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Comparison shows a small decrease, from 95.8 to 94.3, in the children who are
satisfactory, an increase, from 4.2 to 5.7, in the " borderline " cases, and, though
the numbers concerned are but small in comparison with the total inspected, an
increase, from .01 to .08 in those definitely suffering from bad nutrition.
It is important therefore that the position should be considered carefully with
a view to determining whether the possible serious effect on some children of
prolonged poverty of their parents due to continued unemployment, which was
referred to in the annual report for 1933, is beginning to show in the results of school
medical inspection.
Representative school doctors who have been interrogated with regard to the
returns are of opinion that there has been no deterioration in the children's general
condition of nutrition.
Enquiry shows that a very important factor in influencing the classification of
the children has been the scheme of the Milk Marketing Board. In every group of
children surveyed by the physician from the point of view of nutrition, there is
always a certain proportion in which the classification is doubtful. These are
" borderline " cases. Some of these children appear healthy and alert, but are
under the average weight for their height. Formerly the judgment of the school
doctor was unfettered. With the introduction of the milk scheme, however, the
position was changed. The majority of the children in the schools are taking
advantage of the milk scheme, their parents are paying and the milk is being supplied
to them. Where poverty exists, however, the question whether the children should
have the milk in school free of cost depended throughout 1935 upon the doctor.
Only those whom he judged to be physically subnormal could obtain the milk free
of cost.
Thus there were three groups in the schools. Firstly, a large group of children
having milk and paying for it; secondly, a smaller group having milk free on the
doctor's advice ; and thirdly, a small group whose parents professed that they were
unable to pay and who were not found subnormal by the doctor. This placed
the doctor in a very responsible position, and he was naturally anxious to
prescribe milk for children who were perhaps under weight, although apparently
quite healthy and fit, and who were brought before him by teachers or members of
care committees as deprived of milk by poverty. The consequence has been that a
small increased percentage of children on or near the border line have been classified
as subnormal, who would not have been so classified did nothing depend upon it.
It follows from this that it might be anticipated that the number of children in
the schools obtaining milk free should, in 1935, have increased. This is precisely
what has occurred ; for, while the children receiving free milk in the schools in
December, 1934, was 15,691, by December, 1935, it had increased to 20,300.
It is possible that a similar explanation accounts for some, at least, of the
increase, amounting to 127 in all, in the number of children classed in category
" 4 " " definite pathological malnutrition." The school doctors are undoubtedly
paying more attention to question of nutrition, and their standards are, perhaps
unconsciously, being raised, and children on the border line between categories
" 3 " and " 4 " are now probably all classed as " 4 " whereas formerly some would
have been placed in " 3."
Weighing
and
measuring.
In consequence of the intense concern which is felt with regard to the welfare
of the children, and the determination of the Council that no child in the schools
should escape observation and assistance if necessary, it was decided that a height
and weight chart should be commenced for every child in the schools who was below
the age of 12 on 1st June, 1935, and that thenceforward the height and weight of
each child for whom a chart had been begun should be recorded at six-monthly
intervals throughout school life.
Special charts were therefore prepared upon which the average height-weight
curve of London children of school age was printed as a guide. The scheme came
into operation in September, 1935, an addition of 22 nurses having been made to
the staff to enable it to cope with an addition to the work of this great magnitude.