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U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary

CHILDREN’S BUREAU
GRACE ABBOTT. Chief

THE NUTRITION AND CARE
OF CHILDREN IN A MOUNTAIN
COUNTY OF KENTUCKY
By

LYDIA ROBERTS

Bureau Publication N o. 1 10

WASHINGTON
GOVERNMENT PRINTING OFFICE
1922

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Federal Reserve Bank of St. Louis

U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS. Secretary

CHIL DREN'S BUREAU
GRACE A BBOTT. Chief

THE NUTRITION AND CARE
OF CHILDREN IN A MOUNTAIN
COUNTY OF KENTUCKY
By

LYDIA ROBERTS

Bureau Publication N o. 110

W A S H IN G T O N
G O V E R N M E N T PRINTIN G OFFICE
1922

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A D D IT IO N A L C O PIE S
OF THIS PUBLICATION MAY BE PROCURED FROM
THE SUPERINTENDENT OF DOCUMENTS
GOVERNMENT PRINTING OFFICE
■WASHINGTON, D . C.
AT

10 C EN TS P E R C O P Y
V

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CONTENTS
Pag«
Letter o f transmittal___________________ l____ b ____________________ t____________ ,
Introduction ________ ___________;________¿a ____ _________ _______________________
Purpose o f study____________________ ___ __________________ ______________ _
The community studied_________________ ___ 1____ _________ ________ ____
Method of study____________________________________________ ______________
-The physical condition of the children-!_________
_____ _____
Results of weighing and measuring____ __________ ___ ________ ____ _______
Clinical findings________________ ptf___ ________________________________ .___

_______ ill

Number of defects__________ ___ _ j| ____ _____ ____________ - ______a___
Tonsils and adenoids_____ _________ 1'__________ ______1_________ ____
T e e th _________________________ -________________ ]______ 3a_____________ 5
_
Nutrition______________________________ ___ ,_______________________.<
_____

1-5
i
1

3
5 -s
g

5-8
5
6
q

Home conditions determining the care given the children______________ *____ 9—10
Economic status of the fam ily__________________________ ___________ ._______
9
ip
H o u sin g _____________________________________________________ * ______________
S a n ita tio n ____ .______________________________ _____ ’l l _____ _______^________
IQ
W ater supply__________ _______________________________________ _____________
Available food supply— ____ ________ _________ ______ __;_____ .
t_______ H -19
Cereals and bread___________ __ ______________I_________________________
11
Meat ___________________________________________________________________
12
V e g e ta b le s______________ f_______________________ sjT ____________________
14
F r u i t ______________ - _________ ______________ __________________________
15
Eggs -------------------------------------- --------- -L —
__ _______ 1 _ _ — ___ _ _ | 3 :
16
Sorghum ______________________________________________
36
Milk and butter________________________ J.______ ____ ___________________
17
ig
Adequacy of food supply________ _____________________ _________ ______
The diet of the children_________________________________________________
20-82
Infant feeding________________________
20-32
Breast feeding__________________________________________ BHh_________
20
Age of weaning and age at which solid food was given________ l i f t
21
Milk _______
21
Eggs -------------- ------------------------------------_ ------- ----------------------- ------- -----------2 ;
V e g e ta b le s__________ __________________________ >__________________________
F r u i t -------------------------------------------------------------------- ¡j _________________________
M eat
Bread and cereals_____________ j^_||______________ ,*_J______________________

________|p||. < __.________ .____ ;________

C a n d y ---------- —
_______________ _____ ________ __ 2 __:i____ § ___________
Coffee and tea___________________ |__________________________________________
Eating between meals____________
Adequacy o f the diets________________
Relation o f diet to nutrition______________________________________________

23
24
24
25
25
26
28
28

Other items o f care affecting the child’s nutrition and general welfare____ 33-3S
Sleep________________ _ _____
00
-----------------------------------DO
Fresh air_________________________
oHabits o f cleanliness_____________________________
35
Care o f teeth____________________________________________________ /
36

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CON TENTS.

Other items of care affecting the child’s nutrition and general welfare—
Continued.
Page.
Condition of the children’s bowels----------------------------------------------- ------------36
C lo th in g -------------------------------------------------------------p--------------------------- -----------37
Schooling -------------- ..------------------ --------------------------------- — -------------------------38
Summary and conclusions---------------------------------- — — •-#---------------------------------- .39-41
Physical condition of the children— — -------------- —— ------------ -, ---------------39
Home conditions---------------------------------------------39
39
The diet and care o f the children------------------- ^ ----------------------------— —
Possibilities o f improvement---------------------------------------------------------------------40
Schedule used in study---------- ---------------------------------------------------------------- Follows 41

IL L U ST R A T IO N S .
Faces.

Typical “ Knob ” -------------------------------------------------------------------------------------------------A new log house o f better type---------------------------------------------------------------------- —
A typical cabin------------------------------------------------------------------------------------- — ----------View o f a rocky mountain road----------------------------------------------------------- —T- —
School cut off from road by creek----------------------— — — i---------- ---------------—

1
10
10
38
38

C H A R TS.

C hart I. Per cent o f children in each grade o f nutrition------------------------------ .

II. Adequate use o f milk in relation to income--------------.-----------------I I I . Coffee drinking in relation to the use o f milk— — — ---------------- _ 7
IV . Per cent o f children in each grade o f di et—
— -------V . Adequacy of diet in relation to income— ---------- •--------- L.— —
V I. Grade o f diet in relation to use o f milk-------------------------------------V II. Grade of nutrition in relation to grade o f diet-----------------------—

22
27
29
30
31
31

V II I.

Clothing in relation to income------------------

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—

LETTER OF TRANSM ITTAL.

June 14, 1922.
: There is transmitted herewith a report on the Nutrition and
Care o f Children in a Mountain County o f Kentucky, by Lydia
Roberts. The physical examinations were made by Dr. Frances
Sage Bradley, assisted by E. Ida McCune, and Ethel M. Springer
assisted in the direction o f the field work. The visiting o f the homes
was done by Ella Ross and Alta Nelson. The investigation was
planned by Miss Roberts, and the report written by her.
Respectfully submitted.
S ir

Hon.

Jam es J. D

race

bbott,

Chief.

a v is ,

Secretary o f Lahor.
V

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T Y P IC A L “ KNOB.'
Note layer of limestone near the top.

THE NUTRITION AND CARE OF CHILDREN IN A MOUNTAIN
COUNTY OF KENTUCKY.
INTRODUCTION.
PURPOSE OF STU D Y.

This report covers the findings o f the first nutrition survey under
taken by the Children’s Bureau in a rural district. Other rural
studies have dealt with maternity and infant care, and the general
conditions surrounding young children,1 and some o f them have re
vealed data o f interest in connection with the nutrition o f children,
but in none was nutrition the chief object o f the investigation. The
study was made in a community in Kentucky in response to an
appeal from the Kentucky State Board o f Health to help find “ why
a State famous the world over for its prosperity should turn out
so large a percentage o f physically defective men as the draft records
showed.” Its purpose was to ascertain the physical condition o f
children o f selected ages and to discover, i f possible, the chief factors
responsible for the conditions found. The field work was done in
the winter o f 1919-20.
T H E C O M M U N IT Y S T U D IE D .

Kentucky is distinctly a rural State, its urban population, accord
ing to the 1920 census, being 633,543, while its rural population
was almost three times that number. The State board o f health sug
gested a study o f five typical counties in different parts o f the State
in order to secure a representative picture. Unfortunately, such an
extended survey could not be undertaken. Instead a county was
chosen which had two distinct types o f country, a blue-grass section
and a mountain section, and later it became necessary to limit the
survey to the latter only, a section embracing an area o f about 30
square miles. Every home within this area having a child between
2 and 11 years o f age was visited. These years were .chosen because
it was desired to exclude the periods of infancy and puberty, which
1 M aternity and In fan t Care in a R ural County in Kansas, U. S. Children’ s Bureau
Publication No. 26, W ashington, 1 9 1 7 ; R ural Children in Selected Counties o f N orth
Carolina, U. S. Children’s Bureau P ublication No. 33, W ashington, 1 9 1 8 ; M aternity
Care and the W elfare o f Y oung Children in a H om esteading County in M ontana, U. S.
Children’ s B ureau P ublication No. 34, W ashington, 1 9 1 9 ; M aternity and In fan t Care in
T w o R ural Counties in W isconsin, U. S. Children’s Bureau Publication No. 46, W ashing
ton, 1 9 1 9 ; M aternity and Child Care in Selected R ural Areas o f M ississippi, U. S.
Children’ s Bureau P ublication No. 88, W ashington, 1921.

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THE

N U T R IT IO N

A N D CARE

OF C H I L D R E N

involve special problems it was not deemed expedient to consider.
In all, 123 families, with 256 children o f the selected age, were
interviewed.®
In a nutrition study in a rural community, the physiography and
soil assume great importance not only because the food supply is
directly dependent on them but also because they almost entirely de
termine economic status. Rich farming land presupposes an abun
dant food supply and financial prosperity, while hilly, stony soil
usually means uncertain, meager crops and a struggle to obtain the
necessities o f life.
The county in which the area studied is located contains within
its borders extremes o f richness and o f poverty o f soil. The greater
part o f the county is in the blue-grass section where the soil is o f
great fertility, but a small portion o f it extends into “ the knobs, ” or
“ the mountains, ” as the rocky cone-shaped hills are called, where the
soil is for the most part exceedingly poor. It was this small, moun
tainous part which constituted the area studied.
The farms o f the area are o f three types, depending on their loca
tion. The lowland just at the foot o f the mountains is the poorest
soil in the district. It rests upon a bed o f shale only a few feet from
the surface. This land is wet and sour and needs drainage, ground
limestone, and phosphorus. Plenty o f limestone lies near at hand,
for “ the knobs” are composed largely o f limestone and near their
tops are found massive outcroppings o f the rock; if this rock could
be pulverized and put on the land below it would be the greatest
possible boon to the soil. Up to the time o f this study, however,
rock crushers were not available. On the sides of the mountains be
tween the limestone and the lower shale land are farms far better
than those o f the lower land. The soil is better drained, and is en
riched by washings from the limestone areas above. The third type
o f farm is found on the tops o f some o f the knobs. Here the soil is
more nearly comparable than any other in the surveyed area to the
soil o f the blue-grass region, since it rests upon a limestone bed which
by slow disintegration supplies the needed lime. As a rule, there
fore, the better farms in this section are the upland farms, although
similar to these in fertility are the patches o f bottom lands with rich
productive soil which has been formed by overflows o f creeks and the
consequent deposition o f sediment. It is evident that the economic
status o f a family in the area studied can be predicted fairly accu
rately from the location o f its farm.
Although the chief crop o f the section is corn, only enough is pro
duced for local needs. The average yield is about 15 bushels per
a in discussion o f m aterial based upon these interview s, cases not reported as to the
particular item under consideration, usually n ot more than tw o or three in number, are
om itted. The per cents are based upon the total number o f cases.

