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school meals service aims at concentrating the maximum food value into the quantity
of food a child is willing to eat. It has set the following standard:
Age group No. of calories
(i) Under 7 years Minimum of 500
(ii) 7-11 years „ „ 650
(iii) Over 11 years „ „ 800
Meals for children in Groups (ii) and (iii) are planned to contain a minimum of
20 grammes of first class protein; a minimum of 25 grammes of fat; and a minimum of
400 milligrammes of calcium.
The diet of the children taking meals was under the supervision of the Council's
honorary nutritional consultant, Dr. T.F. Macrae, O.B.E., D.Sc. To provide a close check
on the quantities and qualities of served meals, random samples were analysed by the
Council's chemist-in-chief from time to time (see page 33).
Weighing and
measuring of
school
children
At the beginning of the year the Council decided that in future school pupils should
be weighed and measured at the time of the four routine medical inspections held during
their school life. This terminated the practice of six monthly weighing and measuring
which was introduced in 1935, primarily as part of the measures then taken by the
Council for the supervision of the nutritional condition of school children, and the
selection of those in need of special investigation at nutrition centres, or of milk, cod
liver oil or meals in school.
With the many published articles on the subject now available, a brief retrospect of
the Council's experience in this field may be of interest. The original concept was that
Livi's index (100 ∛W ̅̅/H) was to provide the 'yardstick' by means of which an
individual pupil could be 'screened' for special investigation. Later on the results of
the 1938 biometric survey (L.C.C. publication No. 3464) were used as the standard.
By this time the classic paper of Huws Jones (Jour. R. Stat. Soc. 101.1-34) had clearly
demonstrated the defects inherent in attempting to use physical indices as clinical screens.
Whatever the limitations of using biometric standards for assessing individuals, the
potential value of such standards for comparing groups was evident, and the Council
accordingly carried out surveys, and comparative standards were computed in 1942,
1943, 1946, 1947, 1949 and 1950. (See Medical Officer 27.5.44; 5.6.48; and L.C.C.
publication No. 3692. The 1950 results have not been published.) The problem now
was one of the interpretation of the real physiological meaning behind such results as
'over some 30 years there has been an average increase of 5.6 cm. in the height and
3.4 kg. in the weight of boys' (1938 report) and 'between 1938 and 1949 the average
height of London school children increased by about 2 cm. and the average weight
increased by 0.8 kg.' (1949 report). Authorities differ radically in their interpretations
of results such as these. For example, Morant (Proc. Roy. Soc. B. 137.443) thinks that
the final adult stature is unchanged, while on the other hand, Weir (B.M.J. 10.5.52,
p. 1006) thinks that there has been a real secular increase in height.
Since growth is a complex involving many factors—general health, nutrition, race,
environment, social status, climate, season, etc.—it would appear that caution is needed
in the interpretation of the results of large scale surveys of heterogeneous groups. It is
interesting to recall that this is virtually what the late Dr. F. C. Shrubsall—one of the
pioneers of the London school health service—told the Board of Education Consultative
Committee in his ' Notes on the Growth of School Children' as long ago as 1922.
Medical treatment
Although the duty of the Council as local education authority, under the Education
Act, 1944, to secure the provision of free medical treatment of school pupils was not
statutorily modified by the National Health Service Act, 1946, administrative decisions
by the Ministries of Health and Education indicate the principles upon which the
responsibilities for the treatment of school pupils should be shared between the Council
and the various elements of the national health service.