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In the Wolverhampton (1915) report, children with clean heads are given as 57.3 per cent., while
those with nits or vermin equal 42.7 per cent. With regard to the body only 0.9 per cent. are given as
dirty, although it is expressly stated that the other 991 per cent. include those only"fairly clean."The school medical officer here further states that "unfortunately the results of unexpected examinations
are never the same as those of the routine examination, when the parent has notice beforehand."
In the Derbyshire (1915) report, it is stated that 93 7 per cent. of the children have clean heads,
and only 6.3 per cent. have nits and vermin,"but, in regard to visits by school nurses, without any
notice being given to the parents, 15.1 per cent. have dirty heads."Similar statements also occur in
the Cheshire and Brighton (1915) reports.
It is clear, therefore, that the London practice, under which the estimation of cleanliness is made
by the nurse at a preparatory visit of which the parents have no knowledge, represents accurately the
real conditions, and necessarily gives figures more to be relied upon than those obtained at visits of the
school doctor, of which the parents are warned.
Nutrition and Malnutrition was the subject proposed for special consideration, this year, by Nutrition
the Medical Officer of the Board of Education. The conditions under which the work has been carried
on during the year have not admitted of extensive special inquiry upon this subject, but Dr. C. J. Thomas
has made a brief analysis of the facts ascertained. In addition to the three groups—good, fair, and
poor—as regards nutritional state, a fourth group is added—namely, those who are so under-nourished
as to be placed in the category commonly designated by those engaged in hospital out-patient practice as"wasting."Children suffering from this degree of mal-nutrition are rare at the present time in the
schools. The attention now paid to the children is so great that conditions leading to emaciation are
discovered at an early stage, and such children, presented to the school doctors as special cases, are
rapidly referred to appropriate agencies for relief, and are only exceptionally discovered at the routine
inspection of the age groups. During the past year, 1,099 children, or 0.4 per cent. of those inspected,
were placed in this fourth class. The weights and heights of a group of these children showed an average
deficit, in boys, of 4.7 kilograms and 8.9 centimetres from the average of their age, and in girls of 62
kilograms and 9.7 centimetres. About twice as many of the younger, as compared with the older,
children examined were placed in this category, but the incidence was at each age identical upon
the sexes. The proportion of children thus suffering from malnutrition was slightly lower than in the
previous year, when 0.51 per cent. were placed in this group. Each child so reported upon is referred
for special observation and care, and in the Annual Report for 1913, a special study of nearly a thousand
such cases was given.
In that report, the close connection of tuberculosis with malnutrition was pointed out, and in
19.27 per cent. of the cases tuberculosis could be definitely recognised, while in a large additional percentage,
its presence was suspected. It was there stated that the general measures adopted to combat the one
condition are those that must be applied to the other.
Turning now to the actual classification of the children, the figures relating to which are given
for the past four years, it is to be remarked that the state of nutrition of the children generally has been
better during the war than in the period immediately preceding. As in previous years, the younger
children, both boys and girls, show figures that are less satisfactory than those of the older children,
and at each age, the boys are slightly worse than the girls. While the figures for both 1915 and 1916
stand in complete contrast with those of the previous years, and themselves compare very closely together,
there are nevertheless some interesting differences between the two last years, which may repay close
attention. Thus, in 1916, while the proportion of younger children classed as of good nutrition has
definitely increased both in boys and girls, amongst the older children there has been only a fractional
increase amongst the boys, and a definite decrease amongst the girls.
Although a definite proportion of younger children has passed during the year from fair to good,
there has also been a very small proportion passing from fair to poor. This tendency is not seen
among the older children. These variations will be watched with close scrutiny during the coming
year. They seem to show that the younger children more readily re-act than the older to conditions
affecting the nutritional state.
The dominant influence of social conditions in nutrition is to be seen in the returns for the various
London boroughs. Very generally a map showing the nutritional state of the children would correspond
with one showing the social conditions. Limitations of space and time prevent this being worked out
in detail for the whole of London, but taking two boroughs, Lewisham, a typical residential suburban
district, and Bethnal Green, in which conditions of poverty and overcrowding are more prevalent,
the following returns have been made:-
Percentage in each group of children marked Good, Fair, and Poor.

This is a very striking contrast.
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