London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1934

[Report of the Medical Officer of Health for London County Council]

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rheumatic symptoms ; conversely many cases of subacute rheumatism not labelled
chorea exhibit a nervous instability verging on this condition. The analysis referred
to previously of 1,094 cases discharged during 1934 did, however, show that
permanent damage to the heart is relatively rare in cases of chorea in which there
is no history of symptoms suggestive of rheumatism in the ordinarily accepted
sense of the word. Of the 637 girls, 143 (i.e., 22.5 per cent.) were cases of " pure "
chorea, and of these only 13 showed signs of permanent cardiac damage. Of the
457 boys, 77 were cases of " pure " chorea (i.e., 17 per cent.) and only seven of them
developed permanent cardiac lesions. It is noteworthy that the percentage of
cases developing definite cardiac disease was almost exactly the same (9 per cent.),
in the two sexes. A similar fact has been noted when dealing with its relative
incidence as a complication in boys and girls in the case of rheumatic infections
generally (boys 38 per cent.; girls 37 per cent.).
The statistics relating to the work of the supervisory centres are shown in
tables 11 and 14. An increase is shown both in the number of cases attending the
centres for the first time in 1934, and in the total number of attendances throughout
the year. A new centre at the Bermondsey Medical Mission was opened in the
early part of the year, and three new centres, one in Camden Town (in connection
with the Hampstead General hospital), and also one in Poplar and one in Deptford
are to be opened in 1935. At certain of the centres not connected with hospitals,
the doctors expressed a desire for facilities to be provided to enable them to obtain
an orthopaedist's opinion on certain types of case. Arrangements have been made
whereby these cases may be referred to the orthopaedic consultants attached to
the Council's general hospitals. In addition to the 5,466 children under supervision
at the supervisory centres, 1,803 are kept under supervision by the school
doctors, who furnish a report on each case at regular intervals to the divisional
medical officer. Immediate action can thus be taken to obtain further treatment
should necessity arise.
Ancillary to the work of actually treating and supervising children suffering
from rheumatism, a constant endeavour continues to be made to deal as far as possible
with unsatisfactory environmental conditions at home. In this connection the
care committee visitors perform an invaluable service in reporting on the home
conditions of the children. In 1934 following these reports (nearly a thousand in
number), 159 cases of unsatisfactory housing conditions were referred to the
borough medical officers of health. In a large proportion of these cases reports
were subsequently received intimating that the defects complained of (chiefly
dampness) had been satisfactorily dealt with.

Table 11.

Total number of nominations1,2341,845)1,571
Nominations received from voluntary hospitals6351,017804
„ „ „ rheumatism supervisory centres275352313
„ „ ,, school doctors185293320
„ „ „ other sources139183134
Number of children admitted to special hospitals9531,4471,096
Cases seen by medical referee in voluntary hospitals257244348
,, „ ,, „ „ in their homes501720561
„ „ „ „ „ at rheumatism supervisory centres291394329
„ „ „ „ „ at County Hall109357248
„ „ at County Hall on discharge597817867
Number of cases under supervision by school doctors1,1881,4811,803
Reports made by care committees on home conditions8141,147995
Number of rheumatism supervisory centres161617
Number of sessions at rheumatism supervisory centres6869991,051
Number of children attending rheumatism supervisory centres for first time2,0011,9732,187
Total number of attendances at supervisory centres12,88314,88015,340
Number of cases reported to medical officers of health re dampness,
etc., or to valuer for better accommodation152230159