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unchanged at the age of 3, the peak period last year. The figures for the age of 4, again, show
an apparent increase although the small numbers examined at this age vitiate any real comparison
with other ages. The figures for rickets show the same general direction, namely, the
total figures for 1931 show an increase, while the sex variation shown in 1930 is maintained,
30 per cent, boys showing rickets compared with 25 per cent, girls, the respective figures last
year being 25 and 18 per cent. The highest incidence of rickets was found at the age of two,
diminishing towards school age. It should also be noted that the incidence of dental defects
at the age of 2 this year was doubled (16.3 per cent., as compared with 8), while remaining
identically the same amongst the older groups.
The standard adopted for the diagnosis of rickets was the presence of two of the generally
recognised early bony signs, namely, enlarged wrist epiphyses, palpable rosary, Harrison's
sulcus, depressed sternum, narrowed rib angle, crowded hypoplastic teeth, combined with
constitutional symptoms. In many cases the signs were obviously indicative of old but healed
rickets. In other cases signs of past rickets, bossed forehead, pigeon chest, rickety knock
knees, lordosis, bent femora, etc., were present along with signs suggestive of a new early lesion
(rosary, etc.) in children beyond the usual age for the development of rickets; i.e., already
in their fourth or fifth year.
While the exact significance of these findings cannot be assessed solely by clinical
examination, the impression gained of the prevalence of anaemia and rickets and the rates shown
for dental caries amongst the groups examined, under varying social conditions, would seem to
point to an operating cause of a very general character (such as climate or weather) rather than
a special or temporarily operating one (such as lack of food and means in families hit by
unemployment). At the same time the findings would suggest that there is room for further
propaganda on the inter-relation of the factors governing nutrition—air, cleanliness, exercise,
light, etc., in addition to dietetic factors per se—and the relative value of inexpensive foods, at
a moment when many families, in all classes, are bound to be budgeting below their normal
expenditure on actual supplies.
Apart from conditions reflecting nutrition, "nervous" phenomena of various sorts
accounted again this year for a high proportion of the cases referred for observation. As these
conditions do not necessarily end in the pre-school years, nor even when their outward symptoms
are (apparently) successfully submerged, an attempt was made to submit them to analysis
with a view to discovering (a) the situations in which such nervous conditions tended to occur,
and (b) the extent to which they might be expected to yield spontaneously to "time" or,
untreated, to become a definite charge on the community. For nervousness has its immediate
bearing on health, but an equally important, if more remote, bearing on the capabilities
(efficiency and enterprise) of the individual in later life. Such a factor must enter into the
general calculations if it is found recurring with palpable frequency in a group of cases representative
of a community, even at the child stage. It should also, if it resembles other pathological
processes, be most amenable to treatment at this stage, when first able to be recognised,
even if still somewhat ill-defined in character and not sharply to be removed from " normal "
behaviour.
It is, as a matter of fact, accepted that it is at this moment, in the whole of life,
that nervousness, as experienced in adult life in all its many-coloured guises, is created. It
is also known that the creating factors are mostly ignorance, a failure to appreciate the vital
forces playing on the childs mind in evolution, in the actual infant years. The longer these are
allowed to act adversely, the more fixed the "nervous" symptom, the longer and more stormy
the road the individual must face before the evil influence can be outdone. So little, in fact,
does life of itself solve these troubles that the nervous adult is, as a rule, just so much further
from happy release as the years of unsuccess that divide him from the inharmonious child.
No apology is needed, therefore, for examining nervousness present in the pre-school years,
even slight in amount, since it is here most interesting to the observer, most accessible to treatment,
and a much less costly proposition for all concerned if it can somehow be prevented from
becoming an established "defect."
In this instance nervous symptoms of all sorts, and some only nervous by inference,
but that are sometimes physical (e.g., enuresis), provided only they were sufficient to
attract attention at examination, were included in the observation. The causative
jnfluences were obviously beyond the scope of the enquiry, but certain major factors likely to
e involved were open for consideration. For this reason the total cases examined were first
grouped in certain (family) classes or "situations" held to have special significances for the
mental development of children during the pre-school years. All cases examined in the two
years 1930 and 1931 were included in these groups, excluding only certain North Woolwich
cases for whom such regular inspection and classification was not practicable. The classification
18 as follows:-