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79
varying from one week in one or two cases to several months in others. The results
of these re-examinations are tabulated:—
Remaining free Recurring Definite
Centre. symptons. symptons. retrogression.
Elizabeth Bullock 52 43 17
Downham 51 27 9
"Institutional treatment was recommended for all the children who appeared
to be retrogressing.
"A comparison of the above tables seems to bear out the impression previously
gathered that there was a relatively smaller incidence of active rheumatism among
the children seen at Downham than in those of the Elizabeth Bullock Centre. The
former children were, with notable exceptions, cleaner, better dressed and appeared
better nurtured. On the whole their housing conditions were better. These
Downham children were drawn not only from the Downham and Bellingham Estates,
but from the neighbouring places like Lee and Lewisham—open localities with the
cottage type of house and inhabited by better artisan types, and even on the Estates,
although preference for houses is given to those families living under conditions
inimical to health, it is mainly those people with the will and ability to better themselves
and those of steady earning capacity who find sanctuary in such places. A
general survey of the environmental conditions so far collected gives pre-eminence
to no one adverse factor, and leaves the impression that any harmful home or
environmental condition, whatsoever its nature, prejudices children of rheumatic
tendencies."
Dr. Gerald Slot has given assistance to Dr. Nairn Dobbie and also himself
attends the supervisory centre at the Waterloo Hospital, where he holds the post
of Physician to the Hospital. He has furnished the following report on his work
during the past year in (1) inspection of physically defective schools, (2) the charge of
a Rheumatism Supervisory Centre, (3) research work in relation to cardiac
efficiency.
"The work of a rheumatism supervisory centre, such as the one at the Royal
Waterloo Hospital, S.E., consists in the main of four factors.—(1) The examination
of children suspected to be rheumatic or choreic. This is a very important part of
the work. The children are seen by appointment made through the local care
committee officer or divisional medical officer and are nearly all referred by one of
the school medical officers. Their medical record cards come with them and an
opinion is written on these. In this way a second opinion, aided by all the facilities
of a hospital, is available in difficult or doubtful cases to the school medical service.
The need for such a centre is evident, because about 15 cases a session are seen and
appointments have been nearly completely filled for some weeks ahead. Some
cases are referred by private practitioners and some come up by direct application
from a parent, teacher or other social worker. The Council provides an experienced
organiser who attends each session of the clinic and acts as a liaison officer between
the various organisations, outside doctors and the clinic.
"(2) The second factor is the inspection of cases, especially those with a
cardiac lesion, from time to time. Patients receive a reminder from the clinic
when their visit is due.
"(3) It acts as a medium for the propagation of information to the parents
and others about rheumatism. Parents or guardians attend with the children.
More accurate histories are thus obtained and the instruction of the parents is
regarded as a very important factor. Leaflets, founded on those of Dr. Reginald
Miller, are distributed, and a special point is made of interviewing each parent
and ensuring that the importance to the child of a correct treatment and prolonged
rest in active rheumatic cases is understood.
16479 F 2
Dr. Slot's
report.