• TABLE OF CONTENTS
HIDE
 Front Cover
 Front Matter
 Figure 1. Percentage distribution...
 Selection of the school
 Procedure
 Physical examinations
 Standards and methods
 Dietary pattern
 Experimental results
 Discussion
 Summary
 Literature cited














Group Title: Bulletin - University of Florida. Agricultural Experiment Station ; no. 426
Title: Effectiveness of the school lunch in improving the nutritional status of school children
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00015138/00001
 Material Information
Title: Effectiveness of the school lunch in improving the nutritional status of school children
Series Title: Bulletin University of Florida. Agricultural Experiment Station
Physical Description: 32 p. : charts ; 23 cm.
Language: English
Creator: Abbott, O. D ( Ouida Davis ), b. 1892
Publisher: University of Florida Agricultural Experiment Station
Place of Publication: Gainesville Fla
Publication Date: 1946
 Subjects
Subject: School children -- Food -- Florida   ( lcsh )
Children -- Nutrition   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Bibliography: Bibliography: p. 32.
Statement of Responsibility: by O.D. Abbott ... et al..
General Note: Cover title.
Funding: Bulletin (University of Florida. Agricultural Experiment Station)
 Record Information
Bibliographic ID: UF00015138
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 000925497
oclc - 18253388
notis - AEN6148

Table of Contents
    Front Cover
        Page 1
    Front Matter
        Page 2
        Page 3
    Figure 1. Percentage distribution by sex of the children with reference to the degree classification of nutritional diseases
        Page 4
    Selection of the school
        Page 5
    Procedure
        Page 6
    Physical examinations
        Page 6
        Page 7
    Standards and methods
        Page 7
        Page 8
        Page 9
    Dietary pattern
        Page 10
        Page 11
        Page 12
    Experimental results
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
    Discussion
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
    Summary
        Page 31
    Literature cited
        Page 32
Full Text



November, 1946


UNIVERSITY OF FLORIDA
AGRICULTURAL EXPERIMENT STATION
HAROLD MOWRY, Director
GAINESVILLE, FLORIDA










EFFECTIVENESS OF
THE SCHOOL LUNCH IN IMPROVING
THE NUTRITIONAL STATUS
OF SCHOOL CHILDREN

By
O. D. ABBOTT, RUTH O. TOWNSEND,
R. B. FRENCH and C. F. AHMANN














Single copies free to Florida residents upon request to
AGRICULTURAL EXPERIMENT STATION
GAINESVILLE, FLORIDA


Bulletin 426









BOARD OF CONTROL


J. Thos. Gurney, Chairman, Orlahdo
N. B. Jordan, Quincy
Thos. W. Bryant, Lakeland
M. L. Mershon, Miami
J. Henson Markham, Jacksonville
J. T. Diamond, Secretary, Tallahassee




EXECUTIVE STAFF

John J. Tigert, M.A., LL.D., President of the
University3
H. Harold Hume, D.Sc., Provost for Agricul-
ture
Harold Mowry, M.S.A., Director
L. O. Gratz, Ph.D., Asst. Dir., Research
W. M. Fifield, M.S., Asst. Dir., Admin.
J. Francis Cooper, M.S.A., Editors
Clyde Beale, A.B.J., Associate Editors
Jefferson Thomas, Assistant Editors
Ida Keeling Cresap, Librarian
Ruby Newhall, Administrative Managers
K. H. Graham, LL.D., Business Managers
Claranelle Alderman, Accountants




MAIN STATION, GAINESVILLE


AGRONOMY

W. E. Stokes, M.S., Agronomist'
Fred H. Hull, Ph.D., Agronomist
G. E. Ritchey, M.S., Agronomist'
G. B. Killinger, Ph.D., Agronomist
W. A. Carver, Ph.D., Associate
H. C. Harris, Ph.D., Associate
Fred A. Clark, B.S., Assistant




ANIMAL INDUSTRY

A. L. Shealy, D.V.M., An. Industrialist' '
R. B. Becker, Ph.D., Dairy Husbandmans
E. L. Fouts, Ph.D., Dairy Technologists
D. A. Sanders, D.V.M., Veterinarian
M. W. Emmel, D.V.M., Veterinarians
L. E. Swanson, D.V.M., Parasitologist
N. R. Mehrhof, M.Agr., Poultry Husb.S
G. K. Davis, Ph.D., Animal Nutritionist
R. S. Glasscock, Ph.D., An. Husbandman
P. T. Di:: Arnold, M.S.A., Asst. Dairy Hush.'
C. L. Comar, Ph.D., Asso. Biochemist
L. E. Mull, M.S., Asst. in Dairy Tech.
Katherine Boney, B.S., Asst. Chem.
J. C. Driggers, B.S.A., Asst. Poultry Husb.
Glenn Van Ness, D.V.M., Asso. Poultry
Pathologist
John S. Folks, B.S.A., Asst. An. Husb.
W. R. Krienke, M.S.A., Asso. Dairy Mfrs.


ECONOMICS, AGRICULTURAL

C. V. Noble, Ph.D., Agri. Economist1
Zach Savage, M.S.A., Associates
A. H. Spurlock, M.S.A., Associate
D. E. Alleger, M.S., Associate
D. L. Brooke, M.S.A., Associate

Orlando, Florida (Cooperative USDA)
G. Norman Rose, B.S., Asso. Agr. Economist
J. C. Townsend, Jr., B.S.A., Agr. Statistician'
J. B. Owens, B.S.A., Agr. Statisticians


ECONOMICS, HOME

Ouida D. Abbott, Ph.D., Home Econ.1
R. B. French, Ph.D., Biochemist

ENTOMOLOGY

A. N. Tissot, Ph.D., Entomologist and Act-
ing Head of Dept.
H. E. Bratley, M.S.A., Assistant


HORTICULTURE

G. H. Blackmon, M.S.A., Horticulturist1
A. L. Stahl, Ph.D., Asso. Horticulturist
F. S. Jamison, Ph.D., Truck Hort.
Byron E. Janes, Ph.D., Asso. Hort.
R. A. Dennison, Ph.D., Asso. Hort.
R. K. Showalter, M.S., Asso. Hort.
R. J. Wilmot, M.S.A., Asst. Hort.
R. D. Dickey, M.S.A., Asst. Hort.
Victor F. Nettles, M.S.A., Asst. Hort.
F. S. Lagasse, Ph.D., Asso. Hort.2


PLANT PATHOLOGY

W. B. Tisdale, Ph.D., Plant Pathologist'
Phares Decker, Ph.D., Asso. Plant Path.
Erdman West, M.S., Mycologist and Botanist
Lillian E. Arnold, M.S., Asst. Botanist


SOILS

F. B. Smith, Ph.D., Chemist' 3
Gaylord M. Volk, Ph.D., Chemist
J. R. Henderson, M.S.A., Soil Technologist
J. R. Neller, Ph.D., Soils Chemist
Nathan Gammon, Jr., Ph.D., Soils Chemist
C. E. Bell, Ph.D., Associate Chemist
L. H. Rogers, Ph.D., Associate Biochemist
R. A. Carrigan, B.S., Asso. Biochemist
H. W. Winsor, B.S.A., Assistant Chemist
Gee. D. Thornton, M.S., Asst. Microbiologist'
R. E. Caldwell, M.S.A., Asst. Soil Surveyor
Wade McCall, B.S., Asst. Chemist
J. B. Cromartie, B.S.A., Asst. Soil Surveyor


1 Head of Department.
2 In cooperation with U. S. D. A.
3 Cooperative, other divisions; U. of F.
*In Military Service.
On leave.










BRANCH STATIONS


NORTH FLORIDA STATION, QUINCY

J. D. Warner, M.S., Vice-Director in Charge
R. R. Kincaid, Ph.D., Plant Pathologist
W. H. Chapman, M.S., Asso. Agron.
R. C. Bond, M.S.A., Asso. Agronomist
L. G. Thompson, Ph.D., Soils Chemist
Frank D. Baker, Jr., B.S., Asst. An. Hush.



Mobile Unit, Monticello
R. W. Wallace, B.S., Associate Agronomist



Mobile Unit, Marianna
R. W. Lipscomb, M.S., Associate Agronomist



Mobile Unit, Wewahitchka
J. B. White, B.S.A., Associate Agronomist



CITRUS STATION, LAKE ALFRED

A. F. Camp, Ph.D., Vice-Director in Charge
V. C. Jamison, Ph.D., Soils Chemist
W. L. Thompson, B.S., Entomologist
J. T. Griffiths, Ph.D., Entomologist
R. F. Suit, Ph.D., Plant Pathologist
E. P. Ducharme, M.S., Plant Pathologist2
J. E. Benedict, B.S., Horticulturist
B. R. Fudge, Ph.D., Associate Chemist
C. R. Stearns, Jr., B.S.A., Asso. Chemist
James K. Colehour, M.S., Research Chemist
T. W. Young, Ph.D., Asso. Horticulturist
J. W. Sites, M.S.A., Asso. Horticulturist
H. O. Sterling, B.S., Asst. Horticulturist
J. A. Granger, B.S.A., Asst. Horticulturist
H. J. Reitz, M.S., Asso. Plant Path.
Francine Fisher, M.S., Asso. P1. Path.