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IN A M O U N TA IN c o u m

OF K E N T U C K Y .

acre, though some farms in the section yield considerably higher than
this average, and some yield as little as 5 bushels. Other crops in
clude tobacco,2 oats, and rye in limited amounts, cowpeas, and sor
ghum. The upland soil is adapted to fruit culture, and a few o f the
progressive farmers o f the section have planted orchards. In spite
of the fact that frosts may kill the crop for a number o f years in
succession, a good yield once in five or six years, in the opinion o f
experts, makes fruit growing well worth while.
That poor roads and lack o f development in a community go hand
in hand is probably nowhere better illustrated than in the locality
studied. The roads over which the majority of the people have to
travel to get to market are almost universally poor. Although none
o f the families visited lived farther than about 7 miles from a fair
sized town, many were as isolated as if the distance were several
times as great. For them to get to town was at certain seasons not
only a long, laborious task, but often for prolonged periods an abso
lutely impossible one.
The 123 families visited in this survey were all native white and
with very few exceptions were o f mountain stock. Poor roads had
tended to isolate them, although they lived within a few miles of a
small town with railroad and educational advantages, which no
doubt had influenced them to a certain extent. Their natural shyness
and 'reserve, a heritage from many generations of mountain an
cestors, has made them slow in responding to outside influences.
A visitor to the mountains never fails to be impressed by the pre
mature ageing o f the majority o f the people, particularly the women.
The early age at which the women marry and assume the cares o f a
home and family doubtless offers a partial explanation o f this fact.
v M ETHO D OF STU D Y.

A nutrition survey necessarily consists of two parts: First, a study
of the physical condition of the children to determine their state
o f nutrition and to discover any clinical factors which may be either
the result or the cause o f poor nutrition; second, an examination into
the factors o f diet and care responsible for the condition of health
in which the children are found. In the present study the children’s
physical condition was ascertained by means o f a medical examina
tion made by a doctor on the staff o f the Children’s Bureau, and in
formation concerning their diet and care was gathered through inter
views with the mothers in their homes by agents who were specialists
in food and nutrition. A schedule covering the information to be
2 Although the soil in general is not adapted to raising tobacco, the farm ers had found
in their barn lots and dooryards small plots o f 1 to l i acres which could be used temp orarily for this crop.

2648° — 22- ----------2

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THE

N U T R IT IO N

A N D C A R E OF C H I L D R E N

sought from a mother regarding the diet and care of her children was
prepared, and general items of importance in a consideration o f the
nutrition and general health of the children were also included.3
The visiting of the homes was done first, because this part o f the
study required more time, and because it also gave opportunity t'o
explain to the mothers the purpose and value o f the physical exam
ination which formed the second part of the inquiry.
It was usually the mother but sometimes the father who was inter
viewed by the agent o f the Children’s Bureau, Often, indeed, the two
answered the questions together, the mother supplying the informa
tion about the child’s personal habits and the father contributing
facts about the garden, the milk, and general farm matters. As a
rule the agent’s visit was expected, for contact had already been made
with the children through the school, and word concerning the pur
pose o f the inquiry and the intention of the agents to visit the parents
had been carried home. The reception o f the agents in the homes
was invariably courteous, and answers to all the questions were freely
given.
Whatever difficulties arose in securing accurate data came not from
unwillingness on the part o f the mothers to give the information
but from the fact that they did not know their children’s habits, par
ticularly in regard to food. “ I put the food on the table; I don’t
pay no ’tention to what nobody eats,” was a not infrequent response,
The mother, however, always knew what she had cooked, and she
usually knew what the younger children ate, and the older children
could supply the needed data regarding their own food. Since the
agents were specialists in nutrition, they were able to supplement
the schedule inquiries by further questions regarding essential points.
It is believed, therefore, that the information secured is as accurate
as can be obtained by the schedule method.
*
After the home visits were completed, the Children’s Bureau
“ Child-Welfare Special ” came to the locality in order that the chil
dren studied might be physically examined. The “ special” is a
large automobile truck fitted up as a health center and equipped with
scales, measuring devices, and other facilities needed by a physician
in giving a complete physical examination. A doctor, a nurse, and a
clerk travel with the car.4
The “ special ” visited certain schoolhouses in the district, and the
mothers were notified in advance, by letter usually, when and where
to bring their children. Most o f them when visited had seemed
interested in having their children examined when the car should
arrive, but persistent rain, muddy and impassable roads, lack of
8 See schedule, follow in g p. 41.
4 The C hild-W elfare Special. U. S. Children’s Bureau Publication No. 69.
1920.

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W ashington,

A M O U N T A IN

COUNTY

OF K E N T U C K Y .

conveyance, illness, and, in some cases, inadequate clothing* for the
children kept many o f them away. However, 149 children— a little
more than half the number for whom schedules were obtained—
reported for examination. O f those who arrived not a few struggled
through great difficulties. One mother walked several miles in the
rain carrying a baby, while the three older children trudged along in
the mud beside her; another was obliged to walk to town for soap to
wash the clothes her children were wearing, before she could bring
them; and a third also found it necessary to make a trip to town on
foot in order to purchase clothing for the occasion. Even then she
had to borrow from a neighbor in order to have enough. Such are a
few o f the efforts which the mothers are known to have made in order
that their children might have the benefit o f the examination.
The examination was made in the presence o f the mother or other
person who accompanied the child to the car, and since each mother
was told the special needs o f her child as disclosed by the examina
tion, it became o f immediate personal value as well as serving the
purpose of the study.
TH E P H Y SIC A L CONDITION OF THE CHILDREN.
One hundred and forty-nine children, 58 per cent o f the total num
ber between 2 and 11 years o f age for whom information regarding
home care was obtained, received physical examinations.® It is.
therefore, only to these 149 children that the findings with reference
to physical conditions relate.
R E S U L T S O F W E IG H IN G A N D M E A S U R IN G .

The children were weighed without clothes and the height was
taken without shoes or stockings. In the absence o f a standard of
stripped weights with which to compare the weights of these chil
dren, a table derived from the Bowditch figures was used.6 Accord
ing to this scale, 20 per cent o f the children were found to be 7 per
cent or more underweight. A considerable number of this group
were markedly below— from 15 to 23 per cent under the average.
C L IN IC A L F IN D IN G S .

Number o f Defects.
The total number o f physical defects found in the children, with
out regard to the relative seriousness o f the kinds o f defects, is shown
BSee p. 39.
6 Ai table o f average stripped weights was derived by subtracting B ow diteh’s figures of
estim ated w eights o f clothing from his averages including weights o f clothing. B ow ditch,
H. P. : Eighth Annual R eport o f the State B oard o f Health o f M assachusetts 1877.

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THE

N U T R IT IO N

AND

CARE OF C H IL D R E N

in Table I. Thus, abnormal tonsil conditions count as one defect,
decayed teeth as another, any heart defect as a third, and so on.
Only five o f the children examined were found to be free from
physical defect of any kind; the greater number had from 3 to 5
defects, but a number had 6 or 7, and a few even had from 8 to 10.
The total number o f defects found in the 149 children studied was
621, an average of more than 4 to each child. The younger chil
dren—those under 6— averaged 3.2 defects each; the children between
6 and 11 years of age averaged 4.6 defects. This difference may be
partly explained by the greater prevalence o f decayed teeth among
the older children.
T

ab le

I — Number of physical defects, by a g e; children 2 to 11 years of age given
physical examinations.
Children given physical
examinations.

Children given physical
examinations.
f

Number of defects.

2
3
4.......................................

6-11
years
of age.

Total.

2-5
years
of age.

149

• 45

104

5
13
12
20
31

4
9
3
•7

1
4
9
13
26

5................. ................... .-.
0
7.........................................
8.........................................
9.........................................
10.......................................
Number not reported.......

Total.

2-5
years
of age.

29
10
13
6
4
2
. 4

8
1
2
1
1
1
3

6-11
years
of age.
21
9
11
5
3
. 1
1

Total number of defects reported for all children, 621.

It was evident that many of these defects were due to lack of
proper care, and that nearly all needed early attention i f permanent
injury to the children was to be avoided. Comment will be made
regarding only a few defects the relation of which to nutrition is
o f special importance.
Tonsils and Adenoids.
Seventy-four children, 50 per cent o f the total number examined,
were found to have enlarged or diseased tonsils. Symptoms indica
tive o f adenoids were found in 27 per cent o f the children.
Teeth.

More than three-fourths of the children examined (78 per cent)
were found to have carious teeth. Even in the preschool group over
half the children, 25 of 45, had decayed temporary teeth ; 91 of 104
children 6 to 11 years of age, inclusive, had decayed teeth either per
manent or temporary, and nearly one-third of the children in this
age group had one or more permanent teeth decayed.
That lack o f care may have been a factor in producing this condi
tion is indicated by the fact that 122 of the children (82 per cent)
were reported by the examining physician to have dirty teeth, and
26 children (17 per cent), inflammation o f the gums.

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A M O U N T A IN

C O U N T Y OF K E N T U C K Y .

Nutrition.
Weight in relation to height affords a rough indication o f a child’s
general nutritive condition. It is customary, indeed, to class as
undernourished all those who fall a certain per cent (usually 7 or 10
per cent) below the average weight for their height. In the present
study it was desired in determining the nutrition to consider other
criteria than weight alone, and also to show more gradations o f
nutrition than two— those corresponding to the undernourished and
the well nourished. Five grades o f nutrition were established— ex-

C h a r t I.— Per cent, o f children in each grade o f nutrition.

cellent, good, fair, poor, and very poor— and the grade o f each child
was determined by the physician who made the physical examina
tion. The weight was used as a guide, but it was not allowed abso
lutely to determine a child’s grade o f nutrition. As it happened,
practically all the children 7 per cent underweight by the stand
ard used were graded poor by the physician, but the converse was
not always the case. A fat, flabby, anemic child was rated poor
even though he measured well up to the average in weight, as was
also a child who was unmistakably thin and undernourished. Every
available factor, indeed, was taken into consideration in classifying
the children.

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THE

N U T R IT IO N

AND

C A R E OE C H IL D R E N

It was found that only 10 children (7 per cent) could qualify as
“ excellent,” and but 27 children (18 per cent) as “ good.” Twothirds were classed either “ fair ” (35 per cent) or “ poor ” (34
per cent), and 9 children (6 per cent) were so much below par as
to be rated “ very poor.” The significance o f these figures becomes
more apparent when it is borne in mind that with proper care and
adequate and suitable diet maintained continuously from birth, every
child should have been in the “ excellent,” or certainly in the “ good,”
group. When only one-fourth o f the children could be definitely
graded as in excellent or good nutrition and when almost two-fifths
(39 per cent) had to be classed as poorly or very poorly nourished,
it is obvious that something was at fault in the care they had re
ceived. Either the food supply was lacking in amount or kind or
the body was unable to use it. As previously shown, many defects,
were revealed by the physical examinations, including anemia, carious
teeth, enlarged and diseased tonsils, and adenoids, and the prevalence
of these defects undoubtedly accounted in part for the high percent
age o f poorly nourished children; but the diets and the general care
the children received must also have been at fault. The information
obtained from the interviews with the parents throws light upon
these factors.

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HOME CONDITIONS DETERMINING THE CARE GIVEN
THE CHILDREN.
E C O N O M IC S T A T U S O F T H E F A M IL Y .

