• TABLE OF CONTENTS
HIDE
 Front Cover
 Credits
 Table of Contents
 Scope of study
 The staff
 Selection of counties
 Standards and methods
 Physical findings and diet
 Incidence of defects with certain...
 Summary
 Conclusions
 Acknowledgement
 Reference






Group Title: Bulletin - University of Florida. Agricultural Experiment Stations ; No. 216
Title: A nutritional study of the white school children in five representative counties of Florida
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00027214/00001
 Material Information
Title: A nutritional study of the white school children in five representative counties of Florida
Series Title: Bulletin University of Florida. Agricultural Experiment Station
Physical Description: 50 p. : charts ; 23 cm.
Language: English
Creator: Ahmann, Chester F ( Chester Frederick ), b. 1897
Abbott, O. D ( Ouida Davis ), b. 1892
Westover, Georgia
Publisher: University of Florida Agricultural Experiment Station
Place of Publication: Gainesville Fla
Publication Date: 1930
 Subjects
Subject: School children -- Food -- Florida   ( lcsh )
Children -- Nutrition   ( lcsh )
Children -- Health and hygiene -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Bibliography: Bibliography: p. 50.
Statement of Responsibility: by Chester F. Ahmann, Ouida Davis Abbott, Georgia Westover.
General Note: Cover title.
Funding: Bulletin (University of Florida. Agricultural Experiment Station)
 Record Information
Bibliographic ID: UF00027214
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: aleph - 000923524
oclc - 18175638
notis - AEN4075

Table of Contents
    Front Cover
        Page 1
    Credits
        Page 2
    Table of Contents
        Page 3
        Page 4
    Scope of study
        Page 5
        Page 6
        Page 7
    The staff
        Page 8
    Selection of counties
        Page 8
    Standards and methods
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
    Physical findings and diet
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
    Incidence of defects with certain specific defects
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
    Summary
        Page 48
    Conclusions
        Page 49
    Acknowledgement
        Page 50
    Reference
        Page 50
Full Text

Bulletin 216


UNIVERSITY OF FLORIDA
AGRICULTURAL EXPERIMENT STATION
Wilmon Newell, Director






A NUTRITIONAL STUDY OF THE

WHITE SCHOOL CHILDREN IN

FIVE REPRESENTATIVE

COUNTIES OF FLORIDA

By
CHESTER F. AHMANN
OUIDA DAVIS ABBOTT
GEORGIA WESTOVER















Bulletins will be sent free upon application to
The Agricultural Experiment Station,
GAINESVILLE, FLORIDA


June, 1930










BOARD OF CONTROL
P. K. YONGE, Chairman, Pensacola RAYMER F. MAGUIRE, Orlando
A. H. BLENDING, Leesburg FRANK J. WIDEMAN, West Palm Beach
W. B. DAVIS, Perry J. T. DIAMOND, Secretary, Tallahassee

STATION EXECUTIVE STAFF
JOHN J. TIGERT, M.A., LL.D., President IDA KEELING CRESAP, Librarian
WILMON NEWELL, D. Sc., Director RUBY NEWHALL, Secretary**
S. T. FLEMING, A.B., Asst. Director K. H. GRAHAM, Business Manager
J. FRANCIS COOPER, M.S.A., Editor RACHEL McQUARRIE, Accountant
R. M. FULGHUM, B.S.A., Asst. Editor

MAIN STATION-DEPARTMENTS AND INVESTIGATORS


AGRONOMY
W. E. STOKES, M.S., Agronomist
W. A. LEUKEL, Ph.D., Associate
G. E. RITCHEY, M.S.A., Assistant*
FRED H. HULL, M.S., Assistant
J. D. WARNER, M.S., Assistant
JOHN P. CAMP, M.S.A., Assistant
ANIMAL HUSBANDRY
A. L. SHEALY, D.V.M., Veterinarian in
Charge
E. F. THOMAS, D.V.M., Asst. Veterinarian
R. B. BECKER, Ph.D., Associate in Dairy
Husbandry
W. M. NEAL, Ph.D., Assistant in Animal
Nutrition
C. R. DAWSON, B.S.A., Assistant Dairy
Investigations

CHEMISTRY
R. W. RUPRECHT, Ph.D., Chemist
R. M. BARNETTE, Ph.D., Associate
C. E. BELL, M.S., Assistant
J. M. COLEMAN, B.S., Assistant
J. B. HESTER, M.S., Assistant
H. W. WINSOR, B.S.A., Assistant
COTTON INVESTIGATIONS
W. A. CARVER, Ph.D., Assistant
E. F. GROSSMAN, M.A., Assistant**
PAUL W. CALHOUN, B.S., Assistant.
RAYMOND CROWN, B.S.A., Field Assistant


ECONOMICS, AGRICULUTRAL
C. V. NOBLE, Ph.D., Agricultural Economist
BRUCE McKINLEY, A.B., B.S.A., Associate
M. A. BROOKER, M.S.A., Assistant
JOHN L. WANN, B.S.A., Assistant

ECONOMICS, HOME
OUIDA DAVIS ABBOTT, Ph.D., Head
L. W. GADDUM, Ph.D., Biochemist
C. F. AHMANN, Ph.D., Physiologist
ENTOMOLOGY
J. R. WATSON, A.M., Entomologist
A. N. TISSOT, M.S., Assistant
H. E. BRATLEY, M.S.A., Assistant
L. W. ZIEGLER, B.S., Assistant

HORTICULTURE
A. F. CAMP, Ph.D., Horticulturist
M. R. ENSIGN, M.S., Assistant
HAROLD MOWRY, B.S.A., Assistant
A. L. STAHL, Ph.D., Assistant
G. H. BLACKMON, M.S.A., Pecan Culturist

PLANT PATHOLOGY
W. B. TISDALE, Ph.D., Plant Pathologist
G. F. WEBER, Ph.D., Associate
A. H. EDDINS, Ph.D., Assistant
K. W. LOUCKS, M.S., Assistant
ERDMAN WEST, B.S., Mycologist


BRANCH STATION AND FIELD WORKERS

L. O. GRATZ, Ph.D., Asso. Plant Pathologist in charge, Tobacco Exp. Sta. (Quincy)
R. R. KINCAID, M.S., Assistant Plant Pathologist (Quincy)
JESSE REEVES, Foreman, Tobacco Experiment Station (Quincy)
J. H. JEFFERIES, Superintendent, Citrus Experiment Station (Lake Alfred)
W. A. KUNTZ, A.M., Assistant Plant Pathologist (Lake Alfred)**
B. R. FUDGE, Ph.D., Assistant Chemist (Lake Alfred)
W. L. THOMPSON, B.S., Assistant Entomologist (Lake Alfred)
R. V. ALLISON, Ph.D., Soils Specialist in charge Everglades Experiment Station (Belle Glade)
GEO. E. TEDDER, Foreman, Everglades Experiment Station (Belle Glade)
R. N. LOBDELL, M.S., Assistant Entomologist (Belle Glade)
F. D. STEVENS, B.S., Sugarcane Agronomist (Belle Glade)
H. H. WEDGWORTH, M.S., Associate Plant Pathologist (Belle Glade)
FRED YOUNT, Office Assistant (Belle Glade)
E. R. PURVIS, M.S., Assistant Chemist (Belle Glade)
A. N. BROOKS, Ph.D., Associate Plant Pathologist (Plant City)
A. S. RHOADS, Ph.D., Associate Plant Pathologist (Cocoa)
C. M. TUCKER, Ph.D., Associate Plant Pathologist (Hastings)
STACY O. HAWKINS, M.A., Field Assistant in Plant Pathology (Homestead)
L. R. TOY, B.S.A., Assistant Horticulturist (Homestead)
D. G. A. KELBERT, Field Assistant in Plant Pathology (Bradenton)
R. E. NOLEN, M.S.A., Field Assistant in Plant Pathology (Monticello)
FRED W. WALKER, Assistant Entomologist (Monticello)**
D. A. SANDERS, D.V.M., Associate Veterinarian (West Palm Beach)
M. N. WALKER, Ph.D., Associate Plant Pathologist (Leesburg)
W. B. SHIPPY, Ph.D., Assistant Plant Pathologist (Leesburg)
C. C. GOFF, M.S., Assistant Entomologist (Leesburg)
J. W. WILSON, Ph.D., Assistant Entomologist (Pierson)
*In cooperation with U. S. Department of Agriculture.
**On leave of absence.







CONTENTS

PAGE

SCOPE OF STUDY ........ ....................... ........ 5

STAFF .......... .................. ............................. 8

SELECTION OF COUNTRIES ........ ................................ 8

STANDARDS AND METHODS:
V vision ........ ..................... ........................ 9
Hearing .................... ........... ........... 10
Height and Weight ....................... ................. 10
General Physical Conditions .................................. 11
Posture ......................................... .... ..... 11
Mouth ........................ ........................... 11
Nasopharynx .... ........................ .............. 12
Skin ......................................................... 13
Abdomen ....................................... ........... 13
Lymph Glands .............................................. 13
Heart ......................... ............................ 13
Thyroid .................................................... 13
Anemia ............ ........................................ 14
M alaria ........... ... ................................ 14
Hookworm ......................... ....... ................. 14
Diets and Health Habits ..................................... 14
Evaluation of Diets ......................................... 15
Findings .............. ............ ....................... 16

PHYSICAL FINDINGS AND DIET .............. ........................ 17

PHYSICAL FINDINGS IN GENERAL ................................... 17

PHYSICAL FINDINGS:
Eyes ........................... ........................ 19
Ears ............. .......... .............................. 21
Height and Weight .............................. ........... 22
General Physical Condition ..................... ............. 23
M outh .......................................... ........... 24
Nasopharyngeal Defects ................... .................. 26
Skin ...................................................... 27






CONTENTS-Continued

PAGE

G lands ...................................................... 27
Thyroid ................. ........................... 27
Heart .............. ..... ...................... ............. 27
Anemia .................................................... 28
M alaria ........... ..... .................................... 28
Intestinal Parasites ..................................... ..... 28

INCIDENCE OF DEFECTS WITH CERTAIN SPECIFIC DEFECTS:

Prevalence of Defects Among Children with Enlarged Tonsils..... 31
Prevalence of Defects Among Anemic Children.................. 31
Prevalence of Defects Among Underweight Children ............ 34
Prevalence of Defects Among Children with Hookworm.......... 34
Relations of Specific Defects ................................ 34

DIETS ................. ........... .. ........ ...... ........... ... 35

MENUS:
Breakfast ... ................... ........... ............ 40
Lunch ............................................ 42
Dinner ..................... .............. ............. 42

DIETS AND PHYSICAL DEFECTS. ............ .......... ............... 44

DIETS AND WEIGHT ......................... ....................... 45

DIETS AND ANEMIA ................. ............... .............. 46

PHYSICAL DEFECTS WHICH INFLUENCE WEIGHT:
Hookworm Infestation ..................................... 47
Defective Tonsils ............. .......................... 47
Thyroid Disturbances .................................... .. 47

DIET AND TEETH ................. ................... ............... 48

SUMMARY ......................................................... 48

CONCLUSIONS .............. ...................................... 49

ACKNOWLEDGMENTS ..................... .......................... 50

REFERENCES ............... ....................................... 50








A NUTRITIONAL STUDY OF THE

WHITE SCHOOL CHILDREN IN

FIVE REPRESENTATIVE

COUNTIES OF FLORIDA

By
CHESTER F. AHMANN
OUIDA DAVIS ABBOTT
GEORGIA WESTOVER*

This investigation was designed to furnish data concerning the
health, nutrition, needs, and general well-being of the school chil-
dren of five representative counties of Florida. The connection
between a child's physical condition and his diet is a relation
which nutritional workers have recognized and emphasized re-
peatedly. Therefore, this survey was undertaken in order that
better health, more fully developed children physically, and a
keener appreciation of nutritional needs would result.

SCOPE OF STUDY
Since many factors are at work affecting the child's well-being,
it is necessary to collect data regarding his diet, dietary habits,
physical condition, and health habits. These data were obtained
by having the following form filled out for each child.

RECORD OF DIETS AND HEALTH HABITS
(Answer all questions and check any point which is true for you.)
Name Address Grade Age- Sex-
Father- Address
Eating Habits:
Appetite-Good fair poor finicky
Eat between meals, yes no- habit- occasional-
Food:
Milk: Family uses daily-quarts. Uses no milk
Vegetables: leafy daily how often?-
other daily how often?-
potatoes daily- how often ?

*Formerly of the department of home economics, Florida Experiment
Station.







