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damage occurred to this extent; in fact, of the 331 children admitted to Queen
Mary's Hospital, Carshalton, in 1949, permanent cardiac damage was present in only
29 per cent. It is of interest to compare these figures with those obtained by an
analysis of the extent of permanent cardiac damage found in 1,094 rheumatic
children in 1934. In that year cardiac involvement was found to be present in 54.8
per cent, of children admitted to the units, and permanent cardiac damage ensued
in 41.2 per cent, of admissions. The difference in the percentage of children with
cardiac involvement in 1934 and 1949 is negligible, but the difference in the
percentage of children who suffered permanent cardiac damage is substantial.
Table 34 shows the end results of treatment so far as fitness for school or work
is concerned. As in the preceding year about 85 per cent, of the children discharged
were regarded as fit to attend an ordinary school or to take up ordinary occupations
on leaving school. This, of course, does not imply that the heart had entirely
escaped damage and with younger children a recurrence of the rheumatic infection
might entirely alter the final picture.
Supervision
An additional supervisory centre was opened at Wick School Treatment Centre,
Hackney Wick, E.9, in 1949, making a total of 24. The number of attendances at
the centres increased slightly during 1949.
It has been agreed that the responsibility for such specialist clinics as these
supervisory centres will in future be that of the Regional Hospital Boards or
Teaching Hospitals. So far this has made little difference but when the out-patients
clinics at the Royal Waterloo Hospital were closed, the supervisory centre which
was there was removed to St. Thomas's Hospital and opened as part of the
paediatric department. While the centres have served a most important function,
it is considered desirable to associate them closely with a cardiological department
so that full advantage may be taken of modern equipment.
Reports by Care Committee workers on the home conditions of rheumatic
children in 1949 show that there has been some improvement but very many families
are still deplorably housed. Reports of damp, dilapidated and overcrowded
dwellings were very numerous. The local medical officers of health were informed
of these and it is desired gratefully to acknowledge their ready co-operation in
taking such action as was possible to ameliorate the insanitary conditions found to
be present.
Prognosis
During the year a beginmng was made of an investigation into the ultimate
outlook when a child has suffered from rheumatic infection. It is hoped that it may
be possible eventually to trace a statistically significant number of the children who
have been treated at Queen Mary's Hospital, Carshalton, since 1926. The workers
in the School Care Organisation are co-operating in this arduous task, and for this
and their social work in connection with investigations into home conditions of
rheumatic children I tender my grateful thanks.
Audiometric Testing
Tests of the hearing of pupils over 7 years of age, by means of portable
gramophone audiometers with which specially trained school nursing sisters are
able to test forty pupils at one time, were carried out in schools during the year.
Three audiometers were used, originally in three divisions, but the work was
extended into neighbouring divisions as far as possible. Arrangements are in hand
for the purchase of more audiometers so that testing may be carried out in every
division.
Any child with a loss of nine decibels or more in either ear was tested a second
time with the gramophone audiometer, as many, especially younger, children, fail
in the first test through lack of attention or other cause. A limited number of
children who failed the second gramophone audiometer test were given a further