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Report of the Medical Officer (Education).
131
found in going through the individual notes of the other departments although these notes had not
been made in regard to the effect of nutritional alterations, and were therefore unbiassed. Extra
feeding on such a scale is only justified by results which, from the doctor's point of view, were good.
Whilst indiscriminate feeding would be deprecated, yet, the provision of feeding is not only justified,
but a duty, if the condition of the child and its home and the tendency towards disease or retardation
of development are all considered and judgment is deliberately made that by feeding the child may
attain a more normal development and have an increased resistance to the attacks of diseases which
society practically thrusts upon it.
Dr. Hawkes, who made these observations is also medical officer to a secondary school which
receives a certain number of scholarship boys. He notes the inferior physique on admission of boys
who mentally are on an equality with their better fed, housed and clothed fellows in the same school,
and suggests that careful control, observations and a thorough investigation of the whole subject is
urgently needed.
Children requiring Feeding.—As already stated, it is extremely difficult to define any exact
series of physical or mental conditions as caused by malnutrition. Dr. Guest, who has given
some time to this subject, points out that malnutrition may only manifest itself as anaemia, and go on
with apparently normal mental development or even exceptional mentality; whilst children from very
poor homes may exhibit good physique and healthy blood, as judged by the colour of the mucousmembranes,
and yet have mental dulness and inertia in a marked degree. In some of these cases
improved diet certainly affects their mentality. In other cases malnutrition shows itself in the intractability
of otherwise curable ailments. Discharging ears or chronic conditions of the surface of the eyes
are often very difficult to deal with in badly nourished children. A child may be so lowered from malnutrition
that it is almost constantly suffering from minor ailments, such as colds, bronchitis, diarrhoea,
or slight febrile attacks, which in their cumulative effects may be serious. Both the social and physiological
conditions of a child should be considered. If poverty is obvious, from the history of the children
as known by the teachers, from the conditions of their clothes and skin, and from the facts known
regarding the parents' work and wages and this evidence is reinforced by the existence of any medical
defect affected by the condition of nutrition, a clear case exists for feeding the child, which will need
very strong evidence to the contrary before it can be put aside. On the other hand, in a child presenting
marked anaemia or other defect ascribable if only partly to nutrition, without the existence
of marked signs of poverty and without any obvious defect to account for it, then there is a case for
careful medical investigation of the home environment. Respectable and threadbare poverty is often
at the bottom of many such cases. If the school work is not to be affected substantial food should be
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provided for such cases. In many districts malnutrition is certainly one of the most serious and widespread
conditions noticeable in the schools.
The provision generally at cost price of school meals for all who choose to pay for them, would
be a national economy, which would do much to improve the status of the feeding centres and the
standard of feeding. This principle is applied most successfully in schools of a higher grade and might
well be considered in connection with the ordinary elementary schools of the Council. Such a provision
would probably be of the greatest benefit to the respectable but very poor, who are too proud
to apply for charity meals and whose children are often penalised by want and the various avoidable
defects or ailments that come in its train.
The measurement of stature and weight made in the schools during the year enables an
approximate picture to be formed of the distribution of physique in London elementary school
children. This is indicated in the following maps, which show average results for children of 8 and 12
years at their last birthday.
Physique.