Florida Agricultural Experiment Station

Fruits: raw daily how often?
kinds:


Meats:
Eggs:
Cereals:
Fats:
Sweets:
Coffee:


cooked daily-- how often ?
kinds: daily- how often?
daily- how often ?
kinds: daily- how often?
butter lard oleo other
candy other-- how often ?
number of cups strong- weak- habit-
occasional


Food Supply:
Milk: own cow, yes no
buy milk, yes kind: fresh--- canned- ,
powdered
buy milk, no-
Butter: make- buy, yes- no-- substitute, yes- ,
no--
Vegetables: raise buy- canned- dried- fresh-


Menus for two
Lunch


preceding days.
Dinner


HEALTH HABITS
Care of teeth: owns tooth-brush
how often used
Cleanliness: wash hands before meals how often bathe
Fresh air: windows open nights other means of fresh air-
Clothing: winter underwear outer wraps
wear shoes specify time

Further, his physical condition was determined by a medical
examination. His record was kept as shown by the following
form:
Name Father Address
Where born- Date Sex Grade
Entered school at- years. Previous record
Nationality of father mother
Number of children in family

General:
Weight: lbs., height inches.
Nutrition: 1 very fat- 2 fat- 3 muscular- 4 plump-
5 emaciated-


Breakfast


Other







Bulletin 216, Nutritional Study of White School Children 7

Flesh: 1 firm 2 flabby
Shoulders: 1 normal 2 round 3 winged-
Chest: 1 prominent- 2 hollow 3 pigeon chest-
Extremities: 1 bow leg- 2 club foot--- 3 other-
Spine: 1 curvature- 2 lordosis 3 other
Speech: 1 stammers 2 stutters 3 lisps-
Activity: 1 nervous 2 pepless 3 exhausted
Laboratory findings:
Tuberculosis-----Malaria Anemia-- Hookworm
Other intestinal parasites
Medical Examination:
Teeth: 1 carious No. 2 malocclusion -3 chalky-
4 dirty.
Gums: 1 gingivitis- 2 pyorrhea
Lips: 1 herpes 2 other
Nasopharynx: 1 nasal disch. 2 nasal obstr.
3 sinus infect. 4 mouth breath.
5 chron. nasal catarrh 6 adenoids
7 high arch palate-- 8 tonsils enl.---disease---
Eyes: 1 wear glasses-how long 2 conjunct-
3 trachoma 4 vision (a) R. Eye
(b) L. Eye
5 strabismus 6 ptosis 7 other
Ears: 1 hearing R. ear -ft. L. ear ft.
2 otitis (a) chronic (b) acute- 3 disch.
Skin: 1 color (a) yellow- (b) yellowish-green- (c) pale-
2 infect. sores 3 hives 4 ground itch-
5 scabies-- 6 boils 7 eczematous 8 dry-
Abdomen: 1 distended 2 hernia
Lymph glands: 1 enlarged, assoc. infect.
2 enlarged without assoc. infect.
3 cervical 4 axillary 5 inguin.-
Nervous
System: 1 chorea 2 other
Cardiac
Disease: 1 tachyacardia- 2 murmur- 3 other-
Pulmon.
Disease: 1 rhythm 2 other
Spleen: 1 enlarged Thyroid 1 enlarged
Anemic Rachitic


Remarks:






Florida Agricultural Experiment Station


The various factors, diet, cleanliness, health habits, and phys-
ical condition which bear on his progress and development are
thus made available for study. Tabulations were made of the
records of 3,325 children.
These forms may seem unnecessarily detailed for practical use;
however, this is probably the only means of securing sufficiently
detailed and accurate information. This arrangement with this
number of school children has proved satisfactory in showing
large group differences.
THE STAFF
The authors were assisted by the following regular staff: two
or more physicians, two or more dentists, two or more nurses, the
county home demonstration agents, and the teachers.
The Florida State Board of Health Laboratory made hookworm
tests on all of the children.
Blood counts and malarial examinations, when warranted, were
made in the laboratories of the Home Economics Department of
The Agricultural Experiment Station.
The teachers aided in collecting data concerning the diets and
health habits of the children.
The survey met with cordial response from the local organiza-
tions. The school officials, civic organizations and the local hos-
pitals gave practical expression of their interest in the work.
Interest in the survey was also greatly stimulated by the local
press in the respective counties.

SELECTION OF COUNTIES
The counties (1)1 chosen for this survey were selected on the
basis of location, each county being representative of its respec-
tive section of the state.
County No. 1, Alachua: This county is representative of the
central part of Florida, lying north of the citrus section. In this
area general farming is practiced, supplemented by truck farm-
ing, turpentining and the raising of berries.
County No. 2, Jackson: This county is representative of the
northwestern section of the state. The type of agriculture car-
ried on here is general farming, the main crops being cotton, corn
and Spanish peanuts. Watermelons were a specialty in some

LNumbers in italics refer to References in the back of this bulletin.






Florida Agricultural Experiment Station


The various factors, diet, cleanliness, health habits, and phys-
ical condition which bear on his progress and development are
thus made available for study. Tabulations were made of the
records of 3,325 children.
These forms may seem unnecessarily detailed for practical use;
however, this is probably the only means of securing sufficiently
detailed and accurate information. This arrangement with this
number of school children has proved satisfactory in showing
large group differences.
THE STAFF
The authors were assisted by the following regular staff: two
or more physicians, two or more dentists, two or more nurses, the
county home demonstration agents, and the teachers.
The Florida State Board of Health Laboratory made hookworm
tests on all of the children.
Blood counts and malarial examinations, when warranted, were
made in the laboratories of the Home Economics Department of
The Agricultural Experiment Station.
The teachers aided in collecting data concerning the diets and
health habits of the children.
The survey met with cordial response from the local organiza-
tions. The school officials, civic organizations and the local hos-
pitals gave practical expression of their interest in the work.
Interest in the survey was also greatly stimulated by the local
press in the respective counties.

SELECTION OF COUNTIES
The counties (1)1 chosen for this survey were selected on the
basis of location, each county being representative of its respec-
tive section of the state.
County No. 1, Alachua: This county is representative of the
central part of Florida, lying north of the citrus section. In this
area general farming is practiced, supplemented by truck farm-
ing, turpentining and the raising of berries.
County No. 2, Jackson: This county is representative of the
northwestern section of the state. The type of agriculture car-
ried on here is general farming, the main crops being cotton, corn
and Spanish peanuts. Watermelons were a specialty in some

LNumbers in italics refer to References in the back of this bulletin.






Bulletin 216, Nutritional Study of White School Children 9

parts of the county. Few fruits or cultivated berries are produced
in this area.
County No. 3, Hillsborough: This county is representative of
the central west coast area. The chief products from this section
are: citrus fruits, truck crops and strawberries.
County No. 4, Columbia: This county is representative of the
northern portion of the state. In this section the chief occupa-
tions of the people are turpentining, lumbering, general farming,
with tobacco, berries and nuts as main crops.
County No. 5, Indian River: This county is representative of
the central and southeast coast section. The principal industries
of this section are vegetable and fruit growing and fishing.
STANDARDS AND METHODS
Uniform conditions and standards were employed in order to
secure reliable data. All examinations and measurements were
taken by especially instructed persons. This was done to elim-
inate, as far as possible, personal variations.
VISION
The vision was tested, using the Snelling Chart. The large
letters at the top should be read at a distance of 200 feet; the
other rows at 150, 100, 75, 60, 45, 30, 25, and 20 feet. The child
was placed at a distance of 20 feet from the chart. If he could
call the letters on the 20-foot line, he was given a grade of .
If he could not see that line but could see the larger letters in the
line directly above it, he was given a grade of L. The numerator
of the fraction was always the distance between the chart and
the child, and the denominator indicated the smallest line which
the child could see at that distance. A grade of 20 was consid-
25
ered slightly defective, not necessarily requiring glasses, but the
parents were informed to keep the child's vision under observa-
tion. A grade of 20 or poorer was considered defective and the
parents were advised to have the child taken to a specialist.
In order to standardize the grades and to insure uniform con-
ditions the following details were observed in all cases:
1. The same person conducted all the vision tests.
2. The distance between the child and the chart was 20 feet.
3. A card was used to cover one eye while the other was being
tested.
4. The right eye was always tested first.
5. Not much time was spent on the large letters if convinced
that the child could see them.






Florida Agricultural Experiment Station


Eyes. In addition to the vision tests already described, the
following diseases were looked for: trachoma, conjunctivitis,
strabismus, pterygium and ptosis.
An entry was made of all children wearing glasses and the
length of time worn.
HEARING
The hearing was determined by the watch tick method. In
the hearing test, the child stood nine feet from the person con-
ducting the examination, standing in such a position as to have
the ear being tested toward the examiner. His hand was placed
over the other ear. After the right ear was tested, the child
faced about and the other ear was tested. If the child could not
hear at nine feet, he was moved nearer the watch. When he
could hear he raised his hand. The distance between the watch
and the child determined his grade. The number of feet between
the child and the watch was used as the numerator, and nine feet
as the denominator. A child hearing at nine feet would receive a
grade of -2. One hearing at six feet would receive a grade of Any
grade below the latter was considered defective and parents were
advised to have the child examined by a specialist.
The use of the "watch tick" method provided a uniform stand-
ard for grading.
Ears. In addition to the hearing tests the ears were examined
for discharge and chronic otitis.
HEIGHT
In order to obtain a uniform position and standard for the
height measurements the following apparatus was used. A
smooth board with a strip of paper, marked so as to read in frac-
tions of inches, pasted on it, was used. This board was designed
so as to allow it to stand perpendicular to the floor without se-
curing it to the wall. A square could be moved up or down on the
scale when reading the height.
The measurement of the height was made by having the child
remove his shoes, stand erect, arms hanging naturally at sides,
heels together, with the back of his head against the measuring
scale. The square was then brought down firmly to the top of
his head and the reading was taken.
WEIGHT
All weighing were made on the same scales. Each day the
balance was adjusted and corrected. All weighing were taken
with the shoes and the outer garments removed.







Bulletin 216, Nutritional Study of White School Children 11

The height and weight table used as a standard was that given
in Holt and Howland (2) by Bowditch. Each individual was com-
pared to the average with a corresponding height. If a child was
10 percent below average, he was considered underweight, if 10
percent or more above the average, he was considered overweight.
GENERAL PHYSICAL CONDITIONS
Under the heading of general physical conditions, observations
were made of the following: (1) Nutrition, (2) posture, (3) ac-
tivity, (4) speech.
In the absence of an accepted standard for grading nutrition,
a descriptive standard was used. The child was placed in one of
the following groups: very fat, fat, plump, muscular or emaciated.
In addition to this his flesh was observed and classed as either
firm or flabby.
These data, when supplemented by height and weight records,
have been used as a criterion of nutrition. The advantage of
this method over the method of grouping as excellent, good, fair,
poor, and very poor, is that it eliminates the variation due to per-
sonal judgment of the observer.
POSTURE
The general appearance with regard to posture is best deter-
mined by observation of the following: skeletal outline, shoulders,
chest, spine and extremities.
Skeletal outline: There are various defects of each of these
bony landmarks which will effect the general physical appearance.
Shoulders: Round shoulders and winged shoulders were looked
for in marking this point.
Chest: Observations were made as to prominent, hollow or
pigeon-breasted.
Extremities: The following observations were made of the
extremities: bowleg, club-foot, knock-knee, and club-finger.
Spine: The spine was checked as to curvature and lordosis.
Activity: The child's vigor was classed under one of the fol-
lowing heads: nervous, pepless, exhausted. This information was
obtained from the teacher.
Speech: The following defects of speech were noted: stam-
mering, lisping and stuttering.
MOUTH
The following points were noted on examination of the mouth:
teeth, gums, tongue and lips.






