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confessed that they felt the need of being able to prescribe simple supplements when
special deficiencies were diagnosed. Such supplements are comparatively cheap and
remarkably so in relation to the good they do. The practice has, therefore, grown
up of administering various inexpensive vitamin concentrates, and in cases of
nutritional anaemia a simple iron preparation.
The following is the substance of a report by Dr. Batten :—
It is difficult to bring to one centre all the children in this division who require nutritional
guidance, as, wherever it were placed, the centre would be inaccessible to many of the poorer
mothers, while parents who are comparatively well off are unwilling to believe that anything can
be amiss with their children. At other centres the economic problem looms very large, but at
the Paddington centre the poverty picture is rare. The problem here is more individual than
social.
Causal factors fall into four groups. Inherited constitution, disease (past or present),
environment and food (also past and present).
Inherited constitution appears a factor of considerable influence. Present organic disease
is rare. Infected tonsils are occasionally seen and the nutritional state of some children improved
after operation. Even carious teeth are uncommon. A few have been seen with bronchial
catarrh and a few give a history of asthma, but very few.
A history of past illness is much commoner and many have had a succession of respiratory,
gastro-intestinal or infectious complaints in their early years which have left their constitutions
in need of building up. Most of the children are pale, but haemoglobin indications in practically
every case show no anaemia, and many children conspicuously pale have high percentages
reaching 110 to 115 on the Hellige scale. The conclusion appears to be that an;t;mia is very rare
in school children in London, and recent research carried out by Dr. Leonard Findlay in the
east end confirms this.
The triad of extrinsic influences—environment, diet and way of life—plays a part in the
state of health of any child at any time. They are not, however, inevitably yoked, and the
evidence at the Paddington centre points to environment and way of life as the predominant
influences and not to food. The general environment is far from ideal, in many cases families
live in ill-lit, ill-ventilated, overcrowded rooms, sometimes in a basement. Sleep is curtailed
and often disturbed, and too little vigorous and well-directed physical exercise is obtained.
In addition to this there is often ample evidence of unhappiness in the home. With food it is
different. Good food is easier come by than a good home, and there is little evidence of underfeeding
although food habits often determine an unwise choice. Some good cheap foods like
cheese and herring seldom appear. In most cases it is not ample food that is lacking but sleep,
light, exercise and fresh air. In these circumstances it is found that while other action rarely
produces anything more than a slow improvement, the effects of removal to the country, to a
residential open-air school or convalescent home for a time are generally dramatic and last for
months after return. The aim has been to continue observation of each child until his nutritional
state could be described as good and it was clear that he was growing and gaining steadily. The
day open-air school is suggested as the key to unlock the problem for most of the children. The
combination of a well-regulated open-air life with good food has been shown time and again to
be what they need.
With regard to the Poplar centre, Dr. Elman's report is summarised below :—
Of the "old" cases, i.e., those attending first in 1935, 77-6 per cent, made satisfactory
progress. Of 80 children attending first in 1936, evidence of rickets was found in 28, a history
of prematurity in 7, low birthweight 1, members of twins 4, congenital syphilis 1, infantile marasmus
3, history of pneumonia 10, dental disease 9, tuberculosis contact 4. In contrast with some
of the other centres, secondary (nutritional) anaemia is found to be common at this centre, 54 of
the 80 children having haemoglobin percentages below 80 per cent. It is found that amongst
the children in this area the economic factor is of great importance. Thirty-seven of the " new "
children have already made satisfactory improvement.
The following remarks summarise Dr. Elman's notes on the Wapping subcentre
:—
Help is obtained from the ultra-violet ray installation which there exists. The housing
conditions of the children seen here are almost unbelievable. Out of 18 children seen 12 are
living under deplorable conditions, in one case eight persons and in another six persons occupy
a single-room home.
Dr. Elman, like Dr. Batten, dwells upon the value of the open-air school for the
malnourished town child.
Following-up
The returns of the school doctors who re-inspect children found at the routine
inspections in elementary schools to be ailing and in need of treatment make it possible
to compile a statistical record of following-up. During 1936, 129,867 children were
re-inspected. At the first re-inspection, which takes place in the next term but one
after primary inspection, 82,666 cases of defects requiring treatment (some children