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is not our main object) as much as is required to be known of the patients' homes
can be culled from the parents' remarks. Mrs. Farmer, the Council's organiser at
the clinic, has formed the opinion from her friendly discussions with the parents,
apart from whatever diagnosis may later on be made by the physician, that in 66
of the 365 cases the conditions at home are outstandingly damp. Of these 66 cases,
39 were diagnosed as not rheumatic or choreic; 9 were found to have rheumatic
heart disease, past or present, and 18 (15 rheumatic, 3 choreic) had no heart disease.
Of 365 cases 63 per cent, have not been diagnosed as rheumatic or choreic,
17 per cent, have heart disease, past or present, 20 per cent, are rheumatic or
choreic but without heart disease.

All that can be deduced from these figures is that dampness, as assessed at this
clinic, is not yet shown to be of great importance in the causation of rheumatic
heart disease.
Activities of the Clinic.—The main activities of the clinic are continuous diagnosis
and supervision according to diagnosis. When each case has been seen for the first
time and the personal history, family history and present home conditions have
been examined from the more or less complete account obtained from the parent,
a statement is written down by the physician in charge. This is more comprehensive
than a diagnosis and at the same time more accurate for the description of most of
the cases, especially where doubt exists. Some sample notes are here given:—
A.—I consider this boy is healthy. In routine examination at school S.M.O.
found (I understand) some abnormality which caused him to tell the boy he must
not play games and must attend this clinic. There is no history of rheumatism.
Heart.—Apex beat in nipple line, normal impulse, rate natural for the place and
time, sounds normal and nothing added. During inspiration there is a systolic
cardio-respiratory murmur which has no significance. Probably this murmur
caused the S.M.O. to take precautions I should advise that the boy be treated as
normal in every way. Tonsils are enlarged, but in the absence of sore throats, rheumatism,
heart disease, etc., I should not advise interference,
B.—This girl has had acute rheumatism and chorea, and so is liable to it again.
Heart shows no signs of past or present disease. I do not think there is chorea at
present, but for observation in ordinary out-patient department.
C.—This child, very nervous, gets pains and is pale. Apart from this there is
no sign of disease anywhere. It is possible that the mother (having lost two children
and being left with this one alone) tends rather to overdress and over-care for this
girl. At present (as the S.M.O. noted) the heart is natural. As the girl will be kept
under observation she may do drill and keep at school.
D.—This child is liable to acute and sub-acute rheumatism, and her mother and
two sisters are rheumatic. The heart is at present normal. The fidgetiness is not
typical of chorea and is probably emotional in origin and unrelated. A good case
to take trouble over.
E.—This boy, whose heart is normal and who has not definitely had rheumatism,
gets odd pains and lolls about. As his mother, brother and sister have had acute
rheumatism he should be treated vigorously according to present knowledge in order
to prevent acute attacks.