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130
Annual Report of the London County Council, 1913.
Dr. Palgrave's
observations
on
faulty home
management
in relation to
malnutrition.
The scoliosis was usually of the first or second degree, and could be ascribed to faults in
posture accentuated by muscular weakness. In some cases it was accompanied by flat feet, due, so
Dr. Leipoldt was led to believe, to the faulty position assumed during physical exercises in
which the children were made to stand with their toes turned out. Minor deformities of this kind are
interesting from the point of view of treatment. It is usually impossible to get the children to go
to an orthopaedic department where they can get proper corrective exercises, either free standing or
with apparatus; the parents grudge the time and expense necessary for such regular attendance. If
they go to an ordinary hospital, they are in nine cases out of ten, told that there is nothing the matter
with them, since these minor degrees of scoliosis are usually overlooked. It seems that the only
reasonable method of dealing with those cases is to establish, at some central school, classes for the
treatment of these smaller degrees of curvature which could be attended at certain times by children
who go to neighbouring schools, and where the exercise could be supervised by the school doctor. In
asthenic children such regular exercises would be specially beneficial in improving, so far as is
possible, the general condition and carriage of the body.
Some General Conclusions.—From the data already mentioned, it appears that some general
conclusions may justifiably be drawn.
1. Out of a total number of 3,198 children examined, all of school-going age, the costal sign,
to a greater or less degree, was present in 563 or 17.6 per cent., of whom only 120 or 21.3 per cent.
could properly be classed as normal.
2. Among the children in whom a defective physical condition was found to exist, a large
percentage showed, to judge from the family history, a disposition towards tuberculosis, nervous
disease, gastric trouble, or enteroptosis.
3. The costal sign, in conjunction with signs or symptoms denoting gastric or intestinal
atony, and in a markedly asthenic child, is of decided clinical significance so far as the general
nutrition of the child is concerned.
4. Such children should properly be classed as 4 so far as nutrition is concerned. The
prognosis, so far as improvement is concerned, is in their case considerably worse than in other
malnutrition cases in which the sigma costale is not found.
5. Children with a pronounced costal sign generally show a diminished pulmonary capacity
as judged by the chest measurements. Such children should be encouraged to take deep-breathing
exercises, and especially to swim, since both the exercise and the stimulating effect of the water upon
their skin appear to have a markedly beneficial result.
6. Children in whom the sign occurs and who have a pronounced family history of tuberculosis
should be followed up, even if at the inspection they appear to be normal. Such children may
properly be classed as "pretubercular," more especially if they show the habitus asthenicus, and have
anomalous chest signs pointing to deficient entry of air at the apices.
7. Children with the costal sign who have a tendency towards gastric or nervous trouble
should similarly be kept under observation.
Dr. Palgrave has made observations upon malnutrition, as caused by faulty home management,
during examination of children in the Hammersmith schools. His conclusions are based on
consideration of the child's height and weight, together with such points as pallor, facial expression,
and muscular "tone." In many instances more than one cause might reasonably be assumed to be at
work, and it was thus impossible to assign the case to its group with accuracy. But amidst the
confusion of causes of malnutrition one point appeared to stand out very clearly, and that was that
very many of the cases were due, either directly or indirectly, to faulty management in the home;
436 cases (241 boys, 195 girls) were noted in which the "nutrition" appeared below normal, and the
following is a list of the causes found:—
1. Tuberculosis in some form. 8. Lung trouble other than tuberculosis.
2. Heart disease. 9. Eczema.
3. Hernia. 10. Prematurity of birth.
4. Dental caries. 11. Neglect or poverty and ignorance.
5. Throat affections (tonsils and adenoids) 12. Improper feeding.
6. Intestinal parasites. 13. Rickets.
7. Constipation and indigestion.
The children fell into these (approximate) age groups:—
Boys. Girls.
Between 4 and 5 years 85 67
„ 7 „ 8 „ 102 85
„ 11 „ 12 „ 54 43
As a result of information gathered during the enquiries Dr. Palgrave has tabulated in the
following design the rôle that faulty home management plays in causation.