London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1930
[Report of the Medical Officer of Health for London County Council]
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Table 8 shows a classification of the various cases considered to be suffering from organic carditis. In addition there were 11 cases of congenital morbus cordis ; one of these had chorea, 10 were non-rheumatic.
| Classification. | Acute rheumatism cases. | Chorea cases. | Insidious cases. | Total. |
|---|---|---|---|---|
| Myocarditis only | 16 | 5 | 15 | 36 |
| Mitral incompetence | 31 | 7 | 26 | 64 |
| Pure mitral stenosis | 4 | 4 | 2 | 10 |
| Combined mitral disease* | 20 | 6 | 6 | 32 |
| Combined mitral and aortic disease | 1 | — | - | 1 |
| Aortic disease | 1 | — | - | 1 |
| Combined mitral dis. and adherent pericardium | 1 | 1 | - | 2 |
| Total | 74 | 23 | 49 | 146 |
* One case was associated with congenital dextrocardia.
Table 9 shows the occurrence of murmurs considered to be "functional."
| Total cases. | Total with functional murmurs. | Per cent. | |
|---|---|---|---|
| A. Rheumatic fever cases* | 65 | 17 | 26 |
| B. Chorea cases* | 49 | 11 | 22 |
| D. Cases of " insidious rheumatism "* | 203 | 81 | 40 |
| E. Non-rheumatic | 115 | 23 | 20 |
| Total | 432 | 132 | 30 |
* The cases having organic carditis are excluded from these totals.
When a patient gives a history of rheumatism it is a temptation to ascribe any
systolic murmur to " myocarditis " ; on the other hand when a loud systolic murmur
is unexpectedly found in an apparently healthy person there is a temptation to dismiss
it as "functional" without too much attention to its quality. The figures shown
in the table demonstrate that some attempt has been made to assess these murmurs
on their merits and without attention to the history. It is now generally agreed that
a systolic murmur may be of no significance but the large number of systolic murmurs
considered to be functional in this report may almost lead to a suspicion that at
these centres almost too little importance is attached to a murmur. This comment
may be made : during the course of the year a certain number of cases has been
diagnosed as suffering from carditis and subsequent events have rather suggested
that one's view may have been mistaken, but of the numerous cases considered to
have functional murmurs, in not one of them have subsequent events led one to
retract the diagnosis.
Table 10 supports the established view that sinus arrhythmia is essentially a physiological event. The opinion further is submitted that, when this irregularity appears in a heart which is diseased, it is some evidence that it is recovering.
| Total cases. | Number showing S.A. | Percentage. | |
|---|---|---|---|
| Cases with carditis | 146 | 32 | 22 |
| Cases of definite rheumatism without carditis | 114 | 37 | 32 |
| Doubtful rheumatics (without carditis) | 203 | 62 | 30 |
| Non-rheumatics | 115 | 31 | 27 |
Special Inquiries and Reports.
I. This investigation consisted of the examination of the children of families living
in basements and the comparison of the data thus obtained with those obtained from
the examination of controls. The list of basement children was compiled by the
Council's inspectors as the result of inquiry among families occupying basements in
the boroughs of Kensington, Paddington, Westminster, Islington, Finsbury, Poplar,
Stepney and Southwark.
Inquiry into
the condition
of children
living in
basements.
(Dr. A.
Banks Raffle.)