EVERGLADES STA., BELLE GLADE

R. V. Allison, Ph.D., Vice-Director in Charge
J. W. Wilson, Sc.D., Entomologist
F. D. Stevens, B.S., Sugarcane Agron.
Thomas Bregger, Ph.D., Sugarcane
Physiologist
B. S. Clayton, B.S.C.E., Drainage Eng.2
W. D. Wylie, Ph.D., Entomologist
W. T. Forsee, Jr., Ph.D., Asso. Chemist
R. W. Kidder, M.S., Asst. An. Hush.
T. C. Erwin, Assistant Chemist
R. A. Bair, Ph.D., Asst. Agronomist
C. C. Seale, Asst. Agronomist
L. O. Payne, B.S.A., Asst. Agronomist
Russel Desrosiers. M.S., Asst. Plant Path.
N. C. Hayslip, B.S.A., Asst. Hort.


SUB-TROPICAL STA., HOMESTEAD

Geo. D. Ruehle, Ph.D., Vice-Director in
Charge
H. I. Borders, M.S., Asso. Plant Path.5
D. O. Wolfenbarger, Ph.D., Asso. Ento-
mologist
R. W. Harkness, Ph.D., Asst. Chemist


W. CENT. FLA. STA., BROOKSVILLE

Clement D. Gordon, Ph.D., Poultry Geneticist
in Charge2


RANGE CATTLE STATION, ONA

W. G. Kirk, Ph.D.. Vice-Director in'Charge
E. M. Hodges, Ph.D., Associate Agronomist
D. W. Jones, B.S.A., Asst. An. Hush.
E. R. Felton. B.S.A.. Asst. An. Hush.


CENTRAL FLORIDA STATION, SANFORD
R. W. Ruprecht, Ph.D., Chemist in Charge
A. Alfred Foster, Ph.D., Asso. Hort.
J. C. Russell, M.S., Asst. Entomologist
Ben F. Whitner, Jr., B.S., Asst. Hort.



FIELD STATIONS

Leesburg
G. K. Parris, Ph.D., Plant Path. in Charge

Plant City
A. N. Brooks, Ph.D., Plant Pathologist

Hastings
A. H. Eddins, Ph.D., Plant Pathologist
E. N. McCubbin, Ph.D., Truck Horticulturist

Monticello
S. O. Hill, B.S., Asst. Entomologist2
A. M. Phillips, B.S., Asst. Entomologist2

Bradenton
J. R. Beckenbach, Ph.D., Horticulturist in
Charge
E. G. Kelsheimer, Ph.D., Entomologist
David G. Kelbert, Asso. Horticulturist
E. L. Spencer, Ph.D., Soils Chemist
Robert O. Magie, Ph.D., Hort., Glad. Inv.
Donald S. Burgis, M.S.A., Asst. Hort.

Lakeland
Warren O. Johnson, Meteorologist2

1 Head of Department.
2 In cooperation with U. S.
3 Cooperative, other divisions, U. of F.
SIn Military Service.
6 On leave.











Per-
cent
60

90

40

30

20

10





70


SHgmplobin Levels


3 2 1 0 4 3 2 1 0
Fig. 1.-Percentage distribution by sex of the children
with reference to the degree classification of nutritional
diseases. Numerals 0, 1, 2, 3, 4 at the base indicate the
degree classification of the conditions observed as defined
under methods. See also Fig. 2.


I I I I


Boys B


Girls A


/
I, "42
'i


' '45


I I I I








EFFECTIVENESS OF THE SCHOOL LUNCH IN
IMPROVING THE NUTRITIONAL STATUS
OF SCHOOL CHILDREN

By O. D. ABBOTT, RUTH O. TOWNSEND,1
R. B. FRENCH and C. F. AHMANN 2

CONTENTS
Page Page
Selection of Data for General
Selection of the School .. ........... .............. 5 Treatment ..................................... .. 15
Procedure ......................................... 6 Degree Classification of Prevalent
Physical Examinations ........................ 6 Nutritional Diseases .......................... 16
Standards and Methods ........................... 7 Grid Patines ............................................. 23
Dietary Pattern ............................. ......... 10 Variation in Average Hemoglobin
Prenaring and Serving the Noon Values ................................................ ..... 24
Lu-ch .................................................... 12 D discussion .......................... .. ....................... 26
Exper m ental Pe-u'ts ................................... 13 Summary ............... ......... .......................... 31
Initial Physical Examination ............... 13 Literature Cited .......................................... 32

Since 1930, when results of the first nutritional survey (6)3
made by the Department of Home Economics of the Florida
Agricultural Experiment Station showed the malnourished con-
dition of rural white children in 5 counties in Florida, publica-
tions (1, 2, 3, 4, 5) have emphasized the fact that malnutrition
is still present and constitutes a major health problem.
During the depression the condition of the under-fed and mis-
fed children throughout the United States was brought to the
attention of the Nation. Finding remedial measures became a
problem of first order. The school lunch was offered as an
alleviating measure. Instituted in a crisis, it now appears to
have become a permanent part of the public school system.
The object of this investigation was to study the effectiveness
of the school lunch in improving the nutritional status of school
children.

SELECTION OF THE SCHOOL

In selecting the location of the cooperating school the follow-
ing prerequisites were considered advisable: (1) The school
should be strictly rural, without a lunch room, and in a section
where problems in nutrition were known to exist. (2) The com-
munity should offer full cooperation. (3) A large proportion of
the patrons should be property owners-insuring a fairly stable
school enrollment.

ACKNOWLEDGMENTS.-The authors are indebted to the American
Dry Milk Institute for financial support during this 5-year study and to
the Florida Citrus Commission for citrus fruits during 1941-42.
SRegistered nurse, formerly Assistant in Home Economics.
2Practicing physician and consultant for the project.
SItalic figures in parentheses refer to Literature Cited.







Florida Agricultural Experiment Station


A small school meeting the requirements was located in the
north central part of the state, about 14 miles from the county
seat and 6 miles from a paved highway. Predominant soil types
of the district were Norfolk, Leon and Portsmouth sand and fine
sand. About 80 farm families lived in the community; nearly
3/ of them were farm owners or tenants of long standing. The
principal crops were tobacco, peanuts, corn and hogs. Staple
foods were the chief items bought; each farm produced most
of the other foods. Nutritional deficiencies occurred among the
cattle and except for isolated spots and a small area along a
river, were county-wide. A cursory examination revealed that
nutritional deficiencies also occurred among the children.

PROCEDURE
The study of the effect of a well-balanced school lunch on
health and development of children began in September, 1940,
and continued through April, 1945. From the initiation of this
study until the close of the school year, April, 1944, the school
lunch was planned and prepared under the direct supervision
of the Assistant in Home Economics, a registered nurse with
special training in dietetics. Changes in the staff at the begin-
ning of the fifth year made it impossible to continue the program
as planned. From October, 1944, through April, 1945, the pur-
chase .of the food and the supervision and management of the
lunch room of necessity were carried on locally. The authors
continued to plan the menus, to provide the recipes and to give
physical examinations.

PHYSICAL EXAMINATIONS
While the primary interest in this study was in the indica-
tions of nutritional deficiencies, the examinations given at the
beginning and end of the school year consisted of inspections
and tests for changes which might have come not only as the
result of food deficiencies but also from bacterial infections or
from changes where the etiology was not well understood. Dur-
ing the first year an effort was made to alleviate or cure all
defects that might inhibit or obscure the effectiveness of the
feeding program. Thus, 2 children were fitted with glasses,4
8 had tonsillectomies,4 and 10 were examined by a heart special-
ist who prescribed treatments. Children with hookworm,

By L. L. Smith, M.D., Valdosta, Georgia.
SBy L. S. Lafitte, M.D., Jacksonville, Florida.







Florida Agricultural Experiment Station


A small school meeting the requirements was located in the
north central part of the state, about 14 miles from the county
seat and 6 miles from a paved highway. Predominant soil types
of the district were Norfolk, Leon and Portsmouth sand and fine
sand. About 80 farm families lived in the community; nearly
3/ of them were farm owners or tenants of long standing. The
principal crops were tobacco, peanuts, corn and hogs. Staple
foods were the chief items bought; each farm produced most
of the other foods. Nutritional deficiencies occurred among the
cattle and except for isolated spots and a small area along a
river, were county-wide. A cursory examination revealed that
nutritional deficiencies also occurred among the children.

PROCEDURE
The study of the effect of a well-balanced school lunch on
health and development of children began in September, 1940,
and continued through April, 1945. From the initiation of this
study until the close of the school year, April, 1944, the school
lunch was planned and prepared under the direct supervision
of the Assistant in Home Economics, a registered nurse with
special training in dietetics. Changes in the staff at the begin-
ning of the fifth year made it impossible to continue the program
as planned. From October, 1944, through April, 1945, the pur-
chase .of the food and the supervision and management of the
lunch room of necessity were carried on locally. The authors
continued to plan the menus, to provide the recipes and to give
physical examinations.