Florida Agricultural Experiment Station


Teeth: Here was noted the general condition of the teeth, in-
cluding malocclusions, number extracted, number of carious
teeth, chalky teeth and unclean teeth. Any condition causing an
abnormal bite was included under malocclusion.
Gums: Here was noted the condition of the gums as affected
by abscesses, gingivitis, and pyorrhea.
Tongue: Here was noted whether the tongue was coated or
speckled. The frenulum was also noted when short. This would
be a check on conditions of impaired speech as checked in another
part of the examination.
Lips: Here were noted color and disease, as herpes or excaria-
tion.
NASOPHARYNX
On examination of the nasopharyngeal region the following
conditions were observed: nasal discharge, nasal obstruction,
mouth breathing, palate, adenoids and tonsils.
Nasal Discharge: The basis for making a positive entry of
nasal discharge was: (1) A discharge evident, the condition pre-
vailing for several months. (This history was obtained from the
child or the teacher. All children with colds were excluded.)
(2) A discharge with marked excariations of the lip.
Nasal Obstruction: This was tested by closing each nostril in
turn to see if the child could breathe easily through the open
nostril.
Mouth Breathing: This was tested by closing the mouth to see
if the child could breathe freely through the nostrils.
Palate: Observations as to cleft palate and high arched palate
were made.
Adenoids: Various examiners have various standards which
indicate necessity for removal of adenoids. In order to make
these results comparable for the children examined in this study
the following constituted the basis for recommendation for re-
moval of adenoids: 1. Mouth breathing to such an extent as to
cause a facial deformity in absence of nasal obstruction. 2.
Chronic nasal discharge (colds excluded).
Tonsils: It is quite impossible to have an absolute standard as
to what shall constitute a condition requiring removal of tonsils.
The fact that standards do vary among examiners is proved by
greatly varying percentages of affected tonsils recorded in various
publications. Specialists differ greatly as to what forms an indi-
cation for removal of tonsils. With this in mind, definite condi-
tions were designated in this survey, which would constitute a







Bulletin 216, Nutritional Study of White School Children 13

basis which would warrant an entry for defective tonsils. This
was done so that all children in this particular group would be
judged by the same standard.
1. Greatly enlarged tonsils practically filling the throat, making
breathing difficult.
2. Moderately enlarged tonsils with accompanying systemic in-
fection.
3. Moderately enlarged tonsils with greatly enlarged submaxil-
lary glands.
4. Moderately enlarged tonsils with a history of repeated at-
tacks of tonsilitis.
5. Diseased tonsils showing cheesy plugs.
A difficulty which arises in deciding whether removal of tonsils
is indicated in examining a group of school children, is that so
often no satisfactory history can be obtained. History of pre-
vious attacks of tonsilitis and difficulty in breathing are impor-
tant factors in making a decision. In doubtful cases it was rec-
ommended that the child be examined again by a throat specialist.
In this study the doubtful cases were not entered and were not
included in the general conclusions.
From the indications listed above which warranted removal of
tonsils, it is evident that a very conservative standard was main-
tained.
SKIN
The general conditions-dry, clammy, pale, yellow, etc.-were
noted. Also any skin disease was entered when found.
ABDOMEN
Spleen: The subject was examined while standing. The spleen
was considered enlarged if the edge could be plainly and definitely
outlined at or below the costal margin.
LYMPH GLANDS
The cervical, axillary and inguinal glands were examined for
enlargement. They were considered enlarged when they were
easily palpable.
HEART
By means of a stethoscope and the radial pulse the heart was
examined. A rapid heart, tachycardia and murmur were the de-
fects noted in this examination.
THYROID
The thyroid was considered abnormal when characteristic
symptoms were evident and when the gland was easily palpable.







Florida Agricultural Experiment Station


ANEMIA
An anemic condition was determined by observing the color of
the lips, the color of the conjuctiva of the eye, and the effect of
pressure by the fingers on the lobe of the ear. This was then
checked by the use of a Dare hemoglobinometer.
MALARIA
A drop of blood was drawn and placed on a microscopic slide.
A microscopic examination was then made of the blood smear to
determine the presence or absence of the malarial parasite.
HOOKWORM
During the examination the physical features of the child were
observed for symptoms indicating hookworm. These were
marked "hookworm suspected" when the conditions warranted it.
In addition to this each child was provided with a container for
a specimen of the feces so that a laboratory test could be made
for hookworm.
DIETS AND HEALTH HABITS
Methods of Securing Diet Records-Through the help of the
teacher, the health habits and the diet blanks were filled out. For
the younger children, the blanks were sent home so that the data
for the morning and evening meals would be more reliable. The
reports were reliable as to the noon meal, for in most cases the
teacher supervised the lunch rooms. The child with help of the
teacher would list the contents of his lunch box. In other schools,
cafeterias were maintained. Thus it was a simple matter to list
the menu for the noonday meal. The data for the morning and
evening meals were reliable only so far as the child and the
parents were able to remember.
Records for the diets of 2,110 children for two days were ob-
tained from four of the five counties.
Limitations of the Data-An effort was made to secure in-
formation for all of the points listed in the blank. However, it
was found impossible to obtain reliable information in every case.
The material thus secured has definite limitations; chief among
these are: (1) the data on the food used are not quantitative,
except for the amount of milk consumed; (2) the accuracy of
some of the data depends on the child's memory and his honesty;
(3) the diets represent only two days.
It was impracticable in a survey of this type to attempt the
collection of quantitative data on the amount of food consumed,
with the exception of the amount of milk used. However, from
personal observation at the noon meals, the size of servings of







Bulletin 216, Nutritional Study of White School Children 1l

different articles of food, such as cooked vegetables, bread, meat
and cake, did not vary much from child to child. Although no
quantitative study could be made of these data it was possible to
determine much concerning the qualitative adequacy of the diets,
since information was available not only as to the kind of food
eaten, but also as to the approximate amounts of milk used. Thus
the diets were scored on the basis of qualitative adequacy on the
assumption that normal amounts of food were eaten.
In considering the third factor which might affect the accuracy
of the data the following points should be noted: Although the
diets were for only a two-day period, and may have been better
or worse than the usual diets for a particular family, these diets
can be considered fairly typical, for usually a family has fairly
regular dietary habits. Further, diets for Sundays, fast days or
any special days were omitted.
It should also be pointed out that the data included diets for
the various seasons of the year for each community studied.
The above-mentioned limitations should be borne in mind when
considering the effect of diet on the health and state of nourish-
ment of the children. However, when as large number of diets as
4,220 are studied, the trend as to certain relationships between
food habits and health should stand out clearly.
EVALUATION OF THE DIETS
In order to compare diets with one another as well as with a
fixed standard of adequacy it is necessary to have a system which
will represent in terms of numbers, as far as possible, the degree
of adequacy of a diet. A general survey of the data was made.
It was found that by a division of the material into five recognized
types of food all of the individual items of the menu could be
tabulated. These different items were then assigned numerical
values as shown by Table I.
TABLE I.-VALUE ASSIGNED TO THE FOOD TYPES.
Food Score
Milk ........................................................ 20
Butter ............................. ....................... 5
Vegetables:
Leafy ..................................................... 15
Other ................... .... .............. .............. 10
Potatoes ..................................... .. ........... 5
Fruit:
Raw, or sugarcane ................... ... ............... 15
Cooked ...... .............. ............... .. ............... 5







Florida Agricultural Experiment Station


Bread:
Whole grain .................................................. 10
Cereal ............................... ....................... 5
Meat or eggs ............................... ................ 10
100
Faulty dietary habits, deduct. ................... ................... 10
The preceding values represent the optimum score for the diet
of one day. The scores are based on an average quantity and
daily use of each item.
The authors realize that by this method of evaluating the diets
a certain degree of arbitrariness is introduced. However, it has
been found, as pointed out by Davies (3), that this method not
only facilitates the work of evaluating the diets of different char-
acter but also results in total scores which permit comparisons of
the different diets recorded as to the degree of adequacy or in-
adequacy.
The scores for diets were then studied and grouped under the
following heads: (1) extremely deficient, (2) inadequate, (3)
questionable, (4) adequate, and (5) commendable. The numer-
ical values of these groups are as follows: extremely deficient,
5-15; inadequate, 20-35; questionable, 40-55; adequate, 60-80;
commendable, 85-100. The adequate class covers all the needs
for growth and maintenance but is not free from some objection-
able dietary habits. Of these, the following are the most com-
mon: promiscuous eating between meals, unsuitable desserts, im-
proper arrangement of schedule, such as the heaviest meal at
night and irregular times for meals. In the commendable type
there are the diets which are adequate and free from the above-
mentioned faults.
A further study of the diets was made to evaluate the menus
for each meal during the day. These were scored in a similar
manner as the diets for the entire day. Tabulations were also
made to show the frequency with which specified foods appeared
in the menus.
FINDINGS
A record was made in this way of the physical defects and the
dietary habits of each child. The defects of each were then tabu-
lated and studied under the following headings:
1. Prevalence of defects of all children examined.
2. Prevalence of defects of all children by sex.
3. Prevalence of defects of all children by age.
4. Prevalence of defects among underweight children.







Bulletin 216, Nutritional Study of White School Children 17

5. Prevalence of defects among hookworm children.
6. Prevalence of defects among anemic children.
7. Prevalence of defects among children with abnormal tonsils.
8. Relation between weight and hookworm.
9. Relation of diet to underweight children.
10. Relation of diet to overweight children.
11. Relation of diet to anemic children.
12. Relation of diet to teeth.
PHYSICAL FINDINGS AND DIET
Several methods were used in this study in an effort to deter-
mine whether or not any definite relation could be established
between food habits and the state of health of the children.
The physical findings for all the children examined have been
tabulated. Diets were obtained from slightly over 60 percent of
the 3,444 children who were given physical examinations. Com-
plete data were not obtained for the 3,444 children. In 247 in-
stances age was not given; in other cases either height or weight
was not given. However, complete data were obtained for 3,325
children with the exception of age and diet.
Of that group of children from whom diets were obtained and
who were given physical examination the following study was
made:
First, the relation of factors other than diet which might af-
fect weight and general health.
Second, the records of the diets of all children examined were
compared with the diets of those underweight, overweight and
of normal weight.
Third, the relation of anemic conditions to diet.
Fourth, the conditions of the teeth were studied with respect
to diet, especially the use of milk.
PHYSICAL FINDINGS IN GENERAL
Table II shows the presence of defects of all children examined
in this survey. In general it will be noted that: (1) The defects
of the boys are of a higher percentage than those of the girls.
The large proportion of boys with defective tonsils, defective
teeth and hookworm accounts largely for this variation. (2) A
very favorable showing was made for the children without de-
fects. The girls, of whom 5.9 percent were without defects, made
a better showing than the boys, with 5.1 percent free from de-
fects. (3) Defects of naso-pharyngeal region are the most con-
spicuous of the entire group.








Florida Agricultural Experiment Station


TABLE II.-PREVALENCE OF DEFECTS BY SEX OF ALL THE CHILDREN
EXAMINED.


Defects or Disease Both Sexes
No. %
TOTAL 3,444
Complete examination ......... 3,325
Total number weighed .......... 3,027
Without disease ............... 184 5.5
GENERAL
Underweight (10% and over)... 977 32.3
Overweight (10% and over)..... 380 12.5
Anem ic ..................... 1,282 38.6
EYE DEFECTS
Defective vision ............... 886 26.6
Conjunctivitis ................. 1,012 30.4
Strabismus and other eye defects 72 2.2
EAR DEFECTS
Defective hearing .............. 247 7.4
Other ear defects .............. 59 1.8
MOUTH
Decayed teeth ................. 1,520 45.7
Malocclusions ................. 400 12.1
Gingivitis ..................... 394 11.5
NASO PHARYNX
Tonsils (defective) ............ 1,637 49.2
Adenoids (suspected) .......... 586 17.6
Nasal obstructions ............. 331 10.0
GLANDS
Cervical (enlarged) ............ 1,279 38.5
Thyroid (enlarged) ............ 77 2.3
HEART DEFECTS 423 12.7
SKIN
Eczem a ....................... 29 .9
A cne ......................... 17 .5
Im petigo ...................... 167 5.0
Infected sores ................. 145 4.4
Scabies ....................... 27 .8
Dry .......................... 180 5.4
Y ellow ........................ 222 6.7
ABDOMEN
Distended ..................... 403 12.1
Enlarged spleen ............... 129 3.9
H ernia ....................... 10 .3
PARASITES
Hookworm .................... 1,565 47.1
Tape W orm ................... 11 .3
A scaries ...................... 17 .5
BONY SYSTEM
Pigeon breast .................. 35 1.1
Round shoulders ............... 392 11.8
Winged scapulae ............... 62 1.9
R tickets ....................... 2 *
MALARIA 8 .2
SPEECH 62 1.9

*Less than 0.1 percent.


