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97
elementary school, but for the same range of ages there are already in the P.D.
school 6 children from the Marlborough and 4 from the Ashburnham with valvular
disease of the heart.
"The figures show that roughly a third of those with a history of "growing
pains" had clinical signs (i.e., degrees of anaemia and myocardial debility) which
were possibly due to sub-acute rheumatism.
The following particulars are extracted from a report by Dr. D. W. Winnicott
on the work done at the Queen's Hospital Rheumatism Clinic for the year ended
1st May, 1929.
Queen's
Hospital for
Children
Rheumatism
Clinic.
Report by
Dr. D. W.
Winnicott.
During the year 45 treatment sessions were held, at which 313 new patients
were seen, an average of 7 patients per session. There were 310 attendances apart
from first attendances, making a total of 623 attendances. The number of second
and third attendances is small because in the first 2 months only 7 patients were
seen twice. Actually the number of old patients per session is constantly increasing,
whereas the number of first attendances per session is kept constant as far as possible.
In the two months March and April, 1929, the last two of the year in question 90 old
cases attended, an average of 13 per session.
The 313 cases sent to the clinic during the first year were referred from the
following authorities:—194 from school medical officers and care committees (the
proportion from this source will be found to have greatly increased when statistics
which do not take into account the abnormal first few months are compiled), 91
from the hospital out-patient departments (the proportion from this source will be
found to be much smaller in future statistics), 13 from treatment centres, 5 from
head teachers, 2 from patients' private doctors, 2 from Invalid Children's Aid
Association and Charity Organisation Society, 76 brought to the clinic by parents.
During the year there has been a session every Wednesday of the school terms.
New cases are expected to come at 1.30 p.m. and old cases at 4 p.m. Each session
lasts till about 6 p.m.
The following statistics deal with 365 patients, 145 males, 220 females; this
number includes 52 new patients seen in May and June of 1929. For the purposes
of statistical inquiry each case was labelled according to a simple and definite
diagnosis. Without some such plan no statistics can be compiled, though it must
clearly be understood that any attempt to be dogmatic where sub-acute rheumatism
is concerned is from the clinical point of view unwise. Clinically the condition of
the patient is always more important than the diagnosis, and the indications for
treatment must be derived from a study of the whole patient. Therefore the patients
were labelled as follows :—
(1) Those not considered to be, or to have been either rheumatic or choreic ;
(2) Those who have had, and are therefore liable to, either rheumatism or
chorea, or who have active disease of this nature now ;
(3) Those who show very good evidence of past or present (active) rheumatic
heart disease.
230 (95 males, 135 females) either have no physical disease or suffer from some
disease other than the one in question ; of these 96 (42 males, 54 females) may be
called rheumatic, that is, have or have had illness which cannot be distinguished
from the kind of rheumatism that is often associated with heart disease.
48 (12 males, 36 females) have or have had chorea. Nine have had both rheumatism
and chorea, and 65 (24 males, 40 females) have old rheumatic carditis or active
carditis or both. As is usually the case, the predominance of girls over boys is
marked in the chorea group.
The effect of damp home conditions.—The clinic is as yet too young to be able to
contribute anything of value to the investigation of this problem. Also, no attempt
is made to visit on a large scale as (except from the point of view of research, which