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The Underfeeding of School Children.
THE UNDERFEEDING OF SCHOOL CHILDREN.
1044
will hesitate to admit that medical men as class are at least as prone as their neighbours to the bridge mania and the obsession of golf. We may not often catch these complaints in their severest forms, yet some of us may have encountered professional brethren not far removed from the parlous state of the practitioner of whom it was credibly reported that his bridge consciousness had so far got the upper hand over his medical personality that he had come to think and to speak in the phraseology of his favourite game and would convey an unfavourable prognosis by murmuring the mystic word "chicane," or would laud the latest coal-tar product as a remedy with which he had made Grand Slam in a score of diseases. Even, however, when we do not run to these extremes it may still be questioned whether our cult of pastimes of this sort is kept always within the limits which a sane and level view of life would assign to them. Probably there are too many medical men in this country who allow sports to occupy a position of prominence which is detrimental to their proper intellectual interests and which spoils the sports as means of relaxation. We are not advocating a life of endless toil, with no change of interest and no relaxation but are rather pointing out that when a sport or a game is too seriously pursued it ceases to be a relaxation. Theoretically what can be nicer for the hard-worked practitioner than to sit down to his well-earned rubber at the close of a hard day’s work ; but when it appears that the
profession
ventured to
deprecate,
a
and to take
our
amusement that is to soothe his
guise of
an
art that has to be
in the
quivering taught in elaborate text-books, nerves comes
technical phraseology as rich as that of a youthful specialism on its promotion, then we may be allowed to entertain some little doubt as to the sedative value of the with
a
remedy. perhaps venture to suggest that in this matter our professional brethren abroad set a somewhat better example, that they are less prone to confuse the spheres of work and pleasure, and that they are more ready than we are to give up their leisure to intellectual activities that broaden their outlook on life, and may help incidentally their professional efficiency. For modern medicine knows no bounds, and information picked up as pure entertainment, the acquisition of which has been most refreshing, may turn out of practical value at any moment. No one, for instance, who has had occasion to refer to the original literature of any medical, or, indeed, of any scientific subject, and who has turned for help to the continental bibliographer, can We may
have failed to observe how considerable in amount and in quality have been the contributions to knowledge made in France, in Germany, and in Italy by men working in obscure towns
or
in
country districts
remote from the centres of
intellectual movement. The meaning of this is not that the leisure of these observers has been spent in perpetual grinding at their subjects, but that they have taken their pleasure in the pursuit of intellectuality, and in so doing have not necessarily committed themselves to any harder mental task than the text-book of scientific bridge might demand of them. It is difficult to resist the impression that if we fail to give evidence of as high a general level of scientific culture as our continental colleagues, who have assuredly no advantage over us in natural talent or opportunity, the humiliating act may be in part due to the tendency which we have
work,
the
dissipate our energies seriously than our their place in befits than seriously tendency
amusements, if
at all events more
not
to
more
any rational scheme of life.
The
of School
Underfeeding Children.
present time, when public interest is so strongly the question of national physique, it is hardly focussed surprising that the conditions under which school children are fed should engage the attention not only of the educational authorities but also of independent responsible It has, however, been too and philanthropic inquirers. readily assumed from somewhat superficial investigation that underfeeding in the case of the developing child is one of the most important contributory factors in the determination of physical deterioration ; indeed, on this hypothesis enthusiastic reformers may possibly have allowed superficial impressions rather than matured consideration to direct their lines of action. It requires a cursory examination of the children, no more than who, in some rather sweeping form of classification, might come under the category of degenerates and who constitute an appreciable percentage of our urban elemenAT the
on
tary scholars,
to convince the observers of the fact that
and all
from
of malnutrition. The conclusion that this malnutrition is the result of starvation seems but a natural inference. Malnutrition, however, of the kind found in many of them more often proceeds from a combination of hereditary disabilities and acquired constitutional dyscrasias than from the fault of actual lack of food. A very large number of children, who certainly give the impression of being starved, are suffering from a
they
are
one
suffering
some
degree
form of intestinal catarrh which is often the faulty methods of feeding during infancy. These children are usually voraciously hungry but their complaint is of a nature that does not benefit by an increased dietary or a plethora of food. By others than medical men such cases would generally be ascribed to starvation. Although it is impossible to doubt that the majority of the children of the poor are most injudiciously fed, this is very different from the assertion that they are actually starved and it becomes a serious question how far the condition of affairs which often prevails can be improved by the indiscriminate institution of free meals. Recognising, therefore, the great difficulty of discriminatchronic
result of
ing
between what is
tion,
we
heartily
genuine
and what is
welcome the
apparent
painstaking
starva-
efforts of Dr.
