View report page

284
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.
Many children who complain of muscular pains in the limbs
are not rheumatic, but are suffering from, minor postural or orthopaedic
defects; these are referred either for remedial exercises or to
the Orthopaedic Clinic. In others, there may be associated with
the pains, such conditions as debility, malnutrition, anaemia and
mental and physical tiredness; excellent results are achieved by
sending such children to the Open Air School for a period of a
year or eighteen months, where the "debility pains" soon
disappear.
Difficult and severe cases have been referred to the OutPatients'
Department at Croydon General Hospital, where Dr.
Preston, as in previous years, has very kindly given his assistance
and advice.