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supervision of London children suffering from rheumatic disease. Associated with
this the Scheme was concerned with the investigation and amelioration, if necessary
and possible, of the social environment of the rheumatic child, and the collection of
information relating to the incidence and effects of juvenile rheumatism. The
acquisition by the Council in 1930 of Children's Hospitals formerly under control of
the Metropolitan Asylums Board naturally facilitated a considerable expansion in
the number of beds available for institutional treatment, and permitted a much
more intimate association of the treatment side with the administrative and
supervisory side of the scheme. The advantages of such an intimate association
were considerable, and it is to be hoped that under the new regime the benefits of
this close co-operation will not be lost. From the point of view of the continuation
of the campaign against juvenile rheumatism in London (which during the 22 years
the scheme has been in existence has met with no small measure of success) nothing
would be more disastrous than a breaking up of the present co-ordinated organisation
into a number of regional independent organisations associated with individual
hospital treating units. The provision of beds is now a matter for the regional and
other hospital boards, but only by the continuance of a central organisation which
concerns itself with co-ordination of all the branches of the rheumatic problem, can
a true picture be obtained of the position and a satisfactory scheme be maintained.
Nominations for admission to hospital were 614, the average figure for the past
three years being 637. During the three years before the outbreak of war the average
number of nominations was 2,380, which, considering the reduction of the London
school population, gives a rate 50 per cent. above the present one. The average
number of children under supervision is also much smaller as the pre-war number
was 175 per cent. of the present one.
On the other hand the percentage of children admitted with established cardiac
damage tends still to increase, being 70.2 compared with 41 for the years 1934-38
and 67.7 last year. (Table 33.)
These changes may mean that the infection when it does occur is more virulent
or that there is a more severe selection before a case is referred to hospital and
Dr. Thornton, the physician in charge of the scheme, who is in personal touch with
the children while in hospital, favours the first alternative.
Social
Conditions
Reports received relative to the home conditions of rheumatic children are still
depressing. Reports of dampness, the results of bomb damage and general dilapidation,
are still frequent. The energetic co-operation of the Borough Medical Officers
of Health in dealing with such conditions is again gratefully acknowledged.
Audiometric testing
Tests of the hearing of pupils over seven years of age by means of portable
gramophone audiometers, with which specially trained school nurses are able to test
forty pupils at one time, were carried out in schools in three divisions during the year.
Any child with a loss of nine decibels or more in either ear is tested a, second
time by gramophone audiometer, as many, especially younger, children, fail in the
first test through lack of attention or other cause. A limited number of children
who failed the second gramophone audiometer test were given a further test by
puretone audiometer with a view to obviating the reference to special ear centres
for treatment of those not in need of it.
The total number of pupils tested by gramophone audiometer was 26,572, of
whom 6,438 failed in the first test; 2,128 failed in the second test. It was only
possible to arrange for 505 of those who failed the second test to be tested by puretone
audiometer, of whom 214 failed. The pupils failing the puretone audiometer test,
together with the remaining 1,623 of those who failed the second gramophone
audiometer test, were referred to special hearing centres. A total number of 726