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Special record cards of all heart cases are made out and particular
notes are made of their progress each year. All cases are
examined at least once in every year.
In most cases there is very little if anything to call attention
to the condition of the child and it is only on medical examination
that valvular heart affection is discovered.
Considerable attention has recently been drawn to heart
disease in children in the medical press and suggestions have
been made for the treatment and after care of children affected
and especially with regard to prevention.
As regards prevention guidance is given by the history of
rheumatism in the father or mother for there seems to be a distinct
hereditary tendency to rheumatism. Where there is a history
of rheumatism parents should be instructed to exercise a particular
care over their children, especially in avoiding exposure to cold
and dampness, to view with concern any occurrence of joint or
"growing" pains in members of their families and to have them
medically examined. With the exercise of care many cases of
valvular heart disease pass through life without much inconvenience
from the condition of the heart, but on the other hand severe strain
either by excessive exertion or by an acute illness may cause such
a failure of function that the life of the individual is in constant
danger. Fortunately severe cases of heart disease are comparatively
infrequent in school children and it is therefore but seldom that
special residential care is required. Most cases attend school
without any unusual symptoms or loss of attendance, but a small
proportion (in Ealing seven out of a total of 93) shows susceptibility
to extremes of heat and cold or are affected by the school
routine or pressure. In such cases a limited attendance at school
is permitted or residence in a Special Home or School is recommended.
One particular case was sent during the year to a Special,
School for three months, as a result of which he returned to the
ordinary elementary school at which he has since been in regular
attendance.
The subject of heart disease in children is one which calls for
investigation both as to the intimate cause and its prevention.
Until we have the full and exact knowledge it seems we should
devote our attention to the children generally in eliminating
possible sources of infection, say from the teeth and naso-phaynx