London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1931
[Report of the Medical Officer of Health for London County Council]
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47
The increase in the number of cases admitted to Carshalton and Brentwood has been of
great advantage ; it is gratifying to see the satisfactory general condition, even in serious heart
cases, on their return from these institutions ; whilst, for the milder cases, a period of prolonged
treatment is provided, which would be out of the question at a London hospital, but which is of
immense value in giving such cases a good prospect of a permanent recovery.
The help of the Invalid Children's Aid Association has again been most valuable, especially
in the case of debilitated children without active rheumatism or carditis.
Treatment at residential open-air schools is reserved for debilitated children considered
entirely free from rheumatism or chorea.
Table VI shows the arrangements which have been made with regard to school attendance.
Whilst every effort is made to allow as many children as possible to continue at ordinary elementary
schools, experience seems to suggest that children with definite cardiac trouble do better
if they go to a school for the physically defective on their return from an institution. In addition
there are a certain number of cases of quiescent rheumatism and chorea (especially chorea), who,
although free from cardiac involvement, are continually having little set-backs and seem quite
unable to attend school regularly. To tell their mothers to "keep them quiet at home" is often
a mere waste of words ; they simply run the streets and then on their return to school are behind
with their work, with the result that they worry and fret and develop an attack of chorea. If
such children are sent to a P.D. school they are frequently able to attend regularly without relapsing,
and continued courses of residential treatment are avoided. Moreover, in the case of
children considered unfit for active games, etc. (although otherwise fit for elementary schools),
instructions for the exclusion of such activities are frequently vitiated by the fact that such children
have opportunities for taking strenuous exertions on the way home, etc. ; at P.D. schools closer
observation is possible. Further, an invalid child is less likely to develop an " inferiority complex
" when all his companions are in like case, than at a school where all the others are playing
football whilst he is compelled to stand aside.
Table VI.
| Downham. | " Elizabeth Bullock." | Putney. | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cases of rheumatism and chorea with carditis. | Cases of rheumatism and chorea without carditis. | Doubtful rheumatism. | Non-rheumatism. | Cases of rheumatism and chorea with carditis. | Cases of rheumatism and chorea without carditis. | Doubtful rheumatism. | Non-rheumatism. | Cases of rheumatism and chorea with carditis. | Cases of rheumatism and chorea without carditis. | Doubtful rheumatism. | Non-rheumatism. | |
| Attending secondary and central schools | 6 | 3 | 9 | 1 | — | — | 2 | — | 1 | — | — | — |
| Attending elementary schools without restrictions | — | 38 | 65 | 49 | — | 50 | 55 | 30 | — | 5 | 18 | 10 |
| Attending elementary schools with restrictions | 35 | 16 | 10 | 9 | 24 | 22 | 6 | 2 | 15 | 17 | 7 | I |
| Attending P.D. schools | 24(8) | 8(1) | — | — | 26 (14) | 2(1) | 1 | 1 | 4(1) | – | – | – |
| Attending open-air schools | —— | 2 | 4 | 4 | – | – | 1 | – | – | – | – | |
| Attending M.D. schools | —— | – | – | – | 2 | 1 | – | – | – | – | – | – |
| Absent from schools practically throughout | 10 | 2 | 1 | – | 5 | 2 | 1 | — | 2 | 3 | — | — |
The figures in brackets indicate the numbers of cases transferred to P.D. schools during the current year.
As pointed out in the report for 1930, one of the most difficult problems at a rheumatism
supervisory centre is the assessment of those children who complain of recurrent pains in the
limbs without any history of acute arthritis or chorea. At the present time, there appears to
be no definite means of saying which of these cases are "true rheumatics," (and potential cases
of carditis) and one has to rely largely on one's clinical impressions. A review has been made of
the notes of all the cases attending the centres, and certain data prepared for comparison between
the various groups. For this purpose the cases have been sub-divided as follows:—(a) cases
with a definite history of acute arthritis; (b) cases of insidious rheumatism with carditis; (e)
cases of insidious rheumatism without carditis; (d) cases of doubtful insidious rheumatism.
(The classification of a case under (c) or (d) is, of course, only based on clinical impressions and for
some purposes they have been grouped together.)