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134
The number of children taking school meals is falling. Is it due to the greater freedom
in buying food now that rationing has almost ceased, or is it due to the price of dinners
having risen and the parents being unable to pay the increased cost? We should try
to find out and act on the information. Perhaps the time has come when we need
once more to be occupied by the question of nutrition but this time from the economic
angle.
Of course, none of us has any doubts about the improvement in the children's
nutrition and general well-being and that particularly in the last 10 years. I know that
Martin has suggested in his memorandum on "The Physique of Young Adult Males"
(1949) that there has been no real increase of average height. The steady increase in
the heights and weights of school children shown in our returns since 1911 has
apparently merely brought forward the age of physical maturity from 26 years of age
some 50 years ago to 21 years of age to-day. It would be interesting to know if there
is any difference in the National Service men reporting to-day. Martin's analysis
was done on 1939 figures; but, be that as it may, none of us can doubt that the years
of full employment, the priority food policy of the war years, cheap milk for under
fives, free milk in school, and the family allowance (in my opinion one of the best
social security measures ever brought in) have all helped, and are still helping, to
conquer the first of the "biological stresses" for the school child described by the
late Dr. Dunstan Brewer in an address on "The Future of School Medicine" given at
the Royal Sanitary Institute (1941) when he said: "It soon became apparent to the
more enlightened School Medical Officers that the defects they found were not
haphazard accidents, but the inevitable outcome of certain biological stresses to
which the organism was unable to adjust itself—these stresses could be reduced to
three—ill-nutrition, infection, and faulty environment." In 1941 Dr. Brewer was
very gloomy, sure that we had still a long way to go to conquer the nutritional deficiencies.
I feel he would be much more cheerful to-day but we should remember that
the price of good nutrition is eternal vigilance—economically.
I think he would agree that his second "biological stress"—infection—has been
greatly reduced in severity but I have no time to enter into the reasons this afternoon.
What of his third "stress"—faulty environment? Here, materially, the picture
is not so encouraging for the provision of better school buildings and better homes
has been much handicapped by war and its aftermath, but I prefer to deal with a
special form of "faulty environment" this afternoon and that is the emotional
environment, and here it seems to me we have fresh fields to conquer.
Emphasis on Mental Well-being.
Dr. Margaret Mead, the well-known American anthropologist, in a broadcast
after the first International Conference on Mental Health held in London in August,
1948, appealed to the preventive health services to do for mental health what they had
done for physical well-being. To-day the children passing through our schools are
incomparably better than they were 20 years ago. The children coming into the
schools are equally improved; the work of our Maternity and Child Welfare colleagues
is also bearing fruit.
Perhaps the statistics of numbers of defects found show little change, but those
working in the service know that the severity of these defects has also been greatly
reduced and, indeed, defects are listed to-day which, in the mass of more worrying
physical lesions, were rarely listed before the war. One of these coming more and more
to the fore is the "Behaviour Problem" or "The Emotionally Maladjusted Child".
We had already begun to take note of emotional states before Dr. Mead made her
appeal but, as she said, it took 20 to 30 years to improve the physique of school children
and it is likely to take a similar span of time before we see a comparable improvement
in mental well-being.
Until our attention could be released from the pressure of dealing with obvious
and remedial physical ills we could not give time and consideration to the less obvious
emotional difficulties, and indeed the school medical officer himself had to begin to
acquire the knowledge to detect and deal with this new and difficult field of work.
It was not that these behaviour difficulties did not exist 20 or 30 years ago. We
only have to look at the neurotic adults of to-day, or read the literature of the past,
to know that emotional maladjustments have always been with us—at least, in organised
and highly civilised societies ; but we are to-day more aware of the problem and must
equip ourselves to deal with it. At one time I thought that the provision of Child