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" So far as I am aware, this was the first school of this type to be organized, and inasmuch as our experience
may be of some value to others who may have to deal with the same problem, I will summarize the general principles
that have been found of value. For the internal organization of the school Miss Smith, the head mistress, has been
almost alone responsible, and it is a pleasure to me to be able to pay a tribute to the great skill and devotion which
have characterized all her work in what was, in the early stages, a very difficult problem;
The present daily routine at Baskerville is as follows
7.20—Get up.
8. 0—Breakfast.
8.30—Play, rest, or simple household duties (e.g., making bed, etc.),
9.20—" Nerve rest."
9.30—Prayers and singing.
10. 0-12. 0—Morning school.
12. 5—" Nerve rest."
12.15—Dinner.
1. 0- 2.15—Resting, play or free walks in garden.
2.30- 4.30—Afternoon school.
4.35—" Nerve rest."
4.45—Tea.
5.15- 8. 0—Going to bed, or recreation, depending on age or stages of convalescence.
In addition, the resting pulse and temperature of each child have been carefully recorded on continuous
charts, which also contain clinical notes by myself, particulars of treatment and of exercise permitted, and records
of the body weight. As a rule, the school is conducted on what may be called ' partial open-air lines ' ; that is,
in fine summer weather the children are out of doors as much as possible, and their clothing at times is so slight
that it is almost negligible, but in winter and in cold, damp sunless weather my opinion is that they need shelter
and warmth. We have found that it is important to ensure general quietness in the school, and to this end the
children wear soft slippers and are taught to avoid slamming doors and banging things about. Fortunately, traffic
noises do not intrude.
Two warm baths are given each week. The head mistress tells me that one of the surest signs of improvement
in a choreic girl is the recovery of her ability to get out of a bath unaided. Oddly enough after bathing choreic
movements tend to become more marked. The diet is plain and simple, and calls for no comment. In summer,
meat is limited, but there is no need for any special regime.
The new admissions and those with severe carditis have almost total physical rest (stretchers with suitable
desks are provided in the classrooms) ; their dormitory is also on the ground floor.
By ' nerve rest ' is meant a period of ten minutes, during which all the children sit or lie absolutely still and
silent with their eyes closed, and are carefully taught to relax all their muscles. These three intervals have proved
particularly valuable.
Early on I was so impressed with the importance of complete rest that I deliberately admitted to the school
a number of crippled children who were almost totally immobilized by orthopaedic apparatus in order that they
might serve as an object lesson for the rheumatic cases.
We have found that this is now unnecessary, as new arrivals are always associated with children accustomed
to the routine of the school, and for administrative reasons it is, I believe, better to organize a school of this type
for the admission of rheumatic cases alone.
The head mistress has shown great ingenuity in devising a progressive programme for cases of residual chorea.
Briefly, it is as follows. At first the children are kept on stretchers ; while movements are marked they are given
simple handwork to do, such as winding wool, sorting handkerchiefs and other household linen on a suitable desk.
For recreation they are encouraged to play cards, dominoes and draughts, to string beads and to arrange flowers ;
they also have picture books. A little later on they are allowed to paint and make artificial flowers and mats ; they
are also encouraged to knit, crochet and to do easy raffia and fancy work. Knitting is particularly good for the
choreic cases. When the children are first allowed up they dust furniture and clear tables after meals. Usually
one month elapses before they undertake formal school work, and on beginning the time is limited to one hour.
Throughout the school the educational work is individual. Classes are small and each child is given a card on which
is written a list of tasks to be done. No time limit and no order of accomplishment is enforced, and there is no direct
competition. When one card is completed another is given out. Frequently rheumatic children (particularly those
with chorea) appear dull and backward at school work, but with suitable training they nearly all pick up very quickly,
and several instances of marked improvement of the intelligence quotient has been observed within a few months
Often, too, they are very ' uneven ' in the early stages ; ' good and bad ' days in school alternate in a surprising
way, and we have found that it is no use persisting with school work on a ' bad ' day.
When convalescence is almost complete croquet and clock golf are allowed, but no games with a moving
ball; drill for periods of five to ten minutes and finally simple dances to slow music. As a result of experience I
have come to the conclusion that for permanent benefit to result the period of residence at Baskerville for individual
children should be at least six months."
'' The results of the prolonged treatment of rheumatic children at Baskerville School have been
satisfactory and encouraging. In the first place, we have found that with suitable control it is possible
to proceed with their education without prejudice to their physical recovery. Indeed, I am now
convinced that education may be a very valuable therapeutic measure, particularly in cases of residual
chorea. Be it due to suggestion, education or merely improved environment, I can state as a fact
that in no case at Baskerville have choreic movements persisted for more than a fortnight after
admission (and we have admitted cases with very severe movements—so severe that they were unable
to stand alone). This, in itself, would justify the institution of the school, but I have been even more
impressed with the degree of recovery that has occurred in many of the children with damaged hearts.
Nearly all of them, on admission, had signs of cardiac damage. A large proportion of them
leave with normal hearts, and later examination shows that they may escape heart disease altogether.