32 MASS. EXPERIMENT STATION BULLETIN 310 



close agreement between the examinations might well be due to actual changes 

 in the condition of the children because of colds, rather than to inaccurate work 

 on the part of the physician. In confirmation of this it was found that, except 

 when color was in question, in almost every case in which the difference between 

 the two examinations was more than one step (for example from G to G — ) it 

 was in the direction which would easily be explained by the cold. In many cases 

 a variation of one step could be explained in the same way. This is illustrated 

 by Chart 5 in which the relationship of the condition of the tonsils as given in the 

 two sets of examinations is depicted by a scatter plot. Crosses (+) indicate 

 that the deviation could be explained by a cold. Scatter plots of other condi- 

 tions observed give similar pictures. More unexplained discrepancies were found 

 for the color of lips, mucous membrane, and skin, which raises the question of 

 the dependability of observations in which changes of color are an index (Chart 6). 



Change in Condition of Children Shown by Medical Examination 



Tables 9 and 10 give the results of the medical examinations analyzed on the 

 basis of percentages of children showing changes during the experimental period. 



In Table 9 the results of the analysis for each point observed by the physician 

 are compared. The experimental group as a whole was in better condition in 

 June than they had been in September, but the control group was not. In the 

 fed group 63 per cent had improved and only 14 per cent were in poorer condition 

 at the end of the year; while but 33 per cent of the controls improved and 31 

 per cent were in poorer condition at the end of the same period. Improvement 

 in posture, color of the mucous lining of the mouth, tonsils, and glands was also 

 shown in a larger proportion of fed than control children. The difference was 

 less marked in case of expression, hair, color of lips, lungs, heart, abdomen, skin, 

 and muscle tone. For skin color, the eyes and ears as indicated by injection or 

 inflammation of the conjunctiva and drums, amount of subcutaneous tissue, 

 condition of the nervous system, and muscular coordination, the differences 

 indicated, if any, are too small to be significant. In only one instance, bodily 

 repose, are possible ill effects from the lunch suggested, and the differences between 

 the control and experimental groups are too small to seem really significant. 



Because of the effect of colds found when the duplicate examinations were 

 compared with those made on the same children a few days previously, all exam- 

 inations were discarded if made when the child had a cold or an acute infection 

 of any nature, or if there was anything in the child's history which might explain 

 conditions found or changes occurring since the preceding examination. This 

 included recent colds and other acute illnesses as measles or whooping cough from 

 which recovery was seemingly not complete; severe chronic infections which might 

 have caused a loss in spite of the extra feeding; and the removal of tonsils during 

 the year or in the previous summer, as the tonsillectomy might explain any im- 

 provement during the year. A few records were discarded because the father 

 lost his job and the family was thrown into such straitened circumstances that 

 the children received less and insufficient food at home. 



After discarding all examinations in which causes other than the lunch were 

 indicated for the changes observed, this analysis was repeated for those observa- 

 tions in which a significant correlation with nutritional condition had been found. 

 The results are also given in Table 9. As before, the proportion who.se general 

 condition, posture, color of mucous membrane, tonsils, glands, and skin color 

 improved was greater for the fed than for the control children. There was, 

 however, no significant difference shown between the condition of the lungs 



