View report page

musical systolic murmurs at the base were heard, and in three cases a diastolic
murmur. Congenital heart disease was present in two of these cases but in the
remainder the murmurs were not associated with any symptom referable to heart
disease. In no case was there evidence to suggest that rheumatism was a factor.
Acute rheumatism is very rare under three years of age and uncommon under
four years. The importance of detecting these murmurs at this early period is
that later in life rheumatism may be suspected on other grounds. The associated
heart murmur may seem to confirm the diagnosis and only the record of its presence
in early infancy discounts this significance.
Teeth.
In most cases of dental caries dental attention has been advised. The dentist
is in the best position to advise when fillings are practicable, etc. Dental caries
is possibly due to other nutritional deficiencies. There is still room for an investigation
correlating diet and dental caries. When a dietitian is forthcoming this
problem can be tackled. At four years of age the incidence of dental caries had
reached 55 per cent.
Tubercle.
The Mantoux tuberculin test was performed in cases of Tubercle contacts
and in cases in which such signs as large firm cervical glands suggested a possible
tuberculous origin. In cases which showed a positive reaction further investigations
were carried out. No case of active tubercle was detected.
Cervical Glands.
A palpable gland is not necessarily of much significance. A large gland in a
stout child may defy detection and a small gland in a slim child may be easily
palpable. Persistently large cervical glands, however, usually imply the presence
of nasopharyngeal or tuberculous infection.
The chief physical findings on physical examination.
Malnutrition. This subj ec t and the relevant figures have been discussed
Anaemia. in earlier paragraphs.
Rickets.
Dental caries.
At 2 years of age caries was present in 8 per cent, of children.
At 3 years of age caries was present in 35 per cent, of children.
At 4 years of age caries was present in 58 per cent, of children.
Cervical glands.
Palpable glands were present in :—
62 per cent, of the 4-year-old children.
45 per cent, of the 3-year-old children.
38 per cent, of the 2-year-old children.
14 per cent, of the 1-year-old children.