View report page

44
Rheumatism
supervisory
centres—
St. George's
hospital.
East London
hospital.
Lowisham.
During 1931, 3,816 children attended the centres, making 9,767 attendances,
and of these children 1,792 attended for the first time. Recommendations were made
by the medical officers in charge of the centres in regard to 2,913 children, and of these
recommendations 39 related to the home conditions of the children and were referred
either to the medical officer of health of the borough in which the child resided, or to
the housing department of the Council. There were 346 recommendations for residential
treatment; 159 for residential treatment at one of the special hospitals
under the rheumatism scheme; and 187 for treatment at other hospitals. In this
connection it should be noted that some of the subsidised centres attached to voluntary
hospitals admit children direct to the wards of the parent hospital. There were 399
recommendations for convalescence and 1,244 for non-residential treatment. At
the Council's centres such treatment is restricted to conditions which are lowering
the resistance of the child to the rheumatic infection, e.g., dental sepsis, tonsillitis,
etc., whilst at the subsidised centres at voluntary hospitals treatment for the rheumatic
condition is also sometimes prescribed. There were 885 recommendations
concerning school attendance; 331 of these were for exclusion from school for a period,
165 were for schools for physically defective children, and 389 for restrictions in
elementary school activities.
Analysis of the reports on the children visiting the centres for the first time during
1931 reveals that, of 1,792 children, 532 were diagnosed as non-rheumatic, 1,027
as articular rheumatism (400 boys and 627 girls), and 233 (97 boys and 136 girls)
as suffering from chorea. In 148 boys suffering from articular rheumatism the heart
was affected, whilst 213 girls suffering from the same form of the disease had cardiac
disease. In the chorea cases the heart was affected in 18 boys and 31 girls.
From April, 1931, complete returns have been made from the centres showing
the agencies nominating children for attendance at the centres for the first time, and
the information so received relates to 1,403 children. Of this number 138 children
were nominated from County Hall as part of the procedure of following up Public
Assistance cases discharged from Queen Mary's Hospital for Children, Carshalton,
or from the Downs Hospital for Children, Sutton. In all, 936 children were recommended
by school doctors, school care committees or head teachers, 177 were sent
to the centres by hospitals, in 99 cases the parents themselves brought the children
to the supervisory centres, 27 were nominated by private practitioners, 17 children
were nominated bv the Invalid Children's Aid Association, and 9 came from various
other agencies.
Dr. Levick, commenting on the work of the St. George's Hospital rheumatism
supervisory centre, which opened in April, 1931, points out that the first batch of
children attending the centre were those who were suffering from established heart
disease, and who were referred from other departments of the hospital. He emphasises
the value of the convalescence, provided by St. George's Hospital at the Atkinson
Morley home at Wimbledon, in increasing the resistance of those children whose
hearts are as yet unaffected, against the rheumatic infection.
The East London Hospital rheumatism supervisory centre is reported on by
Dr. Gotch, the honorary physician in charge. Dr. Gotch classifies the children attending
the centre during the year :—
(1) Those with symptoms suggestive of rheumatic infection but without
any confirmatory objective evidence (45 per cent.).
(2) Those with symptoms and later (3 to 6 months) showing objective
signs (35 per cent.).
(3) Those with symptoms and definite objective physical signs at the first
examination (20 per cent.).
Dr. Baker reports a successful opening for the Lewisham rheumatism supervisory
centre, which also came into being in April, 1931. One feature of the work at this
centre is the comparatively large numbers of children nominated for attendance by
their parents. Dr. Baker has adopted a system under which children suffering from
true rheumatism, but with no signs of active disease, are inspected every three months,