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"Needless to say, during the course of routine examination at
the Clinic other defects of health besides rheumatism are noted.
44 children have been referred for treatment for dental disease;
in 25 children the condition of the tonsils and adenoids has been
so bad as to necessitate their removal. 1 child was referred for
artificial sunlight, and 15 children were sent for treatment at
hospital.
"I should like to take this opportunity of thanking the school
Authorities for their cordial co-operation in carrying into effect
recommendations made from the Clinic. During the year it was
necessary to recommend exclusion from school of 55 children. In
other cases half-time schooling was advised; while 13 children
were recommended for transfer to the Physically Defective School.
In all cases these recommendations were quickly carried into effect
by the Authorities concerned.
"In the early part of the year, the co-operation of Dr. Hamilton
of the Walthamstow Sanatorium enabled some research work tobe
conducted into the development of hypersensitivity to Haemolytic
Streptococcal Antigen by Scarlet Fever patients (the development
of such sensitivity in rheumatic children had already been
shown by myself and others). I am grateful to Dr. Powell for
allowing this work to be undertaken, and to Dr. Hamilton who
carried out the major part of the work.
"In order to attempt the prevention of acute Rheumatism on
a wider scale the School Medical Service has kindly co-operated
in sending to the Rheumatism Clinic such cases of acute sore throats
as come to its notice. Throat swabs from these children have
been examined in the Research Laboratories of the Hospital for
Sick Children, Great Ormond Street, and those children who were
found to be suffering from Haemolytic Streptococcal throat infection
were kept under observation at the Rheumatism Clinic for a month
or six weeks. So far, 45 such children have been under observation.
It is hoped to expand this aspect of the work during this coming
year.
"The follow-up of all children discharged after Scarlet Fever or
Diphtheria, and the reference to the Rheumatism Clinic of any
who are found to show any suggestion of early rheumatism has
continued. 38 children reached the Clinic in this way, and of
these, 24 were kept under observation on account of irregularities
in their cardiac action. Some of these proved to be temporary,
others have needed prolonged care. It seems likely that this close
follow-up of children who have suffered from these infectious fevers
will lead to the prevention or amelioration of a certain amount of
subsequent rheumatism. This aspect of the work of the Clinic will
therefore be continued during the following year.