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151
Report of the County Medical Officer—Education.
It should be borne in mind that malnutrition and underfeeding are not interchangeable
terms. A considerable number of underfed children are classified as "nutrition 3"; the cases
investigated in this report are returned as "nutrition 4," and are diagnosed as suffering from poor
nutrition to such a degree as to constitute a pathological condition.
Associated Conditions.—It will be seen that 266, or 30 per cent., were children coming from
homes considered good and reported in such terms as "very superior,"
"very comfortably off,"
"maid kept, etc.'; 240 or 27 per cent. came from fair or doubtful homes; and 379 or 43 per cent. from
poor homes in which poverty was a factor in the production of the ill-nourished condition. In many
cases more than one contributory factor was mentioned and it was found impossible always to decide
which of the conditions named was to be assigned as the main cause. Analysing the main conditions
found in association with malnutrition, the following results are obtained:—Poverty, 379, i.e., in 43
per cent, of the cases; neglect, 53 (6 per cent.); tuberculosis, 167 (19.2 per cent.); past or recent
illness other than those specifically named, 139 (16 per cent.); decay of teeth and oral sepsis, 104
(12 per cent); enlarged tonsils, adenoid growths and ear discharge, 81 (9 per cent.); rickets, 04 (7
per cent.) ; congenital weakness, premature birth, etc., 42 (5 per cent.); intestinal parasites, 19 (2 per
cent.); rapid growth, 26 (3 per cent.); want of sufficient sleep, 27 (3 per cent.).
Tuberculosis in relation to malnutrition.—Next to poverty, and bulking largely all through as a
cause of malnutrition, is tuberculosis.
The distribution of tuberculosis according to age and sex was as follows :—
Boys. Girls.
Per cent. Per cent.
Older group 15.7 16.6
Intermediate group 18.3 14.0
Infant group 25.2 20.0
and according to type of home as follows :—
Good. Fair. Poor.
17.3 per cent. 22.2 per cent. 18 per cent.
Thus, while tuberculosis in conjunction with malnutrition was diagnosed more frequently
amongst infants and more frequently amongst younger boys than younger girls, there was very little
difference found as between good homes and poor homes. AVhere malnutrition is a result of tuberculosis
the condition as regards poverty could hardly be expected to make a difference, and this is
what the above figures indicate.
A critical consideration of the cases shews that tuberculosis was suspected as a cause or
result of malnutrition in a number of the cases in addition to the 167 in which it was possible to
diagnose this disease. Many casea in which only malnutrition was diagnosed belonged to homes in
which it was stated that phthisis existed in other members of the family and doubtless many of such
cases would ultimately be found to owe their malnutrition to incipient tuberculosis. Whether
tuberculosis is the cause of malnutrition or malnutrition the precursor of tuberculosis it is in many
cases impossible to determine. Either may follow upon the other.
One precursor of malnutrition given in 5 per cent, of the cases is congenital debility. This
condition is never found amongst necessitous families and is practically confined to "good" families.
It is frequently termed the "pretubercular condition" on account of the great probability of such
children eventually succumbing to an attack of tuberculosis. It appears very clear from a consideration
of all the circumstances that malnutrition and tuberculosis are very closely connected and that
in a very large proportion of all cases the general measures extended to combat the one condition
are those that must be applied in the other. It may safely be said that a town child suffering from
malnutrition if not already the subject of tuberculosis will almost inevitably fall a prey to the disease
sooner rather than later if vigorous preventive measures applicable to the particular case are not
applied in time.
The following 30 successive cases of malnutrition with tuberculosis are taken without selection
as they came to hand, and serve to show the means for combating the disease which have been available
during the past year and the results obtained by their application:—
Z.18 ... Sex, male. Age, 8 years. Height, 115 c.m. Weight, 17 kilograms. Condition of home, good. Mother
a widow. Sleeps badly. School feeding, no. School dinners offered and refused.
Cause—phthisis. Advised to go to Stepney Dispensary.
Result—No benefit.
Z.119 ... Sex, male. Age, 7 years. Height, 112.5 c.m. Weight, 17.7 kilograms.
Number in family, 4. Number of rooms, 1. Condition of home, poor. Mother dying.
Milk and oil advised by school doctor.
Cause—Tuberculosis of lung, neglect (flea bitten).
Action—School feeding, breakfast, dinner and milk (parent paying). Reported to the National Society
for the Prevention of Cruelty to Children. Efforts made to put children in homes.
Result of re-inspection—No improvement.
Z.199 ... Sex, male. Age, 8 years. Height, 121 c.m. Weight, 20.6 kilograms.
Number in family, 6. Number of rooms, 4. Condition of home, good. Bad family history of phthisis.
Milk and oil advised by school doctor.
Cause—Early tuberculosis.
Action—Cod liver oil and malt at school, parent paying. Sent to tuberculosis dispensary.
Re-inspection—Not improving; lost weight.
Z.ll ... Sex, male. Age, 8 years. Height, 105 c.m. Weight, 18 kilograms.
Number in family, 8. Number of rooms, 4.
Milk and oil recommended by school doctor.
Cause—Abdominal tuberculosis.
Action—Milk and oil at school. Admitted to infirmary later.
Re-inspection—Improved. Weight increased to 20 kilograms.