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Where the environment is wrong, it is usually found that the causes may be
divided into two classes: (i) where the diet is insufficient, (ii) where the diet is
improper. Where the diet is insufficient you provide free milk in the schools and
free meals at special feeding centres and your nurses investigate to see that the
parents of the children avail themselves of all the facilities for obtaining a sufficient
diet for them. Cases of inefficient diet are usually more difficult to deal with ;
necessary advice is given and where of course the circumstances of the case demand
it you would undertake to feed such children.
Cases of abnormal children in ordinary environment are very difficult to deal
with. These cases can be divided into two classes : there are those where the
abnormality has existed from birth and those where the abnormality has developed
since birth. Where the disability was present when the child was born, that is, any
congenital cause, the disability may be due to hereditary causes or to disease
contracted before birth.
Every case has to be dealt with on its own merits.
So also where the abnormality is acquired by the child after birth. Each
case is a difficult one and has to be dealt with on its own merits. In Barking
any child who in the estimation of the Medical Officer is 10 per cent. below weight is
submitted to special enquiry. The school nurse pays a social visit and the case
is studied from almost every possible angle. It is, however, to be remembered
that the English are a conglomeration of diverse races and that it is more than
difficult to lay down any precise standard of weights and it is often found that small
children are by no means ill-nourished.
Experiments have been carried out upon sheep to show that there is a definite
relationship between diet and vulnerability to disease and I have no doubt that
the same exists among human beings, but with this chief difference, that in our
crowded communities we have every opportunity for mass infection and when
infection is massive enough, the influence of diet is reduced correspondingly.
(b) Uncleanliness.—Children found in school suffering from uncleanliness of
the head or body are excluded by special form which is forwarded to the parents
in a sealed envelope, particulars also being given of measures to cleanse the head.
Cases of vermin and nits in the head are provided with special soap on attendance
at the Clinics. Special nit combs are also kept at the Clinics, and are loaned on
payment of a deposit to parents who find difficulty in removing nits. In obstinate
or difficult cases, the cleansing of a head is undertaken by a School Nurse at the
Minor Ailments Clinic.