MID-MORNING LUNCH IN RURAL SCHOOLS 13 



of the mechanics of the study may well be closed by saying that there would 

 have been many squeaking cogs but for the fine spirit with which the whole school 

 and community entered into the project. Much of the success in carrying through 

 the study is due to the cooperation of the teachers in adjusting their programs to 

 the periodic disruptions of their rooms caused by the various examinations and 

 tests and in keeping of records of absences and of colds. 



EVALUATION OF THE NUTRITIONAL STATUS OF THE CHILDREN 



The Problem 



The problem of evaluating the nutritional condition of the children was not 

 the least of the difficulties encountered in the analysis of the data collected in 

 this investigation. The first question to be raised was, What does the phrase, 

 nutritional condition or status, mean? Is it simply a question of the quantity 

 of reserve energy as indicated by the amount of fat padding, whether adequate, 

 insufificient, or excessive? Such a view does not seem reasonable since food 

 supplies not only energy but materials for the building of body tissues and the 

 regulation of body processes. In other words, there is a qualitative as well as a 

 quantitative aspect to the problem, and the nutritional condition of an individual 

 involves the general condition and functioning of his tissues and of his body 

 fluids as well as the amount of fat covering his body. Seham (19) put the matter 

 rather pertinently, though in a negative way, in describing malnutrition in child- 

 hood. This condition, he said, is a "a state, a process which manifests itself 

 not onlv in underweight but in many associated functional disorders. * * * It 

 is not enough to measure the height and weight of the child. Nor is it enough 

 to know about the physical changes that have taken place in the individual." 



Weight- Height- A ge-Scales 



It is now 'quite generally accepted that neither weight-height nor weight- 

 height-age tables alone are dependable criteria of the nutritional status of children. 

 This, of course, is only common sense if "nutritional condition" is interpreted 

 in its broader meaning. It was apparent, therefore, that the percentage devia- 

 tion of the child's weight from either Emerson's (6) weight-height scale or the 

 Baldwin-Wood (1) weight-height-age scale could not be used as an index 

 of the nutritional status of our subjects. True, in a large number of cases either 

 standard would probably have given an accurate evaluation, but in many it was 

 obviously incorrect. 



For example, the weight of Girl 189 deviated from the average weight for her 

 height and age by but —2.3 or —0.2 per cent, respectively, according to these 

 scales. Even the most casual inspection of the child, however, indicated that 

 she was not in good condition. Though she was fairly well-padded, the sub- 

 cutaneous tissue was soft and flabby; her color was pale and pasty with huge 

 circles under her eyes; she was listless and apathetic; and her posture was some- 

 what stooped and fatigued. On the other hand Girl 186 was a tall, rather slenderly 

 built child with all the clinical signs of being in good or even excellent condition. 

 While not plump she had sufficient fat padding so that her ribs were not evident 

 and certainly she would not have been called lean nor "malnourished," as a 

 deviation of 9 and 8 per cent below these standards would indicate. Not a 

 few, particularly boys, might be cited who were rated as seriously underweight 

 by either the Emerson or the Baldwin-Wood scale but who did not appear thin 

 and underweight as they stood stripped and who were in good physical condition 



