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POVERTY, NUTRITION, AND GROWTH.CURRENT opinions on social problems are mostly

based on small series of observations by individuals.Nowadays, however, evidence is being collected ona larger scale. Groups of investigators dealingstatistically with great masses of material can formconclusions comparatively free from personal bias, andit is interesting to see how far research scientificallyconducted really bears out the generalisations usuallyregarded as truths. The first results of one suchundertaking are now being published.l After six

vears of work the Scottish Committee for Child Life

Investigation, under the chairmanship of Prof. NOËLPATON, has produced a report so elaborate as to

justify its exceptionally interesting conclusions. The

investigation is described as " the first extensive

attempt to estimate the influence of various environ-mental conditions on the growth and nutrition of theslum child." It was carried out, under the generaldirection of Prof. PATON and Prof. LEONARD FINDLAY,by a number of doctors, statisticians, and healthvisitors, and the data were collected in the poorerquarters of Edinburgh, Glasgow, and Dundee by meansof house-to-house visits and with the help of childwelfare centres. In each of the towns over 93 percent. of the families investigated lived in one- or two-roomed houses, but care was taken that those selectedshould be as far as possible a random sample of theslum population. For purposes of comparison investi- Igations were also made into the condition of thechildren of miners and agricultural labourers invarious parts of Scotland. The whole formed partof a scheme for the study of child life which wasinitiated by the Medical Research Council, but

unfortunately no similar work was carried out in

England at the same time. The report is valuablenot only for its lucid description of this work donein Scotland since 1919, but also because it summarisescarefully the conclusions of previous investigators.Unfounded assumptions are absent, and this mayexplain why the evidence gives little support to

numerous prevalent ideas. ,-

,

Many observers had previously shown that in greatcities the children of the poor are lighter and smallerthan those of the wealthy, and that they also compareunfavourably with those of their own social class whoare reared in the country. About 80 per cent. ofour national population are now town dwellers.Emigration from the country has almost come to astandstill; the towns are breeding more and moretheir own populations, and there is some indication,says the report, that the small size of town childrenis in part at least an inborn characteristic. A stuntedpopulation might conceivably be a result of the survivalof those best fitted for town life. Unfortunately nofigures are available to show the relative weights andheights of town and country children at birth,either in Scotland or elsewhere, but the present inquirysuggests that there is some delay in the rate at whichthe town child grows between birth and the age of18 months. During this time there seems to be alag in development, though afterwards growth goeson as rapidly in the town as in the country child ;but the Scottish Committee has been unable tocorrelate the slowing of growth with any particularenvironmental factor chiefly operative before themiddle of the second year of life. The suggestion thattown infants show this retardation because they donot get enough milk does not explain the facts, forthe amount of milk consumed by the families of rural

1 Poverty, Nutrition, and Growth : Studies of Child Life inCities and Rural Districts of Scotland. Medical ResearchCouncil. H.M. Stationery Office. 1926. Pp. 333. 10s.

miners-who show no such retardation-is even

smaller. " Perhaps the most prevalent belief," saysthe Committee, " is that the small size of the townchild is due to a defective supply of suitable food, ,

but the satisfactory rate of growth after 18 monthsdoes not support this view." In a certain number ofcases in which it was possible to correlate the energyvalue of the food with the weight of the children, it wasfound that if the diet fell much below the equivalentof 2600 calories per man per day the nutrition of thechildren did in fact begin to suffer. On the otherhand, in Glasgow a family diet yielding only 2500to 2700 calories per man per day is the average inthe slum districts, and on this allowance, it is noted,the children grow just as fast as the country childrenwho get more than 3000 calories. It is also rather

