London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1931

[Report of the Medical Officer of Health for London County Council]

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Arterial Pressure.—

VariationAverage
0- 570-12094.6
52- 8061
5-1078-140109
50- 9068
10-1592-150121
50- 9068

Cardiac Classification.—
(а) Potential cardiac cases—
History and complaints suggestive of rheumatism; no cardiac involvement, no
disability for ordinary life 73
Rheumatic history, never cardiac involvement, now well 33
(b) Organic cardiac cases—
Rheumatic history; cardiac involvement which has now disappeared 9
Rheumatic history; present signs of cardiac involvement, but no symptoms
referable to heart 33
History suggestive of rheumatism; present signs of cardiac involvement, but no
symptoms referable to heart 33
Rheumatic history; present signs and symptoms of cardiac involvement, but no
disability for ordinary life 14
Rheumatic history; present signs and symptoms of cardiac involvement, and
definite disability for ordinary life 11
(c) "Functional" cardiac cases—
Transitory cardiac arrhythmias, effort syndrome, etc. 44
250
Clinical observations.—Hereditary and familial factors cannot be disregarded, for manifestations
of rheumatic disease are found frequently to occur in several members of one family.
The degree of aetiological significance to be attached to the several factors in environment is
still uncertain. Influences in lowering general resistance appear to be due to overcrowding,
insufficient sunlight, sitting about in damp clothes, and defects or deficiencies in diet, particularly
of calcium, iodine and phosphorus. Calcium deficiency and acid retention seem to be favoured
by milk poor in quantity and quality. Many children attending are found to be getting not
more than a quarter of a pint of milk a day, and show rapid improvement after increase to a
pint or more.
Till now the tonsils have received more attention than the rest of the respiratory tract.
Yet, independently or not of removal of the whole of the tonsillar tissue, rheumatism and its
recrudescences have been observed in about 80 per cent, of cases to follow a closely precedent
nasal or pharyngeal inflammation.
Ample evidence is afforded by children at this centre of inherent instability and susceptibility.
There is a lack of adaptation to changing meteorological conditions, and the potentially or
actually rheumatic child is the delicate member of the family, with liability to frequent "colds" and
malaise. Instability of the heat-regulating mechanism induces abnormal body temperatures,
as well as functional cutaneous disabilities. On the psychical side these children are often
"awkward" and difficult, with sympathetic instability, evidenced by aberrant vasomotor
reactions, and central nervous lack of control, shown by spasmodic movements at times ending in
Sydenham's chorea.
Modern medicine is reverting to those broad philosophical principles of the ancient Greek
physicians which dealt with diatheses rather than with diseases, and with types of constitution
rather than with morbid entities.
One of the most important of these, the "rheumatic" diathesis, for long has attracted the
attention of physicians, until quite recent times when it became overlaid by the newer bacteriological
concept of "infection."That infections can and do occur during the course of rheumatism
in adults and children alike is undeniable, but the view that infection is responsible for the
earliest manifestations, such as instability, "growing pains,"&c., denying any other causal
possibility cannot, in my judgment be upheld. " Seeds do not grow on every soil," nor do
micro-organisms grow and produce their effects in the body unless under conditions that favour
their development. From this standpoint infection is not primary, "coming as a bolt from the
blue,"but is always grafted upon an underlying metabolic state.
Feeding of school children.
Dinners are provided for necessitous children attending school, and follow menus
which have been approved by the school medical officer. Each dinner provides at
least 25 grammes of protein and 750 calories of heat value.
E2
51
Hair Colour.—Red, in 13 cases; Dark, in 67 cases; Medium, in 138 cases; Fair, in 23 cases;
Not stated, in 9 cases.