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"Convalescence.—During the year 129 children have been distributed to 41
Convalescent Homes for a total period of 1,315 weeks, which means an average
convalescence for each of these children of eleven weeks.
"Special beds at Lancing.—20 beds have been set aside for Rheumatic Clinic
patients at Miss Booker's Home at Lancing, and these are all now occupied by cases
from the Clinic. Dr. Sheldon has paid two official visits to the Home and on each
occasion he has been well satisfied with the condition of the children."
The following report has also been received from Dr. D. W. Winnicott, Assistant
Physician to the Hospital, on the working of the Rheumatic Clinic at the Queen's
Hospital.
Queen's
Hospital.—
Dr.
Winnicott's
report.
"At the beginning of this year (1928) the London County Council made an offer
to The Queen's Hospital for Children of £100 a year towards the running of a Rheumatic
Clinic, this clinic to deal with L.C.C. children, and to aim at the prevention
of heart disease. This offer was immediately accepted.
"No precise instructions were given as to the nature of the work to be done.
One obvious way of developing the clinic would have been to have attempted to
take under its wing all the cases of rheumatism attending the hospital. This was
discussed with Dr. Thomas, and he agreed that it would be impractical to do this
unless the clinic should meet much more often than once a week. Moreover, the
diagnosed cases of sub-acute and acute rheumatism were already being treated
according to present day knowledge by the hospital physicians in the ordinary
hospital out-patient departments.
"But it was felt that a sufficient number of doubtful cases of rheumatism and
chorea were being sent from the school care committees to justify the setting apart
of this clinic of one session a week to deal almost exculsively with this type of case.
Accordingly a start was made along these lines at the beginning of the summer term,
and in the 19 sessions up to the present date 121 new cases and 46 old cases have
been seen.
"Cases referred to the clinic:—
Sent by school M.O.'s and care committee secretaries 95
Referred from Dr. Winnicott's own out-patient department 17
Referred through the L.C.C. organiser from the hospital casualty department 28
Sent by treatment centre doctors 5
Sent by head teachers 4
Came spontaneously 3
Failed appointments 31
As far as possible all children are seen by appointment. Thirty-one parents
failed to keep their first appointments.
"On June the 27th, the secretaries of the school care committees were invited
to the hospital through Miss Jenkins. Between 50 and 60 came, and they were told
about the clinic and its present aims. It was suggested that the care committee
should send their doubtful cases of chorea and rheumatism and heart-disease cases
to the clinic; if it was found that the children were being sorted out and dealt with
in a satisfactory way the practice of sending cases would grow. In this way the
success or failure of the scheme would be represented in the figures.
"It was also pointed out that the clinic did not seek a reputation as a rheumatism
treatment centre. Until some specific treatment is discovered, based on a knowledge
of the organism and conditions responsible for the disease, there was nothing to be
gained by raising false hopes by such a pretence. The object of the clinic would
be to sort out the possible rheumatic diseases, and to become responsible for the
provision of common sense treatment of indirect value. This consists in:—
(1) Convalescent home treatment between attacks.
(2) Rest in bed in a hospital or infirmary during attacks.
(3) Convalescent treatment in special heart homes in the later stages of acute
attack.