View report page

Except in uncomplicated cases of chorea, the blood sedimentation rate has proved
of value in dealing with the question of anticipation and prevention of relapses, as it
frequently makes it possible to anticipate a relapse and put the child back to bed before
clinical manifestations of trouble appear. Apart from this, the clinician has to rely mainly
on careful observation of the child's general condition, especially as regards gain in
weight and response to graduated exercises.
At the outbreak of war in September, 1939, there were in existence five rheumatism
units for the institutional treatment of rheumatic children, with accommodation for
900 patients and a turnover of more than 2,000 annually; 15,000 to 16,000 attendances
of rheumatic children at 21 rheumatism supervisory centres were recorded each year,
and about another 2,500 rheumatic children were kept under supervision by the school
doctors. These activities as well as ancillary ones connected with the home environment
and education of the rheumatic child came to an abrupt end on the declaration of war.
Nevertheless, the machinery of the scheme was tentatively re-started after two months,
although the scope of the work done was necessarily much restricted.
Effect of the
war years
In January, 1940, the essential fabric of the Scheme had been reconstructed. The
only important change in the organisation of the scheme during this period was the
abandonment of the system described above as a preliminary to the acceptance of cases
for admission to the units. Since the specialists formerly employed in this branch of the
work were unavailable, full clinical reports on the cases nominated for admission were
obtained instead from the doctors nominating them, and this method, which on the
whole has proved satisfactory, is still in use.
In July, 1944, owing to the 'flying bomb' attacks, it was decided that the Queen
Mary's and Downs Hospitals should be evacuated (the only remaining unit at High
Wood Hospital had already been cleared of rheumatic children) and transferred to the
Scotton Emergency Hospital, near Knaresborough in Yorkshire. The total number of
rheumatic children transferred was 156 and the combined Unit was placed under the
medical charge of Dr. C. E. Thornton, the Supervising Medical Officer of the Scheme.
An assistant medical officer and nursing personnel from Queen Mary's Hospital accompanied
the Unit, and after a few weeks teaching staff followed and the usual educational
curriculum of the hospital school was resumed. Dr. Thornton, in a special report on the
work of the Unit while at Scotton, stated that on the whole the children did well and
benefited greatly, consequent on escaping from the strain and disturbance of air raids,
although it was impossible at Scotton to obtain anything approaching an open-air regime.
The Unit returned to Queen Mary's Hospital on 26th May, 1945.
The return of peace-time conditions brought about no great changes either in the
working of the scheme or in the numbers dealt with during the later years of the war.
The number of children admitted for treatment was at its lowest in 1941 (248).
Subsequently, the numbers admitted each year were rather higher, but even in 194-6
only 545 admissions were recorded. The number of attendances at the supervisory
centres, however, steadily increased. In 1941 only 1,446 attendances were made, but in
1946 the number had increased to 8,117.
Of the five rheumatism units with room for 900 children only one—the Queen
Mary's Hospital Unit—survived the war, but now accommodating only some 240
children and, even so, being a little overcrowded. On the other hand, all the supervisory
centres survived—in fact an additional one was opened in 1946, making 22 in all, and
the number of children under supervision rapidly increased.
A comparison of the incidence of juvenile rheumatism in 1946 (when conditions
had become stabilised) with that in pre-war years seemed to indicate a substantial
diminution, but it did seem likely that one important factor was the dispersal of a large
proportion of the child population of London to 'safe' areas. A considerable section
of these evacuated children were between six and eleven years of age, i.e., the age of the
greatest incidence of rheumatic infection, and by the time they returned to London
they were less liable to contract the disease.
215