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36
remainder (approximately 700) came in about equal proportions from the Council's
general hospitals, the school medical inspections and from outside sources.
During the year, 1,639 children were actually admitted to the units for treatment,
this representing 83 per cent. of the number nominated. In addition 115
children were found by the medical referees to be unsuitable for treatment under the
scheme and these, together with the 126 whose parents refused to allow the children
to go away, account for the greater part of the discrepancy between the number of
nominations and that of admissions.
Table 19 giving the figures of admissions to the various units and showing the
numbers of the cases in which the heart had been definitely affected before admission
shows that the clinical picture as a whole has changed little from that which last
year's figures indicated. Boys formed a slightly larger proportion than usual of the
total number of admissions, the proportion of girls to boys being usually about
three to two, whereas this year's figures show the proportion to be about six to five.
Approximately 40 per cent. of those admitted had evidence of definite cardiac
damage, and as usual boys suffered to a slightly greater degree than girls (boys,
41 per cent.; girls, 39 per cent.). It is a possibility that the somewhat greater
physical activity which boys exhibit, and their disinclination to accept the role of
invalid until compelled to do so, may be related to this.
In rheumatism the final condition of the heart is a trustworthy indication of the
success or failure of the end results of treatment. Measured by this standard, table
20 shows that in approximately 2 per cent. of cases treatment must be regarded as
having failed since the children were discharged as unfit for any form of activity.
But there is, nevertheless, legitimate ground for satisfaction when it is noted that
84.5 per cent. of the children discharged were regarded as fit to resume normal
life, and the number of those who were partially incapacitated by reason of cardiac
involvement was only 13.5 per cent. of the total, against 16 per cent. during the
preceding year. There is excellent hope that this number will be reduced still
further as it becomes more and more realised by all those who have anything to do
with children that rheumatic infection of the heart is of all diseases the most
treacherous, producing its effects with few or none of those signs which the general
public are accustomed to associate with heart disease. One of the greatest difficulties
experienced by the physician in the treatment of rheumatic infection is to secure the
whole-hearted co-operation of the parents who feel that his attitude is somewhat
" grandmotherly " when he insists that a child who does not complain needs prolonged
rest in bed.
The statistics relating to the work of the supervisory centres are shown in
tables 18 and 21. Somewhat fewer new cases were seen than during the preceding
year, but the decline was trifling. Additional centres were opened at the Hampstead
general hospital, at Poplar, and at Deptford. An increase of 733 in the total number
of children attending the centres, i.e., including old cases, is registered, and a very
considerable increase in the number nominated by the centre doctors for institutional
treatment (526, as against 313 for 1934).
Gratitude must again be expressed for the great help obtained from the care
committee organisation in connection with the reports on the home conditions of the
children. As a result of these reports borough medical officers of health were notified
in 225 instances of defective housing conditions. In addition the care committee
visitors have provided valuable reports on individual cases of children absent owing
to recurrence of rheumatic infection.