Most o f the homes visited— 103 of the 123— were the homes of small
farmers; that is, the economic head of the household was working at
least 3 acres o f land, either owned or rented.8 Where the land is
extremely fertile and farming is intensive, 3 acres may furnish a
good livelihood for a fam ily; but, in sections like the one studied,
where the soil is poor and the farms largely unimproved, a small
farm can not possibly yield an adequate living. Forty-four o f the
103 heads o f families classed as farmers supplemented their income
obtained from that source by earnings from some other occupation.
Information necessary to a fair judgment o f the financial condi
tion of each family was ascertained— regarding, for instance, in the
case o f those managing farms, the size of the farm, the acres culti
vated, and the amount of stock; and in the case o f those hired by the
day or working at trades, their wages. On the basis o f the informa
tion thus obtained the families were classed into three economic
groups— A, B, and C— according to their ability to furnish the
essentials o f adequate living. In Group A are included the families
whose ability to provide adequate food, shelter, and clothing could
not be doubted; in Group B, those less certainly able so to provide for
themselves; and in Group C, those who were unquestionably poor.
According to this classification 25 families containing 42 children
between 2 and 11 years o f age fell into Group A ; 45 families with 95
children, into Group B ; and 53 families with 119 children, into Group
C. In other words nearly half the children (47 per cent) were living
in homes in which the income was so small as to make even a minimum
standard o f care appear impossible, while but 16 per cent belonged
to families clearly able to provide the modest requirements o f ade
quate living.
O f the 25 families with the best economic status, 13 reported obtain
ing their living entirely from their farms, the average acreage o f
which was about 47; the others reported additional sources o f in
come. Twenty five o f the 45 families in the B income group and 21
o f the 53 in the C group reported that they were wholly dependent
upon income from their farms.
8 This classification is in accord with that used by the IT. S. Bureau of the Census. See
Thirteenth Census o f the United States, Vol. V, Agriculture, 1909 and 1910, pp. 2 2 -24.

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THE

N U T R IT IO N

AND

CARE

OF C H I L D R E N

H O U S IN G .

Housing bears an important relation to nutrition, since it affects
directly the family’s health and general welfare. On the whole the
homes o f the families studied seemed pitifully poor. Some were no
more than board sheds with open cracks in the walls and floors, and
no boards or banking at the base to keep out the w ind; some, equally
poor, were timeworn, one- or two-room log cabins with amplp space
between the logs and flooring and around the doors and windows
to allow the air to enter freely; some were new shanties with one
small window or perhaps with none at all. The old log houses,
though often picturesque, were commonly far from desirable habita
tions. In many the chinking had fallen from the cracks, the floor
was sagging, and the doors and windows were loose, so that at a
dozen or more places the cold air had free access.
Only 3 o f the 123 houses visited had a foundation; 37 were built
on high, uninclosed piles, and .81 were placed either directly on the
ground or on low piles or blocks with the space between the floor
and the ground boarded up. Wide -spaces were usually left between
the boards. Only 27 houses had "moderately close-fitting doors and
windows. Broken window panes, unreplaced or stuffed with rags
or covered with pasteboard, were common. Only 45 houses had at
least one room that was plastered or ceiled. The kitchen was usually
the coldest room in the house, being frequently little better than a
shed. The mild climate made these conditions less serious than they
would otherwise have been, but even so the majority of the children
studied were living in houses that did not adequately afford protec
tion from the weather.
A few modest but comfortable homes were found in the community.
Several new log houses and some older ones, that had been kept in
good repair, together with a very small number of clapboarded,
ceiled, or plastered frame houses, were adequate and comfortable
dwellings.
In view of the poor construction of many of the houses, their heat
ing was a problem. A fireplace with its open fire of logs added much
to comfort and cheerfulness, but even a rousing fire on the hearth
failed utterly to warm a house so open as were many o f those visited.
A small stove was not much more effectual. O f the 123 houses 63
were heated by fireplaces, 51 by stoves, and 7 had both a stove and
a fireplace. The cooking in the homes was usually done on a kitchen
stove, though many families also utilized the fireplace to some extent
for cooking.
S A N IT A T IO N .

The method o f disposal of human waste in the district studied
was most insanitary. Considerably over half the families, 56 per

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A NEW LO G H O U SE OF B E TTE R TYP E .
Note the base.

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A TY P IC A L CABIN.

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cent, had no toilet o f any kind, but used the barn, the chicken house,
the yard, or the woods. Only one family had a water-flushed toilet ;
51 had some kind o f a yard privy. More than one o f these privies,
however, because o f broken walls or missing doors failed to offer
even privacy, and others were distinctly insanitary, because easily
accessible to animals and flies. The general attitude seemed to be
that a privy was nonessential.
W A T E R SU PPLY.

More than half the families, 55 per cent, secured water from a
spring, a stream— the “ branch” it was usually termed— an open
well, or some other unprotected source. The remainder obtained
their supply from either a drilled well or a hydrant. Although un
doubtedly the drilled well was a much safer source than the open
well or the stream, the type used in this section appeared less safe
than the term would imply. The well was not fitted with a tight
cover nor the water drawn by a pump. Instead, the pipe, five or six
inches in diameter, extended above the surface o f the ground and
was left open at the top. The water, which could be seen in the
pipe a few feet below ground level, was drawn by means o f a small
bucket fitting into the pipe. The bucket hung by the well or sat on
the ground when not in use. This, together with the fact that the
pipe was uncovered, made contamination possible, though certainly
less probable than in water secured from the other sources.
A V A I L A B L E FO O D S U P P L Y .

The chief concern o f this survey was to secure all the information
possible regarding the diet o f the children. In order to do this in a
rural area, it was necessary to investigate the source o f supply, since
the kind, amount, and variety o f the children’s food depend upon
the food supply and food habits o f the family. In addition, there
fore, to learning the habits o f the individual child with reference
to diet, a detailed study was made o f the foods which were grown
or purchased for family use. Thus information was obtained con
cerning the production, preservation, and use o f milk, butter, eggs,
fruit, vegetables, cereals, breads, and meat—the chief foods in any
dietary.
Cereals and Bread.

Since corn was practically the only grain crop in the area, it was
not surprising to find corn meal universally used for food. Most
farmers took their corn to a local mill and had the whole grain
ground into meal. This meal contained the bran layer and the germ,
as well as the starchy endosperm—the part from which the usual
2648°—22----- 3

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market product is made. Eighty-six families, representing 72 per
cent o f the children, used whole corn meal exclusively; 34 families
purchased their meal at the store and so obtained only the bolted
meal, while 3 families used some o f both kinds. There can be no
doubt o f the distinct superiority o f the whole meal over the bolted
kind, especially if it is used as the main constituent o f a rather re
stricted diet; most o f the mineral matter o f the grain as well as the
vitamines which protect the body against the so-called deficiency dis
eases are contained in the bran and germ.
Wheat flour to some extent in all the homes supplemented corn
meal. This flour was almost always the patent, highly milled variety,
118 families using only that made from bolted wheat. The remain
ing 5 families used some whole wheat or graham flour in addition.
Oatmeal was used to a greater or less extent by 85 families.
Corn bread was the most common type o f bread. Biscuits, how
ever, occupied a place in the dietary second only to that o f corn
bread. Many families had biscuits for breakfast and corn bread for
the other two meals, and frequently both were served at the same
meal. A company meal, it seemed, demanded both, for apologies
were offered when corn bread without biscuits was set before a guest.
Yeast bread— or “ light bread,” as it is usually called—occupied a very
minor place in the dietaries o f the families. In 85 homes, 69 per cent,
corn bread and biscuits were used exclusively; only 37 families re
ported using any light bread. Some families who lived nearer town
than the others bought light bread frequently, but in most homes it
was purchased only on rare occasions. A single exception to the
general practice was found in a home where the mother made light
bread regularly and used corn bread and biscuits for occasional varia
tion. The general relative use o f these breads was strikingly shown
by the local application of the term 1
,1bread,” which, it was soon dis
covered, always referred to corn bread.
This bread was usually made o f corn meal, buttermilk, soda, and
salt. Water was substituted for part o f the milk if the milk supply
was short. The bread was either baked in a sheet or fried in a
skillet.
The biscuits observed in the school lunches and in the homes were
usually large, underdone, and frequently yellow from excess o f soda,
and they were as a rule less palatable than the corn bread. They were
most often made with soda and buttermilk, with water added i f the
amount o f milk was insufficient.
Meat.

Meat was commonly regarded as a necessity and eaten at every
meal. It was the custom for a farmer to keep at least one hog to
fatten during the summer and kill in the fall. In general, it might

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be said that the more prosperous the farmer the more hogs he killed.
F or example, 6 ©f the 9 families who killed five or more hogs be
longed to the A income group, 2 to the B group, and 1 to the C
group; while o f the 27 families who killed but one hog, 12* were
of the C group, 8 o f the B group, and but 1 o f the A group.
A little more than 80 per cent o f the families killed at least a part
o f their own meat. O f these 101 families, 28 killed all they used,
while 73 bought some meat to supplement their own. Twenty-one
families purchased all their meat.
In the majority o f families only salt meat was eaten, except during
a short period immediately following butchering. The weather was
not uniformly cold enough to make preservation by freezing prac
ticable, and so the meat had to be preserved by means o f salt. In
addition to this, the meat which was purchased when the home supply
gave out was usually salt.
In the section studied, hog killing was done in the late fall. The
meat was usually salted on the day o f the killing or very shortly
afterwards. It was spoken o f as fresh,9 however, for some time
after it had been laid down in salt. This study was made during
“ hog-killin’ ” time, and so the majority o f the families were having
“ fresh hog meat” three times a day.
It may readily be seen that a family which depended entirely upon
its own butchering had to eat salt meat most o f the time. This meat
was bound to be fat salt “ middlings ” (the side meat) for a consider
able part o f the year; the fresh meat— ribs, backbones, and sausage—
was eaten first, then the hams and shoulders, and lastly the mid
dlings. When the middlings gave out more was purchased.
Some families bought fresh meat in small amounts the year round,
and most o f them occasionally killed chickens, though these were
much less commonly used than might be expected in a farming com
munity.
In order, in the discussion o f the diet, to distinguish between fam
ilies living almost entirely on salt meat and those having appreci
able amounts o f fresh meat with some regularity, the families have
been separated into two groups— those having a salt meat diet for
as much as eight months of the year and those having fresh meat
as often as weekly for more than four months, no matter whether the
meat was beef, pork, chicken, or rabbit. It will be seen, therefore,
that even the families classed as “ fresh meat users” were not neces
sarily having any large amount of such meat. Yet only 24 per cent
o f the families could qualify for this group, while 60 per cent be9
The use o f this term varied am ong the fam ilies. Some called m eat fresh u n ty it
was hung up to dry, after it had been in salt tw o, three, or even six w eek s; others, only
while it had not yet absorbed enough salt to give it a salty taste, a t the most tw o or
three weeks a fte r salting.

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longed definitely in the “ salt meat group.” Sufficient data to classify
the remainder were not obtained.
These facts are significant from the dietary standpoint. Although
meat was served the year round three times a day, it consisted to
such an extent o f fat salt middlings that it made on the whole a
questionable addition to the protein o f the diet, the chief requisite
that meat is supposed to supply. It is probable, moreover, that the
vitamines which are present in fresh lean meat to a certain extent,
and which are capable o f protecting the body against certain nutri
tional disorders, were almost if not completely destroyed by the salt
ing process. On the whole, therefore, the only food requirement
which the meat supply in this section could be expected to contribute
was that o f energy.
Vegetables.

