View report page

lation that the mortality rate should be so low. This reflects
great credit on the patience and skill of the sisters who have to
look after these cases.
During the winter a long epidemic of diphtheria occurred,
necessitating the removal of several of the boys to the local isolation
hospital. The epidemic is now over, and the boys have all
returned to the school, and the condition of their hearts seems
none the worse for this additional infection.
The children in the heart beds are managed along the lines
customary in residential heart homes, that is to say, they are
slowly worked through a series of grades, the first consisting of
complete rest in bed, and the fifth and last grade being reached
when they are up all day and leading what amounts to a normal
life, with the exception of a mid-day rest and curtailment of vigorous
exercises. The time occupied in each grade varies considerably
with the individual children, the passage from one grade to
the next being governed by the rate of the heart, the increase in
weight, and the general well-being. A blood-sedimentation-rate
test is not employed in this home, because there are no satisfactory
facilities for performing the test. This may perhaps mean
that the boys pass a little more slowly from grade to grade than
might otherwise be the case, but with regard to heart children
this can simply mean erring on the side of safety.
The clinical observation, already made .in other similar
institutions, to the effect that a streptococcal sore throat in a
child with a rheumatic heart disease is likely to lead to a relapse
of fresh rheumatism after an interval of two or three weeks, has
been amply confirmed at St. John's school during the past five
years—that is, since heart cases were particularly catered for.
This would appear to be one of the most important recent additions
to our knowledge of rheumatic heart disease. During the
coming year it is hoped to co-operate with the rheumatic home
at Baskerville, Birmingham, and the Cheyne Hospital, Chelsea,
in an effort to determine whether drugs of the salicylate group,
given at the time of the sore throat and continued for a period
of one month, can do anything to mitigate or abort an ensuing
rheumatic relapse. Although this aspect has already been mooted
in medical literature, a decisive opinion awaits expression, and
this is a question which homes such as St. John's are in a position
to answer."
388