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160
Annual Report of the London County Council, 1910.
The cases admitting of a "Good" prognosis were all examples of uncomplicated mitral regurgitation,
with four exceptions, viz:—
Slight mitral stenosis 1
Slight aortic regurgitation 1
Adherent pericardium (probably) without valvular
lesion 1
Slight double mitral disease 1
Mr. Elmslie has recorded (b) that more than half the deaths at the schools for physically defective
children are due to heart disease. An investigation by Dr. Branson of 343 consccutive autopsies at the
East London Hospital for Children (c) went to show that heart disease is the most fatal of all chronic
diseases for children between the ages of 8 and 15, not excepting tuberculosis. The evil is therefore a
grave one. There is some evidence of a relation between rheumatic affections on the one hand
and "tonsils and adenoids" on the other. In a recent detailed examination of some 500 girls at
Maidstone-street School, Dr. Branson met with 13 cases of acquired valvular disease. Of these 13
no fewer than 10 were subjects of enlarged tonsils or adenoids or both. (It may be mentioned that
the concurrence was not being looked for at the time the records were made.) If this conjunction
could bo established as one of any constancy it would afford a valuable prophylactic indication. Experience
in a children's hospital, and in schools, has convinced him that in predisposed children the
factor exciting an attack of rheumatism is often the swimming bath, which he considers should be strictly
and permanently interdicted for children who exhibit the least rheumatic tendency.

Average height of 17 children with apex beat in 4th space 115.5 cm.
Average height of 33 children with apex beat in 5th space 118.3 cm.
Average weight of 17 children with apex beat in 4th space 20.9 kg.
Average weight of 33 children with apex beat in 5th space 21.7 kg.
II. Congenital Heart Disease.—Of the 14 cases of congenital heart disease there were:
Boys 8, Girls 6. Of the total, 7 were probably examples of congenital pulmonary stenosis. These,
it is well known, are uniformly unfavourable. The remainder are probably to be regarded as cases
of patency in the interventricular or interauricular septa. With regard to cases of this type it is
probably true to say that if the lesion is not severe enough to produce symptoms, it may, from a prognostic
point of view, be placed on a par with favourable mitral regurgitation. But if symptoms are
present the prognosis is bad. Of the 14 cases here considered, two only admitted of a good prognosis.
The limited possibilities of happiness for these unfortunates are greatly extended by permitting
them to continue at the special schools, even when there is no likelihood of their surviving to
become useful citizens.
The Deaf.
Education of the Dear under the Act of 1893 is carried out in 10 schools, of which 7 are
day schools and 3 residential schools; one of the latter (Homerton) is for children who are deaf
and also otherwise defective. The number of deaf on the rolls is 655. There are also 11 evening
continuation classes for the deaf, and this year an experimental class for semi-deaf children has been
opened. Each centre is regularly visited and a complete card index of all the cases maintained. Mr.
Macleod Yearsley is making an exhaustive examination of the conditions of each child, but this is slow
and can be done only in intervals of other work. His reports on educational results will be spread
necessarily over several years' work. The other matters he deals with are the cases seen at the Head
Office, the hard of hearing class and the teaching of lip-reading and articulation.
Cases Seen at the Head Office, 1910.—Examinations were held at the Head Office at which
children were submitted as requiring exceptional educational treatment on account of deafness. The

(b) L.G.C. Report of Medical Officer (Education), 1909, page 86.
(c) British Medical Journal, January 14th 1905, page 72.