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23
sleep, noise outside that precludes sleep unless the windows are shut, basement rooms,
lack of air, light and sanitation, too many stairs for the sick parent, damp, bugs,
rain coming in. These are some of the complaints."

* One of these mothers does home work only and one works 1£ days a week only.
Consideration
of the causes
of malnutrition.
Dr. Elman (north-eastern division) says : " It is quite obvious that to generalise
on the causes of malnutrition is hopeless. Each case must be judged separately.
So many factors are involved that it is difficult to hold any one responsible by itself.
Poor housing, large families, bad early feeding are no doubt contributory causes.
I am not sure that psychological factors are not involved, especially as to appetite.
I am of opinion that a happy home is more conducive to good nutrition than an
unhappy one, although the same economic conditions obtain. In the end one is
drawn to the conclusion that there is close association between poverty and malnutrition,
although in my series the best-off parents did not have the most robust
children."
Dr. Batten (north-western division) states : " It is reported that 4 children out
of 55 were born prematurely and that 7 out of 24 weighed 6 lbs. or less at birth.
In the normal group " (Dr. Batten considered 14 of the children referred to him as
not to be suffering from malnutrition in any sense) " 2 out of 12 were premature,
and 2 out of 6 weighed less than 6 lbs. at birth. There is no evidence, therefore, that
prematurity is a factor of great importance. It has rarely been found possible to
attribute ill-nourishment to a single and well defined cause. The following, however,
is an attempt to classify the presumed aetiological factors under broad headings
with some overlapping : constitutional, 24; environmental, 32 ; food, 8 ; present
disease, 8 ; past disease, 11.
" Constitutional defects and faulty environment predominate. By constitutional
defect is meant a failure to grow, thrive and put on flesh according to expectation,
due so far as can be ascertained to something inherent in the child. Environment
is interpreted widely to include not only the child's material surroundings but all
the external influences impinging upon him, in fact his home and his upbringing.
It is noticeable that dietary faults were only detected with certainty in 8 children
(and doubtfully in 4 others). In a fairly large proportion of cases, home surroundings
were known to be comfortable and food abundant."
Present defects were held responsible in 9 instances and past illness in 11 (together
with 5 others in which there was some doubt).
Dr. Morgan (south-eastern division) attempted to classify his 46 cases according
to the primary cause of subnormality, with the following result: subnutrition due
to insufficiency, 5 ; subnutrition due to incorrect feeding, 5 ; debilitating illnesses