Every family visited except two had a garden. The yield o f
vegetables, however, was very limited in variety and amount. The
vegetables most commonly raised were beans, white potatoes, toma
toes, and onions; next to these came corn, cabbage, lettuce, peas, beets,
sweet potatoes, and squash, or pumpkin; much less common were
cucumbers, radishes, turnips, parsnips, and rhubarb. Carrots, cauli
flower, asparagus, and celery were almost unknown; while greens,
such as chard, collards, and spinach—with the exception o f mustard,
which six families reported raising for greens—were not grown at all.
The list o f vegetables raised, while it shows restricted variety,
makes the situation as regards vegetables appear much better than
it really was; the amounts o f all but a few o f those raised were com
monly found to be so small as to be almost negligible. In many
cases the garden might have been disregarded because o f the small
contribution it made to the family’s food. Sometimes it “ burned
out ” so early in the summer that it furnished nothing at all. “ Our
ground’s plumb wore out, ” commented one woman in explanation of
their garden’s failure. Even in homes where gardens did better,
not more than a few vegetables were raised in any amount.
O f the 123 families, only 13 reported having any vegetables to sell.
This does not necessarily signify that even these families had an
abundant cro p ; more probably it indicates a need for ready money in
the fall. To secure money at that season a few beans or potatoes
were sold, though to do so might mean the buying of these same foods
in late winter or spring at a higher price.
Comparatively few vegetables were stored for the winter. Eight
families stored no vegetables at all; 28 families stored one or two;
and 87 families a little more than two, but not many. More than
four-fifths o f the families canned some tomatoes; one-half o f them
stored white potatoes; somewhat more than three-fifths stored dry

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beans; only one-third stored cabbages and onions, and fewer than
this, beets or turnips.
Again it must be stated that this list, meager as it is for a farming
community, makes the situation appear much better than the reality.
One or two dozen cans o f tomatoes might be all that a family had,
or a bushel or two of potatoes and a few beans might be the winter
supply. It was common to find that the few vegetables which had
been stored were already used by the end o f January. During the
remainder o f the winter the family must either buy more or go with
out. Except for beans, which the family usually purchased, if pos
sible, when its own supply was exhausted, to go without was the
general custom.
It is thus seen that beans were the principal winter vegetable.
In some families they were practically the only vegetable for the
greater part o f the year. Some had beans every day—much as
people in other sections have potatoes—and it was an exceptional
family that did not cook them at least as often as twice a week. To
use local terminology, only two kinds appeared to be u s e d , s o u p
beans ” and “ shuck beans.” The former term is used to designate
any kind o f dry shelled beans—the navy bean, the red kidney, or any
other variety. The navy bean is the one most raised, though spe
cialists say that the red kidney bean would probably do much better.
The “ shuck ” beans are the same beans dried with the shells on—
string beans they are in reality—though the seeds are much larger
than it is usual to let them become. The beans may be broken into
pieces and dried, but more often they are strung on a thread and
hung to dry in the kitchen. They are cooked with pork for a long
time until both pod and seeds are tender.
Fruit.

In spite o f the claim of agricultural specialists that this section
is well adapted to fruit culture, very little fruit is grown. Fully
80 per cent o f the families visited were found to raise no fruit at all,
while the remaining 25 families raised a small number o f apples or
peaches, or, in ’a few cases, both.
This scarcity o f orchard fruit was somewhat alleviated by the fact
that large quantities o f blackberries grow wild in the mountains and
may be had for the picking. As proof of their abundance may be
cited the record o f three women who were out but “ four hours and
picked 14 gallons.” Every family in the section was found to depend
on wild blackberries to add fresh fruit to the diet. The blackberry
season, however, lasts not more than a few weeks at the best, and
so this fruit, which was the only one available in a large percentage
o f the homes, could influence the diet for but a short period unless
it was canned. Practically every family (95 per cent), however,

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canned or preserved some blackberries for the winter, though in
many cases the amount put up was known to be very small.
The extent to which these families depended on blackberries for
fruit is further shown by the fact that no other fruit was canned by
nearly two-thirds o f them (63 per cent). Somewhat less than a
third (32 per cent) put up a few apples or peaches in addition,
while six families canned or preserved no fruit at all, not even
blackberries.
It may readily be seen that fruit, either fresh or preserved, was far
from being a daily article o f diet. Indeed it appears certain that a
considerable number o f families must have been without fruit of
any kind for more than half the year— from the time the few canned
blackberries gave out (in October, November, or December) until
the next blackberry season the following summer.
Eggs.

In spite o f the fact that 85 per cent o f the families kept chickens,
eggs were comparatively little used throughout the section. This
was accounted for, in part, by the small production. The number
o f hens kept by a family was ordinarily not large, and the yield o f
eggs was unusually small. At the time this study was made, in
late fall and early winter, 105 families were keeping a total o f 3,604
hens, and the total daily yield o f eggs was 215. The yield was not
high, moreover, even in the most productive season o f the year.
The explanation o f the poor yield lay in the lack o f care which
was given the hens. Very poor shelter or none at all, even during the
winter, was the usual lot of a flock, and their food was quite on a
par with their housing. They ran wild the year round, and received
practically no food but corn.
The few eggs produced were usually sold. “ We can’t eat eggs
when every egg is worth 5 cents! ” exclaimed one woman, voicing
thereby the common sentiment. The daily consumption o f eggs at
the time o f this study averaged less than one per family.
Sorghum.

In the community studied farmers customarily either raised enough
sorghum for their own use or purchased it from their neighbors.
Butter and “ lasses,” as the sorghum was locally called, was a favorite
combination. The butter was stirred into the sorghum and the mix
ture eaten with biscuit. Children sometimes carried glasses o f it in
their school lunches. Sorghum appeared to be used somewhat less
widely than usual during the year this study was made, due prob
ably, at least in part, to its higher price. Many families were using
a commercial corn sirup instead.

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C O U N T Y OF K E N T U C K Y .

Milk and Butter,

Milk, throughout the area studied, was regarded as a necessity,
and keeping a cow, if it could be afforded, was taken as a matter o f
course. Eighty per cent of the families had one or more cows at the
time o f the study. O f the 24 families without them, 9 were purchas
ing a regular and apparently adequate amount of milk, 4 were buy
ing an irregular or an inadequate supply, while 11 families had very
little or none.
Fifty-seven o f the 99 families keeping one or more cows had no
period when they were without milk o f their own. O f these families
those with more than one cow planned to have them go dry at
different times, while the others traded the cow about to go dry for a
fresh one.10 Thirty-four families, when the cow was: dry, either
bought milk or received it as a g ift from neighbors. The' milk se
cured was usually buttermilk and varied in amount and regularity.
Eight families went without milk when their own cows furnished
none.
Only one family in the whole district used condensed milk, and
milk powder was unknown. To summarize, 100 families, or 81 per
cent, were having a fairly steady milk supply, while 19 per cent
either had no milk at all or were without it for considerable periods.
In many places milk figures little in the diet o f children and per
haps not at all in the diet o f adults. In this community, on the con
trary, it was regarded as a staple article o f diet and whenever obtain
able, was drunk regularly by children and adults alike.
When it
was plentiful great pitchers o f it were put on the table at every
meal. “ Milk,” said one mother, “ is what I ’ve raised my family on.
My family here uses buttermilk like it was water.” A number o f
families testified to using milk “ for water;” and many a strong
man was pointed out proudly as having been reared on milk and corn
bread.
Milk was alike the best feature o f the better diets and the salvation
o f many o f the poorer ones. Indeed, as later will be more fully ap
parent, it was the one redeeming feature of the whole food situation.
Seventy-one per cent o f the families visited were accustomed to
making all their own butter. O f the remainder, 13 families bought
all they used, 4 supplemented their home supply by purchase, and 18
(15 per cent) used no butter. The amount that was made was fre
quently inadequate and the making o f butter was necessarily dis
continued in many homes during the period o f decreasing milk sup
ply as well as during the time when the cow was dry. A t such times
the families who depended entirely on their home supply o f butter
10
I h e r e were traders in this section who made a regular business o f buying up dry
cows and selling them at a higher price when they became fresh.

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substituted drippings. Some families, to be sure, that had more than
one cow could manage so that their own supply never failed. It is
certain that a far larger number than the 15 per cent who did not
use butter at all must have had a very limited supply or lacked this
food entirely during an appreciable part o f the year.
Absence o f butter from the diet is o f small consequence, providing
plenty o f whole milk is used, as it customarily was in the homes of
this section whenever available. But, unfortunately, when the milk
supply diminished or failed entirely and the family could no longer
make butter, it was skim milk or buttermilk rather than whole milk
which was usually secured. Thus the families who were most in need
o f butter, those using skim milk, were the ones without it, while the
families having plenty o f whole milk were also those who had butter.
Adequacy of food supply.

It has been seen that the diet o f families in this section was much
restricted. Vegetables and fruits, which are usually relied upon to
lend variety and flavor to the diet, were little used, while even
potatoes, a staple food, did not figure very largely in the dietary.
Fresh meat, eggs, and butter, all o f which add much in the way of
flavor and general palatability as well as food value, had but limited
use. The diet may indeed be described as one o f corn bread, milk,
and fat salt meat, while in some diets milk was lacking or limited
in amount during at least a part o f the year. Adding to this list
beans, sorghum, and biscuits, with butter when the cow was fresh,
and blackberries and a few vegetables for a short season, there re
sults the usual diet at its best. Only a limited number o f families
fared better than this, their supply o f milk and butter being more
plentiful, fresh meat bought fairly frequently, and vegetables and
fruit used more extensively.
■So restricted a diet is unquestionably monotonous. A hopelessly
monotonous diet, however, mjay be a perfectly adequate one i f it is
capable o f supplying all the body’s needs. The diet o f corn bread
and milk on which a considerable number o f mothers stated they
had reared their families is probably capable of barely meeting all
the needs o f the body, provided that the milk is whole and is taken
in liberal amounts, and provided that the corn meal is made from
the whole grain. Both o f these conditions were often met in the
diets studied in this district.
To suggest the advisability o f living on a diet of these two foods
is not for a moment, of course, intended. It can not be doubted that
the addition o f fruits and vegetables would render such a diet more
surely safe as well as distinctly more palatable. Nevertheless the
fact remains that it would be difficult to find two other foods which
together would be better able to provide an adequate diet. Any

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other whole cereal, or potatoes, might take the place o f the corn meal,
but i f the milk is dropped out, decreased in amount, or changed to
skim milk or buttermilk, as was all too frequently done in this
section, the effect is disastrous.
The corn-bread and fat-meat diet wnicn was the common one
when milk was omitted is deficient in calcium, adequate protein,
and vitamine content. A dd any one or more o f the foods used in
the community— beans, biscuits, sorghum, potatoes, sweet potatoes,
or fresh meat—and though the diet is bettered it still remains in
adequate in some respect, notably in calcium and in the fat-soluble
vitamine. Restore milk and all the deficiencies are covered. Small
wonder, then, that milk is called a “ protective ” food. It is veritably
the salvation o f the diets o f this community.

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THE DIET OF THE CHILDREN.

