A Social Study along Health lines 
OF THE 
First Thousand Children. 
EXAMINED IN THE 
HEALTH CLINIC 
V OF THE 
CANADIAN PATRIOTIC FUND 
MONTREAL BRANCH 
BY i 
I 
Helen R. Y. Reid, B.A. 
i 9 20 Registered according to the Laws of the Dominion of Canada, 
by Miss Helen R. Y. Reid, B.A., at the 
Department of Agriculture. CONTENTS 
PART I. Object-Scope-Procedure page 5 
PART II. Classification of Defects " 13 
PART III. Malnutrition Group " 22 
PART IV. Social Background " 33 ACKNOWLEDGMENTS 
I have felt that the full benefit of the work done at our 
Health Clinic cannot be secured until our figures have been 
given to the public. The records of such a complete physical 
examination of Montreal children have never before been 
published. While they deal only with soldiers' families, they 
would probably apply to the majority of the scholars in the 
public schools. If more serious attempts at securing complete 
data of our school children should be one of the results of this 
study it will be a very satisfactory sequel to our efforts. 
Acknowledgement is due the Children's Bureau, Washing- 
ton, for the use of the charts on pages 35 and 39. To this 
Bureau and to many other American organizations we are also 
indebted for Child Welfare literature which we have distrib- 
uted among our families. 
It is a pleasure to acknowledge here and now the fine 
work and cooperation of the Clinic Staff in our Health Service 
for Soldiers' Children! Dr. W. A. L. Styles, as Clinic Doctor, 
Miss Bessie Scott, R.N. as Nurse in Charge, and Mrs. N. Rigg, 
as Assistant Nurse, have not only given their time and interest 
as regular officials of the Clinic, but have contributed their 
enthusiasm and sympathetic understanding throughout the 
first year of experiment in this new Division of the Fund 
work. 
To Dr. Styles and Dr. A. B. Chandler I am indebted for 
the review of this paper before it was sent to the printer, and to 
Miss Scott, Mrs. Rigg, Mrs. Goold and Miss Robinson acknow- 
ledgement is gladly made for most of the statistical work 
included in the study. 
The City Hospitals and their Social Service Departments 
have given the Fund most gratifying cooperation. The Victorian 
Order of Nurses, the University Settlement Baby Health 
Centre and the Provincial Red Cross have also been of definite, 
practical and helpful assistance. 
Social Service students from McGill University and visit- 
ors from out of town, as well as from other city organizations, 
have expressed their approval of the work in no doubtful 
terms, which encouragement has been duly appreciated by the 
Staff and by 
HELEN R. Y. REID, Director. PART I 
"If we could grapple with the 
whole child situation for one gene- 
ration, our public health, our eco- 
nomic efficiency, the moral character, 
sanity, and stability of our people 
would advance three generations in 
one."-Herbert Hoover. 
OBJECT - SCOPE - PROCEDURE 
The Patriotic Fund Health Clinic was started November 
4th., 1919. Up to October 30th, 1920, 1260 children and babies 
belonging to ex-soldiers have been given complete physical 
examination in Clinic, and have been referred when necessary, 
for treatment, operation or special examination to the City 
Hospitals and Baby Health Centres. 
The Need for Health Clinics for children is obvious to all 
social workers, Public Health nurses and doctors working 
among the poor of great cities and in rural districts. The 
note of Prevention was struck with ever increasing emphasis 
when the revelations of the war disclosed the numbers of 
recruits rejected as unfit for service on account of defects 
which might have been remedied in youth. Records also of 
infantile mortality showed, in a startling way, the depletion 
of the ranks of our future citizens, which, added to data given 
as to the approximate number unborn as a result of the war, 
raised a challenge which could not be ignored. Causes, such as 
poverty, ignorance and neglect, were shown to be in a large 
measure preventable. The economic loss to all nations demon- 
strated to "our legislators and councillors" the need for official 
as well as voluntary cooperation in waging the more profit- 
able war against disease and for the cause of Health, national 
and international, on which is based the success, prosperity 
and happiness of the people. As a result-and compensating 
in some degree for the tragic folly of the war with its slaughter 
of the youth of the world - life-saving and health-saving 
measures have been inaugurated with zeal and enthusiasm 
on the part of both health officers and voluntary organiza- 
tions. These have come perhaps more slowly in most parts 
of Canada than in England and the United States, but our 
program of peace time reconstruction cannot develop to a 
successful issue unless the Health of the nation is assessed at 6 
its true value, and unless, as a result of this assessment, the 
necessary measures are taken to build up the coming genera- 
tion by systematic, thorough and correlated measures for the 
removal of present defects, the prevention of possible disease 
and the formation of sound health habits in the babies and 
children of today-our citizens of tomorrow. 
The Object of the Patriotic Fund Health Clinic was a 
double one. First, to furnish an opportunity for the esta- 
blishment of good health for the children of our soldiers, as a 
practical and helpful recognition of their service for us during 
the war; secondly, to demonstrate to the community and the 
public at large the value of such work. Although only one 
year has gone by since the inauguration of the clinic, we feel 
that we are in a fair way to realize both objects. Soldiers 
and their wives already report to us the improvement noted 
in their children, both at home and in school, after operations 
and treatment and the establishment of some new health habits. 
These parents tell others, and already we have more requests 
for appointments than we can fill. Education in Health is, 
like education in everything else, a slow process. Persistent 
interest and work together with unflagging zeal and patience 
bring, however, a sure and rich reward. The second object, 
namely the educational demonstration to the public, has al- 
ready borne fruit, as seen by the fact that two more branches 
of the Patriotic Fund, one in Sherbrooke, P.Q. and one in 
Hamilton, Ontario, have opened Health Clinics for Soldiers' 
children after visiting and studying the Montreal one. In addi- 
tion to this, The Charity Organization Society of Montreal, 
accepted the offer of the use of our room, record forms and 
equipment and had about one hundred children belonging to 
their Mother's Aid Branch thoroughly examined. It is hoped 
that Children's Institutions, Hospitals, the Red Cross and other 
community organizations will soon establish similar clinics 
while waiting patiently for our legislators to recognize the 
fact that "these things shall be!" 
The Patriotic Fund Health Clinic was fortunate at its 
inception in being given a good start through the kindness of 
the Victorian Order of Nurses and the University Settlement 
Baby Health Centre, both of whom provided temporary nurses, 
and through the gift of a small sum of money from the Provin- 
cial Red Cross to go towards equipment expenses. We are hap- 
py to report that the cooperative spirit shown at that time 
continues to exist. 
At the outset of the venture, letters were sent out to 
soldiers' families notifying them of the opening and of the 
object of the clinic, and asking them to make appointments 
for their children. Printed notices were also very kindly dis- 7 
tributed through the local Pension Board and Soldiers' Civil 
Re-Establishment offices. Appointments were also made daily 
in the Application Room of the Patriotic Fund. Our source 
of supply never fails, though appointments are not always kept 
with the regularity one could wish. Clinic is held at 2 o'clock 
on two afternoons weekly. Appointments by the hour are 
made for from twenty to twenty-five children in the expectation 
that fifteen to twenty will turn up. We examine from one 
hundred to one hundred and twenty-five children each month. 
The Health Clinic for our soldiers' children has no Age 
limit. We welcome babies a few weeks old and grown girls 
and boys up to 18 and 19 years of age. The sole restriction 
governing the work is that those attending must be children, 
or brothers and sisters, of some soldier or ex-soldier. In our 
studies, however, we have kept our Babies' group separate. 
The ages covered in our 1000 children group vary from 2 years 
to 19 years. The average age was 7 and the median 6. 
The Record Form in use was compiled to suit our needs 
from that used by Dr. Wm. R. P. Emerson, Boston, and that 
in use in New York in the Society for Improving the Condition 
of the Poor (see pages 8-9). It will undergo some slight im- 
provements when there is occasion to have a new supply print- 
ed. The two record forms used for our babies under one or 
two years are obtained from the local Affiliated Baby Wel- 
fare Stations (English). As will be seen by referring to 
the form for children, the first column includes Family 
history, the individual child's medical history and certain 
social data bearing on the Health of the child. This in- 
formation is obtained by a worker in the waiting room 
before the mother and child see the doctor. This saves 
the time of the latter and furnishes him with important 
information which is essential for a proper diagnosis and for 
subsequent counsel and instructions to be given. Supplementary 
information (see column 3) is also obtained on the diet of the 
child for each meal, hours at which meals are taken 
and the habits of the child in connection with eating. The 
worker obtaining this information instructs the mother in food 
values, and relative costs, and in food habits, which instruction 
is later followed up in clinic, in class and in the homes. While 
waiting for examination-and the waits are often long ones- 
the children are provided with books, toys and milk for their 
entertainment and comfort. 
The Child in Clinic is partly undressed, boots and outer 
garments all being removed, and is then weighed and mea- 
sured. Each child receives an individual blue printed card from 
the nurse in charge, which gives the actual height and weight 
and what the child should weigh.* On the back of the card, in 
* Measurement Table based on work of Holt, Boas, Burks, Bowditch and Swedley. 8 
HOSPITAL REFERENCE 
For greater cooperation between the PATRIOTIC FUND and 
MONTREAL HOSPITALS 
CASE No. 7290 DATE Oct. 15, 1920 
NAME OF PATIENT Jeanne R AGE 3 years 
ADDRESS 297c P Street 
IF FORMER PATIENT, HOSPITAL CARD No. 
ABLE TO PAY-£N PART IN FULL NO 
NOT AT ALL Refer to C.P.F. 
REMARKS Submerged tonsils 
Enuresis 
Myocarditis 
SENT TO Royal Victoria Hospital 
PATRIOTIC FUND PER B. B. Scott 
HOSPITAL DIAGNOSIS AND RECOMMENDATIONS 
(Confidential) Hypertrophied tonsils and post nasal growth. Tonsil- 
lectomy performed Nov. 23/20. Examined in Children's Clinic Nov. 19 20. 
Nutrition fair. Lungs negative. Myocarditis. 
RETURNED TO FUND BY S. S. Dept., R. V. H. 
DATE Nov. 29, 1920 PATRIOTIC FUND HEALTH CLINIC 
GENITALS: normal A / discharge undescended testicle 
Prepuce: long circumcised 
SKIN: Smooth A / rough clear A / pigmentation eruption Scars 
VACCINATION: last performed 1919 type of scar 
MENTALITY: Normal A / abnormal 
SPINE: Normal Lateral curvature: right A / left 
Round shoulders A / Winged scapulae A / 
CHEST: Normal barrel flat A / funnel pigeon 
Harrison's groove 
STATION: Good poor A / ARCHES: Normal A/ flat 
WEIGHT: (stripped) 81 lbs. Height 5 ft 1% inches. 
DIAGNOSIS:-Malnutrition 19% 
Conjunctivitis, Otitis media, subacute, Rhino-pharyngitis, Carious teeth, Alveolar abscess, 
Enlarged tonsil, Adenitis, Cerumen, Postural defects: Coffee addict. 
