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the accumulation of evidence as to what is and what is not important in the protective
care of toddlers or in the better concentration of teaching at an earlier age.
Evidence of disease, it need hardly be said, can only be based on accredited facts, not
on external observation, but in the beginning it is observation simply that must
determine when it is or is not likely to be worth while to pursue the effort of getting
more exact evidence.
"To go on to the recorded findings it will be seen that the nutrition of the children
seen (as judged by height, weight and general appearance) was considered to be
extremely satisfactory, the rate for actual malnutrition (marked 4 in the Table)
being as low as 0.4 per cent.; and for sub-normal nutrition or simple thinness (3 in
Table) 11 per cent. (The ability to make a thin child fat is of course not always
a question at the disposition of the parents' goodwill, or of their resources). In 53
per cent. of cases, i.e., more than half, the general nutrition was recorded as excellent
(this, however, included some children who were too fat) and in a further 35.5 per
cent. as average. These figures are believed to compare well with findings elsewhere
and are on a par with what has been found in previous years, always, however, showing
a slight improvement. There can be no question—if these observations are just—
of any suffering of the children from under-nourishment, even in difficult times.
The muscle tone, still a better test than weight of the well being of the children, was
put down as excellent in 70 per cent. of those seen.
"Nevertheless there remains the question of possible rickets, aforementioned,
and of anaemia, both commented upon in previous years. The number of cases
showing external evidences of rickets (not necessarily active, in fact, in most cases,
presumably non-active and healed, but the remnant of a non-healthy and unsatisfactory
condition at an earlier age, on such assessment of symptoms as is here possible),
amounts to 30 per cent. and that of anaemia 21 per cent. These figures are in
accordance with what has been noted and annotated upon previously on the same
evidence. Possibly these conditions are factitious, not to be supported by laboratory
findings, but the impression recurs, and one may remember that there is actual
evidence (in regard to anaemia, not rickets) of a proved high incidence of this condition
in non-selected children of an earlier age investigated in a neighbouring part of
London (c.f. Dr. Helen Mackay's work at the Queen's Hospital). If the miasma
that rickets (of a discernible degree) and anaemia may exist somewhat widely amongst
children of pre-school age, unrealised and unchecked till disclosed by routine
examination, can be dispersed, all the better; until it is there remains the uncomfortable
possibility that in spite of all our efforts at intelligent teaching as we understand
it, all of our education of the mothers isn't going home or some of the education
we give is wanting still in knowledge, in an important sense. If the condition, or
conditions, are found to exist in reality, then all the more reason for our efforts to
be increased and to be amplified in knowledge so far as possible. All of this waits
only for research.