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Careful investigation is 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, are carried out at the centres ; but in special cases, when
more extended biochemical investigations are needed, these are made in conjunction
with the Council's laboratories.
The centres are, during the experimental period, working under the immediate
observation of the divisional medical officers, who 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 is in close and continuous touch with the school
care committees, who, by personal visitation, keep in touch with the children both
at home and school, and report to the organiser for the doctor's information. This
arrangement ensures that the recommendations of the doctors are carried out.
In any case, when a period of observation in hospital is desired, this is arranged
at the Council's special hospitals for children, e.g., Queen Mary's, Carshalton, or
High Wood, Brentwood.
Reports on the activities of the centres between their establishment in May,
1935, and the end of the year have been received from the medical officers in charge,
from the divisional medical officers and from divisional treatment organisers.
Each of the centres was open on one session a week. The number of children
who attended the centres was 303. Repeated attendances were necessary in the case
of the majority of the children.
Method of
selection of
children.
It is intended, if the centres continue, that they shall deal with those children
who, as the result of weighing and measuring at six monthly intervals, are found to
be making unsatisfactory progress.
The scheme for regular weighing and measuring of all children, however, only
commenced in September, 1935, and during the period under consideration records
of progress in physique were not available.
Children sent to the centres were therefore partly those selected by the divisional
medical officers from nominations by the school doctors and partly those selected by
nutritional surveys in the neighbouring schools.
In the northern division, Dr. Margaret Hogarth explored the soundness of
selecting children on the basis of marked failure to approach the normal weight for
height. Sixty-six such children were considered, but upon medical examination
it was found that 41 (62 per cent.) were in a good physical state and living under
good environmental conditions. Although they were " lanky," they were healthy.
She therefore abandoned this method of selection in favour of a special survey in
conjunction with the school doctor of the children in four neighbouring schools to
the centre. Children were selected on clinical grounds as the result of observation
of them in the classes where the contrast with normal children emphasized their poor
appearance. The type thus selected was " distinguished by a grey look with unburnished
appearance, their complexion lacking in the bloom that is noticeable in
the skin of the healthy child ; they have a troubled expression very different from the
happy alert expression in the clear shining eyes of the healthy child." It is true that
in every case selected by this method the weight for height was below the normal
standard, but the experience here confirms the opinion already expressed that
deficiency of weight for height is, in itself, no criterion of nutritional state, but needs
to be corrected bv a clinical examination.
Attendance.
Experience varied in the divisions with regard to securing attendance of selected
children.
In the northern division there were no failures, although, when approached, the
mother in many instances protested that she did not consider her child ill or wanting
in any particular.
In the south-eastern division, one-third of those selected failed to attend.
In the south-western division also, failures to attend were relatively high.
Here it was reported that failures were due to cost in money or time to the parents,
the distance of the centre from many homes and refusal on the part of parents to
believe that there was anything wrong with their children.