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"Other Defects.— During the course of routine examination
other defects of health besides rheumatism are noted, but it is
my impression that such defects as carious teeth or septic tonsils
are less frequently seen among the new children attending the
Clinic for the first time than was the case when the Clinic began
its work three years ago. Our knowledge of rheumatism goes to
show that any debilitating conditions make a child more prone
to develop rheumatic manifestations, and therefore the care of
the teeth, the throat, and the general health may well be
regarded as a step in the prevention of rheumatism. During the
year it has been necessary to refer 39 children to the Dentist
(compared with 44 the previous year) and 14 children have been
referred for removal of their tonsils and adenoids (compared with
'25 in the previous year).
"School Attendance.— It is a pleasure to refer again to the
splendid co-operation of the School Authorities in carrying into
effect recommendations made at the Clinic with regard to the
attendance of the children at school. During the year it was
found necessary to recommend exclusion from school of 46 children,
while in two cases half-time attendance was advised for a
period while the child was under observation. Five children
were recommended to attend at the Physically Defective School.
In several cases a recommendation was made for milk to be given
to the children while at school, and on several occasions the improvement
which followed in the condition of the children was
striking.
"In a few cases the School Authorities were asked to furnish
special reports on the condition of certain children while at
school, and these reports were of much assistance in deciding how
best to deal with those particular children.
"Prevention.— The follow-up of children referred to the
Clinic by the School Medical Service on account of sore throats
has been continued. Thirty-seven children were referred in this
way, and were kept under observation for a period of a month.
The number of cases followed up in this way has not yet reached
a sufficiently high figure to enable a valuation to be made of this
line of prevention of rheumatism, and therefore it is hoped to
continue this during the coming year.
"In my report last year I mentioned the follow-up of children
who had been discharged from the Sanatorium after Scarlet
Fever and Diphtheria, and the reference to the Rheumatism
Clinic of any of these children who were suspected of early
rheumatism or other cardiac abnormalities. This has been continued,
and I have no hesitation in saying that by this means
much early rheumatism has been detected and offered immediate
treatment—either by being referred from the Clinic to the private
practitioner or by admission to hospital—while previously many