Boys
No. %
1,625
1,577
1,415
80 5.1


Girls
No. %
1,819
1,748
1,612
104 5.9


431 30.5 546 33.9
140 9.9 240 14.9
630 39.9 652 37.3

452 28.7 434 24.8
512 32.5 500 28.6
35 2.2 37 2.2

146 9.3 101 5.8
34 2.1 25 1.4


807 57.2
235 14.9
182 11.4


824 52.2 813 46.5
290 18.4 296 16.4
178 11.3 153 8.8


666 42.2 613
9 .6 68
181 11.5 242


222 14.1
84 5.3
10 .6

845 53.6
7 .4
10 .6






Bulletin 216, Nutritional Study of White School Children 19

PHYSICAL FINDINGS
EYES
Vision: Table III gives a summary of the findings with regard
to the eyes. It was possible to test nearly all of the children by
the Snelling chart. In the first grades, the illiterate chart, as
described by Rude (4), was used, in case the child did not know
the letters.
Out of the 3,325 children given the vision test 26.6 percent
showed defective sight of varying degree. The degree of abnor-
mality of vision varied from slightly defective to seriously de-
fective in one or both eyes, and even blindness in some few cases.
Children already wearing glasses were tested with their glasses
on, and many were found to have defective sight, even after at-
tention had been given their eyes.


A Ae In years
FIG. 1.-Comparison of the average height for age of Florida boys with
standards.






Florida Agricultural Experiment Station


Apparently there is no significant relation of defective vision
to age. However, it is worthy of comment as shown by Table V
that at the age of six or seven, the percentage with defective
vision was lower than between the ages of 8 and 15. From the
ages of 15 to 19 the percentage decreased again.
Conjunctivitis: The high percentage of children having con-
junctivitis, 31.0 percent, is an outstanding condition found in this
study.
Strabismus: Strabismus was found in 6.1 percent of all the
children examined. Of these, 14 children had corrective glasses.
Trachoma: Trachoma was found (and corroborated by a spe-
cialist) in three children.
A summary of the eye condition is found in Table III.


10 e In Years
FIG. 2.-Comparison of the average height for age of Florida girls with
standards.








Bulletin 216, Nutritional Study of White School Children 21


Vision test
Normal ..
Defective
Seriously d
Blind in on
Conjunctivi
Strabismus
Sty ......
Ptosis ...
Pterygium
Trachoma


TABLE III.-EYE DEFECTS OF CHILDREN EXAMINED.
Total Boys
No. % No. %
ed .................. 3,325 1,577
..................... 2,439 73.4 1,125 71.3
S.................... 886 26.6 452 28.7
effective ............. 144 4.3 81 5.1
e eye ............... 12 0.4 7 0.5
tis ................. 1,012 30.4 512 32.5
... .. ... ... 61 1.8 33 2.0
..................... 10 0.3 6 0.4
..................... 5 0.1 2 0.1
.................... 4 0.1 2 0.1
..................... 3 0.1 2 0.1


Girls
No. %
1,748
1,314 75.2
434 24.8
63 3.5
5 0.3
500 28.6
28 1.6
4 0.2
3 0.1
2 0.1
1 0.1


EARS
The total number of cases of defective hearing was 247, or 7.4
percent of all those examined. Of these 64, or 26 percent, were
associated with earache and tonsilitis. The distribution by sex,
as shown in Table II, parallels the distribution by sex of defective
tonsils, the boys showing a larger percentage of defects of hearing
than the girls.

I




























S, Age In years
FIG. 3.-Comparison of the average weight for age of Florida boys with
standards.
S----_-----_c-- --_^ L _




a---------------------------_---_ ^ -_----_-- ____-


C -_ -_ _--_ _









o --C : i-- Oo'o y fs -----



6 .'0 A96 yn lears

FIG. 3.-Comparison of the average weight for age of Florida boys with
standards.







Florida Agricultural Experiment Station


Aside from defective hearing, 59 cases of chronic otitis were
recorded.
HEIGHT AND WEIGHT
The average height and weight relation for each age of the
children examined in this study is given in Table IV. The values
represent the weight of the children with outer clothing and shoes
removed. Figures 1 and 2 show a comparison of the average
height with age for boys and girls, respectively, with the figures
of Crum and Bowditch, which were used as a standard. The av-
erage height for age is lower throughout than the standard. The
figures obtained are also lower than the values given by Rose (5)
as shown in Figs. 1 and 2.
The weight plotted against age is given in Figs. 3 and 4. These
figures show that the average weight for a given age is lower than
the values given by Bowditch or by Rose.
Figures 5 and 6 give the result of the height-weight relation
for the children examined in this study, and also the values given
by Bowditch and those given by Rose. These values do not show
as great a variation from the standard as do either the height-


Aye/n yerse S
FIG. 4.-Comparison of the average weight for age of Florida girls with
standards.


70 - -I j

Age-h/e/yg4 R4e/o,o

'0 09 1_1 1







Bulletin 216, Nutritional Study of White School Children 23

age relation or the weight-age relation. However, Fig. 5 shows
a marked retardation in development of the boys between the ages
of seven and eleven years and after the eleventh year they prac-
tically coincide with the standard. Fig. 6 shows a retardation
among the girls at about the same age. A possible explanation
of this is found in Table V, defects by age. Hookworm infesta-
tion is the heaviest between the ages of 8 and 12 years. This
should be considered as one of the factors which influence devel-
opment.
GENERAL PHYSICAL CONDITION
Included in this group were the following defects: round
shoulders, winged scapulae, pigeon breast, bony defects of ra-
chitic origin, and impediment of speech. According to Table II,
no marked variation with respect to sex can be found.
Round shoulders were recorded when the condition was marked
enough to produce a hollow chest. This condition far exceeded
all other defects of posture.


ZN


/o -- --- -- -





70 A T


"^l y -0---Q- h" I:,a /a, -?


/Aefa'fXIn /ncehs
FIG. 5.-Comparison of the average height for weight of Florida boys with
standards.






Florida Agricultural Experiment Station


Only two cases of bony defects of rachitic origin were found.
These conditions consisted of beaded ribs, enlarged epiphyses, a
large square head and a pronounced condition of knock-knees.
Functional speech defects were noted in 1.6 percent of the
children, practically equally distributed according to sex. These
defects were stammering, stuttering and lisping.
Prevalence of Defects by Age: In Table V the defects are
given by age. Of the 3,444 children examined the age for 3,202
of the group was recorded. An analysis of Table V shows some
relationships of the various defects to age. Underweight was
found more prevalent among the boys between the ages of 10 and
16 while the girls showed a greater tendency to underweight
between the ages of 11 and 14. Anemic conditions of boys were
found most frequently between the ages of 11 and 16 while the
greatest number of anemic girls were found between the ages of


S ejafIn / e$ /ncnes
FIG. 6.-Comparison of the average height for weight of Florida girls with
standards.


-- __ __ __ __ __ __












7- -- -
0 m i m i z II III lizz


S

S.
\r

9








Bulletin 216, Nutritional Study of White School Children 25

10 and 16. Heart defects were found more frequently above the
age of 11 for both boys and girls. Conjunctivitis occurs most
frequently between the ages of 6 and 11. Defects of the teeth
TABLE IV.-AVERAGE RELATION OF WEIGHT TO HEIGHT.
Boys Girls
Age Height Weight Age Height Weight
years inches pounds years inches pounds
6 44 45 6 44 44
7 46 48 7 45 45
8 48 51 8 45.5 46
9 49 55 9 47 52
10 52 60 10 50 57
11 54 67 11 53 63
12 55 72 12 56 75
13 56.5 79 13 57 88
14 58.5 86 14 60 99
15 62 101 15 61 102
16 63 106 16 63 106
17 66 128 17 63 117
18 68 129 18 63 120
19 69 138 19 63 127
and gingivitis were found to occur most frequently between the
ages of 6 and 12 years. Also defective tonsils and enlarged lymph
glands were found to occur most frequently between the ages of
6 and 11. These figures tend to show that defective tonsils, de-
fective teeth and hookworm, which are most common between
ages of 6 and 11, are contributing factors to anemia and under-
weight which are found at ages above 11.
MOUTH
Teeth: The most outstanding defect of the mouth was carious
teeth. This condition was found more prevalent among the boys,
51.2 percent having carious teeth, than among the girls, with 43.3
percent. As shown by Table V, there is a gradual decrease in
the number of children with carious teeth after the twelfth year.
Malocclusions: As stated before, any condition causing an ab-
normal bite was considered as a malocclusion. This defect showed
only a slight variation by sex. Of the boys 14.9 percent had
malocclusions, while the percentage of girls with this condition
was 11.9.
Gingivitis: The total number of children with this defect was
11.5 percent. Tables VI, VII and VIII show that gingivitis was
much more prevalent among the children with defective tonsils,
18.5 percent; with anemia, 20.3 percent, and underweight chil-
dren, 18.4 percent.







Florida Agricultural Experiment Station


NASOPHARYNGEAL DEFECTS
Defects of the nasopharynx were the most common type of de-
fect noted in this study, occurring in 76.8 percent of all the cases
examined.
Tonsils: A singularly even distribution by sex is noted with
respect to defective tonsils. The number of children who had
tonsils which could be considered normal were about equal to
those who showed enlargement or disease.
The percentage of boys with enlarged or diseased tonsils, 52.2
percent, is a little greater than for the girls, 49.3 percent. Of the
number with abnormal tonsils, 20.4 percent were found who had
tonsils which were considered diseased. In this case also, the
boys had a higher percentage than the girls.
Table VI shows a comparison of the defects between children
with defective tonsils and the defects of all the children examined.
Anemia and defective hearing show a higher percentage among
the children with defective tonsils than the value for all the chil-
dren, as shown in Table VII. The percent of abnormal tonsils for
all the children examined was 49.2 percent, while the percent of
abnormal tonsils among the anemic children was 60 percent. Ab-
normal tonsils are more prevalent among underweight children
than among the normal or overweight children, as shown in Table
VIII. The incidence of heart defects is also more common among
children with defective tonsils.
Adenoids: The percent of children considered as probably
having adenoids was 17.6. This was based on the following symp-
toms which suggested adenoids: (a) mouth breathing; (b) chron-
ic nasal discharge; (c) typical adenoid faces. Adenoids were
slightly more prevalent among boys than girls. The number
definitely decreased with age, a marked drop being noticeable at
the fourteenth year of age.
It is worthy to note the small number of children with adenoids
as compared to those with defective tonsils. One explanation of
this is that the children of Florida can be out in the fresh air all
of the year, and are troubled less with colds than in many other
sections of the country.
Nasal Obstruction: Ten percent of the children examined
showed nasal obstruction. As with adenoids, this condition was
slightly more prevalent among the boys than the girls.
Deflected Septa: Of the total number examined, 12 children
had deflected septa. With the exception of one, these were the
result of accidents.







Bulletin 216, Nutritional Study of White School Children 27

SKIN
Of the skin diseases, impetigo, infected sores, dry and yellow
skin, were the most common, occurring in about 5 percent re-
spectively for each defect. There was little difference by sex for
these defects. As seen by Table V, as age increases the skin de-
fects increase. No apparent relation was shown between impeti-
go and underweight or anemia as shown by Tables VII and VIII.
The examination for skin defects also included inspection for
pediculosis as well. In no case, however, was this condition found.

GLANDS
Superficial Cervical Lymph Glands: The condition of the su-
perficial cervical lymph glands is shown in Table II. These glands
were recorded as enlarged when they were easily palpable. The
percent of children with this defect was higher among the boys,
42.2, than among the girls, 35.1. It was found that enlargement
accompanied, in nearly every case, either carious teeth or en-
larged tonsils. As age increases there is a gradual decrease in
the percent of children with enlarged glands. At 6 years of age
the value is about 40.0 percent, while at 16 years of age the
value is 15.0 percent.
THYROID
In this study, 77 children, or 2.3 percent, were found to have
thyroid enlargement. This defect predominated in a very large
measure among the girls, 68 girls having thyroid enlargement as
compared to 9 boys. A study of Table V shows thyroid enlarge-
ment to be more prevalent in those children 12 years of age and
above. From a study of record forms, it was found that 65 of the
77 children with thyroid enlargement were not native Floridians
but came to Florida from the north central states. It will be seen
in Table VIII that the incidence of thyroid enlargement is much
higher among the underweight children.
HEART
Positive diagnosis of tachycardia or murmur was possible in
423 children, or 12.7 percent of the group. Heart defects were
slightly more prevalent among the girls than among the boys,
Table II. The incidence of heart defects was more common among
the anemic children, those with defective tonsils, and hookworm
infested children. Heart defects for children with anemia was
found to be 20 percent, for children with defective tonsils 17.5
percent, and for hookworm infested children 18 percent; while for






Florida Agricultural Experiment Station


the children who were not anemic, 7 percent had abnormal heart
action, children with normal tonsils, 7.9 percent, and for those
free from hookworm, 8 percent had heart defects. A sharp rise
in the incidence of heart defects comes at about the eleventh year,
Table V.
ANEMIA
In addition to the general inspection of the mucous membranes
for pallor, a haemoglobinometer was used for determination of
an anemic condition. This method gave accurate data not only as
to the number with anemia but also as to the degree of anemia.
Of this group, 38.6 percent were considered anemic. There was
only a very slight difference in this respect between boys and
girls. As shown by Table V, the percentages increase with age
up to about 13 years.
The percentages for anemia were markedly higher among the
children who had hookworm (49 percent), defective tonsils (47
percent), and who were underweight (48 percent), as compared
to 38 percent for all children examined. This is shown in Tables
I, VI, VIII, and IX.
MALARIA
A surprisingly low figure, 8, was found for children with ma-
laria. These were positively identified by microscopic examina-
tion as malaria subjects.
However, this value may be far from representing the true
condition, since many of the children from whom the smears
were made had taken tonics or quinine, although no history of
fever was given.
INTESTINAL PARASITES
Hookworm: Table II shows the percentage of hookworm as
found in this survey. The figures show that, of any one defect,
hookworm is the most prevalent; 53 percent of the boys and 41
percent of the girls were found, by laboratory methods, to have
hookworm infestations.
Table VII shows some of the defects which are more prevalent
among children with hookworm, these being anemia, heart de-
fects and gingivitis.
Table V shows that the time of heaviest infestation is between
the ages of 8 and 12 years.
Ascaries and Tapeworm: Comparatively few children, 17,
were found to be infested with ascaries and only 11 were found
to have tapeworm.




