The full text on this page is automatically extracted from the file linked above and may contain errors and inconsistencies.
U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary
CHILDREN’S BUREAU
GRACE ABBOTT. Chief
PHYSICAL STATUS
OF PRESCHOOL CHILDREN
GARY, IND.
BY
ANNA E. RUDE, M. D.
WASHINGTON
OVERNMENT PRINTING OFFICE
1922
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary
CHILDREN’S BUREAU
GRACE ABBOTT. Chief
PHYSICAL STATUS
OF PRESCHOOL CHILDREN
GARY, IND.
BY
ANNA E. RUDE, M. D.
Bureau Publication No. 111
WASHINGTON
GOVERNMENT PRINTING OFFICE
1922
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
....g l p m
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
CONTENTS.
Page.
Letter of transmittal.........................................................................................................
Introduction................. ................ ........................................................................... ... _
Scope of study....................... . ................................ ............. ......... ........ ..............
S taff........... ......................................................
Methods and standards used.....................................
General method of conducting examinations......................................................
Physical examination record form used..............................................................
Instructions accompanying physical examination schedule..........................
Measuring and weighing..................................................................
Height................................................................
W e ig h t........... .................................................................. '. . . . '........ ..............
Vision testing.....................
Hearing testing..........................................
Indications for recommending removal of tonsils and adenoids.....................
Physical findings............... '................ ............................................................................
Introduction................... .
1............................................. ............. ....... . . . .
Findings in general.............................................
Height and weight............ .......................................................................................
Nutrition..............................
Anemia..............
Vaccination........................................... ...................................................... ....... '..
H ea d ..\ „................. ................................................ , ..............................................
E y e s ..............
Ears.........................................
Mouth................................................................................................
T eeth......................... , ............... ........................................................................
Other mouth defects................................................................................
Nasopharynx__ '............................................................................
Adenoids.................
Symptoms suggesting adenoids.......................................................... ; .........
Tonsils.........................
L ym ph glands.............................................................................
Lungs......................, ............... . ............. . ..........................................................
Heart.......................... ............................................................. ......... . . . . . . . . .
Skin— ..................................
Abdom en...................................................................................
Bony and muscular systems............................................................................
Bony defects of rachitic origin..........................
Postural defects.........................
Arch measurements........... ..................
Nervous system...............................
Mental condition...............................................................................................
Genitalia................................
3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
9
11-13
12
12
13-26
14
15
18
21-23
21
22
23
24
25
27-62
27
28
32
36
39
40
41
42
44
44-45
44
45
45-62
46
47
48
51
55
55
55
56
57-61
58
59
60
61
62
62
4
CONTENTS.
Page.
Appendixes........................................................... ........................................................... 63-83
Appendix A .— General tables on physical findings of the preschool c h ild ..
65
Appendix B.—Results of physical examinations of children under 2
years of age................................................ ........................................................... 75-83
Source of material.....................................................
75
Findings in general...........................................
75
Height and weight..........................................................................
77
Nutrition....................................................................................................... . . ”
77
Anemia....................
78
Vaccination....................
78
Head..........................................
78
Eyes.................
78
Ears........................................................................
79
Mouth...................................................................................................................
79
N asopharynx..................................................................................................... 79-80
Tonsils.................................
80
Adenoids................................................................
80
Glands. . . . . . . . . . . . . . . — .............................
80
Heart................................................................................. J...............................
81
Lungs..................................................................................i ........ .....................
81
Skin...................................................................................................................
81
Abdomen.............................................................................................................
81
Bony and muscular system.............................................................................
82
Arch measurements.............................................................................
83
Mental condition...............................................................................................
83
Genitalia. ^..................................................................................................... .-.
83
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
TEXT TABLES.
Page.
I. Age and sex; children from 2 to 7 years of age'given physical
exam ination..........................................................................
27
II. Prevalence of defects, b y sex; children 2 to 7 years of age
given physical exam ination............................................................ 28
III. Number of defects, b y age and sex; children 2 to 7 years of
age given physical examination...... ......................................
30
IV. Average heights and weights, b y sex and age; white children
7 years of age and under given physical examination........ :
36
V. Grade of nutrition, b y age and sex; children 2 to 7 years of age
given physical examination.......................................................
38
VI. Grade of nutrition, by color and nationality of mother;
children 2 to 7 years of age given physical examination___
39
V II. Grade of nutrition, by earnings of chief breadwinner; children
2 to 7 years of age given physical examination......................
39
V III. Vaccination, b y age and sex; children 2 to 7 years of age given
physical exam ination................................................................ !.
40
IX . Vaccination, time of vaccination, and entrance in school, by
color and nationality of mother; children 2 to 7 years of age
given physical exam ination.......................................................
41
X . Defect of vision, by age; children 2 to 7 years of age given
physical examination......................................................
42
X I . Vision, b y sex and eye disease or other defect;-children 2 to 7
years of age given physical examination..................................
43
X II. E ye disease or defect other than of vision, b y color and nation
ality of mother; children 2 to 7 years of age given physical
examination......... : ........................................................................
43
X I I I . Decayed teeth, b y age and sex; children 2 to 7 years of age
given physical exam ination.......................................................
44
X IV . Naso-pharyngeal defect, b y age and sex; children 2 to 7 years
of age given physical exam ination.........................................
45
X V . Adenoid condition, b y age and sex; children 2 to 7 years of
age given physical exam ination................................................
46
X V I. Condition of tonsils, b y age and sex; children 2 to 7 years of
age given physical exam ination.................................................
49
X V II. Prevalence of diseased tonsils, b y presence of decayed teeth;
children 2 to 7 years of age given physical examination___
51
X V III. Condition of glands, b y age and sex; children 2 to 7 years of
52
age given physical examination........ ............ .......................
X I X . Condition of cervical glands, b y condition of tonsils and teeth;
children 2 to 7 years of age given physical examination___
53
X X . Condition of glands, b y color and nationality of mother;
children 2 to 7 years of age given physical examination----54
X X I . Distended abdomen, by age and sex; children 2 to 7 years
of age given physical examination.........................................
56
X X I I . Defect of bony and muscular system, b y age and sex; children
2 to 7 years of age given physical examination.........................
57
X X I I I . Postural defects, b y age and sex; children 2 to 7 years of age
given physical exam ination................... ...................................
60
T able
5
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
6
PHYSICAL STATUS OP PRESCHOOL CHILDREN.
APPENDIX TABLES.
Page.
A ppendix A— General tables..................................................... ................................... 1 .. 65-73
T able 1. Prevalence of defects, by sex; children 2 to 7 years of age given
65
physical examination............. ......................................................... ....
2. Specified defects, by age and sex; children 2 to 7 years of age
given physical examination............................................................
65
3. Specified defects, by color and nationality of mother; children
2 to 7 years of age given physical examination..............................
67
4. Specified defects, by earnings of chief breadwinner; children
2 to 7 years of age given physical examination............................
67
5. Per cent of children with specified defects, by deviation from
average weight for height; children 2 to 7 years of age given
physical examination...............................................
67
6. Specified skin diseases, by age and sex; children 2 to 7 years of
age given physical examination................
68
7. Condition of specified glands, by sex; children 2 to 7 years of
age given physical examination.....................................................
69
8. Specified defects of bony and muscular system, by age and sex;
70
children 2 to 7 years of age given physical examination...........
9. Relation of weight to height, by age and sex; children 2 to 7
years of age given physical examination.................................. .
70
10. Relation of weight to height, by color and nationality of
mother; children 2 to 7 years of age given physical exami
nation........................................................................................................
71
11. Prevalence of specified defects, by deviation from average
weight for height; children 2 to 7 years of age given physical
examination............................................................................................
72
12. Annual earnings of chief breadwinner, by color and nativity
of mother; children 2 to 7 years of age given physical ex
amination.................................................................................................
73
Appendix B :
T able
I. Number of defects, by age and sex; children under 2 years
of age given physical examination...................................... ......
75
II. Prevalence of disease or defects, by sex; children under 2
years of age given physical examination..................................
76
III. Grade of nutrition, by age and sex; children under 2 years
of age given physical examination.............................................
77
IV . Deviation from average weight for height, by age and sex;
children under 2 years of age given physical examination. .
78
V . Nasopharyngeal defects, by age and sex; children under 2
years of age given physical examination..................................
79
V I. Condition of tonsils, by age; children under 2 years of age
given physical examination..........................................................
80
V II. Condition of glands, by age and sex; children under 2
years of age given physical examination.......................
81
V II I. Rickets, by age and sex; children under 2 years of age
given physical examination.........................................................
82
I X . Rickets, by condition of tonsils; children under 2 years of
age given physical examination.................................................
82
X . Condition of glands, by presence of rickets; children under
2 years of age given physical examination............................
83
X I . Comparison of the prevalence of defects in children under
2 years of age and children 2 to 7 years of age given phy
sical examination.............................................................................
83
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
7
ILLUSTRATIONS.
CHARTS.
Page.
Chart
I. Average heights of boys from birth to six years of age; Children’s
Year, Gary, Gary and Health Conferences combined, and
Crum............................................... ..................................^ ..................
ii. Average heights of girls from birth to six years of age; Children’s
Year, Gary, Gary and Health Conferences combined, and
Crum.......................................................................................................
ni. Average weights of boys from birth to six years of age; Children’s
Year, Gary, Gary and Health Conferences combined, and
C ru m .: ..................................................................................................
IV. Average weights of girls from birth to six years of age; Children’s
Year, Gary, Gary and Health Conferences combined, and
Crum..................................................................................................... .
y. Per cent of children having one or more defects, from birth to six
years of age...........................................................................................
/
32
33
34
35
84
ILLUSTRATIONS.
Measuring........................
Measuring square..........
Measuring strip........ .
Weighing in scoop scale.
Weighing on beam scale
Vision testing................. .
Hearing testing..............
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
. .Faces
. .Faces
. . Faces
Follows
Follows
. .Faces
. .Faces
22
22
22
22
22
23
23
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
LETTER OF TRANSMITTAL.
U. S. D epartment
of L abor,
Children ’ s B ureau ,
Washington, A p ril 2 9 , 1922.
There is transmitted herewith a report on the Physical Status
of Preschool Children, Gary, Ind., by Dr. Anna E. Rude, director of
the child hygiene division of the Children’s Bureau. The investiga
tion on which the report is based was planned by Dr. Grace Meigs
Crowder, formerly director of the child hygiene division of the bureau.
All the field work of the investigation was in charge of Doctor Rude,
and the material has been organized by her with the assistance of
Caroline Legg.
Respectfully submitted.
Si r :
Grace A bbott, Chief.
