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33
The heart was reported to be affected in 392 children (154 boys and 238 girls)
admitted to Queen Mary's hospital, Carshalton, or to High Wood hospital, Brentwood.
Of the 528 cases of articular rheumatism, valvular disease of the heart was
diagnosed in 184 (65 boys and 119 girls), carditis in 122 (58 boys and 64 girls), while
7 children (3 boys and 4 girls) were suffering from congenital heart disease. Amongst
the 195 cases of chorea there were 47 children (18 boys and 29 girls) with valvular
disease of the heart, and 32 (10 boys and 22 girls) with carditis.
Several of the cases of carditis showed a rheumatic infection superimposed on a
congenital heart lesion and evidence is being accumulated in support of the hypothesis
that the congenitally deformed heart falls an easier victim to the rheumatic infection
than does the normal heart.
The Downs hospital, Sutton, admitted 138 children (64 boys and 74 girls)
during 1932. As has already been stated these children would not have been
considered suitable for treatment under the rheumatism scheme as originally
organised. The ability to provide for these cases marks a distinct step forward in
the attempt to deal with the problem of the rheumatic child in London. This is
particularly true of the provision of supervised convalescence for children who are
well on the way to recovery from a rheumatic attack, for convalescence of an
ordinary character does not provide for the medical oversight which is essential in
these cases. Of the children admitted to the Downs hospital, Sutton, 116 (62 boys
and 54 girls) were or had been suffering from articular rheumatism, and 22 (10 boys
and 12 girls) from chorea. Advanced heart disease was present in 31 (16 boys and
15 girls), and 107 (48 boys and 59 girls) were in a convalescent stage.
There were re-admitted to hospital during 1932, 92 children (56 boys and 36
girls) who had been previously receiving hospital treatment under the rheumatism
scheme. Acute articular rheumatism had developed in 4 (2 boys and 2 girls), acute
chorea in 2 (1 boy and 1 girl), sub-acute rheumatism was present in 51 (18 boys and
33 girls) and sub-acute chorea in 35 (7 boys and 28 girls). Valvular disease of the
heart was diagnosed in 27 (9 boys and 18 girls) of the children suffering from articular
rheumatism, and in 8 (3 boys and 5 girls) of those suffering from chorea.
The discharges from hospital during the year were 843 (380 boys and 463 girls).
On admission to hospital 663 (296 boys and 367 girls) were suffering from articular
rheumatism and 180 (84 boys and 96 girls) from chorea. On discharge 301 (112 boys
and 189 girls) had valvular disease of the heart and there were 9 cases of congenital
heart disease (2 boys and 7 girls). The average length of stay in hospital of these
children was rather more than six months.
Of the 843 children discharged from hospital during the year, 572 (253 boys and
319 girls) were reported as being fit for the ordinary curriculum of an elementary
school, 137 (72 boys and 65 girls) were deemed suitable for an elementary school
with restriction of games and drill, 97 (42 boys and 55 girls) were certified for schools
for physically defective children, 30 (7 boys and 23 girls) were over school age, and
in 7 cases (6 boys and 1 girl) the parents of the children had removed outside the
county area whilst their children were receiving treatment in hospital.
There were 11 deaths (4 boys and 7 girls) in hospital during the year. Of these
children 2 had been admitted for treatment in 1930, 4 in 1931 and 5 in 1932.
From 1st May, 1932, to the end of the year accommodation was provided for
all children nominated and coming within the scope of the scheme. In all cases
where this was possible the children nominated were examined within seven days of
such nomination, and, except for a week or two at the end of the year when there
was a little delay the admission of suitable cases to hospital followed promptly.
Summary.
In the report for 1931 it was stated that the pressure of work had fallen with
particular severity on two of the centres which are responsible for the supervision of
children suffering from rheumatism. The centre at the Queen's hospital for
children had been over-worked during the whole of 1931, and to relieve this centre
an additional rheumatism centre was opened in April, 1932, at the school treatment
centre in Church-street, Stoke Newington. The monthly session held at Putney
was found to be inadequate to the needs of the district and from April, 1932, sessions
took place fortnightly. It was also found necessary to hold an extra weekly session
Rheumatism
supervisory
centres.