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84
The distribution of chorea in London so far as it can be gauged by the
percentages of total causes of absence for the various districts exhibits considerable
variation.
Lambeth 14.4 per cent. Wandsworth 8.6 per cent. Chelsea 6.2 per cent.
Camberwell 8.9 „ Greenwich 80 „ Hackney 60 „
Poplar 8.6 „ Islington 7 .3 „ St. Pancras 5.6 „
City and Stepney 8.6 „ Paddington 6.6 ,, Southwark 5 .0 „
The number of tubercular cases amongst children has decreased steadily in
the last four years. The percentages of out-of-school cases notified as tubercular
during the years 1920-23 were 22.33, 20.1, 17.3 and 16.95 respectively. The steady
decrease is undoubtedly due to more efficient supervision, the thoroughness of
which is shown by the following figures. In all, 421 children out-of-school were
certified as tubercular; 251 of these were in convalescent homes, 96 attended the
various metropolitan hospitals, 31 attended dispensaries, 27 were treated by private
doctors, 12 were in infirmaries and 4 were on holiday in the country. There were
only 20 cases, in the whole of London, which did not seem to be under constant
medical supervision. A detailed analysis of the data shows that the numbers of
boys and girls afflicted are about equal (227 boys and 214 girls). There is a definite
preponderance of surgical cases amongst the boys and of medical cases amongst
the girls. The figures also suggest that the onset of the disease seems to be decidedly
earlier in surgical than in medical cases.
Employment of School Children.

Of the 2,728 children only 66 were girls. Seventy per cent, were to be
engaged in the delivery of newspapers. In 1.4 per cent, the school doctors refused
certificates on account of the general ill-health of the child or the physical unsuitability
of the child for the employment proposed. The rejections included two cases
of tuberculosis, 13 of heart disease and rheumatic affections and 10 of general debility.
The proportion of children for whom conditional certificates were granted
was 3.2 per cent. The conditions mainly imposed were that necessary medical
treatment of defects should be carried out including dental attention, and correction
of visual defect and treatment of minor ailments, but in some instances a shorter
period of work than the by-laws permit and restrictions upon the lifting or carrying
of heavy weights were imposed.
These children and others in whom the doctors had doubts were kept under
continuous medical observation. In about five per cent, of the children employed,
continuous medical observation was considered necessary. In only one instance
was a license revoked in consequence of deterioration of health; this was in the case
of a boy engaged in newspaper delivery who developed trouble in the knee joint.
So far as medical observation can discover, the introduction of the by-laws
has cured the evils which formerly undoubtedly arose through the employment of