Hon. James J. Davis ,
Secretary o f Labor.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL STATUS OF PRESCHOOL CHILDREN,
GARY, IND.
INTRODUCTION.
In connection with the social and economic study of infant mor
tality and the preschool child in Gary, Ind., made in 1918 by the
United States Children’s Bureau, an investigation to determine the
physical condition of the children was conducted by the hygiene
division of the bureau. In all, 4,348 individual examinations of
children under 7 years of age were made during the six-month period
extending from April to October.
The splendid interest and hearty cooperation of the Gary school
authorities made possible the systematic examination of practically
all children under 7 years of age who were attending the kindergartens
and primary grades in all the public schools and in three parochial
schools.
The school examinations occupied the first three months of the
investigation, following which the examinations were conducted in
children’s health conferences. The first conference center was in a
vacant store in the center of the business district on the North Side
of Gary. The conference rooms were open from 9 a’clock in the
morning until 4.30 o ’clock in the afternoon every day except Satur
day and Sunday. Children were examined by appointment only.
The second conference or consultation center was opened for the last
two months of the study on the South Side of the city, where a large
proportion of the foreign population lived.
In order to stimulate interest in the health conferences and instruct
the public as to their general purpose, the cooperation of the Gary
Children s Year Committee of the Council of National Defense was
enlisted. This committee secured active interest and cooperation
from the mayor, the women’s organizations, the men’s clubs, and the
school authorities, and conducted a poster contest on the subject
of child care in the Gary schools. Two men’s organizations, the
commercial club and the chamber of commerce, donated $75 for
prizes in the form of thrift and war-savings stamps.
An exhibition of posters from all the school grades in a down-town
shop window, prior to the awarding of the prizes, helped to arousfe
11
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
12
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
interest and attract attention to the forthcoming conferences, where a
large collection of posters was finally displayed.
Another feature of the conferences which attracted considerable
attention was the exhibit of small models which included a bed
properly prepared for a mother at confinement, baskets and cribs for
the baby, the necessary bath equipment, utensils for preparing food
and Pasteurizing milk, an iceless refrigerator, play pens, simple and
cheap homemade screens, etc. There were also models of infants’
clothes, and paper patterns from which the mothers might cut dupli
cates if they so desired. Simple meals for the preschool child were
shown in a glass case, and the values of particular kinds of food were
explained by a nurse. Children’s Bureau publications dealing with
prenatal care and the care of infants and young children were dis
played, and given free to persons desiring them. Much interest was
evinced in these exhibits, and in the wall charts which pictured
various phases of child care with warnings and suggestions to
mothers.
SCOPE OF STUDY.
Tabulations were made of the records of 3,125 children whose ages
ranged from 2 to 7 years,1 and of 994 infants under 2 years of age.
The data relating to the latter are presented in Appendix B, but the
descriptions of methods include those used in the examinations both
of infants and nf older children. In both age groups the distribution
by sex was fairly even. The older group included 1,555 boys and
1,570 girls. It was possible to make certain correlations for this group
with items on the family schedules which were taken for all of these
children in the general study of children of preschool age made by
the Children’s Bureau.2
STAFF.
The regular working staff consisted of three physicians, two nurses,
and four clerical assistants.
A specialist from Chicago was engaged for one day a week to
examine all children who had been found upon examination to have
eye, ear, nose, or throat defects. These special examinations were
discontinued after the conferences were begun, owing to the fact that
the majority of the examinations in the conferences were of infants
and the comparative infrequency of these defects in infancy made the
services of the specialist seem unwarranted.
During the examinations in the schools, the school nurses were
loaned to the Children’s Bureau staff for almost full-time assistance.
1 Included in this group were 220 children who had passed their seventh birthdays between the date
of beginning the study and the date of the physical examination. Since the majority of these 220 children
were still less than 7J years of age, and since data concerning them appeared in the family schedules which
had been taken and had already been incorporated in other reports on the Gary investigation, they have
been included in all discussions where ages are not distinguished; but where ages are distinguished this
group is not separately discussed.
2Children of Preschool Age in Gary, Ind. (In press.)
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
METHODS AND STANDARDS USED.
13
They determined from the school register what children were eligible
for examination, notified parents as to date and time of examination,
invited them to be present, and brought the children in turn to the
examination room. The interest of the parents was most encouraging; in several of the school districts approximately 75 per cent of the
mothers were present for the examinations. The nurses also helped
with the undressing and dressing processes. During the entire study
they rendered valuable assistance by following up cases reported by
the physicians as in need of special attention. One nurse acted as
interpreter, such service being indispensable during the conference
on the South Side of Gary, where the families of the foreign-bom
predominated. A list of the defects noted upon examination was
transcribed on the school physical examination card for a permanent
school record, a duplicate of which was sent by the school authorities
to’ the parents.
M ETHODS AND STANDARDS USED.
The chief value of this report on the physical condition of the
preschool child in a typical industrial center lies, perhaps, not so
much in the data gathered as in the presentation of the methods and
standards used in the study. The dearth of definite information
regarding the physical condition of the preschool child is noteworthy;
the data obtained in this investigation are offered as the result of
uniformly careful examinations. The usual l£ck of uniformity in
methods of examination, record forms, etc., makes for apparent
unreliability in data, and this has a tendency to lower rather than to
raise standards. It is doubtful if any physical examination record
form or method of examination would meet with universal approval.
The methods and standards used in this study are not offered as
ideal; but since there is a generally recognized need for standardiza
tion in all phases of child-welfare work, the plan has been given in
detail in the hope that the report may serve to some extent as a
handbook for similar scientific investigations as well as for the less
technical popular health activities of both private and Governmental
organizations.
In order that data gathered in this study might conform to the
standard of exactness required in making statistical tabulations, it
was necessary to plan definite standards for recording observations.
The difficulties involved are readily recognizable, since much of the
information secured through ordinary physical examinations shows
variation, according to the individual examiner’s judgment. While
such data may be sufficiently accurate for clinical purposes, they do
not have the degree of conciseness and uniformity necessary for
statistical tabulations.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
14
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
GENERAL M E TH O D OF CONDUCTING EXAM IN ATIO NS.
.
The following general procedure was adhered to almost without
exception throughout the six months devoted to the physical examina
tions recorded in this study.
The child was first given the vision and hearing tests, in a room
specially set aside for the purpose. This was done first in order to
eliminate the possibility of any nervous strain after subjection to
the physical examination. It was most important in testing eyes and
ears to gain the child’s undivided attention, for if it was at all strained
or unnatural the results were necessarily less accurate. Moreover, by
subjecting him at the start to an active rather than a passive examina
tion, i. e., to one in which his own faculties were exercised, the child’s
cooperation and confidence were secured for the more trying ordeal
of a complete physical examination. The details of the vision apd
hearing tests and the method of grading will be described subse
quently.3
After the tests of sight and hearing were completed the child was
directed to a dressing room and completely undressed by a nurse or
parent; separate rooms were provided for boys and girls. As soon
as the clothing was removed the child’s body was covered with a
clean square of flannelette fastened around the trunk and falling to
the knees, and the height and weight were taken. This was done
either at one end of the large room in which the examinations were
made or in a smaller separate room, according to available facilities.
After the record of height and weight was made the child was ready
for the doctor.
The physical examination was strictly private, each physician
having a curtained booth about 8 by 10 feet. The examining table
was covered with a clean white sheet and provided with all necessary
equipment for making a thorough physical test, including stethoscope,
thermometer, tongue blades, culture tubes and slides, standard tape
measures and rulers, paper towels, facilities for sterilizing instruments,
and celluloid toys which were used to divert the attention of younger
children during the more trying parts of the examination. A clerical
assistant at one end of the table recorded the details of the examina
tion as dictated by the doctor, and noted such facts as date of birth,
age at entering school, grade attained, and history of previous ill
nesses.
A record of height and weight, vision and hearing grades, and
defects found, if any, together with suggestions concerning their
correction and dietary advice applicable to the individual child,
were given to the mother before she left the conference rooms.
3See pp. 23 and 24.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
METHODS AND STANDARDS USED.
15
PHYSICAL EXAM IN ATIO N RECORD FO R M USED.
A physical examination record form was prepared from which
statistical data could easily be transcribed. While to the average
physician this form may appear unnecessarily detailed for practical
use, experience has shown that the system of establishing uniform
standards and then requiring every item to be checked is probably
the only means of insuring sufficiently accurate and detailed informa
tion in routine physical examinations.
The practicability of this particular record form has been tested
by use both in this study and in subsequent work. Some of the items
could well be omitted, and the form could be made practical for
continued use only by providing space for the records of repeated
examinations on the reverse side of the card. The general arrange
ment, however, has proved satisfactory and practical from a statis
tical standpoint.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Gary, Ind., S. N.
U. S. D epartment of L abor,
0. B.
Oi
children’ s bureau .
Su rn am e ........................................... . .F a th er ............................................... Ch ild .............................................. .A ddress
[PHYSICAL EXAM INATION RECORD FO RM .]
Sym.
E xamined
by.
yrs.
mos. N asopharynx: 30. Mouth breathing, N. 31. Nasal
discharge, N.
33. High arch palate, N.
yrs. (b)First grade, N., at yrs. 32. Nasal obstr., N.
34. Tonsils: Rem. (a) enlrg., N. (b) greatly enlrg., N.
(c) dis. N.
PHYSICAL EXAMINATION.
35. Other abnorm.
General: 5. Weight
lbs.
oz. 6. Height
in. 36. Diagnosis of Sp.
7. Anemia, N.
8. Nutrition: Excel., G., P., VP.
9. Temp. ° 10. Vaccinated, N. (a) Age
yrs. (b)Scar,N.
Head : 11. Size: Normal, large, small.
Circumference
in.
Palp En Gr’t ’y Associated in
G l a n d s : 37.
12. Shape: Normal, abnorm. (spec.).
able. larg’ d enlrg. fection (spec.)
13. Fontanelle: Closed, open
cm.
14. Craniotabes, N. 15. Abnormal condition, N.
16. Diagnosis:
(a) Occipital........... Y N Y N Y N N
E yes: 17. Vision (a) R .
(b) L.
(c) Imposs. to test.
(b) Submaxillary. . Y N Y N Y N N
(c) Cervical............. Y N Y N Y N N
N R L (d) Axillary............ Y N Y N Y N N
N R L Defects.
18. Defects.
(e) Epitrochlear . . . Y N Y N Y N N
YN YN N
( f ) Inguinal............ Y N
(f) Conjunctivitis: N
(a) Blepharitis.. . . . .
(g) Other................ Y N Y N Y N N
Acute.............