surprising to find that after the ninth month infantswhich have been fed at the breast show no superiorityover those which have been weaned early ; but beforethis time the breast-fed infants are stronger, andthere is the possibility of a selective mortality to beborne in mind. Careful investigation supported thefinding of Prof. KARL PEARSON that there is little orno connexion between the health of the mother duringpregnancy and the nutrition of the child during thefirst year of its life. The physique of the child isaffected to a small extent by variations in the generalhealth of the mother, but that is because sicklymothers cannot care for their children properly.And here we reach one of the most positive conclusionsof the report. Maternal efficiency was found to havea more definite effect on the nutrition of the childrenthan any other single factor studied. The chief wayin which overcrowded homes and small air spacehinder the development of children is by influencingthe moral and the activities of their mothers. Onthe other hand, it may be feebleness of character thatkeeps the parents in a bad environment. Amongstagricultural labourers and rural miners, whose housesare not so overcrowded, the proportion of inefficientmothers was very small, and it appeared that thefew women whose work was unsatisfactory were thosewhose husbands were badly paid and who had over-crowded homes. In Scotland the families of the ruralcoal-miner are brought up under environmentalconditions far better than those of the slums. Theyspend more time in the open air, they are better fed,and nearly all of them are* reasonably well lookedafter in their homes.

Poverty brings to bear on the child many forcesnot easily resolved into their components. Of thoseso far considered-overcrowding, underfeeding, andmaternal inefficiency-only the last was shown bythe investigators to be definitely correlated with thechildren’s physical condition. They expected to findthat nutrition would vary as the family income, butno such direct relation was found. The contentionthat a mere increase of wages would, per se, leadto better growth of the children is therefore not

supported, and this is one of several conclusions ofpolitical as well as medical interest. Prof. PATONand Prof. FINDLAY set out to gain definite know-

ledge which would indicate the proper approach tosocial problems as they affect children. Are the largesums spent on child welfare and other schemes directedinto the best possible channels ’? They report :

" The provision of improved housing accommodation bypermitting a larger proportion of mothers to care more

efficiently for their children and homes might prove to be abeneficial measure. What is not demonstrated is thatsimple increase of income would be followed by improvementin the condition of the children. Bad parents, irrespectiveof their incomes, tend to select bad houses as the money isoften spent on other things. The saying that ’ what is the

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matter with the poor is poverty’ is not substantiated bythese investigations, which show that the problem of aslum population is far more complex than such a statementwould indicate."Current teaching, they suggest, gives too much,rather than too little, weight to the environmentalfactors which, theoretically at least, it might be

possible to remedy by economic adjustment ; in

spite of conditions around him the slum child tendsto develop on the lines of his parents. Both for its

interesting conclusions and as a record of well-e6n-ceived investigation the report deserves wide circula-tion. It is a work of art, because it depicts elusive eand complicated phenomena in words and figures,and to read it is an education in scientific method.

THE B.M.A. MEETING AT NOTTINGHAM.NOTTINGHAM was something of a surprise to the

many hundreds of medical men and women gatheredthere last week at the ninety-fourth annual meetingof the British Medical Association. Although a veryimportant industrial (entre, and happily in mostdirections a prosperous one, the stigmata of industrial-isation are scarcely to be observed in a city of

cleanly aspect with pleasant undulations and largeopen spaces, and the casual visitor may remainunaware that there are several coal-mines within the

municipal boundary and at least one hundred hosieryfactories within the county, apart from the mass

production of fine chemicals, tobacco, and cycles.Most of the meetings of the Association took placein the University College which, through the generosityof Nottingham’s industrial magnates, is shortly to beremoved to a new and admirable site where, it is

hoped, a great North Midland University may sooncome into being. Happily, the hospital buildings bysuccessive enlargement have kept in touch with theincreasing population and with the growing demandsof scientific medicine, a new out-patient departmentwith a magnificent central waiting-room is approachingcompletion, and when the time comes these buildingsare fit to take their place on the clinical side of themedical school which need hardly wait long to appearafter the grant of a charter to the University. The sectional meetings covered a wide range of