PHYSICAL EXAMINATION 
DATE OF BIRTH: Nov. 9, 1905 
Examiner Dr. Styles Dat® June 4 1920 
INSPECTION: Bright A / ; dull nervous apathetic 
temper phlegmatic 
DEVELOPMENT: Good ; fair ; poor A/ MUSCLES: firm flabby A/ 
NUTRITION: Good ; fair ; poor A/ 
HEAD: Normal A / ; abnormal ; measurement 21% inches. Pediculosis 
EYES: Pupils equal A/ Motion: nor. A/ abnor. 
Blepharitis Conjunctivitis A/ 
VISION TEST: right 20/20 left 20/20 
NARES: clear crusted discharge A/ 
MOUTH: Normal A/ open Herpes Cough Mucous Memb. pale 
cyanotic normal A/ Uvula: normal abnormal 
TONGUE: Normal moist A / dry white coat A/ 
brownish fissured A / ulcerated tied 
TONSILS: Normal Rt. large A/ buried cryptic inflamed absent 
THROAT: Normal congested A/ granular A/ mucous A / 
GLANDS: Normal enlarged A/ epitrochlear ant. cervical A/ post cervical 
TEETH: No. good 25 No. decayed 3 Approximation good poor A / 
poor stained Alveolar abscess A/ 
EARS: Right drum, normal perforated A/ abnormal cerumen A/ 
Left drum, normal perforated abnormal cerumen A / 
Hearing: normal tinnitus vertigo 
HEART: Apex at 4th 5(h A/ 6th space in nipple line, 
inch outside nipple line 1 inch inside nipple line A/ 
Action: regular A/ irregular Rate 
Thrill: present absent A/ 
MURMURS: absent A/ 
Child's Name Urban S. 
Age: 14 yrs 6 mos. 
Address 
St., Verdun. 
FAMILY HISTORY 
NAMES 
Relationship 
to Child 
A ire 
Health 
Dead 
Julius 
Father 
55 
Poor 
Eva 
Mother 
40 
*• _ 
Hilda 
Sister 
7 
1900 
Diphtheria 
Mayland 
Brother 
22 
1918 
Killed in action 
Oscar 
18 
1918 
" " " 
Iris 
Adop. Sister 
7 
INFORMATION REGARDING BIRTH AND INFANCY 
Born at full-term ? A / 
Months Breast-fed? 12 
1st Tooth at 6 mos 
Labor? 
j Normal? A / 
I Abnormal? 
RECOMMENDATIONS :- 
Dental Clinic 
Nose and Throat Clinic 
Postuie Clinic 
Hospital slips for all 
Clinics given to Mont- 
real General Hospital. 
Artificial Feed? 
PREVIOUS DISEASES (with dates) 
Walked at 12 mos 
Spoke at 18 mos 
Measles 1911 
Mumps 1911 
Scarlet-f eve r 1919 
Diphtheria 1917 
Whooping-cough 1912 
Chicken-pox 1912 
Rheumatism 
Meningitis 
Pneumonia 
Bronchitis 
Tonsilitis 1919 
Convulsions 
Chorea 
Otorrhoea 
Operations 
Naevus over right eye. 
History of headaches and Migraine. 
Has always been sickly and backward in school. In third grade, only. 
DIET: Breakfast: Porridge, bread and butter, coffee. 
Dinner: Average meal, Bread and jam, butter or marmalade, water or cocoa to 
drink. 
Supper: meat and vegetables. Nothing for dessert. Never takes milk or eggs. 
Seldom cheese or any dessert. 
SUPPLEMENTARY INFORMATION 
GENERAL HEALTH AND HABITS 
Appetite Good 
Tea No 
Coffee Yes 
Constipation No 
Frequent colds Yes 
Condition of Home, etc. fair 
GENERAL HEALTH: good 
DAILY BRUSHING OF TEETH: Yes 
Bed-wetting No 
Sleeping hou:s 10 p.m. to 7.30 a.m. 
No. in room 2 
No. in bed 2 
No. of rooms 6 
Rent $14.50 
fair 
soft sys. 
loud sys. at 
diastolic 
apex 
pulmonic 
aortic 
tr. to 
ant. axillary line 
mid. " " 
angle of scapula 
LUNGS: Chest measurement 27% inches at rest 
Resonance: normal A / impaired 
Respiration: normal A/ abnormal 
ABDOMEN: normal A / large lax distended tender tympanitic 
Hernia: 
Liver: dulncss space rib to costal border nipple line. 
Spleen: palpable not palpable 
Income $70 00 
Poor Yes 9 
French and English, are some simple health rules which each 
child is asked to follow in order to become strong, healthy and 
beautiful! The nurse in charge follows the doctor's examina- 
tion of each organ (see Record form, column 2) and indicates 
the presence of the condition by ticking in ink thus V. In the 
third column under "Diagnosis" she enters the defects as they 
are disclosed, and under "Recommendations" instructs the se- 
cond nurse to provide the mother with the necessary Hospital 
reference for each child if special treatment, examination or 
operation is advised by the doctor (see page 8). Hospitals are 
selected according to the Clinical facilities and the Social service 
provided, the language spoken and their location near the home 
of the family. The back of the Record form is used for sub- 
sequent notes by the nurse in charge after visits to the home, 
or when the children come again to clinic or to class, and also 
when the Hospital references are returned with information of 
operation performed or treatment given. If the child is a 
baby under two years of age, it is referred by letter to the 
nearest Baby Health Centre (see page 10), the address of which 
is given to the mother with full instructions as to the value 
of regular attendance. A small dispensary in the Clinic affords 
temporary relief when certain pills, salves or cough mixtures 
are needed for the children. Before the mother leaves the 
clinic she receives instruction from the doctor and nurse as 
well as Health literature of various kinds, according to the age 
and needs of her children and her ability to read and under- 
stand the simple advice given. 
The work in the Clinic is accompanied by the study of the 
social case reports on file in the Patriotic Fund office proper, 
many of which date back to August 1914. It is supplemented 
by Visits to the Homes. One visiting nurse stresses the im- 
portance of removal of defects and urges sometimes unwilling 
and oftimes ignorant, ill, weary and overworked mothers to 
make or keep the hospital appointments for the children. In 
many cases this nurse undertakes to accompany the children 
herself if she finds it is impossible for the mother or relatives 
to fulfil this duty. The Nurse in Charge specializes on the 
malnourished children and induces them to return to Clinic 
regularly to be weighed and measured, or to come to class, and 
in all cases urges them to keep up their Health habits in con- 
nection with eating, drinking, rest, fresh air, exercise, clean- 
liness and regular hours. The home visits of the nurses have 
proved a very important part of the work. By actually seeing 
home conditions and the relationship of the family in the home, 
the nurse is able to make reasonable demands along the lines 
of least resistance and to come into friendly and intimate con- 
tact with the parents and children. All kinds of parents have 10 
CANADIAN PATRIOTIC FUND 
Patron H. M, THE KING President Hisf Excellency The Governor-General 
MONTREAL BRANCH 
RELIEF COMMITTEE 
DRUMMOND BUILDING 
ROOMS 315 TO 323 
CORNER ST. CATHERINE & PEEL STS 
PHONE UP 4405 
When replying quote date 
of this letter and No. DA-10980 
Montreal, 23rd. July 1920 
Iverley Settlement Bahy Health Centre, 
2, Richmond Square, 
Montreal. 
Dear Madam- 
. We heg to refer to you Mrs. Justine 
X, 157 Guy Street, who needs advice 
and follow-up care in connection with her 
hahy Joseph. The child has heen examined at 
our Health Clinic, and the Doctor's diagno- 
sis and recommendations are given helow. 
May we have your cooperation in 
this case, and may we he assured that it 
will receive your prompt, generous and 
continuous attention? 
Yours truly, 
HELEN R. Y. REID, 
DIAGNOSIS : Eczema of face: Gastro-Enteritis: Anaemia. 
RECOMMENDATIONS: General follow-up care and instruction 
in health habits for mother and child : to be seen by 
B. H. C. Doctor. 11 
to be met: weak, stern, selfish, ignorant and anxious; the 
willing mother but the father who does'nt believe in operations 
or hospitals; the sensitive mother who is hurt by the truth 
she learnt at Clinic and won't put up with delays attendant on 
Hospital service; the mother of many children who cannot 
leave her babies to take her older children to be treated; the 
mother who has had ten children with only two living, who 
knows how to bring up her family and won't be helped or in- 
structed by a young woman who is not even married! These 
types and many others have to be met, informed, persuaded 
and helped, for without the home cooperation one cannot go 
very far in preventing trouble and in establishing health 
habits on which the future well-being of the children depend. 
Needless to say, much of the success of the work depends on 
the personality of the nurse. Without tact and patience, a love 
of children and a vision of the beauty and value of this service, 
a worker will not go far, however efficient and well-equipped 
she may be in other ways. We have been most fortunate in 
this respect, and much of the credit for the recognized service 
of the Clinic is due to our nursing staff. 
The two nurses have made 1233 visits during the year to 
621 families, in addition to attendance at Clinic twice a week, 
keeping up all Clinic records, writing reports of each visit for 
filing in the Fund records and keeping in touch with Hospitals, 
etc., in special cases. The Head Nurse, in addition, is in 
charge, two mornings a week, at our Woman's Clinic, and in 
the Nutrition Class on one afternoon. With more nurses, 
the follow-up work would, of course, be more intensive and 
complete. Many of our Fund families proper who are still 
in receipt of allowances under Post-War Regulations, are, 
fortunately, being called on frequently by the regular visitors 
of the Fund, who cooperate in every way along health lines 
to see that Clinic and Hospital instructions are carried out. 
During the year we have been able to record 312 operations 
and 458 other cases under treatment at hospitals. Tonsil 
and adenoid operations numbered 254; circumcision opera- 
tions 45. Eyes were treated in 264 cases and glasses provided 
in 87 (many were not reported). As the reporting of opera- 
tions and treatments depends on both Hospitals and patients 
more than on the Clinic and the nurses, and as reports are not 
always sent in, we feel that the above record-not an unworthy 
one-is a decided understatement of what has really been 
accomplished in this field. In addition, it has to be remember- 
ed that large numbers of children examined within recent 
months have not yet actually got round to the Hospitals or to 
fulfil appointments made there for operation or treatment. 
That a lack of appreciation exists of the need and the benefit of 12 
such preventive measures, is to affirm what is still sadly 
familiar to all health workers. An increasing number of 
voluntary calls at Clinic demonstrates, however, that the slow 
work of Health education is really progressing and that word is 
being passed from house to house and family to family that the 
Clinic is indeed a good thing as proved by personal experience. 
This is valuable testimony and the kind that carries most 
weight where it is most needed, namely, among the ignorant 
and unbelieving who are not restricted to any one social class. 
Records of results of Home and Clinic instruction in Health 
Habits are unfortunately of a kind difficult to obtain without 
weekly or bimonthly visits. These have not been possible with 
the present staff of nurses, 2. There is a great difference in 
knowing what to do and what not to do, and in the actual doing 
or not doing of it. And there is also an equally important diffe- 
rence in knowing what to do, and doing it regularly, until it 
has become a habit and can be performed unconsciously and 
automatically-Education in Health involves all such instruc- 
tion. The time to learn Health Habits is in early youth. 