In the discussion o f the family food supply, the possibilities for the
children’s diet in the families studied have to no small extent been
indicated. Diet is o f such importance in relation to nutrition, how
ever, that an effort was made to secure more detailed information
concerning the feeding o f the children between 2 and 11 years of
age. The actual diet of a child on the day preceding the inter
view was learned,11 and to supplement this information his food
habits were ascertained—the amount o f milk he drank; the frequency
with which he ate fruit's, vegetables, meat, and eggs; his likes and
dislikes for important foods; his custom with reference to eating*
between meals; his indulgence in candy and other sweets; and his
use o f coffee and tea. As a result a fairly clear picture o f the child’s
dietary was obtained, and what is believed to be a tolerably safe
judgment regarding its adequacy was in most cases possible.
The feeding o f the children during the period o f infancy will first
be discussed, after which consideration will be given to the use o f
the different classes o f food and the adequacy o f the diets as a whole.
I N F A N T F E E D IN G .

No study o f the factors responsible for a child’s nutritive con
dition would be complete without some inquiry as to his care and
feeding during infancy. In this survey a detailed study was im
possible, but a few important questions were included in the schedule.
Information was secured as to whether or not a child was breast
fed, the age at which he was weaned, and the time at which he was
given solid food.
Breast feeding.

Practically all the children in the survey had the very distinct
advantage o f having been breast fe d ; 221, oi 86 per cent, were re
ported to have been nursed for 6 months or longer, 4 less than this
time, and only 9 had never been breast fed. For 22 children, no
reply as to infant feeding was obtained. It was indeed fortunate
that so many had had the benefit o f breast feeding, for a breast-fed
child has not only a better chance o f living beyond infancy but can
withstand much more in the way o f unwise care and feeding than
can an artificially fed child.
_______ _________________
ii
i f the diet on the day preceding varied from the ordinary one, a more typical day's
diet was ascertained instead.

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Age of weaning and age at which solid food was given.

Not only was breast feeding common but prolonged nursing was
not at all unusual. O f the 221 children who were nursed for six
months or longer only 22— 10 per cent— were weaned before they
were a year old. About half were weaned when they were between
1 year and 18 months o f age and 44 per cent were nursed for 18
months or longer. Indeed, more than a fourth were not weaned until
the age o f 24 months or even later.
The prevalence o f this custom o f late weaning would be o f greater
significance had the children received no other food than breast milk
before weaning. It was a, common practice, however, to give tastes
of food to very young babies. Thirty-four children (18 per cent)
were given solid food before they were 1 month old, and fully
two-thirds o f the children were receiving it when they reached the
age of 6 months. By solid food is meant food from the family table.
The common belief and practice in respect to early feeding was
probably summed up by the mother who stated that at about one
month she began giving her babies “ mighty nigh anything ” that was
soft, and at 5 months the whole family diet, because “ a great big
baby 5 months old can eat anything.”
The feeding o f babies, as the foregoing discussion indicates, was
rarely according to plan, but followed rather the line of least resist
ance. A baby was nursed because it was the custom; he was taken
to the table in his mother’s arms and given tastes o f whatever the
mother ate; he was nursed whenever he cried; and he weaned himself
when he grew big enough to prefer other food to breast milk or when
another baby had usurped his place.
M IL K .

Where the family food supply is as limited as in the.locality studied
the role which is played by milk becomes a doubly important one.
Especial effort was therefore made to gather information regard
ing its use by the children. The amount o f the family supply, taken
in connection with the number in the family, afforded some indication
o f the amount available for each child, but further effort was made to
learn how much each child consumed. The daily amount was usually
reported by the mother as so many ucups.” Since a “ cup ” might
hold from a fourth to a half o f a pint, the agent asked to see the cup
which the child used and then approximated the amount. Inquiry
was also made regarding frequently used foods containing milk, such
as corn bread and milk gravy. From the amount consumed by the
entire family, the number in the family, the amount which was taken
as a beverage by the child, and the amount consumed in other food,
a conservative estimate o f the total amount o f milk consumed by the
child was made.

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On the basis described above, it was judged that nearly threefourths o f the children, 72 per cent, consumed at least a pint o f milk
daily, the amount commonly regarded as the minimum for children
o f the ages covered by the study. The majority in this group, 57
per cent, had daily as much as one and one-half pints, a quart, or
even more. Eighteen children were receiving well over a quart of
milk a day, some o f them nearly 2 quarts.
Not all were so fortunate, however; 63, or 25 per cent, of the chil
dren fell below the standard o f a pint a day, and 24 o f these, or 9
per cent o f the total, had no milk at all— a serious situation for any
children but doubly so for those in this section where the diet was so
restricted in other respects.
--------------------------------—

1 0 0 %-------------------------------------►

Income

Adequate milk
C h a r t I I .— A d eq u ate use o f m ilk in rela tio n to incom e.

The failure o f these children to have sufficient milk was evidently
not to any large extent the result o f dislike for it, since only 16
children, or 6 per cent, were said not to care for milk, while a fourth
o f the children were getting less than the minimum amount. That
milk was so generally liked by the children was probably due, in part,
to the monotonous diet common in the community, and to the ab
sence o f highly flavored foods which tempt the appetite and make
a bland, mild-flavored food like milk unpalatable. The fact that
milk drinking by old and young was a community custom undoubt
edly helped also.
Chart I I shows how the proportion o f children whose milk supply
was adequate varied in the different income groups. Seventy per
cent o f the children in families with A incomes—the highest income
group—had an adequate supply, and only about 50 per cent in the
B or C groups.

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A child’s physicial condition, however, depends not only on his
present use o f milk but on 'what he has had. throughout his life.
An effort was made, therefore, to secure for each child as complete a
milk history as possible. In the belief that sufficient data were thus
obtained to warrant forming a judgment as to whether or not a
child had an adequate milk supply for practically all his life, the chil
dren have been classified as follow s:
Class A : Those who undoubtedly had always had an adequate
supply o f milk.
Class B : Those who had experienced periods of ample and o f
scant supply, or children the adequacy o f whose milk supply
was doubtful.
Class C : Those who undoubtedly had not had an adequate
supply.
More than half the children, 52 per cent, were considered as be
longing in class A ; nearly a third, or 31 per cent, were placed in
class B ; and about one-eighth, or 17 per cent, in class C.
EGGS.

Since eggs were not plentiful in this community they could not
figure very largely in the diet o f the children. Even during the
period o f maximum yield only 159 children, 62 per cent, had eggs
twice a week or o f tener—with sufficient frequency, that is, to in
fluence their diet to any extent. O f the remainder, 24 were given an
egg about once a week, 7 about once in twp weeks—or even less fre
quently— and 64, or 25 per cent, had no eggs at all.
In the winter eggs were practically never eaten; 208 children, or
81 per cent, did not have any during that period; 7 had them as
rarely as once in two weeks; only 17, about weekly; and only 23, or
9 per cent, twice a week or oftener.
Occasionally a mother said her child did not eat eggs because he
disliked them, or because they disagreed with him. But usually the
reason for the infrequency o f eggs in the diet seemed to be that they
were regarded as money.
VEGETABLES.

Vegetables other than beans did not figure largely in the family
food supply and hence played but small part in the diet o f the
children. During the very short time the gardens produced, nearly
all the children had access to fresh vegetables and ate them almost
daily, but throughout the remainder o f the year there was little op
portunity for any variety. True, during the winter two-fifths o f the
children, 41 per cent, were reported to have some kind o f vegetable as

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often as five or six times a week; a somewhat larger number, 47 per
cent, as often as two, three or four times.a week; and only 27 children,
or 10 per cent, ate no vegetables at all. But if it is recalled how few
vegetables were raised, how short the garden period was, what lim
ited amounts were canned or stored, and how restricted the purchase
of them was, practically the only vegetable purchased being beans, it
is clear that beans were often o f necessity the only vegetable the
children had during the winter and until the next garden season.
Children apparently failed to eat vegetables not because o f distaste
for them but rather because o f the meagemess o f the supply; 214
children, 84 per cent, were reported as eating and liking all the
kinds they had had opportunity to try, and more than half the remain
der, 22, were said to like all but one. It would appear that, on the
whole, they ate willingly whatever was offered them.
F R U IT .

Plenty o f fruit is commonly regarded as essential in the diet o f chil
dren and fruit o f some kind at least once a day is practically always
considered a minimum requirement. Only 85 children included in this
study, 14 per cent, customarily had fruit every day; 80 children, 31
per cent, had it several times a week; and more than half, 55 per
cent, had little or none.
Fifty-four per cent o f the children almost never had any other fruit
than wild blackberries. The remainder occasionally had in addition
an orange or a few canned or dried apples. A very limited number
o f those having fruit every day were known to be receiving a mod
erate variety.
M EAT.

Although meat was usually served three times a day in the com
munity studied, the children did not necessarily eat it at every meal.
The figures show that 94 children, or 37 per cent, were eating meat
two or three times a day; 102, or 40 per cent, were eating it once a
d a y; while 58 children, 23 per cent, ate it less frequently than daily
and six o f these ate no meat.
Although these figures seem to show that the children’s meat
consumption was rather high and that, therefore, they were securing
a liberal supply o f protein, this was not the case. During “ hogkillin’ time,” to be sure—the period during which the study was
made— many children were having fresh meat with a fair propor
tion o f lean in it three times a day. One could tell which families
had butchered by observing which children had fresh hog meat in
their dinner pails at school. This period lasted but a short time.
Considerably more than half the children were known to belong to
families in which the meat supply was practically all salt middlings

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5JO

and in the families o f most o f the remainder fresh lean meat was by
no means common. I f, as was true in many cases, the children had
no other lean than the f little lean streak ” in the middlings they could
not be regarded as securing much protein even though they ate a
“ streak ” or two o f lean at each meal. Meat, therefore made on the
whole but a negligible contribution to the protein of the children’s
diets. With eggs little used, it may be seen that milk was the only
food which could be relied upon to supply the needed animal protein.
BREAD

AND

CEREALS.

Biscuits made o f bolted white flour and corn bread made in the
majority o f cases out o f whole corn meal were the only bread eaten
by 70 per cent o f the children (119). The remainder had some yeast
bread in addition, though usually as a rare treat rather than as a
customary part o f the diet. Only one child included in the study
had light bread most o f the time.
CANDY.

The candy habit, though not so extreme as among city children,
was still a problem with which to reckon. Only 47, or 18 per cent,
o f the children had no candy at all or had it very infrequently; 17
had it almost daily; 80 (31 per cent) several times a week; and 111
(43 per cent), about once a week. More important than the fre
quency o f eating, however, is the time at which candy is eaten. At
the close o f a meal a piece or two is probably harmless for children
past early childhood, but eaten between meals it certainly can not be
so regarded. The candy eaten by the children studied was almost
invariably eaten between meals, for only five were said to have it at
the end o f meals.
The younger the child, the greater the harm which may be done by
injudicious eating of unsuitable foods. The candy habit, like the
coffee habit, is often started very early in life. Nearly half the
children here considered (42 per cent) began eating it before they
were six months’ old, and all but 32 o f the remainder who had candy
at all were given it by the time they were 1 year o f age. One mother
said that long before they could sit alone her children had candy,
while another knew that one of her children was given his first candy
when only a few days old, for, as she explained, “ it was while I was
still a layin’ in the bed, for I remember callin’, ‘ Maw, do come and
see Andrew Jackson eat this stick o f candy! ’ ”
The amount o f candy consumed and the frequency o f eating it
probably depended more upon accessibility to a source o f supply and
financial ability to purchase it than upon any convictions the parents
had as to its harmful effects. Thirty-four o f the. forty-seven children

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who had little or no candy belonged to families in the C income group.
Six children, however, were refused it because their parents felt it
was not good for them. The fathers o f these children brought from
town fruit instead o f candy for their treat. O f the 17 children who
had candy almost daily 7 passed a store on their way to school; the
parents o f 2 others were in town every d a y; and 5 were “ only chil
dren ” and were humored by their parents.
Over two-fifths o f the children, as has been noted, had candy about
once a week. The father usually went to town on Saturday, and,
apparently, did not feel that he had done his duty unless he brought
home candy for the children. When the family was large and the
income small, the amount each child received was not sufficient to
do much harm, though eaten, as it was, between meals; but some
times the amount was greater and a child was allowed to eat all he
wanted, to the extent o f interfering with his appetite for whole
some food. “ He refuses his grub,” observed the mother o f a 2-yearold boy, whose father, to use the mother’s words, “ is a sight to buy
candy.”
Although undoubtedly some o f the children were eating too much
candy for their good, the majority probably did not receive enough
to do them much harm. It is probable, however, that candy would
have been as great a menace to the children’s health in the locality
studied as it is in any other if stores had been nearer at hand, and
the money more easily spared.
COFFEE

AND

TEA.

