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77
"The only prophylactic measure at present known, apart from removing the
child from unhealthy surroundings, is to attempt to alleviate adverse home and housing
conditions and to increase the well-being and resistance of the child by homely
advice to the parent on domestic conditions, on feeding, lighting and ventilation,
on cleanliness, on regular habits, on rest and on conserving the body heat by suitable
clothing and boots, and to follow this up by home visits of trained social workers,
and when the financial standing of the parent precludes suitable or ample nurture
to ensure that every official and voluntary means of extra help is at the disposal of
the child, e.g., school meals, guardians' relief, etc.

"The great majority of the children seen were referred by school doctors who
during their routine examinations have neither the time nor the conditions necessary
for a more extended examination and review of the often indefinite symptoms and
signs that are the features of early rheumatism. Children referred from hospitals
were mainly quiescent cases whose homes were close to the centres. Cases sent by
private practitioners were referred mainly for treatment under the Council's Scheme.
Parents are increasingly bringing up others of their children for examination and
advice—a procedure encouraged, as it is becoming more and more clear that rheumatism
tends to run in, certain families.
"There are always some children whose delicacy, whether inborn or acquired,
is brought out by various adverse circumstances which apparently do not greatly
affect their stronger fellows. Such children everywhere present great difficulty,
since in the majority of cases their several conditions of subnormal health cannot
definitely be traced to any one disease. More harm than good results in labelling
such children with one or other of the great crippling diseases, rheumatism or tuberculosis.
Rheumatism has become synonymous with heart disease to many people
and when a child without full justification is deemed to be rheumatic there is sometimes
unnecessary anxiety and depression on the part of the parents which reacts
badly on the child. Moreover, the 'tag' of rheumatism sometimes precludes such
children from benefiting by the very facilities which exist for their betterment, as it
is rightly held that 'rheumatic children do not thrive in day open-air schools,' or,
again, that certain localities 'are inimical to rheumatism.' There are also many
children in apparently good general health who complain of 'pains' and yet thrive
and develop along normal lines and who never develop carditis.
"Pain is a purely subjective expression, the intensity and often even the
significance of which cannot be measured by any standard or norm, and so its
significance must be interpreted in conjunction with other symptoms and signs
before a justifiable diagnosis of rheumatism is permissible. The writer's criteria
of rheumatism were outlined in the Annual Report of 1927. The conditions of 50
children seen at the Elizabeth Bullock Centre and 59 at Downham were thought not
to be specifically indicative of rheumatism. 13 of these children at the Elizabeth
Bullock Centre and 19 at Downham were discharged after their first visit, and the
remaining children were referred for re-examination, usually in 6 months' time.
Of the children referred, 14 boys went to Bushy Camp School and 18 girls were either
convalesced or went to residential open-air schools for a period of a month or
longer, and all of them remained free from symptoms while away and were benefited
16479 F