Opportunities for raising our national strength and happiness 
to a new and higher standard lie, therefore, almost altogether 
in the hands of parents and teachers, public health nurses, 
doctors and social workers who, by nature of their calling, come 
in contact from day to day with the baby and the growing 
child. 
Student nurses in the Victorian Order of Nurses and 
students in the Social Service Department of McGill Univer- 
sity have welcomed the privilege of visiting the Clinic for 
observation purposes in connection with their lecture course 
on "Child Hygiene". Students of the newly established School 
for Graduate Nurses, McGill University 1920-21, will also visit 
Clinic in 1921. PART II. 
"It is self-evident that a nation's 
greatness depends on the efficiency 
of its citizens, and that personal 
efficiency depends on a healthy body 
governed by a normal brain and 
nervous system".-Terhune. 
CLASSIFICATION OF DEFECTS 
For the further purposes of this study, we have taken 
the records of the first thousand children actually examined. 
The Table on page 14, alphabetically arranged, gives the name 
and number of each defect found in this group, making a total 
of 6,404 defects in the thousand children, an Average of 6.4 
per child. The Table on page 16, shows that only two children 
in the thousand were found free of defects; that one hundred 
and eighty-four, the largest group and therefore the Median, 
had each seven defects, the median giving perhaps a truer 
picture of prevailing conditions that the average of 6.4. The 
maximum number of defects-fifteen (15), was found fort- 
unately in only one poor child, though fifty children had ten 
defects, twenty-five had eleven, seven had twelve, and three 
had thirteen. Our average and median are in excess of the 
averages found among school children in the United States 
and England. This may be due to the personal factor 
of interpretation on the part of the Clinic doctor, a well 
known pediatrician in Montreal, or it may indicate 
a greater prevalence of disease and defects in our 
Montreal children than that found in children in England or 
the United States. When comparisons are made, however, 
along general mortality and infantile mortality lines between 
our local and provincial records and those of some other pro- 
vinces in Canada as well as those of England and the United 
States, the inference is borne out that our children have 
not had as good care and as favourable health opportunities 
as the others referred to, and that the incidence of defect 
indicated is doubtless reliable when applied to Montreal 
children in general. This knowledge should surely challenge 
us to prompt and thorough grappling with the problem of 
prevention of disease and defect, the promotion of health and 
the consequent mitigitation of child suffering within our midst. 14 
REPORT OF THE FIRST ONE THOUSAND CHILDREN EXAMINED 
IN THE CANADIAN PATRIOTIC FUND HEALTH CLINIC. 
The following defects were found in the children examined, most of whom 
were presumably well children. 
1st 
100 
2nd 
100 
3rd 
100 
4th 
100 
5th 
100 
6th 
100 
7th 
100 
8th 
100 
9th 
100 
10th 
100 
Total 
Adenitis 
59 
65 
71 
72 
86 
90 
87 
76 
74 
80 
760 
Adenoids 
17 
1 
3 
0 
6 
3 
2 
2 
0 
0 
34 
Alveolar Abscess 
1 
0 
1 
1 
6 
8 
5 
0 
5 
4 
31 
Acne Vulgaris 
0 
0 
1 
0 
5 
I 
0 
0 
0 
0 
7 
Arthritis 
0 
0 
0 
0 
0 
0 
1 
0 
0 
0 
1 
Anaemia 
4 
0 
0 
0 
0 
0 
3 
0 
0 
0 
7 
Apthous Ulcers 
0 
0 
0 
0 
0 
0 
0 
0 
0 
2 
2 
Bronchitis 
21 
12 
18 
9 
21 
17 
8 
6 
6 
10 
128 
Blepharitis 
3 
4 
2 
1 
4 
2 
2 
1 
3 
2 
24 
Blind one eve 
0 
0 
0 
2 
0 
0 
0 
0 
0 
0 
2 
Carions teeth. 
69 
56 
69 
71 
67 
62 
64 
65 
64 
74 
661 
Chorea 
0 
0 
0 
1 
1 
1 
0 
3 
0 
0 
6 
Cerumen 
43 
34 
30 
28 
46 
56 
64 
45 
53 
62 
461 
Chloasma 
0 
0 
2 
0 
0 
0 
0 
0 
0 
0 
2 
Conjunctivitis 
1 
3 
18 
19 
44 
52 
52 
54 
70 
66 
379 
Corneal TJlcer 
0 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Cleft Palate 
o 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Convulsions 
1 
0 
0 
0 
0 
0 
0 
0 
0 
0 
1 
Congenital Keratitis 
0 
0 
0 
0 
0 
1 
0 
0 
0 
0 
1 
Defective eyesight 
19 
8 
7 
11 
8 
3 
1 
0 
0 
0 
57 
Deviated Septum 
0 
0 
0 
1 
0 
0 
0 
0 
0 
0 
1 
Dactylitis 
0 
0 
0 
0 
0 
0 
0 
1 
0 
0 
1 
o 
0 
0 
0 
0 
0 
0 
0 
1 
0 
1 
o 
0 
0 
0 
0 
0 
0 
0 
0 
1 
1 
Dacrocystitis 
0 
0 
0 
0 
0 
0 
0 
0 
0 
1 
1 
]Ftn uresis 
14 
7 
17 
12 
13 
13 
15 
14 
17 
16 
138 
Epilepsy 
0 
0 
0 
0 
0 
I 
0 
0 
0 
1 
2 
Tfczema .... 
10 
4 
11 
11 
13 
29 
19 
19 
13 
11 
140 
Encephalitis 
0 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Bnrunculosis 
0 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Genu Varum 
0 
1 
0 
0 
0 
1 
0 
0 
0 
0 
2 
Genu Valgus 
0 
0 
0 
0 
0 
0 
0 
0 
0 
2 
2 
Gingivitis 
0 
0 
0 
0 
0 
2 
0 
1 
0 
1 
4 
Gastroptosis 
0 
0 
0 
0 
0 
1 
0 
0 
1 
0 
2 
Geographical Skin. ..... 
0 
0 
0 
0 
0 
0 
0 
0 
0 
1 
1 
Heart disease (func). ... 
4 
1 
I 
1 
4 
5 
6 
] 
0 
5 
28 
" " (org.).... 
10 
7 
6 
5 
4 
2 
3 
4 
1 
6 
48 
Hernia (ing.) 
0 
0 
0 
1 
0 
2 
1 
0 
1 
1 
6 
" (Umb.) 
14 
9 
4 
4 
4 
10 
7 
4 
9 
12 
77 
" (Ventr.) 
0 
1 
4 
4 
2 
1 
1 
1 
1 
0 
15 
Herpes 
2 
0 
1 
0 
0 
0 
0 
1 
0 
0 
4 
Haemophilia 
0 
0 
0 
0 
0 
1 
0 
0 
0 
0 
1 
Hypospaedias 
0 
0 
0 
0 
0 
0 
0 
0 
1 
0 
1 
Carried forward.... 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
0000 15 
REPORT OF THE FIRST ONE THOUSAND CHILDREN EXAMINED 
IN THE CANADIAN PATRIOTIC FUND HEALTH CLINIC. 
( Continued} 
1st 
100 
2nd 
100 
3rd 
100 
4th 
100 
5th 
100 
6th 
100 
7 th 
100 
8th 
100 
9th 
100 
10 th 
100 
Total 
Brought forward.... 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
000 
Icthyosis 
1 
1 
0 
2 
o 
0 
o 
0 
0 
1 
5 
Intertrigo 
0 
0 
0 
0 
1 
0 
o 
0 
0 
0 
1 
Impetigo 
3 
3 
0 
0 
0 
0 
0 
0 
2 
1 
9 
Inf. Rheumatism 
0 
0 
0 
0 
0 
o 
1 
0 
0 
0 
1 
Laryngitis 
0 
0 
0 
0 
0 
1 
0 
0 
0 
0 
1 
Malnutrition 
49 
36 
31 
18 
21 
22 
39 
29 
29 
25 
299 
Mental Defect 
3 
0 
1 
0 
1 
3 
0 
1 
0 
1 
10 
Neurasthenia 
0 
0 
0 
0 
0 
0 
0 
1 
0 
0 
1 
Otitis Media 
30 
26 
38 
41 
31 
37 
32 
25 
28 
22 
310 
Onychia 
1 
0 
0 
1 
0 
0 
0 
0 
0 
0 
2 
Pyogenic inf 
0 
0 
0 
0 
0 
0 
0 
0 
1 
0 
1 
Potts' disease 
0 
1 
0 
0 
1 
0 
0 
0 
0 
0 
2 
Posterior Synechia 
0 
0 
1 
0 
0 
0 
0 
1 
0 
0 
2 
Postural defects 
35 
71 
77 
64 
69 
81 
76 
76 
74 
79 
702 
Phimosis 
10 
10 
4 
7 
14 
6 
5 
4 
4 
7 
71 
Pediculosis 
41 
33 
27 
24 
25 
29 
27 
26 
32 
27 
291 
Pharyngitis 
68 
54 
62 
66 
59 
63 
61 
52 
43 
68 
596 
Pavor Nocturnus 
0 
1 
3 
2 
4 
1 
0 
0 
5 
2 
18 
Ptosis 
0 
0 
1 
1 
2 
0 
0 
0 
0 
0 
4 
Pin Worms 
0 
0 
1 
0 
0 
0 
1 
0 
0 
0 
2 
Psoriasis 
0 
0 
0 
0 
0 
0 
1 
0 
0 
0 
1 
Ringworm 
0 
1 
0 
1 
0 
0 
0 
0 
0 
3 
5 
Rhinitis 
45 
39 
12 
14 
17 
24 
24 
17 
17 
22 
231 
Rigg's disease 
0 
0 
0 
3 
0 
1 
0 
0 
0 
0 
4 
Strabismus 
9 
5 
8 
6 
11 
9 
6 
5 
9 
8 
76 
Syphilis 
0 
1 
0 
0 
0 
0 
0 
0 
0 
0 
1 
Scabies 
0 
0 
0 
4 
5 
0 
2 
2 
2 
0 
15 
Somnambnlism 
0 
0 
0 
2 
0 
0 
0 
1 
0 
1 
4 
Scarlatinal nephritis .... 
0 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Scar tissue 
0 
0 
0 
0 
0 
0 
1 
0 
0 
0 
1 
Sexual precocity 
0 
0 
0 
0 
0 
0 
1 
0 
0 
0 
1 
Tonsils, diseased 
55 
37 
50 
53 
47 
66 
54 
56 
52 
59 
529 
Thyroid enlargement.... 
0 
0 
1 
3 
1 
0 
3 
0 
0 
1 
9 
Tuberculosis 
0 
4 
0 
1 
0 
0 
0 
0 
0 
0 
5 
Tape Worm 
0 
1 
0 
0 
0 
0 
0 
0 
0 
0 
1 
Tongue Tied 
0 
0 
0 
0 
1 
0 
0 
0 
0 
0 
1 
Talipes equinovarus .... 
