MID-MORNING LUNCH IN RURAL SCHOOLS 15 



Medical Examination 



The medical examination alone, without taking weight or amount of sub- 

 cutaneous tissue into consideration, very apparently also gave an inaccurate 

 estimation in numbers of cases, especially of children who were in good general 

 condition but were thin. As Franzen found in his study, there was a tendency 

 for the physician to disregard the lack of subcutaneous tissue in evaluating the 

 condition of such children. For example. Boy 345 who was in excellent general 

 condition was rated as e.xcellent nutritionally even though he was so thin that he 

 appeared to have not one ounce of subcutaneous fat, and though the rating of 

 23.5 or 19.0 per cent underweight which was indicated by the Baldwin-Wood 

 and the Lucas-Pryor standards seemed to fit the picture he presented. This of 

 course was an exceptional case, but other less striking examples might be cited. 

 On the whole, however, the medical records appeared to give a more reasonable 

 picture than the other standards which it was possible to use with the data 

 available, e\en though the former were less objective. 



Courtis (3) in a recent discussion of "The Prediction of Growth" has said, 

 "Agreement of experience with prediction is the supreme test of scientific truth: 

 That is 'true' which works." Each of the standards available so obviously did 

 not work in so many instances that their dependability as a measure of the 

 nutritional status of the children seemed questionable. 



Method of Evaluation Used 



In the absence of any reliable standard which would give an objective evalua- 

 tion of the general condition of the individual .child, at the end of the study 

 in each school the senior observer (B. W.) and the assistant who had worked in 

 that school pooled all data which had been collected for each subject and weighed 

 them as carefully as possible. The information used included all the medical 

 records, the evaluation of the child's nutritional condition as made by both the 

 nutritionist and the doctor at the end of each medical examination, the dental 

 records, the child's past history, his absences during the school year, his rate of 

 growth in height and weight together with his deviation from both the Baldwin- 

 Wood and the Lucas-Pryor standards, and a knowledge of the child gained by 

 having worked with him and watched him day after day throughout the school 

 year. From this careful consideration of all information available the general 

 nutritional condition of the child at the time of each medical examination was 

 rated as E, E-, G+, G, G-, F + , F, F-, P-f, P, P-, VP+ and VP. In 

 many of the aNnalyses, these ratings have been used simply as excellent, good, 

 fair, poor, and very poor. Two ratings were made in each case, the first an 

 evaluation of the child's condition irrespective of his weight and based largely 

 on the medical records. Reference has already been made to this in discussing 

 the medical examination as an index of nutritional status. The second was an 

 attempt to evaluate the general nutritional status of the subject using all data 

 available and considering both the quantitative and qualitative aspects of the 

 situation. 



Such an evaluation was difificult in any case and was very difficult in many 

 instances, especially when the children (as B 345 referred to above) were in good 

 or excellent condition as indicated by the medical records but were nevertheless 

 underweight; or when they had sufficient subcutaneous tissue but their general 

 condition otherwise was only fair or even poor. Just how much importance 



