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82
Children absent from school on account of illness.
A special census is made in November each year of children out of school for
chronic illness. The results for the past four years are given in the appended table.
While the total numbers reported each year do not greatly differ, the percentage
of children suffering from tuberculosis tends to decline, while that relating to rheumatism
tends to increase. The number of children stated to be suffering from
chronic nervous disorders increased during 1923.
Of the 2,726 children, 1,170 were boys and 1,556 girls. In boys, the percentage
absent from rheumatism was 19.4, and from tuberculosis 20.1; in girls, on the other
hand, the percentage suffering from rheumatic disorders was 27.3, and from tuberculosis
14.6, showing very remarkably the excessive incidence of rheumatic diseases
upon girls compared with boys.

The greatest number absent is at age 6, next to this at age 13. The least number
is at age 10. At age 12, the proportion of the whole is 12 per cent, in girls and only
7.6 per cent, in boys.
Chorea.
The records show an increase in the number of cases of the disease designated
chorea. In 1920, the proportion of the out-of-school children suffering from chorea
was only 7.4 per cent; in 1921 it was 8.19, in 1922 it reached 9.2, and in 1923 it was
9. In seeking an explanation, it is necessary to bear in mind that chorea is no longer
the clear-cut clinical entity it was formerly supposed to be. Although some still
maintain that chorea is almost invariably a rheumatic manifestation, others are now
insisting that it is primarily a nervous disease.
In 1923, the total number of out-of-school cases was 2,725, and 230 of these
were certified as choreics. This figure does not reflect adequately the loss of education
due to chorea, as these children remain out of school for longer periods than
those suffering from most other complaints. Seventy per cent, of the chorea cases
were girls. Up to the age of ten there is great disparity between the numbers of
choreic girls and boys. In fact, amongst the nine-year old cases, the boys
were in a slight majority. After the age of ten, the girls were greatly in the
majority ; and amongst the thirteen-year-old cases there were 41 girls and only
2 boys.
The age distribution is specially interesting. With one exception, the number
of cases increases continuously up to the age of thirteen. Below the age of ten,
the choreic children formed 6.69 per cent, of the out-of-school cases, whereas between
the ages of ten and thirteen the percentage is 11.3, and amongst the thirteen-yearold
children 13.3 per cent, of the whole group of out-of-school cases suffer from
chorea. So many children leave the school in their fourteenth year that it is
impossible at present to estimate the incidence of chorea at ages above thirteen.
It is evident from the figures that what is certified as chorea is a disease that
increases in frequency up to the age of adolescence and the increase is considerably
accelerated during the pre-puberty ages and especially amongst girls.