0 
0 
0 
0 
0 
0 
0 
0 
0 
1 
1 
Undescended testicle 
0 
0 
0 
0 
0 
0 
0 
0 
1 
0 
1 
Vaginitis 
1 
0 
1 
0 
0 
2 
0 
0 
0 
0 
4 
Visceroptosis 
18 
10 
21 
12 
11 
18 
16 
13 
9 
135 
Whooping Cough 
0 
0 
0 
2 
0 
1 
0 
0 
2 
0 
5 
Warts 
0 
0 
0 
0 
0 
0 
0 
0 
1 
>0 
1 
661 
547 
605 
581 
660 
728 
691 
601 
635 
695 
6404 16 
TOTAL DEFECTS 
1st 
100 
2nd 
100 
3rd 
100 
4th 
100 
5th 
100 
6th 
100 
7th 
100 
8th 
100 
9th '10th 
Total 
100 
100 
0 
0 
0 
0 
0 
0 
0 
0 
2 
0 
2 Children 
had 
0 defect. 
1 
2 
1 
3 
4 
0 
0 
I 
0 
0 
12 
4 4 
1 " 
5 
2 
3 
4 
2 
1 
3 
5 
5 
3 
33 
4 4 
2 defects. 
7 
14 
5 
4 
2 
I 
4 
8 
5 
2 
52 
3 
7 
14 
14 
11 
16 
6 
3 
8 
7 
10 
96 
< c 
4 
13 
18 
22 
18 
10 
12 
18 
15 
18 
10 
154 " 
44 
5 
13 
23 
19 
19 
8 
13 
13 
21 
15 
13 
157 
4 4 
6 
17 
13 
13 
26 
20 
21 
20 
16 
15 
23 
184* " 
4 4 
7* < < 
14 
6 
10 
10 
16 
19 
16 
19 
16 
17 
143 
4 4 
8 
10 
5 
4 
3 
10 
14 
12 
3 
6 
14 
81 
4 4 
9 
9 
2 
5 
1 
6 
9 
5 
2 
7 
4 
50 
4 4 
10 
1 
1 
2 
1 
6 
3 
5 
2 
3 
1 
25 
<4 
11 
3 
0 
2 
0 
0 
0 
1 
0 
1 
0 
7 
4 ( 
12 
0 
0 
0 
0 
0 
1 
0 
0 
0 
2 
3 
4 4 
13 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
0 
4 4 
14 
0 
0 
0 
0 
0 
0 
0 
0 
0 
1 
1 Child 
4 4 
15 
100 
100 
100 
100 
100 
100 
100 
100 
100 
100 
1000 
* Median 
The defects found were neither exaggerated nor fanciful. 
Analysis of the table confirms this. Throat obstructions, 
destructive processes in eye or ear, are all real 
things. Pathological conditions such as heart disease, Potts' 
disease, epilepsy, etc., endanger the life of the child, and con- 
tagious infections such as pediculosis, intestinal parasites, 
scabies, whooping cough and vaginitis are diseases from which 
all "well children should be protected. 
The largest Defect groups in our series are: 1. Naso- 
pharyngeal, including adenoids (34), deviated septum (1), 
pharyngitis (596), rhinitis (231), and diseased tonsils (529), 
a total of 1,391 defects. 2. Muscular affections, including gas- 
troptosis (2), visceroptosis (135), ptosis, (4), hernia (inguinal 
umbilical, ventral) (98), postural defects (702), a total of 
941. 3. Ear affections, covering cerumen (461), otitis media, 
(310), deafness (1), a total of 772. 4. Glandular affections, 
including adenitis (760), thyroid enlargement (9), a total of 
769; 5. Diseases of the teeth and gums, covering alveolar 
abscess (31), carious teeth (661), gingivitis (4), Rigg's 
disease (4), a total of 700. 6. Eye affections, including ble- 
pharitis (24), blindness (2), conjunctivitis (379), corneal ulcer 
(1), defective eyesight (57), dacrocystitis (1), strabismus 
(76), a total of 540; 7. Constitutional disorders, including 
acne vulgaris (7), arthritis (1), anaemia (7), eczema (140), 17 
furunculosis (1), posterior synechia (2), heart disease-func- 
tional and organic (76), haemophilia (1), inflammatory 
rheumatism (1), malnutrition (299), pyogenic infection (1), 
psoriasis (1), syphilis (1), a total of 538; 8. Parasitic diseases, 
including pediculosis (291), ring worm (5), tape worm (1), 
pin worm (2), scabies (15), a total of 314; 9. Genito-urinary 
affections including phimosis (71), vaginitis (4), enuresis 
(138), a total of 213. 
Referring to the largest group, the Naso-pharyngeal-(see 
table on page 17), of 851 children with 1391 defects, we may 
note the findings of Dr. Thos. D. Wood, Chairman of the Com- 
mittee on Health Problems of the National Council of Education, 
New York. Among the possible injurious effects resulting from 
adenoids he quotes the following:-"Narrowing of upper jaw, 
deformity of chest, disturbed development of teeth and vocal 
organs, large tonsils, mental disturbances, deafness, defects 
in smell, taste and voice, chronic catarrh, obstruction of air 
passages with open mouth and restlessness at night, head- 
ache, cough and hoarseness, croup, bronchial asthma and 
enuresis, with malnutrition and anaemia, under-development, 
predisposition to other diseases such as tuberculosis, diphtheria, 
scarlet fever as well as to middle ear disease, laryngitis and 
intermittent colds. Enlarged or diseased tonsils produce many 
Kind of Disease or 
Defect 
Total number 
of Defects 
Number of 
Children 
affected 
Percentage 
1. Naso-pharyngeal 
1391 
851 
85% 
2. Muscular 
941 
769 
77% 
3 ... 
772 
616 
61 % 
4. Glandular 
769 
761 
76% 
5. Teeth and Gums 
700 
694 
69% 
540 
489 
49% 
7. Constitutional 
538 
457 
45 % 
8. Parisitic 
314 
306 
30% 
9. Genito-Urinary 
213 
199 
20% 
10. Respiratory 
134 
126 
12% 
45 
44 
4% 
12' Skin 
27 
26 
2% 
13. Bone 
7 
7 
.07% 
14. Alimentary 
2 
2 
•02% 
1 5. Congenital 
5 
5 
•05% 
1 6. Contagious 
5 
4 
• 04% 18 
of these unfavourable results and increase susceptibility to 
tonsillitis, quinsy, rheumatism, pneumonia and other forms 
of infection". (6) 
The second group, that of the Muscular Affections, 769 
children with 941 defects, calls for early and regular attention 
in order to prevent postural defects from becoming chronic 
and real spinal curvature from developing. Proper feeding 
and exercise will help to improve the condition of children 
suffering from visceroptosis, while treatment or operation for 
hernia may prevent great trouble in the future for the child, 
involving, as rupture does, serious and often dangerous weak- 
ness of the abdominal walls. 
Our third largest group of defects or abnormalities is that 
of the Auditory System, 616 children with 772 defects. Catarrh 
of the middle ear often leads to mastoid disease. Norsworthy 
and Whitney of Columbia University, New York, state that 20 
per cent of American school children are defective in one or 
both ears. They make the comment that "while the results 
of ear defects may not be so severe on the nervous system as 
eye strain, they certainly interfere with perception and there- 
fore with knowledge" (5). Children who do not hear quite 
well, develop slowly and seem dull because they do not get the 
full class instruction at school. They are often considered 
stupid and queer, and if the defect is not discovered, and reme- 
died when possible, they may grow up anti-social as well as 
sub-normal both physically and morally. 
761 children with defects of the Glandular System (4) furnish 
us with 769 defects. These are closely associated with those 
of the Naso-pharyngeal group (see above). 
The fifth largest group of defects, 700, is that of the 694 
children with "bad" Teeth and Gums. Osler says:-"If I were 
asked to say whether more physical deterioration was pro- 
duced by alcohol or by defective teeth, I should unhesitatingly 
say defective teeth. In some schools as many as 98 per cent 
of pupils have defective teeth. From 50 to 75 per cent of all 
school children in this country need, at this moment, dental 
care" (7). Dr. Wood estimates that 34 to 48 per cent of school 
children in the United States are suffering with diseases of 
the teeth and gums. (6) which is less than the estimate given 
by Norsworthy and Whitney, viz. 60 to 96 per cent (5). The 
excruciating pain from toothache causes great loss of time 
and rest with consequent nerve strain. Dr. Wood cites among 
the direct effects of defective teeth "unsightly and inflamed 
mouth with foul breath, improper mastication of food, exten- 
sion of decay to sound teeth, infection of glands and jaw 
bone, earache and deafness, headache and disturbed vision, 
digestive disturbance with indirect effects of poor nutrition, 19 
lowering- of vitality and resistance to disease, formation of 
culture bed for pathogenic germs which, with lowered resist- 
ance, leads to increased frequency of infection with possible 
danger to life." (6) 
Four hundred and eighty-nine children with Eye 
defects to the number of 540, form our next 
largest group. Symptoms of eye trouble include com- 
lalnts of headache, especially towards the end of school time, 
holding the head too near the book, temporary deviation of 
either eye from the normal position and imperfect sight of 
common near-at-hand objects and people. The suffering which 
is attendant on eye strain affects the nervous systems to an 
alarming extent. Some medical authorities attribute epileptic 
and epileptiform seizures to abnormal eyes. Convulsions 
occur in a few cases. The injurious effects more commonly 
recorded include nervous exhaustion and lack of control, head- 
ache and nausea with consequent digestive disturbance and 
malnutrition, slow mentality and possible backwardness at 
school because of lack of visual understanding. 
The seventh largest group of defects classified as 
Constitutional disorders, 538, refer to 457 children and include, 
as noted, 76 cases of heart disease and 299 of malnutrition. 
Dr. Wood's remarks on abnormal conditions of the heart 
may well be quoted in this connection. He says that such 
conditions "even if temporary, may disturb health, and if 
neglected may result in permanent weakness of the heart 
itself or of the body in general. The condition of the heart is 
always an important index of the health condition, and is often 
a valuable guide in adjusting the amount of sleep, arrangement 
of school program, and selection of muscular exercise which is 
most suitable for the pupil." (6). For remarks on Malnutrition 
see page 22. 
