London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1934

[Report of the Medical Officer of Health for London County Council]

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of 1 pitch 160 by 110 feet, or 2 pitches each 110 feet by 60 feet; 2 concrete cricket
wickets for net practice for boys; a jumping pit; a garden plot of about 100 square
yards; 20 square feet per head to be provided for infants, with separate playground
of 800 square feet or more near the babies' room.
Provision of meals.
Dinners are provided for necessitous children attending school, and follow menus
which have been approved by the school medical officer.
Samples of meals provided are taken from time to time and submitted for
analysis by the Council's chemist. Forty-two samples (representing 21 two-course
meals) were examined during the year, the required standard being that each complete
meal should contain 25 grammes protein and have a heat value of 750 calories.
It is the function of the school care committee to place upon the feeding list
every necessitous case requiring additional nourishment in order to profit by
the education provided. It is considered reprehensible to wait until ill-nourishment
due to lack of food has occurred to the extent that it requires the intervention of the
school doctor.
The head teacher of the school is empowered immediately to place any
necessitous child provisionally upon the dinner list, without waiting either for the
care committee's consideration of the case, or for the school doctor's visit.
The arguments which led the Council to adopt economic rather than medical
grounds for feeding necessitous school children were as follows:—
(a) If no action is taken until the child shows signs of malnutrition, the
child must already have gone through a stage of suffering unalleviated, in which
he or she was unable to take full advantage of the education provided and
unnecessary suffering is inflicted, which the Education Committee refused
to contemplate. A wise education authority will prevent malnutrition, not
wait until it is established.
(b) The sudden cessation of food supply to a vigorous, well-nourished child
immediately produces suffering, and prevents that child taking full advantage
of the education provided even within a few hours, although a doctor could
find nothing wrong. The child is hungry and obviously cannot pay attention
to its lessons, and the more vigorous and healthy the child is the greater his
suffering. It would be cruel to deny such a child food, yet no doctor could
find anything more than any lay person, i.e., a medical examination is unnecessary.
It is well known that ill-nourished children do not suffer to the same extent.
By a merciful dispensation of providence after the pangs of the first week or so the
body sinks into a dull tolerance of the condition and the children cease to feel hunger;
and, although malnutrition will after some time become apparent on medical examination,
the failure of the children to take full advantage of the education provided
is less obvious than it is when the condition is acute and the children's vigour still
present.
While children are placed upon the school dinner list as soon as there is social
need, and before malnutrition has had time to develop, additional nourishment in
the shape of milk or cod-liver oil is given to the children who are specially in need
of it, irrespective of financial or social necessity, on the advice of the school doctors.
These children are kept under continuous and careful observation by the care
committees and the school doctors and are weighed regularly by the school nurses.
The practice of giving milk under the powers of the Education (Provision
of Meals) Act, 1906, to children found at medical inspection to be debilitated began
in London in 1909. In the winter of 1909-10, Dr. Hawkes a part-time school
doctor working in Bethnal Green called attention to the children of one school
(Wolverley-street). Most of them belonged to large families dwelling in small