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"Advice is also given on such matters as clothing, diet, bedding,
exercises, etc. The weight of each child is recorded at each
attendance, as this affords a valuable means of checking the child's
progress. It is found that the Rheumatic process may safely be
regarded as quiescent so long as the weight continues to show a
normal rise.
"(2) To act as a Consultative Centre to which the School Medical
Service and Local Practitioners can refer children whom they suspect
of being rheumatic. In some of these an opinion can be given at
the first attendance; others it is necessary to observe at the Clinic
over 2 or 3 months before forming an opinion. Of the 203 children
so far examined, 134 have been considered truly rheumatic. Of
the remainder, some have had cardiac abnormalities other than
rheumatic, some have required advice re diet, etc., others suffering
from various degrees of debility have been referred for convalescent
or other appropriate treatment. Thirty-five children in all have
been referred for convalescence. In only 2 cases have the parents
refused to allow this, and the I.C.A.A. and Miss Lewis are to be
congratulated on having placed already 25 children at suitable
Convalescent Homes. In 12 cases, the heart condition has been
such that Hospital treatment has been judged necessary.
"(3) To co-operate with the Attendance Officer in estimating to
what extent the children are able to attend school, whether half-time
schooling is necessary as a temporary arrangement, or whether the
child needs the particular advantages of a Physically Defective
School. It is a pleasure to report that the most cordial co-operation
has taken place in this direction. Of the 203 children, 20 have
needed complete exclusion from school for variable periods. In 2
cases, satisfactory arrangements have been made for half-time
attendance, and 4 children have been transferred to the Physically
Defective School.
"Prevention.—There is no doubt that in so serious a malady as
is the rheumatism of childhood, prevention of the disease is to be
aimed at as far as possible. This has been attempted with definite
results in the children who have recently had either Scarlet Fever
or Diphtheria, two infectious diseases which are prone to be
followed by rheumatism. At the time of their discharge from the
Isolation Hospital, the children are referred to the ' 'Infectious
Disease Clinic," and those who are suspected in any way of
harbouring early rheumatic symptoms are sent to the Rheumatic
Clinic. The following figures give some indication of the value of
this arrangement:—
"Out of 198 children discharged after Scarlet Fever, 30 were
singled out for transfer to the Rheumatism Clinic, and of these 11
were found to exhibit evidence of early rheumatic heart disease.