London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1913

[Report of the Medical Officer of Health for London County Council]

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Report of the County Medical Officer—Education.
131
He points out that almost every factor in the list, if not directly due to some error in hometreatment,
may be, at any rate, partly attributable to this cause. For example, if children's hands
were kept cleaner and their nails shorter intestinal parasites would not be so common as they now
are. Amongst the 436 cases a history of worms was elicited in over 11 per cent.
Other points discussed by Dr. Palgrave in relation to malnutrition, are ignorance on the part
of parents of the value of fresh air, of regular habits, and of care for the teeth, all three of which are
important accessory factors. Wilful neglect and over-employment out of school were, in his
experience, exceedingly rare contributory causes. Ignorance is more potent as a cause than wilful
dereliction of duty. He is of opinion, however, that the work which has been done in educating
parents towards an understanding of the need of care of teeth is beginning to bear fruit, and reports
to the same effect were made by Dr. Cowell and Dr. Tosswill.
Dr. R. H. Norman undertook an investigation during the summer session of 1913 in the
infants' departments of unselected schools in the Boroughs of St. Pancras and Holborn, to determine
if any difference could be found in the nutrition of children, who, during their first year of life, had
been fed on breast-milk, or otherwise on cow's milk, or one of the various artificial infants' foods. If
a child had been fed on breast-milk and nothing else for the first six months of its existence,
it was regarded as a breast-fed child, this period being the most important in a baby's life, and these
cases are classed together with those who had breast-milk, and breast-milk only, for the first nine or
twelve months, i.e., a breast-fed baby is one fed entirely on mother's milk for the first six months of
life or longer.
The investigation was limited to the infant departments, and the ages of the children ranged
from 3 to 8 years of age, the bulk of them being 4, 5, or 6 years old. Details of the methods of feeding
313 children of these ages were obtained, of these 158 were boys, 155 girls. The first fact emerging
was the preponderance of breast-fed over bottle-fed babies, thus 70.7 per cent. were brought up on
their mother's milk, 29.3 per cent. on cow's milk or one of the artificial foods. It was noticed that
the poorer the home conditions the more likely was the infant to have been breast-fed. There was
scarcely any difference in each group in the percentages of boys and girls brought up by the one or
the other method.
Dr. Norman's
report on a
comparison
of the nutrition
of breast
and bottle-fed
children in
the infants'
departments
of the L.C C.
elementary
schools.

The following table gives an analysis of the results of the enquiry:—

Breast Fed.Bottle Fed.
Age.Sex.No. of children.Percentage of total No.Percentage below average weightPercentage below average height.Percentage of total No.Percentage below average weight.Percentage below average height.
4Boys5669.3605330.75370
Girls3874.4645725.67030
5Boys7068.5507731.43650
Girls8077.5566222.54472
6Boys3265.7575234.37272
Girls3762.2825237.86450

The numbers are too small to justify final conclusions, but so far as they go tend to show:—
1. A preponderance of breast-fed over bottle-fed children, roughly 2 to 1.
2. A greater percentage of breast-fed children fall below the average weight than bottlefed
ones.
3. A greater percentage of breast-fed children fall below the average height than bottlefed
ones.
No superiority of breast-fed children as compared with bottle-fed ones could therefore be
distinguished at school age in this series of cases.
Dr. Norman mentions in his report the fact that the better the home the more likely is the baby
to be bottle-fed; it seems clear therefore that he was here contrasting children from two types of home,
and it is much more important to a baby to be born into the right type of home than to be brought
up by one particular method of feeding rather than another.
Closely associated with the existence of malnutrition is the question of the conditions under
which the children are housed and particularly those under which they sleep. Lack of sufficient sleep
is not infrequently the main cause to which is to be ascribed undernourishment or backward development.
Dr. Mabel Russell has during the past year paid attention to this factor while inspecting
children in the Stepney area. She reports that:—
A considerable number of the children in that area do not get sufficient sleep. It is by no
means uncommon to have a child brought up by the Head Teacher, with the request "will the
School Doctor examine him in order to ascertain whether the small amount of progress this child
is making, in his general work, is due to some physical defect or to laziness." On examining
such a child, and further investigating the case, one frequently finds (especially among the
Jewish children) that the child, aged eight or nine years, does not go to bed until 11 p.m.—and
often later; that he shares a bed with two or three other persons (often adults), that there are in
23610 s 2
Dr. Mabel
Russell's
enquiry into
the sleeping
conditions of
some Stepney
school children.