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The number of children suffering from chorea of such severity as to need institutional
treatment still seems to fall, but it is noted that the percentage of those with cardiac
and valvular damage has risen somewhat, and that this is more noticeable amongst the
girls than amongst the boys (see Table 18, page 188).
The schools for physically handicapped children still prove a valuable haven of
refuge for cardiac cripples and enable them to return to a more satisfactory attitude of
mind with regard to their disability. The modified activities and rest periods which are
available for them, help to tide over that period between invalidism and competitive
life which would otherwise engender strain to their cardiovascular system and cause
possible relapse. Table 19, page 188, gives details of the condition on discharge from
hospital.
The role of the streptococcus as a factor in causing cases to relapse has always to be
kept in the forefront of the picture, and physicians in charge of rheumatism supervisory
centres are careful in checking upper respiratory infection and sore throats at the earliest
possible stage; while it has now become routine to deal with dental extractions in
cardiac cases under a penicillin umbrella.

Child
guidance units
Child psychiatry
In London most child guidance clinics have always been provided by or in association
with the teaching hospitals and by voluntary associations taken over by the metropolitan
regional hospital boards. There are now 23 such clinics which, however, draw their
patients from a wide area in the south of England and which tend to be concentrated
in central London, so that there are parts of the County which are not so well served.
The Council opened its fourth child guidance unit in October in a well designed suite
in the new comprehensive health centre at Woodberry Down. The consultant psychiatrist
and medical director is employed by the regional hospital board and the rest of the
staff, educational psychologist, psychiatric social worker and clerk, by the Council.
All the units have more cases than they can treat and a child has to wait for between
two weeks (Earls Court) and three months (Woodberry Down) before being seen,
but more serious is the much longer period of up to six months before therapy can be
commenced for those children found to require it.
The Earls Court unit continued throughout the year without any staff changes.
At Battersea the psychiatrist resigned in June and a new appointment was made;
the educational psychologist's sessions were increased from four to six weekly and the
psychiatric social worker gave all her time (instead of only eight sessions a week) to the
work of the unit.
At Brixton one of the psychiatrists and one of the psychiatric social workers resigned
during the year and the other psychiatric social worker transferred to other work in
the school health service; two new social workers and one educational psychologist
were appointed. The medical director continued to be responsible for the training of
a number of child psychiatrists from the Institute of Psychiatry and, in addition to the
therapeutic work in the clinic, was able to develop educative work among teachers,
health visitors, and other adult groups in the area. The senior Registrar at the unit
attends two of the local infant welfare centres each week and it is noteworthy that
more than 10 per cent. of the new cases referred were under the age of five.