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bread, butter and jam at 3.30 p.m. In season, sandwiches of lettuces or grated carrots
are given at the last meal. Nearly a pint of milk a day is consumed by each child,
and in each school about a third of the children are, on medical advice, given cod
liver oil and malt.
This dietary, fresh air, free exercise and sleep in a restful atmosphere very quickly
have their effect. Change in the condition of the skin has been particularly remarked.
Described in many new admissions as being like a "nutmeg grater" (a condition
associated with vitamin deficiency) the skin gradually becomes smooth and soft.

Physical training has contributed largely to the improvements noted. More
than a third of the children attending Old Church-road come from homes of a single
room, and at Columbia Market also many homes are very poor. The free exercise,
impossible at home, which is obtained at the nursery school, is a potent factor in
promoting healthy growth and in the prevention and cure of rickets. The apparatus
provided, together with musical games and rhythmic exercises, are very suitable for
little children.
At both schools the doctor visits fortnightly and examines each child at least
once a term. A nurse attends every morning for supervision of cleanliness, treatment
of minor ailments and inspection for infectious disease. All children are seen on admission
by the school nurse and within a fortnight by the school doctor, and only a
very few have been excluded. At Old Church-road the school doctor is also medical
officer to certain of the Stepney Borough Council infant welfare centres, and many
children are sent by her from the centres to the nursery school. At both schools
there is full co-operation between the local medical officers of health and the Council's
staff.
As indicated in the reports of both school doctors, treatment is being promptly
carried out, and this cannot fail to have influence in the prevention of serious physical
defects.
The following report has been submitted by the school doctor (Dr. Turover)
on the Columbia Market nursery school:—
The school has very well justified its existence since its opening in August, 1930.
The children are cleaner and better cared for by their mothers. They are all a better colour
and poor circulations have improved. There has been a marked diminution in the incidence of
coughs and colds during the last term, although during their first term at school there were a
number of cases of bronchitis, especially in children with enlarged tonsils who were not used to
being out of doors in all weathers. This has greatly fallen off now.
A considerable proportion of the cases of enlarged tonsils and adenoids marked for observation
have cleared up after a term or so in the school and those requiring treatment were promptly
attended to.
"Sores" are disappearing—although there are still a few cases of urticaria—with superadded
infection—but, of course, many other factors are involved here.
The social atmosphere of the school has a most important influence on the children. Those
of them who were mismanaged at home, were asocial, and would not talk or mix with the other
children, have mostly got over their difficulties. What impresses one most is to see them all
happily occupied in games or individual play. The "jungle gym" and the sand pit are usually
the centres of great attraction and the various running games, etc., keep the children warm in
cold weather and provide the necessary amount of exercise.
Judging by the steady increase in weight and height measurements and the general state of
nutrition, the nourishment provided seems to be adequate. Very rarely is there any difficulty
in the taking of food, and the children have got used to drinking more milk than they did at first.
The children are, of course, carefully sorted out before admission. Up to now I have only
had to reject epileptic children. One would, of course, not admit any rheumatic children, but
the question of rheumatism rarely arises between the ages of two and five.
The parents have, on the whole, responded very well as regards treatment for dental caries,
enlarged tonsils and orthopaedic conditions. We have the advantage here of getting early treatment
of these conditions, thus preventing deafness, otorrhoea, bronchial affections, maldevelopment
of jaws and palate, and in securing good mental development in consequence.