No attempt has been made in this study to distinguish between
coffee and tea, as their effect on children is about the same. In the
following discussion, therefore, the use o f the term “ coffee ” should
be interpreted to mean either coffee or tea. As a matter o f fact, it
was coffee rather than tea which was generally used.
Coffee drinking was common among the children, though not to
the extent that it frequently is among children in other localities.
O f the children studied 45 per cent drank neither coffee nor tea.
Four o f these had previously done so, but had discontinued the habit,
one because his mother thought it umade him nervous ” and two o f
the others—in one family—because their mother, who had first given
them tastes at about 6 months o f age, decided that coffee was affect
ing one child’s kidneys, and so stopped giving it' to both. A few
mothers were found who had never allowed their children coffee,
because they believed it was not good for them, but usually when
children did not drink coffee it was because they did not want it.
There were 142 children (55 per cent) who drank coffee, 64 irregu
larly, but 78, or 30 per cent, at least once a day. This is more sig
nificant in view o f the fact that the coffee which the children drank

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was not as a rule diluted with water or a large amount o f milk O f
the children who used coffee at all 85 per cent drank it as strong
as the adults in their families, and only 13 per cent had it diluted to
any extent.
A second consideration which increased the probability o f harm
was the early age at which coffee drinking started. O f the 124 chil
dren whose age at beginning to drink coffee was ascertained all but
9 had started before they were 6 years o f age. Sixteen had been given
coffee before they were 6 months old and 50more by the end o f their
first year. An early start seems to establish the habit; o f the chil
dren who began at 1 year o f age or younger 46, or 70 per cent, were
liavmg it daily or oftener. One small boy revealed that coffee had
already become a necessity to him by. his statement that it “ hurt him
m the head ” if he did not have it,

100%
No m ilk
J pint.

or less

than

è pint under 1 pint,

1 pint under 1J p in t s .. .

1« pints under 1 quart.

1 quart and over.

C h a r t I I I . — C offee d rin k in g in relation to th e use o f m ilk .

table m her arms and gives him tastes from her cup, just as she
gives him tastes o f potatoes and other foods. The custom o f allow
ing small children to drink coffee is also in accord with the belief
that they are competent to choose their own foods and to eat ariythmg which the rest of the family have.
The consumption o f coffee was apparently greater when the use
o f milk was small. H alf the children who drank no milk drank cof
fee four times a week or oftener, while only 29 per cent o f those who
drank a pint or more o f milk a day drank coffee to this extent.
I f he has milk, he doesn’t care for coffee,” was a comment not in
frequently made by mothers. One mother explained that her child

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BETW EEN

OF C H IL D R E N
M EALS,

Among the children in the district eating between meals was not
so serious a problem as it usually is among city children. Neverthe
less, the habit o f “ piecing ” was indulged in to a greater extent than
can be considered wise. Only 10 o f the children were said not to eat
between meals, while 142 habitually did so at least once a day. The
seriousness of the habit, however, depends not only upon its fre
quency but also upon the kind of things which are eaten. Simple
foods, like bread and butter, milk, and fruit, eaten as an extra meal
after school or as a midmorning lunch, are commonly regarded as
harmless and sometimes even as advisable; but promiscuous indul
gence in candy or other sweets or haphazard eating o f any food,
however harmless in itself, is fairly sure to interfere with a child’s
appetite for his regular meals.
At least 109 children— 43 per cent— either because o f the frequency
o f eating between meals or the character o f the food eaten or both
were probably harming themselves by this habit. “ He eats every
time he comes in the house,” “ lie carries a piece o f bread around
most o f the time,” “ he snacks so much he don’t get hungry,” are
typical descriptions by the mothers o f this sort o f promiscuous eating.
Little parental authority, apparently, was exercised to control this
habit. A very few mothers expressed the belief that it was not
good for children to eat between meals, but the more common atti
tude was to allow them to do as they pleased. “ It stunts a child’s
growth not to get the food he wants,” was the opinion expressed by
a mother; while one of the fathers was convinced thit the best way
to bring up children was to “ give them all they want to eat and let
them eat every time they get hungry.” These statements, undoubt
edly; sum up the current belief and practice in the locality.
ADEQUACY

OF THE

D IE T S .

Owing to the method employed in this study only a very rough
estimate o f the quantity o f food eaten was obtainable, and it was
not possible to secure much definite information concerning the
factors which determine the digestibility and assimilation of this
food. Hence, in formulating judgments concerning the adequacy of
the diets these two factors have been disregarded and the judgment
in each case has been based upon whether or not the diet, assuming
that enough was eaten and the body was able to utilize it, probably
contained the constitutents necessary to nourish the child. It is
evident that a judgment thus arrived at does more than justice to
the diets, for it is known that an insufficient amount o f food and
inability to utilize food eaten are two important causes o f malnutri
tion in children; and even with these factors eliminated the evi
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dence still remains that the majority of the children studied were
living on diets which were very far from meeting their requirements
for growth.
In order, to facilitate discussion and make possible the relation
o f diet to other conditions, the children have been placed in three
groups according to the adequacy o f their diets. Class A comprises
all children whose diets it seemed fairly certain included the con
stituents required to nourish the growing body; class C includes

B
%

Adequate.

Questionable.

Inadequate •

C h art I V .— P e r cen t o f ch ildren in each grad e o f diet.

children whose diets just as certainly failed to meet these needs;
and class B includes the children whose diets could not clearly be
assigned to class A or class C. Classes A and C have been further
subdivided into A1and A 2, C1and C2, to show gradations o f ade
quacy and inadequacy. The distinction between A x and A 2 diets is
merely that the latter consist very largely, if not exclusively, of
milk and corn bread made o f whole meal, and so are very monot
onous; while the former contain in addition fruit, vegetables, and
in general a better variety. In the same way C* diets, though
plainly inadequate, may have some redeeming feature, while those
designated as C2 are practically “ deficiency diets.”

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According to this classification, 28 per cent, or more than a fourth
o f the children, had class A diets ; 10 o f these could be ranked as A 13
while 62 were on diets o f A 2 grade. Nearly the same proportion
o f the children—27 per cent— were found to be receiving class C
diets, 48 o f them being considered Cl5 while the diets o f 20 were so
exceedingly poor that they were classified as C2. The remainder
o f the children—45 per cent—were in the group having class B
diets.
These figures reveal a situation which is undeniably grave. When
nearly three-fourths o f the children between the ages o f 2 and 11
years in a community are living on diets which are either plainly
inadequate or o f very doubtful adequacy, it is time to inquire into
the cause. That poverty was to a considerable extent responsible

Adequate diet
Ch a r t

V .— A d eq u acy o f d iet in rela tio n to

incom e.

appears evident from Chart V. Seventy-four per cent o f the chil
dren o f families in the A income group, 30 per cent o f those in fami
lies with B incomes, and but 12 per cent o f those in families with C
incomes were receiving diets judged as adequate (class A ). That
ignorance and lack o f control were also responsible can not be
doubted. Little knowledge existed o f children’s food needs and little
or no control was exercised over their diets. Even though poverty
might be relieved, and improvement in the dietary follow, there
would still remain the need o f education in the food requirements of
children.
Milk, as has already been stated, was the salvation o f the diets in
this section. O f the children having less than a pint o f milk a day
practically all had an unquestionably inadequate diet. No child hav
ing less than a pint o f milk daily had a class A diet, and even o f
those securing this amount only half could be so classified. This
indicates what was actually the fact, that the diets on the whole

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were so lacking in all other important foods that their only chance
o f attaining adequacy was the inclusion o f a liberal amount o f milk.
With no dependable supply o f vegetables, fruit, eggs, butter, or lean
«—

:------------------------------

tlilïHliPi

A DIET

100% ------------------------------- _►

B DIET

C DIET

Ch a r t V I .— G ra d e o f d iet in relation to use o f m ilk.
I

meat, the sole food which could be counted on to any extent to fur
nish vitamines, minerals— particularly calcium— and adequate pro
tein, was milk.

- - - - - - - - - - - - - - - - - - looy.--------- 1 __ _ _ _ _ _ „

C h a r t V I I . — G rade o f n u trition in re la tio n t o grad e o f diet.

R E L A T IO N

O F D IE T T O N U T R IT IO N .

The nutrition o f the children, as determined by the medical exami
nation, has already been discussed,12 and the children have been
classified into five groups— those with excellent, good, fair, poor, and
very poor nutrition. It is o f interest to compare the distribution
12 See p. 7.

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o f the children according to the adequacy o f their diets with their
classification by grades o f nutrition. Chart 7 shows that nearly
one-half (47.2 per cent) o f the children with the best type o f diet were
classed by the physician as having either excellent or good nutrition
and that this proportion falls to about one-sixth (16.2 per cent) for
those in the poorest diet groups. Likewise, over one-half (51.4 per
cent) of the children in the latter group were in poor nutrition as
compared with only one-sixth o f those (16.7 per cent) in the best
diet group.

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)
OTHER ITEMS OF CARE AFFECTING THE CHILD’ S
NUTRITION AN D G EN ERAL W E LFARE .
Although the chief emphasis in the survey was placed on the food
problem, other factors o f hygiene known to affect the nutrition arid
general well-being of children were likewise studied. These included
sleep, fresh air, habits o f cleanliness, adequacy of clothing, and con
ditions o f schooling.
N

SLEEP.

