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Report of the Medical Officer (Education).
129
It would appear that cases with an index of 2.1 or under need special investigation ; they are
somewhat more frequent than are the cases in the worst grade of the fivefold scale of ocular estimates.
Oppenheim maintains that the relation between the girth of the empty chest and the maximum girth
of the relaxed arm gives an indication of the nutrition of the individual which is superior to any
other measurable ratio. Arm× 100/ Chest nutritional quotient. He finds the ratio to be practically independent
of age and to present an average value of 29. A series of observations on the children
attending London secondary schools gave an average of 29, while the same ratio calculated from the
published measurements of boys at Marlborough College proved to be 28.6. A ratio below 26 might
be taken to show bad nutrition, one over 29 good nutrition. Classifying the boys in a London secondary
school by this means, 3 per cent. appeared as bad, 42 per cent. as medium, and 55 per cent. as good.

In the Council's secondary schools the results are definitely correlated with the ocular estimate,
but no records having been made in elementary schools, a comparison with the former is impossible.
The method merits further enquiry.
Children in North Kensington.—Whilst the variation in physique of the children as shown
in figures varies broadly over London, the examination of particular districts often shows a very
patchy distribution in poverty and ill-health. The social conditions under which the children in
North Kensington live vary considerably. At such schools as Portobello-road and Oxford-gardens
they are fairly prosperous and comfortable, approaching the class found in secondary schools, only a
few poor or neglected children being sprinkled through the classes. At Oxford-gardens the physique
and nutrition of the children are very good, whereas at Edinburgh-road, a few streets away, the type
of child is entirely different, many being dirty, ill-fed and neglected, and the numbers requiring medical
treatment, or entered as necessitous being relatively high. At St. James' Norlands and St. John's,
there are comparative comfort and well-being, while at Sirdar-road the mass of the pupils are suffering
from poverty and bad home conditions, and at St. Francis in the adjacent street, the distress and destitution
are very marked. At Wornington-road School during the last two years the prosperous child
has gradually become more rare and the necessitous child more common; this is shown also by the
increase in the number of meals provided and by the statement of the teachers that the neighbourhood
is going down. In the Kensal-road district there are three schools, St. Andrew's, Bosworth-road, Middlerow,
and St. Mary's Roman. Catholic, East Row. Although the better class girls in the district prefer
to attend St. Andrew's, there is a large percentage of malnutrition and poverty among the children there,
while at Middle-row and St. Mary's these conditions are accentuated. A definite improvement has
taken place during the last two years in the condition of the children attending Middle-row school. This
is in part due to the medical inspection, to the work of the school nurse, the increased number of meals
supplied, the improved quality of the food provided at the dinner centre, and in a great measure to the
unremitting efforts of the teachers in all that concerns the physical welfare of the children. The
Kensal-road district has become even poorer and more necessitous during the last two years and the
home conditions also tend always to deteriorate. The amount of disease found among the North
Kensington children is not very great. In the infants' department the children are on the whole healthy,
the cases of organic disease and mental deficiency form only a small proportion of the whole. In the
senior departments a larger number of cases of eye, throat, and ear trouble are met with, but the
general impression obtained is that the material is fairly good, it is the conditions of life which are at
fault. The great amount of anaemia and malnutrition among the children is attributable to poverty,
with its resultant evils of dirt, ill-feeding and underfeeding, neglect and female labour. The necessity
for buying cheap food results in the purchase of food-stuffs which are deficient in nutrient properties.
The main articles of diet are indifferent bread and butter, the fag-ends of coarse meat, the outside leaves
of green vegetables, and tea, with an occasional pennyworth of fried fish and potatoes. Children who are
supplied with milk at school or who are given breakfast and dinner respond at once to the better
feeding, and show distinct improvement in their class work. Dirt is one of the most potent factors in
the production of malnutrition; large numbers of the children are verminous, and many more show
evidence of the infested state of the houses and bedding. Infants are often drowsy and inclined to sleep
all day because they have no proper quiet sleep at night. In one school on a roll of 392 girls, 208
were found to be dirty, and the examination of 1,670 children showed that 516 were dirty and 86
verminous. The unemployment among the men obliges the women to seek for work outside the home,
and the underpayment of female labour has its effect upon the nutrition of the family. Investigation
in the senior departments of one school showed that 144 children were being supported by their mothers
only, 57 were living on their sisters, 68 upon the joint earnings of elder brothers and sisters, while