(b) Stye..................
Chronic..........
(c) Ptosis....... : ........
Phlyctenular..
(d) Corneal opacities
(g) Strabismus.........
H eart: 38. Heart.
(e) Corneal ulcer___
(a) Apex beat displ., N. (b) Enlarged N .
(c) Murmur, N. (loc.)
19. Glasses, N.
Transmitted back, axilla, sternum, N.
39.
Heart
disease, N., Diagnosis:
20. Other abnorm.
L ungs: 40. Chest: (a) Excursion:
21. Diagnosis of Sp.
Normal,
abnorm. (spec.).
E ars: 22. Hearing: R .
ft. L.
ft.
(b) Fremitus: Normal, deer., incr.
23. Otorrhea: (a) Acute, N .,R .,L .
(b) Chrome, N.,R.,L.
(c)
Dullness,
N. (spec.).
24. Other abnorm.
(d) Rales: N., kind
loc.
25. Diagnosis of Sp.
41.
Other
defects.
M o u t h : 26. Teeth: (a) Temp. No.
Decayed No.
Filled No 42. Respiratory dis., N., Diagnosis:
(b) Penn. No. Decayed No. Filled No. 27. Malocclu
sion, N.
28. Gum abscess, N.
29. Other abnorm.
Child: 1. M. F. 2. Born
4.Entered(a)Kinderg’t ’n,N .,at
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
191 . 3. Age
D a t e ............................1918.
Skin : 43. Pediculosis: (a) body, N. (b)
scalp, N.; insects, N.; nits, N.
44. Eczema, N. (loc.)
45. Acne,N.
46. Hypertrichosis, N. 47. Impetigo,
N. 48. Infected sores. N.
49. Scabies, N. 50. Ringworm: (a)
scalp, N. (b )bod y, N.
51. Other conditions.
A bdomen : 52. Distension, N.
53. Tenderness, N. (loc).
54. Enlarged liver, N.
55. Enlarged spleen.
56. Hernia, N.;umbilical;inguina!,R.;
L., double;, femoral, R ., L.
double. 57. Other defects.
B ony and Muscular System: 58.
Beaded ribs, N.
59. Harrison sgroove, N. 60. Enlarged
epiphyses, N.
61. Round shoulders, N. 62. Winged
scapulae, N . 63. Scoliosis, N .
64. Lordosis,N. 65. Kyphosis,N. (loc.).
66. Knockknee, N. 67. Bow legs, N.
68. Flat foot, N.
69. Pigeon breast, N . 70. Club foot, N .
(spec.).
71. Arthritis, N. (spec.).
72. Paralysis, N. (spec.)
73. Other defects (cong. and acq.).
Nervous System: 74. Speech defects,
N. (a) Stuttering, N.
(b) Stammering, N. 75. Tic, N
(spec.).
76. Chorea, N. (spec.).
77. Other defects.
78. Nervous dis., N., Diagnosis:
PH YSICAL STATUS OF PRESCHOOL CHILDREN.
School ..........................................................................
METHODS AND STANDARDS USED.
[rec o r d
FO R M — R E V E R S E .]
G enitalia.: 79. Male: prepuce adherent, contracted, normal.
80. Female: vaginal discharge, N.
Mental Condition : 81. (a) Normal, N. (b) Defect app. (spec.),
(c)
Abnormality susp. (spec.)
82. L aboratory F indings :
83. P revious I llness : (a) Contagious:
(b) Respiratory:
(c) Digestive:
(d) Other:
84. B ad H abits :
85. Summary
of
D efects
86. R ecommendations:
108178°— 22------ 2
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
and
D iseases :
17
18
PHYSICAL STATUS OP PRESCHOOL CHILDREN.
INSTRUCTIONS ACCOMPANYING PHYSICAL EXAM INATION SCHEDULE.
Every question on the schedule must be checked. If abnormal,
check this word or the condition listed; if normal, check N, meaning
“ N o ” or not abnormal. Care should be taken that the check is in
the letter or word intended. Carelessness in checking means inac
curacy in tabulations, and schedules with omissions deplete the total
base or are thrown out.
General.
(5) 4 WEIGHT. To be taken without clothes.
(6) HEIGHT. To be taken without shoes.
Measuring board to be brought down until horizontal part just
touches child’s head firmly while perpendicular part is pressed
against the wall. Most mistakes are made in reading; therefore
measurements to be taken twice, once before and once after exami
nation, and entry made on record after the second measurement.
(7) ANEMIA. To be determined by inspection of color of mucous
membranes, especially conjunctivae.
(8) NUTRITION.5 “ Excellent” indicates a condition superior
to “ good.” “ G ood” is to be checked if the child’s weight is within
a 10 per cent deviation below average weight for height. “ P oor”
to be checked when weight is below 10 per cent deviation from average
weight for height and when supervision is required. “ Very poor”
to be checked where weight is more than 10 per cent below average
weight for height and medical treatment is required. “ P oor” or
“ very poor” is always to be noted under Summary and Recom
mendations.
(9) TEMPERATURE. To be taken only if symptoms indicate.
(10) VACCINATED. Unless the mother is with the child it may
not be possible to ascertain the age at which he was vaccinated for
smallpox, but it may be learned from the teacher whether or not it
was done before he entered school.
H
ead
.
(11) SIZE. If abnormal, the fronto-occipital circumference is to
be measured with tape and the measurement recorded.
(12) SHAPE. If abnormal, “ square head,” “ hydrocephalic,”
“ oxycephalic,” or “ scaphocephalic” may be specified.
(13) ABNORMAL CONDITION. Here may be noted abnormal
conditions of scalp, features, hair, etc.
E
yes.
(17) VISION. To be tested by one person, using “ illiterate”
chart.6 All cases of defective vision to be listed and referred for con
sultation with specialist.
(20) OTHER ABNORMALITIES. Such conditions as nystag
mus, etc., to be noted here and every case to be listed for consultation
with the specialist.
4 Figures refer to items on record form.
6 See page 36.
6For details of vision testing, see page 23.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
METHODS AND STANDARDS USED.
19
E ars .
(22)^ HEARING. To be tested by one person, using “ whispered
voice.” 7 If hearing is diefective or there is any discharge, the child
is to be listed and referred to the specialist for examination for ceru
men, retracted drums, and adenoids.
Mouth .
(27) MALOCCLUSION. Includes any condition causing an
abnormal bite.
(29) OTHER ABNORMALITIES. Here should he noted general
conditions of cleanliness and types of teeth, such as syphilitic, rachitic,
and those devoid of enamel, abnormal condition of gums and mucous
membranes, badly coated tongue, offensive breath, etc.
N asopharynx .
Children with colds are to be excluded from examination until well.
(30) MOUTH BREATHING. To be tested by closing the mouth
to see if child breathes easily through nostrils.
(32) NASAL OBSTRUCTION. To be tested by closing each
nostril in turn to see if child breathes easily through the open nostril.
(34) TONSILS.8 “ Rem.” means removed; “ Enlarged” indi
cates moderate enlargement; “ Greatly enlarged” are those nearly
filling the throat; “ Diseased” tonsils are those showing (1) cheesy
plugs, (2) localized injections of the surrounding vessels. All posi
tive entries in Nos. 30 to 36, inclusive, are to be listed and referred
to specialist for absolute diagnosis.
(35) OTHER ABNORMALITIES. Here may be noted any mal
formations such as harelip, cleft palate, bifid uvula, etc. All abnormal
conditions of the nasopharynx to be listed and referred to the spe
cialist for absolute diagnosis.
Glands.
(37) “ EN LARG ED ” glands are those over | inch in diameter;
“ Greatly enlarged” glands are those 1 inch in diameter or over. In
looking for the infection associated with enlarged glands, look
among other causes for bites on the body and if present, examine
clothing for pediculosis and the head for nits.
(37-g) OTHER— SPECIFY. Includes thyroid, etc.
H eart .
(38) HEART. Enlargement to be determined by axillary border
and apex beat if latter is below the fourth or fifth interspace and
outsicfe the mammary line.
L ungs.
Percuss the paravertebral regions and listen with the stethoscope
over the bases and the paravertebral regions.
(41) OTHER DEFECTS. Asymmetry, abnormal shape, poor
development, etc.
7For details of hearing testing, see page 24.
8For details on indications for recommending removal of tonsils and adenoids, see page 60.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
20
PHYSICAL. STATUS OF PRESCHOOL CHILDREN.
Sk in .
(51) OTHER CONDITIONS. May be included general condition
of the skin such as cleanliness, rough, dry, clammy; also birthmarks,
furunculosis, urticaria, etc.
A bdomen.
(54) LIVER. Is “ enlarged” if more than 1 inch below border of
ribs. Specify in inches.
(55) SPLEEN. Is “ enlarged” if palpable; “ moderately en
larged” if 1 inch below border of ribs; “ greatly enlarged” if felt as
tumor mass in abdomen.
(57) OTHER DEFECTS. Note should be made of distension
due to tympanites as in rickets, or ascites, etc., and measurements
taken at a level of the umbilicus, if greatly enlarged from any cause.
B ony and Muscular System .
(68) FLAT-FOOT. Child to be examined standing in stocking
feet or barefoot, and height of arch recorded in inches. This is to
be measured with ruler held perpendicularly from floor to tubercle
of scaphoid bone, which is the top of the arch. Observe child’s
walking and record position of feet, i . e., toes straight ahead, toes in,
toes out.
_.
,
(71) ARTHRITIS. If present, try to get a history of previous
infections.
„ ..
_
■_
. .. .
(73) OTHER DEFECTS. Note flabbiness of muscles, clubbed
fingers, tuberculous bone affections, etc. Record here also in every
case whether or not pronation of feet is present, i. e., rotation of the
axis of the foot.
N ervous System .
(77) OTHER DEFECTS. Note to be made of extreme nervous
ness, etc.
„
,
„ .
. .
MENTAL CONDITION. Note to be made of sluggish or active
mentality and confer with teacher if questionable.
L aboratory Findings .
In this space may be recorded results of urinalysis, cultures or
smears, from reports furnished b y the Gary Board of Health labora
tory.
P revious I llness.
This information may be obtained only in case the mother accom
panies the child and can make apparently reliable statements.
(83-d) OTHER. General diseases such as rheumatism, malaria,
intestinal parasites, etc.
B ad H abits .
(84) Such as finger sucking, masturbation, nail biting, perverted
appetites, enuresis, etc. Information probably can be obtained
only from mother or teacher.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
METHODS AND STANDARDS USED.
n
S ummary of D efects and D iseases .
To include all checked defects found in general examination.
R ecommendations.
