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cases with or without anaemia. The percentage of anaemic cases showing pallor, therefore,
is a little higher than the percentage of children showing pallor amongst the general
population. Moreover, 47 per cent of the pallor children were considered to be anxmic.
It would appear, therefore, as if the association of facial pallor with anaemia in the
popular idea is to some extent supported, but the correspondence is not absolute and an
equal proportion of pale children was in fact found who showed not the slightest sign
of anaemia judged by the condition of their mucous membranes. It was unusual for the
pallor to coincide with the evidence of the anxmia when found, but one or two cases
were observed in which a moderate degree of anxmia was followed at a later stage by
exceeding pallor.
Persistence of anamic symptoms. Two hundred and nine of the 478 anxmic cases
were re-examined at an interval varying from 3 to 12 or more months. The results of
re-examination were as follows:—of the totals re-inspected, 52 per cent showed
improvement of the anxmia (irrespective of any other sign), 34 per cent appeared to be
as before, and 14 per cent were worse. Of those re-examined at an interval of one year or
longer, a higher percentage than at shorter intervals was found to be improved, namely
60 per cent. As already stated, in 8 cases an uncomplicated anxmia was found at the
second examination to be accompanied by a heart murmur, and in 4 by symptoms of
rheumatism. Those cases which were complicated by cardiac symptoms from the
beginning are recorded in respect of these symptoms amongst the cardiac groups, the
notes taken of the cardiac complications at re-inspections receiving attention in the
corresponding part of the report.
Final consideration. This brings one to the final consideration in these observations
and that is the treatment available for the anxmic children under the conditions
noted as prevailing at the clinic. For all anxmias taken as severe, medical treatment
was adjudged to be necessary and the mother was immediately put into touch with,
in most cases, hospital, so as to secure adequately correct diagnosis and continuity of
treatment. The majority of other cases were advised solely on dietetic or hygienic lines,
concentrating on a close scrutiny of the actual feeding and environmental conditions in
the home as reported by the mother or, in some cases, by the health visitor. Many of
these environmental conditions (e.g., overcrowding, lack of exercise, unemployment)
have already been discussed, but the factor that loomed large in the offing and ;hat so
far had not been probed, was that of diet—too big and evasive a subject to be dealt with
exhaustively in the time available for questioning at consultations. Mothers are known,
whether from pride, prejudice, or inattention, to be apt not to provide, when asked,
an accurate picture of what their child eats and how its food is prepared. At best one
can only generalise from the information provided and take heed of the fact that the
conditions complained of are not limited to one group of cases or to one grade of income.
Certain impressions, in view of these factors, stand out. It is, for example, impossible
to be certain that any proportion of the children examined have milk to drink every day
(i.e., something more than a portion of tinned skimmed milk in tea) and, it so, what
amount. Many of the mothers admit to not measuring, or even thinking twice o\er,
the amount once the infant stage has been passed and the child has come to be
considered a member of the family. Many of the mothers own to making no milk