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and pains in the limbs, somewhat loosely termed rheumatic but
dependent upon a condition of bodily debility rather than any more
definite rheumatic process.
"In my report last year, I remarked upon the fact that
coincident defects of health, such as carious teeth and septic tonsils,
were being met with less frequently than when the clinic was first
formed. The same is true with regard to actual rheumatic heart
disease, for whereas some six or seven years ago there were many
children with hopelessly damaged hearts, the number of these now
attending the clinic has fallen to a remarkable extent, and in an
inverse ratio the number of children with mild or early heart disease
has risen. The implication of this is that children with heart disease
are reaching the clinic at an earlier stage of their illness than
hitherto, while the effect of constant supervision is to prevent, at
any rate in many of the children, deterioration of the cardiac
condition.
"Of the 176 cases attending for the first time, 54 were found
to be suffering from heart disease. One of them required immediate
admission to hospital, while for others arrangements were made for
prolonged stay at one of the heart homes in the country. During
the year, 192 children were discharged from the clinic, some because
the presence of rheumatism was not confirmed, others because their
rheumatic symptoms had faded away, and a few on account of
having reached the school leaving age.
"Cordial co-operation has been maintained with the various
other departments by which subsidiary treatment has been obtained.
Thus, 16 children were referred for operations on the tonsils and
adenoids, while 38 children received dental treatment. Eight
children were referred to the Physically Defective Centre and 5 to
the Open Air School. It was found necessary to exclude 35 children
from attending school at all, while arrangements were made for
5 children to attend half-time school. While 20 children were
excluded from taking part in school games and exercises, 24 who
had previously been excluded were able to resume their games and
exercises.
"Convalescence.—Forty-six children were referred for convalescence
and 60 were actually placed in suitable homes. I should
like to draw particular attention to the very valuable work done
for the children with early heart disease in the special Heart Homes
such as West Wickham. the Edgar Lee Home, the Cheyne Hospital
and the Lancing Heart Home. The special care of heart children
over many months has been specially studied in these homes and is
proving of great benefit to the children, while at the same time
increasing our knowledge of various aspects of rheumatic heart
disease. Much of the usefulness of the clinic results in the cooperation
obtained with these homes.