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50
King's
College
hospital.
Eltham and
Royal Free
hospital.
St.
Marylebone
general
dispensary.
to give their children a generous supply of vitamins in the form of fresh fruit, viz.,
orange juice, apples and other cheaper fruits in season.
Dr. Slot sums up the measures of chief value in the prophylaxis of rheumatism
at a rheumatism supervisory centre :—
(1) Co-operation with parents is ensured.
(2) The elimination of naso-pharyngeal and dental sepsis.
(3) The building up of the constitution by adequate convalescence.
(4) The administration of glucose in the form of barley sugar. (This simple
measure has been found of great value in suitable cases.)
(5) The realisation of a special rheumatic psychology.
Dr. A. Gilpin's report on the King's College Hospital centre reveals that, out
of a total of 273 children attending the centre, 253 were Council cases. During the
year 137 children attended for the first time and of these 92 were considered to be
suffering from rheumatic conditions. Of these 92 cases, 22 had rheumatic pains alone,
with no cardiac involvement, no chorea or nodules. The remaining 70 cases were
suffering from "further" rheumatic manifestations in the form of cardiac disease,
chorea, etc.
In the 45 non-rheumatic cases seen during the year the following diagnoses were
made:—
Debility and other minor ailments 18
Functional cardiac bruits 11
Tonsils and adenoids 8
Tic and habit spasms 4
Congenital heart disease 3
Enlarged mediastinal glands 1
Dr. Olive Rendel classifies the condition of the children seen by her at the
Royal Free Hospital and Eltham centres :—
Active rheumatism 23
Quiescent rheumatism 48
Doubtful rheumatism 38
Probably not rheumatic 20
Dr. Rendel diagnosed the non-rheumatic cases : Oral sepsis, 2; septic tonsils, 1;
rickets, 1; congenital heart and septic tonsils, 1; habit spasms, 2; functional
cardiac murmurs, 8; postural defect, 1; allergy (cyclical vomiting, asthma, urticaria),
3; and badly fitting boots, 1.
Dr. Halls Dally has communicated a report on the St. Marylebone centre from
which the following extracts have been made:—
The preventive aspect is held to be the prime objective. Parents are encouraged to bring
their children for examination whenever possible prior to the manifestation of rheumatic
symptoms, and for treatment where the disease already exists. Pale and weakly children, often
irritable, fretful and troublesome, possibly with nervous twitchings, and difficult to deal with,
when coming of rheumatic stock, are brought for supervision before actual stigmata of rheumatic
disease have become apparent. The disease frequently begins insidiously as a general falling-off
in health, accompanied by pallor, " growing pains," and occasional sore throats.
By timely advice to parents, as to pre- and post-natal management, combined with
appropriate treatment to raise the resistance of the child against unfavourable influences in
general, it is believed that weakly children of rheumatic stock may themselves be aided to work
out their own immunity.
A detailed analysis of 250 cases is appended.
Rheumatic History previous to Attendance.—Pains in limbs, in 177 cases; Upper respiratory
infections, in 78 cases; Acute rheumatic fever, in 28 cases; Chorea in 16 cases; Rheumatic
cardiac affections, in 9 cases; Swelling of joints, in 15 cases; Erythema nodosum, in 2 cases;
No symptoms in 15 cases.
Symptoms on First Attendance.—Pains in limbs, in 121 cases; Tonsillitis, in 1 case; Swelling
of joints, in 4 cases; Pallor and loss of weight, in 8 cases; Twitching, in 15 cases; Nervous
instability, fatigue, anorexia, vasomotor disturbances, &c., in 69 cases; Dyspnoea, in 7 cases;
No symptoms, in 46 cases.
Nutrition.—Good, in 90 cases ; Fair, in 94 cases ; Poor, in 66 cases.
Teeth.—Excellent, in 8 cases ; Good, in 94 cases ; Defective, in 148 cases.
Eye Colour.—Grey, in 92 cases ; Brown, in 65 cases; Blue, in 41 cases; Hazel, in 29 cases;
Not stated, in 23 cases.