PHYSICAL EXAMINATIONS
While the primary interest in this study was in the indica-
tions of nutritional deficiencies, the examinations given at the
beginning and end of the school year consisted of inspections
and tests for changes which might have come not only as the
result of food deficiencies but also from bacterial infections or
from changes where the etiology was not well understood. Dur-
ing the first year an effort was made to alleviate or cure all
defects that might inhibit or obscure the effectiveness of the
feeding program. Thus, 2 children were fitted with glasses,4
8 had tonsillectomies,4 and 10 were examined by a heart special-
ist who prescribed treatments. Children with hookworm,

By L. L. Smith, M.D., Valdosta, Georgia.
SBy L. S. Lafitte, M.D., Jacksonville, Florida.







Effectiveness of the School Lunch


chronic otitis and such skin defects as ringworm, impetigo and
boils were given specific medication at school. In most cases,
cures were effected in a few months and thereafter minor ills
were treated as they occurred. Children with severe colds and
sore throats or those with symptoms of contagious diseases were
sent home until the danger of spreading infection had passed.

STANDARDS AND METHODS
When possible, uniform standards and methods were used.
In any malnourished condition, non-specific and specific indicators
are recognized. Non-specific symptoms such as loss of appetite,
apathy, slow mental reactions, and drawn and wrinkled skin are,
regardless of cause, more or less common in nutritional ill health.
Specific and characteristic changes in particular organs and
tissues have been accepted as a basis for diagnosis of a deficiency
in any 1 food factor. In the following classification the degree
of severity of deficiency disease has been given a numerical
rating: 0, normal; 1, subnormal; 2, mild; 3, moderate; 4, severe.
Further, this degree classification has been associated with pro-
gressive changes in a tissue caused by a mounting deficiency.
The specific criteria are outlined under blood, eyes, skin, hair,
gums and lips.
Blood.-The routine examination of the blood consisted of
hemoglobin determinations, total erythrocyte counts and micro-
scopic studies of erythrocytes in stained smears. Peripheral
blood was used in all determinations.
The concentration of hemoglobin was determined by a Fisher
electro-hemometer; total erythrocytes by microscopic examina-
tion using a Levy-Hausser counting chamber; and abnormal
variation in size and in shape of erythrocytes by microscopic
examination of blood smears stained with Wright's stain.
Several more or less arbitrary ranges of hemoglobin have been
designated as follows:
0. Normal-hemoglobin values above 13.6 gm. per 100 cubic
ml. of blood.
1. Subnormal-11.4 to 13.6 gm. hemoglobin.
2. Mild anemia-9 to 11.4 gm. hemoglobin.
3. Moderate anemia-6.1 to 9 gm. hemoglobin, reduced red
cell count (less than 4 million), irregularities in size and shape.
4. Severe anemia-below 6.1 gm. hemoglobin; basophilic de-
generation and'the appearance of crescent or ghost cells.
Eyes, Skin and Hair.-Although a deficiency in vitamin A has







Effectiveness of the School Lunch


chronic otitis and such skin defects as ringworm, impetigo and
boils were given specific medication at school. In most cases,
cures were effected in a few months and thereafter minor ills
were treated as they occurred. Children with severe colds and
sore throats or those with symptoms of contagious diseases were
sent home until the danger of spreading infection had passed.

STANDARDS AND METHODS
When possible, uniform standards and methods were used.
In any malnourished condition, non-specific and specific indicators
are recognized. Non-specific symptoms such as loss of appetite,
apathy, slow mental reactions, and drawn and wrinkled skin are,
regardless of cause, more or less common in nutritional ill health.
Specific and characteristic changes in particular organs and
tissues have been accepted as a basis for diagnosis of a deficiency
in any 1 food factor. In the following classification the degree
of severity of deficiency disease has been given a numerical
rating: 0, normal; 1, subnormal; 2, mild; 3, moderate; 4, severe.
Further, this degree classification has been associated with pro-
gressive changes in a tissue caused by a mounting deficiency.
The specific criteria are outlined under blood, eyes, skin, hair,
gums and lips.
Blood.-The routine examination of the blood consisted of
hemoglobin determinations, total erythrocyte counts and micro-
scopic studies of erythrocytes in stained smears. Peripheral
blood was used in all determinations.
The concentration of hemoglobin was determined by a Fisher
electro-hemometer; total erythrocytes by microscopic examina-
tion using a Levy-Hausser counting chamber; and abnormal
variation in size and in shape of erythrocytes by microscopic
examination of blood smears stained with Wright's stain.
Several more or less arbitrary ranges of hemoglobin have been
designated as follows:
0. Normal-hemoglobin values above 13.6 gm. per 100 cubic
ml. of blood.
1. Subnormal-11.4 to 13.6 gm. hemoglobin.
2. Mild anemia-9 to 11.4 gm. hemoglobin.
3. Moderate anemia-6.1 to 9 gm. hemoglobin, reduced red
cell count (less than 4 million), irregularities in size and shape.
4. Severe anemia-below 6.1 gm. hemoglobin; basophilic de-
generation and'the appearance of crescent or ghost cells.
Eyes, Skin and Hair.-Although a deficiency in vitamin A has







Florida Agricultural Experiment Station


been shown to affect many organs and tissues, changes in the
eyes, skin and hair have been accepted as the basis for clinical
diagnosis of avitaminosis A.
The degree of conjunctival involvement was designated as
follows:
0. Healthy conjunctiva, eyes clear and bright.
1. Any slight departure from normal, either in color or thick-
ness of the conjunctiva or in the dullness of the sclera.
2. Definite injection of the capillaries in the conjunctiva, ir-
ritation and redness.
3. Marked injection of the conjunctiva, granulation and local
folliculation.
4. Acute injection of the conjunctiva, edema, Bitot spots and
extensive folliculation.
Specific changes in the skin and hair were classed as follows:
0. Healthy skin and hair.
1. Both skin and hair tend to be dry and rough.
2. Dry skin with associated roughness and desquamation
especially noticeable on the extensor surface of the arms and
legs, across the chest and shoulders. Hair very dry and stiff
(staring).
3. Extensive desquamation and xerosis, with popular erup-
tions about the pilosebaceous and hair follicles.
4. In addition to the above, follicular keratosis and extreme
xerosis and atrophy of the skin.
Gums.-While scurvy represents the acute and fully developed
case of vitamin C deficiency, frequent and early indications of
this deficiency are to be seen in the gums.
The following conditions were noted in assessing the status
of the gingival tissues:
0. Healthy gums.
1. Slight congestion in the gingiva.
2. Puffy gingiva, associated with hemorrhagic manifestations
and recessions.
3. Gingiva rolled in the interproximal spaces and along the
marginal spaces with bleeding and color changes from a bright
to a purplish red.
4. In addition to the above, a breakdown of the supporting
structures causing a loosening of the teeth, often associated with
secondary infections and hematoma.
Lips.-Clinical evidence of a riboflavin deficiency appears to
be confined primarily to certain parts of the face and head.







Effectiveness of the School Lunch


Since the clinical evidence of this deficiency was quite pro-
nounced on the lips, the condition of the lips was classified as
follows:
0. Lips healthy.
1. Epithelium red and thinning.
2. Epithelium quite red, shining and wrinkled.
3. Epithelium swelled and scaling, often accompanied by
angular stomatitis.
4. Epithelium cracked and bleeding, lesions at the angles of
the mouth white and macerated.
Heart Defects.-The heart was examined by means of a
stethoscope and the radial pulse. In cases of severe or unusual
symptoms the child was taken to a heart specialist for further
diagnosis.
Skeletal and Tooth Defects.-Manifestations of abnormal cal-
cium and phosphorus metabolism are shown in the skeletal out-
line. Skeletal defects were determined by examination of the
following:
Chest: Observations were made as to formation of the chest
such as prominent, hollow, pigeon-breasted, and as to beaded
ribs and scaphoid sternums.
Extremities: The extremities were examined for such ab-
normalities as knock-knee, bow-leg, club-foot and flat feet.
Spine: The spine was checked for curvature and lordosis.
Head: Observations were made as to the prominence of the
parietal bones.
Teeth: Examination of the teeth was made by the cooperat-
ing dentist 6 of the Bureau of Dental Health, Florida State
Board of Health, who noted the general condition of the teeth,
such as chalky, unclean, malocclusions, number extracted or
needing extraction and number carious.
Bacterial Infections.-In addition to nutritional deficiency dis-
eases, bacterial infections also were present and were factors
contributing to ill health. The nose, skin, ears and glands were
the parts usually infected. Observations were made for colds
and for chronic discharges from nose and throat.
Skin: The skin was examined for acne,. impetigo, boils and
other infections.
Ears: The ears were examined for discharge and otitis.
Tonsils: The condition of the tonsils was classified as follows:
0. Healthy tonsils, normal in color, size and shape.
SD. H. Turner, D.D.S.







