the child now has a serious defect which, in all probability, will remain with him for
the rest of his existence, crippling his usefulness and curtailing his expectation of life.
It is this quiet, unsuspected onset and the impossibility of predicting who,
amongst the large number of children who suffer from recurrent sore throat and vague
pains in the limbs, are those that will later show the more serious symptoms of
rheumatism which make the disease so baffling, and render it in the highest degree
unlikely that compulsory notification will give any real assistance in solving the
administrative problem. It is through closer attention to the early and in themselves
unimportant symptoms, through the development of "supervisory centres,"
and through the provision of sufficient beds assigned to children, who require long
periods of rest under observation, that the prevention of the more serious and
disabling manifestations of rheumatism must be sought.
The Work of the School Nurse.
The obvious improvement in the condition of the children in elementary schools
during the past twenty years is very largely to be ascribed to the quiet and unobtrusive