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been in part due to the long interval between sessions, the same
trend has become increasingly evident for some years.
"The figures quoted above give an overall picture of the work
of the clinic and of how the numbers changed, but the change in
type of case was equally striking, although actual figures to substantiate
this are lacking. In the latter years the majority of the
children attending with organic heart conditions had congenital
lesions. New cases of rheumatic carditis were few and the old
ones grew up and left school or died (two cases). New cases of
congenital heart disease were still referred and were kept under
observation, but at long intervals.
"Some cases of congenital heart disease were deemed suitable
for surgery and admission to hospital was arranged for them. One
boy with severe cyanotic heart disease died after operation but the
other cyanotic cases were all benefitted by surgery and follow-up
was continued at the Walthamstow Clinic. In the acyanotic group
the only surgery carried out was for closure of patent ductus
arteriosus and although the children were all seen at the clinic
after operation they were usually discharged within a year.
"To sum up then: the main cause for the great fall-off in
attendances at the Walthamstow Cardiac Clinic seems to have been
the decrease in acute rheumatic disease in childhood. This decline
is world-wide and the reasons for it are not clear but certainly
improved economic conditions and improved housing play a large
part in limiting the streptococcal infections which precede and
'trigger off' both the first attack of acute rheumatism and the
relapses. The more efficient treatment of streptococcal infections
with sulphonamide and antibiotics is probably not an important
factor because the decrease was already well under way before these
became freely available, but sulphonamide and penicillin have a
valuable part to play in preventing second attacks in the known
rheumatic child and prophylaxis by continued oral administration of
either sulphonamide or penicillin has been shown to be effective in
this respect in the U.S.A."
(f) Child Guidance Clinic.—The Consultant Psychiatrist, Dr.
Helen Gillespie, reports as follows:—
"Our lay psychotherapist, Miss E. Daunton, left in July to
take up a teaching appointment at the University of Cleveland,
Ohio. We were sorry to lose her services, and we wish her every
success in her new post. Her departure created a vacancy for
four sessions per week, three of which were filled by Miss H. Carr,
the remaining session being still vacant.
"Miss Lacquer, one of our psychiatric social workers, has
been away on sick leave from June to September and was very
much missed. We welcome her return to the clinic.