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flagging in health and becoming irritable and unequal to school life,
still more if we find warnings of chorea, we must advise a term away
from school and advocate mental and physical rest. Chorea is certainly
rare among those school children whose parents can afford to take them
away from school and give them mental and physical rest for a term.
Possible Steps for the Prevention of Chorea.
1. The education of parents as already indicated.
2. Simple lectures on rheumatism to parents and school teachers.
3. An investigation by school medical officers into the frequency
of chorea in school children and into their histories just before their
actual breakdowns. The facts which would be ascertained would cause
parents to attend to ill-health more promptly.
Already the school medical officers have done splendid work and
have picked out many cases and sent them for treatment. May it not
be that having regard for the sensitiveness of rheumatic children, some
modification of the educational machinery for such children may be
promoted where non-existent?
The Weak Point in Hospital Treatment.
To-day, when a child has been nursed through an attack of acute
rheumatism in hospital, we have to send the child direct to its own
home, often situated in an unhealthy overcrowded street. Instead of
this there ought to be an auxiliary hospital near London to which convalescent
children could be sent so as to get the much needed rest and
graduated exercises required in this ailment, in addition to fresh air,
sunshine and good food. In course of time the patient would be able
to return home with a heart strengthened to the level of carrying on an
ordinary life; if that is unattainable, then the child's limitations must
be made clear to the parents. Look therefore for that country auxiliary
hospital with its level paths and gradients of different degrees, with its
massage and, yes, for its arrangements for the general education of the
patients, who are gradually mending back to the work-a-day level of
health. Think of the great value of such an institution acting as the
handmaiden of, say, Great Ormond Street Hospital.
Suitable Employment for Cardiac Cases.
Why is it that there is a greater organisation in America for the
care of "heart" cases of all ages and so little in our own country,
comparatively? Realising that so many of our lads and girls approaching
school age have hearts of different degrees of weakness