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of functional variation are particularly susceptible to suggestion and react well in
an atmosphere of confidence and encouragement. Too many restrictions often defeat
their own ends and induce invalidism. When active carditis is present, hospital
treatment is necessary. Restriction in school games and exercises is adopted when
it is thought that the child, though perhaps able to benefit by exercises, if he can
limit his activities when he feels tired, should not compulsorily compete in the
activities of his stronger fellows. It is an indication to the teacher that the child
requires watching.
" Swimming is contra-indicated in children with a definite rheumatic history.
"Exclusion from school is advised pending a child's admission to hospital or
during any active illness when the mother is capable and the home is such that rest
can be assured, otherwise exclusion from school does more harm than good. These
considerations were discussed last year and are again raised as they form an important
feature in dealing with these children and are points on which some difference of
opinion exists.
" If proper convalescence of sufficient duration has been carried out a special
physically defective school is not indicated in the absence of heart disease, but if the
heart is affected and the damage appears stationary, special school education may
be considered. A uniform policy based not only on an appreciation of the child's
condition but also on the knowledge of home and school conditions is necessary to
prevent conflicting advice and administrative difficulty.

"It happens in many cases that restrictions are made and advice given by
doctors prior to the child's attendance at the centre. These are usually endorsed
pending further re-examination and assessment of the child's condition. Although
every child sent up is fully examined, when a child is already under constant treatment
it is not thought advisable to keep him under observation unless the treating doctor
desires it. If other than a favourable diagnosis is given, this is done out of hearing
of the child. The parents of all children who are discharged are advised to re-attend
should the child's condition cause any anxiety.
" Forty-five children at the Elizabeth Bullock centre and 51 at Downham were
discharged after the first re-inspection and 53 children from the former centre and
41 from the latter who were first seen last year are still under observation.

" When the child is known and remains free from symptoms and physical
signs the interval between re-examinations can safely be extended to six months,
so long as the parents know they can re-attend on the recurrence of any illness on
the child's part; others must be dealt with on their merits, active and usually
institutional treatment is indicated in those who retrogress.
"While every effort is made to better the home conditions by advice and by
official action if such is indicated and to procure for the child the benefit of all the
existing facilities, there are some practical points to which attention should be
called. It is obvious that any personal defects should be treated and few of these
will be found that have not received attention prior to attendance at the centre.
It is not uncommon, however, to find children sleeping in the same underclothing as
17710 G