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In short the clinic represents an effort to better the lot of the pre-school
child and the chief aspects of this very difficult problem will be discussed
separately.
Malnutrition.
According to the particular dietetic deficiency numberless diseases may be
produced. Three types may relevantly be discussed in this report (a) iron deficiency,
(b) rickets, (c) a heterogeneous group in which the predominating features are,
thinness, lack of muscle tone, bad posture, pallor, etc.—the type of child that is
usually dubbed " badly nourished." In this group it is probable that iron deficiency
often plays a part; but other important factors in the production of this type of
child are recurrent infection, hereditary and bad management. The plain diagnosis
" badly nourished " is incomplete and misleading, and gives the impression that
there is not enough correct food for the child's requirement whereas a child may
live on the " fat of the land " and yet be thin and puny on account of recurrent
infection. On the other hand a child may be fat and bulky and yet suffer from such
severe nutritional deficiency diseases as active rickets and severe anaemia.
The feeble puny child must be fully investigated, but the diet is just one of
many possible factors. Incidentally, a diet can only be assessed accurately by a
trained dietitian. In the near future the services of trained dietitians might be
utilised in deciding whether certain families are capable of securing adequate
food.
*Anaemia.
A careful study of the incidence of anaemia among the pre-school children
of this borough has been made and is believed to constitute the most extensive
survey yet carried out at this period of life. For the sake of scientific accuracy
the rather laborious Haldane method was used. (It is suggested that in future
the quicker Sahli method be substituted for ordinary diagnostic purposes.)
There is still some difference of opinion as to the optimum haemoglobin
level in the pre-school period. One of the least rigorous standards is that recently
proposed by Findlay. It is indicated by curve Fon the diagram.
% Haemoglobin (Haldane Scale).
* The details of these investigations will be published fully in a clinical
journal in the near future.