These are to be such as will correct or improve defects found by
referring to specialists— correction of habits, dietary and general
hygienic advice.
MEASURING AND W EIGH IN G .
In an attempt to secure accurate figures on standing height and
nude weight, these measurements were taken largely by one specially
instructed person in order to eliminate, so far as possible, personal
variations. Each measurement was made twice, once before the
physical examination and once after, the second figure serving as a
check on the previous one.
Height.
The measuring apparatus consisted of two pieces as follows:
(1) A blue-print paper measuring scale.9 The scale was prepared
from a standardized meter stick secured from the United States
Bureau of Standards, a draftsman making the tracing from which
blue prints could be obtained. The strips of paper were 72 inches
long and 3 inches wide, with a scale divided into J-inch units. The
inch lines extended across the paper and the half-inch lines were
inch in length. The strips wore pasted on a smooth pine board
which could be attached perpendicularly to the floor, thus insuring
a standard position which is impossible in the ordinary room due
to wainscoting and sheathing. For the examination of infants too
young to stand, the measuring strip was pasted directly on the
examination table, and a board 4 by 6 inches was fastened perpen
dicularly to the end of the table for a headrest. (2) Square. This
second essential part of the measuring apparatus was a plane to
■Slide down over the measuring scale, when reading the height. It
consisted of two pieces of wood, each 6 inches long, 4 inches broad,
and ^ inch thick, fastened together at a right angle. A crossbar on
the inside served as a handle and further strengthened the apparatus,
which simulated a book end with a crossbar.
The measurement of standing height was made by having the child
stand erect, arms hanging naturally at sides, heels together, back
and the back of the head (the eyes in a horizontal plane) against
the board to which the measuring scale was attached. The “ book
end,” as the square was sometimes called, was brought down firmly
on the top of the head and the reading taken. The 4-inch width of
* This type of scale was prepared after consultation with Dr. A. Hrdlicka, anthropologist of the Smith
sonian Institution.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
22
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
the measuring apparatus was a definite advantage in that the inch
lines across the printed scale insured an accurate horizontal position
of the square because it must not only touch the top of the head
fir m ly but also be parallel to the longer lines across the scale.
The reclining length of infants was taken by pushing the square
firmly against the soles of the feet, which were held at right angles
to the table.
Weight.
For weighing children who could stand, an upright beam scale
was used. Infants were weighed on a grocer’s scoop scale with a
very heavy base, to which the scoop was securely riveted.
All weights were taken without clothes. The flannelette square
used as a protection for the child as he came from the dressing room
was removed and held in front of him by the mother or nurse as a
screen while the weight was taken. So far as possible, the weighing
was done by one nurse who had been specially instructed in the
importance of accuracy in adjusting the balance of the scale several
times daily and reading the record of weight with the beam hori
zontal or at mid-balance. After the physical examination the child
was reweighed, and the second reading was checked up with the
original figures before entry was made on the record form.
The height and weight table used as a standard was that prepared
by the Children’s Bureau for the weighing and measuring test during
the Children’s Year campaign, the averages for children at birth and
for boys at 3 months having been taken from Dr. L. Emmett Holt’s
figures from original observation; those for children aged 6 to 48
months, from the anthropometric table compiled by F. S. Crum; and
those for children aged 5 to 7 years, inclusive, from Bowditch. Since
all the children included in this study were weighed without clothing
and the Bowditch figures included weight of clothing, it was necessary
to deduct from the latter the average weight of clothes (Bowditch’s
averages.)10
In order to economize time as well as to eliminate possible errors
through hasty computation, this table was adapted for the use of the
examining physicians, weights being shown in half-year periods,
decimal or fractional pounds being changed to ounces and decimal
inches to fractional inches. Weights 10 per cent below the accepted
averages were also computed and arranged in a column parallel to
the corresponding averages. The saving of time, the elimination of
the possible chances of mathematical error, and the uniformity of
method made possible are obvious. The adapted table is here given,
since it offers some practical suggestions, although its form could be
more conveniently arranged.
io see The Diseases of Infancy and Childhood, by L. Emmett Holt, M. D., p. 19. New York, 1916.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Q
—
.
A
"
7
=
"
a
MEASURING.
A
_
—
__
4
T
______
■
.
5>
--
/
____
_
—
MEA SUR IN G SQUARE.
0 -------------MEASURING STRIP.
Scale
22— 1
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
§
Inch equals 1 inch.
GH NG
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
scoo
SCALE
22—3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
W E IG H IN G ON BEAM SCALE.
i
V IS IO N
TE S TIN G
H EARING TESTING,
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
►
23
METHODS AND STANDARDS USED.
Heights and weights o f boys.
Heights and weights o f girls.
Weight.
Age.
Birth..........................
3 months....................
6 months....................
7 months....................
8 m onths...................
9 months....................
10 months..................
11 months..................
12 months..................
Height.
10 per
cent
below
average.
Inches. Lbs. Oz.
20#
6 13
11 11
23}
264
16 3
27}
17 3
17 12
27#
28}
18 5
28}
18 13
29
19 4
29§
19 11
Weight.
Age.
Height.
Average.
Lbs.
7
13
18
19
19
20
20
21
21
Oz.
9
2
12
6
14
6
14
Birth..........................
10 per
cent
below Average.
average.
Inches. Lbs. Oz. Lbs. Oz.
20}
6 8
7 3
6 months....................
7 months....................
8 m onths..................
9 months....................
10 months..................
11 months..................
12 months.................. *
25}
26}
27
27#
27}
28#
28}
15 1
15 10
16 7
17 3
17 9
18 2
18 11
16 12
17 6
18 4
19 2
19 8
20 2
20 12
13 months............. .
14 months............. 1..
15 months..................
16 months..................
17 months..................
18 m onths.................
19 months..................
20 months..................
21 months..................
22 months..................
23 months..................
24 months..................
29#
29}
30}
30}
30}
31}
31}
32
32}
32#
32}
33#
18
19
19
20
20
21
21
21
22
22
23
23
14
7
11
6
9
1
6
11
4
12
1
12
21
21
21
22
22
23
23
24
24
25
25
26
33}
33}
33}
34#
34}
34}
35}
35#
35#
36}
36}
36}
24 3
24 8
24 8
25
25
25 7
25 14
26 2
26 3
27 2
27 4
27 7
26
27
27
27
27
28
28
29
29
30
'30
30
11
14
7
13
30
31
31
32
32
32
32
33
33
33
33
33
13 months..................
14 months..................
15 months.................
16 months..................
17 m onths.................
18 m onths.................
19 months. tX ............
20 months..................
21 months..................
22 months..................
23 m onths..,.......... .
24 months..................
29}
30}
30}
3l|
311
31}
32}
32#
32}
33}
33»
33}
20 9
20 11
21 4
21 11
22 1
22 3
22 15
23 3
23 3
24 3
24 5
24 7
22
23
23
24
24
24
25
25
25
26
27
27
25 months..................
26 months..................
27 months..................
28 months..................
29 months..................
30 months........ .........
31 months..................
32 months..................
33 months..................
34 months..................
35 months..................
36 months..................
34
34}
34}
35}
35#
35»
35}
36
36}
36}
36}
37}
25 1
25 7
26 2
26 3
26 5
26 9
27 7
27 9
27 9
28
28 11
29
27
28
29
29
29
29
30
30
30
31
31
32
2
4
8
8
10
10
2
14
4
25 months..................
26 months..................
27 months..................
28 months..................
29 months..................
30 months..................
31 months..................
32 months..................
33 months..... ............
34 months..................
35 months..................
36 months..................
37 months..................
38 months..................
39 months..................
40 months..................
41 months..................
42 months..................
43 months..................
44 months..................
45 months..................
46 months..................
47 months..................
48 months..................
37»
37}
37}
38}
38»
38#
38}
38}
39
39
39}
*39}
29
29 2
29 13
30 2
30 4
30 6
30 6
30 13
31 1
31 4
32 3
32 5
32
32
33
33
33
33
33
34
34
34
35
35
4
6
2
8
10
12
12
4
8
12
12
14
37 months..................
38 months..................
39 months..................
40 months..................
41 months..................
42 months..................
43 months..................
44 months..................
45 months..... ............
46 months..................
47 months..................
48 months..................
36}
37
37}
37}
37}
38
38}
38}
38}
38}
38}
39
27
27
28
28
29
29
29
29
29
30
30
30
4} years......................
5 years.......................
5} years......................
6 years.......................
6 } years. . : .................
7 years.......................
7$years......................
8 years.......................
8} years......................
9 years.......................
9} years......................
10 years......................
40#
41f
42}
43}
44}
45f
46}
47}
48}
49}
50}
51}
33
34
36
38
39
41
43
45
47
50
51
53
37 1
38 4
40 6
42 6
44
45 9
48
50 6
53 1
55 11
57 11
59 9
4} years......................
5 years.......................
5 } years......................
6 years.......................
6} years..... ................
7 years........................
7} years......................
8 years........................
8} years.....................
9 years........................
9 } years......................
10 years......................
40}
41}
42#
43#
44}
45}
46#
47#
48}
49#
50#
51}
31
33
34
36
38
39
41
43
45
48
50
52
6
7
5
2
10
3
5
12
2
15
10
14
10
2
8
10
8
12
12
14
2
14
4
4
8
11
15
2
2
6
13
3
13
7
8
10
8
15
3
3
1
35
36
38
40
42
-44
46
48
51
53
55
57
10
14
10
14
6
12
2
12
4
10
6
14
4
4
12
12
4
12
2
2
4
8
12
10
4
8
12
4
8
8
12
6
14
11
8
4
4
8
1
9
12
14
VISION TESTING.
The “ illiterate” chart was the one used for testing the vision of
these children, most of whom were too young to know the alphabet.
This chart consists of eight rows of letter E’s, gradually diminishing in
size and turned in four different positions. The child was given a
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
24
PHYSICAL STATUS OF PRESCHOOL CHILDREN-.
pasteboard letter E and instructed how to turn it to correspond to
the position of the particular letter in the chart at which the nurse
pointed. The child’s own fingers could also be used to indicate the
position of the fingers of the E. At the side of each row of letters
there was a number which indicated the distance in feet at which the
letter should be read by a normal eye. The large letter at the top
should be read at a distance of 200 feet; the other rows at 100, 65, 50,
39, 25, 20, and 15 feet.
