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modation falls far below requirements a step forward was made during the year in
that more than fifty children received treatment at Carshalton or Brentwood than was
the case in 1929. As in former years, the medical superintendents of Queen Mary's
Hospital, Carshalton, and High Wood Hospital, Brentwood, have always shown
themselves willing to help in providing, as far as was in their power, accommodation
for children requiring immediate treatment either on account of the severity of their
illness or because their home surroundings were unsatisfactory.
Two advances have been made in the work of following-up children who have
received hospital treatment for rheumatism. Before 1st April, 1930, when the Local
Government Act, 1929, came into force, only a limited number of children with
rheumatic affections, who had been admitted into the Metropolitan Asylums Board's
children's hospitals through the local boards of guardians, were supervised under
the scheme after their discharge. Now, however, by co-operation with the special
hospitals division and the general hospitals division every rheumatic child recommended
for treatment in a special hospital is known to the rheumatism section with
the result that medical discharge reports are now received from the Downs Hospital,
Sutton, and effect is given to recommendations concerning attendance at rheumatism
supervisory centres or for examination for certification for attendance at a school for
physically defective children. The children reported on are supervised in school
in the same manner as those discharged from Queen Mary's Hospital or High Wood
Hospital.
The other advance is that the supervision of children who have received hospital
treatment under the scheme has now also been extended to include the years
immediately following their leaving school. From the information supplied by the
returns of such supervision it will be possible to ascertain the effect of child rheumatism
in adolescence, to estimate the handicap which the disease inflicts on the young
worker, and to assure that the children are supervised or treated if this should be
necessary after they have passed out of the care of the school medical service. The
results of a few months' experience of this additional supervision are set out later.
With the further provision of supervisory centres during the year the number
of children dealt with is greatly in excess of former years : 1,387 children attended
the centres during 1930, making 6,670 attendances. These centres are a vital part
of the rheumatism scheme for they not only provide for the diagnosis and supervision
of children who do not require a stay in hospital as part of their treatment but also
select for the hospital beds available the most suitable cases. One of the most
striking feature of the year's work has been the increase in the number of children
who have been admitted to Carshalton or Brentwood on the recommendation
of the medical officers of the supervisory centres. Such children have not had, as
so many of those referred by the voluntary hospitals have, preliminary treatment
in hospital, and not only is their need of accommodation in the Council's hospitals
greater but also they furnish especially valuable information on the course which
rheumatism takes in children.
It is expected that further centres will be opened in 1931, adding to the framework
which is being gradually extended throughout the Council's area, and on which
will be built future developments of the medical and social work among rheumatic
children.
Work of
supervisory
centres.

Nomination
for hospital
treatment
during 1930.