ALFRED
GREENWOOD, the medical officer of health of the county borough of Blackburn, to elucidate by systematic investigation the extent to which alleged starvation exists among the children attending at the elementary schools situated in the area under his medical supervision. The result of his inquiries has been embodied in a little brochure of
commend to the notice of all of his interesting figures will be found in our Manchester correspondent’s letter this week. Although the field of Dr. GREENWOOD’S investigations has been confined to a narrow area, nevertheless, some
our
76 pages, which
readers, while
some
we
THE ROYAL COMMISSION ON MOTOR TRAFFIC.
1045
living organisms, represents a more or less responsive a to the circumstances of the environment, but the adaptation i of the social and educational problem presented by ill- more closely these circumstances are investigated the less c nourished board-school children than many more demon- do they appear to depend on the starvation factor. The In his inquiry best 1 results in physical and mental development can clearly strative generalisations on the same subject. into the extent of underfeeding among school children (only be obtained under the best conditions of feeding, in his district Dr. GREENWOOD has employed methods of 1hygiene, and education ; but if starvation plays so uninvestigation which were thorough and free from the iimportant a part as this investigation of Dr. GREENWOOD to creep intowould lead us to suppose, it is merely playing with a vital error which are very liable sources of this of kind. All were 1problem to imagine that the question of physical deterioraprecautions inquiries necessary taken to avoid deception and the range of the inquirytion as it exists among school children can be dealt with was sufficiently wide to arrive at a very fair esti- by the provision of free meals. mate of the truth. The plan of the campaign included a house-to-house inspection of the homes of all the children who were suspected by their teachers to be suffering from the ill-effects of auy form of underfeeding. Out of all the 22,952 children attending at the "Ne quid nimis." public elementary schools within his district the names and addresses of 540 children only were supplied to Dr. GREENTHE ROYAL COMMISSION ON MOTOR TRAFFIC. WOOD as being desirable and suitable cases for inquiry. An IN the Heuse of Commons on June lst last Mr. Balfour analysis of the results obtained enabled him to come said that the existing Motor Act would be reintroduced next to the definite conclusion that underfeeding does not occur session in an amended form, and on August 7th the appointfrom various reasons, such as poverty, illness, and neglect, ment of a Royal Commission was announced to inquire and in more than 313 children within his district and that report as to (1) the working of the Motor Car Acts, 1896 and these children are included in 95 independent families. 1903, and of the regulations under them ; (2) the law and Based, therefore, on the somewhat rigorous standard practice in relation to motor-cars in the principal foreign (3) what amendments, if any, should be made in adopted by Dr. GREENWOOD it is improbable that more countries; the Motor Car Acts and the regulations under them ; (4) the than 1’ 3 per cent. of the Blackburn school children are injury to the roads alleged to be caused by motor-cars ; and genuinely underfed. These conclusions, though strictly (5) whether any, and if so what, additional charges should applicable only to a limited group of school children, justify be imposed in respect of motor-cars and how any money thus the inference that more or less similar conditions would be received should be applied. The terms of reference appear On the one hand, they refound to obtain among other groups of children situated to be fairly comprehensive. that the of motor traffic is yet in its whole question cognise in comparable circumstances. At any rate, they bear and cannot be put on a cut-and-cried basis at once. infancy out what has been repeatedly stated in the columns of On the other hand, they will allow discussion of the circumTHB LANCET-namely, that malnutrition, which is so stance that not a few motorists have outrageously overstepped frequently ascribed to starvation, is more often than not the bounds of decency and have shown an utter disregard of due to causes which are the relics of injudicious feeding the rights of other users of the road. Great efforts are being during the period of infancy or which are the outcome of made by persons interested in the motor industry to prepare the facts of the situation for presentation to the Commission ignorance and neglect on the part of the parents. in the most favourable form, and it is therefore in accordance While admitting that a certain proportion of children with the fitness of things that the medical profession, to in Blackburn would benefit by increased quantities of whom the whole question of motor propulsion is of great GREENWOOD importance, should have been called upon to give information nutritive varieties of food, more Dr. is of the opinion that " the question of underfed upon certain points in a statistical form issued to them by
in that his inquiries represent an answer to a finite question, they will probably carry greater weight in the solution
c other
Annotations.
