Acute rheumatism in children in its relation to heart disease.

Date:
1927
Catalogue details

Licence: Public Domain Mark

Credit: Acute rheumatism in children in its relation to heart disease. Source: Wellcome Collection.

    54/114 (page 42)
    Incidence of heart defects in ordinary School Children seen in routine examinations. There are approximately 5,000,000 children in average attendance in Public Elementary Schools in England and Wales. Somewhat more than one-third of these were subjected to routine medical examination in 1925, the actual total being 1,798,397 ; and a further 820,953 were also inspected as “special cases ”’ (7.e., selected by teachers, etc., as specially needing examination). These totals do not include medical re-examinations of children found to be in need of medical attention at previous examinations. Information as to the incidence of organic heart disease in all these children is not available, but in 1924 an analysis was made of the defects revealed in a large sample, 598,167, made up of the elementary school children of the three age groups (5-6, 8-9, and 12-13 years), examined in London and in 24 large districts repre- sentative of the whole of England and Wales during the course of routine examinations. Of these 598,167 children, 4,285 (or 0°7 per cent.) were considered. to have organic heart disease ; 3,231 (or 015 per cent.) of these being referred for observation only, whilst 1,054 (or 0°2 per cent.) required treatment. In addition I'l per cent. of the whole number examined were considered to have functional heart disease, which in 0:1 per cent. was severe enough to require ~ treatment. This incidence of 0-7 per cent. organic heart disease in rowtine examinations of elementary school children of all three age groups in England and Wales (1924) may be compared with Scotland (1924) 0-52 per cent. ; New York* (250,000 elementary school children, routine examination) 1 per cent. We may therefore take it that an incidence of 0-5 per cent. of heart defect for which only supervision is required and 0-2 per cent. of heart defect sufficiently severe to require treatment are con- servative figures for the incidence of organic heart disease in children actually in attendance at ordinary elementary schools in England and Wales. J. M. Martin} has recently pointed out in a preliminary note that in Gloucestershire there seems to have been a heavy incidence of organic heart disease in elementary school children born round about the year 1913, and that this liability has steadily diminished among the children born subsequently. The general average of the percentages found is, however, much higher than that found by most other observers, and deductions therefrom must on this account await the results of the further investigation promised in the preliminary note. Some school medical officers differentiate in their returns between organic and functional defects, others hold that a definite * R. H. Halsey, Jl. American Med. Assoc., 1923, April 7, p. 971. {+ Brit. Med. Jl., February 19th, 1927, p. 349.