View report page

68
CLINICAL REPORT.
Age and Sex.
The rheumatism scheme of the Royal Borough of Kensington concerns itself only with children under the age
of sixteen years. In the third annual report a graph was reproduced representing the age incidence of juvenile
rheumatism. It was found that the highest peak occurred at the age of eight and that there was a secondary
peak at twelve years old. In commenting on the report Dr. Alison Glover suggested that an explanation of the
secondary peak at twelve years old might be due to the fact that there is a routine examination of children in the
schools at this age, and that in consequence cases would be sent up by the school medical officer in greater numbers
at the age of twelve. It was decided therefore to investigate this point, and a series of 440 cases have been
analysed, and the results shown in the table and graphic reproduction below. The children sent up to the clinic by
private doctors, Princess Louise Hospital, and the Invalid Children's Aid Association, or any other source, have
no routine age examination, so they have been separated from those sent up by the school medical officer. It
must be noted, however, that the age at which the child is sent up by the school medical officer is not always
coincident with the age when rheumatic symptoms have first manifested themselves. The school medical officer
may send a child for supervision at the centre for various reasons—because he thinks the child is suffering from
juvenile rheumatism at the time of examination, because he finds evidences of rheumatic carditis which are not
active at the moment but are proof that the child has had rheumatic carditis, or because he knows from the
history that a child has been attended at home or in hospital for juvenile rheumatism at some previous date. It
has been necessary therefore in separating the cases sent up by the school medical officer from all other cases, to
sub-divide the former again into two groups, (i) those sent up at the time when juvenile rheumatism first
manifested itself and (ii) those in whom the onset of juvenile rheumatism was before the recommendation by
the school medical officer that the child should attend the clinic. In the latter group the routine examination of
school children at the ages of eight and twelve would not affect the age incidence graph, as the first incidence was
at varying times before the school medical officer sent up the child. For instance, in one case a child was sent
up for the first time at thirteen years of age, but she was known to have had rheumatic fever at four years, and
is therefore included in the four year old cases. In the former group, however, the routine examination of cases
at the ages of eight and twelve might easily reveal more cases at these ages, and so affect any true estimation of
the age incidence in juvenile rheumatism.
A. From all sources except school medical officer (sub-divided).
B. From school medical officer (sub-divided).
C. Total male and female from all sources.
D. Total sent up by school medical officer.
E. Total sent up by school medical officer and whose first manifestation of juvenile rheumatism coincided
with the time at which they were sent up.
F. Total from all sources less E.