The eighth and last large group of defects to be noted is 
that of 314 cases of Parasitic Diseases among 306 child- 
ren, including 291 cases of pediculosis, 15 of scabies 
and 8 of worms. These are all contagious, uncomfortable, 
unhealthy and disgusting diseases. Well children should not 
have to suffer contact, as they now do, with children who are 
thus affected. Removal of the trouble is in each case possible, 
and only requires understanding, decision and action on the 
part of both teachers and parents. No item in all the wonder- 
ful measures for health care of the soldiers in the trenches 
is more significant than the systematic treatment of their 
bodies and clothes at frequent intervals to rid them of the 
troublesome and dangerous parisites which abounded in their 
midst. Shall not our children receive as good care in this 
respect as our soldiers on service at the front? 20 
The small group of Nervous affections, 45, among 44 child- 
ren, covers ten conditions, many of which may be symptomatic 
of other primary troubles; for instance, "night startles", som- 
nambulism and convulsions may be indications of abnormal eyes, 
defective teeth, malnutrition or bad health habits. Unless 
these causes are removed and the defects remedied, grave troub- 
le is in store for the child in the future. Norsworthy and Whit- 
ney claim that 5 per cent of the American school children 
are neurotic and that 1 per cent of these have chorea frequent- 
ly in the spring months,-that this is more frequent with girls 
than boys and occurs most often between the ages of 8 and 15 
years. (5) Full cooperation of parents is necessary in order to 
effect the needed changes and to get children to take proper 
food at frequent intervals, to prevent over-fatigue and to esta- 
blish sufficient home control to ensure good health habits. A 
reference to the Tea and Coffee Table, see page 20, has 
some signifiance in connection with the question of nervous 
affections among children. Seven hundred and nineteen of 
our 1000 children drank tea and 199 coffee. The distribution 
of food literature and the never-ending instruction in clinic 
and home to substitute milk, cocoa and water for these stimul- 
ating and non-nourishing beverages has borne fruit in count- 
less numbers of cases, many of the children shaking hands 
with the doctor on their promise to give up drinking tea and 
coffee, and many mothers reporting better sleep and health as 
a result of the new system. 
The 10 mental defectives found bears out exactly the 1 
per cent mental defectives found by Dr. Wood among American 
children, though his later examination does not give quite such 
a high percentage viz.-.8 per cent for country school children 
and .2 for those in cities (6). Norsworthy and Whitney find 
that 30 to 35 per cent of the school children in the United 
States are retarded one year or more, and that boys show 
this more frequently than girls (5). Our findings bear out 
their statement that the physical characteristics of aments 
show a greater prevalence of stigmata of degeneration, - 
physical defects, - than do those of children of higher intelli- 
1st 
•2nd 
3rd 
4th 
5th 
6th 
7th 
Sth 
9th 
10th 
100 
100 
100 
100 
100 
100 
100 
100 
100 
100 
Tea Drinkers 
67 
70 
84 
73 
70 
54 
66 
79 
86 
70 
719 
Coffee Drinkers 
14 
27 
39 
32 
16 
22 
12 
15 
12 
10 
199 
81 
97 
123 
105 
86 
76 
78 
94 
98 
80 
918 MALNOURISHED CHILD 
This child is 1 0 years and 8 months old, measures 4 feet 
8 inches, is tall for her age and is 2 1.5 pounds or 25% under- 
weight for her height. She has eight defects, including 
carious teeth, enlarged tonsils, chronic suppurative otitis 
media, marked postural defects. She drinks tea, "picks" 
her food and is anaemic. MALNOURISHED CHILD 
This child is not underweight for height, but she is 4.2 
inches under the average height for her age. The lax, pro- 
minent abdomen, the flaring scapulae, the narrow contracted 
chest, all are part of the typical posture of the malnourished 
child. She is 9 years 2 months old, has carious teeth, enlar- 
ged tonsils and adenoids, has a poor appetite, drinks coffee 
and keeps late hours. There are also faulty diet and faulty 
health habits to remove. 21 
gence. Our records show that our 10 mental defectives had 
in all 89 defects, the largest number for any one being 12. , 
This percentage, 8.9, varies notably from our average 6.4 or 
median 7 among mentally sound children. No mental tests were 
made of possibly retarded or backward children. No records were 
kept of advanced children, of whom we are told there are 4 per 
cent among American school children who are two years above 
their mental age. While much study is being given by 
Mental Hygiene and Educational Committees to backward or 
retarded children, special classes being arranged for them, 
little or nothing seems to have been done for the advanced 
child, who would be a tremendous asset to the nation if given 
opportunity, which is sometimes economically and socially 
denied him. We need prophets, saints and martyrs in this 
day of materialistic adventure, but we also need scientists, 
poets and artists of genius for the future health of our spirit, 
soul and mind I Who is going to open the door of Opportunity 
for the advanced child? Norsworthy states that "records show 
that children who have advanced in school work are more 
often than not taller and heavier than the average for their 
age; they maintain their lead, finish earlier and occupy good 
positions in life" (5). Superior hereditary endowment is quoted 
as the cause in 90 per cent of these cases. Without the help 
of opportunity and of good environment, however, we need 
not expect to get the best from our supernormal children or to 
get brilliant results from any of them who do not get their 
chance. PART III. 
"To. be habitually 7% under- 
weight is to be retarded at least 
one year in development." 
-Dr. Wm. R. P. Emerson. 
MALNUTRITION - GROUP OF 299 CHILDREN 
Besides many cases of poorly nourished children, the 
Clinic records show 299 children whose weight was at least 
7% less than what it should be for their height. David 
Mitchell of the New York Bureau of Educational Experiments, 
says of this class of child:-"Clinical experience has led us to 
the conclusion that a child who is chronically 7% or more 
underweight might be considered an ill child". (1) A result 
of a cooperative experiment covering four months in 1918, 
and 894 children of different school grades in New York City, 
is reported by Dr. Mitchell as indicating that 16.8% of the 
entire United States school population are 7% or more under 
the weight which they should be for their height. This means 
that in New York City, with approximately 1,000,000 school 
children, 168,000 are undernourished. Dr. Thomas D. Wood 
of Columbia University, New York City, records 20% of 
American School children as malnourished-this being based 
on a study of 22 million children in 1918. In a later study 
based on reports of over half a million city and country child- 
ren, Dr. Wood estimates that 16.6 rural school and 7.6 city 
school children are undernourished. (6) 
Dr. Wm. R. P. Emerson says:-"Extended studies have 
shown conclusively that at least one-third of the children in 
the United States of school and pre-school age are sufficiently 
underweight for their height as to require treatment for 
malnutrition" (4). 
The apparent agreement of Dr. Wood and Dr. Mitchell 
as against the number, almost double, quoted by Dr. Emerson 
cannot lessen the truth of the fact that malnourishment is 
prevalent as an actual illness in hundreds of thousands of 
children in the United States. Without similar extensive and 
intensive surveys to guide us in Canada, no accurate conclu- 
sions can be drawn for national application here. The infe- 
rence, however, is plain that similar poor conditions do exist 
in connection with our children of school and pre-school age. 
The number of malnourished children recorded in our group 
of 1000, namely 299, approximates more closely to Dr. Emer- 23 
son's 33-1/3 per cent than to the lower estimates of Dr. Wood 
and Dr. Mitchell. 
Malnutrition is certainly a fundamental handicap. As 
stated by Norsworthy and Whitney:-"It affects height and 
weight, interferes with general development, delays puberty, 
lowers vitality, making every child susceptible to infections 
with less chance of recovery and more chance of relapse. It is 
likely to precede tuberculosis, to produce rickets, and it 
retards mental development, as two or three times more cases 
of malnutrition are found in retarded mental cases than in 
normal mental cases." (5). 
The causes leading to malnutrition are generally many in 
number and kind, and include the presence of carious teeth 
or diseased tonsils, insufficient diet, wrong kinds of food and 
badly prepared food, bad food habits such as irregular and 
hurried meals, the use of stimulants such as tea and coffee, 
lack of sleep and insufficient rest, fresh air and exercise; over- 
work and excitement or worry, and previous diseases (whoop- 
ing cough, measles, etc.). Many cases of malnutrition are 
found among the children of the well-to-do, this being due to 
the ignorance and carelessness of both parent and child as to 
the desirable conditions under which food should be taken. 
Dr. Julius Levy of the New Jersey State Board of Health gives 
his findings on "The undernourished child of pre-school age" 
in the following suggestive remarks:-"To sum up I would say 
that malnutrition in the child of pre-school age is largely the 
result of improper care and feeding in the first year of life. 
Secondly, that it is the result of unnecessary and improperly 
managed contagious diseases, and thirdly, that it requires for 
its cure more the application of the rules of hygiene, nutrition, 
discipline and training than it does the administration of drugs 
and medicines." (8). The symptoms of malnourishment are 
loss of weight and height, overheight, indigestion, flabby mus- 
cles, decayed teeth, pale skin with dark circles round the eyes, 
fatigue, irritability. 
The illustrations of two of our malnourished child- 
ren are typical of many other cases, (pages 20-21). Such 
children, when dressed, often pass muster. It is only after 
weighing and measuring, and after full physical examination 
that the seriousness of the conditions found is fully realized. 
The first little girl looks fairly well when she is dressed, except 
that she has the serious expression of countenance which the 
malnourished child usually presents. She is 10 years and 8 
months old, 4 feet 8 inches, tall for her age, and is 21.5 pounds 
underweight for her height, or 25%. She has eight defects 
including carious teeth, enlarged tonsils, chronic suppurative 
otitis media, marked postural defects. She drinks tea, "picks" 
her food and is anaemic. The second child is not underweight 24 
MALNOURISHED CHILDREN GROUPED SEASONALLY WITH RE- 
LATED DEFECTS:-NOV., DEC., JAN. & FEB., 134; MAR., APRIL, 
MAY & JUNE, 82; JULY, AUG., SEPT. & OCT., 83; TOTAL, 299. 
