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also actively co-operated with the Cancer clinics in dealing promptly and efficiently with the cases
which have been referred to them, that 52 patients have sought advice at these clinics and that 18
cases were found to be suffering from conditions requiring operation or other active treatment, and
that of these 18 cases 12 were suffering either from Cancer in one case, or from conditions known to be
forerunners of Cancer in 11 cases. The remaining 6 of the 18 cases treated by the Hospitals suffering
from conditions the relationships of which to Cancer are not established.
RHEUMATISM.
Like Cancer, Rheumatism is the cause of a large number of deaths, but unlike Cancer, the
majority of these deaths are not directly attributable to the disease. In 1929 there were only 7
deaths attributable to Acute Rheumatic Fever and 6 attributable to Chronic Rheumatism, but
Rheumatism in its remote effects is the main cause of deaths from diseases of the heart. In 1929, there
were 349 such deaths and it is fairly safe to assume that in the majority of cases the rheumatic infection
causing death was contracted before the end of school life.
It will be seen therefore that the problem of Rheumatism is a large one and that the immediate
loss in school time and still more the ultimate burden to the community from the ravages of this
disease are very great indeed.
The disease in the young may take several forms:—
(a) As an acute fever, with sore throat, swelling and pains in the joints—Acute Rheumatism
(b) As a milder fever associated with fleeting pains, breath lessness and anæmia—Subacute
Rheumatism.
(c) As vague pains ("growing pains") often associated with chilblains, skin rashes, etc.
(d) St. Vitus' Dance.
All these types are dangerous because sooner or later the valves of the heart are liable to
become affected which often leads to permanent disability unless the disease is checked in time.
The remedy varies with the extent of the infection and the condition of the heart. Both the acute
and sub-acute types require careful treatment and prolonged supervision at home or in hospital.
Rest is the essential factor and may be necessary for a period of several months. Convalescence
must be slow and the patient guarded against chills in case of a relapse. There is often a septic depot
from which the rheumatic poison is absorbed into the system, thereby causing the condition to persist.
This focus is usually in the teeth, tonsils or bowels, and no recovery is possible until it is removed.
In respect of the third type, a great number of children are prone to vague muscular and joint pains—
the familiar " growing pains " which were at one time believed to be unworthy of serious consideration,
but are now regarded as the danger signals of Rheumatism. They are frequently associated with
sore throats, and this is significant in view of the fact that the rheumatic germ is believed to enter
the system by way of the throat. Here again the treatment consists in removal of all septic depots
and careful attention to clothing and footwear. But we cannot overstress the importance of these
apparently trivial pains because of the risk of heart trouble in later years. Lastly, St. Vitus' Dance
is a serious condition amongst the school population, not only because it handicaps a child at school,
but frequently ends in damaging the heart. It is often necessary to exclude these nervous children
from school and send them to one of our convalescent homes, viz., St. Patrick's Open Air School,
Hayling Island, St. Dominic's Open Air School, Godalming, and the Russell-Cotes School of Recovery,
Parkstone. Unfortunately many of them tend to relapse after returning home and the need for
more prolonged rest and supervision in a special residential home becomes apparent.
It will be noted that something is being done in Willesden to mitigate the evil results of
Rheumatism, but co-ordinated effort is needed. Some authorities have established Rheumatism
Supervisory Centres and these are doing good work although full benefit cannot be expected until
the later years of life. This benefit would be demonstrated in respect of prolonged years at work
and a diminished death rate from Rheumatism and Rheumatic Heart Disease.
INFECTIOUS DISEASES.
During the year 1929, 2,843 cases of Infectious Disease were notified as compared with 1,976
in the previous year. The total of 2,843 includes 413 notifications of Diphtheria as compared with
457 in 1928, 574 cases of Scarlet Fever as compared with 541 in 1928, 402 cases of Pneumonia as
compared with 273 in 1928 and 912 cases of Whooping Cough as compared with 281 in 1928.
Return Cases of Scarlet Fever.—The following statement gives the return cases that
have occurred during 1929:—
I. Home Cases.—Approximately 60.
(a) No. of infecting cases giving rise to return cases not longer than
28 days after release from isolation 1
,, return cases they gave rise to 1
,, infecting cases per cent. of total home cases 1.7
,, return cases per cent. of total home cases 1.7