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121
It will be understood that the meals supplied by the Education Committee are not intended
to represent the complete daily food intake of the average child of 10 years. But as the economic
circumstances of the families from which such children come are low it is desirable that they should
be supplied with the essential and more expensive foodstuffs at school so that the supplementary
feeding at home may be comparatively easy and cheap.
Having regard to these considerations I am of opinion that the dietary now submitted for the
consideration of the Committee is a sound and proper dietary for the average child fed, namely, a
child of 10 years, for the following reasons:—
It provides about 6/7ths of the total calories requires.
It provides nearly all the animal protein and about 4/5ths of the total protein required.
It provides all the fat required.
It provides about 3/4ths of the carbohydrate required.
It provides all the mineral elements required.
It provides vitamins in sufficient amount.
The dietaries might conceivably be criticised on the ground that there is an insufficiency of
raw fruit and green salads but in my opinion the extra cost of these does not warrant their inclusion
in the menus. These foodstuffs contain Vitamin C which is protective against scurvy but having
regard to the fact that a case of scurvy is very seldom seen in the population nowadays I do not think
there is any clamant need for any further addition of fresh fruit and salads to the dietaries submitted.
The average daily costs of the dietaries are:—
Pence.
Breakfast 2.7
Dinners 3.8
Milk 0.5
Fruit 0.14
7.14
The weekly cost is therefore 50d.
The Problem of Selection.
Having decided upon the dietaries the next problem which the Local Authority have to solve
is which children in their area are unable by reason of lack of food to take full advantage of the
education provided for them.
It has been suggested that this selection may be made (a) by medical examination, or (b) by
having regard to the economic circumstances of the family.
Selection by Medical Examination.—It should be observed that the state of nutrition depends
on many factors, including, Previous Disease, for example, Rickets in early childhood leading to
stunted growth; Existing Disease; Chronic Fatigue, due to prolonged hours of work or too little
sleep; Environmental Conditions, for example, overcrowding or absence of mother at work; and
Diet.
Selection of the undernourished child by medical examination has been the subject of much
discussion and various methods have been tried for assessing the state of nutrition, including
Anthropometric Measurements; Co-ordinational Tests; Lung Capacity Tests; Volitional Tests;
Fatigability Tests; Endurance Tests; Estimation of Haemoglobin; and Clinical Assessment.
The Advisory Committee on Nutrition reporting to the Minister of Health in 1936 reported on
the Assessment of the State of Nutrition in the following terms:—
"We have endeavoured to obtain information as to the measurement of the state of
nutrition as we considered that the correlation of the state of nutrition with the diet
consumed would be of assistance to us in our inquiries.
"We have had under review the various methods which have been tried or are in process
of trial or have been suggested for the assessment of the nutritional state. We are unable
to recommend any known method as reliable. So far as our present knowledge goes it would
seem that the clinical method given in detail in Administrative Memorandum No. 124 of the
Board of Education is the most promising, but the trial of this method has not been sufficiently
prolonged to establish its reliability."
The Clinical Method has received much attention recently and it is fair to say that confidence
in this method is now considerably shaken. Different doctors have been asked to examine the same
set of children and the results show that physicians differ widely in their estimates of the nutritional
states of the same children. I shall quote only one such result of a nutritional survey of children of
each sex conducted by school medical officers in Brecon, Glamorgan and Carmarthen. There were
6 doctors and the same children were examined by all of them. The comments of the County Medical
Officer for Brecon on the results are:—
(1) All six doctors only agreed unanimously on 19 children.
(2) Five doctors agreed with one dissentient on 24 children.
(3) Four doctors agreed with two dissentients on 43 children.
(4) In no less than 17 instances the same child was assessed as " Excellent " by some and
"Subnormal" by others, while other children were similarly labelled " Normal " by
some and "Bad" by others.