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129
Feeding in infancy was a factor which might be expected to enter into the production
of anaemia, since the incidence of anaemia was found amongst the cases observed to
decline steadily between the ages of 2 and 5, after the influence of a particular method
of feeding in infancy might be passing off, and the percentage of iron also is notably
less in cows milk than in human milk.
The duration of breast feeding observed amongst the anaemic children was as
follows:— breast fed not longer than 3 months, 46; between 3 and 6 months, 76;
between 6 and 9 months, 222; over 9 months of age, 4. This gives a percentage amongst
the anaemic children of 65.4 breast fed for 6 to 9 months, and 21 per cent breast fed
for a period of 3 to 6 months. Only 13 per cent were breast fed for a lesser period than
3 months and could truthfully be described as artificially fed infants. The rate of
breast feeding from 6 to 9 months for Woolwich as a whole, on the other hand, was
38 per cent in 1929— a year which would enter into these calculations^—and this rate
has shown but very slight variations from year to year. The figures, therefore, would
show not an apparent preponderance of anaemia amongst the artificially fed as might
have been expected, but that far more of the anaemic children were breast fed than of
the ordinary population— a finding that would make one look further back into antenatal
conditions and the state of the health of the mother as an important factor in the
causation of ansemia, if natural feeding during infancy is truly not a protective. In
this relation it may be mentioned that the form of artificial food in general use at the
infant welfare centres of the Borough is dried milk, but that not until 1932, i.e., after
the period covering the infancy of the children examined, was a form of dried milk
reinforced with iron utilised, as is now the case. The findings quoted, therefore, hold
good not for breast feeding versus an "improved" method of artificial feeding as now
advocated, but for the ordinary methods of bottle feeding advocated in centre work or
arrived at of choice in non-centre cases by the mothers themselves.
Anamia and general condition. The nutrition of the anaemic children, judged by
their height-weight ratio and general appearance, was recorded as below average in
31 per cent of the total anemic cases and 46.6 per cent of the group marked severely
anaemic. This compares with a percentage of 27 "below normal" cases for the total
children examined in the three years 1930-32. There would therefore appear to
be some association of anaemia with under-nourishment (or mal-nourishment) in the
severer cases, but amongst the moderate or lesser cases of anaemia, under-nutrition
was not noticeably more prevalent than amongst the general group of children examined.
Anamia and rickets. Thirty-nine per cent of the total anxmic children showed
definite rickets, compared with 29 per cent of the total children examined during 1930-32:
an additional 18 per cent showed minor evidence of rachitic change. It would appear
trom this that the incidence of anaemia plus rickets is higher than the incidence of
either of these two conditions alone, i.e., there would appear to be some degree of
association between the presence of rickets and of anaemia in the children submitted
to examination. Further than this it is impossible to go, since neither the rickets
nor the anaemia was necessarily seen in its initial stages during the age period under
review.