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under medical examination at an early stage every child who does not show normal
progress in physique.
As the result of recent nutrition surveys in the schools it was found that certain
children, found to be undernourished after extremely careful examination by an
experienced physician, were sent to voluntary general hospitals by the school care
committees.
They were found at the hospitals to have no disease and were sent away with
nothing done. The parents were dissatisfied, as well as the school care committees,
and the suggestion was made that the school service referred to hospital very trivial
conditions " which wasted the time of the hospital physicians."
On the other hand, a strong public opinion has grown up, which holds that the
local education authorities should be doing more for the ill-nourished child, especially
in the very earliest stages of malnutrition.
It was therefore decided, in a tentative and experimental way, to include in the
programme of the school medical service for the year 1935-36 additional provision for
special investigation of such children referred from the ordinary school medical
inspections at special inspection centres and, as the children concerned are those
who show failure to reach the normal condition of nutritional state for reasons not
immediately apparent, the arrangements proposed were termed " nutrition
centres."
As, during the experimental period, they should be immediately under the
observation of the divisional medical officer, a centre has been chosen in each division
as near as possible to the divisional medical offices.
The divisional medical officers have each nominated from the staff engaged in
their divisions an assistant medical officer (part-time) with special experience in
paediatrics.
To each centre an experienced nurse will be allotted and a specially selected
organiser with experience in social economics. At each centre it is proposed during
the first year to hold one session per week.
The function of the centres has been set out above. It is intended to carry
out a more extended enquiry into the causes of the failure to reach a satisfactory
nutritional state in certain children than can be carried out in the press of the
ordinary school medical inspection.
Careful investigation will be made of the family budgets and dietaries, and advice
on the latter given to the parents. Simple observations such as urine testing and
haemoglobin estimation will be carried out at the centres, but in special cases, if more
extended bio-chemical investigations are needed, these can be made in conjunction
with the Council's laboratories.
The centres will, during the experimental period, work under the immediate
observation of the divisional medical officers, who will report and compare notes at
the regular conferences which are held at the County Hall with the senior medical
officer in charge of the school medical service.
The organiser at the centre will be in close and continuous touch with the school
care committees, who, by personal visitation, will keep in touch with the children
both at home and school and will report to the organiser for the doctor's information.
In any case where a period of observation in hospital is desired, this will be
arranged at the Council's special hospitals for children, e.g., Queen Mary's, Carshalton,
or High Wood.
The selection of children will be carried out by the divisional medical officer
from nominations by the school doctors. The primary cases to be included are those
at present under observation by the school doctors for nutritional defect who at
the periodical re-inspections and weighings at school have not shown improvement.
Co-operation of voluntary bodies.
The general care of the children in the London elementary schools is carried on
by a social service, consisting of voluntary workers organised into school care
committees, which are assisted and directed by paid organisers. This system prevents
the work of medical inspection and treatment and the wider work of general physical
E
Social care
organisation.