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122
The following table similarly suggests the inconsistency and unreliability of the results obtained
by Clinical Assessment in Willesden, even allowing for the differing social circumstances of the area.
PERCENTAGE OF WILLESDEN CHILDREN EXAMINED, GROUPED ACCORDING TO
THIER STATE OF NUTRITION AS REQUIRED BY MEMORANDUM 124 OF THE BOARD
OF EDUCATION.

It may be that a clinical observer would be able to detect serious undernourishment in a child
resulting from underfeeding over a period although having regard to the findings above quoted even
this may be doubted. But whether this be so or not it should be remembered that it is unsound
public health practice to wait until underfeeding has produced obvious malnutrition before applying
the remedy. The child should be fed wherever the circumstances of the family are such that sufficient
money at home is not available for the purchase of food.
Selection by Economic Circumstances.—In endeavouring to determine the need of children to
be fed on account of economic circumstances it is necessary to find out how much it costs to keep the
average unit in a family receiving school meals. Excluding Rent, Insurance, National Health Unemployment
Insurance, Fares to and from work and Payments for the care of children, the costs of
living fall under the following headings:—
Food,
Clothing,
Heating and Lighting,
Sundries, including cleaning materials, replacements, haircutting, postages, stationery,
recreation and unforeseen expenditure.
Food.—The child of 10 years may be assumed to be the average unit so far as food is concerned
in the families receiving school meals. Such a child requires some 2,800 calories in the food as purchased
as compared with some 3,400 calories for the adult male doing light work.
It has been already shown that the weekly cost of the meals provided by the Education Committee
at contract prices is 50d. per week. It is probable that 25 percent, would be added to this
cost if the foodstuffs were bought at retail prices in small quantities, thus bringing these costs up to
62½d. per week. This sum, however, only provides 2,400 calories and 2,800 calories are required
which at the same rate could be purchased for 73d. It should be observed that the 400 calories to be
supplied at home are cheaper calories than those supplied at school, but I think the figure of 73d. or
6/1 should be used so as to provide a margin.
The diet prescribed by the British Medical Association in its report in 1933 supplied 3,400
gross calories in suitable proportions of protein, fat and carbohydrate per average man. This diet
has recently been examined and amended in the light of greater knowledge by R. F. George who, in
his address on "A New Calculation of the Poverty Line" in 1937 to the Royal Statistical Society,
revised the weekly cost in relation to prices obtaining in 1936 with the following result:—

These figures are slightly below the figure of 6/1 for the average child of 10 years given in this
report but the cost of living index for food only has gone up from 29 in July, 1936, to 41 in August, 1938.