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of this report. An account was given in the Annual Report for 1923 (vol. III.,
p. 81) of the scheme of co-operation between the tuberculosis officers and the
school medical service. The scheme has been continued during 1924.
As an example of the combined work between the school medical service and the
tuberculosis dispensaries the following account supplied by Dr. F. E. Lewis, the
divisional medical officer in the N.E. Division of London may be given. " In this
division during the year 1924 the total number of children upon whom watch has
been kept amounts to 1,113. After joint review between the tuberculosis officers
and myself of the individual records this figure has been reduced to 302 who are to
remain on the scheme during the ensuing year. On these 21 are first to be reexamined
by the tuberculosis officers.
The subjoined table shows the distribution among the dispensaries. During
the year it was necessary to refer back to the dispensaries certain cases who have
moved or left school or who appear to need attention from the tuberculosis officers.
These are indicated in column 3. The cases regarded as satisfactory are grouped
in column 4, and those to be "carried over" for 1925 in column 5. The figures
in brackets, which are included in the main figures of the column, indicate cases
which the tuberculosis officers wish to re-examine themselves.'*5

Children absent from school on account of illness.
The attendance officers are in communication daily with the divisional medical
officers regarding children absent from school, and the vast majority of the children
return at the earliest possible moment. When a child is absent for three months
the name is sent to the school medical officer in order that the case may be considered
if necessary in regard both to special treatment and to fitness for special
education. A census of long period absences is taken once a year and the following
table gives the results for the past four years. Important points arising are the
great reduction in the number of children absent for tuberculosis, the very great
improvement in absences from ringworm, contributed to both by reduction in
number of cases and by a shortening of the duration of disease, and the continued
and unabating influence of rheumatism as the chief cause of long continued absence
from school. Further analysis of absences in 1924 shows chorea to be the chief
single cause of long illness, as ten per cent, are absent from this. The ten-year old
children suffer more from chorea than any of the others, a steady rise in the number
taking place from 5 to 10 and a steady fall again from 10 to 14. Girls suffer from
chorea in comparison with boys in the ratio of two to one. Encephalitis lethargica
appears for the first time as a substantial cause of long absence, there being 40
children notified as absent definitely at one time from the results of this disease,
and, of course, there are probably additional cases with unspecified nervous condi-