Aside from diet there is probably no factor which has a greater
influence than sleep on the physical well-being of a child. The bed
time and rising time, the number o f hours o f sleep, and the conditions
under which the children slept were therefore ascertained.
Bedtime was found to be, on the whole, commendably early, but
because o f the early hour o f rising the total sleep in the majority o f
cases was less than the needed amount. Almost two-thirds of the
100 children under 6 years o f age were in bed by 7 o’clock—the latest
hour usually advised for children o f this age—while all but 7 of the
remaining third were in bed by 8 o’clock. Unfortunately, however,
the time of rising was correspondingly early, since nearly two-thirds
o f this group were up by 5 o’clock, and 23 o f them by 4 o’clock. Only
4 o f the children under 6 got up later than 6 o’clock.
It is impossible to state the exact number of hours o f sleep which
are needed by children o f these ages; no doubt the amount varies
with different children and with the quality of the sleep. Various
authorities advocate different amounts— some, 12 or 13 hours; others,
a minimum o f 11. The majority o f the children under 6 years o f
age included in the study were found to fall below any o f these stand
ards; 65 o f the 100 were having less than 11 hours sleep, and 38 were
having even less than 10 hours.
The condition was much the same among the children 6 to 11
years of age. The bedtime, as with the younger children, was early,
for nearly 90 per cent o f them were in bed by 8 o’clock and half by
7 o’clock; but again the early rising hour cut short the amount of
sleep. Only 7 o f the 156 children in this group got up later than
6 o’clock in the morning, while almost seven-tenths were up by 5 and
29 arose as early as 4. The number o f sleeping hours, therefore, in
spite o f the early bedtime.-was less than it should have been. Almost
half the children in this group fell below a 10-hour minimum, the
least amount estimated as sufficient for children 6 to 11 years o f age.
09

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A popular impression exists that sufficient sleep is not a problem
for children in rural communities because of the habit o f early
retiring. This study shows that the w,early-to-bed ” habit was by
no means a sure indication that a child was getting sufficient sleep.
In spite o f the fact that the large majority of the children in the
district studied were going to bed early, more than half— 55 per
cent-—were securing less sleep than the amount required, according
to the lowest standards for their respective ages.
It is difficult to understand why little children should be required
to get up so early. The explanation seems to be that all the members
of the family— adults, children, and babies—follow the same hours,
both for retiring and rising. A 7-o’clock bedtime for an adult means
that by 3 or 4 o’clock in tlje morning he is ready to get up. The
children may be required to conform to the hours of their elders,
or if the whole family sleeps in the same room the children are dis
turbed when their parents rise, so get up with them.
It is probable that one mother gave the explanation for others as
well as herself when she said o f her 4-year-old child.: “ Sometimes he
gets up at 3 o’clock when I d o ; but i f he isn’t up by 4 o’clock, I wake
him, because I want to learn him to be smart.” There seemed to be
a general belief that a child who was not up to eat breakfast with
the family, no matter how young the child nor how early the break
fast hour, would never amount to anything.
A separate bed in a separate room is usually considered the ideal
sleeping arrangement for a child. Few of the children in this study
were thus provided for. Only 18 o f the 256 included slept alone;
106 slept two in a bed; while more than half (132) slept three or four
in one bed. Rooms were crowded as well as beds. Only 4 children
slept in rooms by themselves, while half (128) shared rooms with
four or more other persons. Thirty-six children were sharing rooms
with 5 others, 15 with 6, 26 with 7, and 4 with 8.
This does not necessarily indicate crowding as determined by the
number o f cubic feet of air per person. The room was often large
enough to accommodate two or three beds and yet give ample space
to be used as a sitting room ; not infrequently, however, it was small
and distinctly crowded. But disregarding the size o f the room
altogether, it can not be doubted that the sleeping conditions o f many
children were not conducive to either their physical or their moral
well-being. A child sleeping one o f four in a bed, in a room with as
many as eight occupants, can scarcely have peaceful, undisturbed
rest. Moreover, six, seven, eight, or nine persons— adults, small
children, grown boys and girls— can not be thus herded in one sleep
ing room without endangering moral standards.
In the winter season, when this study was made, 205, or 80 per cent,
o f the children either removed only a few outer garments at night

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or slept in all their clothes except their shoes. Only 51 children, or
20 per cent, had some sort o f night garment, and but 17 o f these
customarily removed all their day clothing. Not more than about 7
per cent o f all the children, therefore, were sleeping in a suitable
night garment with all day clothing removed.
The cold houses, the lack o f privacy, and bedding frequently inade
quate accounted for this at least in part. “ Yes,” answered one
mother when this question was put to her, “ the children sleep in
all their clothes. I f they didn’t they would freeze to death.” Not
all the failures to attain the standard in this particular can be
accounted for on these grounds, however. It was evident that pro
vision o f suitable sleeping garments did not enter into the ordinary
standard o f living o f the locality.
FRESH

A IR .

Fresh air in abundance day and night is requisite to the proper
care o f children. In the district studied it was the requirement most
commonly fulfilled, but from compulsion and not from choice. It
is probable that most o f the children would not have had any fresh
air at night if it had not been for poor housing, for 93 per cent o f
them were sleeping in winter in rooms the windows of which were not
opened. On account o f the poor construction o f houses, however,
resulting in cracks in floors and walls and loose-fitting doors and'
windows, most o f the children were receiving abundant fresh air,
Ofljy about 6 per cent, in fact, were to be regarded as having in
sufficient fresh air at night; these children belonged to the families
who lived in the better Jiouses and were able to exclude fresh air
by keeping windows closed. Improvement in the housing conditions
o f the community, therefore, sorely needed as it is, must be accom
panied by education concerning the value of fresh air.
The greater number of children spent considerable time out of
doors, even in the winter. More than three-fourths— 79 per cent__
averaged at least 2 hours a day in winter and 6 hours daily in s u m ,
mer. Some o f the younger children, and older ones who had inade
quate clothing, were out o f doors less in the wintertime.
H A B IT S O F C L E A N L IN E S S .

Somewhat more than half the children, 52 per cent, customarily
washed their hands before meals; 47 per cent had neck and ears, face
and hands washed daily. In the summer, when many of the children
went swimming, bathing was more frequent; in winter, slightly more
than three-fifths, 62 per cent, had a weekly bath. O f the remainder,
35 bathed once in two weeks in winter, 28 about once a month, and
33 even less than monthly. Twenty-six did not bathe at all in the

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THE

N U T R IT IO N

AND

C A R E OE C H I L D R E N

wintertime. “ No, I don’t wash them plumb off nary time, all cold
weather,” answered one mother. “ I wash their feet, neck, and ears
once a week.” Another mother’s answer to the question regarding
winter bathing was, “ I don’t never do that in cold weather! I
wash their feet when they are going somewhere.” Still another ex
plained that when she had had a fireplace she had made it a rule to
bathe the children twice a week, but now that they were living in
a “ little old open house ” it was not easy and they were bathed less
frequently.
It is easy to censure a community for upholding no higher stand
ard of personal cleanliness, but in view o f the cold houses, the
lack o f privacy, and all the difficulties involved in carrying and
heating water for bathing, that so much was accomplished under
such conditions seems surprising.
CARE

OF TEETH.

The children’s teeth were very generally neglected. Eighty-two
per cent o f the children, 211, did not own a toothbrush, and only 15
o f the 45 who did, brushed their teeth as frequently as once a d a y; 29
brushed them irregularly, and one confessed that although he had
a brush he never thought to use it. A very few who owned no brushes
made some attempt to clean their teeth occasionally in other ways.
Three children of one family about weekly used dogwood brushes
of their own making; two other children cleaned their teeth with
cloths. Such irregular and ineffectual attempts are far from ade
quate, however, and may for the most part be disregarded. Less
than 6 per cent of the children, the 15 who brushed their teeth as
often as daily, may be considered as giving their teeth even a mini
mum o f care.
The teeth were found to be in the condition which might be ex
pected from this lack o f care. O f the 149 children who were given
physical examinations, 82 per cent had conspicuously dirty teeth.
The 27 children not so described were chiefly the younger ones whose
teeth had not had time to become much coated, and the few who
regularly brushed their teeth.
Not only was lack o f care shown by dirty teeth, but by decayed
teeth as well. O f the children examined, 77.8 per cent were found
to have one or more teeth decayed; 31 per cent of those 6 to 11 years
o f age had one or more permanent teeth in this condition.
C O N D IT IO N

OF THE

C H IL D R E N ’S B O W E L S .

In a consideration of nutrition the condition o f the bowels is im
portant. Constipation not only may be the result o f an unsuitable
diet, but also may operate as a direct cause o f undernutrition by de
creasing the appetite and the total amount o f food eaten.

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A M O U N T A IN

C O U N T Y OF K E N T U C K Y .

It is interesting to note that not one mother reported that her child
was constipated. Ten children were reported to be somewhat irregu
lar, but 245, or 96 per cent o f all the children studied, were, accord
ing to their mothers’ statements, absolutely regular. The extremely
plain diet, which often consisted largely o f whole corn meal contain
ing the bran, and was therefore laxative, together with abundant
exercise in the open air and the simple, regular habits of living prob
ably helped in no small measure to make constipation uncommon.
It is also probable, however, that many mothers in reality knew little
about their children’s habits in this respect and that children became
constipated without the mothers’ knowledge and eventually began
to feel sick from the effects. Then mothers, for the “ sickness.’* not
for constipation, gave some medicine— “ black draught,” perhaps to
correct the evil. While fully 70 per cent o f all the children were
never given any medicine to assist bowel movement, 69 children—27
per cent— whenever they were sick were given a cathartic.
«--------------------------- ----------- ¡00% ------------------------------------ ►
Income

C h art V I I I .- — C lo th in g in relation to incom e.
C L O T H IN G .

Inquiries regarding clothing were made to discover whether the
children had garments which gave them adequate protection from
the weather. Only three-fifths o f the children were found to have
at least the follow ing: Shoes, an overcoat or other extra wrap, and
some kind o f winter underwear. Sometimes, however, the garments
were so poor and thin that they could not possibly afford much
warmth. Only about one-fourth o f all the children, 27 per cent,
were found to have clothing which could furnish adequate protection
from the elements.
That poverty was largely responsible for this situation seems evi
dent from Chart V III, for it will be noted that almost all the chil
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THE

N U T R IT IO N

AND

CARE

OF C H IL D R E N

dren (98 per cent) in the highest income group had adequate cloth
ing, while practically the whole ($9 per cent) o f the lowest income
group had clothing which was totally inadequate for winter wear.
S C H O O L IN G .

The area studied comprised five school districts. Terms were
short and attendance poor. Cold weather, inadequate clothing, dis
tance from school, and the bad condition o f the roads contributed to
this poor attendance.13 Many children lived a mile or more back in
the mountains and the lanes which led to their homes were bad
beyond description. It was often literally impossible for a child
to trudge a mile or more in the thick, wet clay o f the roads. More
over, the numerous streams were commonly without bridges, and
when swollen were too deep for a child to cross on foot.
In one school district the only way for about half the children to
get to school was by a road down which for some distance ran a creek,
which they were obliged to wade. Even the schoolhouse was com
pletely cut off from the road by a stream which, at the time o f the
study, was too wide for a child to jump across. A small board or a
few stepping stones would have made it possible to cross dry shod,
but no one had taken the trouble to provide either. It seemed cer
tain that practically all the children in this school, during the rainy
season, had to sit throughout the day with wet feet. Many mothers
in the district kept their children at home when the creeks were
swollen.
It has been found among city children that study outside o f school,"
“ home lessons ” and music lessons chiefly, are often to a considerable
extent responsible for undernutrition. The worry and the nervous
strain resulting are a menace to health, and additional harm is done
if by reason o f home lessons the child is deprived o f his right to play
long hours daily in the open air. O f the children included in this
investigation, only 45 were doing any studying at home, and these
studied voluntarily and for short periods only.
18 T h e co m p u lsory sch ool a tten d a n ce la w o f K en tu c k y in effect in ru ra l sch ool d istricts
a t th e tim e o f th e stu d y required a ll ch ild re n betw een th e age s o f 7 an d 1 2 yea rs, in
clu siv e, to be en rolled in an d to a tte n d som e pu blic or p r iv a te d a y or p a roch ial school
each sch ool yea r fo r th e f u l l term o f sa id school, exe m p tin g on ly ch ild ren ta u g h t a t hom e
an d given e q u iv a len t in s tru c tio n , an d those n o t in proper p h y sica l or m e n ta l con ditio n
co atte n d sch ool. T h e p e n a lty fo r a p a re n t’ s fa ilu r e to cause h is ch ild t o a tte n d school
a s required by th is la w w a s a fine o f n o t less th a n $ 5 nor m ore th a n $20' fo r each offense.
T h e la w a lso required t h a t th e s ch o o l term sh o u ld be n o t less th a n six m o n th s ( 1 2 0 d a y s ).

