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22
Procedure
at the
centres.
The investigation consisted in two parts—medical and social.
On the medical side came the examination, history, family history and investigations.
A complete clinical examination was made in every case, including also height,
weight, urine-testing, muscle power (by means of the dynamometer) and the measurement
in most cases of the haemoglobin percentage. In special cases further investigations
were deemed necessary, such as Wasserman and Kahn reactions, blood counts,
X-ray examinations, Mantoux tests. Such special investigations were carried
out by the pathological departments at the Council's hospitals.
The social investigations were carried out partly by the organisers at the centres
and partly by the care committee workers in the homes, and were regarded as of
extreme importance in judging the environmental influences on nutrition. They
covered dietary points, economic circumstances, family budgets, and housing
conditions.
Results of
medical
inspection
A considerable proportion of the children were found to present evidences of
present or past disease or defect.
Such conditions as dental caries, ear, nose and throat defect and visual defect
do not appear to be greater in their incidence than in the normal population.
Indeed, in some groups the total amount of such defect was less than might be
expected. In the north division serious dental decay was remarkable by its comparative
absence. Only 7 (out of 53 cases) showed dental decay in more than two
teeth, and none in more than 3. In 26 there were no signs of decay. Anaemia was
also surprisingly uncommon. Children with the appearance of pallor on ocular
inspection were found on accurate measurement with the haemoglobinometer not
really anaemic. In the northern division, the average haemoglobin content in all the
children was 92.5 per cent.
Dr. Batten (north-western division) states that, out of 40 children, whose haemoglobin
content was estimated, it is remarkable that in only 3 was the percentage
less than 80. Dr. Peake (south-western division) reports : " the children are not on
the whole anaemic, many have good haemoglobin counts of 80 to 96 per cent." Postural
defects were very frequently noted. Out of the 63 children definitely subnormal at
the centre, Dr. Batten describes 37 with postural defects. In only five could posture
be described as definitely good. Nearly all were noted as being " below normal in
vitality, that is to say, they had an air of apathy, tiredness or timidity more or
less pronounced."
Predisposing
causes.
Careful enquiry was made into the previous history of all cases. Amongst the
predisposing causes, prematurity of birth, low birth-weight, errors in infant feeding
(often associated with rickety signs), severe past illnesses, such as pneumonia, acute
bronchitis, infectious diseases, and rheumatism, were found in a certain proportion
of the cases.
Dietetic
points.
In all cases the home diets were minutely investigated. Ill-adjusted diets
resulting from restricted incomes on the one hand, and ignorance of the dietetic
needs of the child on the other, were often found. There was the usual tendency to
feed the child on stodgy foods with excess of carbohydrates to the neglect of sufficient
proteins, green vegetables and salads.
It was, however, in many cases impossible to obtain a really accurate account
of the individual child's diet.
Social
enquiries.
The nature and extent of the enquiries which were carried out by the social
workers are shown in table 10, which gives the results of enquiries made into the
economic circumstances of the 62 children investigated at the Shoreditch centre
(northern division).
Housing conditions were unsatisfactory in many cases. In the north-eastern
division the children were graded in regard to housing as : fair, 29; poor, 17; overcrowded,
9 ; no report, 1. In the south-eastern division housing conditions were
held to be a factor prejudicially affecting the children in 12 out of the 46 cases.
Dr. Peake (south-western division) remarks : " Parents have often become
hopeless from disappointment in their search for better accommodation. Overcrowding,
the need to wait for the whole family to go to bed before the children can