,
children in Blackburn at present is not demand direct municipal assistance."
"’
so
acute
as
to
His inquiries further lead him to two interesting conclusions. The first is distinctly foregone, it is that considerable waste occurs in many households from a want of knowledge of the The second is nutritive value of the food employed. it sh9ws that the measures which we because interesting are all prone to consider as proving the thrift of those who employ them may be regarded in some cases as sad examples of waste. Pennies are saved but health is spent. Dr. GREENWOOD considers that a serious tax is frequently incurred by weekly payments to burial and other clubs, payments! which are often quite out of proportion to the wages; earned and to the benefits secured. The chief preventable causes of such cases of underfeeding as do occur are ascribed by Dr. GREENWOOD to alcoholism, laziness, indifference, and bad management on the part of the parents. So-called physical deterioration in school children, as int ,
’
-
the Joint Committee of the Automobile Club and the Motor Union. While the individual returns from the medical profession will be regarded as strictly confidential, the consensus of opinion on the several points cannot fail to be of value in directing the course along which future legislation should travel. The motor industry in this country is becoming very important. Some idea of it can be gauged by the statistics, said to have been compiled from official sources, of M. Georges Prade, in which he calculates that in the first seven months of this year motor-cars and motor cycles of the value of 8,000,000 sterling were produced. This is a sufficient safeguard to insure that no unnecessarily restrictive legislation, tending to strangle the industry, will be introduced. In fact, we may be certain that all that is possible will be done for the motorist commensurate with due respect to the rights of other citizens. In our opinion the dust problem is the hard nut to crack. If the Commission can " laythe dust, sensible and even-handed legislation can to a large extent" lay"" the scorcher, and it will not be necessary to maintain the law by police traps. It is not, as
1044
will hesitate to admit that medical men as class are at least as prone as their neighbours to the bridge mania and the obsession of golf. We may not often catch these complaints in their severest forms, yet some of us may have encountered professional brethren not far removed from the parlous state of the practitioner of whom it was credibly reported that his bridge consciousness had so far got the upper hand over his medical personality that he had come to think and to speak in the phraseology of his favourite game and would convey an unfavourable prognosis by murmuring the mystic word "chicane," or would laud the latest coal-tar product as a remedy with which he had made Grand Slam in a score of diseases. Even, however, when we do not run to these extremes it may still be questioned whether our cult of pastimes of this sort is kept always within the limits which a sane and level view of life would assign to them. Probably there are too many medical men in this country who allow sports to occupy a position of prominence which is detrimental to their proper intellectual interests and which spoils the sports as means of relaxation. We are not advocating a life of endless toil, with no change of interest and no relaxation but are rather pointing out that when a sport or a game is too seriously pursued it ceases to be a relaxation. Theoretically what can be nicer for the hard-worked practitioner than to sit down to his well-earned rubber at the close of a hard day’s work ; but when it appears that the
profession
ventured to
deprecate,
a
and to take
our
amusement that is to soothe his
guise of
an
art that has to be
in the
quivering taught in elaborate text-books, nerves comes
technical phraseology as rich as that of a youthful specialism on its promotion, then we may be allowed to entertain some little doubt as to the sedative value of the with
a
remedy. perhaps venture to suggest that in this matter our professional brethren abroad set a somewhat better example, that they are less prone to confuse the spheres of work and pleasure, and that they are more ready than we are to give up their leisure to intellectual activities that broaden their outlook on life, and may help incidentally their professional efficiency. For modern medicine knows no bounds, and information picked up as pure entertainment, the acquisition of which has been most refreshing, may turn out of practical value at any moment. No one, for instance, who has had occasion to refer to the original literature of any medical, or, indeed, of any scientific subject, and who has turned for help to the continental bibliographer, can We may
have failed to observe how considerable in amount and in quality have been the contributions to knowledge made in France, in Germany, and in Italy by men working in obscure towns
or
in
country districts
remote from the centres of
intellectual movement. The meaning of this is not that the leisure of these observers has been spent in perpetual grinding at their subjects, but that they have taken their pleasure in the pursuit of intellectuality, and in so doing have not necessarily committed themselves to any harder mental task than the text-book of scientific bridge might demand of them. It is difficult to resist the impression that if we fail to give evidence of as high a general level of scientific culture as our continental colleagues, who have assuredly no advantage over us in natural talent or opportunity, the humiliating act may be in part due to the tendency which we have
work,
the
dissipate our energies seriously than our their place in befits than seriously tendency
amusements, if
at all events more
not
to
more
any rational scheme of life.
