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is made up in amounts of not more than two ounces at a time, as
it deteriorates on keeping, and it is kept in a glass-stoppered
amber-coloured bottle. A Rauchfuss scoop-pattern insufflator is
used.
A fundamental for success is thorough cleansing of the ear
prior to the insufflation.
RHEUMATISM CLINIC.
As has been stressed in previous reports, this Clinic is not in
any sense a "treatment centre," but is concerned with the
diagnosis, supervision, advice, and re-examinations of all types
of rheumatic infections in children.
The bulk of the children have been drawn from school
children coming under medical inspection, either at school or at
an Inspection Clinic. In addition, some cases have been referred
from the Tuberculosis Dispensary and the Maternity and Child
Welfare Centres.
A definite differentiation must be made between the chronic
rheumatic arthritic pains of adults and the acute and sub-acute
rheumatism of childhood.
The manifestations in childhood are varied; the most common
in the acute type being inflammation of the joints, Chorea, Tonsillitis,
and affections of the muscle and valves of the heart; in
the sub-acute and milder forms a series of mild sore throats, slight
indefinite pains and aches in muscles and joints, frequently
associated with a chronic insidious state of poor health.
The most serious complication is that of heart disease, and
it is in the prevention and supervision of these lesions that the
Clinic has its major usefulness.
As a consequence of steady propaganda, parents are becoming
increasingly aware that "growing pains" in children must be
taken seriously. Some have written to the Head Teacher concerning
their child's "pains," and ask for an appointment for
the Clinic. This is an indication that the Clinic is becoming more
widely known and appreciated.
Is is important in cases of heart disease that parents should
be advised immediately, so that further cardiac damage may be