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The size of classes in schools for the delicate is limited to 30, and the curriculum is
the same as that of schools for normal children. All children receive three meals a day,
rest for one hour at midday, and whenever possible, work in open-air conditions.
The Council's boarding schools are intended primarily for those children for whom
a change of air is necessary. Treatment and education are similar to those given in day
schools. The average length of stay at a boarding school is two terms, but this period
can be prolonged if it is considered advisable. If pronounced fit, the pupil returns at the
end of that time to the day school he formerly attended: however, if it is considered
advisable, he may be admitted for a time to a day open-air school.
In addition to providing places in its own boarding schools, the Council accepts
places in voluntary schools.
The Rheumatism scheme
In London, the beginning of an organised effort to combat rheumatism, on a scale
commensurate with the magnitude and importance of the problem, dates from the
latter end of 1926, when a special unit of 60 beds was established by the Metropolitan
Asylums Board at Queen Mary's Hospital, Carshalton, for the treatment of rheumatic
children in the early acute stages of the disease. Until that time, acute rheumatism in its
various manifestations was dealt with by the special children's hospitals as well as the
general and special hospitals in London. The length of time spent in a hospital bed in
the case of rheumatism was prolonged as compared with other diseases. Poor Law cases
were admitted to the infirmaries. There was very little special provision for convalescent
treatment of rheumatic children other than that provided by the Poor Law. Impressed
by the urgent need for such provision, the Invalid Children's Aid Association had
established two small homes, but the waiting lists were very long and the need for
further accommodation was manifest.
Early efforts to
combat
rheumatism
Interest in the problem of rheumatism in children was not really aroused (although a
good deal of pioneer work had been done in America) until about 1923, when the
question was discussed at the annual meeting of the British Medical Association. After
this, Sir George Newman in his annual report to the Board of Education in 1924, and
Dr. Poynton in a memorandum on behalf of the Invalid Children's Aid Association to
the Public Health Committee of the London County Council urged the necessity for the
provision of more institutional beds for rheumatic children where it would be possible
to continue the child's education during the latter part of its stay in hospital. A report
by Dr. Gordon Pugh to the Metropolitan Asylums Board followed the same lines
and the establishment of the unit of 60 beds referred to above was the result of the
cumulative effect of these representations. It was quickly recognised that this could
only be regarded as a beginning. A comprehensive scheme was therefore organised
with gradual increase in the accommodation in special rheumatism units, until beds in
sufficient number were available to provide for an average period of treatment of at
least six months for all children showing signs of active disease. Rheumatism supervisory
centres were established and staffed by specialists, for the purpose of early diagnosis of
doubtful cases and supervision of quiescent cases.
A system of supervision of children after discharge from rheumatism units was
started.
Investigation and amelioration, if necessary and possible, of the child's home
environment was attempted and the various branches of the scheme were co-ordinated
centrally. Although the provision of hospital accommodation fell far below requirements,
a step forward was made in 1930 in that fifty more children received treatment
at Queen Mary's Hospital, Carshalton, or High Wood Hospital, Brentwood, than was
the case in 1929.
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