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Every effort is made to persuade the parents to take the child to the Centre for
examination. In cases where the patient is too ill to go, but in which the private
medical practitioner desires his opinion, the rheumatism expert arranges to visit
the patient's home and to consult the private practitioner there.
(2) Cases of rheumatism, or cases of suspected rheumatism, coming to the notice of any of
the following persons or bodies, are recommended to attend the Centre, even though
they are not notified or not notifiable: the Medical Officer of Health or his staff
(Health Visitors, etc.), the physician-in-charge of the Centre, the Invalid Children's
Aid Association, the Charity Organisation Societv, the Infant Welfare Centres, the
staff of the Children's Hospital, and the School Medical Service. Such cases are
either notified at the Centre, or, if not notifiable, a card similar to that used for
notified cases and shown above is filled up by the vountary worker who visits the
home.
(3) The Council have appointed a Rheumatism Sub-Committee to undertake the
vision of the scheme. This Sub-Committee is composed of Miss Keeling (Chairman
of the Public Health Committee), Miss O. A. Nixon (Secretary of the North Kensington
Branch of the Charity Organisation Societv), Miss M. G. Crombie (Secretary
of the Kensington Branch of the Invalid Children's Aid Association), Miss
Webster (Representative of the School Care Committee), and the Medical Officer of
Health. Miss Crombie acts as Secretary of this Committee. The work of the
Centre is performed by the physician-in-charge, Dr. Lightwood, and by Dr. Davies,
a medical assistant. The first home visit of all notified cases is paid by the
Council's Health Visitor in charge of the district in which the patient lives. These
ladies are trained hospital nurses and qualified Sanitary Inspectors, and at this
visit they fill up the enquiry card outlined above.
The Invalid Children's Aid Association gives considerable assistance through their
Kensington Secretary and voluntary workers attached to that organisation. In
particular, Miss Kahn and Miss Dudley Baxter have identified themselves with the
scheme and performed invaluable duties in connection with home visiting, preparation
of record cards and assisting generally under the direction of Miss Crombie.
(4) The policy of the Centre is outlined in the following leaflet, which has been circulated
to the medical practitioners in the Borough:—
RHEUMATISM SUPERVISORY CENTRE
(For the supervision of children suffering from rheumatism, chorea and rheumatic heart disease).
The Centre is intended to meet the need shown by rheumatic cases for careful supervision during periods of apparent
quiescence to prevent the development of heart disease.
The plan adopted is to supervise the care cf the children when apparently well by periodical examinations, and to
instruct the parents to consult their usual practitioner or hospital should fresh symptoms of rheumatism supervene. Treatment
at the Centre itself is given only in urgent cases.
Whilst it is not the policy of the Centre to treat ordinary cases of rheumatism but rather to supervise sufferers from
this condition during their periods of apparently normal health, patients may be accepted for treatment in cases where their
medical practitioner (if any) has expressed a desire that treatment should be carried out at the Centre.
In this way it is hoped that the Centre will form a useful link between medical practitioners, the School Medical
Service and the hospitals, for the benefit of the patients.
Further, instruction is given to parents in the care of rheumatic children; and investigations into the causation of
rheumatism are being made.
The Centre is under the direction of one of the Honorary Assistant Physicians to the Hospital, and has behind it all the
scientific resources of the Hospital.
Beds are set apart at St. Mary Abbots Hospital and certain of the Metropolitan Asylums Board hospitals for rheumatic
cases requiring in-patient treatment.
(5) Sessions are held once a week, the patients being seen by appointment. Clinical records
are kept at the Centre on appropriate record cards.
(6) St. Mary Abbots Hospital.
Cases requiring in-patient treatment, whether seen at the Centre or in consultation with
practitioners, are drafted to St. Mary Abbots Hospital, where they are under the
carc of the rheumatism expert and are seen at weekly intervals. They are seen daily
by the Resident Medical Officer acting under his instructions.
(7) Other Institutional Treatment.
All cases requiring convalescent treatment are recommended for such to the Metropolitan
Asylums Board, or convalescence is arranged through voluntary channels.
Beds will be available later at the Princess Louise Hospital for rheumatic children
requiring such treatment as operations on the ear and throat.
(8) The clinical material arising is being investigated as follows:—
(a) Environmental factors.
Damp housing.
Locality.
School conditions.
Social position.
Family incidence.