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examining medical officer. Conversely there is the child who gets a temporary flush in the
presence of the examining medical officer, and is as a result as highly placed as the former pallid
child is lowly placed by the inexpert. It is well not to make assessment in appearance without
seeing the children in a group later, when their appearance may entirely belie the original estimate.
How well I remember the fury of one of our ablest school medical officers in the country, as the
result of a notice with regard to his daughter, who had won a scholarship at a famous secondary
school, where she had been examined by a junior medical officer, to the effect that she was suffering
from anaemia—she being one of the pallor cases referred to.
Eight years ago I called attention to the importance of the clinical syndrome as compared
with mathematical methods. It is good indeed to see that at last there is to be an investigation
based on clinical experience. There is also occasionally a class of case which it is true does not
conform to type in that viewed above the collar the primary impression is one of malnutrition,
which is negatived by the condition of the child when stripped. Again there is a class of case
which needs further investigation, in that all the circumstances are favourable and yet without any
previous history of gross illness there is some imbalance, possibly endocrine, which is manifesting
itself as malnutrition. Sherman is abundantly right in insisting on the failure to convert money
into the proper diet. This has been evident for long to those of us who know the homes internally.
Thanks to the Carnegie Trustees I am being enabled, as a result of a grant of £500,
supplemented by my Borough Council, to carry out investigations to assist in the acquisition of
more knowledge as to how money can be transformed into nutrition.
In conclusion, let me quote from an old record of eight years ago. At a tea given in one of
our schools, I picked out 13 children sitting at table, who, in my opinion, were suffering from
malnutrition. In 12 of the cases either the father was dead or had been out of work for six
months, and in the 13th case I had no time to go into the question of dietetic error. Surely a
syndrome accurate to this extent is an obvious clinical entity, as obvious as myxoedema, but it
must be admitted, as elusive in lesser cases as early myxoedema. How often one has seen in the
past, families living side by side on the same wage and under practically identical conditions, in
which the following contrast occurs. In the one case the man has married a woman who has
been in domestic service in a professional man's family where she obtained years of experience
in utilising everything in the way of food that was left over, and in practising economy, an
economy unknown to many of those with much smaller incomes, but whose children are
nutritionally satisfactory. Whereas in contrast to this is the housewife next door whose
feckless habits in the matter of food are evidenced by the malnutrition of her children.—I am, Sir,
yours faithfully,
Elwin H. T. Nash,
M.O.H. and S.M.O., Borough of Heston and Isleworth.
(b). Uncleanliness.
The number of cases discovered at routine medical inspections was 99, and special medical
inspections at the Clinics revealed a further 595 cases.
Three hundred and ninety-six children were excluded from school during the year on
account of nits or vermin.
(c). Minor Ailments and Diseases of the Skin.
A total of 449 cases of various skin diseases were reported during the year, and with the
exception of 16 cases, all were referred for treatment. As usual, impetigo was the commonest
disease. Table II. shows that there where 214 cases of " Other skin disease; " these include such
conditions as eczema, alopecia, seborrhcea, etc.
(d). Visual Defects and External Eye Disease.
Routine medical inspections revealed 237 cases of defective vision, 206 being referred for
treatment. Twenty cases of squint were also discovered, 17 being referred for treatment.
At the Special Clinics, 133 cases of defective vision and 17 of squint were referred for
treatment.
Twenty-one cases of minor disease of the eye were discovered at routine medical inspections,
and 205 cases were discovered at the Special Clinics.
(e). Nose and Throat Defects.
Two hundred and forty-six children were found to be suffering from chronic tonsillitis,
and of these 114 were referred for operation.
Twenty-five children had Adenoids only, 15 being referred for treatment and 10 for observation.
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