TABLE V.-DEFECTS AND AGE.


Age and Sex No Defects
No. %
Both 6 13 3.2
Sexes 1
Age in 7 12 3.6
Years 8 14 4.5
9 14 4.4
10 14 4.3
11 9 3.0
12 11 4.5
13 12 5.0
14 10 5.1
15 13 8.0
16 15 9.8
17 8 8.3
18 5 7.3
19 5 8.2
Boys 6 9 4.4
7 4 2.6
8 6 3.8
9 3 2.8
10 6 3.1
11 4 2.9
12 4 3.4
13 5 4.8
14 4 4.2
15 5 6.7
16 7 10.1
17 3 8.3
18 2 6.9
19 4 17.4
Girls 6 4 1.9
7 8 4.6
8 8 4.7
9 11 6.1
10 8 5.0
11 5 3.1
12 7 5.5
13 7 5.1
14 6 5.9
15 8 8.5
16 8 9.1
17 5 7.1
18 3 7.7
19 1 3.3


Underweight
No. %
93 23.2
66 20.0
77 23.7
87 27.6
83 27.0
91 30.7
87 37.7
80 35.7
70 36.3
46 27.7
41 28.3
27 28.5
13 18.6
6 11.1
43 20.8
32 20.5
34 22.3
28 22.4
35 23.0
40 29.1
38 35.0
36 38.1
36 40.1
22 30.0
23 35.2
9 25.0
5 16.6
3 13.0
50 25.6
34 22.0
43 25.2
59 32.8
48 31.6
51 32.2
49 40.4
44 33.3
34 32.6
24 25.5
18 21.4
18 32.0
8 20.6
3 9.1


Overweight
No. %
29 7.1
23 7.0
22 6.7
38 11.6
33 10.2
38 12.7
31 12.7
30 12.4
28 14.3
31 18.4
21 13.7
13 14.0
9 12.0
6 10.7
11 5.3
8 5.1
7 4.6
22 16.7
14 8.5
13 9.5
11 9.5
12 11.5
7 7.4
8 10.8
8 11.6
3 8.4
1 3.4
3 13.0
15 7.5
15 8.7
13 7.4
15 7.7
19 11.9
22 13.5
21 16.4
21 15.3
21 20.6
23 24.5
13 15.5
10 17.5
8 20.5
3 9.0


Anemic
No. %
151 37.4
130 39.5
115 35.8
107 34.6
134 43.4
116 39.7
88 36.1
101 43.2
77 39.3
68 40.5
45 29.4
26 28.6
17 25.0
9 14.7
78 37.9
58 37.2
58 38il
49 37.1
68 41.5
54 39.4
45 38.8
49 47.1
38 40.4
35 47.3
19 27.5
8 22.2
8 27.6
3 13.0
73 36.8
72 41.6
57 33.5
58 32.2
66 41.2
62 40.0
43 33.6
52 39.3
39 38.2
33 35.1
26 30.9
20 35.0
9 23.1
6 18.1


Hookworm Enl. Tonsils Adenoids
No. % No. % No. %
181 45.1 219 54.7 59 14.8
170 51.7 174 52.9 68 20.7
167 52.0 171 53.2 59 18.3
169 54.1 157 50.3 43 13.8
184 56.8 183 56.5 64 19.7
160 54.3 159 54.0 55 18.7
103 42.2 118 48.4 38 15.6
104 44.3 89 37.8 35 14.9
90 45.9 83 42.3 19 9.7
68 40.5 80 47.6 12 7.1
61 39.9 48 31.4 9 5.9
30 32.6 41 43.2 3 3.2
21 30.9 22 32.2
6 11.5 14 25.0 .
101 49.2 115 55.8 36 17.5-
87 55.8 97 62.1 33 21.2
100 65.7 82 54.6 33 21.7
80 60.6 68 50.0 20 15.1
103 62.8 97 52.4 30 18.3
81 59.1 76 55.4 26 19.0
57 49.1 66 48.1 26 22.4
57 54.8 44 42.3 18 17.5
45 47.9 37 39.4 11 11.7
36 48.8 41 55.4 6 8.1
32 46.4 22 31.9 7 10.1
12 33.3 14 40.4 1 2.8
13 44.8 8 27.6 .
5 21.7 7 30.4 ..
80 41.0 104 53.5 23 12.0
83 48.0 77 44.5 35 20.2
67 39.4 89 52.3 26 15.4
89 49.4 90 50.0 23 12.8
81 50.6 86 60.6 34 21.3
79 50.0 83 52.5 29 18.4
46 35.9 52 40.6 12 9.4
47 35.6 45 34.5 17 13.1
45 44.1 46 45.1 8 7.8
32 34.0 39 41.5 6 6.4
29 34.5 26 30.9 2 2.4
18 31.5 23 40.4 2 3.4
8 20.5 14 35.9
2 6.0 6 18.4


Hearing
No. %
24 5.9
15 4.6
21 6.4
28 8.6
20 6.2
19 6.3
18 7.4
23 9.5
23 11.7
14 8.3
16 10.5
5 5.3
3 4.4
3 4.9
17 8.2
10 6.4
10 6.6
9 6.8
10 6.1
11 8.0
11 9.5
15 14.4
14 14.9
7 9.5
10 14.5
3 8.3
2 6.9
3 13.0
7 3.5
5 2.9
11 6.3
19 9.7
10 6.3
8 4.9
7 5.5
8 5.8
9 8.8
7 7.4
2 2.4
2 3.4
1 2.6


Thyroid
No. %


2 0.6
1 0.3
3 0.9
5 1.7
6 2.5
16 6.6
7 3.6
14 8.3
2 1.3
7 7.4
4 5.9
2 3.3




1 0.6
1 0.7

2 1.9

2 2.7






2 1.1
1 0.5
2 1.9
4 2.5
6 4.7
14 10.2
8 7.8
12 12.8
2 2.4
7 11.9
4 10.3
2 5.3





TABLE V.-DEFECTS AND AGE-Continued.


Age and Sex Heart
No. %
Both 6 28 7.1
Sexe 7 22 7.3
Age in
Years 8 24 7.3
9 25 8.0
10 46 14.2
11 33 11.2
12 35 14.3
13 31 13.1
14 30 15.3
15 26 15.5
16 21 13.7
17 13 13.7
18 11 16.3
19 5 8.2
Boys 6 12 5.8
7 66 3.8
8 9 5.9
9 10 7.6
10 21 12.8
11 12 8.8
12 14 12.1
13 11 10.6
14 11 11.7
15 11 14.9
16 9 13.0
17 4 11.1
18 1 3.4
19 2 8.7
Girls 6 16 8.0
7 16 9.2
8 15 8.6
9 15 7.7
10 25 15.6
11 21 12.9
12 21 16.4
13 20 14.6
14 19 18.6
15 15 16.0
16 12 14.3
17 9 15.3
18 10 25.6
19 3 7.9


Vision
No. %
68 16.9
71 20.9
94 29.1
94 30.0
111 34.3
83 28.3
76 31.1
73 31.1
69 35.2
33 19.6
45 29.4
13 13.7
10 14.7
6 9.6
25 12.1
35 22.4
48 31.6
46 34.8
68 41.5
47 34.3
37 31.9
42 40.4
39 41.5
20 27.0
20 29.0
5 13.9
4 13.8
2 8.7
43 22.0
36 21.8
46 26.0
48 24.6
43 26.9
36 22.3
39 30.5
31 23.8
30 29.4
13 13.8
25 29.8
8 14.0
6 15.4
4 9.1


Conjunc-
tivitis
No. %
157 39.1
120 36.5
97 30.0
125 40.0
94 29.0
90 30.6
90 36.8
51 21.6
36 18.4
34 20.2
30 19.6
22 23.6
15 22.0
7 12.5
80 38.3
60 38.5
50 32.8
65 49.2
48 29.2
46 33.5
48 41.3
26 25.0
19 20.2
17 23.0
17 24.5
9 25.0
8 27.6
3 8.7
77 39.6
60 34.6
47 27.7
60 33.3
46 28.7
44 27.8
42 32.8
25 19.0
17 16.5
17 18.0
13 15.4
13 22.8
7 18.0
4 12.1


Teeth Gingivitis
No. % No. %
200 49.3 55 13.7
159 54.4 40 12.1
179 56.5 38 11.8
172 55.2 31 9.9
162 50.1 49 15.1
135 46.3 31 10.5
107 45.5 22 9.0
92 39.0 27 11.7
61 34.2 22 11.2
50 29.8 13 7.7
42 27.4 12 7.8
23 24.8 4 4.3
18 26.5 3 4.4
15 25.0 2 3.5
114 55.3 30 14.6
86 55.1 20 12.9
97 63.8 18 11.8
80 60.6 15 11.4
96 58.5 21 13.0
71 51.8 16 11.6
52 44.8 9 7.7
43 41.3 14 13.8
36 38.3 15 16.1
27 36.4 7 9.4
21 30.4 7 10.1
9 25.0 2 5.6
11 37.9 1 3.4
6 26.0 1 4.6
86 44.1 25 12.8
73 42.2 20 11.6
82 48.2 20 11.7
92 51.1 16 8.8
66 41.2 28 17.5
64 40.5 15 9.4
55 42.9 13 10.1
49 37.1 13 9.8
25 24.5 7 6.8
23 24.4 6 6.3
21 25.0 5 5.9
14 24.5 2 3.5
7 18.0 2 5.1
9 27.2 1 3.3


Skin
No. %
105 26.1
76 23.1
71 22.0
78 25.0
88 27.1
79 26.9
61 25.0
53 22.4
46 23.4
42 25.0
25 16.3
15 16.1
8 11.8
5 10.7
57 27.6
36 23.1
38 25.0
41 31.1
44 26.8
39 28.5
31 26.7
29 27.9
26 27.7
22 29.7
13 19.0
7 19.4
4 14.1
3 13.0
48 24.6
40 23.1
33 19.4
37 20.5
44 27.5
40 25.3
30 23.4
24 18.1
20 19.2
20 21.2
12 14.2
8 14.0
4 10.2
2 6_0


Enl. Glands
No. %
175 43.6
124 37.7
106 32.9
115 36.8
130 40.1
93 31.5
85 34.8
63 26.7
58 29.6
65 38.7
27 17.6
13 14.0
12 17.6
13 23.2
92 44.7
57 36.5
66 43.4
53 40.2
71 43.3
47 34.3
38 32.7
31 29.8
39 41.5
30 40.5
17 24.6
4 11.1
4 14.1
4 17.4
83 42.5
67 38.7
40 23.5
62 34.4
59 36.9
46 29.1
47 36.7
32 24.2
19 18.6
35 37.2
10 11.9
9 15.8
8 20.5
0 979


Posture
No. %
34 8.5
33 10.0
48 14.9
43 13.7
39 12.0
38 13.2
23 9.4
23 9.7
16 8.2
15 8.9
9 5.9
7 7.5
6 8.8
4 7.1
21 10.2
17 10.9
30 19.7
19 14.4
20 12.2
23 16.8
16 13.8
9 8.6
6 6.4
8 10.8
4 5.8

