View report page

65
Visual defect, heart strain and incipient deformity are more marked in secondary
school girls than in the boys. Comparing the 12-year old children in secondary
schools with the 15-year old pupils, it is found that these defects in girls still further
increase; for instance, while the percentage of girls with perfect vision sinks between
12 and 15 from 723 to 69.9, the percentage wearing spectacles increases from 13.3
to 17.3; and while 4.9 per cent. are suffering from anaemia at 12, 6.3 per cent. are
suffering at the age of 15.
The strain of education falls very heavily upon girls at this important physiological
age, and more consideration requires to be given to periods of recreation
and their proper utilisation.
Special Enquiries.
Dr. Chaikin, with the assistance of the school doctors working in the Eastern
Division, has conducted an enquiry into cases of chorea occurring amongst the
school population in that district between 1919 and 1923. In all 124 cases were
investigated. 91 of the cases were between the ages of 7 and 12, although there were
two cases at the early age of 3 years. The number of girls affected was excessive,
being 75 out of the 124; this excess fell chiefly upon girls aged 10, 11 and 12, of
whom there were 36.
The largest number of new cases occurred in 1922, with 51 cases as opposed to
29 in 1921. The heaviest seasonal incidence in the 13 quarters studied was in the
second quarter of 1921 and the first quarter of 1922. As the point of seasonal
incidence is of some interest, it may be as well to set out the whole of the cases
occurring in quarters-1919, 3rd quarter, 9; 4th quarter, 4-1920, 1st quarter, 8;
2nd quarter, 7; 3rd quarter, 4; 4th quarter, 10—1921, 1st quarter, 9; 2nd quarter,
22; 3rd quarter, 10; 4th quarter, 10-1922, 1st quarter, 15; 2nd quarter, 12;
3rd quarter, 4. With regard to weather influence, Dr. Chaikin points out that in
1921, when the largest number of cases occurred, the year was warm, dry, and
sunny, and the particular quarter in which the greatest excess of cases occurred was
the driest period of that year. There is a definite tendency for the cases of chorea
to follow inversely the rise and fall of barometric pressure, but no relationship could
be found between changes of relative humidity and the incidence of chorea.
Dr. Chaikin considers that no close relationship could be established between
the instances of chorea and the prevalence of scarlet fever. On the other hand,
if chorea be regarded as possibly a manifestation of post scarlatinal rheumatism,
the exceptionally high prevalence of scarlatina in the last quarters of 1920 and
1921 cannot be entirely ruled out. The age distribution of the cases lends some
support to the theory that school pressure has some influence, and the special
incidence upon girls between the age limits of 10 and 12 suggests that the combined
effect of school anxiety and exhaustion of the vital forces entailed by the
pre-puberta1 increase in growth is a determining factor in these cases.
The periods of absence from school of the choreic children varied from 2 to
75 months, the general average loss of school attendance per child subsequent to
notification was 7.19 months.
Dr. Chaikin draws a comparison between the tuberculous child and the rheumatic
child. In the former it is possible to deal with the case in the pre-tuberculous
period, and forces are mobilised to this end, so that a great deal of preventive work is
not only possible but actually carried out. In the rheumatic child, however, there
is usually no attention drawn to the case before the supervention of profound
disease such as chorea, or, worse still, organic heart trouble. The onset of rheumatism
is unseen and insidious, "as a thief in the night so is the poison of rheumatism."
Stress is laid upon the necessity of general attention to unhealthy throat
conditions which favour the entry of the disease.
Chorea.
Dr. C. N. Atlee has carried out an investigation into the prevalence of goitre
amongst children in the south-eastern quarter of London. No child was included
Goitre.