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41
"Some of the points that suitable research would elucidate are clear and interesting.
Is the anaemia, if it exists, merely a hang-over from Dr. Mackay's nutritional anaemia
of infants, or is it of a separate etiological and environmental origin? (i.e. when
and how must we prevent it?) Can the rickets be established by X-ray findings
and biochemical reports as true rachitis arising by the same causes as in earlier
infancy? Is it healed or active? At what age did it begin? Does any of it, as
a result of recent difficult times, and possibly selective feeding, show evidence of
having arisen as a real deprivation complex, absolute or relative, in children who
have been exposed to hardship, at an age corresponding with the hardship, and possibly
at an age later than rickets is usually thought to be incurred? Does it correspond
with any particular social stratum or circumstance? Or is it uniform (so far as it
exists) throughout the centres in the district and the grades and circumstances
roughly corresponding with these?
"Dental caries is a condition recorded in the Table, that elsewhere has been
associated with rickets, on laboratory evidence, as being secondary to a poor formation
of enamel coincident with defective calcium-phosphorus metabolism such as we
know exists in rickets. This year the figures for dental caries in the children examined
show a diminution at the earliest age (3.5 per cent. of children shows caries at the
age of 2, i.e., at an age between their second and third birthdays, compared with
the best previously recorded figure of 8 per cent.). At the next age, 3 years, the
figure remains high at 27 per cent., and at the age of 4, unfortunately, still 48 per
cent. The diminution at the youngest age is, however, very gratifying if it is real,
but it may in fact be somewhat falsified by the fact that children now come more
accurately in their birthday month for routine inspection, than at odd dates between
birthdays, and at the exact age of two, one would expect to see less caries than for
example, some months later, nearer 3.
"Of the 45 per cent. of children showing tonsil enlargement only 3.6 per cent.
were considered to require operation."