3 10.3

13 6.6
16 10.4
18 10.5
24 13.3
19 11.9
15 9.4
7 5.5
14 10.6
10 9.8
7 7.4
5 5.9
7 12.3
3 7.7
A 101


Total No.
Children
401
329
322
312
324
295
244
236
196
168
153
93
68
56
206
156
152
132
164
137
116
104
94
74
69
36
29
23
195
173
170
180
160
158
128
132
102
94
84
57
39
00


--







Bulletin 216, Nutritional Study of White School Children 31

INCIDENCE OF DEFECTS WITH CERTAIN
SPECIFIC DEFECTS
An effort was made to determine whether the incidence of cer-
tain defects was greater among some specific defects than among
other defects. In order to do this, four defects-anemia, under-
weight, defective tonsils and hookworm infestation-were chosen
as the specific defects. Four tables were made, one for each of
the above-mentioned defects, and the defects accompanying the
specific defect were tabulated. In this way the frequency with
which other defects occurred among children having one or more
of the specific defects could be compared to the frequency with
which they occurred for the whole group; also the frequency
with which other defects occurred among children free from the
above-mentioned specific defects. Tables VI, VII, VIII and IX
point out some interesting relations.
PREVALENCE OF DEFECTS AMONG CHILDREN WITH
ENLARGED TONSILS
In Table VI are tabulated some of the defects which were found
among children with enlarged tonsils. A comparison of the fre-
quency with which these same defects occur for the whole can be
made. Those defects which show a decided increase among the
children with enlarged tonsils are: anemia, defective hearing, de-
fective teeth, gingivitis, and heart defects. Of these, anemia and
heart defects are the most outstanding; 47.2 percent of the chil-
dren with defective tonsils being anemic, while 30 percent of the
children with tonsils not defective were anemic; and 17.5 percent
of the children with defective tonsils had heart defects, while 8.8
percent of the children with normal tonsils had heart defects.
Defective hearing also was found to be quite prevalent among the
children with defective tonsils, 9.5 percent, while for children
with normal tonsils, 5.4 percent had defects of hearing. Gingi-
vitis and- teeth defects also show an appreciable difference for
the two groups.
PREVALENCE OF DEFECTS AMONG ANEMIC CHILDREN
Table VII shows a comparison of the defects common to anemic
children with the defects of the whole group of children exam-
ined. Of the anemic children, 57.3 percent have hookworm, while
40.6 percent of these not anemic have hookworm. Defective ton-
sils are more common among anemic children, 60.2 percent, as
compared to 52.3 percent for children not anemic. Conjunctivitis,
gingivitis and carious teeth are other defects which are more








TABLE VI.--DEFECTS OF CHILDREN WITH DEFECTIVE TONSILS COMPARED WITH DEFECTS OF ALL CHILDREN EXAMINED.
Defects All Children Examined Children with Defective Tonsils 0
Both Sexes Boys Girls Both Sexes Boys Girls
No. % No. % No. % No. % No. %'o No. %
Total No. Examined 3,325 ... 1,577 ... 1,748 .
Total No. Weighed.3,027 ... 1,415 ... 1,612 ...
Tonsils ...........1,637 49.2 824 52.2 813 46.5 1,637 ... 824 ... 813 ...
Hookworm ........1,565 47.1 845 53.6 720 43.7 776 47.4 428 51.9 348 42.8
Anemia ..........1,282 38.6 630 39.9 652 37.3 773 47.2 403 48.9 370 45.5
Overweight ....... 380 12.5 140 9.9 240 14.9 139 8.5 49 5.9 90 11.1
Underweight ...... 977 32.3 431 30.5 546 33.9 572 34.9 256 30.9 316 38.8
Vision ............ 886 27.5 452 28.7 434 26.3 464 28.2 209 25.4 253 31.1
Conjunctivitis .....1,012 30.4 512 32.5 500 30.3 386 23.6 195 23.7 191 23.5
Hearing .......... 247 7.4 146 9.3 101 6.1 156 9.5 86 10.4 70 8.6
Gingivitis ........ 384 11.9 182 11.5 202 12.3 271 16.5 132 16.0 139 17.1
Teeth ............1,520 45.7 807 51.2 713 43.3 886 54.1 485 58.9 401 49.3 o
Impetigo ......... 167 5.0 88 5.6 57 3.5 83 5.1 47 5.7 36 4.4
Heart ............ 423 12.7 181 11.5 242 14.7 288 17.5 157 19.0 131 16.1
Thyroid .......... 77 2.3 9 .6 68 4.1 35 2.1 2 .2 33 4.1

TABLE VII.-DEFECTS OF ANEMIC CHILDREN COMPARED WITH ALL CHILDREN EXAMINED.
Defects All Children Examined Children with Anemia
Both Sexes Boys Girls Both Sexes Boys Girls
No. % No. % No % No. % No. % No. %
Total No. Examined 3,325 ... 1,577 ... 1,748 ...
TotalNo. Weighed 3,027 ... 1,415 ... 1,612 ...
Anemic ...........1,282 38.6 630 39.9 652 37.3 1,282 100.0 630 100.0 652 100.0 r
Hookworm ........1,565 47.1 845 53.6 720 41.2 735 57.3 402 63.8 333 51.1
Tonsils ...........1,637 49.2 824 52.2 813 46.5 772 60.2 410 65.1 362 55.5
Overweight ....... 380 12.3 140 9.9 240 14.9 137 10.7 68 10.8 69 10.6
Underweight ...... 977 32.3 431 30.5 546 33.9 437 34.1 209 33.2 228 35.0
Vision ............ 886 26.6 452 28.7 434 29.8 391 30.5 181 28.7 210 33.2
Conjunctivitis .....1,012 30.4 512 32.5 500 28.6 512 39.9 261 41.4 251 38.5
Hearing .......... 423 12.7 181 11.5 242 13.8 97 15.4 56 8.9 41 6.3
Teeth ............1,520 45.7 807 51.2 713 40.8 721 56.2 396 62.9 325 49.8
Gingivitis ........ 384 11.5 182 11.5 202 11.6 260 20.3 126 20.0 134 20.5
Impetigo ......... 167 5.0 88 5.6 79 4.5 83 6.5 47 7.5 36 5.5
Heart ............ 423 12.7 181 11.5 242 13.8 264 20.6 117 18.6 147 22.5
Thyroid ........... 77 2.3 9 .6 68 3.9 41 3.2 4 .6 37 5.7




TABLE VIII.-DEFECTS OF UNDERWEIGHT CH


Defects All Children Examined
Both Sexes Boys
No. % No. %
Total No. Examined 3,325 ... 1,577 ... 1
Total No. Weighed 3,027 ... 1,415 ... 1
Underweight ...... 977 32.3 431 30.5
Hookworm ....... 1,565 47.1 845 53.6
Anemia ..........1,282 38.6 630 39.9
Tonsils ........... 1,637 49.2 824 52.2
Vision ............ 886 26.6 452 28.7
Conjuctivitis ......1,012 30.4 512 32.5
Hearing .......... 247 7.4 146 9.3
Teeth ............. 1,520 45.7 807 57.2
Gingivitis ......... 394 11.5 182 14.9
Impetigo ......... 167 5.0 88 5.6
Heart ............ 423 12.7 181 11.5
Thyroid .......... 77 2.3 9 .6


[IIDREN COMPARED WITH ALL CHILDREN EXAMINED.
Underweight Children
Girls Both Sexes Boys Girls
No. % No. % No. % No. %


,748 .
,612 .
546 33.9
720 41.2
652 37.3
813 46.5
434 29.8
500 28.6
101 5.8
713 40.8
202 11.6
79 4.5
242 13.8
68 3.9


977 100.0
475 48.6
475 48.6
572 58.5
300 30.7
395 40.4
78 8.0
545 55.8
181 18.5
64 6.6
151 15.5
54 5.5


431 100.0
241 53.9
230 53.4
256 59.4
120 27.8
199 46.2
39 9.0
266 61.7
84 19.5
39 9.0
62 14.4
8 1.8


546 100.0
234 42.8
245 44.9
316 57.8
180 53.0
196 35.9
39 7.1
279 51.1
97 17.8
25 4.6
89 16.3
46 8.4


TABLE IX.-DEFECTS OF CHILDREN WITH HOOKWORM COMPARED WITH ALL CHILDREN EXAMINED.
Defects All Children Examined Children with Hookworm
Both Sexes Boys Girls Both Sexes Boys Gi
No. % No. % No. % No. % No. % No.
Total No. Examined 3,325 ... 1,577 ... 1,748 ..
Total No. Weighed 3,027 ... 1,415 ... 1,612 ...
Hookworm .......1,565 47.1 845 53.6 720 41.2 1,565 100.0 845 100.0 720
Tonsils ........... 1,637 49.2 824 52.2 813 46.5 760 45.1 387 45.8 319
Anemia ..........1,282 38.6 630 39.9 652 37.3 776 49.6 389 46.0 387
Overweight ...... 380 12.3 140 9.9 240 14.9 272 17.3 112 13.2 160
Underweight ...... 977 32.3 431 30.5 546 33.9 347 22.2 183 21.7 164
Vision ............ 886 26.6 452 28.7 434 29.8 326 20.8 160 18.9 166
Conjunctivitis .....1,020 30.4 512 32.5 500 28.6 538 34.4 278 32.9 260
Hearing .......... 423 12.7 181 11.5 242 13.8 81 5.2 51 6.0 30
Teeth .............1,520 45.7 807 51.2 713 40.8 837 53.5 487 57.6 350
Gingivitis ..........384 11.5 182 11.5 202 11.6 262 16.7 137 16.2 125
Impetigo ......... 167 5.0 88 5.6 79 4.5 63 4.0 39 4.6 24
Heart ............ 423 12.7 181 11.5 242 13.8 282 18.0 132 15.6 150
Thyroid ........... 77 2.3 9 .6 68 3.9 24 1.5 4 .5 20


rls
.%


100.0
44.3
53.8
23.8
22.8
23.0
36.1
4.2
48.6
17.4
3.3
20.8
2.8


--







Florida Agricultural Experiment Station


prevalent among anemic children. Heart defects were found to
be almost three times as high among anemic children as among
the children not anemic. Only a slight difference was found for
the percent of underweight among anemic children, 34 percent,
and children not anemic, 30 percent. Anemia is usually consid-
ered a fairly constant sign of malnutrition; however, these figures
do not justify the statement that underweight is definitely asso
ciated with anemia.
PREVALENCE OF DEFECTS AMONG UNDERWEIGHT CHILDREN
In Table VIII are given some of the relationships of defects
among underweight children and the whole group of children
examined. As shown by Table VII, anemia is not necessarily
accompanied by underweight. However, Table VIII shows that
anemia is more prevalent among underweight children: 39.3
percent of the children who were not underweight were anemic,
while 48 percent of the underweight children were anemic. These
data show that anemia is more common among the underweight
children but, on the other hand, they do not permit the conclusion
that underweight is common among anemic children.
PREVALENCE OF DEFECTS AMONG CHILDREN WITH HOOKWORM
Table IX shows that anemia is more common among hookworm
children than among children free from hookworm. Defective
teeth and gingivitis occur most frequently among hookworm
children. Heart defects were found prevalent among hookworm
subjects, paralleling heart defects among anemic children and
children with defective tonsils. Overweight was more prevalent
among the hookworm group than in any other group. One pos-
sible explanation of this is that children heavily infested with
hookworm fail to make the average growth in height while at the
same time edema and a distended abdomen develop. This added
weight, with a shorter stature, causes overweight, Table IX.
RELATIONS OF SPECIFIC DEFECTS
A study of Tables VI, VII, VIII and IX points out some factors
which contribute to pallor, malnutrition and abnormal weight re-
lations. Defective tonsils, defective teeth, thyroid disturbances
and hookworm infestation are some of the causative factors. In
interpreting these relations, it must be kept in mind that other
factors are involved and that parallelism does not necessarily
prove cause and effect relations. It is not the intent here to give
the impression that the above-mentioned defects are the only







Bulletin 216, Nutritional Study of White School Children 35

factors in causing a condition resembling malnutrition and
abnormal weight relations.
These tables also show a very marked association of defective
tonsils, hookworm infestation and anemia, with heart defects.
The Public Health Reports (6) show that in the period 1921-
1927, 20 out of every 100,000 children from 5 to 19 years of age
died of heart disease annually in the registration area. Practi-
cally 75 percent of all cases of heart disease develop in children
under 10 years of age. Special reports obtained by the United
States Public Health Service for 1928 from certain states with an
aggregate population of 25 million, showed that 228 persons out
of every 100,000 died from heart disease as compared with 106
from kidney disease, 105 from cancer and 100 from pneumonia,
the four great killers of mankind.
Tabulations of physical records of approximately 5,000 school
children under Public Health Service supervision showed that 40
out of every 1,000 children with defective tonsils had heart dis-
ease, while, of the children who had normal tonsils, 9 out of every
1,000 had heart disease.
It should be noted that in this survey not only defective tonsils
but also hookworm infestation are associated with heart defects,
and that the incidence of heart defects is higher in this group
than is reported in tabulations by the United States Public Health
Service. This is a grave situation! From the standpoint of
health promotion it is unfortunate that people are more impressed
by new and startling events regarding diseases than by more
serious conditions which develop slowly. Few people realize the
growing menace to life of heart disease and that its importance
as a public health problem is greater than that of tuberculosis
or cancer.
DIETS
The diets of 2,110 children were studied and scored by the
methods previously described. The principal items in the menus
for the entire day appear in Table X and are given in Fig. 7. The
scores for the diets for the entire day are shown in Table X and
also appear in Fig. 8.
It should be borne in mind that the commendable diet, repre-
sented by a score of 85 or above, is one that is capable of meeting
the body's needs and is not one difficult of attainment. Further,
such a diet need not be an expensive one-dairy products, cereal,
vegetables, fruit, an egg or meat daily being sufficient to allow a
diet to qualify in this group. This being the case, one would ex-














Fruit ...........
Cereal ..........
Egg ............
Milk or Cocoa....
Coffee ..........
M eat ...........
Rice or Grits.....
Hot Cakes ......
Biscuit .........
Syrup ..........
Butter ..........
Potato ..........
Vegetable, leafy..
Vegetable, other..
Dessert .........