The child was placed at a distance of 20 feet from the chart. If he
could then turn his letter correctly to correspond to the letters on the
20-foot line, he was given a grade of
If he could not see that line
but could see the large line above, he was given a grade of -f-f, the
numerator of the fraction being always the distance between the
chart and the child, and the denominator indicating the line which the
child could see. A child who received a grade of -|f saw only twothirds of what he should see; one who received
saw only two-fifths
of what he should see. Every child whose vision grade was §-§- or
less was referred to an eye specialist. If a child’s vision wa^ so poor
that at a distance of 20 feet from the chart he could not see the top
letter, which should have been visible at 200 feet, he was moved
toward the chart until he could see it, and the distance between him
and the chart was then measured. For instance, a child might
receive a grade of -^¡y. Vision graded
was considered “ slightly
defective” and not necessarily requiring glasses, but when a child
received such a grade the mother was advised to keep his vision
under observation; vision graded §-§• or worse was tabulated as
“ seriously defective” and requiring glasses.
Important details to be observed in testing vision by this method
are:
1. Have the child stand 20 feet away from the chart.
2. Always test the right eye first.
«
3. Use a card to cover one eye while testing the other, being careful not to press on
the covered eye.
4. Use a bright-colored pointer, such as a red penholder.
5. Do not point to the same letter consecutively, since that tends to puzzle the child.
6. Place the pointer directly under the letter, being careful not to touch the letter
at any point.
7. D o not spend a great length of time on the larger letters. If you are convinced
that the child sees them readily, pass on to the lower lines before the child grows
tired or loses interest.
8. Always try the letters which are easiest for the child to see, and if the light is
better on one side of the chart, as for instance when a lamp is used, point to the
brightest letters.
HEARING TESTING.
In the hearing test the child stood 20 feet away from the nurse
who made the examinations, with his head turned so that his right
ear was toward her and with his finger in his left ear. The “ whispered
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
METHODS AND STANDARDS USED.
25
voice was used— simple numbers and phrases whispered on the
exhalation of a breath, 66 or any other number ending in 6 being
avoided. After the right ear was tested the child was faced about
and the left ear was tested in the same manner. The repetition of
the number or phrase heard indicated the child’s ability to hear.
The advantage of having the same person conduct all the hearing
tests is self-evident, since individual variations in pitch of voice,
enunciation, etc., in a number of examiners might result in uneven
grading.
A child standing 20 feet away from the nurse and repeating cor
rectly the whispered words, received a grade of f§. If the child had
defective hearing, the nurse advanced slowly toward him until he
could hear what she was saying. The grade was then determined by
measuring the distance between the child and the nurse. For
instance, a child might receive a grade of
All cases of defective
hearing were referred to a specialist. In the tabulations, hearing
was entered as slightly defective” if the grade was between
and
and “ seriously defective” if it was less than
INDICATIONS FOR R ECO M M END IN G REM OVAL OF TO NSILS
AN D AD EN O ID S.
A difficult point in the consideration of naso-pharyngeal defects in
children is the decision as to what cases shall be listed as having
enlarged tonsils and adenoids. The fact that standards for deter
mining this have varied greatly among different examiners is proved
by the greatly varying percentages of this defect recorded by differ
ent medical school inspectors. Specialists differ greatly in their
estimate of what are enlarged tonsils and what forms an indication
for their removal. This obvious difference in standards is largely
due to the fact that hyperplasia of lymphoid tissue is physiological
in young children, and that normal tonsils are proportionately larger
in children than in adults.
In this study it was, in the first place, found necessary for statistical
purposes to determine definite standards for making the entries on
the record form; it was also necessary that each of the symptoms
present be definitely outlined before removal of tonsils was recom
mended. From the standards which follow it is evident that a very
conservative point of view was taken in making recommendations
for removal of tonsils or adenoids.
Difficulties, of course, arise in deciding whether removal of tonsils
and adenoids is indicated, when examining a group of children from
many of whom no history can be obtained. The history of previous
attacks of tonsillitis, and of habitual mouth breathing and snoring at
night, are important factors in making the decision. In doubtful
cases where no history could be obtained, no recommendation for
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
26
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
removal of tonsils and adenoids was made; but it was recommended
that the child be examined again by a throat specialist, and the
throat conditions watched. x
The following was the basis on which recommendations were made
for the removal of (1) tonsils, (2) adenoids, or (3) tonsils and adenoids.
1.
Indications for removal of tonsils:
(а) Greatly enlarged tonsils, practically filling the throat and making breathing
difficult; or
(б) Moderately enlarged tonsils with repeated attacks of tonsillitis, four or
five a year; or
(c) Moderately enlarged tonsils with a severe systemic infection, such as
- heart, joints, etc.; or
(d) Greatly enlarged submaxillary glands, together with moderately enlarged
tonsils.
(e) Diseased tonsils; i. e., showing cheesy plugs.
Where moderately enlarged tonsils were found but the above
positive indications were not present, no recommendations for
removal were made.
2. Indications for removal of adenoids:
(а) Marked mouth breathing with adenoid facies, in absence of other causes
of nasal obstruction.
(б) History of habitual snoring and mouth breathing at night (only to be
obtained where the mother was present at the examination).
(c) Chronic ^asa.l discharge with marked excoriation of the lip (simple colds
excluded).
(d) Marked retraction of the ear drums.
(e) Soft palate standing off from the posterior wall of the pharynx.
3. Indications for removal of tonsils and adenoids:
The indications here would be a combination of those of (1) and (2).
A digital examination for adenoids was not undertaken in making
these examinations, as it was not considered feasible. In all cases
where a child was examined to see whether an operation for the
removal of tonsils and adenoids was indicated, or whether the case
should merely be watched, an examination of the drum membrane
was made.
Mouth breathing not of marked degree (i. e., that which has not
caused any facial deformity and that of a child who breathes through
his nose during the examination, even though he has been observed
to breathe through his mouth when not self-conscious) was not con
sidered an indication for removal of adenoids. The recommenda
tion in these cases was that the child be watched and that a specialist
be consulted again if the mouth breathing continued.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL FINDINGS.
INTRODUCTION.
The term “ preschool,” while literally referring to the years of life
prior to school attendance, necessarily applies to a period of variable
length, inasmuch as school entrance ages in different sections of the
country range from 5 to 8 years. Clinically, early childhood has
long been divided into two periods, viz., infancy, the first two years
of life, and the preschool age, from 2 to 6 or 7 years. In this study
the term “ preschool” covered the period 2 to 6 years inclusive.11
A very considerable proportion, about 50 per cent, of all the chil
dren of preschool age in Gary were given physical examinations.
The proportions of different ages who had physical examinations
varied from approximately one-third of the' children 3 years of age
to about two-thirds of the 6-year-old children.
Nearly one-half (1,544) of the 3,125 children of this group given
physical examinations were attending kindergarten or primary
grades, and the examinations were made in their respective schools.
The remaining 1,581 children were attendants at the health confer
ences.12
A singularly even distribution b y sex is noticed in the entire group
"as well as at each age.
T a b l e I. — Age and sex; children from 2 to 7 years o f age given physical examination.
Age.
All ages............................
2 years, under 3.......................
3 years, under 4............................
4 years, under 5......................
5 years, under 6.............................
Cyears, under 7................................
7 years, under 8..............................
Both
sexes.
Boys.
Girls.
3,125
1,555
511
496
549
667
682
220
261
251
337
To what extent the social and economic environment of these
children affected their physical condition would be difficult to deter
mine; but a consideration of the nationality and income of parents
in relation to physical conditions offers interesting data.
11 For explanation of inclusion see Note 1, page 12.
12 See page 11.
27
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
28
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
Children of foreign-born white mothers constituted 60.7 per cent
of the children in this study. The principal nationalities represented
were Serbo-Croatian, Slovak, Polish, Magyar, Italian, German, and
Lithuanian. (See General Table 10, p. 72.)
Family incomes were tabulated in groups ranging from those below
$650 to those of $2,250 and over. Practically two-thirds of all the
children of foreign-born white parentage belonged to the lower in
come groups, i. e., those under $1,450. (See General Table 12, p.
73.)
FINDINGS IN GENERAL.
Table II gives an enumeration of the kinds of defects found and
their distribution according to sex. The boys on the whole showed
a slightly higher percentage having defects than the girls, 96.9 com
pared with 93.6. The large proportion of boys with genital defects
(47.1 per cent) unquestionably accounts largely for this variation be
tween the sexes, although dominance in defects of the nasopharynx,
bony and muscular systems, and glands also helped to swell the higher
percentage for boys.
T a b l e I I .— Prevalence o f defects, by sex; children 2 to 7 years o f age given physical
examination.
Both sexes.
Disease or defect.
Num
ber.
Per
cent.
Boys.
Num
ber.
Girls.
Per
cent.
Num
ber.
Per
cent.
Total.............................................................
3,125
100.0
1,555
100.0
1,570
100.0
Without defects......................................................
With disease or defect......................... . ................
149
2,976
4.8
95.2
48
1,507
3.1
96.9
101
1,469
6.4
93.6
303
2*3
163
151
13
2
1 890
738
245
78
70
28
1
13
11
76
<295
25
3
22
258
2,091
2,021
343
101
9.7
7.8
5.2
4.8
.4
.1
28.5
2 36.1
7.8
2.5
2.2
.9
(3)
.4
.4
2.4
9.4
5 1.4
.1
.7
«8.3
66.9
64.7
11.0
3.2
140
113
105
102
5
1
437
355
127
42
38
16
1
7
7
33
171
' 14
2
15
148
1,043
1,007 .
163
53
9.0
7.3
6.8
6.6
.3
.1
28.1
2 35.6
8.2
2.7
2.4
1.0
.1
.5
.5
.21
11.0
5 1.6
.1
1.0
«9.5
67.1
64.8
10.5
3.4
163
130
58
49
8
1
453
383
118
36
32
12
10.4
8.3
3.7
3.1
.5
.1
28.9
2 36.6
7.5
2.3
2.0
.8
General:
U nderweight (10 per cent and over).......
Anemia...................... ..............................
Head................................................................
Abnormal shape.......................................
Open fontanelle........................................
Craniotabes...............................................
E y e s.;..............................................................
Vision defective........................................
Diseases and defects other than of vision.
Conjunctivitis...........................................
Blepharitis................................................
Stye........... ...............................................
Ptosis.........................................................
Corneal opacities......................................
Strabismus................................................
Ears..................................................................
Hearing defective.....................................
Acute otorrhea..........................................
Chronic otorrhea.......................................
Retracted ear drums................................
Mouth...............................................................
Decayed teeth...........................................
Malocclusion.............................................
Gum abscess.............................................
.4
.3
2.7
7.9
«1.2
.1
.4
• 7.0
66.8
64.6
11.5
3.1
1 In 1,081 cases, vision was not tested; hence this number does not include all possible cases of defective
vision.
