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44
from those vague pains which are so frequent in debilitated children. A certain
number can be eliminated by a positive diagnosis of some other condition which would
adequately account for the symptoms ; the rest can only be kept under observation
and final judgment reserved. At the present time the majority of these cases are
being kept on the roll for periodic re-examination, including those thought to be not
rheumatic, for the following reasons
(1) The cases at present classified as " D " must be either rheumatic or
non-rheumatic ; actually a definite opinion is formed (but not expressed) at the
first examination but obviously the opinion can be of no value until the lapse
of time has proved the correctness or otherwise of the opinion. It is hoped that
after a sufficient interval some useful purpose may be served by a comparison
of these two groups.
(2) The treatment and management of a child suffering from true
rheumatism is entirely different from that of a child suffering from the vague
pains of flabby muscles, deficient calcium, etc. The former requires rest and
the restriction of strenuous exercises which will tax the heart ; for the latter,
exercises and games are to be encouraged. When in doubt it is a temptation to
" play for safety " and to restrict exercises, but if the child's heart is normal
(and a heart must be either normal or abnormal) one is doing it serious disservice
by the adoption of a policy which may make it a flabby hypochondriac
for the rest of its life. At these centres it is the practice to encourage exercises
for those children considered to be non-rheumatic ; it is realised, however, that
in a certain number of them the view may be mistaken and therefore it is
considered that there is an obligation to keep them under observation so that the
mistake may be recognised at the earliest possible opportunity. It may be
added that present impressions are that an error is more often made on the side
of over-caution than the reverse.
(3) Although these cases may not be rheumatic many of them are unwell,
and if a mother brings a child up for certain symptoms it seems hardly fair to
discharge it without suggesting something to help. It is encouraging to note
that some of these cases show definite improvement in health as the result of
simple suggestions as to diet, general hygiene, etc., and it is to be hoped that
some of them will grow up to believe that a bottle of medicine is not essential
for the maintainance of good health. With regard to diet one certainly gains
the impression that many of these children improve as the result of milk and
cod-liver oil in school ; in those cases in which glucose has been recommended
the results have been less dramatically successful than some modern teaching
would lead one to hope.