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63
The chief points that may be noted are as follows :—
A. General.
Nutritional conditions, including sub-normal nutrition and anaemia but excluding
rickets, show an agreeable diminution in 1933, following an almost uniform
rate for the previous three years. The figures for sub-normal nutrition work out
at 16 per cent. of the total cases, compared with 25 per cent. in 1932. Anaemia is
rated at 17 per cent. as compared with 24 per cent. last year.
Anaemia this year shows an equal incidence in boys and girls (17 per cent.) and
is recorded at the following rates according to age:—19 per cent. at the age of 2 ;
13 per cent. at the age of 3, and 17 per cent at the age of 4. This curve shows some
variation from the curve observed last year for all cases examined between 1930
and 1932, which declined steadily from infancy towards school age, but the deviation
probably is of no great significance.
Rickets, with its undimished showing at 30 per cent., is one of the less satisfactory
conditions observed. So high an incidence (based on the clinical evidence available)
would seem to show that neither from the point of view of prevention nor treatment
has this condition so far been satisfactorily plumbed. Its general significance may
be adduced from the fact that it is associated not only with bony deformities apparent
to the eye, but with profound disturbance of the metabolic system that affects
health and well-being in many less obvious directions. The prevalence of such a
condition is a factor of high importance in the public health and it may be that the
public health clinic typically offers one of the best opportunities for its closer, more
purposive study, since children of all grades and in all conditions of health are there
brought under review. But special methods are required and at the moment no
more can be done than draw attention to this condition, known elsewhere as " the
English disease," that seems to pervade our child community throughout this
country, not less widely, possibly more widely than in the old days when lack of
facilities allowed it sometimes to advance to an extreme grade before treatment
was instituted.
In the present group of cases, 30 per cent. were marked as definitely rachitic,
but 34 per cent. of the remaining children showed minor signs that might have
developed into florid rickets if not recognised, or that might remain from early
rickets treated, a total of 14 per cent. This figure corresponds with findings in other
parts of this country where careful routine observations have been made. As a
comment on the ultimate significance of rickets may be quoted one fact, interesting
in maternity and child welfare, that the existing high rate of maternal mortality
throughout the country, which has so far not yielded to treatment, has been abundantly
proved to be due in a majority of cases to instrumental delivery, the chief
cause of which is old rachitic deformity of the mother's pelvis, of various types and
degrees, causing bony contraction. Our mothers of to-day are suffering from the
minor rickets of a generation ago and the infants of these births suffer concurrently.