2 Per cent based on 2,044 cases tested, 998 boys and 1,046 girls.
8 Less than one-tenth of 1 per cent.
<In 1,279 cases, hearing was not tested; hence this number does not include all possible cases of defective
hearing.
8 Per cent based on 1,846 cases tested, 901 boys and 945 girls.
8 A minimum statement—not all children were examined for this defect.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
6
4
43
124
11
1
7
110
1,048
1,014
180
48
29
PHYSICAL FINDINGS.
T a b l e I I .—Prevalence o f defects, by sex; children 2 to 7 years o f age given -physical
examination— Concluded.
Both sexes.
Boys.
Girls.
Disease or defects.
Num
ber.
With disease or defect—Continued.
Naso-pharynx............. ; ..............
Defective tonsils..-...............
Adenoids (definite)..............
Adenoids suspected..............
Mouth breathing...................
Nasal discharge.............. .
High-arch palate...................
Nasal obstruction.................
Glands:
Enlarged or greatly enlarged.
Occipital glands.............
Submaxillary glands___
Cervical glands...............
Axillary glands..............
Inguinal glands..............
Thyroid glands..............
Heart........................................ .
Heart disease........................
Questionable heart disease..
Lungs...........................................
Lung disease.........................
Questionable lung disease.. .
Skin..............................................
Eczema..................................
Acne......................................
Pediculosis.................... ........
Impetigo.................................
Infected sores..........................
Ringworm..............................
Scabies....................................
Scars........................................
Abdomen......................................
Distended abdomen...............
Enlarged liver........................
Hernia.....................................
Bony and muscular system.........
Beaded ribs............................
Pigeon breast..........................
Harrison’s groove...................
Enlarged epiphyses................
Round shoulders...................
Winged scapulae.....................
Scoliosis...................................
Lordosis..................................
Kyphosis................................
Knock-knee.............................
Bowlegs...................................
Clubfeet...................................
Arthritis..................................
Paralysis.................................
Nervous system.............................
Speech defect..........................
Tic...........................................
Chorea....................................
Qther nervous disease............
Very nervous or restless.........
Mentality.......... ...........................
Defect apparent......................
Defect suspected.....................
Genitalia, male..............................
Prepucial defects....................
Other defects...........................
Genitalia, female:
Vaginal discharge...................
Per
cent.
Num
ber.
Per
cent.
Num
ber.
Per
cent.
2,157
1,626
1,050
207
1,232
299
1,027
1,194
69.0
52.0
33.6
6.6
39.4
9.6
32.9
38.2
1,118
836
570
106
670
157
535
651
71.9
53.8
36.7
6.8
43.1
10.1
34.4
41.9
1,039
790
480
101
562
142
492
543
66.2
50.3
30.6
6.4
35.8
9.0
31.3
34.6
908
2
704
241
15
51
60
99
14
85
32
11
21
318
80
1
145
8
67
29
9
165
464
423
11
47
1,308
31
53
175
209
103
452
57
16
1
194
300
4
3
5
75
54
8
1
4
12
37
19
18
29.1
.1
22.5
7.7
.5
1.6
1.9
3.2
.4
2.7
1.0
.4
.7
10.2
2.6
489
1
383
143
12
38
21
48
9
39
21
6
15
137
49
1
35
3
35
18
5
97
234
214
5
24
709
15
38
112
146
62
238
27
10
1
92
193
3
2
4
42
28
5
1
3
7
26
12
14
732
719
22
31.4
.1
24.6
9.2
.8
2.4
1.4
3.1
.6
2.5
1.4
.4
1.0
8.8
3.2
.1
2.3
.2
2.3
1.2
419
1
321
98
3
13
39
51
5
46
11
5
6
181
31
26.7
.1
20.4
6.2
.2
.8
2.5
3.2
.3
2.9
.7
.3
.4
11.5
2.0
110
5
32
11
4
68
230
209
6
23
599
16
15
63
63
41
214
30
6
7.0
.3
2.0
.7
.3
4.3
14.6
13.3
.4
1.5
38.2
1.0
1.0
4.0
4.0
2.6
13.6
1.9
.4
102
107
1
1
1
33
26
3
6.5
6.8
.1
.1
.1
2.1
1.7
.2
1
5
11
7
4
.1
.3
.7
.4
.3
37
2.4
(Q
4.6
.3
2.1
.9
.3
5.3
14.8
13.5
.4
1.5
41.9
1.0
1.7
5.6
6.7
3.3
14.5
1.8
.5
(!)
6.2
9.6
.1
.1
.2
2.4
1.7
.3
C1)
.1
.4
1.2
.6
.6
1
.3
6.2
15.0
13.8
.3
1.5
45.6
1.0
2.4
7.2
9.4
4.0
15.3
1.7
.6
.1
5.9
12.4
.2
.1
.3
2.7
1.8
.3
.1
.2
.5
1.7
.8
.9
47.1
46.2
1.4
v
1Less than one-tenth of 1 per cent.
The actual number of children without physical defects was found
to be only 4.8 per cent of those examined— 149 out of 3,125. The
girls, of whom 6.4 per cent were without defect, made a more fa-
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
30
PHYSICAL STATUS OP PRESCHOOL CHILDREN,
vorable showing than the boys, with o n ly '3.1 per cent free from
defect.
Boys also had the larger number of defects per individual, 44.8
per cent having 5 or more, as compared with 31.2 per cent of the
girls. The average number of defects per child, based on all those
who had defects, was 4.2 for both sexes, 4.5 for boys, and 3.8 for
girls. This average for the different age groups was as follows: For
the 2-year-olds, 2.7; for the 3-year-olds, 3.1; and .for the 4-, 5-,
and 6-year-olds, 3.5, 4.8, and 5, respectively. The proportion with
no defects decreased from 15.1 per cent at 2 years to 0.3 per cent at
6 years.
T a b l e I I I .— Number o f defects, by age and sex; children 2 to 7 years o f age given physical
examination.
2 years,
under 3.
Total
children.
Number of de
fects, and sex.
6 years,
under 7.
5 years,
under 6.
4 years,
under 5.
7 years,
under 8.
Per
Per
Per
Per
Per
Per
Per
cent
cent
cent
cent
cent
cent
cent
Num dis- Num dis- Num dis- Num dis- Num dis- Num dis- Num disber.
triber.
tritriber.
triber.
triber.
triber.
ber. tribu
bubububububution.
tion.
tion.
tion.
tion.
tion.
tion.
Both sexes. 3,125 100.0
With defects__ 2,976
Less than 5. 1,789
1.......... 332
2.......... 440
3.......... 537
4.......... 480
5 to 9.......... 1,123
5.......... 426
6.......... 316
196
7..........
8....... ... 123
62
9..........
64
10 to 15.......
10
30
11
21
12
8
3
1
1
Without defects ' 149
95.2
57.2
10.6
14.1
17.2
15.4
35.9
13.6
10.1
6.3
3.9
2.0
2.0
1.0
.7
.3
11
With defects. . . 1,507 96.9
Less than 5. 810 52.1
136
8.7
1..........
181 11.6
2..........
3.......... 242 15.6
4.......... 251 16.1
5 to 9.......... 652 41.9
5.......... 233 15.0
184 11.8
6..........
121
7.8
7..........
4.8
74
8..........
2.6
40
9..........
10 to 15
45
2.9
10
21
1.4
1.0
5
J.
2
1
48
511 100.0
496 100.0
549 100.0
434
373
125
116
85
47
60
31
16
6
3
4
1
1
84.9
73.0
24.5
22.7
16.6
9.2
11.7
6.1
3.1
1.2
.6
.8
.2
.2
453
361
84
111
96
70
90
56
18
9
4
3
2
91.3
72.8
16.9
22.4
19.4
14.1
18.1
11.3
3.6
1.8
.8
.6
.4
2
.4
531
352
48
70
131
103
172
59
63
32
10
8
7
1
3
2
15.1
43
8.7
(I)
(i)
4.8
Boys.......... 1,555 100.0
Without defects
3 years,
under 4.
77
Girls.......... 1,570 100.0
.2
3.3
682 100.0
660
324
38
66
95
125
311
124
79
47
43
18
25
8
13
3
1
99.0
48.6
5.7
9.9
14.2
18.7
46.6
18.6
11.8
7.0
6.4.
2.7
3.7
1.2
1.9
.4
.1
680
286
27
60
98
101
372
122
96
84
48
22
22
16
1
3
2
99.7
41.9
4.0
8.8
14.4
14.8
54.5
17.9
14.1
12.3
7.0
3.2
3.2
2.3
.1
.4
.3
7
1.0
2
.3
220 100.0
218
93
10
17
32
34
118
34
44
18
15
7
7
4
2
99.1
42.3
4.5
7.7
14.5
15.5
53.6
15.5
20.0
8.2
6.8
3.2
3.2
1.8
.9
1
2
.5
.9
251 100.0
274 100.0
337 100.0
334 100.0
98 100.0
235
194
57
57
45
35
41
19
12
4
2
4
237 94.4
174 69.3
32 12.7
59 23.5
44 17.5
39 15.5
61 24.3
34 13.5
16 6.4
1.6
4
1.6
4
1.2
3
2
.8
269
156
17
26
61
52
108
36
36
24
8
4
5
1
2
1
98.2
56.9
6.2
9.5
22.3
19.0
39.4
13.1
13.1
8.8
2.9
1.5
1.8
.4
.7
.4
335 99.4
133 39.5
15 4.5
5.3
18
39 11.6
61 18.1
184 54.6
65 19.3
49 14.5
9.2
31
26
7.7
13
3.9
18
5.3
5 1.5
10 3.0
2
.6
1
.3
333 99.7
117 35.0
2.7
9
5.4
18
40 12.0
50 15.0
202 60.5
63 18.9
47 14.1
50 15.0
8.4
28
14 4.2
14 4.2
11 3.3
98
36
6
3
13
14
56
16
24
8
6
2
6
4
1
100.0
36.7
6.1
3.1
13.3
14.3
57.1
16.3
24.5
8.2
6.1
2.0
6.1
4.1
1
1.0
26
90.0
74.3
21.8
21.8
17.2
13.4
15.7
7.3
4.6
1.5
.8
1.5
10.0
250 100.0
i Less than one-tenth of 1 per cent.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1
18
667 100.0
261 100.0
2
.8
14
5.6
1
1
3.1
96.7
64.1
8.7
12.8
23.9
18.8
31.3
10.7
11.5
5.8
1.8
1.5
1.3
.2
.5
.4
245 100.0
1
.4
5
1.8
275 100.0
2
.6
330 100.0
2
1
.6
.3
1
.3
348 100.0
1.0
122 100.0
PHYSICAL FINDINGS.
