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The children afflicted with this condition were described by him as "thin, with
slight figure, marked slenderness of the limbs, long slender hands and feet, narrow
oval face with proportionately greater development of the cranium than facial bones,
smooth transparent dry skin with well marked surface veins, long eye lashes, well
grown downy hair on arms and back, markedly pale complexion, long shallow narrow
thorax, a sharp epigastric angle, a short and stiffened first costal cartilage (Freund's
sign), marked flattening of the angulus ludovici (Rothschild's sign), and a floating
tenth rib or costa decima fluctuans (Stiller's sign)."
Dr. Leipoldt concentrated his attention especially on the last sign, viz., the
floating tenth rib. He found that children with this sign were congenitally weaker
than normal children, resist infection less, and are more prone to nervous diseases
and diseases of nutrition. In Dr. Leipoldt's investigation Stiller's sign was present
in 13.6 per cent. of 500 unselected London school children examined by him. There
is no doubt that Dr. Leipoldt's description of asthenia congenita universalis is very
close to Dr. Young's description of arachnodactyly and that they describe a single
type. The type is one vaguely recognised by all who have had experience of school
medical inspection, as has been described variously as "congenitally debilitated,"
"the nervous type," "the pretuberculous type," etc. Children so described, often
exceptionally intelligent, are constantly brought forward on account of frequent
absences from school, tendency to suffer from manifold ailments, particularly night
terrors or chorea, and inability to withstand school pressure.
It is these children that furnish the irreducible remnant of the malnourished and,
as Dr. Young points out, they are the children who frequently disappoint when sent
away for convalescence by returning in statu quo ante.
Feeding of
school
children.
Supervision of dietaries.
Dinners are provided for necessitous children attending the schools and
follow menus which have been approved by the school medical officer. Occasionally
samples of the actual meals given to the children are taken in order to ensure that each
child receives sufficient quantities of nitrogenous and calorific elements. Ten such
samples were analysed in the public health department, all being satisfactory in
food value.
While children are placed upon the school dinner list by care committees as
soon as there is social need, and before malnutrition has time to develop, additional
nourishment in the shape of milk or cod liver oil is given to the children who are
especially in need of it—irrespective of financial or social necessity—on the advice
of the school doctors during medical inspection. These children are kept under
careful and continuous observation and are weighed regularly by the school nurses.
Excluding special schools, the numbers of "milk meals" or "oil meals "given in
1930 in the elementary schools upon the doctor's advice were:—
Milk meals—To necessitous children 1,363,455
To non-necessitous children 3,396,549
Total 4,760,004
Oil meals—To necessitous children 279,444
To non-necessitous children 496,748
Total 776,192
In the case of the non-necessitous the cost was recovered from the parents, no
charge, however, being made for service. The results of milk or oil given in this
discriminating way have proved to be astonishingly good.
Over and above the official scheme detailed above, there is a very large number
of " milk clubs " in the schools taking advantage of the arrangements made by the
National Milk Publicity Council for the supply upon a paying basis of milk to the
scholars in bottles containing ½ pint. The general effect is no doubt excellent, but
it is not possible to assess the benefit obtained from arrangements which are voluntary