0©<»'30>Oi*'WtO-Oe<»MO)Oii»>.WK)^OtOOO*JO;Oi*WtOHJOtOOOMOOi^Wt4k-0©X<IffiOi*WN'- 
Malnutrition 
MX MMXXXXMXMMMXXXXMXXHXMXMMXMXXXXXMXXXMXX M X X X X X 
Naso- 
Pharyngeal 
XXX XXXX X XX X X X X X X XX XXXX XXX X X X X X X 
Ear 
X X X XXX XXXXXXXXXXXXX XXXX XXXX XXXX X X X X X X 
,! C5 to OS 04 -J OS Ot to On -J 04 05 4- 4- Cl 4- 04 ©WMW ® W (0 K t>3 00 00 to 00 tO i-' - 04 04 
Teeth 
xx X XXX XX XXXXXX XXXX X X XX X X XXXX 
Muscles 
4-5 T» < 1 • • 
51 
52 
53 
54 
65 
56 
57 
58 
59 
69 
61 
62 
63 
64 
65 
66 
67 
68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
82 
83 
84 
85 
86 
87 
88 
89 
90 
91 
92 
93 
94 
95 
96 
97 
98 
99 
00 
Malnutrition 
XXXXXX X XX XXXXXXXXXXXXX XX XX XX XXX XX XXXXXX XX 
Naso- 
Pharyngeal 
XXX XXXX XX XXXXX X XXXX XXXXXX 1 
Ear 
X XXXXXXX XXXXXXX X ~ X X X - XXXX X X 
00 tO 04 04 ^3 04 C5 K) W 4k to W W -1 - C5 04 on I- 05 04 04 04 05 4- 
Teeth 
XXXXXX XX X XXXXXX XXXXX XXXX XXXXXXX XXXXXXX XXXX 
Muscles 
• 
101 
102 
103 
104 
105 
106 
107 
108 
109 
110 
111 
112 
113 
111 
115 
116 
117 
118 
119 
120 
121 
122 
123 
124 
125 
126 
127 
128 
129 
130 
131 
132 
133 
134 
135 
136 
137 
138 
139 
140 
141 
142 
143 
144 
145 
146 
147 
148 
149 
Malnutrition 
XX X XXXXXXX X XX XXXXXX X XXXXXX XXXX XX XXXXXXX 
Naso- 
Pharyngeal 
X XXX XXXXXXX X X XXXX X XX XXXX XX 
Ear 
XXXXXX XX XXXXX X XXXXXX * X X XX XXX X X XXXX X 
Ci 05 04 4- 4k oo bO - -4 60 0505 4 05 60 00 tO tO 4- 0 4- 00 04 4- C 4 0C 04 tO W 4 « 4 OH 
Teeth 
XXXXXX XXXX XXX XX XXXXXX XXXX XX XXX XX XXX XXXX 
Muscles 25 
MALNOURISHED CHILDREN GROUPED SEASONALLY- Continued 
oocococococDcocDtDtotooocoaoooooacooccoooo44--4'<|4j^j^i*q^j»4^q©oj©©©©©®©©cntnotcnOicnctOte40' I Malnutrition 
4- O CO X -1 Cl Cl ,4 W IS 41 O '£ CO M ~J St 4* U tC " O ® W M ® O< »• W to ■- O X -.1 Cj Si 4* W ti - C CO 00 M Ci S' >^W l-i 1- © 1 
Naso- 
xxxx xxxxxxxxx xxxxxxxxx x xx xxxxxxxx xx x xxxxxxxx Pharyngeal 
xxx xxxx x x x xx x x xx x xxxxx xx x xxx x x1 Ear 
X XX XXX X XXXXX * X X X X XXXX XXXX XX XX X * X X XXX X Taofh 
w o w w to to on co oooo tow ww 4* i-^4 m to 44 ww w to to w co oo ® wm w item 
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxx xxxxxxxxxxxxxx Muscles 
to to to to to to to to to to to to to to to to to to to tO tO IO ti to to to to to to to to to to to to to a to to to to to to to to to to to to to to to , , , , 
w ci c 4- 4- 4- 4- o- 4- 4- 4- 4- 4- w w w w sow w w w os to to to to to to to to to to >- >- >-< m i-h m« mocoooooo Malnutrition 
to >- o ® oo-i o> w to o co a a si w to >-c co a>-i m a 4- w to >- c ® cc-t i® c» a wto*-o® oomojoi^ w to 
Naso- 
xxxx xxx xx xxx xxx xxx x xx xxx xxx xxxxx xx xxxx Pharyngeal 
xx xxxxx xx x xxxxxxxxx x xxx xx xxxxx x xx x | Ear 
XXX XXX XXXXXXXXX X * X XX XXXXXX XXXXXXXX XX TWh 
wtoto to to w i- to 4- to to to 04 to to ©w to to co 4- 44 oo oo © ootooo w oo w m to -Leem 
XXXX XX XXX XXXXXXXXXXXXXXXXXXXXXXX XXX XXXX X X X ( Muscles 
itotototototototototototototototototototototototototoiototototototototototototototototototototo nr i , ... 
|CD O (O CO O O O O C CD X X X GO QO X X 00 CO X Q Gi Ci Ci Q O CX O> » Cl Cl Oi O1 Ql Malnutrition 
1 CO X -1 C. St 4- W to 4 O O CC M ® S' 4 W W " O co X -T ® W to - C CO X -1 ® S' 4- U to O X X -1 C & O W 
S £ Naso- 
5-o e» xxxxxxxxxxxxxxxxxxxxxxxx xx xx xxxxxxxxxx pharyngeal 
cn »-* 
tn X X X X X XXXX XX X X X XXX XXXX XXXX X XXX Ear 
05 NJ x X ..... 
io o XXXXXX X X 4 XXXXXXX XX X -XXX XXX XX XXXX xxx TppMi 
5-0 oo w oi 4* w ci to to 44 © to w to to to tocu 44 oo w >- to to w o< w cnto«x>4- to 44 44 xeein 
00 Nd 
5^ w XXXXXXX XXXXXXX XXXXXX XXXXXXXXXXXX X XXXXXXXXX Muscles 26 
for height, but she is 4.2 inches under the average height 
for her age. The lax, prominent abdomen, the flaring scapulae, 
the narrow contracted chest are all part of the typical posture 
of the malnourished child. She is nine years and two months 
old, has carious teeth, enlarged tonsils and adenoids, has a 
poor appetite, drinks coffee and keeps late hours. There are 
also faulty diet and faulty health habits to overcome. 
The table on page 24 indicates the number of related defects 
found in these 299 children in addition to that of malnutrition. 
As will be clearly seen, the number of enlarged tonsils and 
adenoids and other naso-pharygeal affections in 246 children 
or 82 per cent, corresponds very closely with the total of 299. 
Obstruction in the breathing passages causes irregular 
shallow breathing almost always through the mouth, exhibit- 
ing more or less deformity of face and preventing the children 
from getting sufficient oxygen. Fertile ground is provided 
for infection and for greater frequency of certain diseases 
which affect malnutrition. Dr. Thos. D. Wood's description 
of the appearance of a child with marked adenoid enlargement 
is as follows and bears out very generally, case after case 
examined in the Fund Health Clinic. "Mouth open; dull, 
sleepy with enquiring look; upper lip short and thick; upper 
jaw narrow; nasal orifices small and pinched; the face full 
under the eyes; listless and indisposed to physical or mental 
exertion; stupid and backward in school, from one to two years 
behind the normal pupil of the same age; undersized." (6). 
Defective Hearing is closely associated in many instances 
with nose and throat trouble. Dr. Wm. R. P. Emerson of 
Boston says in this connection:-"It is remarkable with what 
accuracy this condition of naso-pharyngeal obstruction can be 
diagnosed by the appearance of the ear drums alone". 175 or 
58% of the children of this group had ear affections. 
In the David Mitchell report, results found did not show 
a very marked effect of Carious Teeth in the percentage of 
underweight, owing perhaps to the fact that "the numbers 
(88 children) were too few to lead to any clear-cut conclusion". 
Mitchell suggests "that there may be very faulty conditions 
of the teeth without in any way interfering with the chewing 
surface or supplying sufficient toxins to the system to interfere 
with the process of digestion". (1). Dr. Emerson, on the other 
hand, notes the close relationship of both malnutrition and 
nose and throat defects with the large number of children 
having carious teeth, the incidence being greater in the mal- 
nutrition group (4). In the Fund Clinic group of 1000 children, 
we found 700 children suffering with diseases of the teeth and 
gums, a percentage of 70. In the 299 malnourished children 
we find 208, or 69 per cent, having 898 carious teeth between 
them, an average of 4 per child. Several mouths were so bad 27 
that the shells of the teeth could be pried out with a tongue de- 
pressor. In this group the number of carious teeth varied 
from one to twelve. While noting the ugliness and the pain, the 
bad odor and taste, we feel convinced with most students of 
malnutrition that there is a very definite relationship between 
ill health, particularly malnutrition, and defective teeth, in spite 
of the fact that the percentages found in the special mal- 
nourished group and in the whole group of children 
examined are practically identical. Together with the 
decreased power of thorough mastication due to decay and 
irregularities, and the toxic effect of pus absorbed directly 
into the blood or taken into the stomach and intestines, there 
must be a reflex nervous disturbance due to pain on the impac- 
tion of teeth, and there is always the possibility that the 
decayed teeth may act as a breeding ground and disturbing 
centre for harmful bacteria. Toothbrush drill was unfamiliar 
to most of the children examined and very few of the children 
knew the use of even the "Family" toothbrush, which occasion- 
ally was reported. The children themselves rarely grasped 
the truth of the modern Health proverbs "A tooth in the head 
is worth ten on a plate", and "A brush in time saves nine!",- 
and the parents of large families with limited resources find 
this dental "detail" often insignificant as compared with the 
more pressing need of clothing the children, feeding them 
and getting them off to school. 
"Free" Dental Clinics are not sufficient in number or 
sufficiently free to place the need and the opportunity for effi- 
cient dental service adequately before the people. Each one 
of our children suffering from carious teeth or disease of the 
gums has been given a Hospital Slip to one of the three public 
dental clinics in Montreal, and where the parents have been 
really unable to pay for service, the Fund has indicated on the 
Hospital slip their readiness to undertake this expense. Our 
records depending on outside cooperation are not complete in 
these cases, but through the accounts that have come in and 
the home visits of the nurses we find that many children have 
received dental treatment up to date. The Hospital Clinics 
are all overworked and frequently these out-patients wait 
hours before their turn for attention comes. The Social Ser- 
vice Departments insure a friendly welcome and sympathetic 
reception which goes a long way towards overcoming the 
hesitation and reluctance which many people still have in 
connection with hospital attendance. A need for doctors 
and social workers who speak French has made itself felt from 
time to time. The Hospital Superintendents and staffs have 
endeavoured, in every way, to provide for the large number of 
children we send them daily, and their interest in our service 28 
and demonstration has been unfailing and friendly in the 
fullest degree. 
Postural defects were found among 243 children of 
the malnourished group, 81 per cent. The early detection of 
spinal curvature is of the greatest importance. Bad sitting hab- 
its, induced possibly by defective hearing or vision, may in turn 
induce curvature and round shoulders. Obstruction to respira- 
tion causes narrow chest and round shoulders, and such ob- 
struction affects nutrition and thereby lowers the health and 
powers of resistance of the child. We have been fortunate in 
being able to send several of our aggravated cases to posture 
Clinics in two of our hospitals where they have reaped much 
benefit after attending regularly for the period, usually six to 
eight weeks, recommended by the Doctor in charge of the 
clinic. 
The postural habits of the child at school bear a definite 
relation to the defects found. Certain tasks are required of 
the child which induce certain habits, impose certain restric- 
tions and allow certain opportunities, each of which procedures 
has its own dangers as far as the physical well-being of the 
child is concerned. A child is taught to read and write. Do 
the teachers sufficiently appreciate and note eye strain result- 
ing from bad posture? Home study is assigned regardless of 
home conditions, which make the work of doubtful benefit when 
done under conditions definitely injurious to health. As Nors- 
worthy and Whitney say:-"The physical child is always in- 
volved in all school work and the school tasks imposed on that 
physical child force responsibility on the teachers of the 
school for the health and the growth of the children. All 
those who deal with children must realize the importance of 
this problem of physical development. So long as they are 
not alive to its signifiance, so long as they do not know the 
facts of child development, so long as they are ignorant of the 
danger points of the causes of increased susceptibility-just so 
long will the children both of this generation and the next 
suffer." (5) 
Besides the opportunity for Health instruction in the 
schools-unrivalled as it is because of the permanency of the 
group and the regular occasions afforded for Health instruction 
in Reading and Composition lessons, through the use of films, 
Health games, nutritional class work, school lunches, domestic 
science, etc., there is a great opportunity, just beginning 
to be appreciated, for extended Health Service in our Children's 
Institutions. The permanent group, tragic as it may appear 
on account of the causes sending children to institutions, has a 
great deal in its favour from the point of view of group in- 
struction, periodic complete physical examination, weighing 
and measuring, close observation of gain after physical defects 29 
have been removed, and a careful adjustment of work, rest and 
play according to the individual needs of the child. A properly 
trained visiting dietitian or nurse could be used to advantage 
in this work under the direction of a competent physician by 
a small group of institutions, with the assured results of turn- 
ing out children fitter, physically at least, to cope with the 
calls made upon them in adult life than those found in 
many an individual home. This service will, I think, be a part 
of every up-to-date institution's work in the near future. 