Isubjects, many of them of immediate practical interestto the general practitioner of medicine, and the Dukeof PORTLAND was no doubt right in describing themeeting as a magnificent opportunity offered to

general practitioners to learn the latest advances inmedicine and to hand them on in turn to their patients.Several sections took on an international character intheir discussions, notably the Section of Anaesthetics,which utilised the opportunity of a visit to Europeof a number of transatlantic anaesthetists, a jointmeeting with the Section of Surgery being arrangedto discuss the principles of anaesthesia in abdominalsurgery as they have not previously been discussedin this country. While we have many excellentmethods of anaesthesia, most of them fairly easy ofapplication, and while the art of anæsthetisation isrising to the status of a science, it has still to beremembered that relaxation and quiet breathing, soessential to the abdominal surgeon, are not the onlythings to be kept in mind, for the patient is somethingmore than an abdomen, and has a brain, a heart,kidneys, and a liver, which may be impaired by theanaesthetic employed. Several American and con-

tinental delegates set out the practice of the newergaseous combinations whose attractive novelty is nottheir only justification for employment as analgesicagents. In the Section of Medicine, one session ofwhich we are able to report this week, a discussion

on blood transfusion in the treatment of disease tookon a wider scope from the presence of Prof. R. CRUCHET,of Bordeaux, and Prof. E. A. GRAHAM, of Toronto,while Prof. CARTER WOOD, of Colombia, communicatedhis experimental results with lead in the treatmentof malignant neoplasia to a later session of the samesection.On the administrative side this year’s Representative-

Body had no burning question to discuss. Dr.

BRACKENBURY, as chairman of the Body, was able-to report, with perhaps a twinge of regret from apractised controversialist, a year of smooth passagein the affairs of the Association. Only the Memo-randum of evidence submitted to the Royal Commissionon Local Government came in for some hostile criticismand was referred back to the Council for further-consideration before action. All were agreed as tothe principle of separating health services from other-administrative services and then combining them,first centrally and then locally, under one form of-

administration, and agreed also on the impracticabilityof the ideal parcelling out of the country into freshareas, each with a large town as centre ; but theMedico-Political Committee of the Association, throughits Chairman, voiced its disfavour of the proposal togive to county councils control of all health matterswithin the county even should it contain such a

large borough as Willesden with its 200,000 inhabitants.and its successful autonomous authority of longexperience. There was some feeling in the Bodythat the proposals in the Memorandum might smooth-the way for a State Medical Service, in spite of Dr.BRACKENBURY’S categoric assurance that the extendedemployment of local practitioners in auxiliary services.and clinics should act as a bulwark against a Stateservice. In his admirable presidential address,which we published last week, Mr. HOGARTH cham-pioned the principle of voluntaryism, so triumphantly-maintained in hospital practice, and stated the oneurgent need of the Insurance Service to be the linking-up of the insurance practitioner with the consultantphysician and the consultant surgeon in order to

give the insured patient the benefit of specialised as-well as general medical knowledge. He also fore-casted the rapid extension of the system of payingwards in hospitals. The key-note of his address.was the consistent aim to raise the general standardof health among all ages of the community and-

especially among the adult workers. This aspect ofhealth work was reflected in the remarkably interest-ing sessions of the Section of Medical Sociology whichwe also briefly report in this issue. The discussion-was piquant for the frank line taken by speakers, bothlay and medical, in denying the existence of harmful-monotony in the life of factory operatives under-

proper conditions. One prominent welfare worker,indeed, challenged the right of those who chose sucha sport as angling for their recreation to brand as.monotonous any repetitive occupation. If only the-work is done under healthy conditions, and theworker has the opportunity of honest pride in thefinished product, medicine can say little, it was.

urged, against routine occupation which leaves the-worker free to develop his powers of body and mindin his leisure time. Most of the world’s work is-routine work, said Mr. HOGARTH in his address, andthe conditions of factory life as observed in Nottinghamduring the visit of the British Medical Associationno doubt gave many of its members the opportunity ofreconsidering some of the almost prejudged questions-of industrial fatigue. The meeting of the Association,although not outstanding in any one direction, was-felt to be a thoroughly useful and instructive one.