MID-MORNING LUNCH IN RURAL SCHOOLS 25 



Results of the Feeding as Indicated by the Medical Examinations 



Evaluation of Records 



The evaluation of the records from the medical examinations presented as 

 many problems and proved as difficult as the estimation of the nutritional status 

 of the children. The reports of other investigators offered little by way of help. 

 Some have attempted to analyze data from medical examinations by tabulating 

 the number of defects found per child, others by determining the relative fre- 

 quency with which such defects as poor posture, carious teeth, or infected tonsils 

 appeared in the different groups observed. Such analyses did not seem adequate 

 for our purpose, for no improvement would be indicated by these methods unless 

 a given defect was completely corrected, and no possible injury except as a new 

 defect appeared. To illustrate: posture might improve from fatigued to round- 

 shouldered, but round shoulders would still be classed as a defect. To assume 

 that a mid-morning feeding would be a panacea for the correction of the ills of 

 malnutrition and undernutrition seems presumptuous. A more reasonable 

 expectation i^ that these ills would be either aggravated or improved and occa- 

 sionally corrected by a supplementary lunch. Our problem was to devise some 

 way of estimating changes in degree of the defects found as well as noting their 

 incidence and disappearance. 



One possible method of reaching this objective in part was to ascertain the 

 relative number of children in each group in whom some change for better or for 

 worse occurred in each of the points described in the medical records, as had been 

 done for general nutritional condition; that is, to observe in how many instances 

 the child's posture, or his color, or his tonsils improved or not. Such an analysis 

 has been made and will be discussed later, although it does not give a picture of 

 the changes in the child's physical condition as a whole. 



An attempt was made to compile a score card for the evaluation of the medical 

 records which would give such a comprehensive picture. This did not prove 

 feasible, for there were not sufficient data available to indicate how much weight 

 should be given posture, color, tonsils, lungs, subcutaneous tissue, et cetera, in 

 making a complete score card. Whether the conditions found in some of the 

 points observed, as injected conjunctivae, congested lungs, protuberant abdomen, 

 or muscle coordination, are at all influenced by the nutrition of the child or are 

 entirely dependent on other causes, were found to be debatable questions with 

 no data adequate for answering them. A number of experienced pediatricians 

 who were particularly interested in child health from a positive standpoint were 

 approached, but their opinions of the relative importance of various observa- 

 tions in a picture of the whole child were so divergent as to be of no assistance. 

 One man, for example, considered the condition of the lungs in itself to be no 

 indication of the child's nutritional condition; another considered it one of the 

 criteria of minor importance; while a third rated it second to no other and would 

 consider a child with a severe congestion of the lungs, particularly if there were 

 any symptoms suggestive of tuberculosis, to be in poor nutritional condition 

 irrespective of his condition in other respects. All of which is no criticism of 

 pediatricians but simply indicates that our knowledge of what makes up good or 

 poor nutrition and of the extent to which various factors contribute to the whole 

 picture is in a stage which may be quite accurately described as a muddle. 



In such a quandary the entirely subjective method which has already been 

 briefly described in the discussion of the estimation of the general nutritional 

 condition of the children was resorted to in evaluating the data given in the 



