View report page

49
intermittent pains in the limba without showing any cardiac abnormality. On the other hand,
the cases of insidious rheumatism "with organic carditis often complain very little of pain,
whilst (as shown in Table VII) 50 per cent of children who have had rheumatic fever have not
complained subsequently of pain. Yet that some of these "mild cases" really do suffer from
quite severe pains cannot be denied, and one sometimes asks oneself whether one is doing these
cases full justice in directing so much attention to their hearts ; is it possible that some of these
children have a myo-fibrocitis of chronic nature ? Many of one's adult patients suffer from
similar symptoms and one's efforts are principally directed to the relief of the pains by means of
baths, massage and other forms of physio-therapy.
In our present state of knowledge (or lack of it), it does not seem reasonable to say that
any child, persistently suffering from pains in the limbs, is not rheumatic, unless one can provide
some alternative explanation for the occurrence of the pains. The following disorders have
been found among children sent to the clinics for supposed rheumatism. Flat feet and other
minor orthopaedic defects; scoliosis and postural defects; coxa vara (one case); defective
circulation from tight garters, etc.; arthritis of traumatic origin; calcium deficiency; an»mia
and general debility; dyspepsia and acidosis; catarrhs; enlarged glands; habit spasms ;
nervousness; abnormal psychology; congenital morbus cordis; healthy children with functional
murmurs; erythema nodosum; purpura.
During the year the rheumatism supervisory centre at the Hospital for Sick
Children, Great Ormond-street, lost the services of Dr. Sheldon, who had been in
charge since its inception. Dr. Moncrieff, in reporting on the work of the centre for
1931, pays just tribute to Dr. Sheldon's outstanding pioneer work. A little over
half the number of the children attending the centre are on the rolls of Council schools,
the remainder coming from extra-metropolitan areas. Dr. Moncrieff reports that
the children attend regularly, and that the increase in parental interest is shown by
the small number of patients discharged for non-attendance in 1931 compared
with previous years. He emphasises the valuable work done by the Hospital's
Heart Home at Lancing, to which 63 of the children attending the clinic were sent
for convalescence during the year, and points out that the accommodation of the home
has been increased by the addition of twenty beds. He also reports its recognition
as a residential school by the Board of Education.
Dr. Sophian, in his report on the Woolwich rheumatism supervisory centre,
records that, of 119 children attending the centre during the year, 21 had definite
rheumatic heart disease, suspicious heart changes were found in 40 children, and that
58 showed no clinical evidence of heart involvement. Dr. Sophian states" It has
become apparent to me that greater resort must be made to convalescence . . .
thereby exploiting to the full the usefulness of the supervisory centre."
Dr. Gerald Slot, who is in charge of the Hammersmith and Royal Waterloo
centres, has investigated the conditions under which the children attending these
centres sleep. Of 455 children, 44 had a bed and room to themselves, 129 had a bed
to themselves but shared a room, whilst 282 shared a bed with one or more others.
Dr. Slot emphasises the point that in many of these cases it is impossible for the
children to secure the necessauy amount of rest. On the preventive side he relies
upon the Invalid Children's Aid Association and schools for physically defective
children; and he is of opinion that, where special treatment at Queen Mary's Hospital,
Carshalton, or High Wood Hospital, Brentwood, has been deemed necessary, consolidation
of such treatment at a school for physically defective children is indicated.
Dr. Slot states further that in his opinion if these children are sent to a school for
physically defective children they will make satisfactory progress with their education,
whilst, if they are allowed to remain at an ordinary school for a lengthy period, their
activities being restricted, the effect on their characters is very disturbing. The
effect of prescribing "no school" for several weeks or months has a like effect,
and Dr. Slot states that these children are much better off at a school for physically
defective children, where they have medical supervision and the attention of specially
trained nurses, than when they are playing in the streets or acting as household
drudges.
At the Hammersmith centre an investigation has been made into the diets of
the children. On the whole the diets appeared to be deficient in protein, and the
parents were advised to make use of the cheaper protein foods, e.g., herrings, and
rheumatic
cases.
Hospital for
Sick Children.
Woolwich.
Hammersmith
and
Royal
Waterloo
hospital.
E