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Rheumatic, and other cardiac conditions
Dr. R. Cove-Smith, cardiologist, who acts as the Council's consultant on rheumatism,
has given the following observations on the changes over the years, as far as his specialty
is concerned :
' This steady fall in the number of cases of rheumatic heart disease attending schools
for physically handicapped pupils, does not necessarily signify any great advances in
the treatment of juvenile rheumatism, although the inception in 1926 of the Council's
rheumatism scheme, with its organisation of supervisory centres, played a big part in
checking the spread of, and preventing complications from, this condition.
' The fact that rheumatic fever has become both a less common and a less severe
disease during the last twenty-five years, as has scarlet fever, has diminished the incidence
of rheumatic heart disease considerably. Apart from this, improved social conditions,
a general advance in health consciousness of parents and teachers, the introduction of
chemotherapy, together with the early diagnosis and effective treatment of throat
infections, and particularly the early employment of penicillin in cases of β hæmolytic
streptococcal infections have all played their part.
' As the cases of rheumatic heart disease requiring special schooling have diminished,
so from 1928 to 1951 the cases of congenital heart defect increased.
' This is due in part to improved diagnosis and recognition by the medical profession
that congenital heart conditions are not of themselves necessarily a label of prolonged
invalidism. Consequently during the period from 1928 to 1951 more cases were brought
into our physically handicapped schools, where they could obtain appropriate education
and training instead of languishing idly at home.
' Since that date, however, the numbers are again diminishing as the rapid advance
of cardiac surgery has enabled many of those with defective hearts to be restored to
good functional activity. Whereas in 1928 the numbers of those with rheumatic heart
disease greatly exceeded those with congenital heart defects (1,088/251), by 1951 they
were about equal, while during the subsequent six years rheumatic heart cases diminished
considerably in number, giving a ratio in 1957 of 72/147. This still left a hard core of
severe rheumatic lesions to be catered for, but in addition, congenitally defective hearts
are now being repaired so rapidly by the surgeons that the numbers of sufferers are
gradually diminishing. Futhermore, it is being found quite feasible for a child with a
mild congenital defect to cope with ordinary school life, provided activity is adequately
supervised. Several children with cardiac lesions have achieved grammar school status
during the last six years and more than one has been awarded a university scholarship.
This shows that the modern outlook enables the individual to transcend the limitations
of his apparent handicap.
' The largest number of congenital malformations comes under the heading of
interventricular septal defect (40) while the interauricular septal defects (27) run closely
parallel to the tetralogy of Fallot (31) ; though many of the latter have at some stage
or other undergone an operation to improve their aeration and mobility, such as
anastomosis or valvulotomy, or both. Ten cases of patent ductus and some forty other
cases of less easily classifiable malformations and circulatory defects complete the
picture with which the cardiologist has to contend. There is little doubt that without
such scope as is provided for these children at a school for physically handicapped pupils,
many by the very nature of their disability would be confined to their own homes.
So far no mention has been made of the cases of rheumatism with chorea that numbered
166 in 1928, whereas in 1951 there was only one, yet not even one in 1957—perhaps
this is due to the fact that subacute rheumatism is rarely seen now and to a more ready
appreciation of the causes and cure of many cases of " limb pains" and "nerves", and
their more satisfactory rehabilitation to ordinary school life.
'On the whole, therefore, the future outlook for the child with cardiac trouble,
either congenital or acquired, is hopeful and the numbers that will need special attention
in a school for physically handicapped pupils is steadily diminishing, thus altering the
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