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40
Factors
influencing
the
recurrence
of rheumatism.
Of other factors environment and heredity seem to play that indefinite part which
is met with in studying the causes of rheumatism. In these relapsed children a
family history of rheumatism was met with in 27 (40 per cent.) of 67 cases in which
the information was available. In 609 cases in which the family history was known
and in which no relapse occurred rheumatic inheritance was shown in 212 (34 per
cent.). In 100 of these relapsed children the home conditions were investigated.
Taking as unsuitable environment, dampness, or four or more persons per room, or
three persons or more in the child's bedroom, or a combination of these, 62 (62 per
cent.) of the children were unsuitably housed. This figure may be compared with 426
children out of 748 cases, or 57 per cent, investigated, whose home surroundings were
not good and who have not relapsed. Unfortunately no information was available
on the family income per head, or details as to the feeding of the children, perhaps the
most important point of all.
Handicap
of the
rheumatic
child.

The decisions recorded in this table are revised according to the needs of the
children as decided by the assistant medical officers at their special periodic
examinations of the children in school, and by the doctors in charge of the various
rheumatism supervisory centres, but the figures shown indicate to some extent the
handicap of the rheumatic child during its school life.
Detailed
reports of
rheumatism
supervisory
centres.
The physicians in charge of the Council's rheumatism supervisory centres have
in many cases supplied detailed reports of the year's work. The rapidity with which
the centres have grown in number and the readiness with which the parents of
rheumatic children seek advice upon them are testimony to the need and value oi
this type of institution. Rheumatism now takes the first place amongst diseases
which produce chronic invalidity in our children and the work of the supervisory
centres is an attempt to limit so far as possible the crippling which results from this
most serious complaint.
Woolwich
supervisory
centre.
Dr. John Sophian, at the Woolwich supervisory centre, has noted that the
incidence of rheumatic pains falls more heavily in the Eltham area than in the
other districts served by the centre, and he suggests that among the factors to
account for this, are the clay sub-soil, and the large proportion of newly built
houses. He refers especially to the high percentage of attendance and to the
willingness of the parents to follow the advice given. The help given by the Invalid
Children's Aid Association is gratefully acknowledged.
King's
College
Hospital.
Dr. J. H. Easton reports that the rheumatism supervisory centre at Kings
College Hospital opened on April 2nd, 1930. Especial care has been taken in enquiries
into the conditions governing the environment of each of the 186 patients who have
attended, and where possible adequate steps have been taken to improve these.
East London
Children's
Hospital.
Dr. W. F. Gaisford reports that the supervisory centre at the East London
Hospital started in January, 1930. Special care has been taken to impress upon the