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155
Report of the County Medical Officer—Education.
which would constitute luxury if no ill-health existed, and the provision of these comforts, such as
extra milk, is beyond the means of many homes assessed as fair. The practice of different care
committees varies greatly in this respect. It would be well in all cases of malnutrition, where doubt
exists as to whether the home is above or at the poverty line, if milk meals or cod liver oil were given
in school during the morning recess, as experience shows it is unsafe to rely upon this being done
regularly in such cases at home. Even in good homes the parents will often gladly pay for milk
meals given under these conditions in school.
The following case is one which shows the benefit of giving meals in school. Re-inspected
four months after inspection, the child was found to have put on 1.2 kilograms in weight only; the
school doctor then urged the provision of school feeding; this was carried out and a further
re-inspection five months later showed an increase of 3.4 kilograms—a very great improvement.
Z.77 Sex, female. Age, 12. Height, 131 c.m. Weight 24 kilograms.
Milk and school dinners recommended.
Number in family, 7. Number of rooms, 2. Condition of home, poor.
Cause—Underfeeding, poverty.
Result— 21.5.13. Weight 24 kilograms.
12.9.13. Weight, 25.2 kilograms, dinners and milk started.
23.2.14. Weight, 28.6 kilograms—very great improvement.
In regard to the measures taken to remedy malnutrition one other means must be especially
mentioned. Next to the effect of convalescent treatment, dental treatment in cases where oral
sepsis was a contributory cause has given examples in which the most striking degree of improvement
has occurred. This, perhaps, is not surprising when it is remembered that in such cases, when
unremedied, all food ingested is mixed with the products of bacterial decomposition arising from the
unhealthy state of the mouth. It will be noted that six deaths occurred amongst the 885 cases; one
in a "good" home, two in "fair" homes, and three in necessitous homes.
The following are the particulars:—
X.161 Sex, male. Age, 12. Condition of home, necessitous. Cause, poverty. Admitted to infirmary soon after
being seen by school doctor. Died in infirmary.
X.422 Sex, female. Age, 6. Height, 97 c.m. Weight, 16 kilogr. Number in family, 8. Number of rooms, 2.
Condition of home, bad ; sleep insufficient. Action taken, none. Died of measles and pneumonia
3 days after being taken ill.
Z.111 Sex, female. Age, 9. Height, 110 c.m. Weight, 14.4 kilogr. Condition of home, poor. Cause—Tuberculosis.
Excluded from school, attended dispensary. Finally died.
Z.67 Sex, male. Age, 10. Weight, 30.7 kilogr. Cause—Cyst on liver and tuberculosis. Action—admitted to
hospital and died.
Z.72 Sex, female. Age, 8. Height, 101 c.m. Weight, 13 kilogr. Condition of home, fair. Milk,malt and oil
given in school. Died.
Y.46. Sex, female. Age, 5. Height, 104 c.m. Weight, 15 kilogr. Number in family, 4. Number of rooms, 2.
Condition of home, good. Cause—Carious teeth, ? tuberculosis. Medical treatment obtained. Died
of intestinal ulceration and meningitis.
Medical inspection of feeding centres.
Reports have been received from the school doctors upon 287 feeding centres during the year.
The centres were visited at the hour during which the children were being fed and in addition to the
sanitary condition of the centre reports were made upon the dietary, the methods of feeding, refusal
of food, and other points of hygienic importance. The number of cases in which unfavourable reports
were made is relatively small.
Out of 51 centres upon which unfavourable reports were made last year, it was found that 18
have been since closed and of the remaining 33 the conditions considered unsatisfactory have been
improved in 22 cases.
The warming was reported to be insufficient in 22 centres ; in most cases the means of heating
exist, but use is not made of them.
Warming
centres.
It was reported that sanitary accommodation was lacking or unsatisfactory in 34 instances. In
most of these no accommodation exists. The extent to which this lack is to be considered unsatisfactory
depends, of course, to a large extent upon the distance of the centre from the contributory schools.
The rule by which the head teachers instruct the children to use the school accommodation before leaving
for the centre is probably satisfactory where the distance is small, but in the case of distant centres
this is hardly a sufficient safeguard. Fortunately in most instances the schools are near. The provision
at one feeding centre was reported to be in an insanitary condition and needing attention.
Sanitary
accommod
tion, &c.
In 21 cases the provision or utensils was reported insufficient. The question or drinking mugs
is one of considerable difficulty. Sharing of mugs is a practice sometimes met with which on hygienic
grounds is strongly to be deprecated. It is unnecessary, and indeed undesirable, to place drinking
supplies upon the tables; and the most satisfactory plan is that whereby children wishing for water to
drink may have it after the meal is over from a tap, under which the mugs may be rinsed if it is necessary
for them to be used a second time. There is at some centres inadequate seating accommodation, and
overcrowding or standing at meals results. Insufficiency in one or two centres led to the undesirable
result that more than one child used the same utensils without intervening cleansing.
Provision of
utensils, &c.
Uncleanliness of utensils and furniture were reported in four instances. This was due either to
insufficiency of help or to carelessness.
Cleanliness
The use of fingers instead of forks or spoons for conveying food to the mouth is of frequent occurrence.
In some instances children are found to attend at the dinners with extremely dirty hands, and
as the class of child, whose personal cleanliness leaves something to be desired, is also the class which
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