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Dr. R. Cove-Smith, the Council's consultant on rheumatism, writes :
It was just thirty years ago that the Council's Rheumatism Scheme was inaugurated
at the suggestion of Dr. C. J. Thomas, Principal Medical Officer for School Health at
that time, so perhaps a brief review of some of the findings at each decade might not be
inappropriate.
In 1936 the percentage of children with cardiac involvement admitted to the
rheumatism units was 37.7, but by 1946 the figure had risen to 62.4, only to fall again to
40.8 this year. It was in 1941 that the percentage began to rise steeply but as this rise
occurred during the war, when there was a reduction in the number of beds available for
treatment, it is doubtful whether it represented a real increase in severity or merely the
selection of the more severe cases for the beds available. The percentage of cases regarded
as permanently unfit on discharge from rheumatism units in 1936 was 2.9 and in 1946
2.4, but in 1956 the figure worked out at 14. Although the percentage of incidence of
permanent and severe cardiac damage can be looked upon as a fair indication of the
severity of the rheumatic infection these figures are hardly comparable, for whereas in
1936* 2,039 cases were accepted for treatment in rheumatism units and in 1946 591,
there were only 49 recorded from Queen Mary's Hospital for Children, Carshalton,
in 1956. It would appear that the milder cases are being dealt with adequately elsewhere,
and only the more severe cases are seeking hospital admission. Here it should also be
mentioned that the rheumatism unit at Queen Mary's Hospital as such has ceased to
exist and that rheumatic cases are being nursed in the general wards, so that instead of
being sent to Queen Mary's Hospital for long term treatment, the tendency is for the
cases to be retained in the general hospitals and then sent to their own convalescent
homes or to the Canadian Red Cross Hospital, Taplow, where there is a special
rheumatism unit and research work with follow-up investigations is still being carried
out. Twelve London children (7 girls, 5 boys) were admitted to and discharged from
Taplow during the year. Of these, four had rheumatism with no residual carditis, one
chorea with no carditis, one rheumatism and chorea ; three had mitral and aortic disease
and three Stills disease. On discharge, eight were fit for ordinary school and four for
schools for the physically handicapped.
Since the inception of the scheme thirty years ago the streptococcal aetiology of
juvenile rheumatism has been established and the pioneer work of Poynton and Paine
brought to fruition, but the exact nature of the sensitivity reaction, which causes
carditis in a certain proportion of those infected by the haemolytic streptococcus still
remains to be elucidated ; nor can we yet say in which cases this is most likely to occur.
The association with scarlet fever still persists. Although both are diminishing in
severity the seasonal incidence of the two diseases shows little correlation.
In 1936 the percentage of the school population accepted for treatment in the
rheumatism units was 0.42, but in 1946 this figure had fallen to 0.19, while in 1956 it
was 0.01.
Nearly twice as many girls as boys were admitted to Queen Mary's Hospital this
year and among them the percentage of carditis was much higher, 40.60 per cent,
as against 18.25 per cent.
* This was the first year in which cases were accepted from the Council s own hospitals as well as outside sources.
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