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135
The Royal College of St. Katharine.
Report of the Senior Medical Officer.
The Circular (1290) issued by the Ministry of Health on October
22nd, 1932, headed ''Nutrition," and calling attention to the results of
recent research work, has been acted upon in this Borough. Dried milk
Containing iron has been made available for bottle-fed babies, and a
solution of iron ammonium citrate for the breast-fed. Cod liver oil is
Supplied free for those who cannot buy it, and at cost price for others.
The advice in the Circular implies that nutritional anaemia, and rickets
in its milder forms are sufficiently prevalent for it to be simplest to take
their occurrence for granted and to prescribe prophylactic measures for
every child
Recommendations as to the diet of expectant and nursing mothers
are also given; and cod liver oil is advised in cases where Calcium and
Vitamin D deficiency is suspected. A fall in the incidence and severity
of dental caries is looked for in the children through an improvement in
the health of their mothers. The last point mentioned is the need to
ensures adequate milk in the diet of the growing child.
In the Clinics here we have often identified cases of anaemia and
referred them for treatment, particularly in twins and premature babies;
but we had not suspected it to be anything like so prevalent as Dr. Helen
Mackay's finding imply. A much more careful search was started when
her paper was published, and the first impression gained is that it is
very difficult, if not impossible, to make anything near a correct guess
at the degree of anaemia by ordinary inspection. A haemoglobin count
as low as 50—60 Percent. is not reliably shown in the tint of the skin or
mucous membrance and one of 80—85 per cent. may exist in a child
not pallor suggests a much lower level. This goes far to explain how
easy it is to overlook the condition, and since haemoglobin estimation is
the mass in more than a small proportion of babies seen in the Clinics,
the mass prescription of iron offers the best hope of security. So far the
response to iron seems to be variable, but it is possible that lack of
regular administration accounts for some of this; or that all are not
instances of simple nutritional anaemia.
The definition of rickets, in its early stages and in a mild degree,
we have always held to be a difficulty, especially when a large number of
babies is under review and when many problems of upbringing also have
to be considered. The first detection of head sweating, failure of muscle