The
of School
Underfeeding Children.
present time, when public interest is so strongly the question of national physique, it is hardly focussed surprising that the conditions under which school children are fed should engage the attention not only of the educational authorities but also of independent responsible It has, however, been too and philanthropic inquirers. readily assumed from somewhat superficial investigation that underfeeding in the case of the developing child is one of the most important contributory factors in the determination of physical deterioration ; indeed, on this hypothesis enthusiastic reformers may possibly have allowed superficial impressions rather than matured consideration to direct their lines of action. It requires a cursory examination of the children, no more than who, in some rather sweeping form of classification, might come under the category of degenerates and who constitute an appreciable percentage of our urban elemenAT the
on
tary scholars,
to convince the observers of the fact that
and all
from
of malnutrition. The conclusion that this malnutrition is the result of starvation seems but a natural inference. Malnutrition, however, of the kind found in many of them more often proceeds from a combination of hereditary disabilities and acquired constitutional dyscrasias than from the fault of actual lack of food. A very large number of children, who certainly give the impression of being starved, are suffering from a
they
are
one
suffering
some
degree
form of intestinal catarrh which is often the faulty methods of feeding during infancy. These children are usually voraciously hungry but their complaint is of a nature that does not benefit by an increased dietary or a plethora of food. By others than medical men such cases would generally be ascribed to starvation. Although it is impossible to doubt that the majority of the children of the poor are most injudiciously fed, this is very different from the assertion that they are actually starved and it becomes a serious question how far the condition of affairs which often prevails can be improved by the indiscriminate institution of free meals. Recognising, therefore, the great difficulty of discriminatchronic
result of
ing
between what is
tion,
we
heartily
genuine
and what is
welcome the
apparent
painstaking
starva-
efforts of Dr.
ALFRED
GREENWOOD, the medical officer of health of the county borough of Blackburn, to elucidate by systematic investigation the extent to which alleged starvation exists among the children attending at the elementary schools situated in the area under his medical supervision. The result of his inquiries has been embodied in a little brochure of
commend to the notice of all of his interesting figures will be found in our Manchester correspondent’s letter this week. Although the field of Dr. GREENWOOD’S investigations has been confined to a narrow area, nevertheless, some
our
76 pages, which
readers, while
some
we
THE ROYAL COMMISSION ON MOTOR TRAFFIC.
