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159
Report of the Medical Officer (Education).

These 2,479 gave 1.9 per cent. showing some signs of heart trouble (1.5 per cent. boys and
2.3 per cent. girls), and in 14 per cent. of all the heart trouble was definite and indubitable. When
ill-nourished and debilitated children are selected on this account rheumatism comes prominently
forward, and heart disease is a striking part of the picture. Dr. Cardale examined particularly over
500 necessitous children—by this, meaning children fed at school. Of these 234 belonged to
the Isle of Dogs, and 283 to the Homerton district, and he states that 181 were free from defect whilst
336 presented definite defects ; slight temporary variations from health being excluded ; 190 of the
336 defectives, or 56 per cent., presented what he regards as definite valvular affection of the heart,
being about 36 per cent, of the necessitous children examined. In one school in the Isle of Dogs, 42 of
the 60 being fed presented heart affection, temporary hæmic murmurs being excluded from the
reckoning. Probably it is the anaemia resulting from antecedent rheumatism that had most to do
with the selection of these cases for feeding, but the whole matter is worthy of very careful inquiry.
The explanation of the frequency of heart disease given by Dr. Cardale is that a very large number
of these children are neglected, poorly clothed, and badly shod ; that their homes are often draughty,
cold and damp ; the children run the streets at all hours of the evening and night exposed to cold and
wet, and frequently during bad weather they sit in their wet clothes and boots. Attacks of acute and
subacute rheumatism are common, especially those insiduous attacks, of the subacute variety, which
are regarded as " influenza colds," and receive no treatment but may leave valvular mischief.
Obviously rheumatism may be difficult to detect, but it is well worth a very careful study in relation
to age incidence, sex, locality, and possibly school work, for a careful physician of the last generation
wrote a book on chorea, in which he concluded that it was largely a school-produced disease.
Spinal
curvature,
Spinal curvatures, which we regard in London as mainly slight developmental defects
only, run into serious disease in rare cases. Dr. Hirsch has carefully examined about 600 girls
in. Woolwich schools as regards these curvatures. The children were stood to toe a line, the
hands hanging by the sides and the head held erect. The angles of the scapulae were then felt with the