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S C H O O L C U T OFF FROM ROAD BY CREEK.
Children must wade this “ moat” to get to the schoolhouse.

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V IE W O F A R OC K Y M O U N TA IN

ROAD.

The road referred to over which the produce from an
adjoining county must be hauled to market.

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SUMMARY AN D CONCLUSIONS.
This study o f a small mountain section o f Kentucky included 123
families in which lived 256 children from 2 to 11 years o f age. The
heads o f households in 103 families were farmers, but only 59 were
occupied in farming alone, while 44 supplemented work on their
farms by some other occupation.
P H Y S IC A L

C O N D IT IO N

OF THE

C H IL D R E N .

A total o f 149 children were given physical examinations. H alf
this number had enlarged or diseased tonsils; more than a fourth
showed symptoms o f adenoids; over three-fourths had carious teeth.
Only 7 per cent o f the children were ranked excellent in nutrition;
18 per cent, g o o d ; 35 per cent, fair; 34 per cent, poor; and 6 per cent,
very poor.
H O M E C O N D IT IO N S .

The income in the homes o f 42 children was considered adequate;
in the homes o f 95, its adequacy was doubtful; 119 children, or 47
per cent, were living in homes clearly incapable o f providing the es
sentials o f a simple standard o f living. Sanitary facilities were
poor; 56 per cent o f the families had no toilet. More than half the
families * (55 per cent) depended for their water supply upon a
spring, stream, open well, or other source which might suffer
pollution.
The family food supply was restricted both in kind and amount and
the family diet was in consequence monotonous and sometimes so lim
ited as not to furnish all the elements necessary. Milk and whole corn
meal were the redeeming features o f the diet, but in many homes even
the supply o f milk was too limited, especially at certain periods,, to
insure an adequate diet, though 80 per cent o f all the families kept one
or more cows.
THE

D IE T A N D

CARE

OF THE

C H IL D R E N .

Only 28 per cent o f the children were having a diet which probably
included all the constituents necessary to nourish their bodies, pro
vided enough was eaten and the body was able to utilize it. The diets
o f 27 per cent were clearly inadequate for the needs o f growing chil
dren. In other words, nearly three-fourths o f the children were living
on diets o f either doubtful adequacy or certain inadequacy.
39

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THE

N U T R IT IO N " A N D C A 15

OF C H IL D R E N

Fruit and vegetables occupied a minor place in the children’s diet
a ry ; beans were the predominating vegetable ; wild blackberries were
practically the only fruit, either fresh or canned, 54 per cent o f the
children had. Eggs were almost entirely absent from the winter diet
and even at the time of greatest yield were eaten by only 62 per cent
o f the children as often as twice a week. Seventy-seven per cent o f
the children had meat daily or oftener, but since meat in this com
munity was usually fat salt meat it made a very questionable contri
bution to the protein in the dietary. It was estimated that 72 per cent
o f the children had at least a pint of milk daily; 70 per cent had corn
bread made o f whole corn meal or biscuits made o f bolted white flour.
Coffee was used by 55 per cent o f the children, though only 34 per cent
drank it four or more times a week. Eating between meals was in
dulged in by 43 per cent to such an extent as probably to be harmful.
O f the children in the highest income group, 74 per cent, as com
pared with only 12 per cent in the lowest, were receiving diets which
could be considered adequate. The diet grades corresponded closely
to the nutrition grades as revealed by the physical examinations.
Chiefly because of the early rising hour, but 45 per cent o f the chil
dren were having sufficient hours of sleep. Only a little more than a
fourth o f the children had clothing which could be considered suf
ficient to furnish adequate protection from the elements. Care o f the
teeth was very generally neglected.
P O S S IB IL IT IE S O F IM P R O V E M E N T .

There is urgent need in the community studied for improvement
in the conditions affecting the health and welfare o f children. In
order to better the physical condition o f the children, adequate diets,
improved housing, more adequate clothing, and higher standards o f
general hygiene are essential.
I f the diet o f the children is to be improved, the family food sup
ply must be enlarged. This will involve increase in the amount and
quality of milk; improvement of gardens; raising and canning or
drying more vegetables; greater utilization o f the wild blackberries,
until fruit culture can be developed; and increase in the yield o f eggs
until enough are available both for family consumption and for sell
ing. The use o f meat could in many cases be restricted without harm
ing the diet. The use o f sorghum and the use o f beans, particularly
those dried without removing the pods, could well be extended.
Soil improvement and education in better farming methods would
improve economic conditions and dietaries. Better housing, more
adequate clothing, and generally higher standards o f living would
follow. Instruction o f the mothers and fathers in the health needs
and care o f children is also essential.

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IN' A M O U N T A I N

COUNTY

OF K E N T U C K Y .

In such a program a county agricultural agent, a county home
demonstration agent or nutrition specialist, and a county public
health nurse could render valuable service. Education in diet and
hygiene through the public school would also be o f assistance. At
the time o f the study the county had an agricultural agent on part
time, and much had been accomplished through his, efforts. The
territory covered was too large, however, and a full-time ‘agent could
be employed with advantage.

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SCHEDULE USED IN STUDY
OFFICE No.
C H IL D R E N S

SURNAM E

M. F. W . C.

1. Age:

yrs.

Date of visit, yr.

Height:
Average

CHILD

FATH ER

A . Child.

Date of birth, yr.

in.

S . N o ________________

BUREAU

3. Weight:

19. Inf. feeding: (a) Breast only

(6) Weaned

20.

oz.

lb.

C. Diet.

lb.

Underweight

Sym.

Hr.

COUNTY

A D D R E SS

31. Control of parents (spec.).
D. Family. 32. Ch. Under 2,_

Summer.

Winter.

Preced. 3 meals.

Over 14,

F. M. Total

2-5,

6-11,

oth., ad.

ch.

12-14,
Total h. h.

33. Financial status: (a) Farmer, oth. (spec.)

Appearance: (a) Fat, plump, med., thin, emaciated.
(ft) Color: Sang., pale, (c) Under eyes: Nat., blue, dark.

(ft) Farm: Acres

Id) Flesh: Firm, med., flab, (e) Muscles: Firm, med., flab.

(f) Shoulders:.. Nor., round, wings.
(a) Chest: Nor., oth. (spec.).

cult.

Income

OT (C.S.) H. wages

milch c.
sheep

hogs

horses

chickens

(d) Ev. prosp: Tel, auto, h. help, sew-m, piano, victrola.

5, Activity: (a) Inact., mod. act., ext. act.

Sym.

Present diet L..
B.

Sym.

STATE

oth. (spec.).

Tire easily, N.

(e) Ev. poverty:

_(ft) Nervous, N. .(spec.).

Teeth: Total

Filled

Decaved (temp.

34. Housing: (a) No. rooms

___ (temp.

perm.

)

perm.

Rem. (temp.

perm.

(ft) Fdn. N, piles, oth. (spec.).

)

(a) Walls and ceiling: Plas, ceiled, oth. (spec.).

7. Tonsils: Nor., enl., dis., rem.

Oth.

Adenoids: N. prob. (spec.).

9. Med. exam., N.

35. Heating: Furn., stove, firepl.

Summary.
21. Eating habits: (a) Appetite: G., F., P., finicky.

(b) Good breakf., N.

Hookworm N. no test.

Up at

(b) Sleeps with

Hrs. nap

(b) Ch. drinks daily

Total

All day clothes off, N.

12. Fresh air: (a) Window open nights, W . N.
Window open S. N.

Amt.

qts.

pts.

No. using

Likes, N.

(d) Total estimate

(b) Hrs. out doors W.

pts.

23. Vegetables: Potatoes, wh., how oft?

13. Cleanliness: (a) Hands bef. meals, N.

Oth., how oft?

Kinds:

24. Fruits: How oft?

Kinds:

26. Eggs: How oft?

(a) Bef. sch.

hrs.

Aft. sch.

hrs.

Sat.

hrs.

17. Clothine: Winter underwear, N ; outer wrap, N, o-c, sw.;
heavy cap, N ; mittens, N ; foot protection, N.
18. School: Grade
Reason for non. at.

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Lastyr.,m os.

used.

powdered.
Make lbs. wk.

Substitutes (spec.).

39. Vegetables: (a) Garden, N.

das.

Raised:

27. Bread and cereals, (spec.).
(ft) Surplus: Sold
28. Eaten on bread: Butter, lard, drippings, oleo, oth.(spec.).
Stored

hrs.
Music N.

period.

Kinds:

(spec.).

(b) Vacations,

used.

Min.

Used, lbs. wk.

25. Meat: How oft?

16. Work, play, exercise.

period.

38. Butter: Buy, lbs. wk.

(ft) How oft. uses

15. Bowels: (a) Reg., irreg., constipated.
( b) How often cathartic

used.

Max.

Can’d (spec, kind.)
S.

14. Care of teeth: (a) Owns brush, N.

(ft) Yield, pres.

Milk supply: Nòne; buy fr., amt

(6) Face, hands, neck, ears, daily, N.
(c) How often bathes.

Slope from privy: Up, down, N.

Pot., sweet, how oft?

(ft) Water: D u gw ., drill, w., spr., str., oth. (spec.).

37 Milk: (a) Source: Own cows; buy, amt.

(e) Prev.: Ad., inad., oth.

(spec.).

Amt.

36. Sanitation: (a) Toilet, N ; privy, oth. (spec.).

E. Family food supply.

I n room with

Night clothes.

Cook: stove, firepl.

How oft?

22. Milk: (a) Fam. uses daily

B. Health Habits.

Foods

10. Summary of condition: E x., G., F., P., V. P.
11. Sleep: (a) Bed at

Used for sleeping.

)

29. Sweets: (a) Candy, how oft?
Eaten: Meals, betw’n.

Amt.
Habit since

(age).

Dried
Canned

(6) Oth. (spec.).
30. Coffee or tea: N
Habit since

Cups
(age).

[Size: H i by 8?".]

strong, weak (M. W .).

Agent.

[Reverse of Schedule]

Sym .

40. Fruits: (a) Raised

(b) Surplus: Sold
Stored

(b) Period fresh meat
(c) Period salt only

..............

Oth. foods used: Eggs

milk

.
N,

greens

.
N,

—T ' “ “

butter N (spec.). ,

Additional notes'
42. Eggs: Pres, yield

Used

Max. yield

period

used

Min. yield

period

used

43. Cereals, flours: Wheat;
meal, whole bolted,

whole bolted:

corn-

oth. (spec.).

44. Foods purchased:

Store
................. ....... ........’ - ft

F . N o te s concerning methods of cooking (use of fried foods,

soda, hot breads, coffee, fat, molasses, underdone or
unpalatable foods, etc.).

HI;

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Full text of The Nutrition and Care of Children in a Mountain County of Kentucky, Bureau Publication No. 110

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