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49
manent heart disease, to provide means for ascertainment of earlycases
and facilities for efficient and effective treatment. Many
children suffer from vague aches and pains which require the fullest
investigation to exclude the possibilities of sub-acute rheumatism.
A clear decision is therefore essential not only to institute preventive
measures as early as possible, but also to avoid unnecessary restriction
of activities in children suspected to be suffering from rheumatism
without foundation.
In November, 1945, an experimental Rheumatism Clinic was
established, which until the size of the local problem had been
determined was to be staffed by members of the school health service
with Dr. Leff (Senior Assistant Medical Officer) in charge. The
environmental history of each case, including economic status,
housing circumstances, diet and supplementary feeding, facilities
for outdoor play and parental efficiency is recorded from the home
visits of the school health visitor. A comprehensive medical inspection
of the child then takes place at the rheumatism clinic, with
special reference to affections of the heart.
During the short period the rheumatism clinic had been
established, i.e., six weeks, 45 cases were seen of which the diagnosis
of rheumatism was confirmed in 23 cases.
It is interesting to compare the cases of rheumatism with nonrheumatic
cases, as referred to the clinic:—
Family history in this series seems to have no significance, as
sixteen of the total cases had a family history of rheumatism, and
only nine cases with rheumatism had a family history of
rheumatism.