T able III.
Number o f defects, by age and sex; children 2 to 7 years o f age given physi
cal examination— Concluded.
Total
children.
Number of de
fects, and sex.
31
2 years,
under 3.
3 years,
under 4.
4 years,
under 5.
5 years,
under 6.
6 years,
under 7.
7 years,
under 8.
Per
Per
Per
Per
Per
Per
Per
cent
cent
cent
cent
cent
cent
Num dis- Num dis- Num dis- Num dis- Num dis- Num dis- Num cent
ber. tri- ber. tri- ber. tri- ber. tri- ber. tri- ber. tri- ber. distribububububububution.
tion.
tion.
tion.
tion.
tion.
tion.
With defects. . . 1,469 93.6
199
Less than 5. 979 62.4
179
1..........
196 12.5
68
2..........
259 16.5
59
3.......... 295 18.8
40
‘
1..........
229 14.6
12
5 to 9.......... 471 30.0
19
5
....................
193
12.3
12
6
....................
132
8.4
4
7
....................
75
4.8
2
8
....................
49
3.1
1
9
....................
22
1.4
10 to 15.......
19
1.2
1
10
....................
9
1
.6
11.........
6
.4
12.........
3
.2
13.........
1
.1
Without defects 101
6.4
51 j
79.6
71.6
27.2
23.6
16.0
4.8
7.6
4.8
1.6
.8
.4
216 88.2
187 76.3
52 21.2
52 21.2
52 21.2
31 12.7
29 11.8
22
9.0
2
.8
5
2.0
.4
.4
262 95.3
196 71.3
31 11.3
44 16.0
70 25.5
51 18.5
64 23.3
23
8.4
27
9.8
8 2.9
2
.7
4
1.5
2
.7
1
1
20.4
29
11.8
13
.4
.4
J
4.7 j
325 98.5
191 57.9
23
7.0
48 14.5
56 17.0
64 19.4
127 38.5
59 17.9
30
9.1
16 4.8
17 5.2
5
1.5
7 2 1
3
.9
3
.9
1
.3
5
1.5
347 99.7
169 48.6
18 5.2
42 12.1
58 16.7
51 14.7
170 48.8
59 17.0
49 14.1
34 9.8
20
5.7
8 2.3
8 2.3
5
1.4
1
.3
1
.3
1
.3
1
.3
120
57
4
14
19
20
62
18
20
10
9
5
1
98.4
46.7
3.3
11.5
15.6
16.4
50.8
14.8
16.4
8.2
7.4
4.1
.8
1
.8
2
1.6
Correlations with, nationality showed that children ot foreign-bom
white parentage had slightly more defects than those of native white
parentage.
The proportion without defect was higher among children of native
white mothers than among those of the other nationality groups— 6.8
per cent as compared with only 3.6 per cent among the children of
foreign-bom white mothers and 2.8 per cent among the colored
children. Among the foreign nationalities represented in the study
the Polish had the largest proportion without defects, 5.4 per cent,
the Magyar came next with 4, then the Slovak with 3.5 per cent,
the Italian with 3.2 per cent, the German with 2.9 per cent, the
Lithuanian with 2.4 per cent, and the Serbo-Croatian with only
1.6 per cent free from defects. The average number of defects per
individual child among the children who had one or more defects
varied in a similar manner; it was lowest, 3.8, for the children of
native white mothers, next for the children of foreign-bom white
mothers, averaging 4.3, and highest, 4.6, for the colored children.
Among the foreign nationalities, the Polish had the best record, with
only 3.8 defects to a child; the German were next, with 4.1; the
Italian followed, with 4.3; the Slovak and Lithuanian, each with 4.4,
the Serbo-Croatian, with 4.5; and the Magyar, with 4.6.
The proportion of children without defects varied also according to
fathers’ earnings. Thus in families where the fathers earned $2,250
and over the percentage of children without defects was 6.6, as com
pared with a percentage of only 3.9 in families where the fathers
earned less than $1,050.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
32
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
A discussion of the findings in detail follows, the items covered by
the examination appearing in the same order as on the record form.
H EIGH T AND W EIG H T.
<
The average heights and weights of Gary boys and girls 7 years of
age and under, according to age, are recorded in Table IV. As has
Ch art I. Average heights of boys from birth to 6 years of age; Children’s year, Gary, Gary and
health conferences combined, and Crum.
Inches.
m
Months
6
12
18
24
30
36
Children’s year
------------------------Gary health conferences
------------------ —
Gary and other health conferences.............................
Crum
------ —
42
48
54
60
66
72
already been stated, these figures represent the results of stripped
examinations, in which measurements were made uniformly and
were carefully verified. These figures are lower throughout than
Crum’s and Bowditch’s, which were used as standards at the exami
nations, and also lower than the averages obtained from the figures
submitted by doctors and nurses in all parts of the country during
the Children’s Year campaign.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
33
PHYSICAL FINDINGS.
In explanation of these differences it may be noted that Doctor
Crum’s figures were based upon children weighed and measured at
baby health conferences and baby contests, in many of which prizes
were given for the most perfect physical development. The children
brought to these conferences and contests undoubtedly included
many who were taller and heavier than the average. The Children’s
Year figures were based on a sample of slightly over 1 per cent of the
Chart II. Average height of girls from birth to 6 years of age; Children’s year, Gary, Gary and
health conferences combined, and Crum.
Inches.
Months
6 1 2
18
2 4 3 0
36
Children’ s years
-------------------Gary health conferences
-------------------Gary and other health conferences........................
Crum
— - - — -------
42
4 8 5 4 6 0
6 6 7 2
total number of children under 6 years of age in the country, who
were weighed and measured in the course of the Children’s Year
weighing and measuring campaign. Though the campaign was
designed to reach all classes of the population, the sample included
in the tabulation may have been slightly biased, since the California
children, who were found to be somewhat taller and heavier than
108178°— 22----- 3
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
34
PHYSICAL, STATUS OF PRESCHOOL CHILDREN.
children in other parts of the country, were more largely represented
in the group tabulated than in the total population under 6 years
of age.
The Gary heights and weights, however, as already stated, were
based upon a very large proportion of the children in the city under
6 years of age, and there was therefore less chance for these averages
to be influenced by any biased selections.
Ch akt
in.
Average weights of boys from birth to 6 years of age; Children’s year, Gary, Gary
and health conferences combined, and Cram.
Pounds.
Months
6
12
18
24
30
36
Children’s year
-------------------Gary health conferences
--------------- - Gary and other health conferences........................
Crum
--------- ----------
42
48
54
60
66
72
On the other hand, the Gary averages are for children in a group
in which the nationality composition varies considerably from that
in the country as a whole. About three-fifths of the children under
7 years of age in Gary had foreign-born mothers, as compared with
only about one-fourth in the country as a whole. The principal
foreign nationalities represented were the Slavic groups— including
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
35
PHYSICAL FINDINGS.
Polish, Serbo-Croatian, and Slovak— and the Magyar, the Italian,
and the German. Of these, the Italians are of markedly shorter
stature than the British stocks which form the principal element in
the native white population, and the Poles and Serbs are somewhat
shorter, while the Germans are of very nearly the same stature as
the British stocks.13 The special nationality composition of the
Ch art I V . Average weights of girls from birth to 6 years of age; Children’s year, Gary, Gary and
Months 6
12
18
24
30
36
Children’s year
' -------------------Gary health conferences
-------------------Gary and other health conferences.......................
Crum
— ------- --------
42
48
54
60
66
72
Gary group of children may therefore account for the low average
heights, and, since at these ages weight depends very largely upon
height, it may account for the low average weights also.
18 For statistics as to the average statures of adult males of these races, see The Medical Department of
the United States Army in the World War, Vol. X V , Statistics, Part I, Army Anthropology, by Charles
B. Davenport and Albert G. Love, pp. 47,113. Washington, 1921.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
36
PHYSICAL STATUS OF PRESCHOOL CHILDREN,
T a b l e IY . — Average heights and weights, by sex and age; white children 7 years o f age and
under given physical examination.1
- Boys.
Age.
Number.
Under 1 month............................................
1 month, under 2.........................................
2 months, under 3........................................
3 months, under 4........................................
4 months, under 5........................................
5 months, under 6........................................
6 months, under 7........................................
7 months, under 8........................................
8 months, under 9........................................
9 months, under 10......................................
10 months, under 11....................................
11 months, under 12...................................
12 months, under 13.....................................
13 months, under 14.....................................
14 months, under 15.....................................
15 months, under 16.....................................
16 months, under 17.....................................
17 months, under 18.....................................
18 months, under 19.....................................
19 months, under 20................................. 1.
20 months, under 21.....................................
21 months, under 22....................................
22 months, under 23....................................
23 months, under 24.....................................
24 months, under 27....................................
27 months, under 30.....................................
30 months, under 33.....................................
33 months, under 36......................... ...........
36 months, under 39......................... ...... . :.
39 months, under 42....................................
42 months, under 45.....................................
45 months, under 48.....................................
48 months, under 51.....................................
51 months, under 54.....................................
54 months, under 57.....................................
57 months, under 60.....................................
60 months, under 63.....................................
63 months, under 66.....................................
66 months, under 69.....................................
69 months, under 70.....................................
72 months, under 75.................................
75 months, under 78.....................................
78 months, under 81.....................................
81 months, under 84.....................................
84 months, under 87.....................................
3
10
22
22
25
29
31
30
20
22
15
28
31
24
15
24
9
19
16
15
19
40
24
19
79
64
62
52
68
42
59
74
69
64
69
62
80
86
83
79
90
90
74
69
65
Girls.
Average Average
Average Average
height
weight Number. height
weight
(inches). (pounds).
(inches). (pounds).