1045
living organisms, represents a more or less responsive a to the circumstances of the environment, but the adaptation i of the social and educational problem presented by ill- more closely these circumstances are investigated the less c nourished board-school children than many more demon- do they appear to depend on the starvation factor. The In his inquiry best 1 results in physical and mental development can clearly strative generalisations on the same subject. into the extent of underfeeding among school children (only be obtained under the best conditions of feeding, in his district Dr. GREENWOOD has employed methods of 1hygiene, and education ; but if starvation plays so uninvestigation which were thorough and free from the iimportant a part as this investigation of Dr. GREENWOOD to creep intowould lead us to suppose, it is merely playing with a vital error which are very liable sources of this of kind. All were 1problem to imagine that the question of physical deterioraprecautions inquiries necessary taken to avoid deception and the range of the inquirytion as it exists among school children can be dealt with was sufficiently wide to arrive at a very fair esti- by the provision of free meals. mate of the truth. The plan of the campaign included a house-to-house inspection of the homes of all the children who were suspected by their teachers to be suffering from the ill-effects of auy form of underfeeding. Out of all the 22,952 children attending at the "Ne quid nimis." public elementary schools within his district the names and addresses of 540 children only were supplied to Dr. GREENTHE ROYAL COMMISSION ON MOTOR TRAFFIC. WOOD as being desirable and suitable cases for inquiry. An IN the Heuse of Commons on June lst last Mr. Balfour analysis of the results obtained enabled him to come said that the existing Motor Act would be reintroduced next to the definite conclusion that underfeeding does not occur session in an amended form, and on August 7th the appointfrom various reasons, such as poverty, illness, and neglect, ment of a Royal Commission was announced to inquire and in more than 313 children within his district and that report as to (1) the working of the Motor Car Acts, 1896 and these children are included in 95 independent families. 1903, and of the regulations under them ; (2) the law and Based, therefore, on the somewhat rigorous standard practice in relation to motor-cars in the principal foreign (3) what amendments, if any, should be made in adopted by Dr. GREENWOOD it is improbable that more countries; the Motor Car Acts and the regulations under them ; (4) the than 1’ 3 per cent. of the Blackburn school children are injury to the roads alleged to be caused by motor-cars ; and genuinely underfed. These conclusions, though strictly (5) whether any, and if so what, additional charges should applicable only to a limited group of school children, justify be imposed in respect of motor-cars and how any money thus the inference that more or less similar conditions would be received should be applied. The terms of reference appear On the one hand, they refound to obtain among other groups of children situated to be fairly comprehensive. that the of motor traffic is yet in its whole question cognise in comparable circumstances. At any rate, they bear and cannot be put on a cut-and-cried basis at once. infancy out what has been repeatedly stated in the columns of On the other hand, they will allow discussion of the circumTHB LANCET-namely, that malnutrition, which is so stance that not a few motorists have outrageously overstepped frequently ascribed to starvation, is more often than not the bounds of decency and have shown an utter disregard of due to causes which are the relics of injudicious feeding the rights of other users of the road. Great efforts are being during the period of infancy or which are the outcome of made by persons interested in the motor industry to prepare the facts of the situation for presentation to the Commission ignorance and neglect on the part of the parents. in the most favourable form, and it is therefore in accordance While admitting that a certain proportion of children with the fitness of things that the medical profession, to in Blackburn would benefit by increased quantities of whom the whole question of motor propulsion is of great GREENWOOD importance, should have been called upon to give information nutritive varieties of food, more Dr. is of the opinion that " the question of underfed upon certain points in a statistical form issued to them by
in that his inquiries represent an answer to a finite question, they will probably carry greater weight in the solution
c other
Annotations.
,
children in Blackburn at present is not demand direct municipal assistance."
"’
so
acute
as
to
His inquiries further lead him to two interesting conclusions. The first is distinctly foregone, it is that considerable waste occurs in many households from a want of knowledge of the The second is nutritive value of the food employed. it sh9ws that the measures which we because interesting are all prone to consider as proving the thrift of those who employ them may be regarded in some cases as sad examples of waste. Pennies are saved but health is spent. Dr. GREENWOOD considers that a serious tax is frequently incurred by weekly payments to burial and other clubs, payments! which are often quite out of proportion to the wages; earned and to the benefits secured. The chief preventable causes of such cases of underfeeding as do occur are ascribed by Dr. GREENWOOD to alcoholism, laziness, indifference, and bad management on the part of the parents. So-called physical deterioration in school children, as int ,
’
-
the Joint Committee of the Automobile Club and the Motor Union. While the individual returns from the medical profession will be regarded as strictly confidential, the consensus of opinion on the several points cannot fail to be of value in directing the course along which future legislation should travel. The motor industry in this country is becoming very important. Some idea of it can be gauged by the statistics, said to have been compiled from official sources, of M. Georges Prade, in which he calculates that in the first seven months of this year motor-cars and motor cycles of the value of 8,000,000 sterling were produced. This is a sufficient safeguard to insure that no unnecessarily restrictive legislation, tending to strangle the industry, will be introduced. In fact, we may be certain that all that is possible will be done for the motorist commensurate with due respect to the rights of other citizens. In our opinion the dust problem is the hard nut to crack. If the Commission can " laythe dust, sensible and even-handed legislation can to a large extent" lay"" the scorcher, and it will not be necessary to maintain the law by police traps. It is not, as