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The children were first tested on a group testing gramophone audiometer, by
means of which up to 40 children can be tested at the same time. Those failing
were again tested by the same method, to eliminate any who failed the first time
through lack of attention and other causes. Children who failed the second gramophone
test were then tested individually by a pure tone audiometer and those who
failed were referred to see an otologist at the audiology centre (see page 00).
During 1951 over 30,000 children were tested in this way, and the value of consecutive
"screening" in reducing to a minimum the number of children that need
be referred to an otologist is shown by the fact that although 25 per cent. failed the
first gramophone test, only 6 per cent. (of the original number tested) failed the
second gramophone test, and only two-thirds of these (i.e. 4 per cent. of the original
number tested) failed the pure-tone test and were referred to an otologist.
Rheumatism scheme
The decrease in the number of children nominated for institutional treatment,
noticed in the two previous years, continued in 1951, and tends to suggest that
Dr. Glover's dictum of twenty years ago that "rheumatism is an obsolescent
disease" might be true; nevertheless, in spite of the fact that the severity of the
disease seems less than in the past, its crippling tendency and late manifestations
play a prominent part in the total amount of illness and absenteeism from work
in later life. For this reason alone we need to guard against being lulled into a false
sense of security by failing to attempt to follow up and eradicate the causes of the
condition. In fact, it is by attention to these causes, rather than to the treatment
of the established condition, that we shall eventually hope to stamp out the disease.
The preventive aspects of the work must always be kept in the forefront of our
approach to the problem, and the success of the work will be measured by the number
of persons prevented from developing carditis, rather than by the number of carditis
cases treated. For this reason it is interesting to see that the percentage of cases
in which there was no cardiac involvement remained reasonably and encouragingly
high (see Table 28); and the numbers returned as fit for ordinary school or ordinary
employment were well maintained (see Table 26).
Of late years the number of children suffering from chorea of such severity as
to need institutional treatment has fallen, and there seems some seasonal variation
in the prevalence of their recurrence. Taken month by month, the numbers increase
in the months of February and March, and again in October and, as usual, the condition
is seen to occur more frequently in girls than in boys. It might be suggested
that in the susceptible child the female sex is more sensitive to the trigger action of
emotional shock or psychological stress, but the age group incidence does not suggest
the possibility that the strain of scholarship examinations plays a very prominent
part in deciding the time of onset.
The hereditary factor still seems an important feature in deciding which members
of the community are likely to develop the disease, and in assessing this, the work
of the organisers and care committee workers, from whom reports are obtained of the
family history and home conditions, is of much value and is greatly appreciated;
while the active co-operation of the borough medical officers of health enables a good
deal of headway to be made in correcting some of the deplorable housing conditions
with which some of our children have to contend. Whenever possible an attempt
is made to improve the local environment before a patient returns from institutional
treatment, so that the liability of recurrence is lessened.
Recent work on the surgery of the heart and great vessels has led us to review
our cardiac cases more critically in the last few years, while the possibilities of mitral
valvulotomy opens a fresh field of hope for some cases that have in the past seemed
doomed to early and progressive congestive failure.
Tables 25 to 28 (page 154) give details of this service.