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126
Annual Report of the London County Council, 1913.
Dr. Leipoldt in his earlier routine inspections, in the Deptford and Bermondsey schools, merely
noted, privately, in his note books, whether the floating tenth rib was present, without at the same
time stating whether the child showed evidence of the status asthenicus or not. The only record for
these earlier cases he, therefore, possesses is the entry "S.S." (Stiller's signs) occurring among his
other notes. Since 1912, however, he has kept more careful notes, usually with the addition of some
indication as to the degree of mobility of the rib, the weight, height, chest circumference, colour,
and general state of the child.
Taking the Deptford and Bermondsey schools, on classifying 500 children examined at various
routine inspections, the existence of Stiller's sign was recorded in 68 cases. As no record was kept
of the degree in which the tenth rib was moveable in these cases no attempt is made to adopt any
refinements of classification here. Some of the points of interest mentioned in the notes are, however,
available.
Number of boys examined, 250. S.S., present 27. Per cent. 10.8.
Number of girls „ 250. ,, „ 41. „ 16.4.
Total number „ 500. „ „ 68. „ 13.6.
Boys.—Of those who presented Stiller's sign every one was below the average weight in relation
to his height. Chest measurements are not available. Eighteen were stated to be "pale—no definite
anaemia;" in three of these well-marked basal murmurs developed after exertion, such as jumping
or running about the room. Fifteen had "prolonged expiratory murmur at right apex; no dulness;
no other signs." Ten had oral sepsis, pigmented skin, or glandular enlargement; five had slight
lateral curvature, described as "postural"; nine had flat feet. Advice cards for teeth, curvature
anaemia, and in one case for hydrocele, were given in 11 cases out of the 27. One showed marked
intermittency of the pulse; one had otorrhœa, for which he was being treated; three were
apparently normal.
Girls.—Of the 41 who showed Stiller's sign, no fewer than 29 were noted as presenting" pallor;
no definite anaemia"; one had slight tremor of the fingers, diagnosed as "chorea"; five had errors of
refraction, for which advice cards were given; three had" slight enlargement of the thyroid; no
symptoms"; 18 had "slight flat feet"; nine had "slight lateral curvature"; one had marked
gastric symptoms, " succussion splash, probably dilatation" (advice card given); 20 had carious teeth
(no record whether advice card was given); one had" scaphoid scapula, perhaps congenital lues " ; one
had a mitral systolic murmur; seven were apparently normal, since beyond the note" S.S." there
was no other record.
As no good purpose would be served by tabulating all the notes made during inspections this
year only certain series of inspections of infant entrants, and of children born in the years 1901 and
1904 are taken, sufficient in number to enable some general conclusions to be drawn.
Boys.—Out of 1,093 boys examined at 18 schools during 1913, 181 showed fairly well marked
sigma costale; four showed Stiller's sign. This gives the following percentages: Sigma costale 16.5
per cent.; Stiller's sign 0.36 per cent. Analysing the statistics, it is found that of the four boys who
showed Stiller's sign, two were entrants below six years of age, one born in 1901 and one born in
1904. Of these all had marked signs of gastric disturbance. The following are the notes:—
1. Undersized weakly child, height 100 cm., weight 15.8 kilograms, chest measurement not
taken; child fretful and crying, teeth carious, stomatitis, pigeon chested; S.S.; has had
convulsions, incontinence, and probably worms; pallor, no bruit; breathing shallow, no
adventitious sounds. No family history of tuberculosis obtainable. Mother states child had
"meningitis" when a baby.
2. Thin, wiry child, markedly pale complexion, veins on chest wall well marked; down on
arms and back. Height 110 cm., weight 17.2 kilograms; chest measurement not taken. Fidgety,
restless child, said to be subject to night terrors; teeth good, no glands in posterior triangles
palpable. Tongue coated; is stated to vomit frequently; no succussion splash. Constipated;
is given senna and liquorice powder. History of consumption on mother's side. Cardiac and
pulmonary examination negative. S.S.
3. Born 1904. Tall, thin boy, 130cm. high, 26.8 kilograms in weight; chest measurement,
expiration 51 cm., inspiration 63 cm. Breathes well, lung sounds well marked over both lungs,
no adventitious sounds. Sharp epigastric angle, asthenic habitus, abdomen somewhat protuberant,
not lumpy. Was treated in infancy at Great Ormond-street for tubercular
peritonitis." Teeth sound, but tongue furred. Slight lateral curvature, unilateral flat foot.
Suffers from sick headaches; eyesight normal; reflexes increased. Fathers brother has
consumption: two uncles on mother's side stated to have suffered from consumption; mother's
father was in asylum. No family history of visceral displacement.
4. Born 1901. Height 140 cm. Weight 32 kilograms. Chest measurement, expiration 60,
inspiration 69 cm. Pale, reflexes increased, nervous lad, badly nourished. Well marked
succussion splash (examined at 11a.m.; last meal at 8.15 a.m.) Constipation. S.S. Teeth
sound; no sign of oral sepsis; no tremor; thyroid normal. Cardiac sounds normal; lungs,
prolonged expiration note over both apices, a few rhonchi at left base; no other adventitious
sounds. Parent not present; boy does not know particulars of family history.
All these four cases showed marked pallor. In the first the most probable cause of the poor
nutrition was worms; in the second and fourth malassimilation, due to atony of the stomach or bowels,
probably underlay the bad physique. Here, as in the other cases, there was well marked diminished
pulmonary capacity, as judged by the chest measurements. In order to obtain a standard by which to
judge the chest measurements, similar to that presented by the table of average heights and weights for