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centre and supply a list of the names and a resume of the condition of each child to
the County Hall so that any recommendation of the examining doctor can be acted on.
" The scheme would be impossible without the active sympathy of the teachers,
whose interest is shown in numerous ways. In addition to friendly advice and encouragement
to the parents, they watch those children whose activities should be
limited, they help in securing school meals and milk, and often in supplying boots
and other clothing; they encourage the attendance of the children at the centres,
and in many instances have arranged tea parties and meetings of parents at which
homely talks on simple hygiene and care of the children in connection with rheumatism
have been given.
" Several lectures to care committee workers have been given on the administrative
and preventive measures adopted under the scheme.
" Since rheumatism was made notifiable in Holborn last Easter, arrangements
have been made with Dr. Hutt, the medical officer of health, for the borough council's
health visitors and the Council's organiser to co-operate fully in every direction.
A somewhat similar arrangement was later made with Dr. Caley, the medical officer
of health of Wandsworth. Such close and friendly relationships are extremely
necessary in London to prevent overlapping in the duties of independent authorities
and to secure for the child and his parents such help as exists for their benefit.
" The existing rheumatism supervisory centres were mentioned last year.
Owing to the impossibility of keeping pace with the numbers nominated for the
Council's Elizabeth Bullock and Downham centres, the collecting areas for each
of these had to be narrowed, thus indicating the necessity of establishing centres
in other districts where no facilities exist. A new centre, directly administered by the
Council was opened in Woolwich at the beginning of January, 1930, and arrangements
are well forward for opening similar centres at Hammersmith and at Putney. In
addition to these facilities a centre will shortly be opened at King's College Hospital,
which, it is proposed, shall be in close association with the children's care organisation
" One session in each week has been held at both the Elizabeth Bullock and
the Downham centres throughout the school year, and experience has shown that
these centres neither encroach on the work of the private practitioner nor on that of
the hospital, but fill an obvious gap by providing supervision where necessary of
many children who would not in the ordinary way attend any doctor until perhaps
irreparable damage had been done.

" The incidence of rheumatism is highest in children from the poorest schools.
Attention should be focussed on these, and every effort made to encourage the
parents to bring rheumatic or potentially rheumatic children from the poorest
schools to the centres ; it is such children who stand most in need of the facilities
that exist for their benefit.
The sources of reference of the children were very similar to those of last
year, the great majority being sent by the school doctors and from school treatment
centres, though an increased number has been referred from private doctors. The
parents are increasingly alive to the value of full examination of children showing
any prodromal signs of rheumatism. Children nominated otherwise than by doctors
are either out of school or thought to be suffering from rheumatism and not under
treatment or supervision elsewhere.