CHAPTER V

THE EFFECT OF SCHOOL MEALS ON THE CHILDREN

Since the causes of malnutrition are so many and diverse it is obvious that this defect cannot be remedied or prevented solely by the provision of school meals. But that the provision of wholesome food at regular hours has a marked effect in the improvement of the physique of the children, there is abundant evidence.

Unfortunately, though the periodic weighing of children who are receiving school meals, in order to ascertain the effect produced, has been strongly advocated by the Chief Medical Officer of the Board of Education,[488] this advice has rarely been acted upon. It is true that a few--a very few--Education Authorities profess to have a system of weighing children who are receiving meals, before they are put on, and after they are taken off, the feeding-list, but for the most part this weighing is only done spasmodically, and the records are not accessible.

Footnote 488:

Report of the Chief Medical Officer of the Board of Education for 1911, p. 286.

Several such enquiries have, however, been made in the past, the best known being that made by Dr. Ralph Crowley at Bradford in 1907.[489] The results of this experiment have been often quoted, but they are so important that they will bear repetition. Forty children were selected from two of the poorest schools in the city, the children being mainly those who appeared to be most in need of food, though a few were included primarily on the ground of their particularly poor home circumstances.[490] To these children from April 17 to July 24 two meals a day were given--breakfast, consisting of oatmeal porridge with milk and treacle followed by bread and margarine or dripping, with hot or cold milk to drink; and a dinner comprising in rotation one of seventeen different menus specially drawn up so as to contain the amounts of fat and proteid necessary for a child's nourishment.[491] Every effort was made to render the meals of as much educational value as possible, and special attention was given to such matters as the provision of table-cloths and flowers and the inculcation of good manners.

Footnote 489:

Bradford Education Committee, Report on a Course of Meals given to necessitous children from April to July, 1907.

Footnote 490:

_Ibid._, p. 3.

Footnote 491:

_Ibid._, pp. 4, 5.

The children experimented on were weighed three times during the five weeks preceding the starting of the meals, and every week while they were receiving them. For the purpose of making comparative observations 69 children were selected who were being fed at home, and who in other respects were as comparable as possible with those who were receiving the breakfasts and dinners. These "control children" were also weighed weekly. During the four weeks, March 12 to April 9, before the feeding began, the forty children gained on an average .17 kilos, and during the week previous to feeding .008 kilos. At the end of the first week of feeding the average increase was found to be .58 kilos (1 lb. 4 oz.).[492] During the next week, there was a slight loss of .001 kilos, followed by a gain during the next two weeks of .15 and .13 kilos respectively. During the ensuing eleven days, the Whitsuntide holiday, no meals were given. At the end of this period it was found that the "control children" who, during the three weeks preceding the holiday, had lost .003 kilos on the average, had during these eleven days gained an average of .23 kilos; in the case, however, of the children fed at school, not only had the lack of food neutralised the benefits of fresh air and exercise, but they had actually lost an average of .48 kilos, a loss which it took them nearly a fortnight to make up, after the meals had been started again. During the eleven days after the holiday the "control children" only gained .02 kilos. A group of "control children" from another school similarly gained .21 kilos during the holiday, and only .04 kilos during the subsequent fortnight. The same result was observed during the five weeks' summer holiday; the "control children" gained on an average .37 kilos (_i.e._, at the rate of .074 kilos per week), while the children fed at school lost .46 kilos.[493] The accompanying chart illustrates the rate of increase of the two groups of children. Apart from the increase in weight, the improvement in the general appearance and carriage of the children who received the meals "was more or less apparent in all, and very obvious in some of the children, who visibly filled out and brightened up."[494] The reverse process was equally apparent after the summer holidays.

Footnote 492:

"The average gain per year of children of this class and size," Dr. Crowley points out, "is not more than two kilos (4 lbs. 6 oz.) for the whole year." (_Ibid._, p. 9.)

Footnote 493:

_Ibid._, pp. 9-11. As Dr. Crowley points out, several points have to be considered in interpreting the effect on weight. "The increase in the weight of children normally varies greatly at different seasons of the year," and "at any given season fluctuates much, sometimes, comparatively, even from week to week. The proportional increase in weight varies with the age of the child, or rather with the weight to which the child has already attained." (_Ibid._, p. 8.)

