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The supervision of children who had received hospital treatment under the scheme
was extended to include the years immediately after their leaving school. From the
information supplied it was possible to ascertain the effect of child rheumatism in
adolescence, to estimate the handicap which the disease inflicted on the young worker,
and to assure that the children were supervised or treated if this was necessary after they
had passed out of the care of the school medical service.
In his annual report for 1924 the Chief Medical Officer of the Board of Education
had urged on local authorities the need for the establishment (inter alia) of special
rheumatism clinics for the purpose of supervising the rheumatic child. In 1936, 20 such
centres were in existence and during 1935, 6,199 children were under supervision.
Ten of these centres were staffed and equipped by the Council; the remaining ten were
organised at the out-patient departments of certain of the voluntary hospitals, the
Council making a contribution to the hospital, and in some cases paying the specialist
in charge of the centre.
The arrangements for the supervision of children after discharge from the rheumatism
units consisted of:
(a) Supervision at rheumatism supervisory centres.
(b) Supervision through the school medical service by the school doctors.
(c) Supervision in the out-patient departments of the voluntary hospitals.
The particular method of supervision to be adopted in any individual case was
decided by the supervising medical officer of the scheme when the case was reviewed
on discharge. The arrangements provided for a minimum period of two years'
supervision after discharge from the unit.
The rheumatic child is particularly susceptible to an unhealthy environment, and
it was realised that much of the good done by prolonged institutional treatment under
ideal conditions would be nullified if the child had to return to a damp, ill-ventilated,
overcrowded home. Arrangements were therefore made for obtaining a detailed
report on the home conditions of all children who received institutional treatment under
the scheme. Structural or sanitary defects were reported to the borough medical officer
of health, who could thus take immediate action. In desirable cases where the family
was on the waiting list of applicants for a house or flat on one of the Council's housing
estates a recommendation that preferential consideration should be given to the application
was passed to the appropriate department.
The selection, grading and allocation of the cases for the special rheumatism inpatient
units were dealt with by the supervising medical officer and the decision as to
when a child was fit to return home was made by the medical superintendent of the
unit. When a child was discharged, the superintendent sent a discharge report to the
supervising medical officer. A copy of the report was also supplied to the doctor who
originally nominated the patient for treatment under the scheme.
Periodical visits were made by the supervising medical officer to the various units
and a full record was kept at the County Hall of every child who received treatment
under the scheme.
The essential function of a rheumatism unit is to give the rheumatic child the prolonged
treatment and nursing the disease requires, but, ancillary to this, is the provision
of facilities for education during the latter stages of treatment. This helps the child to
re-enter the ordinary school world without any great and sudden change in its mode of
life. Provision was therefore made to deal with this aspect in units permanently allotted
for rheumatic cases which, for this purpose, were recognised as ' hospital schools' by
the Board of Education and staffed by suitably qualified teachers.
The essence of treatment is rest, under the best possible hygienic conditions; and
the rest must be physiological, rest of the body and mind. As regards acute cases, a
stay in hospital of six months is probably the shortest period that can be regarded as of
real value.
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