Florida Agricultural Experiment Station


1. Enlarged tonsils.
2. Moderate enlargement with accompanying systemic in-
fection.
3. In addition to the above, enlarged submaxillary glands,
and a history of repeated attacks of tonsillitis.
4. Diseased tonsils showing cheesy plugs.
Lymph Glands: The cervical and axillary glands were exam-
ined for enlargement. The gland was considered enlarged when
it was easily palpable.
Parasites.-Specimens of feces were obtained from nearly all
of the children. These were sent to the laboratory of the Florida
State Board of Health, where they were examined for intestinal
parasites.
Height and Weight Relations.-A measuring stick reading in
inches and fractions thereof was used in determining height.
This measure was stationary and a square could be moved up
and down the scale. In preparation for the determination of
height, the child removed his shoes, stood erect with arms hang-
ing naturally at his sides, heels together, with the back of his
head against the measure. The square was then brought down
firmly to the top of the head and the reading made to the nearest
1/4 inch.
All weighing were made on the same balance which was
examined daily for inaccuracies and adjusted if necessary. The
child removed his shoes and outer clothing, stepped on the bal-
ance and the weight was read to the nearest 1/2 pound.
After weight and height measurements were made, the chan-
nel of given body type on an age schedule specific for the subject
was determined on a grid. The grid devised by N. C. Wetzel,
M.D. (8) of the Babies' and Children's Hospital and of Western
Reserve University, Cleveland, Ohio, consists of a set of cali-
brated standards. By the use of these standards, growth, de-
velopment, physique, nutritional grade, age advancement and
other items can be separated and depicted graphically from the
data on weight, height and age alone.

DIETARY PATTERN
In planning the special feeding program, it was evident from
the beginning that a well balanced and adequate lunch should
be served. If best results were to be expected, this lunch should
be planned according to optimal standards, and furnish at least
the minimal daily allowances of essential food factors. Later







Effectiveness of the School Lunch


when the War Food Administration issued the diet pattern for
the 3 types of school lunches it was found that the complete
Type A lunch was comparable in all essential food factors to
the lunch served in this special feeding program. It was recog-
nized that in cases of severe malnutrition response to a good
diet is apt to be slow. Therefore, when hemoglobin values were
below 8 grams, supplementary iron was given and when clinical
evidence of severe vitamin A or C deficiencies (classed as 4 under
methods) was detected, supplements of these vitamins were
given. This supplementation was carried out until the child
approached the median nutritional level of his group and such
supplementation was seldom necessary after the first year. The
diet pattern used in this study was as follows:


Food Items
Milk (1 pint daily--/2 pint as beverage) .......
Eggs ............. ................................ ......
Meat ................................. ...... ...... ......
Legumes, cheese or fish ....................................
Citrus fruit ............................................ ......
Other fruit ......... ..................... .......................
D ried fruit ............................. ................................
Tomatoes ................................................ .......
Raw vegetables .................................................
Cooked vegetables .................................................
Potatoes ............................................................
Bread (2 to 3 times daily) ..................................
Dessert ......... ...... ................................
Butter or fortified margarine .........................


Times Served
Per Week
5
3 to 5
3
2
3
2
3
2
5
5
3
5
5
5


It was estimated that with average servings and with the
supplementary foods a lunch planned according to the above
pattern would furnish the following constituents daily:


Calories '..............1,500
Protein ............. 60 to 70gm.
Calcium .............. 0.5 to 0.6 gm.
Phosphorus ........ 0.5 to 0.6 gm.
Iron ..................... 8.5 mg.


Vitamin A ............4,000 I.U.
Thiamine ............ 0.75 to 1 mg.
Riboflavin ............ 0.90 to 1 mg.
Ascorbic acid ...... 50 to 60 mg.


In preparing the daily menu that would provide these con-
stituents, a wide range of foods was included. During the first
4 years of this study much of the food served came through the
government's direct marketing and distribution program, of
which the school lunch was a part. Foods coming through this
channel were of many kinds, from many sections and processed
in various ways. During the last year of the study less food
came through government channels and more from local sources.
The main food groups and their sources were as follows:







Florida Agricultural Experiment Station


Fruits.-Oranges, grapefruit (both canned and fresh), tan-
gerines, lemons and limes were used. Some of these fruits came
from Texas and California but mainly from several sections of
Florida. Other fruits used included: Apples from Washington,
Oregon and Virginia; pears and persimmons from the school
district; bananas from Central America; pineapples from Cuba;
and dried fruit from California.
Meat.-Much of the beef, veal and lamb was purchased from
neighboring counties, the remainder from local sources. Fresh
pork was produced within the county and bacon came through
the distribution program.
Milk and Butter.-As there were no dairies in the county,
little or no fresh milk was used. The milk requirement was met
by the use of dry milk solids and evaporated milk. Milk bever-
ages were prepared by reconstituting these products. In 1940-41
butter was scarce; but during 1941-42 considerable butter came
through the distribution program; thereafter small quantities
were bought from local sources and through local stores. The
larger part of the table fat was furnished by fortified margarine.
Vegetables.-With the exception of canned vegetables, po-
tatoes, cabbage and carrots, which for a time came through
government channels, all vegetables were grown within the state.
Turnip and mustard greens, collards, sweet potatoes, field peas
and other vegetables in season were grown in the school district.
Bread.-Beginning in 1942 all breads were made with enriched
white flour or with whole wheat flour; the corn bread for the
most part from locally ground meal.
PREPARING AND SERVING THE NOON LUNCH
Contrary to popular belief, malnourished children have very
poor appetites and their food consumption is much below recom-
mended standards for children of school age. As a consequence,
the first problem of major importance was to get the children
to eat. The problem was attacked from several angles.
One of the means used to induce higher food consumption was
to increase the nutritive value of all recipes to the limit of
acceptable food practices. As supplementary foods, dry milk
solids, eggs and butter were the foods used in greatest abund-
ance. In this way a small quantity of food had a high nutritive
value.
Another way was to serve appetizers in addition to the regular
meal. These consisted of bowls of mixed raw vegetables-







Effectiveness of the School Lunch


radishes, onions, cabbage, turnips, celery, tomatoes, parsley and
any other vegetables that could be served raw. By serving a
mixture of vegetables, a child was able to find something he
liked. Fresh or dried fruits were given the children as they
left the lunch room.
For extremely malnourished children mid-morning and mid-
afternoon lunches were served. In the morning the supplement
was usually fruit, as this would not dull the appetite for the
noon lunch; in the afternoon, something left from the lunch.
As the appetite improved, food consumption increased and
foods in wider variety were eaten. Special meals also proved
of value in increasing food consumption. On days before holi-
days the local Parent-Teacher's Association assisted with the
preparation of special lunches.
In introducing new foods the Supervisor explained to the
children what they were, why they should be eaten and urged
each one to eat his portion. Classes in nutrition and food
demonstration were held at the school to familiarize parents with
the preparation of new foods and new ways of cooking the com-
mon ones.

EXPERIMENTAL RESULTS
INITIAL PHYSICAL EXAMINATION
At the initiation of this study, September, 1940, there were
204 pupils enrolled in the school. .Because of parental objection
and removal from the district, only 186 children had the pre-
scribed examinations as outlined under methods. The results
of these examinations are given in Table 1. The data show
the incidence of defects or diseases in all children examined.
The prevalent ones were caries, defective tonsils and diseases
of nutritional origin: approximately 90 percent of the group
had gingivitis, 71 percent anemia, 71 percent conjunctivitis, 64
percent cheilosis and angular stomatitis, and 63 percent skeletal
defects. Heart defects which, because of association with
anemia, were classed with the deficiency diseases, were found in
22 percent of the children. Nearly 77 percent of the group had
some degree of tonsil involvement, 54 percent had chronic colds
and 37 percent had otitis and discharging ears. Other defects
such as enlarged cervical glands and minor skin infections were
found in a smaller but quite significant incidence.
The examination for internal parasites made for the authors
by the laboratory of the Florida State Board of Health showed







Florida Agricultural Experiment Station


TABLE 1.-PREVALENCE OF DEFECTS OR DISEASES AS FOUND AT THE INITIAL
EXAMINATION OF 186 CHILDREN, SEPTEMBER, 1940.

