View report page

294
The mild and potential cases benefit greatly by a period of
convalescence at Coombe Cliff Convalescent Home. With extra
rest, a nourishing and well-balanced diet, and supervision under
satisfactory hygienic conditions, the rheumatic symptoms
frequently clear up. For other suitable cases extra nourishment
in school, such as milk or cod liver and malt, are provided.
Cases of fully developed chronic valvular heart disease, who
are medically unfit to attend a public Elementary School, are
recommended to St. Giles' School for Physical Defectives. The
accommodation here was extended during the year.
Children who have recently been discharged from hospital
or convalescent home following a rheumatic attack, or children
whose hearts are affected and might be injured further by undue
exertion, are excluded for a suitable period from partaking in
games, drill or school swimming. It should be emphasised,
however, that both from the mental and physical well-being of
the child, it is inadvisable to limit normal activities more than is
absolutely necessary. Children in whom rheumatic manifestations
are quiescent and who have a mild fully compensated
cardiac lesion, and others in whom a systolic murmur is purely
functional, may be turned into introspective invalids by exclusion
from the normal school routine.
In all cases the general health is carefully watched and
particular attention is paid to the tonsils and teeth, treatment
being provided when required.
The houses of all new cases attending the Clinic have
continued to be inspected by a Sanitary Inspector, and notices
are served on the owners for any necessary repairs; or the family
recommended for consideration for a Council house.
Rheumatism is an insidious disease. Acute rheumatic fever
is far less common that the vague joint pains or mild chorea so
frequently met with. The mild form, in which there are only
vague joint pains or mild muscular twitching, may cause irreparable
cardiac damage if neglected or overlooked; it is for this
reason, and because relapses are common, that the constant
supervision afforded by the Clinic is so necessary.
One clinical note may be of interest; children who complain
of pains around the knees and back of thighs following exercise
and in whom the heart is unaffected are probably non-rheumatic.
A simple test helps to demonstrate this. If such a child be asked
to bend down and touch its toes, in most cases it will fail to