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94
The Organisation.
The organisation for the supervision of cases of rheumatic heart disease amongst children
includes:—
(1) A Rheumatism Supervisory Centre.
(2) Hospital Beds.
At the Rheumatism Supervisory Centre the following work would be undertaken:—
(a) Ascertainment.
(b) Diagnosis of doubtful cases.
(c) Supervision.
The rheumatic cases or rheumatic heart cases would be classified and supervised according
to the stage of the disease. In a certain proportion of cases hospital beds will be required. These
are generally for cases in the acute stage. Other cases again, unable to secure a hospital bed or for
some other reason, would require to be excluded from school. Another class of case—usually one
which has returned home from treatment in hospital—will be able to attend school, but with physical
exercises restricted. This class of case will require systematic examination at the Centre to ascertain
the progress of the heart. Another class, again, may attend school without restriction, the head
teacher being advised to keep a watchful eye on the child. Other cases may require to attend the
P.D. School on account of permanent heart damage.
The work of centres already established shews that approximately 50 per cent. of the attendances
need examination and supervision only; 25 per cent. need restriction of games, with more
frequent examination and more strict supervision; 20 per cent. need exclusion from school and
treatment ; while 5 per cent. need prolonged institutional care.
All poorly nourished children should have adjuncts given them in the shape of cod liver oil and
malt and nutritive foods.
All these various classes will require supervision at the Centre, at the school, and at the home,
so that complete co-operation between doctor, nurse, teacher and parent can be secured.
With regard to the number of beds required, the Rheumatism Clinic at Great Ormond Street
Hospital, with 600 cases on the register, has 120 beds for such cases, or one bed for every 5.
The London County Council, with 11,000 cases on its register, has 520 beds, including 350 beds
recently established at Carshalton, or approximately one bed for every 20 patients on the register.
It is to be noted that cases attending Great Ormond Street Hospital would generally be more acute
than those which would come within the general purview of the School Medical Officer. The proportion
of beds, therefore, required in connection with rheumatism supervision in Willesden would
more nearly approximate that provided by the London County Council, that is, one for every 20
cases, or 20 beds.
The Committee will observe that the estimates are based on school children. No doubt a
number of children under school age would also require to be dealt with, as approximately 12 per cent.
of all rheumatic heart cases begin under the age of 5. But at the outset the figure of 20 beds suggested
may be considered sufficient.
It may also be of interest to note that some parents in Willesden have heard of the help to
be obtained through Heart Clinics already in operation at Paddington, Kensington and elsewhere,
and have been asking the Health Visitors to make appointments at Heart Clinics in Willesden, under
the impression that they were also established here.
Staffing and Cost.
Rheumatism Supervisory Centre.—This would be organised in connection with existing Health
Centres. The additional expenses involved would be the attendance of a Medical Consultant (£3 3s.
per attendance) and a Health Nurse.
Hospital Beds.—The required 20 beds could be established at Kingsbury, where space is
available. The cost of erection of the last new pavilion, excluding foundations in part (12 beds
on 2,000 cubic feet basis) was £4,169.

GEORGE F. BUCHAN,
Medical Officer of Health.