Both Sexes Boys Girls
Num- Per- Num- Per- Num- Per-
ber cent her cent ber cent

Total enrollment ................... 204 100 107 52.4 97 47.6
Complete examination ........-... 186 100 103 55.4 83 44.6
Defects or diseases
Anemia .................................. 133 71.5 76 73.8 57 68.7
Functional heart defects.... 41 22.0 21 20.4 20 24.1
Follicular conjunctivitis ... 133 71.5 75 72.8 58 69.9
Gingivitis .............................. 168 90.3 97 94.2 71 85.5
Skin defects ... ................... 131 70.4 75 72.8 56 67.5
Cheilosis and angular
stomatitis .......................... 119 63.9 69 66.9 50 60.2
Staring hair ......................... 126 67.7 70 68.0 56 67.5
Skeletal defects ........-........... 117 62.9 62 60.2 55 66.3
Carious teeth ........................-- 154 82.8 90 87.4 64 77.1
Malocclusions .----......-............. 9 4.8 6 5.8 3 3.6
Otitis and discharging ears 68 36.6 36 35.0 32 38.6
Enlarged and diseased
tonsils ............ .....-----... 143 76.8 82 79.6 61 73.5
Enlarged cervical glands .. 25 13.4 10 9.7 15 18.1
Colds ...--....----.. ......----.. 101 54.3 49 47.6 52 62.7
Impetigo ...-.......... .. -- ---- 10 5.4 8 7.7 2 2.4
Infected sores ....-.............. 17 9.1 10 9.7 7 8.4
Acne ..........................-----............ 15 8.1 12 11.7 3 3.6
Hookworm .--.....................------... 62 33.3 36 35.0 26 31.3
_ _ I .1 _


that about 1/ of the children
infestation.


had some degree of'hookworm


While the differences in the percentages of boys and girls
affected with the above defects or diseases were for the most
part not very great, in general, the percentages of boys were
higher than those of the girls. There were, however, some ex-
ceptions. The girls had the higher percentages of heart defects,
enlarged cervical glands and skeletal defects. Attention is called
to the nearly identical percentages of children with anemia,
conjunctivitis, dry, stiff hair, and rough, dry skin.
By plotting height, weight and age on the grid, comparative
data on the physical status and developmental age of the chil-
dren were obtained. These data are summarized in Table 2.
According to body build determined by height-weight relations,
53.8 percent of the children were classed as good, 23.2 percent
as fair, 12.9 percent as borderline, 4.8 percent as poor, and 5.3
percent as stocky and obese. Variations in percentage distribu-







Effectiveness of the School Lunch


tion between girls and boys in both good and fair classifications
were slight, and 77 percent of the children were in these classes.

TABLE 2.-PHYSICAL STATUS AND DEVELOPMENTAL AGE OF 186 CHILDREN
IN THE SCHOOL, SEPTEMBER, 1940.

Both Sexes Boys Girls
Num- Per- Num- Per- Num- Per-
ber cent ber cent ber cent
Physical status
Good ..................................... 100 53.8 57 55.4 43 51.8
Fair ........................................ 43 23.2 23 22.3 20 24.1
Borderline ............................ 24 12.9 17 16.5 7 8.4
Poor ........................................ 9 4.8 4 3.9 5 6.0
Stocky ............................... .. 6 3.2 2 1.9 4 4.8
Obese ......... ......................... 4 2.1 0 4 4.8
Developmental age
Normal .............................. 12 6.5 7 6.8 5 6.0
Retarded less than 1 year.. 60 32.2 36 35.0 24 28.9
Retarded from 1 to 2 years 37 19.9 16 15.5 21 25.3
Retarded more than 2 years 33 17.7 12 11.7 21 25.3
Advanced less than 1 year 24 12.9 19 18.4 5 6.0
Advanced from 1 to 2 years 16 8.6 11 10.7 5 6.0
Advanced more than 2 years 4 2.2 2 1.9 2 2.4


The grid also gives data on the age at which the children
of a given height and weight arrive at any developmental level.
It is shown that in 6.5 percent of the cases the chronological
and developmental ages coincide; in 32.2 percent the develop-
mental age was retarded by less than a year, and in 12.9 percent
it was advanced less than a year. It will be noted that nearly
20 percent of the children were retarded from 1 to 2 years, while
only about 9 percent were advanced to the same extent. Also
17.7 percent of the group were retarded more than 2 years, while
only 2.2 percent were advanced more than 2 years. Percentages
of boys with advanced developmental ages were considerably
higher than those of girls.

SELECTION OF DATA FOR GENERAL TREATMENT
Ninety-four of the pupils ate regularly in the lunch room for
4 years and 82 were present throughout the entire experimental
period of 5 years. Certain data on these pupils were chosen for
exhaustive treatment. Results of the examination in 1940 con-
stitute a base line and are used for comparison with those ob-
tained at the end of the school years 1942, 1944 and 1945. That







Florida Agricultural Experiment Station


environmental conditions during the course of the experiment
had not improved over the base of 1940 is shown in Table 3,
which presents the results of the examination of the children
of 6 years of age who entered the school at the beginning of
each school year.
In the following presentations, data for 1941 and 1943 proved
to be intermediate and were omitted from the graphs.

TABLE 3.-NUTRITIONAL STATUS OF CHILDREN AT THE AGE OF 6 YEARS
ENTERING SCHOOL DURING THE COURSE OF THE EXPERIMENT.

Year .................. 1940 1 1941 1942 1943 1944
Number of I
SChildren ........ 25 22 35 24 17
SPer-I Per- I Per- Per- I Per-
No. cent No. cent I No. cent No. I cent No. cent
Anemia ............ 24 96.0 21 95.5 31 88.6 22 91.7 9 52.9
Conjunctivitis 21 84.01 17 77.3 30 85.7 14 58.3 14 82.4
II I
Gingivitis .....-- 19 76.01 16 72.7 29 82.8 18 75.0 12 70.6
Cheilosis and
angular
stomatitis 18 72.0 16 72.7 28 80.0 18 75.0 12 70.6

DISTRIBUTION OF CHILDREN WITH REFERENCE TO DEGREE
CLASSIFICATION OF PREVALENT NUTRITIONAL DISEASES
The percentage distribution of children with reference to the
degree classification of the prevalent nutritional diseases or de-
fects is given in Figures 1 and 2 and in Table 4. These data
present certain effective results of the special noon lunch.
The changes are presented graphically as distribution curves
with intervals representing the degree of clinical deficiency as
outlined under methods. Separate curves for girls and boys are
presented for level of hemoglobin and condition of the con-
junctiva, the gingiva, the lips and the skin.
In all cases the principal effect of the lunch room feeding
noted in this presentation is the shift from the norm distribution
around a pronounced clinical deficiency to a norm around a con-
dition of sufficiency.
. The base norm for 1940 for hemoglobin (Fig. 1 A and B)
shows a distribution around a greater degree of deficiency than
do the other base norms (Fig. 1 C, D, E, F and Fig. 2 A, B, C, D);
In 1945 the hemoglobin curve, unlike the rest, suffered a sharp
shift to a distribution around a lower norm.








Effectiveness of the School Lunch

rollicular ConIunctivitie
T- -7 I I


Girls A


145
'14a

/ 140
*/


-/ I
**" / \ .,


4 3 2 1 0


Boys B



4 114
7/ -



.40


/ s
,' *' *


3 2 1 0


Fig. 2.-Percentage distribution by sex of the children
with reference to the degree classification of nutritional
diseases and tonsillar defects. Numerals 0, 1, 2, 3, 4 at
the base indicate the degree classification of the condi-
tions observed as defined under methods.


Per-
cent
60

50

40

30

20

10





0T

60

50

40

30

20

10




70

60

50
40

30

20

10

0


Tonsil Defects

Girls E Boys F



A A
- -




,// '
: ;;: / V ^ M .440
",.



I I I I I I I I-


I I I .. .








Florida Agricultural Experiment Station


TABLE 4.-PERCENTAGE DISTRIBUTION BY SEX OF THE CHILDREN WITH
REFERENCE TO THE DEGREE CLASSIFICATION OF NUTRITIONAL DISEASES AND
TONSILLAR DEFECTS.

Degree of
Deficiency .... 4 3 2 1 0
ITotall I Per- I Per-- Per- Per-[ I Per-
Year I No. cent No. Icent No. I cent | No. I cent No. I cent
HEMOGLOBIN VALUES


3 5



3 6


31 53
3 5
1 2
3 6

24 49
1 2


9
14
6
12

11
13
10
7


16 71 12 8
24 14 24 27
11 15 28 31
25 27 55 7

23 9 18 2
27 12 24 .23
24 10 24 21
21 14 43 12


FOLLICULAR CONJUNCTIVITIS


1940
1942
1944
1945

1940
1942
1944
1945


F '3
F 2
F -
F -

M 5
M 1
M 1
M -


1940 58 F 8
1942 58 F 1
1944 53 F 2
1945 49 F -

1940 49 M 13
1942 49 M 1
1944 41 M 1
1945 33 M -


1940 58
1942 58
1944 53
1945 49

1940 49
1942 49
1944 41-
1945 33


3

1

3
--


5 8 14 23 40
L 3 5 10 17
- 6 11
- 4 8

) 12 24 11 23
! I 5 10 10 20
! 1 2 3 7
- 2 6

GINGIVITIS

13 22 18 31
3 5 11 19
S 2 4 9 17
1 2 9 18

12 24 14 29
3 6 8 16
2 5 5 12
3 9

SKIN-INFECTIONS


2
3

3

4
2
1
2


3
5

6

8
4
2
6


22
11
8
5

17
11
4
2


1940
1942
1944
1945

1940
1942
1944
1945


58
58
53
49

49
49
41
33


8 19
22 30
32 30
37 27

12 15
23 22
37 21
45 16


5
13
17
18

6
11
15
15




11
20
14
17

6
15
9
14




16
7
9
11
11
12
9
5


33
52
57
55

31
45
52
48.




