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155
although the difficulty of knowing whether a local paralysis may not increase must
he considered before an operation can be performed.
On their discharge from Winchmore Hill all children are examined by one of
the Council's certifying officers in order that the question of school attendance
may be considered, A certain number of those who have been crippled by the
disease have been found suitable for attendance at P.D. schools provided the condition
is not accompanied by serious disorderly conduct. Severe cases of advanced
Parkinsonism are unfitted for any form of education and certain of the conduct cases
have been dealt with under the Mental Deficiency Act or in some instances under
the Lunacy Acts. Others are able to continue under close observation in ordinary
or special day schools but their future is very uncertain.
The Council has contracts with the managers of the colony schools for epileptic
children at Chalfont, Lingfield and Much Hadham, by means of which it provides for
the education and necessary treatment of those whose parents are willing for them
to leave home and who are of the necessary mental grade to profit by instruction.
The available number of places is likely to increase in the future so that the chief
difficulty is not so much the question of accommodation as of the disinclination of
the parents and their medical advisers to allow the children to leave home for treatment
at an early stage at which the prospects of improvement are much greater.
During the year 1927, some 86 children were being maintained in these special
residential schools for epileptic children.
Rheumatism,
chorea and
their
sequelae.
As was pointed out in the Report for the year 1926, a definite start has been
made in the provision of treatment for this insidious yet serious disorder. Up till
then all that could be done was to secure that a suffering child was under medical
treatment either by a private practitioner, at a hospital, or the like, a few being dealt
with through the I.C.A.A. while rheumatism supervisory centres were just coming
into existence. Since that date a considerable advance has been made in the
provision of institutional accommodation by the Metropolitan Asylums Board.
Cases are admitted thereto, on the nomination of the Council's medical officer of
health, after the case has been investigated by members of the Council's medical staff,
home circumstances ascertained, and the consent of the parents obtained.
The accommodation provided consists of 66 beds at Queen Mary's Hospital,
Carshalton, 84 beds at High Wood Hospital, Brentwood, and 77 beds for convalescent
rheumatic cases at the Downs Hospital, Sutton, and Queen Mary's Hospital. The
Metropolitan Asylums Board is also pressing forward with plans for additional
buildings at Queen Mary's Hospital which will provide 350 more beds for rheumatic
children at that hospital. Children who have failed to be admitted, owing to lack
of accommodation, have been assiduously followed up jointly by the school medical
service and the Invalid Children's Aid Association, and the best that is possible has
been done for these children.
Co-operation with the medical officers of the metropolitan boroughs has been
established. In Kensington and Paddington rheumatism in children has been made
a notifiable disease. In every case where the condition of the home of a rheumatic
child, dealt with under the scheme, in relation to dampness or overcrowding, etc.,
seems to have a bearing on the aetiology of the disease, the medical officer of health
is communicated with, while the child is still away, with a view to improving the
home conditions before the child returns from the residential hospital.
While the provision of beds has been proceeding much attention has been focussed
upon the question of the rheumatic child generally. Opinion, both on the part of
professional men and laymen, has been crystallising in favour of the establishment
of local rheumatism supervisory centres to which parents of children suspected to
be rheumatic or requiring observation for rheumatism might bring them periodically
to receive advice upon their management. At such centres also it is probable that
the earliest symptoms would be more likely to be detected, and, in addition, the need