Footnote 494:

_Ibid._, p. 8.

[Illustration: Chart illustrating the average gain or loss in weight--during the intervals shown--of the children who were fed at Bradford. The broken line shows the average increase in weight--during the same time--of the "Control Children."]

At Northampton, in 1909, a similar experiment was conducted under the supervision of the Medical Officer of Health. Forty-four children were given breakfast and dinner for fourteen weeks, and weighed weekly, together with forty children of the same social class who were not receiving meals. At the beginning of the experiment the average weight of the fed children was 1.71 kilos less than that of the "controls"; in the second week their average gain was much greater, and by the end of the fourteenth week the difference in weight was reduced to 1.02 kilos. During the Easter holidays of ten days in which no meals were given, the children who had previously been fed lost in weight while the "controls" gained.[495]

Footnote 495:

Report on the Working of the Education (Provision of Meals) Act up to March 31, 1909, pp. 14-15.

Another interesting experiment was conducted by Dr. Haden Guest in a poor school in Lambeth in the early part of 1908.[496] A large number of children were selected--244--but the attendance of many of these was irregular and continuous records were obtained in the case of only 89 children. From January 24 to April 11 a midday meal was given six days a week. The meal consisted of two courses, a normal portion of which was calculated to be sufficient to supply the amounts of proteids, carbohydrates, fats and salts, physiologically necessary for children. The same meal was never given twice in succession, a variation of six menus being repeated over twelve consecutive days. The room in which the meals were served was bright and airy, the surroundings having, in Dr. Guest's estimation, an important physiological bearing on good digestion. All the children in the school were weighed before and after the experiment and again in the first week of July, the children who were receiving dinners being also weighed regularly during the experiment. Taking first the case of the elder children, we read that the results "showed a very decided and positive improvement both from the general standpoint and from that of increase in weight, the fed children increasing at a more rapid rate than the other children in the school with whom they were compared."[497] "Starting a good deal below the normal of their own school mates, they tended, under the influence of one good meal a day, rapidly to approach that normal." And again, "the increase in the healthy appearance of the children and in their general alertness was marked. Children with sores, small abscesses, colds and blepharitis recovered from these ailments.... The amount of absence from school due to illness was considerably less during the course of the experiment." This testimony was fully borne out by the headmaster. "The effect of the feeding of the children," he declared, "is a marked improvement judging from the general appearance of the boys, who are almost all brighter. The improvement is particularly noticeable in their play. They are more vigorous and enter more heartily into the rougher games of boys and bear the knocks without coming to the teacher to complain. They certainly enjoy their play more and show less fatigue. There are few lads shivering against the walls with hands in pockets, sloping shoulders and pale faces. In school, the effect during the first few weeks was drowsiness. This was succeeded by improved tone and greater independence of character, and generally a greater individuality. The difference in mental condition is not so marked, and is certainly more difficult to measure. There is less fatigue in lessons, and the lads are capable of more continuous exertion." The teachers' reports on the girls were of the same character, though not so decided in tone, except on one point--that those who were fed were "more troublesome," that is to say, more full of spirits, a factor which appeared also in their play. Turning to the effect of the meals on the infants a most disquieting state of affairs was disclosed. It was found that, while the weight of the infants who were fed was less than that of the other infants of their own school, "the difference was much less than in the case of the bigger children, the increase in weight in each case correspondingly slow, and the amount by which both groups fell below the normal greater." During the first week there was a remarkable fall in weight among the infants who received meals, ascribable partly to the fact that they did not receive the necessary attention which was afterwards given them, partly to the fact that they were unfamiliar with good nourishing food (a factor operating in the case of the elder children also, though to a far less degree[498]); largely, however, it was due to their being "actually unable to digest and assimilate this food." This slow progress on the part of the infants Dr. Guest attributed to improper feeding at home. In most Lambeth homes the younger children received the same diet (the staple articles being tea and bread and butter) as the older ones, but whereas the latter could manage on this diet, and, with a good midday meal in addition, even flourish, the former could not thrive. Dr. Guest therefore advocated that necessitous infants should be fed at least twice a day, on a diet different from that given to the elder children, and that more individual care should be devoted to each child, since in most cases they required coaxing before they would eat the wholesome food provided.

