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14
There can be no doubt but that this result is to a large extent due to the fact
that all connected with schools—managers, care committee members, teachers,
attendance officers, school doctors and school nurses—have been on their mettle.
In London means exist to cope with any case of malnutrition or threatened
malnutrition immediately and effectively. The children are daily for hours under
the observation of kindly, intelligent adults who have the power of immediate
intervention in case of necessity. If there is a child in a London elementary school
suffering from lack of nourishment who is not immediately dealt with someone is at
fault.
There is a certain number of children who are not necessitous but belong to the
types mentioned above. They have been delicate from birth, or they have suffered
serious illness, or they are of the nervous worrying kind; in these cases there is a
lack of resistance—they require special help such as additional milk or cod liver oil,
transfer to a special (open-air) school, or a period in the country.
There is another set of figures prepared for table II of the annual return for the
Board of Education. Here what is asked for is not the total number of children in
categories 3 and 4, but the number marked by the school doctor for treatment or
observation. This is a much smaller number than the totals of categories 3 and 4.
It contains all the children in category 4 and a certain number of those in category 3.
This number has risen during the past three years of economic crisis.
The children marked "for observation" with regard to nutrition are mainly
those referred for treatment for some other condition of which the disturbance of
nutrition is regarded as a symptom. They are weighed at regular intervals by the
school nurses.

Two points arise out of these figures. In the first place there may have been
with a stationary number of children who are undernourished a slight worsening of
the condition in certain individuals; on the other hand it may be that the keen
anxiety felt with regard to economic conditions has led to a greater readiness to take
preventive action before definite deterioration has taken place.
Taking routine and special examinations together the number of children noted
for treatment or observation for malnutrition fell from 3,921 in 1932 to 2,886 in 1933.
These represent the "working figures" which reveal the active measures taken, the
result of which has been to preserve the children from serious deterioration.
Following on previous reports made on the present nutritional state of school
children, I was on 23rd January, 1933, instructed to make similar inquiries and
examinations of groups of children in further areas.
The medical examination of the children was performed throughout by Dr. R.
H. Simpson, who conducted the former inquiries. The collateral inquiries into
social conditions were carried out by the personnel of the school care organisation.