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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A detailed inquiry into the factors tabulated below was made by the care committee. They
paid a visit to each of the homes of the 60 cases recorded, which were selected as a " random "
sample, and filled in a questionnaire, in each case, and from these, the following table is

Table 49.

Number of cases.Factors investigated.
Average number of individuals in family.Average earnings.Average number of individuals in bedroom.Average number of individuals in 1 bed.Average hours of sleep.Standard of ventilation.Number of cases of damp houses.Where child plays.Average hours out of doors daily.Estimate of feeding.
40 (36 of poor and 4 of bad physique).6£2 64.32.51129 good 3 fair 8 poor.834 in yard 6 in parks.30 good 7 fair 3 poor.
20 (all of exceptionally good physique).5-5£2 10321117 good 3 fair217 in street 3 in garden17 good 3 fair.

Here again the table shows no significant difference between the two groups, though it
shows the number of large families and general overcrowding. The largest family comprised
11 members, in 16 cases over 4 individuals shared a bedroom, the maximum being 8. In this
case, 6 were in a bed! In 6 cases, 3 shared a bed. In the family of 11, the physique of the child
was bad. The records of the other cases show no outstanding cause for bad physique.
It will be seen that the inquiry includes an estimate of the type of feeding; as this was
made by the care committee, it is very difficult to convey the standard, as the estimate is an
expression of opinion by their individual members. An example of the type of feeding described
as good was as follows: breakfast—2 pieces of toast, egg, or cereal, or bacon; dinner—meat
dish, vegetable, potatoes; tea—bread and butter ; sunper—broth or meat.
An example of "poor" is: bread and butter for tea, supper and breakfast (while the parent
was out of work Quaker Oats or rice for dinner could not be afforded); meat puddings and
vegetable for dinner.
Obviously the opinion must be formed on the spot. The care committee, in summarising
their results, say: "In most cases the children seemed to be getting enough to eat; there were
three cases where the physical condition might have been due to under nourishment, and 6
where the children were finicky about food; on the other hand, a few cases were exceptionally
well fed, porridge, meat, vegetables and fruit, forming a large part of the diet." They express
the opinion that housing overcrowding seems to be the real difficulty. They conclude by saying
that, in their opinion, in all the cases of the children of exceptionally good physique, although
other circumstances are the same, "the mother is an extraordinarily capable and efficient
manageress." As these families average 5½ in size, and the income averages £2 10s., such a
statement is a testimony to a high degree of skill on the part of the mother.
Although none of the findings shows a direct ætiological relationship to the case of poor
and bad physique, probably the overcrowding and lack of suitable facilities for outdoor
recreation (51 out of 60 of the children played in the street), play an important part in bringing
about the condition of unsatisfactory physique; the more so as pallor was so often an outstanding
feature. If these conditions could be altered, it seems a reasonable assumption that
a number of the children now classed as " poor," would fall into the "average" class.
The writer, moreover, would like to put forward two other theories as to the unsatisfactory
condition of these boys.
(i) A tentative suggestion that there is a psychological factor present, indirectly due
to the overcrowding. Under the conditions in which these children live they are perpetually
surrounded by others, they have no privacy; and, as is at times revealed by children,
they are aware of and worried by the difficulties with which most of their parents have to
contend. This, in conjunction with the noise, might be responsible for the strained expression
and prematurely old faces of so many of these children.
(ii) A more definite suggestion, often confirmed by findings at routine inspections, that
these children frequently get insufficient sleep.
These points might repay investigation. Finally, there is the question of diet. The care
committee report reveals little actual shortage of food, though the quality of the food does not
come up to a very high standard. At a time when the question of nutrition is to the fore, it is
as well that other factors, such as those cited above especially fresh air and sunshine, should
not be lost sight of. It must be emphasised that this enquiry was not into the question of
malnutrition, but into the condition of physique, which as Dr. Robert Hutchinson has aptly
pointed out, is quite a different matter. Dr. Neustatter's estimation of the nutritional state