Footnote 496:

MS. Report on Lambeth School Children Feeding Experiment, by Dr. L. Haden Guest, 1908.

Footnote 497:

We have, unfortunately, not been able to obtain a copy of the figures on which Dr. Haden Guest's report is based.

Footnote 498:

In the case of the boys, their weights, during this week, only increased a little; those of the girls remained stationary.

On the cessation of the meals we find the same result ensuing as we have already noticed at Bradford and Northampton. For when, in July, 1908, three months after the meals had been discontinued, all the children were again weighed and measured, it was found that there was a general decline in weight; the decline was so general that it was obviously due

## partly to a diminution in clothing, but "the necessitous children, who

after the conclusion of the experiment were only fed spasmodically, show a greater decrease than the other children, pointing to either a stationary weight during the twelve weeks from April to July or a loss of weight."

Interesting figures as to the effects of different dietaries were obtained at Sheffield in 1910. Before this date the meals provided for necessitous children had taken the form of cocoa breakfasts. As an experiment at one school some of the boys were given porridge for several weeks. Their weights were compared with those of a group of other boys who were receiving cocoa breakfasts at school, and also with a group of boys who were being fed at home. The two groups of boys who were fed at school were drawn from equally poor districts, those who were fed at home being somewhat better off. It was found that the boys who were receiving cocoa breakfasts only gained on an average .0451 kilos or 1.58 oz. per week; the boys who were being fed at home gained .0594 kilos (2.09 oz.); while the boys who were receiving porridge breakfasts gained as much as .0942 kilos (3.317 oz.). As a result of this proof of the superiority of porridge diet, porridge breakfasts were substituted for cocoa breakfasts in all the schools.[499]

Footnote 499:

Report of Chief School Medical Officer for Sheffield for 1910, pp. 26-27. We may quote here striking results observed in the improved physique of the children at a special school for cripple children in London consequent on an improved dietary. A two-course dinner of meat, potatoes and pudding had been previously given, but in the summer of 1901 it was decided to provide a more liberal and varied dietary, _e.g._, more hot meat, eggs, milk, cream, vegetables and fruit. The results were soon apparent. "Partially paralysed children," writes Mrs. Humphry Ward a few months after the change, "have been recovering strength in hands and limbs with greater rapidity than before. A child who, last year, often could not walk at all from rickets and extreme delicacy and seemed to be fading away, and who in May was still languid and feeble, is now racing about in the garden on his crutches; a boy who last year could only crawl on his hands and feet is now rapidly and steadily learning to walk, and so on.... Hardly any child now wants to lie down during school time, whereas applications to lie down used to be common, and the children both learn and remember better." (Letter from Mrs. Humphry Ward, _The Times_, September 26, 1901.)

At Brighton it has for the last few years been the practice to weigh before and after the course of meals the children who have been recommended for feeding on medical grounds. At the end of the last session, 1912-13, 269 children who had received meals for nine weeks or more were thus re-examined. It was found that 133 of these, or 50 per cent., no longer needed meals on medical grounds, that is, they had been brought over the average weight for a given height.[500]

Footnote 500:

Brighton Education Committee, Report on the re-examination of children receiving free meals during the winter session, 1912-13.

Where only milk or codliver oil is given a remarkable improvement is often effected. Indeed, several teachers told us that in their opinion the provision of milk was more beneficial than either breakfasts or dinners. At a Bethnal Green school, during the winter of 1909-10, it was found that out of 57 boys and 109 girls examined at the medical inspection, 24 of the boys and 61 of the girls were underfed. These children were given a tea-spoonful of codliver oil in a cupful of warm milk every day during the morning interval. At the end of the year the nutrition was re-assessed, with the following results:--[501]

Footnote 501:

Annual Report of London County Council for 1910, Vol. III., p. 130.

Good. Average. Bad. 57 boys Before 4 19 34 After 26 28 3 109 girls Before 3 49 57 After 42 61 6

The results of these experiments are sufficient in themselves to establish conclusively the benefit to be derived from regular feeding even when no other factor in the child's environment is changed. "No doubt," says Dr. Haden Guest, "irregular and late hours, disturbed sleep, overcrowding, improper clothing and employment of children after and before school hours, do each and all exercise a very detrimental effect on the children of poor parents. But that the greatest influence for evil is exerted by improper and insufficient food is a matter over which it appears impossible to have great controversy."[502]

Footnote 502:

MS. Report by Dr. L. Haden Guest on Lambeth School Children Feeding Experiment, 1908.

