View report page

28
(i) Heart Disease and Rheumatism.—Dr. Sheldon contributes
the following interesting report on the work of the
Rheumatism Clinic during 1938.
"During the past year there have been 44 sessions with 729
attendances. Of these attendances, 192 were made by children
attending for the first time, while 537 were made by children who
were being kept under observation. The number of new cases
shows an increase of 16 over 1937, but this does not indicate that
this last year has been a particularly bad year for rheumatism,
or that the amount of rheumatism in Walthamstow is on the
increase. Indeed, it is my impression that during the last 8 years
the amount of serious and crippling rheumatism in children is
steadily becoming less evident, at any rate in Walthamstow.
"Our present knowledge of the disease would lead us to expect
that a reduction in the amount of rheumatism would follow an
improvement in the general standard of health in the children, and
particularly if the incidence of septic conditions such as dental
sepsis and sore throats were to diminish. The examinations made
by the School Medical Service would furnish information as to these
latter points, but it is certainly my impression that dental and
throat sepsis is less prevalent in the children seen at the Rheumatism
Clinic than was formerly the case.
"Of the new cases, 53 were found to have some rheumatic
cardiac defect. One of these required urgent in-patient hospital
treatment, but the remainder were able to remain at home under
the supervision of the clinic. During the year, 208 children were
discharged from further attendance. This figure is slowly rising
year by year, and seeing that the number of cases discharged on
account of leaving school or moving from the district remains fairly
constant year by year, this increase in the number of discharges
again reflects the fact that the degree of injury produced by
rheumatism is not quite so great as hitherto.
"As in previous years, close co-operation has been maintained
with the school attendance authorities, and I should like to stress
how important this is, and how closely it affects the value of the
work done in the clinic. During the year it was found necessary to
exclude 30 children from attending school, while a further 25 were
allowed to attend school but had to be exempted from games and
exercises. One of the duties of the Medical Officer is to watch
closely those children who are not allowed to take part in games
and exercises in order that, as soon as their cardiac condition
improves sufficiently for them to be allowed to resume a normal
child life, no time may be lost in getting them back to taking part
in the school activities.