14
40
49
45

8
45
59
49




26
64
66
61

29
49
66
73


19
34
26
35

12
31
22
42




28
12
17
23

22
25
22
15
I


8
23
26
22

4
22
24
16




15
37
35
30

14
24
27
24







Effectiveness of the School Lunch


TABLE 4.-PERCENTAGE DISTRIBUTION BY SEX OF THE CHILDREN WITH
REFERENCE TO THE DEGREE CLASSIFICATION OF NUTRITIONAL DISEASES AND
TONSILLAR DEFECTS-(Concluded).

Degree of I
Deficiency .... 4 I 3 2 1 0
Total Per- Per- I Per- Per- Per-
Year No. Sex No. cent No. cent I No. cent No. cent No. cent

CHEILOSIS AND ANGULAR STOMATITIS

1940 58 F 3 5 4 7 13 22 23 40 15 26
1942 58 F 3 5 10 17 19 33 26 45
1944 53 F 1 2 4 8 13 24 35 66
1945 49 F 1 2 2 4 5 10 11 23 30 61
1940 49 M 4 8 3 6 16 33 12 24 14 29
1942 49 M 2 4 11 22 11 22 25 52
1944 41 M 5 12 6 15 30 73
1945 33 M 5 15 8 24- 20 61

DEFECTIVE TONSILS

1940 58 F 8 14 5 8 19 33 '14 24 12 21
1942 58 F 3 5 6 10 26 45 8 14 15 26
1944 53 F 5 9 7 13 16 30 11 21 14 27
1940 49 M 8 16 8 16 22 45 8 16 3 7
1942 49 M 6 12 13 27 23 49 3 6 3 6
1944 41 M 5 12 1 5 12 22 54 5 12 4 10


Hemoglobin.-The yearly variation in distribution of girls and
boys in the several hemoglobin ranges is given in Fig. 1 A and B.
At the initial examination (1940) the percentages of both girls
and boys having hemoglobin values in the lowest 2 ranges varied
slightly and approximately 75 percent of the group had some
degree of anemia. In the highest or normal range there were
14 percent of the girls but only 4 percent of the boys.
At the examination made at the close of the school year 1942,
47 percent of both boys and girls had hemoglobin values in the
normal range, 24 percent had subnormal values, while the re-
mainder had some degree of anemia. However, there were no
children in the lowest range.
The distribution curves for 1944 sh6w the effect of the special
school lunch program for 2 additional years, or a total of 4 years.
At this time 59 percent of the girls and 52 percent of the boys
had normal values, 28 and 24 percent subnormal values, and
13 and 24 percent were still anemic. With the exception of 1
girl there were no children with hemoglobin values in the lowest







Florida Agricultural Experiment Station


2 ranges. It will be noted that thus far the blood picture of
the girls is somewhat better than that of the boys.
At the final examination (April, 1945) the percentage of girls
in the highest range was identical with that at the beginning of
the study; 14 percent now had normal hemoglobin values, 55
percent had subnormal values and 31 percent were anemic. On
the other hand, the percentage of boys in the highest range had
dropped to only 36 percent, 43 percent had subnormal values and
21 percent were anemic. While the percentages of children in
the normal range had decreased there were still no children
with hemoglobin values in the lowest range and very few in the
next lowest.
Follicular Conjunctivitis.-Figure 2 A and B give the percent-
age distribution of the sexes in regard to nutritional conjuncti-
vitis. The data show that in 1940 while there was little difference
in the percentage distribution of girls and boys in the highest or
normal range, the percentage of boys having extensive granu-
lation or folliculation was considerably higher than that of girls.
In 1942, 52 percent of the girls and 45 percent of the boys had
no indications of conjunctivitis; in 1944 the percentages were
57 and 52 percent, respectively. In 1945 there was a slight
decrease in the percentage of both boys and girls in the highest
range, but no children of either sex had a severe or even a
moderate degree of eye involvement.
Skin Defects.-Figure 2 C and D show the degree of skin
involvement during 1940, 1942, 1944 and 1945. In 1940 the
percentages of girls and boys with defects or diseases of the skin
associated with a vitamin A deficiency varied slightly. But
during 1942 the percentage of girls free from skin defects was
considerably higher than that of boys. Sixty-four percent of
the girls were in the highest grouping, only 49 percent of the
boys. However, at this time there were no children with severe
defects of the skin. At the close of the school year in 1945,
61 percent of the girls and 73 percent of the boys were now free
from skin defects associated with a deficiency of vitamin A.
Six percent of each group continued to show extensive desqua-
mation with popular eruptions, while the condition of the re-
mainder was classed as mild or subnormal.
Gingivitis.-Figure 1 C and D show the percentage distribu-
tion of the children in regard to the degree of gingivitis. In
1940 the percentages of boys in the lowest 2 ranges were higher
than those of the girls in the same ranges. While the girls have







Effectiveness of the School Lunch 21

a higher percentage in the highest or normal range than the
boys, only 14 percent of the girls and 8 percent of the boys
were in this group. But in 1942, while 2 percent of each group
continued to have severe gingivitis with a loosening of the sup-
porting structures, 40 percent of the girls and 45 percent of the
boys had healthy gums. The percentage of children in this group
continued to increase during the next 2 years and at the end
of the school year 1944, 49 percent of the girls and 59 percent
of the boys had no symptoms of gingivitis. But in 1945 both
groups had suffered some regressions. There were now only
45 percent of the girls and 49 percent of the boys in the highest
range. However, there were no subjects in the lowest range
and only 2 percent of the girls in the next lowest.

GRID for Evaluating PHYSICAL FITNESS
STm a PI IalRHTQ Boou r B.ld), DEZVEOPMOITAL uVL -d BAAL MZTABOLIM No......
'"IM -A G;iLd to IndiLidual Progrss from Infancy to Maturity -








A G* ..GOa
Br B 7

.-a d........ .. .... 1








7-
t .' 4- --.. 142. -


..A b.. .,. .. ,___....... 1944 '-_ -




-, ~ ~ ----------- . . 1 9 14 -2 -'. ^ .


Fig. 3.-Progress of girls along physique channels and in developmental-
chronological relations during the course of the experiment.







22 Florida Agricultural Experiment Station

Cheilosis and Angular Stomatitis.-In 1940, as shown in Fig-
ure 1 E and F, 5 percent of the girls and 8 percent of the boys
had symptoms of severe cheilosis and angular stomatitis, and
26 and 29 percent, respectively, had no indications of these de-
fects. In 1942 there were no children with a severe form and
45 percent of the girls and 52 percent of the boys were free from
these defects. Improvement was considerably more marked by
1944 and 66 percent of the girls and 73 percent of the boys were
in the highest range. Both girls and boys suffered some regres-
sions in 1945, 5 percent for the girls and 12 percent for the boys.
However, there were no boys in the lowest 2 ranges and only
6 percent of the girls.
Defective Tonsils.-Figure 2 E and F represent the condition
of the tonsils according to the degree classification. It will be

GRID for Evaluating PHYSICAL FITNESS
t T- ol PHYSIQUE (ody BIld), DEVELOPMENTAL LEVEL -d BASAL META LIM N.... ..... ...
-A Guide to Individual Progress from Infancy to Maturity -

i b, 0 "f


2 5.,Jsr -, '5. V .... / ,'
*: ,fU 'I. 1 HL I) d .!. ,'---/ / /. I -



,- (.....67%)-- 1.













*=-- -----~-3--. 9,,__- -
!--'i ,-Ad, db, ... & '? . ...- --' '. "


Fig. 4.-Progress of boys along physique channels and in developmental-
chronological relations during the course of the experiment.







Effectiveness of the School Lunch


noted that the norms for both sexes indicate a mild degree of
tonsil involvement. Twenty-one percent of the girls and 7 per-
cent of the boys had tonsils classed as healthy; 14 percent of the
girls and 16 percent of the boys fell in the lowest range. The data
suggest that there had been no significant change in distribution
of either sex in the several ranges throughout the course of
the experiment.
GRID RATINGS
Average body build and average developmental age of the chil-
dren who ate in the lunch room for 4 years are given in Figure
3 for girls and Figure 4 for boys. The basal curve in 1940 is
compared with the curves for 1942 and 1944. In 1940 both girls
and boys at the age of 6 years were on the line between channels
M and A1; but at the age of 7 years and again at 8 years there
were shifts towards lower levels, and at 9 years for the boys
there was a further shift towards a lower channel. Both the
girls and boys at ages 9, 10 and 11 years followed the B1 chan-
nel, but at the age of 12 years the girls had made a shift of
nearly 2 channels to the right while the boys continued on in
the B1 channel. According to the grid, the physical status of
the girls was now near the B3 channel. It will be noted that at
the age of 13 years the girls had again shifted, this time nearly
3 channels to the left, and were now approaching the A1 line.
The shift for the boys which covered only 1 channel came at
the age of 14 years, or a year later than that of the girls.
At most ages the curves for the developmental ages in 1940
indicated retardation, as they ran to the right of the 67th norm.
After eating in the lunch room for 2 school years both boys
and girls, except for minor deviations, made steady advance-
ment up the M channel of the graph. This progress indicated
that growth in height and weight was proceeding according to
schedule. When these data were transferred to the develop-
mental chart the curves show that in most cases there was an
actual increase in developmental age over the 1940 base.
At the close of the 4th year the curves for both physical status
and developmental age varied slightly from those of 1942. The
boys continued directly up the M channel while the girls showed
a trend toward the A1 channel. The auxodromes for all groups
crossed the age lines to the left of, or close to, the 67th norm.
This indicated that height and weight in relation to age were
following the norm or were slightly advanced.







