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105
Malnutrition.
Obvious malnutrition due to underfeeding is not, in my experience,
prevalent among the patients attending the dispensary. Concerning
minor degrees of malnutrition it is not, however, possible to speak definitely.
The problem is a complex one, for slight malnutrition is difficult
to define, and its detection clinically is often uncertain. The majority of
children attending for observation gain weight steadily, which may be an
indication that they are not seriously underfed. On the other hand,
many children seen are definitely ill, and if some of these are debilitated
or below par it is reasonable to ascribe this in some measure to illness,
although it may be impossible in all cases to rule out malnutrition as a
causal factor in such illness. These debilitated (non-tuberculous) children
who fail to progress satisfactorily are recommended for convalescence, and
during the year convalescence was arranged for 12 such children through
the Invalid Children's Aid Association. Some of these children failed to
gain weight during convalescence, and this fact would appear to rule out
underfeeding as a cause of their debility.
Suspected malnutrition should not necessarily be sought primarily
in the children. Some of the healthiest children seen during the year
were members of a family of eleven occupying two rooms. The father
was unemployed, and there was a net income of £2 14s. 6d. after only
rent and insurance had been deducted. In this case the mother, a
quiescent, non-infectious case of tuberculosis, was, I thought, undernourished,
and I formed the opinion that she was going without proper
food for the sake of the children. I therefore recommended the granting
to her of extra nourishment, which was arranged through the Public
Assistance Committee. On receipt of this the patient began to gain weight
and is now maintaining a steady weight 5lbs. better than her weight
previously.
Dental Treatment.
Tuberculous patients requiring dental treatment are referred to St.
Andrew's Hospital on Tuesdays and Fridays at 12 noon. 16 patients
were referred during the year, and the small number referred is accounted
for by the following reasons:—
1. If Institutional Treatment for tuberculosis is urgently needed
this is immediately arranged, and any necessary dental treatment
is carried out while the patient is away.