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Anaemia was noted in similar proportions, 15 per cent. boys, 19 per cent.
girls, at the age of 2 years, but in 24 per cent. of both at the age of 3 years. These
figures are high, but they may indicate such circumstantial factors as undue confinement*
rather than nutritional fault, since the figures for anaemia during school
life show an abrupt diminution (1 per cent. from entrants' age onwards, in London
County Council reports).
Rickets.—Rickets must also be considered as a general nutritional condition.
Evidence of rickets was commoner in boys than in girls, 25 per cent. as compared
with 18 per cent., but these must not be taken to be active cases at the moment
of examination since all definitely rachitic, though minor, deformities, were included ;
e.g., deformities of head, chest and teeth, as well as more obvious deformities of
the limbs.
Muscle Tone.—This was specially noted in all cases as providing a very
good indication of health. It was most satisfactory to note that in only 16 per
cent. of all the cases examined was there real softness. A few cases of minor
spasticity on the other hand gave the clue to unexplained delays in walking.
Dental Conditions.—Dental caries, often rachitic in origin, is a sign that has
been widely complained of in this country in children entering school. The Report
of the School Medical Officer of the London County Council for the year 1929 shews
dental defects in 68 per cent. of children of all ages examined, and notes ' the
appalling onset of caries among all children during the fourth year.'
Of the children examined in the Toddlers' Clinic, 31 per cent. showed signs of
caries between the ages of 3 and 4, and 48 per cent. between the ages of 4 and 5.
8.5 per cent. of cases already showed caries between the ages of 2 and 3. These
figures are much smaller than the figures for London as a whole, but they would
seem to indicate two things:—(a) that further work is necessary in instructing
parents as to the manner of development of, and the measures necessary for, conserving
the teeth, and (b) that periodic dental examination of children before school
age, starting, if possible, in the third year, is a useful prophylactic that might be
expected to limit the incidence of caries by correcting it in its early stages, and
so also prevent the serious secondary effects of untreated dental disease.
As a further index of nutrition, sound and unsound, throughout the infant
period, these figures for dental caries are also of considerable interest.
Respiratory Conditions.—In Dame Janet Campbell's latest Report on Infant
Mortality, respiratory disease is shown to have succeeded gastro-enteric disease as
the chief cause of deaths amongst young children. In view of this a history of
* Compare paragraph on "Hours of Sleep."