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Some of the points still being studied and carefully considered by the physicians in
charge of the rheumatism supervisory centres are the causes of relapse. It is noted,
that, although the number and severity of the new cases that are dealt with seem to
be declining, there is still a regrettable number of cases that continue to relapse. Systematic
tonsillectomy in selected cases during the convalescent stage certainly seems to
mitigate the frequency of these relapses, while another line of attack is to exhibit one
of the sulpha drugs in a small daily dose over a prolonged period in order to obviate
secondary infection of the upper respiratory passages. The prompt attention to upper
respiratory infections and their early treatment by antibiotics does seem to be important,
but the value of prolonged administration of such drugs seems open to doubt on grounds
other than that of the production of resistant strains of bacteria. A research on the use
of sulphanilamide for such cases, carried out by some of the Council's physicians eight
years ago did not show favourable results; yet the use of more modern sulpha derivatives
seems to be popular in some quarters nowadays. It would be interesting if the relapse
rate of those undergoing such treatment could be more fully followed up and perhaps
it may be possible to do this in the future.
Remedial exercise classes
Special classes to correct foot defects, before they develop into permanent disabilities,
which were first introduced in 1948, continue to be held mainly in primary schools.
They are taken by a class teacher who has attended a course given by the Council's
consultant on postural defects (Dr. Doris Baker), and the senior inspectors of physical
education of the Education Officer's department. The general medical supervision of
the classes is undertaken by one assistant medical officer in each division who is also
responsible for selecting the children and for their discharge on improvement. Dr. Baker
visits each class at least once during each year.
Diabetic children
The Council's diabetic unit is housed in the residential school at Hutton, Essex, and at
the end of 1953 contained 35 pupils, 16 of whom were from out-County education
authorities. Children suffering from diabetes mellitus, which cannot be adequately
controlled at home, and who are of such intelligence as to profit by their stay are
admitted. The principles of the control of the disease and the importance of dietary
are taught at the unit, and the children are trained to render their own insulin injections
and to guard against the accidents of a diabetic life. They take part in all school activities,
including a fortnight's visit to a holiday camp.
A visiting medical officer and nursing staff with special experience provide the day
to day care and a consultant visits fortnightly and at such other times as are necessary.
The laboratory work, to ensure control, is undertaken by a technician under the direction
of the consultant.
During the year the Diabetic Association again organised a scheme whereby diabetic
children from various parts of the country attend holiday camps at Walton-on-the-Naze,
Essex; Etton, Nr. Beverley, Yorkshire; and Deal, Kent. A small number of diabetic
children attending ordinary schools in London were sent to these camps and benefited
not only from the holiday itself but also from instruction in the diabetic way of life.
The accommodation at Martello Camp, Walton-on-the-Naze, was provided by the
Council and the camp was held in conjunction with the Council's diabetic unit.
Child psychiatry
In London most child guidance clinics have been provided by or in association with
the teaching hospitals and by voluntary associations taken over by the Metropolitan
Regional Hospital Boards, and there are now 23 such clinics. They draw their patients,
however, from a wide area in the south of England and not exclusively from London.