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whom no definite evidence of tuberculosis has been found, and some who have been even inmates of
a sanatorium but who have been discharged without the diagnosis of tubercle being established.
Most of these patients seem to derive benefit from artificial sunlight.
(b) Cases of enlarged glands.—In every instance except one these patients had enlarged glands
in the neck. They had all previously had their tonsils and adenoids removed. In almost every
case shrinkage of the glands was noted and in some they ceased to be palpable. Two cases who
were suspended from treatment owing to the disappearance of the glands relapsed and had to have
renewed recourse to artificial sunlight.
(c) Cases of definite tuberculosis which had been in sanatoria.-—The results in these cases were
not so good. It must be remembered that they were living at home, often under adverse circumstances
and most of them hardly held their own and in several instances had to return to a sanatorium.
(d) Rickets.—All the cases of rickets did well, as was to be expected. The lesions for the
most part were not very severe, slight curved tibiae and genu valgum. But it is necessary for both
parents and medical men to remember that ultra-violet light will not correct deformity, although
it may prevent it from getting worse, and that mechanical measures for this purpose still remain
necessary in many cases.
(e) Asthma.—Artificial sunlight is of undoubted value in this disease. Out of six cases five
were greatly benefited and three may be regarded as cured.
(/) Various types of skin disease. Psoriasis.—One case only was treated, it did not derive
any benefit, in fact it seemed to be made worse and the treatment was stopped.
Eczema or dermatitis.—Four cases were treated, one a case of flexural eczema in a boy aged
10 with an ichthyotic skin which had persisted since infancy, did very well. Another in which the
eczema was associated with asthma (a not infrequent combination) also did well although the progress
of the case was interrupted at one time by the formation of large submental abscess. In treating
cases of eczema the actual lesions were always kept covered, general irradiation alone being employed.
Alopecia areata.—Six cases were treated, all did well.
(17) The average cost of current per hour was 8-64d.
(18) The average cost of each patient's treatment was £1 17s. 3d.
H. HALDIN-DAVIS,
January, 1927. Dermatologist to the Willesden Urban District Council.
APPENDIX H.
RHEUMATISM IN CHILDHOOD.
(Being Notes bearing chiefly on its control, in relation to the School Medical Service)
by
C. T. Maitland, M.D., M.R.C.P., B.Sc., D.P.H., D.T.M. & H., Assistant Medical Officer.
Definition.—The term " rheumatism " has been loosely used to describe various morbid conditions
certain of which have no connection with the present subject, such as muscular rheumatism
and chronic joint changes. The confusion in terminology is well brought out in the Ministry of
Health's Report, "The Incidence of Rheumatic Diseases" (1924). The simple term rheumatism
is best reserved for a disease commonly beginning in childhood and clinically as clear-cut as tuberculosis,
whose danger lies in the damage it inflicts on the heart. The other manifestations, sore throat,
acute joint inflammations, chorea (St. Vitus' dance), and less important conditions are of importance
chiefly as indicators of the probability of accompanying cardiac involvement.
The Causation of Rheumatism.
I. Rheumatism an Infection..—The integration of the various rheumatic manifestations as
primarily due to one underlying cause has been largely delayed by the failure to isolate unequivocally
one organism as in all cases responsible. Nevertheless, the prevalent modern view is that a micrococcus
is the specific cause—a streptococcus, similar in certain respects to that normally found in the
human mouth. It is unnecessary to state the reasons which lead to that conclusion. However, the
correlation of the clinical appearances and the provisional acceptance of rheumatism thus envisaged
as a unity has been of great value, indeed was necessary, for the planning of successful preventive
measures.
In Dr. A. P. Thomson's words, " everything considered, the most reasonable hypothesis is that rheumatism
is due to a streptococcal infection which probably enters first by way of the tonsil, soon'is engrafted in the lymphoid
tissue of the alimentary tract, and also establishes itself in the various rheumatic lesions throughout the body. That
general reinfection may occur from subsequent activity of any of the focal lesions (as happens for instance in tuberculosis)
is not an unreasonable suggestion."