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43
In continuance of the following up of children who had received residential
treatment under the scheme and who have since left school, care committee representatives
have visited the homes of 101 children (33 boys and 68 girls). Their reports
show that 37 of these children have had rheumatic symptoms since leaving school,
and that 33 of them have remained under medical supervision. It is gratifying to
learn that 91 of these children have been regularly employed, some of them, of course,
in sedentary occupations. The reports of the school care committee visitors show,
moreover, that the children are generally well housed : there being only three cases
of overcrowding and two of dampness notified in the 101 visits.

The larger number of total cases in the later age periods is explained by the fact
that the rheumatism scheme having begun in 1926, many of the younger cases in
the scheme have not as yet attained the age of 14 years.
One thousand attacks of rheumatism, distributed over a period of five years,
were studied in relation to monthly variations in rainfall, air humidity, air and earth
temperature, and hours of sunshine. An increase in incidence of rheumatism was
usually found when the rainfall was below normal for the time of year : not so
constantly an excessive rainfall spelt less rheumatism ; both these being contrary to
popular opinion. Variations in air humidity appear to have little influence on the
prevalence of rheumatism. A low air temperature with an average rainfall has also
little influence, but a temperature above normal with an average or excessive rainfall
seems to diminish the incidence. An increase in the hours of sunshine usually diminishes
the amount of rheumatism, but the influence of the increased number of sunny
hours does not combat the influence of a decrease in rainfall. Less sunshine usually
means an increase in rheumatism.
So far as it is justifiable to draw conclusions from the data available, a rainfall
below the average for any season of the year appears to be the most potent factor in
the production of an increase in rheumatic incidence, the combination most likely
to give an increase in rheumatism being a rainfall below normal, a diminution of the
amount of sunlight, and a low air temperature; that producing an opposite effect
being a rainfall above normal, more than the average amount of sunshine, and a
high air temperature.
Three new rheumatism supervisory centres were opened during the year: Lewisham
(April), St. George's Hospital (April) and Eltham (August). From April the
Royal Free Hospital rheumatism supervisory centre was subsidised by the Council
for the first time. There are now 15 rheumatism supervisory centres working under
the scheme, and it is hoped to relieve the pressure on the Queen's Hospital Centre
and on that at the Royal Waterloo Hospital by the provision during the coming
year of a centre at Stoke Newington, and allowing an extra session to cope with the
increase in work at the Royal Waterloo Hospital. It is also intended to have one
session a fortnight at the Putney centre, instead of one session a month as at present.
Followingup
of
discharged
children.
Age of
onset in
relation to
heart disease.
Rheumatism
and climatic
conditions.
Rheumatism
supervisory
centres.