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97
Report of the County Medical Officer—Education.
(3) Girl, 128/12, home poor, school dinners and milk given, gained 34 kilograms in 5 months.
(4) Boy, 109/12, tall, overgrown, good home, working for scholarship ; given milk, cod liver oil,
and malt at parent's expense, gained 2.9 kilograms in 3 months.
(5) Girl, 87/12 good home, good food, but poor appetite, much below normal height and weight.
Cod liver oil and malt given, gained 2.1 kilograms in 3 months.
The cases in which there was a marked decrease in weight recorded at re-inspection were :—
(1) Boy, 113/4, home condition and feeding good, milk diet given, gained 2 centimetres in height,
but lost 0.9 kilograms in 5 months, no cause assigned.
(2) Boy, 88/12, home condition and feeding good, poor appetite, suffered from congenital debility
due to premature birth; said to have worms. Cod liver oil given and child attended tuberculosis dispensary,
gained 4 centimetres in height, but lost 2.3 kilograms in 4 months.
(3) Boy, 111/12, overgrown, 9 centimetres above normal height, but 1.6 kilograms below normal
weight for his age, home conditions, good. Milk given at school; no increase in height, and lost 2.3
kilograms in 4 months, no cause assigned for malnutrition.
Enquiries as to the adequacy of sleep do not as a rule result in reliable information. In almost
all cases the child is said to have 11 or 12 hours sleep, but in some few cases there is other evidence
that the child is often out late, that a boy does a milk round in the early morning, that the home conditions
are such that sleep is impossible before midnight, and in one case a boy of 8 was said to be attending
a class in Hebrew until 9 o'clock each night.
The causes assigned for the condition of malnutrition in 330 cases were classified as follows :—
Poverty 77 Congenital debility 34
Neglect 21 Rickets 12
Tuberculosis (or tubercular tendency) 73 Overgrown 3
Improper feeding 16 Deformity 2
Digestive trouble, worms, etc. 7 Other illnesses 10
Heart disease, anæmia and rheumatism 23 No cause stated 52
330
Poverty and neglect are an important cause of malnutrition and the temporary loss of work
by the bread-winner soon makes its effect felt upon the health of the child.
Cases of neglect include wilful negligence on the part of the parents, cases of alcoholism and also
cases in which the mother goes to work and is unable to provide a proper midday meal for her children. In
quite a large number of the instances under review, it is noted that the death or prolonged illness of either
parent by throwing the responsibility of the care of the child on the other parent, brings about neglect
of this kind. Out of some 250 cases in which the care committees enquired into the circumstances it was
found that the father was dead in 15 instances and the mother in 13, while in one case both parents were
dead. Criminal neglect could be alleged in nine cases. In three cases the parents were prosecuted, in
two instances the National Society for the Prevention of Cruelty to Children had the children put
under proper care, and in one case cautioned the parents, while in three instances alcoholism was
alleged, but there was not sufficient evidence to prosecute.
Tuberculosis in one form or another is a cause of malnutrition in over 25 per cent, of the cases
where any cause is assigned, and the parents are urged by the care committee to attend the local tuberculosis
dispensary or other institution where treatment can be obtained.
Anæmia and heart disease were causes in 8 per cent, of the cases. Congenital debility was noted
in 34 cases. Many of these were instances of children prematurely born and in each of 9 cases the child
was a twin. Rickets was noted in a few cases and in others the child's condition was attributed to some
previous illness.
In respect of treatment, cases of malnutrition may be divided into two groups (a) those where
feeding and care are needed, and (b) those in which some definite disease is suspected. Of the cases
coming under review during the year, 188 received school meals or extra nourishment at home.
The following table shows the number of children to whom meals were supplied and indicates
whether they were given free, at the parent's expense, or supplied by a charitable agency.
Meal.
Supplied at.
Council's Cost.
Parent's Cost.
Cost of Institution.
Total.
Breakfasts
7
_
_
7
Dinners
46
2
_
48
Milk
45
32
—.
77
Cod Liver Oil
30
34
22
86
Malt
4
12
10
26
It will be seen from these figures that about one-third of the 188 children were supplied with
more than one kind of extra nourishment. The period for which the meals are continued depends upon
the necessity of the cases and it comes under review at short intervals. In some cases the child was
already on the school feeding list at the time of inspection, and the care committee reports show that
this was so in regard to 30 children either at the time of, or just prior to, the case being noted at medical
inspection.
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