Florida Agricultural Experiment Station


VARIATION IN AVERAGE HEMOGLOBIN VALUES ,
In Table 5 data are given on changes in hemoglobin values
of girls and boys who ate in the lunch room regularly for 4 to 5
years. These changes are depicted graphically in Figure 5.

TABLE 5.-CHANGES IN HEMOGLOBIN VALUES OF CHILDREN WHO ATE
REGULARLY IN THE LUNCH ROOM FOR AT LEAST 4 YEARS.

Grams Hemoglobin per 100 ml. of Blood
Sex Age Sept. April Sept. April I Sept. April Sept. April I April
1940 1941 1941 1942 1 1942 1943 1943' 1944 1945

F 6 8.58 10.60 9.82 10.92 11.07* 12.90 12.63 13.57 12.48
M 6 9.36 11.54 10.60 10.92 13.10* 13.72 13.10 13.26 12.48
F 7 9.36 13.41 11.23 12.79 11.70 14.35 14.04 14.35 12.01
M 7 8.58 12.79 11.38 12.79 11.54 13.88 13.26 14.66 12.48
F 8 11.07 12.63 11.70 12.48 11.23 13.41 13.10 14.04 11.85
M 8 9.98 12.01 10.92 12.79 11.70 13.72 13.26 13.41 12.48
F 9 9.98 12.16 11.23 13.26 11.70 13.57 13.41 13.88 12.63
M 9 9.52 12.16 10.92 11.70 11.07 13.57 13.41 14.04 12.48
F 10 8.58 12.16 12.01 12.63 10.60 13.26 12.16 13.72 12.79
M 10 9.98 11.23 9.98 11.38 10.60 13.57 11.85 14.35 13.72
F 11 10.60 12.79 12.48 14.50 11.70 14.04 13.72 14.04 12.90
M 11 9.82 12.01 10.60 12.79 11.23 14.50 13.57 15.28 14.35
F 12 10.60 12.16 12.48 13.72 12.16 13.57 12.48 12.79 -
M 12 9.67 13.10 11.85 14.20 11.23 14.35 14.50 14.82 -

Iron salts were given from April to September.

It will be noted that there are no consistent variations in
hemoglobin values that could be attributed to sex until the
groups that started at the ages of 10, 11 and 12 years reached
adolescence. In April, 1944, these children were approximately
14, 15 and 16 years old and it is at these ages that the boys
have higher values than the girls.
The data show that the rate and degree of hemoglobin re-
sponse of the children of both sexes and all ages to the improved
dietary gave curves of striking similarity. At the beginning
of the study in September, 1940, the mean hemoglobin values
of all groups were less than 11.1 grams. But at the examination
of the children in April, 1941, the values of all groups had in-
creased materially. The largest increases were in the boys of
7 and 12 years and in girls of 7 and 10. However, it was found
that during vacation-from April to September-the values for
all groups decreased, while from September to April the values







Effectiveness of the School Lunch


M 3 r i o

Fig. 5.-Changes in hemoglobin values of children who ate regularly in
the lunch room at least 4 years.

for all groups again increased. For the most part this seasonal
variation continued throughout the experimental period. Dur-
ing the second vacation period the hemoglobin values of the boys
and girls, starting at 6 years, increased from April to September
but iron salts were given this group throughout the summer.
During the third summer the boys, starting at 12 years, were
able to hold their hemoglobin levels.
The data show that while the hemoglobin levels usually drop-
ped during each vacation, the gains made from September to







Florida Agricultural Experiment Station


April were of such magnitude that a net yearly gain occurred.
But during the last year-April, 1944, to April, 1945-the
hemoglobin values of all groups fell-the largest losses occur-
ring in boys who started'at the age of 7 and 9 years and in the
girls who started at the ages of 7 and 8 years.
In addition to those pupils just reported there were 176
children who ate in the lunch room for periods varying from
8 months to 2 years. Hemoglobin values of these children are
given by sex and by age in Table 6 and in Figure 6. Here it is
shown that the hemoglobin values of these children follow the
same pattern as the smaller group, that is, it has a low initial
value, increases during the school year, and decreases during
vacation.

TABLE 6.-CHANGES IN HEMOGLOBIN VALUES OF 176 CHILDREN WHO ATE
IN THE LUNCH ROOM FROM 1 TO 2 YEARS.

Num- Grams Hemoglobin per 100 ml. of Blood
ber Age Sex
SSept. April Sept. April
31 6 F 10.14 12.31 10.45 11.85
29 6 M 10.76 12.31 11.23 11.70
5 7 F 9.98 12.63 10.45 13.26
8 7 M 9.04 12.31 10.60 14.50
5 8 F 11.54 12.01 11.54 12.01
10 8 M 9.36 13.57 11.23 13.88
3 9 F 10.14 12.48 11.23 13.41
7 9 M 9.98 12.31 10.92 13.57
6 10 F 10.92 13.10 11.23 13.88
7 10 M 9.20 11.70 9.67 10.76
3 11 F 9.04 11.07 10.60 13.72
5 11 M 9.04 12.16 10.14 10.76
9 12 F 11.07 13.72 12.48 13.26
6 12 M 8.73 10.14 8.88 12.16
3 13 F 10.92 11.70 11.07 14.66
6 13 M 10.92 13.26 12.90 14.04
4 14 F 11.38 12.48 11.70 13.57
5 14 M 9.67 12.01 11.38 13.26
5 15 F 10.45 12.01 9.20 13.72
5 15 M 10.14 14.50 12.31 14.97
5 16 F 10.76 12.16 10.45 12.79
3 16 M 9.98 11.70 12.48 14.82
3 17 F 9.82 11.85 11.23 13.41
3 17 M 11.07 12.90 12.48 15.13


DISCUSSION

From the very nature and extent of the defects found in the
first examination, it was evident that many children were suf-
fering from malnutrition due to multiple deficiencies upon which









Effectiveness of the School Lunch


Ga. Hemoglobin

4.0


12.5 //

10.9 /' -
/, /

8.6 -

14.0

12.5 a 9 10 rs / \ 10 years 11 year





8.6 -

14.0 -
7 4' V









12.5 -
i 12 years / I 1I year I ,1 14 year
S13 years






10.9



8.6


14.0 -
/ 12 years : 13 years 11 year











12.5 /

10.9 / \ V
y ir

g.6 i I II I





Fig. 6.-Changes in hemoglobin values of children who ate regularly in
the lunch room from 1 to 2 years.
0 0


Fig. 6.-Changes in hemoglobin values of children who ate regularly in
the lunch room from 1 to 2 years.


bacterial infection and parasitic infestation often were super-
imposed. Signs of nutritional diseases, associated with de-
ficiencies in iron, vitamins A and C, and riboflavin were present.







