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(four with rickets), 10; syphilitic taint, 3; tuberculous diathesis, 2; cyclic
vomiting (allergic diathesis), 10; spoilt child, 1; environmental conditions (bad
housing or home), 5; catarrhal or septic infection, 2; congenital weakness, 1 ;
other causes, 2.
Dr. Gourlay's (north division) impression was that the under-nourished condition
of the children coming before her was due in the main to social environment and in
particular to three main causes, in order (1) life under impoverished conditions,
(2) ignorance of dietetic principles on the part of the parent, (3) poor housing and
overcrowding.
Kecommendations
and
advice.
Advice as to diet, daily routine and general hygiene was given to the mother.
Means were devised in appropriate cases to supplement the dietary (including
school milk, dinners, malt and oil, alteration in home diet, glucose, Parrish's Food).
Treatment for defects was advised and in most cases carried out. Open-air
school, open-air class and convalescence were frequently recommended.
Ultra-violet treatment was obtained for several children.
In the northern division, Dr. Gourlay worked out a weekly dietary, not indeed
ideal but practicable, to form a basis upon which the mother could work. It was
intended to show her how she could keep the child well if she spent her money
wisely. A copy of this dietary was given to each parent, and it was obvious that
the advice was appreciated and that efforts were made to follow it.

All the recommendations were iollowed up and arrangements are in hand for
such as are outstanding. Failure to carry out recommendations was due in some
cases to lack of parental co-operation, e.g., refusal to allow their children to have
dinners in school, or to go to an open-air school.
In the great majority of the cases, milk in school was already supplied to the
children before their first attendance and this was, of course, continued.
In some cases milk was refused or found impossible to retain owing to idiosyncrasy.
In these cases malt and oil or other supplementary articles were
substituted.
Results and
conclusions.
The nutrition centres are an attempt toa blaze a new trail through uncharted
territory. The medical officers in charge were given a free hand, although standardised
records and procedure and consultations ensured that similar lines of enquiry
were followed.
It is clear that the groups of subnormal children differed in character, and the
problems to be faced were also distinct in the five widely separated districts. In the
north-western and south-eastern divisions a large proportion of the children referred
to the centres were judged not to be cases of true nutritional deficiency; in the
south-eastern division indeed the centre assumed the character in part of a child
guidance clinic. In the north-eastern and northern divisions the children were
all cases of nutritional deficiency ; but, while in the north-eastern (Poplar) division
rickety manifestations were notable in frequency, in the northern division they were
conspicuous by their absence, the remarkable freedom of the children from dental
caries in this division being confirmatory evidence.