While helping the child to become a healthy, happy, self- 
supporting and prosperous citizen, committees will be lessening 
the future charge on the community of thousands of incompe- 
tents such as are now to be found in our insane asylums and 
jails and on our streets. These people constitute a drag, a 
menace, a waste and a financial burden, and many of them are 
physically unfit and have been so since childhood. They repre- 
sent a veritable army of those who never had a Health 
chance! Institutions doing such Health work will also be fur- 
nishing the physical foundation without which educational 
advantages count for little-"Mens sana in corpore sano" is as 
true today as it was when a beautiful and healthy body was 
the aim of the ancient Greeks to harmonize with an equally 
beautiful and healthy mind. 
The greater advantage of the fixed group in schools and 
institutions has been felt by way of contrast in the Clinic 
follow-up work. The Clinic is not in daily intimate contact 
with the children and there is no compelling factor to make 
them come to Clinic or Class. By the very nature of these cir- 
cumstances we have had to look for our success to the 
effective service in Clinic and to the educative influence of the 
nurses in the homes-a far more difficult task, and one which, 
if done thoroughly, would require a large staff of nurses or 
Health visitors. For this reason-the lack of a fixed group to 
work with-we recognize that our Nutritional Class as such, 
has been a partial success only. The Head Nurse, who is em- 
ployed by the Fund from the Victorian order of Nurses, was 
sent in January 1920 to take a two weeks' Nutrition Course 
under Dr. Emerson in Boston, and profited greatly by the expe- 
rience. On her return she instituted a Nutrition Class 
composed of twenty to twenty-five of the worst cases in our 
large group of 299. The children's diet was carefully observed, 
their defects removed, new health habits formed, while special 
stress was laid on rest periods and extra lunches. Some of 
the children were taken from school in order to be able to 
fulfil the rules imposed. Encouraging progress was noted in 
these as in many of our non-class children. Had the nurse 
been able to spend most of her time in looking after this group, 
or had the group been more regular in attendance, they might, 30 
doubtless, all have gone "over the top" of their normal weight 
line as illustrated in the individual chart presented, which 
shows the progress made from week to week by one of the 
class. 
The child of page 31 was described by his mother as 
being "always delicate and sickly". He was in third grade 
only and found even the work demanded in that early grade 
a burden. He had enlarged tonsils, adenoids, alveolar abscesses, 
three carious teeth, otitis media and conjunctivitis. He slept 
with a sickly adult in a room with windows closed - drank 
coffee and remained up until 10 P.M. These conditions were 
corrected and changed. The child has grown one inch, and 
has gone above his normal weight for height. His school 
work also is no longer a burden to him. (See his record form, 
page 8). 
In view of the relative non-success of our nutritional 
class and also of our stressing the greater value of home visit- 
ing, it is of interest to read the findings of B. B. Burritt of the 
New York Association for Improving the Condition of the 
Poor, who reported on the results of an intensive attack on 
Malnutrition made recently by the Association. Mr. Burritt 
says, "As a result of the work carried on thus far, the author 
feels that a nutrition class or clinic while very useful in the 
attack on Malnutrition, is only an incidental feature, and that 
the campaign if it is really to be preventive in character must 
be made on a group of children who are too young for the 
class method of treatment, and that the chief emphasis must 
be placed on the home." (9) 
In closing this section of the report, I quote in part, the 
stimulating words on the subject of Child Health of Mr. 
Herbert Hoover in his address at the eleventh annual 
meeting of the American Child Hygiene Association, 
held last October in St. Louis. Mr. Hoover said:-"Any study 
of the nutritional problem for children in the city quickly 
divides itself into malnutrition due to poverty and that due to 
ignorance on the part of the parents We have accepted the 
fact that we cannot as a nation rely for the upbuilding of the 
race upon the initiative of the parents alone-We, every one 
of us, pay the price in our jails, in our poorhouses, in our hos- 
pitals, in the loss of our economic efficiency, - the fertile 
ground that we furnish for all the social patent medicines, - 
for our failure to have grasped the entire problem of child 
development, not only intellectual but physical as well... After 
children have arrived at school age, we have opportunity to 
correct malnutrition due to ignorance or misfortune by pro- 
viding at least one meal a day in schools of those sections that 
need it. This has a warrant not in charity but in insurance 
to the whole community against the deficiencies in health and 
mind of our population in the years to come." 31 
t Tonsil and Adenoid operation. PART IV. 
"To make growth more perfect, 
life more vigorous, decay less rapid 
and death more remote." 
THE SOCIAL BACKGROUND 
The question of Housing bears heavily on our ex-soldier 
population as it does on the whole people of Canada. There 
are One Hundred and Twenty Thousand (120,000) houses in 
the City of Montreal to accommodate a population of approxi- 
mately Six Hundred and Forty Thousand (640,000) people. 
(Suburbs not included), (1918 City Hall Report). 
Of the 532 families bringing their 1000 children to the 
Patriotic Fund Health Clinic during the year,wehaveno records 
from 30 as to the number of Rooms or Houses rented. Of the re- 
maining 502 families we find the largest number, the median, 
using 4 rooms, the average being 4 plus for all the families. The 
greatest number of rooms in any house was 9 and the lowest 
1. Thirty-one families were living in 1 room each, a total of 
102 people; 14 of these families had 3 members, 6 had 4 and 
4 had 5 persons living in one room. Nineteen families were 
living in 2 rooms, a total of 82 persons. Two of these families 
had each 8 members, one had 6 persons and five had 5 in each 
family. We had 40 families with 7 members; 26 with eight; 
14 with 9; 6 with 10; 3 with 11; 1 with 12; and 1 with 14. 
The family of 14 lived in 6 rooms. The family of 12 and two 
families of 11 lived each in 7 rooms, one family of 11 living 
in 5 rooms. 
We are told by our City Sanitary Engineer that of the 
120,000 houses in Montreal only 12.5 per cent are occupied by 
their owners. In one district (Notre Dame de Grace) 37% of 
the owners occupy their houses. The average density of the 
city population is 21 inhabitants to the acre. In St. Louis 
ward we have a density of 141 persons per acre. We find that 
there are in Montreal proper 5.3 persons per house. In 1907 
there were 3.7-New York has a density of 15.6 persons per 
house, Boston 9.2, Cambridge 7.2 and Los Angeles 4.6. 
While overcrowding bears an important relation to mortal- 
ity and morbidity rates, other causal factors, such as poverty 
and ignorance, contribute even more directly to community 
death and disease. In this connection we note that, despite its 
scattered population, Ahuntsic-Bordeaux ward with only three 33 
persons to the acre has the largest mortality in the city-20.2, 
while St. Louis Ward, the most densely populated, has a mor- 
tality of 12.5 (10). The story of overcrowding, however, 
emphasizes the health and moral handicaps under which so 
many of our people are living. Even with a comfortable 
income, many of our soldier's families have suffered on this 
account more or less consciously through a certain lowering of 
health habits and of standards of decency which is bound to 
tell in time on the growing and receptive children in the home. 
Only 9 of the 532 families owned their homes. Uncertain 
industrial conditions with a moving industrial population, the 
unsettling effect of the war, together with the cost of living 
may be responsible for this, but there does not seem to be the 
same attachment to the owned home here as there is in the 
Old Country, in spite of the fact that the largest number of 
our children were registered as children of English and 
Scottish parentage. 
Forty-two families gave no record of Rent; five lived rent 
free in exchange for services rendered. Of the remaining 485 
families we get an average monthly rental of $12.82 with a 
median of $10.00 in the first group of families which rose 
steadily through each succeeding group of 100 children, till for 
the tenth group we registered an average rental of $14.20 
with a median of $15.00. The lowest rent was $3.50 (for one 
room) and the highest $40.00. These are all rather below the 
average though ever-increasing rentals quoted in the "Labour 
Gazette" during the year 1919-20, when these families 
brought their children to clinic (page 34). It must be 
remembered, however, that the average accommodation quoted 
in the "Labour Gazette" is a six-roomed house, while the ave- 
rage accommodation for our families was 4 plus rooms. In very 
many instances, the neighbourhood and condition of the houses 
left much to be desired in the way of light, back yards, 
household conveniences, etc., all of which bear directly on the 
health, social, mental and physical, of the children. 
122 of the families did not report their Income. Of the 
remaining 410 families we have a record of as low as $10.00 
monthly and as high as $175.00. The income of this group of 
ex-soldiers' families was a most uncertain quality, due largely 
and directly to the effects of the war. Some of the ex-soldiers 
and widows were on pension, total or part, according to the 
degree of disability or to death due to service; some of them 
were on pay and allowances, if the ex-soldiers were taking 
treatment or training under the Soldiers' Civil Re-Establish- 
ment Department. Other men, who were getting treatment, 
were not on pay and allowances as the disability from which 
they suffered could not be traced to war service; the Patriotic 
Fund, in these cases, carried the families on a generous budget. 34 
AVERAGE RENT OF SIX-ROOMED HOUSES IN MONTREAL 
QUOTED FROM LABOUR GAZETTE OF THE 
LABOUR DEPARTMENT, OTTAWA 
With conveniences 
Without conveniences 
1919 
October 
$14.00 to $18.00 
$12.00 to $13.00 
November 
14.00 to 18.00 
12.00 to 13 00 
December 
14.00 to 18.00 
12.00 to 13.00 
1920 
January 
$14.00 to $18 00 
$12.00 to $13.00 
February 
14.00 to 18.00 
12.00 to 13.00 
March 
14.00 to 18.00 
12.00 to 13.00 
April 
14.00 to 18.00 
12.00 to 13.00 
May 
14 00 to 18.00 
12.00 to 13.00 
June 
18.00 to 25.00 
13.00 to 18 00 
July- 
18.00 to 33.00 
13.00 to |8.00 
August 
18.00 to 25.00 
13.00 to 18.00 
September 
18.00 to 25.00 
13 00 to 20.00 
October 
18 00 to 25.00 
13.00 to 18.00 
Many ex-soldiers, out of work, were doing odd jobs and not 
earning a living wage for themselves or for their families. 
Many of the women did not know what their men earned. The 
uncertainty of the times, war restlessness, strikes, lockouts, 
poor home management, loafing, illness and mental defect 
were all immediate causes for the irregularity or absence of 
income in many of the homes, the economic factor bearing 
directly on the health of the whole family and particularly on 
that of the children. If there was not enough food to go round, 
the wage earner would, more often than not, get first share 
in order to keep up his strength, and the children would go 
hungry, or mothers would take work outside the home with 
the consequent danger of neglect of the children. One need 
only refer to the startling studies made by the Child Labour 
Bureau, Washington, (2), to learn in a convincing way how 
infantile mortality increases as the income goes down, and as 
women go out to work to supplement the insufficient earnings 
of the home. (See Chart, page 35). Continued low incomes 
furnish a sure index of a high death rate and of lowered 
vitality and increased ill health particularly among children. 
