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44
of night enuresis present at the age of 2 years. The retardation here mentioned
is not in any sense organic, merely a question of training and possibly lack of
the stimulating companionship of other children. (Mental deficiency is recorded
separately). The behaviour symptoms were practically always such as to
yield to simple treatment, and in particular to the salutary change of circumstance
which results from a child being able to go to school at the age of 3 years—
a privilege which the mother of a lonely, difficult, or unduly clever child is
coming more and more to appreciate and voluntarily to accept.
With a view to comparison with adult conditions a really careful note
was kept of all alimentary symptoms this year and it is perhaps astonishing
to find that only 11 out of 1,385 children were credited with symptoms referable
to acidosis, once much written up as a children's complaint, and only 15 were
constipated, some of the cases very markedly so, but yielding rapidly to treatment
in the form of dietary measures and improved regime. Six children only
showed worms. It is obvious that the gastro-enteritis discomforts prevalent
in adult life in this century have not yet punctuated the pre-school age period.
The problem of rickets, past, present, or imaginary, remains with us as it
will till we can submit all questionable cases for X-ray confirmation and biochemical
verdict. Cases considered to be showing undoubted rickety stigmata
on external appearances once more amount to 18 per cent.—a similar figure to
last year—but there were a number of other cases in which a careful record of
groups of deformities was kept, in which the diagnosis might well have been
made, though the stage for clinical symptoms was long past. In the writer s
opinion this problem of possible rickets, which has far reaching bearings on our
community life—on our stature, trunk development, respiratory capacity, and
therefore, surely, on our crude physical power—on our ease and grace of movement
and, therefore, our skill in athletic sports—on the deaths of mothers or
infants in difficult labour—not to mention possible effects in increased
liability to infection in the first year or two of life—will not be solved until
in some suitable mixed community, and, on a large scale, not only
doubtful cases, but, for control purposes, all children of a certain period
of life, are submitted to the test of X-ray and biochemical findings
correlated with clinical observation. Until this happens we are all working
in the dark, perhaps missing something important or perhaps going out on lost
trails ; but whoever has the courage to arrange to finance such a scheme of
routine examination of children in the susceptible years will be improving the
point of welfare work, whether it means that some of our present efforts can
be relaxed or whether we shall be called on to refocus or intensify our measures
to safeguard nutrition at an earlier age or in some other way than at present.
Only a few years ago (1933) we were frank enough to admit in this report that
we suspected the presence of (past) rickets in about 34 per cent. of cases, in
addition to the 30 per cent. we put down as definitely rachitic. These figures