And these results are corroborated by abundant testimony from School Medical Officers, teachers, Care Committee workers and others, of the benefit derived by the children where the Provision of Meals Act has been put in force. "The children derived an enormous amount of benefit" from the meals.[503] "The physical appearance of the children speaks in pronounced terms" of the value of feeding.[504] "Those who have any practical experience ... are all agreed that such meals [free breakfasts] are of the greatest value, not only from a humanitarian point of view but also as a necessary adjunct for successful education."[505] "There is continuous evidence of the immense benefit conferred upon the children by the administration of this Act--both from the inspection of the scholars at the dining-centres and from the reports of the teachers."[506] These are a few typical opinions culled from reports of School Medical Officers. At Manchester "the operation of the provision of free meals acts very largely ... not so much in the way of improving the physical condition of children already emaciated and debilitated, but of preventing their ever reaching that condition by stepping in when the home income fails. It is certain that since the organisation of the supply of free meals at centres covering practically all parts of the city where they are required, _the number of underfed children_--_i.e._, the number showing signs of underfeeding--_has decreased markedly_. It is also certain that the type of child at the feeding centres is gradually improving--_i.e._, there are fewer children found in the centres with signs of the result of bad nourishment, and there are fewer such children in the schools."[507] At Bradford, where the Local Education Authority has systematically endeavoured to effect an improvement in the condition of the children both by the school medical service and the provision of meals, there has been in the last few years a very marked improvement in nutrition and "a fairly regular increase in weight amongst Bradford children as a whole. They are approaching nearer each year to the national average."[508]

Footnote 503:

Report of School Medical Officer for Macclesfield for 1911, p. 18.

Footnote 504:

_Ibid._ for Workington for 1911, p. viii.

Footnote 505:

_Ibid._ for Hastings for 1911, p. 14.

Footnote 506:

Report of School Medical Officer for Newcastle-on-Tyne for 1910, p. 49.

Footnote 507:

Report of School Medical Officer for Manchester for 1911, pp. 256-7. In the following year he reports that out of over four hundred children attending eight feeding centres, only ten cases of markedly bad nourishment were recorded. (_Ibid._ for 1912, p. 31.)

Footnote 508:

_The Health and Physique of School Children_, by Arthur Greenwood, 1913, pp. 65, 66. "It may perhaps be urged," he continues, "that this progress is purely accidental; but a close examination of a large number of school medical officers' reports does not show any general increase during the few years for which records are available. There are variations from year to year, of course, but no apparent regular improvement, except in isolated instances, of which Bradford is one." (_Ibid._, p. 65.)

The witness of the teachers is no less favourable. In London, for instance, the Education Committee in 1910 made enquiries among the head teachers of some of the schools where a considerable number of meals were provided; the majority of the teachers were enthusiastic as to the benefit derived. "Physical progress is most marked," said one headmistress. "The disappearance of chronic headaches, sores on faces, gatherings on fingers, pains in chest ... point to a more 'fit' condition, which the children can only express for me by saying that they 'feel better now,' for they 'are not hungry all the afternoons now.'"[509] And a headmaster writes, "The change in the children after a month's provision of suitable and nourishing diet for breakfast and dinner has been distinctly beneficial. They have been more inclined to take part in the school sports, into which they have entered with considerable zest. Their appearance, too, has greatly improved. Their eyes have become brighter, their cheeks rounded. If, for any reason, such as temporary absence, they have lost the advantage of regular feeding, they have almost immediately shown signs of deterioration. When the period [of feeding] has been prolonged to three or six months, their health has permanently improved, and their capacity for work and play has still further developed."[510] "The children on the necessitous register," says another headmaster, "now fully participate in these

## activities [games and sports] and supply rather above their

proportionate number of prominent performers; this is equally true of swimming. It is indisputable that in the past lack of nourishment, where it did not entirely exclude, greatly limited the part taken by many children in this the most attractive side of school life."[511]

Footnote 509:

Annual Report of the London County Council for 1910,