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97
Relating this with the total number of children examined in a year it was
estimated that approximately 10 epileptic cases pass through the remand home
during a year.
Largely owing to associated personality defects, the difficulties which they
offer, as regards control and disposal, are often out of all proportion to their
numbers.
Rheumatism Scheme
(I am indebted to Dr. C. T. Thornton, who not only supervises the whole scheme
but who is also the physician to the cardiac wards at Queen Mary's Hospital for
Children, for the information in this section of the report.)
In reviewing the work of the Council's Rheumatism Scheme during 1949, the
most interesting fact revealed is the extraordinary decrease in the number of children
nominated for institutional treatment (Table 32, p. 139). In 1949 the number of
nominations received was only slightly more than half the number received during
each of the preceding two years. Not since 1927 (the first complete year the Scheme
was in existence) have there been so few nominations, and if this number can be
regarded as an index of the prevalence of juvenile rheumatism in London, it
indicates a most unusual decrease. In the annual report of the School Medical
Officer for 1948, it was pointed out that during the three post-war years (1946,
1947 and 1948) the number of nominations for institutional treatment had
remained fairly constant (613, 690, 638 for the respective years) but at a much
lower level than in the pre-war years when, in an average year, about 2,000
nominations were received. This decrease was much greater than could be
explained by the decrease in the school population in the years succeeding the war.
In the same report it was suggested that the decrease might be in part due to an
increasing tendency to nominate only the more severely affected children instead of
(as in pre-war years) regarding prolonged institutional treatment desirable for even
the mildest attacks of rheumatic infection. But although there may have been
some truth in this supposition, it would be unlikely to be the explanation of the
remarkable decrease revealed by this year's figures. It may be that hospitals are
now tending to deal with the cases themselves or through the regional hospital
organisation instead of through the school health service but there is no definite
information on this, one way or the other. Apart from this possibility the figures
seem definitely to point to an absolute decrease in the prevalence of rheumatic
infection. It may be that this decreased prevalence during 1949 was a temporary
phenomenon associated with the exceptionally "fine" weather which prevailed
during the greater part of the year which, doubtless, reduced the incidence of upper
respiratory infections in children. If this was so, it may be expected that a more
"normal" year, from a weather point of view, will be conjoined with an increase
in rheumatic infection. There is, however, another factor which may in the future
have an increasing influence on the prevalence of rhematism. During the last few
years (and probably especially during 1949), sulphonamide and penicillin therapy
for throat infections has greatly increased. The treatment of throat infections by
these compounds usually quells the infection within a few hours with a consequent
greatly diminished risk of an allergic rheumatic reaction. It may be that the
decrease in the number of nominations for institutional treatment indicates a real
decrease in the prevalence of juvenile rheumatism. Whether or not this decrease
will continue remains to be seen.
Cardiac
damage
Figures showing the percentage incidence of cardiac involvement in children
admitted each year to the rheumatism units between 1935 and 1949 inclusive are
given in Table 35. This year, for the first time since 1940, a substantial decrease is
evident, although the figure is still much higher than the figure for 1940 (51.7 per
cent. in 1949 compared with 32.1 per cent.). It must be, however, emphasised that
these figures refer to cardiac involvement and do not imply that permanent cardiac