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(4) Persistence of abnormal conditions. Only a proportion of the total cases
discovered to be showing cardiac disturbances were examined a second time within
the period of this inquiry. Of these, 28.5 per cent showed more notable disturbances
at the second examination, 53.5 per cent showed less marked signs, and 18 per cent
were as before. Included among the cases taken as showing increased disturbances
are those that developed symptoms of rheumatism on top of cardiac signs. Even so,
the figures would suggest a purely temporary character for the majority of defects
found and a response to the advice given, generally on the lines of improved dieting
and hygiene. No attempt was made to test those cases that simply had a murmur.
The number of re-inspections is too small and the periods of observation too short
to permit of comparisons of individual defects qua persistence or general results. A
few notes on one or two points, however, have already been made. The chief
consideration would be that, within the age period of the examinations, that is up to
and including the end of the fourth year, there was no evidence of disability as the
result of cardiac defect, apart from those cases marked congenital heart disease, even
if one third of the total cases did show at some time or another some minor cardiac
sign. But on the other hand, there was plenty of evidence to show that in this early
age period, often considered " safe" from the point of view of cardiac infection,
disturbances did exist that, in a percentage of cases did seem to go on and that might
be the forerunners of defined organic defect and/or rheumatic disease in later childhood.
C. Pallor.
Facial pallor was found to exist in a large number of children, independently of
pallor of the conjunctivae. As this symptom is taken by so many to denote anxmia
in itself and is described as a frequent concomitant of early rheumatism in young
children, the cases in which pallor was specially noted were submitted to further
examination in certain particulars.
Pallor and certain other conditions. Total cases showing facial pallor unaccompanied
by anxmia (as herein described) or cardiac or rheumatic symptoms equals 51; total
cases showing pallor plus anxmia, cardiac or rheumatic symptoms equals 60. Total
cases showing pallor equals 111. Percentage of total children examined noted as pale
equals 7 per cent. Percentage of children considered to be anxmic equals 30 per cent.
Percentage of pale children considered to be anxmic equals 47 per cent. Percentage
of anxmic children showing pallor equals 10.8 per cent. Therefore anxmia exists in
9 cases out of 10 without pallor of the cheeks, but of those children that are pale
approximately one half are anxmic. Anxmia, therefore, should be specially looked
for in cases where pallor is present, but the presence of a bright complexion does not
contra-indicate anxmia. The percentage of pale children showing heart murmurs
equals 22.5 per cent. The percentage of anaemic children showing heart murmurs
equals 20 per cent. The incidence of heart murmurs in the two conditions, therefore,
is similar and is higher than the incidence in the total children examined. The percentage
of pale children showing putative rheumatic symptoms equals 3.6 per cent. The
percentage of total children examined showing putative rheumatic symptoms equals
2.3 per cent. Therefore the incidence of symptoms likely to be indicative of early
rheumatism is rather higher in pale than in other children. The percentage of