Florida Agricultural Experiment Station


These were anemia of the hypochromic type, follicular conjunc-
tivitis, skin defects, gingivitis and cheilosis and angular stoma-
titis.
The severity and degree of involvement of these diseases
ranged from a mild to a severe form. Often cases of advanced
deficiencies were associated with a secondary infection and tis-
sue destruction. When multiple deficiencies existed and each
produced changes in the same tissues it became increasingly
difficult to recognize and separate the overlapping symptoms
and to diagnose the deficiency. For example, deficiencies in
vitamin A and in riboflavin both produce changes in the con-
junctiva and skin. When these deficiencies occur together, the
final picture may not be characteristic of either; and if secondary
infections are also superimposed the diagnosis is still further
complicated. Moreover, as yet there are no simple methods for
estimating subclinical manifestations of deficiencies of several
of the common vitamins. In this study classical signs of de-
ficiencies associated with the lack of thiamine and niacin were
present in the adults of the community. The children, however,
showed no symptoms specific for deficiencies in these factors.
There is, of course, the possibility that many children had a
mild deficiency in both thiamine and niacin that could not be
detected in the usual examination. In contrast to this, hemo-
globin values determined by means of a precision instrument ex-
pressed accurately slight changes in hemoglobin levels.
Data from the initial examination furnished the base line for
estimating the effective results of the school lunch on the health
and development of the children. Each succeeding examination
gave a new norm, thereby making it possible to follow not only
the yearly trend of the group but also the progress or retarda-
tion of the individual. The examination of the children 6 years
of age who entered the school during the 4 successive years of
the experiment gave evidence that there had been no general
improvement in nutritional status over the 1940 base which
could be attributed to changes in environment.
The data presented on the children eating regularly in the
lunch room for 4 to 5 years indicated that after 2 years there
had been a shift towards a higher norm with reference to the
degree classification of the prevalent nutritional defects. At the
end of the 4th year still more improvement was noted. Not only
were there no children in the lowest grouping but also there were







Effectiveness of the School Lunch


few in the next lowest, and more than half the group were ap-
parently free from signs of nutritional defects.
In addition to the advance in nutritional status, there were
indications that better food had brought about other improve-
ments. These were seen in the shift of grid channels toward
better physique and the change in developmental level from a
lag to a lead. That the deviations in the up channel progress
and the retardation in respect to developmental age of both
sexes were associated with a low nutritive status is emphasized
by comparing the base line for 1940 with the lines for 1942 and
1944. With an adequate school lunch the progress of both boys
and girls was directly up the median channel.
The shift to a lower channel which occurred in the girls of 12
years, or about the age of puberty, is of interest. This is an
age of instability and the data indicate that at this physiological
age girls are particularly sensitive to food deficiencies and that
their requirements are somewhat higher than those of the boys
of comparable ages. The sudden cessation of growth in height
and the increase in weight for the girls of 13 years suggests a
glandular imbalance. The cessation of growth in height and
a shift to a higher channel came for the boys at 15 years, or
2 years later than for the girls.
If only the data in the 1940 curve were considered, these de-
viations in channel might be attributed to sex differences. But
during the years when an adequate school lunch was served
there were no shifts and progress of both boys and girls was
directly up the median channel. It therefore seems logical to
conclude that the channel deviations in the 1940 curve were a
part of the syndrome of malnutrition.
In previous work with malnourished children (5) it was shown
that the fluctuations in hemoglobin found during adolescence had
no statistical significance. This was not in conformity with the
data reported by Mugrage and Andresen (7), who found that
differences in hemoglobin values of boys and girls began in the
period between the 13th and 15th years, resulting in higher
values for the boys. In Figure 5 it will be noted that after
several years of better feeding the hemoglobin values of the
boys at the ages of 14, 15 and 16 gradually increased over those
of the girls of comparable ages. It now appears that with an
improved nutritional status this difference in hemoglobin values
which had been reported for adolescents from other sections
also occurs in this group.







Florida Agricultural Experiment Station


In the same graph it is shown that the hemoglobin values
of both sexes and all ages increased through the school year
(September to April, inclusive) and then decreased during vaca-
tion. At first glance it might be suggested that the variations
were due to changes in seasons, but a more plausible explanation
is that the school lunch contributed more of the factors influenc-
ing the production of hemoglobin than did the meals prepared
at home.
After the second year of improved diet the summer decrease
for most of the age groups became less, and each year a small
net gain was made. This increased ability to tide over the sum-
mer might be attributed to several factors, operating singly
or together. With reduction in bacterial infections and in para-
sitic infestations the general health and resistance would be
improved. This would help the child to go through the summer
with smaller or no loss of hemoglobin. Or, with better feeding
during the past 3 years, the child may have built up a reserve
of hemoglobin precursors that would carry him through the
vacation period.
For the first 4 years of the experiment hemoglobin values of
both sexes and all ages increased throughout the school year
and then decreased through vacation. The increase made during
the school year was so large that a yearly net gain in hemoglobin
occurred. At the end of the 5th year the hemoglobin values
of both sexes and at all ages showed a net loss, a fact that is
also reflected in the degree classification by a shift from a norm
of sufficiency to one of subnormality (Fig. 1 A and B).
These changes and smaller ones in the other degree classifica-
tions (Fig. 1 C, D, E, F and Fig. 2 A and B) indicate that during
the 5th year the diets were apparently somewhat inadequate in
vitamins A, C and riboflavin, but definitely so in factors neces-
sary for regeneration of hemoglobin. In explanation of this
dietary inadequacy several factors should be considered. Most
important of all, the lunch room during this year was not under
the management of a dietitian. Because of transportation dif-
ficulties (which were great for this isolated community in 1945)
and scarcity of certain foods, many replacements had to be made
for important dietary items. These were not always judicious.
The resultant of these factors is expressed in the graphed data
that suggest that the children were not as well fed during 1945
as they had been in the previous years.
From the data presented it may be concluded that when






Effectiveness of the School Lunch


adequately supervised, when planned to take care of known
deficiencies, and when special attention and supplementary vita-
mins and minerals are given as necessary, the school lunch offers
an effective means of raising the nutritional status of school
children.
SUMMARY
A 5-year study has been made of the effectiveness of a school
lunch in improving the nutritional status of rural children.
From September, 1940, through April, 1944, the lunch was
planned and prepared under the direct supervision of the dieti-
tian. This lunch, planned according to optimal standards, fur-
nished at least the minimal daily allowances of essential food
factors. From October, 1944, through April, 1945, the purchase
of the food and the supervision and management of the lunch
room were carried on locally. The authors continued to plan
the menus, furnish the recipes, and to give the physical exami-
nations.
Specific and progressive changes in organs and tissues were
accepted as a basis for a degree classification of a deficiency for
any 1 food factor.
Data presented show the incidence of defects or diseases in
the 186 children who had the prescribed examinations as out-
lined under methods. The prevalent defects or diseases were
caries, defective tonsils and diseases of nutritional origin: 90
percent of the group had gingivitis; 71 percent anemia; 71 per-
cent follicular conjunctivitis; 64 percent cheilosis and angular
stomatitis; and 63 percent skeletal defects.
Results of the examination in 1940 with reference to the de-
gree classification of the prevalent nutritional defects are com-
pared with those of 1942 and 1944. The principal effect of the
school lunch noted in this presentation is the shift in norm dis-
tribution around a pronounced clinical deficiency to a norm
around a condition of sufficiency.
Data presented show that during the course of the experiment
there had been no significant change in the degree classification
of tonsillar condition of either girls or boys.
The effect of the school lunch on average body build and aver-
age developmental age was shown by comparing the basal curve
for 1940 with the curves for 1942 and 1944. With better feeding
there was a shift in channels towards better physique and a
change in developmental level from a lag to a lead.







Florida Agricultural Experiment Station


For the first 4 years of the experiment hemoglobin values of
both sexes and all ages increased during the school year and
then decreased during vacation. The increase made through
the school year was so large that a net yearly gain in hemoglobin
occurred.
During the 5th year the hemoglobin values of both sexes and
at all ages showed a net loss. This loss caused a shift from a
norm of sufficiency to one of subnormality for hemoglobin, while
only slight changes occurred around the other norms. These
changes in hemoglobin and the smaller ones in the other degree
classifications indicate that during the 5th year the diets were
apparently somewhat inadequate in vitamins A and C and ribo-
flavin, but definitely so in factors necessary for regeneration of
hemoglobin.
From the data presented it may be concluded that when ade-
quately supervised, when planned to take care of known de-
ficiencies, and when special attention and supplementary vitamins
and minerals are given as necessary, the school lunch offers an
effective means of raising the nutritional status of school chil-
dren.

LITERATURE CITED
1. ABBOTT, OUIDA DAVIS. The effect of improved diet on children with a
moderate degree of hookworm infection. Jour. Home Econ. 26:
577-580. 1934.
2. ABBOTT, OUIDA DAVIS, and CHESTER F. AHMANN. Nutritional anemia
and its prevention. Fla. Agr. Exp. Sta. Bul. 328: 1-12. 1938.
3. ABBOTT, O. D., and C. F. AHMANN. Iron deficiency anemia in children.
Amer. Jour. Dis. of Children, 58: 811-816. 1939.
4. ABBOTT, OUIDA DAVIS, and CHESTER F. AHMANN. The "trace" or "micro"
elements in the service of Florida Agriculture-Human relationships.
State of Florida, Dept. of Agr. Bul. 115: 61-67. 1942.
5. ABBOTT, O. D., RUTH O. TOWNSEND and C. F. AHMANN. Hemoglobin
values of 2,205 rural school children in Florida. Amer. Jour. Dis.
of Children 69: 346-349. 1945.
6. AHMANN, CHESTER F., OUIDA DAVIS ABBOTT and GEORGIA WESTOVER.
A nutritional study of the white school children in five representa-
tive counties in Florida. Fla. Agr. Exp. Sta. Bul. 216: 1-50. 1930.
7. MUGRAGE, E. R., and M. I. ANDRESEN. Red blood cell values in adoles-
cence. Amer. Jour. Dis. of Children 56: 997-1003. 1938.
8. WETZEL, N. C. Physical fitness in terms of physique, development and
basal metabolism. Jour. Amer. Med. Assn. 116: 1187-1195. 1941.




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