View report page

137
rheumatic children showing pallor equals 10 per cent. The percentage of total children
examined showing pallor equals 7 per cent. Therefore, pallor is rather commoner in
children suspected of early rheumatism than it is in children as a whole.
Pallor and housing. Taking the 51 cases showing pallor as a symptom by itself,
26 lived in rooms, 1 in a house minus a yard or garden, 20 in houses with yards or
gardens, and in 4 cases no particulars were obtainable. This gives a percentage of
57 children (of whom particulars are known) living in rooms or houses minus a place
to play in out of doors. The percentage of families in Woolwich having sole
possession of a house has already been given as 60, i.e., put otherwise, 40 per cent of
Woolwich children are known to live in premises shared with other families, that are
possibly rooms minus a garden. Comparing this with the 57 per cent of pale children
living in rooms, it is obvious that there seems to be a connection between the lack of
air and light suffered by people living in rooms without access to a garden, and the
production of facial pallor.
D. Rheumatism.
Total number of cases showing symptoms that might be rheumatic, including
possible chorea equals 44, equals 2.5 per cent of the total children examined. Of these,
20 showed some degree of anaemia. This equals almost 50 per cent compared with 30
per cent of total children examined showing anaemia. Anaemia would therefore appear
to be to some extent a symptom accompanying the early signs of rheumatism. 10 per
cent of the potential rheumatic children have already been recorded as showing pallor.
Type of symptoms present. Apparently definite " rheumatism," 14 cases ; fleeting
pains in limbs, 25 cases ; symptoms suggestive of chorea, 6 cases including 1 also
showing pains. Joint swellings were a condition not commonly complained of. One
third, therefore, of children showing signs suggestive of rheumatism appear to be
fairly definite cases. In several cases the record of " acute rheumatism," " rheumatic
fever was made on a previous diagnosis by the private doctor.
Of the cases suspected of rheumatism or chorea, the following showed cardiac
disturbances:— 2 modified first sound only; 15 soft mitral murmurs; 1 loud mitral
murmur plus murmur at base; 5 basal murmurs; 1 cardiac dilatation without murmur;
3 disturbances of rhythm simply, and 5 further signs of carditis (in addition to a possible
murmur at apex or base). This means that 60 per cent of the possible early rheumatism
cases already showed some degree of functional cardiac disturbance and 40 per cent
apical murmur present, with or without murmurs at the base or other cardiac signs.
In 10 per cent there appeared already to be a definite degree of what is now called
carditis." In 2 cases an apical thrill was felt. The incidence of cardiac disturbances
(and the type of cardiac disturbance) is therefore much more noticeable amongst the
children showing signs suggestive of rheumatism than amongst the children simply
showing signs of anaemia. It would appear from these figures as if cardiac
infection did accompany rheumatism even in its earliest stages and at an early
age (at an age period at which rheumatism used to be considered not to exist) and as
if the presence of a variety of cardiac disturbances, however minor in character, should
he some warning of the risks of imminent rheumatism, even if signs be not already
present. It was not found in the group of children examined that signs of carditis