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they wear during the day. In those children prone to night sweats this practice is
dangerous and exposes them to chilling during the day. Light, porous clothing is
better than layers of heavy things. Feet as well as hands are found to sweat in these
children, and so the stockings should be changed and washed often. Wet boots
should be changed in school for plimsolls or simple home-made slippers. It is
better for a child to sleep alone, even on some kind of made-up bed. If this is impossible
a bolster or some other device should separate one child from another to
ensure rest. There is no definite length of time which any child should sleep;
normally they sleep longer than adults, but the only test is whether the child wakes
spontaneously in the morning. The skin in order to function properly should be
clean. Although children vary in their appetites, no child will willingly starve to
death ; all children love fuss and many children are " finicky " with their food
because of the excitement it causes in their elders. If food is suitable and varied
and the child refuses it, it is better to let that child go without this meal as his appetite
will be better at the next. While this is a good working rule, it cannot be applied
unless the diet is known to be sound. Many of these children get bread and jam
and margarine with occasional tinned foods and little else apart from the sweets
they are so often munching. Their diet is therefore devitalised, and consists largely
of carbohydrates. Glucose and sugar are sometimes a necessity to balance or
partially replace an over rich diet, but some easily assimilated and vitamin containing
fat must be added to the fat-free diet of many of the poorer elementary school
children. Fat is the main vehicle of vitamins A and D. It is a physiological necessity,
complementary to carbohydrate and necessary for the proper assimilation of calcium,
of phosphorous and of the salts generally. Fruits and vegetables are also indicated.
Milk is the only natural food that contains all the principles of an ideal diet; its
worth has been proved by Dr. Corry Mann even in what was supposed to be a fairly
generous mixed diet in a large residential institution for boys, and more recently
the value of giving milk to ordinary elementary school children was demonstrated
by Dr. J. B. Orr in some Scottish schools. It is certainly a necessity for ensuring
the health of many of the children seen at these centres. Cod liver oil is also indicated
in many debilitated children. These points, apparently trivial, are of moment to
many of these poor children. In reviewing the work of the past few years, it occurs
to me that clinical acumen is not so important as an intimate knowledge of their
homes, their Barents and their wavs of life."
Waterloo
Hospital,
Supervisory
Centre.
Dr. Gerald
Slot.
Dr. Gerald Slot has contributed the following report of the work done at the
Waterloo Hospital Rheumatism Supervisory Centre for the year 1929 :—
" During the period under review, 226 new cases have been seen at the clinic,
and there were 707 re-inspections. Of the new cases, 33 were admitted to the wards
of the hospital; 21 cases were nominated for High Wood ; 21 were referred to an
infirmary owing to no hospital bed being available or to the case being unsuitable
for hospital treatment; 48 cases were recommended for convalescent treatment;
50 were certified for P.D. schools. A group of 208 cases attending the centre has
been very carefully investigated. The cases have been divided into three groups.
A. 108 cases with definite evidence of myo-endocarditis. B. 22 cases with a history
of rheumatism and showing cardiac irritability but no definite evidence of myoendocarditis.
C. 78 cases with a history of rheumatism, but no evidence of cardiac
disease.
" The sex incidence in series, per cent., is as follows :—
A. B. C.
Males 27 27 40
Females 73 73 60
"These figures show a marked preponderance of females in the group with
organic heart disease.