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This means (1) Tonsillectomy (already arranged for) ; (2) Holiday while well,
and repeat.
Memo : Home conditions not ideal—bedroom especially.
F.—This girl has had pains for five years. She is short but not thin.
She is very nervous and excitable. 1926 had acute rheumatism with swelling
of ankles. Tonsils have been removed, and yet sore throats have persisted.
Heart normal at present. Probably a genuine rheumatism, latent. (Genuine
rheumatism in family history.)
G.—This child, with occasional pains, is kept under observation because her
twin is said to have acute rheumatism at present. This child is not ill, but examination
of heart makes it imperative to treat as rheumatic, because the heart is dilated
and the rate is raised (although she is not scared).
These case notes are afterwards copied by the organiser, on to the following-up
card, and a r6sum6 is sent to the County Hall. The care committee receives a
letter notifying each new case and each subsequent attendance. The County Hall
is also notified after each attendance. Apart from these notes and letters the
organiser has in the fourteen months written about 1,470 letters to various authorities
and about 330 letters to parents.
Treatment for rheumatic and other than rheumatic conditions has been arranged
for as follows :—
Of 365 cases—172 have been referred to other departments of the hospital,
about half of this number being referred to one of the ordinary out-patient departments
of the physician in charge of the clinic. 4 were admitted to the wards of the
hospital. 32 were referred for tonsillectomy and operated on. 3 were referred for
an opinion but not operated on. 19 were treated for dental abscesses. 2 were
referred to the eye department. 13 were X-rayed. 2 attended for a period for
breathing exercises. From this it can be seen that the Queen's Hospital for
Children, by work done in its ordinary out and in-patient departments (for the
running of which it is dependent on voluntary contributions) is whole-heartedly
supporting the clinic. In addition 4 were admitted to Highwood ; one was admitted
to Carshalton ; one went to a police orphanage.
Treatment by change of surroundings.—In dealing with the class of case sent to
this clinic it is logical to try to get a holiday for each debilitated child where the
debility seems to be largely the result of home conditions. Especially has this been
aimed at in doubtful rheumatic cases and in rheumatic cases between attacks, the
essential feature being absence of active carditis. In following up this idea the
clinic has been fortunate in that it has had the support of the authorities providing
such holidays. 6 children went to Bushy on our recommendation. 2 children
stayed with relations. 5 children went to the hospital's home at Bexhill. 50
children were dealt with by the Invalid Children's Aid Association. Of the lastmentioned
50 cases, 35 received holidays in I.C.A.A. homes. 4 holidays are being
arranged. 7 were arranged but the parents disliked vaccination. 1 was arranged
but fell through owing to payments. 1 was arranged but patient went to work
instead. 1 went away after being referred to the Jewish Board of Guardians. 1 went
through I.C.A.A. to Downs. Of those patients who received no treatment it may
be assumed that either they needed no treatment and were content to receive no
treatment, or they required treatment of a psychological nature for various anxiety
or other states, such treatment being at present not available for many, and in
most cases not absolutely necessary, although desirable.
The types of case seen.—One of the results of the work done in the clinic is
the increased knowledge of what may and what may not be a " rheumatic " case,
(that is, one carrying with it a liability to rheumatic heart disease). Knowledge
on this point is still deplorably deficient, and exact diagnosis must probably wait
for the bacteriologist and experimental pathologist. As more cases, however, are