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mencing rheumatic changes in hearts, joints, or nervous tissues,
and where such are present directing the mode of life and dieting
to be followed.
Cases referred from school medical inspections, Routine or
Special, continue to make up the bulk of the register, but in
addition to these, children have been referred from other departments.
Of these the Tuberculosis Dispensary has provided the
greatest number. As the symptoms found in Tuberculous and
Rheumatic children are very similar a constant co-operation must
be maintained between these departments. A few Rheumatic
children of pre-school age have been noted by Medical Officers
from M.C.W. centres and referred for supervision at the clinic.
During the year it was found that the common age group of
those referred for the first time to the clinic corresponded more to
the first age group. This is what would be expected, for the
number of older children in attendance at the schools who show
rheumatic symptoms for the first time is relatively small, and as
so many examinations and inspections of childr en in the older age
groups have taken place, the time should come when all children
with Rheumatism, definite or potential, in the older groups attending
elementary schools will have been placed under supervision;
new cases for the most part being drawn from the entrant group.
With the reduction in the number of new cases referred to the
clinic for the reasons outlined above, if has been found possible
to reinspect the active cases on the register, at more frequent
intervals. This is an advantage as these are children in whom
serious organic involvement might develop, often insidiously.
A general review of cases seen indicates that, while mild and
potential types predominated, a number of cases of active disease,
some having definite or organic heart involvement, were met with
and referred to the appropriate hospital or specialist for treatment
Dr. Preston at the Croydon General Hospital very kindly cooperated
with the Clinic and saw a number of special cases referred
to him by the Medical Officers and where necessary he had them
admitted to the wards of the hospital. For the Convalescents
requiring change of air and surroundings, with rest, the newly
opened home at Coombe Cliff has played a most useful part. Quite
a number of Cardiac cases were admitted to this home and they all
benefited greatly.