*EI~EI EIEEhEE
MMMII EKE.

mhhhhhhEhEEEI IEEE..

mEEEEEhEEEEI

EEEEEEEEEEE.E


TT7T-====7'_=.


0 ZO 40 60 80
Percent
FIG. 7.-Frequency with which the most usual foods appear in the menus for the entire day.


/00


_I I I 1 1___I






Bulletin 216, Nutritional Study of White School Children 37


Sc ores
FIG. 8.-Food score for the entire day.







Florida Agricultural Experiment Station


pect a large majority of the children to fall into this group. How-
ever, only 1.2 percent of the children could qualify. Likewise the
number in the adequate group, 60-80, was small, amounting to
only 23.4 percent. Almost twice this number, 45.7 percent, had
diets which were highly questionable, this group being repre-
sented by the numerical values 40-55. Almost one-third, or
29.9 percent, of the children had diets which were plainly incap-
able of meeting the bodily requirements; of this group 1.4 per-
cent had diets which were classed as distinctly deficient.
In Table X and also in Fig. 7 are shown the frequency with
which certain foods occur in the menus for the entire day. Meat
heads the list; 69.6 percent of the menus included meat. Vege-
tables other than leafy or potatoes were next, occurring in 59.9
percent of the menus. Another item to occur in more than 50
percent of the menus was biscuit. The items which were found
so frequently are foods that are low in value on scoring.
Another group of foods occurring quite frequently and also low
in scoring value includes: cereal, rice or grits, potato and dessert.
Foods with high values on the score sheet occur less frequently.
These include fruit, found in 20.9 percent of the menus; milk,
found in 28.4 percent of the menus; and leafy vegetables, found
in 27.0 percent of the menus.

TABLE X.-FREQUENCY WITH WHICH CERTAIN FOODS OCCUR IN THE MENUS
FOR THE ENTIRE DAY.
Food Number Percent
F ruit ......................................... 442 20.9
Cereal ............................ ........... 884 41.8
Egg ....................... .................. 759 35.9
Milk or Cocoa ................... ... ....... 600 28.4
Coffee ........................................ 520 24.6
M eat ...................................... 1,470 69.6
Rice or Grits .................................. 878 41.6
H ot Cakes ................................... 135 6.3
Biscuit ......................................... 1,076 50.9
Syrup ....................................... 412 19.5
Butter ........................................ 642 30.4
Potato ............................ .. ......... 801 38.0
Vegetable, leafy ................................ 568 27.0
Vegetable, other ................................ 1,266 59.9
D essert ... .................................. 801 38.0
Total Number of Menus ........................ 2,110


TABLE X-a.-SCORE OF MENUS FOR THE ENTIRE DAY.
Scores Number Percent
5- 15 30 1.4
20- 35 601 28.5
40- 55 963 45.7
60- 80 493 23.4
85-100 23 1.1











Fruit.. .........
Cereal. ............
Egg ...............
Milk or Cocoa......
Coffee.............
Doughnuts .........
Meat or Bacon......
Rice or Grits.......
Hot Cakes.........
Biscuit............
Syrup.............
Butter.............
No Breakfast.......


0 20 40 60 80
reeercen
FIG. 9.-Frequency with which the principal items appear in the breakfast menus.


/oo


.l.I II I- I I


IR3 ill I


M i


I







40 Florida Agricultural Experiment Station

MENUS
A study was made of the menus for the different meals
throughout the day. Tables X, XI, XII and XIII and Figs. 7, 8,
9, 10 and 11 show in a large majority of cases that no attempt
was made to provide foods particularly suited for growing chil-
dren.
BREAKFAST
An analysis of the menus for breakfast, given in Table XI,
shows that biscuit, cereal and meat* were the foods most fre-
quently eaten at breakfast. A little over a third of the children
had cereal and milk, 18.5 percent had eggs, but only 13.0 percent
had fruit. Coffee and tea were used in 23.9 percent of the menus.
Fig. 9 and Table XI show the principal items appearing in the
menus for breakfast.
Table XI-a shows the scores for the breakfasts. By reference
to Table I a value of 40 will be found as the score required for an
adequate breakfast. A score of 25 to 35 represents the numerical
values for questionable breakfasts and anything below 25 is in-
adequate. Over 50 percent of the children had inadequate break-
fasts, about 40 percent had questionable breakfasts, and about 10
percent had adequate breakfasts. Of all the children, 45 had no
breakfast on the two days the menus were collected and 111 had
breakfast consisting of biscuit and butter.
TABLE XI.-FREQUENCY WITH WHICH CERTAIN FOODS OCCUR IN
BREAKFAST MENUS.
Food Number Percent
Fruit ....................................... 276 13.0
Cereal ........................................ 856 40.5
Egg ........................................... 391 18.5
M ilk or Cocoa .................................. 600 28.5
Coffee ......................... .............. 505 23.9
D oughnuts ..................................... 51 2.4
M eat or Bacon ................................. 1,113 52.7
Rice or Grits ................................... 562 26.6
H ot Cakes ..................................... 136 6.4
B iscuit ........................................ 789 37.3
Syrup ........................................ 399 18.9
Butter ........................................ 149 7.0
N o Breakfast .................................. 46 2.1
Total Number of Breakfasts ..................... 2,110
TABLE XI-a.-BREAKFAST SCORES.
Scores Number Percent
No Breakfast 46 2.1
5-20 1,193 56.5
25-35 671 31.2
40 and Over 202 9.5
Total Number of
Breakfasts 2,110
*The term meat includes bacon.










Fruit..............
Cereal............
Eggs.............
Milk or Cocoa......
Coffee.............
M eat.............. L f i
Rice or Grits......
Biscuit............
Butter .............
Potato .............
Vegetable, leafy ...
Vegetable, other .... i t i
Pie................
Cake .............. I
Candy..............

0 20 40 6"0 80 /00
Srcen t
FIG. 10.-Frequency with which the principal items appear in lunch menus.







Florida Agricultural Experiment Station


LUNCH
Of the principal items occurring as shown by Table XII and
Fig. 10, in the lunch menus, eggs (32.7 percent), meat (42.8 per-
cent), vegetables other than potatoes or leafy vegetables (38.7
percent), were found most often. Rice and grits (25.1 percent)
and milk (26.1 percent) came next. Fruit (19 percent) was low,
especially for lunch menus.
In Table XII-a are given the scores for lunch. As many as 48
percent of the children fell into the group with a score of 25
or less, representing an inadequate lunch. Thirty-nine per-
cent of the menus had a score of 30-45, or were menus of which
the adequacy was questionable. Thirteen percent of the children
were in the group with a score of 50 or above, indicating that they
had an adequate lunch.


TABLE XII.-FREQUENCY WITH WHICH CERTAIN FOODS OCCUR
LUNCH MENUS.
Food Number
Fruit ......................................... 409
Cereal ......................................... 496
E ggs .......................................... 691
M ilk or Cocoa .................................. 435
Coffee ......................................... 221
M eat .......................................... 903
R ice or Grits ................................... 530
B iscuit ........................... ............ 350
B utter ........................................ 218
Potato ........................................ 288
Vegetable (leafy) ........ ....................... 351
Vegetable (other) ............................. 817
Pie ............................................ 132
C ake ......................................... 252
Candy ......................................... 334
Total Number of Lunches ....................... 2,110


IN THE
Percent
19.0
23.5
32.7
26.1
10.4
42.8
25.1
16.5
9.8
13.6
16.6
38.7
6.2
11.8
15.6


TABLE XII-a.-LUNCH SCORES.
Scores Number Percent
No Lunch 55 2.6
5-25 957 45.7
30-45 823 39.0
50 and Over 275 13.0
Total Number of
Lunches 2,110
DINNER
The chief items of the dinners are given in Table XIII and in
Fig. 11. Vegetables other than leafy or potatoes head the list.
Meat was found to be the next most prevalent item of the dinner
menus. Rice and grits, potatoes, butter, cereal and milk were
found in nearly one-third of the menus, while fruit, 18.5 percent,
and leafy vegetables, 21.6 percent, were surprisingly low.
By reference to Table XIII-a it will be seen that over 53 percent











Fruit........ .....
Cereal .............
Egg..............
Milk or Cocoa......
Coffee.............
Meat .............. m ]lE E
Rice or Grits.......
Biscuit ............
Butter.............
Potato .............
Vegetable, leafy ...
Vegetable, other ....
Pie ...............
Cake..............
Ice Cream......... (7)

0 20 40 60 SO /00
/ rcen t
FIG. 11.-Frequency with which the principal items appear in dinner menus.







44 Florida Agricultural Experiment Station

of the children scored less than 40 for the principal meal of the
day. A score of 35 or less represents an inadequate diet. A score
of 40-50 for the dinner menu was considered as a ration of ques-
tionable adequacy. In this group there were 26 percent of the
children. About 18 percent of the menus were in a group the
score of which was 50 or above, these being considered as ade-
quate.

TABLE XIII.-FREQUENCY WITH WHICH CERTAIN FOODS OCCUR IN
DINNER MENUS.
Food Number Percent
Fruit .......................................... 391 18.5
Cereal ......................................... 551 26.2
E gg ........................................... 442 20.9
M ilk or Cocoa .................................. 560 26.5
Coffee ......................................... 285 13.5
M eat .......................................... 1,078 51.0
Rice or Grits ................................... 627 29.7
Biscuit ........................................ 344 16.3
Butter ........................................ 570 27.0
Potato ........................................ 596 28.0
Vegetable (leafy) .............................. 456 21.6
Vegetable (other) .............................. 1,252 59.3
P ie ............................................ 154 7.3
C ake .......................................... 180 8.5
Ice Cream ..................................... 280 13.2
Total Number of Dinners........................ 2,110
TABLE XIII-a.-DINNER SCORES.
Scores Number Percent
No dinner 20 0.9
5-15 113 5.3
20-35 803 38.7
40-50 795 37.8
55 and over 379 18.0
Total Number of
Dinners 2,110
A general survey of these data on menus shows that some of
the factors responsible for so large a percentage of inadequate
diets were the scanty use of milk, leafy vegetables and fruit. The
extensive use of rice, vegetables other than leafy, grits and meat,
especially bacon, is a fault in so many of the dietaries, for when
these items are not served there is a tendency toward greater use
of the more essential foods.

