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104
minutes, are possibly abnormalities of vagal control without physical basis. The
former may be evidence of old rheumatic carditis, the latter are not
related to rheumatism. Premature beats have not been found, in the very limited
experience of the clinic, to be part of the picture of active carditis. A case of
typical paroxysmal tachycardia has been sent to the clinic. The child is not
rheumatic.
The relation of the length of systole to the length of diastole is sometimes
interesting. The following observations are put forward tentatively. Hypertrophy
with mitral regurgitation tends to lengthen systole, as also the rare condition
of aortic obstruction. Aortic regurgitation lengthens diastole. The excited heart
is either normal in having a slightly longer interval between the second and first
than between the first and second sounds, or tends to have equal intervals. The
heart of poor tone works away owing to increased speed with equally spaced sounds,
not easily affected by slight emotional strain and stress.
Mid-diastolic murmurs.—The second sound is normally complex, and the two
main components may under varying conditions become separated by a short interval,
so that a split second sound is heard. This has no significance in the diagnosis of
carditis. Quite distinct from this is a very significant sound, a mid-diastolic apical
murmur heard best inside the nipple line. In some cases this murmur is best heard
with the patient lying down ; in other cases it is best heard with the patient standing.
Such a murmur is always taken seriously in this clinic. It is true that in some of
the cases the murmur disappears with a return to health, but it is thought that the
illness has in that case always been rheumatic. In some of the cases the murmur later
becomes an aortic diastolic, indicating aortic regurgitation. In other cases it
becomes a pre-systolic murmur of mitral stenosis and the prognosis becomes correspondingly
serious. Several of these cases are being watched in the clinic, and
later these will confirm or modify these present views.
Special Reports and Enquiries.
Members of the Council's medical staff have during the year assisted in various
enquiries undertaken on behalf of the Board of Education and its special committees.
These enquiries have included an investigation into the relationship between rickets
and enlarged tonsils and adenoid growths (Drs. E. J. Boome, J. N. Dobbie, D. Leys
and A. G. Wells), an investigation into changes of refraction in the eyes of young
children (Drs. V. Brander and J. H. Mcllroy) and an investigation into the dental
condition of leavers (Dr. A. Livingston).
Other special reports and enquiries were made as follows :—The investigation
of rheumatic conditions in school children (Drs. G. Slot, D. W. Winnicott and M.
Russell) which are given in the section on rheumatism and a further enquiry by
Dr. E. J. Boome into the condition of school children in the hop gardens of Kent
to which extended reference was made last year.
Degree of
myopia in
Gentiles and
Jews
attending
sight-saving
schools.
Dr. E. M. McVail has continued her investigation into the degree of high myopia
presented by Gentile and Jewish children in the sight-saving schools.
In the Annual Report for 1928 it was stated that comparing Gentiles and Jews
it appeared that the greatest percentage of high myopia occurred amongst the
former, although the numbers examined (86 Gentiles and 24 Jews) were too small
for any definite conclusion.
Further investigation has been made as to the degree of short sight in nearly
all myopic children attending the sight-saving schools. The degree of myopia has been
estimated from the glasses most recently prescribed, children whose myopia was
associated with corneal scarring and other complications such as albinism being
omitted, and also a few with doubtful glasses. The numbers seen were 479 Gentiles
and 106 Jews, and these include at least 90 per cent, of the children with pure myopia.