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74
Ethel A., set. 8. Height 113 cm., deficiency 5. Weight 18.6 kilos., deficiency 4.5.
August 2nd. Nutrition 3. Teeth 3. Tonsils and glands enlarged. Old rickets. Pigeon
chest.
August 8th. Haemoglobin 80 per cent.
September 26th. Haemoglobin 80 per cent.
"Weight in tenth week 20.9 kilos. Increase 2.3 kilos. Increase per cent, of body weight 12.3.
Ethel T., æt. 10. Height 126 cm. (normal). Weight 25.7 kilos, (normal), Chorea three years
ago.
July 29th. Pale. Has had chorea for three weeks. Heart normal. Nutrition 3. Teeth
2. Tonsils enlarged.
August 2nd Slight improvement. Heart normal.
August 9th. Haemoglobin 75 per cent. Movements less. Heart slightly enlarged.
Murmur at apex. Recommended to rest whole time in school.
August 13th. Still a murmur at heart. Rests all day.
August 27th. Ditto. Movements lessening.
September 6th. Murmur of heart less pronounced.
September 17th. Heart improving. Movements gone.
September 26th. Haemoglobin 80 per cent.
Weight in tenth week 27.3 kilos. Increase 1.6 kilos. (6.2 per cent.).
Gertrude P., æt. 10. Height 122 cm., deficiency 8. Weight 21.6 kilos., deficiency 5.7.
July 29th. Club fingers. Said to have chronic bronchitis. Nutrition 3. Teeth 3.
Tonsils and glands slightly enlarged. Left lung much disease—bronchiectasis.
August 6th. Haemoglobin 80 per cent.
August 27th. Haemoglobin 85 per cent.
Weight in tenth week 23.3 kilos. Increase 1.7 (7.8 per cent.).
Kathleen M., aet. 11. Height 141 cm., excess over average 6. Weight 31.1, excess 1.3.
August 2nd. Nutrition 4. Teeth 3. Glands not enlarged ; looks fairly well but anaemic.
August 6th. Haemoglobin 75 per cent.
August 27th. Looks quite well.
September 27th. Haemoglobin 80 per cent.
Weight in tenth week 36.2 kilos. Increase 5.1 (16.4 per cent.).
Any absence for a few days was generally accompanied by distinct loss of weight, and there was
loss of weight, to be discussed later, on finally leaving the open-air for the ordinary schools.
The cardiac conditions of debilitated children are worth careful study, and at Shrewsbury House,
which stands about 320 feet above the level of the districts from which the children came, some fears
were expressed lest the steep ascent might tell on the children. The work was, however, eased by the
stop at Plum-lane (215 feet) for breakfast. Dr. Theodore Fisher examined the cardiac condition of
these children carefully on several occasions. Of the boys, 14 had some abnormality, but none had
definite organic disease. Eighteen girls had abnormalities, and another with chronic lung disease
appeared to have chronic heart trouble also. In about half of the cases the signs disappeared whilst in
attendance at the school. The medical notes may be summarised in the following paragraph :—
The actual abnormalities found among the 35 boys were, four with localised systolic murmurs at the apex but
nothing further to suggest organic disease, one disappeared whilst under observation. Two had basic systolic murmurs,
one of which disappeared ; in six the diastolic sound sometimes called false reduplication of the second sound
was heard at the apex; in three this disappeared ; in two there was reduplication of the second sound at
the base of so marked a character that it was worth noting, and in one this disappeared. Among the 44 girls, in
two who had suffered from chorea there was possibly but not certainly mitral disease, but a definite diagnosis would
be impossible before several more months ; no change was detected in them whilst under observation ; 13 had basal
systolic hæmic murmurs ; in three these disappeared. On the other hand, in a few of the most anaemic no cardiac
abnormalities could be detected ; in two there was also a systolic murmur at the apex ; in two a diastolic sound
sound at the apex was the abnormality, and it cleared up in one case.
At Montpelier House, Dr. Clive Riviere noted five boys with some cardiac dilatation at the
first examination; in all it increased under the strain of school life, and restrictions became necessary.
With one boy it appeared to be aggravated by an operation for adenoids, and he was greatly hampered
by it during his stay at the school. The admission of strong or robust children among debilitated
or weakly ones in an open-air school should be avoided, as although they themselves derive great
benefit, they set an example of strenuous living to the weakly ones which is actually harmful
Similar conditions have been found in boys going on school excursions (page 20).