DIETS AND PHYSICAL DEFECTS
The customary method of grading nutrition is based upon
height-weight ratios. An effort was made in this study to use
weight as a criterion of the state of nutrition of the children and
as an index of the type of food used. After a careful study of
Tables VI, VII, VIII, IX and XIV, it was found that other factors
in addition to diet affect weight. According to Roberts (7), "chil-






Bulletin 216, Nutritional Study of White School Children 45

dren that are above or equal to the average weight tend to remain
in that group, and those that are below the average tend to re-
main below the average." From the results obtained in this sur-
vey it can be definitely stated that the height-weight relation is
not an index of the health of the children, nor is it a criterion by
which the diets could be judged. The reasons for this statement
are as follows: (1) The study of the diets of 2,045 children for
whom weights were obtained fails to show that the grade of the
diet has a significant influence on weight. (2) The following
physical defects influence weight: (a) hookworm infestation,
(b) abnormal tonsils, (c) thyroid disturbances.
DIETS AND WEIGHT
As stated previously, the various food types of the menus were
given numerical values and on this basis the diets were scored.
Table XIV points out clearly that the scores for these menus show
little relation to weight. The children were divided into three
weight groups, underweight, overweight and correct weight. In
each weight group each type of diet is found. In the extremely
deficient diet group, 2.6 percent of the underweight children, 1.4
percent of the overweight children and 0.7 percent of the children
with correct weight, were found. In the inadequate group very
little difference was found between the percent of overweight and
underweight children, 23.6 percent of the underweight children
had inadequate diets as compared to 23.8 percent for the over-
weight group. On the other hand, 32.0 percent of the children
in the group with correct weights had inadequate diets. In the
group, diets of questionable adequacy, no relation of diet to
weight exists. It is true that there are more underweight than
overweight children in this diet group, but again there are more
overweight children than children with correct weight. No very
great difference was found in the adequate group, although the
trend here points to the fact that underweight decreases with im-
proved diet, 20.0 percent of the underweight children having an
adequate diet as compared to 23.3 percent of the children with
correct weight. However, this difference is not great enough to
warrant the conclusion that diet is an important factor in weight
relations. In the commendable group there were more under-
weight children than children with correct weight.
It is evident from Table XIV, that for each weight group the
scores for the diets vary very little, and that the grade of diet
has little influence on weight.






Florida Agricultural Experiment Station


TABLE XIV.-RELATION OF DIET TO WEIGHT.
Extremely Inade- Question- Commend-
Deficient quate able Adequate able
Score 5-15 20-35 40-55 60-80 85-100
No. No. % No. % No. % No. % No. %
Total ........... 2,045 28 1.3 582 28.4 934 45.7 477 23.4 24 1.1
Underweight .... 562 15 2.6 133 23.6 288 49.4 119 20.0 7 1.2
Overweight ..... 295 4 1.4 68 23.8 138 46.9 80 27.0 5 1.7
Correct Weight 1,188 9 0.7 381 32.0 508 42.7 278 23.3 12 1.0

DIET AND ANEMIA
The diets of 514 anemic children were tabulated and scored.
In Table XV are given the scores of the diets and the number of
anemic children in each of the diet groups. According to these
data there is a relation between anemia and improper diet; 3.5
percent of the anemic children have extremely deficient diets,
40.2 percent have inadequate diets, 39.1 percent have questionable
diets, while only 17.0 percent have adequate diets.
This table also shows that diet is more closely related to anemia
than it is to weight. The percent of anemic children with ade-
quate diets is lower than the percent of underweight children with
adequate diets. Also, 2.6 percent of underweight children have
extremely deficient diets as compared to 3.5 percent of anemic
children in the same diet group. A much more striking difference
is shown for the inadequate group; 23 percent of the underweight
children fall into this group, while 40.2 percent of the anemic
children have inadequate diets.
A study of the menus also substantiates this view. The use of
food of high calorie value was found to be more prevalent in this
study than the use of food which is high in mineral content, such
as fruit, vegetables and milk. These data, then, show that im-
proper diet is one of the causative factors in anemia.
TABLE XV.-DIET SCORES OF ANEMIC AND UNDERWEIGHT CHILDREN.
Anemic Children Underweight Children
Score No. % No. %
5- 15 ................... 18 3.5 15 2.6
20- 35 ................... 207 40.2 133 23.6
40- 55 ................... 201 39.1 288 49.4
60- 80 ................... 84 16.3 119 20.0
85-100 ................... 4 0.7 7 1.2

PHYSICAL DEFECTS WHICH INFLUENCE WEIGHT
In addition to the study made to determine the influence of
diet on weight, tabulations were made to ascertain what relation-
ship, if any, exists between abnormal weight and physical defects.
It was shown in Tables VI, VII and IX that hookworm infestation,







Bulletin 216, Nutritional Study of White School Children 47

abnormal tonsils, and thyroid disturbances are causative factors
for overweight and underweight.

HOOKWORM INFESTATION
To judge the state of nutrition and health by height-weight
ratio exclusively would be very misleading, as shown by Table
XVI. The tabulations here show that, although a child may have
the correct weight for his height, he is not necessarily a well-
nourished child nor can it be concluded that he is in the best of
health. The following relation stands out clearly: hookworm
infestation contributes to a condition of overweight and not to
underweight. Table XVI shows that 71.6 percent of the over-
weight children are hookworm infested, while only 38.1 percent
of those who are underweight are hookworm subjects. It should
also be borne in mind that 56.6 percent of the children who have
the average weight for their height have been found as positive
hookworm children. Thus it cannot be concluded that because
the height-weight ratio is correct the child needs no further
physical examination. This condition alone shows that too much
stress should not be placed on height-weight relations in judging
the physical condition of children, especially in areas where hook-
worm infestation is prevalent.
TABLE XVI.-WEIGHT-HOOKWORM RELATION.
Condition Both Sexes Boys Girls
No. % No. % No. %
Total number examined ...... 3,325 .... 1,577 .... 1,748 .
Total number with weights .... 3,027 .... 1,415 .... 1,612 ....
Total number overweight...... 380 12.3 140 9.9 240 14.9
Hookworm-overweight ...... 272 71.6 112 80.0 160 66.6
Total number underweight .... 977 32.3 431 30.5 546 33.9
Hookworm-underweight ..... 375 38.1 195 45.2 180 32.9
Total number correct weight.. 1,670 55.4 844 59.6 826 51.2
Hookworm correct weight ..... 946 56.6 550 65.1 396 47.9
DEFECTIVE TONSILS
From a study of Table VI it will be noted that 58.0 percent of
the children with defective tonsils are underweight. The per-
centage of underweight children free from defects of tonsils is
13.0 percent. These data show that defective tonsils contribute
to underweight conditions.

THYROID DISTURBANCES
Another factor which influences weight is the condition of the
thyroid gland. These data show that of the 77 children with
thyroid disturbances, 56, or 73.0 percent, are underweight. It
must be recognized that this defect occurs in a small percentage






Florida Agricultural Experiment Station


of cases and does not affect the average weight of a large group.
On a basis of the effect of factors other than diet, height-weight
ratios cannot be used as an index regarding the diet. Thus in or-
der to study the effect of diet on general health and underweight,
these other factors must be eliminated.

DIET AND TEETH
A study of the relation of diet to teeth was made of 406 chil-
dren of one county. As shown in Table XVII, 53.8 percent of the
children using milk had teeth which were not defective, while
only a little more than 10 percent of the children who did not use
milk had good teeth. The incidence of carious teeth was twice as
common for the children who did not use milk as for those who
did. Chalky teeth were also more prevalent in the group not
using milk.
The smallness of the number does not permit of any positive
correlation between the use of milk and the condition of the
teeth. However, the differences for the group using milk as
compared to those not using milk undoubtedly are significant.
TABLE XVII.-MILK AND THE CONDITION OF THE TEETH.
Children Using Children not
Condition of Teeth Milk Using Milk
No. % No. %
Total ................................ 186 .... 220
Teeth not defective ................... 100 53.8 22 10.0
Carious teeth ......................... 62 33.3 146 66.4
Chalky teeth ......................... 8 4.3 32 14.5
Malocclusion .......................... 16 8.6 20 9.1
SUMMARY
In this study of the physical condition and dietary habits of
3,325 children of five representative counties in Florida, the fol-
lowing points are of interest:
1. A very favorable showing was made for children free from
defects.
2. The percent of girls with defects is lower than the percent
of boys. This is due to the fact that the percent of boys with
carious teeth, defective tonsils and hookworm infestation is great-
er than the percent of girls with these defects.
3. The data for height and weight show that, for a given age,
these children are in general below the average in. height and
weight up to the age of 14.
4. More than 45 percent of the children were found to have the
following defects: carious teeth, abnormal tonsils and hookworm






Bulletin 216, Nutritional Study of White School Children 49

infestation; while more than 30 percent of the children were
found with enlarged lymph glands, conjunctivitis, abnormal
weight relations, and anemia.
5. Heart defects were found in slightly more than 12 percent
of the children. This value is far above the average reported in
other studies.
6. It was found that among the children with hookworm infes-
tation and defective tonsils, heart defects and anemia were almost
three times as great as in children free from these defects.
Among the anemic children, defective tonsils, hookworm infesta-
tion, conjunctivitis, heart defects and underweight conditions
were much more prevalent than among children not anemic.
7. An analysis of the data on diets shows that less than 25 per-
cent of the children have adequate diets. However, the surpris-
ing lack of underweight children, living on extremely deficient or
inadequate diets, must be emphasized.
8. Underweight is found evenly distributed among the differ-
ent diet groups.
9. The data point out a relation between anemia and diet, ane-
mia being much more prevalent in the group of children with in-
adequate diets.
10. These data show that diet does matter, even though chil-
dren whose diets were deficient in many respects were found to
be of normal weight. Such diets, if continued, cannot fail to
work havoc in some way, although they do not always cause un-
derweight; as shown in this study anemia is likely to be one of
the abnormal conditions to make itself manifest.
11. If weight alone is a standard of nutrition, many children
who have serious defects, as hookworm infestation, abnormal ton-
sils, and heart defects must be regarded as in "good condition."

CONCLUSIONS
Hookworm infestation and defective tonsils are defects which
should be corrected, since these are causative factors in many ab-
normal conditions, if the aim of nutrition workers is better health.
As a criterion of the condition of nutrition, the weight to height
ratio alone is not sufficient.
General education in food requirements and methods of pre-
paring suitable foods is also of immediate importance, but before
any significant change in nutrition can be brought about, physical
defects must be eliminated or controlled.






Florida Agricultural Experiment Station


ACKNOWLEDGMENTS
The authors wish to acknowledge the valuable assistance given
by the county health officers and local physicians of the counties
included in this study. Especial thanks are due to Drs. L. M.
Anderson and J. Harkness of Columbia County, Dr. F. A. Brink
of the Florida State Board of Health, Mrs. Lassie Black, (at the
time this study was made) county home demonstration agent of
Columbia County, and Miss Leila Bunkley, Public Health Nurse
of Indian River County, for their interest and active assistance
in this study.
REFERENCES
1. United States Department of Commerce. Bureau of the Census. United
States Census of Agriculture, 1925. Part 2, The Southern States.
2. HOLT, L. E., and HOWLAND, JOHN: Diseases of infancy and child-
hood. Appleton, p. 21, 1926.
3. DAVIES, S. ESTHER: The food consumption of rural school children
in relation to their health. Mass. Agr. Exp. Sta. Bul. 241. 1928.
4. RUDE, ANNA E.: Physical status of preschool children, Gary, Ind.
U. S. Dept. of Labor, Children's Bureau. Bureau Publication No. 111,
p. 28, 1922.
5. ROSE, M. D.: Feeding the family. Macmillan, pp. 462-465, 1924.
6. United States Treasury Department. United States Public Health
Service. Public health reports, 44:41:2463. 1929.
7. ROBERTS, F. L.: Growth of children that are below average weight.
Jour. Am. Med. Assn. 89:847-849. 1927.






Florida Agricultural Experiment Station


ACKNOWLEDGMENTS
The authors wish to acknowledge the valuable assistance given
by the county health officers and local physicians of the counties
included in this study. Especial thanks are due to Drs. L. M.
Anderson and J. Harkness of Columbia County, Dr. F. A. Brink
of the Florida State Board of Health, Mrs. Lassie Black, (at the
time this study was made) county home demonstration agent of
Columbia County, and Miss Leila Bunkley, Public Health Nurse
of Indian River County, for their interest and active assistance
in this study.
REFERENCES
1. United States Department of Commerce. Bureau of the Census. United
States Census of Agriculture, 1925. Part 2, The Southern States.
2. HOLT, L. E., and HOWLAND, JOHN: Diseases of infancy and child-
hood. Appleton, p. 21, 1926.
3. DAVIES, S. ESTHER: The food consumption of rural school children
in relation to their health. Mass. Agr. Exp. Sta. Bul. 241. 1928.
4. RUDE, ANNA E.: Physical status of preschool children, Gary, Ind.
U. S. Dept. of Labor, Children's Bureau. Bureau Publication No. 111,
p. 28, 1922.
5. ROSE, M. D.: Feeding the family. Macmillan, pp. 462-465, 1924.
6. United States Treasury Department. United States Public Health
Service. Public health reports, 44:41:2463. 1929.
7. ROBERTS, F. L.: Growth of children that are below average weight.
Jour. Am. Med. Assn. 89:847-849. 1927.




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