Schemes for Unemployment Insurance, some forms of 
which are in force in a few private business concerns, in many 
Labour Unions and as Government measures in twelve Europe- 
an countries (11), are linked up definitely with the social and 35 
INFANT MORTALITY RATES, 
ACCORDING TO FATHERS' EARNINGS. 
COMBINED FIGURES FROM SEVEN CITIES STUDIED BY U. S. CHILDREN'S BUREAU. 
170 
160 
150 
140 
130 
120 
IIO 
100 
90 
80 
70 
60 
0 
Under $450 
$4501« $549 
$5501» $649 
$650 to $849 
$850 to $1049 
BI050to$l249 
1250 and Oven 
The babg death rate rises 
as the fathers' earnings' fall. 
CHILDREN'S BUREAU, U. 5. DEPARTMENT OF LABORS. 
industrial changes now going on in Canada and in the rest of 
the world. The Canadian Governments-Federal, Provincial 
or local-have not formulated any plans as yet covering insur- 
ance for ill health and old age, nor have they made any 
attempt to cope with the problem of unemployment, 
which promises to assume acute proportions, both seasonal 
and cyclical, in the not distant future. It is true that 
a very splendid Federal Insurance provision is now 36 
working for all ex-soldiers and their dependents, that our 
Canadian Pensions are the most generous in the world, and 
that the placement systems of both the Soldiers' Civil Reestab- 
lishment Department and the Employment Service of Canada 
are admirable in their plan and efficiency,-but these aids, to 
minimize the effects of the war and the present lack of work, do 
not actually meet the problem of unemployment, and no place- 
ment system can cover the demands for work when factories 
close down and hands are turned off by the hundreds and 
thousands and no work is to be had. General industrial de- 
pression reacts directly on the Health of the people and parti- 
cularly on that of the children. If we are ever to be an A. 1, 
nation physically, we must take speedy measures, govern- 
mental and voluntary, to prevent our deteriorating into a 
Class-3 population. Unemployment, for nine tenths of the 
people, spells poverty. Poverty is father of ill health. Poverty 
and ill health in their vicious circle mean national unrest and 
danger. The present situation offers an opportunity to lay 
the foundations for the establishment of the means for hand- 
ling the problem of unemployment not only in the present but 
in the future. We can no longer afford to take for granted 
the seasonal and cyclical recurrences of business depression. 
We should make organized effort to anticipate these conditions, 
and to minimize by every sound social means in our power the 
hardship, suffering and ill health they inevitably cause. In 
this way only can we surely build the health foundation on 
which the wealth and happiness of our people ultimately 
depend. 
The incidence of defects according to Nationality (table 
on page 37) varies from 5.2 in the small group of Belgian 
children (9) to 7.1 in the Italians. The largest groups, 
English, English-Canadian and French-Canadian, vary little 
from 6.3 to 6.4 and 6.7 respectively. The third column indi- 
cates the total number of children living in the family groups 
and the fourth the number dead. The succeeding columns, 
showing the number of miscarriages and still-births, are away 
below the actual facts, as the records here were incomplete, the 
importance of obtaining this special information not being 
realized by an early recorder. The data, however, together 
with the number of previous diseases (2561) indicates the 
great field for preventive health work and lifesaving service 
that lies open to all Child Health workers on every hand. There 
is no strong evidence that children of any special race are 
more susceptible to special diseases than are other children. 
Racial or age predisposition to disease often really resolves 
itself into increased opportunities for infection, and lessened 
resistance because of unsanitary homes or insufficient food, 
etc. 37 
NATIONALITY 
Totals 
Miscellaneous ....... 
English Canadian.... 
French Canadian .... 
French Reservist.... 
Belgian Reservist.... 
Italian Reservist 
3 
r 
n 
% 
1 0 
3* 
Enodish 
s 
hC 
205 
61 
15 
4 
76 
107 
15 
! 
24 
IB 
Families 
5 
418 
114 
28 
9 
120 
212 
26 
9 
38 
26 
Total number 
children examined 
1630 
668 
164 
54 
18 
236 
333 
33 
12 
55 
57 
Number of 
children living 
CO 
Oi 
107 
30 
18 
3 
41 
129 
13 
2 
23 
9 
Number of 
children dead 
K) 
CO 
42 
5 
4 
2 
13 
47 
1 
4 
5 
0 
Miscarriages 
16 
4 
0 
0 
3 
11 
0 
0 
0 
0 
Still-births 
to 
36 
14 
5 
1 
12 
19 
6 
1 
4 
4 
Father dead 
Mother dead 
O o O 1-' O to C O " o 
Both parents dead 
- 
60 
20 
6 
] 
23 
52 
1 3 
3 
4 
5 
Father ill 
- 
33 
9 
4 
2 
11 
38 
0 
1 
6 
1 
Mother ill 
2561 
1113 
290 
71 
20 
316 
527 
70 
22 
74 
58 
Number of 
previons diseases 
6404 
2643 
664 
178 
56 
770 
1429 
175 
47 
272 
17C 
Number of 
present defects 
6.3 
5.6 
6.4 
6.1 
6.4 
6.7 
6.7 
5.2 
7.1 
6.5 
% Defects 
School inspection of an adequate character, where an 
ample budget provides a sufficient staff of doctors and nurses, 
and where these public servants have high-class training, 
might have prevented a large number of previous diseases 
(2561) and present defects (6404) from which our children 
of school age suffered together with the runabout children of 
from two to five years. 
Warm lunches in schools are now being given in over 90 
cities and in 21 States of the United States as well as in some 
rural schools in 9 States. If these were provided more 
generally in selected Canadian schools, an immediate improve- 
ment should be noticed in the health and mental alertness of 
the pupils. Open air classes and organized athletics and 
recreation give definite returns in health. Children who are 
malnourished and those who have had bad postural habits 
regain their tone and condition, both mental and physical, 
when attention is regularly paid to these important health 
factors. 
There can be no doubt as to the salutary effect of prenatal 38 
work on the Health of early infancy and of mothers in child- 
birth. Wherever any intensive work has been done, as in 
New Zealand, England, New York and Boston, clearcut results 
have been obtained, the mortality being reduced more than 
one-half. Montreal has a long way to go in reducing its infantile 
mortality which, in 1918, stood at 191.5 per 1000 births. 
With proper prenatal care, breast feeding and efficient 
medical and nursing attention at the time of confinement, 
many deaths of children (375), many miscarriages and still- 
births (157), and many deaths (17) and illnesses of mothers 
(105) might have been prevented. 
"With frequent and regular medical and nursing inspection 
in the Home, at Health Centres and Baby Welfare Clinics, the 
babies and pre-school children of this group need not have 
suffered from so many preventable previous diseases (2561). 
(See Chart, page 39). 
The large number of fathers dead (102) and ill (187) 
suggests the effects of the war on these families through the 
temporary or permanent loss of the breadwinner. The finan- 
cial difficulty has been partly met in many cases by Govern- 
ment provision of Pension or Allowance, or by allowances from 
the Patriotic Fund. All ex-soldier fathers in ill health and 
out of work, however, are not entitled to Pension or treatment 
unless their disability can be traced to War Service. In these 
cases a percentage allowance from the Fund based on the per- 
centage of the non-pensionable disability, 25 to 50 or 75 per 
cent as the case may be, is not enough to cover the family needs 
and to ensure the maintenance of Health. The problem, 
economic and social, of the sub-standard man not on pension 
and not drawing Unemployment or Health Insurance is'one 
that will have to be faced in the near future. These men are not 
wanted in industry where they clog the wheels of production. 
If they are to maintain their 50 or 75 per cent health standard, 
they are able to produce in part time only. Part time and light 
jobs are few and far between. Wives and children cannot be 
supported on them. Unless some form of subsidized workshops 
or Insurance is soon developed to cover the needs of these 
worthy, self-respecting and suffering people, we are going to 
multiply the numbers of our paupers^ fill our institutions with 
non-productive charges and fail signally in preventive work 
along Child Welfare and other lines. 
Homes broken by the loss of the mother (17) or handi- 
capped by the mother's serious illness (105) form an even 
more serious social problem from the point of view of the 
children's health, if they are not so serious from the angle of 
family income as are the homes suffering from the loss of the 
■breadwinning father. In the case of death or serious illness 
on the part of the mother, no financial subsidy can make up 39 
INFANT MORTALITY THERMOMETER. 
REATHS UNDER I YEAR OP AGE PER WOO D/RIND. 
HUNGARY 
CHILE, 
AUSTRIA 
GERMAN EL^^ 
SERBIA 
ITALY 
ERAAICE 
EHGLA/^^L^ 
NEW EEALAND 
RUSSIA 
MaHtresl • 1^18 
ROUMAMIA 
BULGARIA 
BELGIUM 
UMTED STATES 
wtzerlamd 
AUSTRALIA 
NR/ZEALANDLOPEDTEWER LADLED THAN ANY OTHER COWRY. 
RATES ADE FOE LATEST AM4II^4ELE YEARS UR TO LSUC. 
CHILDREN'^ EUREALT, (L.J. DEPARTMENT Of.LAEOR. 
for the loss of all that constitutes a mother's thoughtful, 
loving, patient care of her children. Preventive health work 
for the children's sake as well as for the sake of the mothers 
must, therefore, reach back to the last generation as well as 
forward to the next. It must be as broad as the health needs of 
Humanity, the humanity of the present and the future, and as 
intensive as opportunity and the child and man and woman 
will afford! In this way, and in this way only, will the race, 
marching forward on the feet of little children, carry with 
it a vision of the Nations beautiful, strong and healthy 
which are to be! REFERENCES 
1. "Malnutrition and Health Education" - David Mitchell, 
New York Bureau of Educational Experiments. 
2. "Infant Mortality in Relation to Income" - Children's 
Bureau, Labor Department, Washington. 
3. A Nutrition Clinic"-Wm. R. P. Emerson, M.D., Boston, 
Mass. 
4. "A Group Study of the Results of One Hundred Physical 
and Mental Examinations of so-called well children" - 
Wm. R. P. Emerson, M.D., Boston, Mass. 
J 
5. "The Psychology of Childhood"-Norsworthy and Whit- 
ney, Columbia University, New York. 
6. "Health Essentials for Rural School Children" - Dr. 
Thos. D. Wood, New York. 
7. "Osler-"Lancet" - October 21st, 1902. 
8. Dr. Julius Levy, - "The Undernourished Child of Pre- 
School Age"-New Jersey State Board of Health. 
9. B. B. Burritt, "Survey" June 19th, 1920. 
10. Mr. Aime Cousineau, City Hall, Montreal. 
11. Mr. Bryce M. Stewart, Employment Service Council, 
Labour Department, Ottawa, Canada.