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"REPORT ON SURVEY OF SUB-NORMAL NUTRITION IN SCHOOL
CHILDREN AND ON THE POSSIBLE NEED FOR A SCHEME FOR
PROVIDING MEALS FOR THOSE IN NECESSITOUS CIRCUMSTANCES.
In accordance with the resolution of the Education Committee passed
on the 2nd February, 1937, I submit herewith a report on sub-normal nutrition
in children attending the public elementary schools in Ealing and on the
possibility of providing meals for those whose parents are in necessitous
circumstances.
The first step that had to be taken was to ascertain as far as practicable
the total number of school children who were in a condition of sub-normal
nutrition. This meant a general survey, which was carried out from June
until the end of the year, of the children in the schools. It could be surmised
that it would be impracticable with the medical staff at my disposal to
examine individually all the children in the schools and therefore means had
to be devised by which the sub-normal children could be ascertained without
that necessity. The help therefore of the school teachers was invoked.
The school teachers are daily in close association with the children and at
the same time they are in touch with the parents. They are thus able to
formulate in their own minds ideas regarding the nutrition of the children
and to glean information as to the financial circumstances of the parents.
The head teachers were therefore asked (1) to make a return of the names
of all children considered by them to have signs of sub-normal nutrition,
and (2) to supply the names of all the children known to be in poor financial
circumstances on account of unemployment, large family and so on, in whom
no signs of sub-normal nutrition were observed.
As a guide to the head teachers a circular letter was issued to them
in which it was stated that the physical evidences of sub-normal nutrition
to be considered were smallness, thinness, pallor, poor carriage, recurring
illnesses such as bronchitis, sore throat, headaches, abdominal pain and
frequent colds and educational evidences to be inattention, dullness, irritability,
anxious expression, tiredness, mental slowness, and scholastic attainment
below probable mental capacity.
Thereupon the children whose names appeared on the list were inspected
by one of four medical officers in the department who, after consultation
with the head teacher, finally placed each child within one of the four groups:
{a) Nutrition excellent.
(b) Normal.
(c) Slightly sub-normal.
(d) Definitely sub-normal or bad.
The children who were considered by the medical officer to be slightly
sub-normal or definitely sub-normal were further investigated. This investigation
consisted of :
(1) A particular physical examination,
(2) A report from the school teacher and
(3) An enquiry into the home circumstances by the school nurse.
1. Physical Examination.
There is no sure criterion of sub-normal nutrition. The diagnosis is
arrived at from a group of signs or symptoms such as poor development,
pallor, condition of the skin and lack of muscular tone, which as a whole
convey to the mind of the examiner the condition of sub-normality. As a
group of signs does not always convey the same impression to different
individuals the results obtained might vary according to the medical examiner.
Nevertheless, on the whole, because of constant co-operation and consultation
between the individual medical examiners, the results may be deemed to