A HOME FOR CHILDREN WITH RHEUMATIC HEART DISEASE.

1326 at Nantes with his uncle, William Laennec, who required, and if they returned home they might be superintended his education in medicine at the seriously and unnecessarily handicapped for the rest hospital there, protecting him from the horrors of of their life for want of skilled care. In this new home the Revolution and the parsimony of his niggardly patients could be kept for several months if necessary, father. He left for Paris in 1801 and continued his and would be regularly visited by Dr. J. W. Prince, medical studies there, taking his degree in 1804. of Hartfield ; periodically by a member of the He lectured constantly on morbid anatomy, which consulting staff. Proof of the value to fitting cases of such a home subject he was the first to raise to a science ; he not only gave admirable descriptions, but correlated is afforded by the encouraging results obtained at the conditions found after death with the signs and the Edgar Lee Home, Stonebridge Park. This is a symptoms observed during life. In spite of wretched home founded for boys with rheumatic heart disease health and many family troubles he worked extra- by the Invalid Children’s Aid Association in 1918. ordinarily hard, conducting a large fashionable Since its inception 327 cases have been admitted. The practice, studying languages, making post-mortems, boys on leaving are advised as to the nature of the and lecturing to those who came from all over the work they can safely undertake, and the Association world to hear him. In 1816 he announced his discovery endeavours to keep in touch with them afterwards. that it was possible to listen to the chest with a At a medical inspection last year of some of those who stethoscope. In August, 1819, he published his had passed through the home, of 39 boys only three famous " De 1’Auscultation Mediate," containing were considered to require further treatment. Dr. F. J. precise and original descriptions of clinical symptoms Poynton, who also spoke to the guests of the I.C.A.A. and post-mortem appearances. Many of these at Kurandai, pointed out that children with rheumatic referred to conditions previously unknown, of which heart disease are unsuitable for the ordinary conthe most celebrated was his demonstration that valescent home where children are recovering from tubercle is a new formation, and that phthisis is tuber- some surgical operation or minor illness. They are culous. Laennec described all the multitude of high strung, and the damaged heart requires much Those without special opportunities for physical signs that may be recognised with the stetho- care. scope, and in his first chapter explained what may be investigation have not the slightest conception of the learned from listening with the stethoscope on the frequency of rheumatic heart disease. Dr. Poynton chest to the patient’s spoken voice. From this noted that of 140 deaths at the Hospital for Sick chapter in this book arose our practice of telling the Children, Great Ormond-street, from heart disease, patient to say ninety-nine. Sir William Hale-White 90 were due to rheumatism and all were in children illustrated an absorbing account of the story of under 12 years. It was not, however, the fatal cases Laennec’s life with many pictures of the scenes and the totally incapacitated children that this home among which this great doctor worked, lived, and died. would help, but those cases who had passed through A HOME FOR CHILDREN WITH RHEUMATIC HEART DISEASE.

Kurandai, Hartfield, Sussex, was opened three months ago by the Invalid Children’s Aid Association as a home for children suffering from rheumatic affections of the heart, boys being taken up to 7 and girls up to 14 years of age. There are three main open-air wards, two facing south, in which the children’s beds are placed, each ward having its own bathrooms attached. The whole front of the sheds is open to the garden, but some shelter can be secured on that side, when necessary, by means of shutters. There are also two small rooms on the ground floor The children of the house with large windows. receive regular education by two trained teachers, and their games and exercise are arranged according to their capacity. The nursing staff consists of the matron, a sister, and six nurses. Fifty children can be taken and 48 are actually in residence, including a few cases of chorea. A garden party was given at Kurandai by the I.C.A.A. on June 21st, when Sir John Broadbent explained lucidly to the assembly the need for such a home. He pointed out that rheumatism was very prevalent in this country, and that in childhood it attacked the heart rather than the joints, giving rise to lesions of the valves and muscular walls of the heart. Lesions of the valves impaired the mechanism of the heart as a pump, and certain changes took place in the cavities and walls of the heart which were in part an effort by Nature to counteract and overcome the difficulties entailed by the valvular lesion. For the development of these changes a long period of time was often necessary, during which the child should be kept more or less at rest and under supervision. Even more important was the injury to the muscular wall of the heart, which might result from rheumatism, as this damaged the propulsive mechanism. As a result of rheumatic pericarditis the tonicity of the heartmuscle might be greatly impaired, so that it resembled perished rubber and gave way under the strain of its ordinary work ; hence ensued great dilatation of all the cavities of the heart and symptoms of heart failure. Recovery was common even in serious cases, but it was obvious that patients could not be kept in a busy general hospital for the many months of rest

one or more attacks and had, as a result, hearts weakened or permanently damaged in slight degree. These children, he said, could lead useful, if restricted, lives provided they were given time to get strong hearts, that their hearts were tested by gradual increase in physical exercise, and their education continued. They should return to their homes with an indication as to their physical capacities, and report to their hospitals or medical supervisors. At this home the object would be to train hearts to renewed health and strength, to keep minds active and happy, to increase our knowledge of the power of the heart for recuperation, to learn more of the life-history of rheumatic heart disease, and to take a practical and living part in the national study of the prevention of rheumatism and its complications.

THE ROYAL SOCIETY CONVERSAZIONE. CONVERSAZIONE was held at Burlington House on June 18th, when Sir Charles Sherrington, the President, and Lady Sherrington received a numerous company. Many interesting exhibits were shown, and during the evening Prof. Lucien Bull, of the Marey Institute, Paris, gave two demonstrations of recent developments in high-speed cinematography. His beautiful slow films illustrating the flight of birds, and the equally graceful movements of a dancer, gave great pleasure. Among the exhibits Captain C. Diver and Prof. A. E. Boycott, F.R.S., demonstrated the results of breeding experiments with the snail Limncr!z peregra. Whereas most snails are typically coiled in a right-handed spiral, occasionally left-handed examples are found. Breeding from a sinistral race of these animals records have been obtained for some 600 families (about 53,000 snails), and it is apparent that a definite system of inheritance is being followed. Dr. T. S. P. Strangeways, Dr. R. G. Canti, Dr. M. Donaldson, and Dr. F. G. Hopwood demonstrated living cells growing in vitro under the influence of radium. The internal cytological structure was displayed by the use of dark-ground illumination. A large collection of permanent tissue-culture preparations, illustrating the effect of exposure to X rayss upon the different phases of mitosis, was also shown by Dr. Strangeways. Sir Almroth ZYright, Mr. A. Fleming, and Dr. L. Colebrook demonstrated new methods for the exploration of bacterial disease, and A