21.3
21.9
23.3
24.3
24.8
25.7
25.9
26.4
27.0
27.7
27.7
28.4
28.7
28.8
29.7
29.5
30.3
30.8
31.5
31.5
31.5
32.0
32.3
32.7
33.1
34.3
34.8
35.2
36.2
36.9
37.3
38.0
38.2
39.2
39.7
40.3
41.1
41.5
42.1
43.3
42.1
44.0
44.1
45.1
45.1
10.0
10.8
12.3
13.5
14.3
15.9
16.3
17.3
17.8
19.0
19.9
19.8
19.8
19.7
20.4
20.5
22.3
22.2
23.6
23.5
23.4
24.6
24.2
25.3
25.7
27.1
28.3
28.9
30.1
31.1
31.7
32.7
33.0
34.5
35.5
36.1
37.5
38.2
39.0
40.0
40.9
42.6
42.9
44.2
45.0
5
18
16
25
20
17
19
29
13
23
28
18
24
14
17
15
18
25
22
13
18
23
25
.16
55
65
56
65
51
40
64
85
79
69
53
66
76
84
80
83
81
82
83
87
93
19.4
21.3
22.8
23.7
23.9
24.8
25.0
25.9
26.3
27.1
27.4
27.3
28.3
28.4
28.8
29.7
30.3
30.0
30.2
31.2
31.6
31.3
31.8
32.2
32.9
33.6
34.4
35.0
35.4
36.7
36.9
37.5
38.4
39.1
39.7
40.5
40.6
41.3
42.0
42.9
43.1
43.3
44.0
44.4
45.2
8.3
9.5
11.3
12.6
13.3
14.1
14.8
16.2
16.7
17.4
17.1
18.2
18.8
20.3
18.8
20.9
20.9
21.1
20.9
22.0
22.8
22.1
23.7
23.7
24.6
25.9
26.8
28.4
28.2
30.7
30.2
31.2
32.4
33.5
35.1
36.2
36.4
36.9
37.5
39.8
40.4
39.9
41.8
42.3
45.2
1 Twenty-five excluded owing to physical defects.
NUTRITION.
In the absence of any absolute standard for grading nutrition, an
adaptation of the Dunfermline scale14 was used in distinguishing
four grades of nutrition, since, in addition, this system implies the
types of remedial measures necessary.
While the Dunfermline system takes into consideration the general
appearance of the child, including the condition of the skin, sub
cutaneous fat, muscle turgor, anemia, posture, vigor, etc., conditions
all necessarily contributory to a complete picture of nutrition, any
test based upon individual observation and judgment would produce
14 The four groups are distinguished by the Dunfermline scale as follows: 1. “ Excellent” means the
nutrition of a healthy child “ of good social standing.” 2. Children whose nutrition falls just short of
this standard are “ good.” 3. Children “ requiring supervision” are on the border line of serious impair
ment. 4. Children “ requiring medical treatment” are those whose nutrition is seriously impaired.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL FINDINGS.
37
as great a variation in results as there were examiners. In this study,
therefore, “ grade of nutrition,” as recorded for statistical purposes,
was based upon deviations from the average weight-height ratios,
irrespective of age. “ Excellent” included all children above average
weight for height whose general condition in the opinion of the exam
iners was better than “ good.” “ G ood” indicated that the weight
was not under the arbitrary standard now in common usage, i. e., 10
per cent deviation below average weight for height. “ P oor” and
“ very poor” meant a weight-height ratio 10 per cent or more below
average, and distinguishable by the attention required, “ poor” re
quiring supervision only and “ very poor” indicating the need of
medical attention.
While the weight-height ratio is recognized as but a single criterion
in the composite picture of nutrition, and therefore in no sense a
definite guide, its value as even a rough index of the general condi
tion of nutrition was tested in various ways by the tabulations in this
study. The distribution of undernourishment, thus graded, was de
cidedly less in this group of children than ordinarily reported— 9.7
per cent. Since the care and uniformity with which the heights and
weights were taken insure the reliability of the figures, the question
is logically raised whether or not the average weights used as standard
in this study are correct— and whether the 10 per cent deviation is
applicable to children of these ages.
During the course of the study, it was frequently observed by the
medical examiners that a grade intermediate between “ good” and
“ poor” was desirable, as a number of children w~ere graded “ poor”
and others graded “ good” because the weight-height index placed
them in these groups, contrary to the judgment and observation of
the examiners. With this in mind, experimental tabulations were
made to determine the number and kinds of defects in various weightheight groups, namely: (1) Average and above, (2) less than 7 per
cent below the average,15 (3) 7 per cent, but less th&n 10 per cent
below, and (4) 10 per cent or more below.
The incidence of the various kinds of defects as they appeared in
these four weight-deviation groups 16 suggests that except for anemia
and defects of the bony and muscular systems there may be no definite
relation between number and kinds of defects and degree of under
weight.
These results also make apparent the need for further study of the
growth of children between 2 and 7 years of age before any approxi
mate standard of deviation from the average weight can be made for
children at this age period. The large proportion of defects among
16 Seven per cent deviation is apparently as arbitrary a standard as 10 per cent, but was the figure
suggested by nutrition workers at the time this study was in progress as being a more significant deviation
than the commonly used 10 per cent.
1» See General Table 5, p. 68.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
38
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
children of average weight or above suggests the importance of pe
riodic physical examination.
Based on the weight-height ratio alone, Table V indicates that at
least an average condition of nutrition (good and excellent) was found
in 90.3 per cent of the group, although only 18.6 per cent were con
sidered “ excellent.”
Boys varied from the average less than girls; of the latter 20.4 per
cent were found in the “ excellent” grade and 10.4 per cent in the
malnourished group (poor and very poor combined) in contrast
with the comparative percentages of 16.7 and 9, among the boys.
T a b l e Y . — Grade o f nutrition, by age and sex; children 2 to 7 years o f dge given 'physical
examination.
Grade of nutrition.
Age and sex.
Total
chil
dren.
Exeelllent.
Good.
Num Per Num Per
ber. cent. ber. cent.
Poor.
Very poor.
Num Per Num Per
ber. cent. ber. cent.
Both sexes..................................
3,125
580
18.6
2,242
71.7
281
9.0
22
0.7
2 years, under 3....................................
3 years, under 4....................................
4 years, under 5....................................
5 years, under 6 ....................................
6 years, under 7 ....................................
7 years, under 8....................................
511
496
549
667
682
220
71
88
100
126
142
53
13.9
17.7
18.2
18.9
20.8
24.1
355
349
393
497
492
156
69.5
70.4
71.6
74.5
72.1
70.9
81
57
54
41
40
8
15.9
11.5
9.8
6.1
5.9
3.6
4
2
2
3
8
3
.8
.4
.4
.4
1.2
1.4
Boys.............................................. 1,555
259
16.7
1,156
74.3
130
8.4
10
.6
2 years, under 3 ....................................
3 years, under 4....................................
4 years, under 5....................................
5 years, under 6 ....................................
6 years; under 7....................................
7 years, under 8....................................
261
251
274
337
334
98
35
42
42
57
62
21
13.4
16.7
15.3
16.9
18.6
21.4
183
180
204
264
252
73
70.1
71.7
74.5
78.3
75.4
74.5
40
28
27
16
17
2
15.3
11.2
9.9
4.7
5.1
2.0
3
1
1
1.1
.4
.4
3
2
.9
2.0
Girls............................................. ;
1,570
321
20.4
1,086
69.2
151
9.6
12
.8
2 years, under 3 ....................................
3 years, under 4....................................
4 years, under 5........................ .
5 years, under 6....................................
6 years, under 7....................................
7 years, under 8....................................
250
245
275
330
348
122
36
46
58
69
80
32
14.4
18.8
21.1
20.9
23.0
26.2
172
169
189
233
240
83
68.8
69.0
68.7
70.6
69.0
68.0
41
29
27
25
23
6
16.4
11.8
9.8
7.6
6.6
4.9
1
1
1
3
5
1
.4
.4
.4
.9
1.4
.8
Classified according to nationality, the well nourished showed an
equal distribution among children of native and of foreign-born white
parentage, although the former group had a slightly higher per cent
of “ excellently” nourished—20.9 as against 17. The highest per cent
of “ excellently nourished” in any nationality appeared in the Lithu
anians (28.9), and the highest per cent of poorly nourished appeared
in the Germans (15.1). Colored children showed an average condition
regarding nutrition.
The higher income groups contained 20.5 per cent excellently nour
ished children and 9.4 per cent poorly nourished. The lower income
groups contained 16.7 per cent excellently nourished and 10 per cent
poorly nourished—indicating that higher family incomes do not nec
essarily imply more intelligent feeding and care.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
39
PHYSICAL FINDINGS.
T a b l e V I .— Grade o f nutrition, by color and nationality o f mother; children 2 to 7 years
o f age given physical examination.
Grade of nutrition.
Color and nationality of mother.
Total
chil
dren.
Excellent.
Good.
Poor.
Very poor.
Num Per Num Per Num Per Num Per
ber. cent.1 ber. cent.1 ber. cent.1 ber. cent.1
3,125
580
18.6
2,242
71.7
281
9.0
22
0.7
W hite.................................................... 3,047
Native............................................ 1,151
Foreign-bom.................................. 1,896
Serbo-Croatian........................
321
Slovak...................................... ' 313
Polish.......................................
224
176
157
German...................................
139
83
All other..................................
483
71
7
563
240
323
58
36
29
34
33
27
24
82
15
2
18.5
20.9
17.0
18.1
11.5
12 9
19.3
21.0
19.4
28.9
17.0
21.1
2,188
797
1,391
235
243
172
131
115
91
53
351
49
5
71.8
69.2
73.4
73.2
77.6
76.8
74.4
73.2
65.5
63.9
72.7
69.0
274
106
168
26
29
21
11
9
20
6
46
7
9.0
9.2
8.9
8.1
9.3
9.4
6.3
5.7
14.4
7.2
9.5
9.9
22
8
14
2
5
2
.7
.7
.7
.6
1.6
.9
Total...........................................
1
.7
4
.8
1Not shown where base is less than 50.
T a b l e V I I .— Grade o f nutrition, by earnings o f chief breadwinner; children 2 to 7 years
o f age given physical examination.
Grade of nutrition.
Earnings of chief breadwinner.
Total
chil
dren.
Excellent.
Good.
Poor.
Very poor.
Num Per Num Per Num Per Num Per
ber. cent. ber. cent. ber. cent. ber. cent.
T ota l..........................................
3,125
580
18.6
2,242
71.7
281
9.0
22
0.7
Under $650............................................
$650-$849...............................................
$850-$1,049............................................
$1,050-11,249..........................................
$1,250-$1,449..........................................
$1,450-$1,849..........................................
$l,850-$2,249..........................................
$2,250 and over................. ...................
No chief breadwinner and no
earnings.............................................
Not reported.........................................
110
240
412
491
456
613
262
303
11
36
56
94
88
121
53
68
10.0
15.0
13.6
19.1
19.3
19.7
20.2
22.4
89
179
317
342
326
430
183
212
80.9
74.6
76.9
69.7
71.5
70.1
69.8
70.0
9
20
34
53
39
60
24
22
8.2
8.3
8.3
10.8
8.6
9.8
9.2
7.3
1
5
5
2
3
2
2
1
.9
2.1
1.2
.4
.7
.3
.8
.3
58
180
11
42
* ■
19.0
23.3
42
122
72.4
67.8
5
15
8.6
8.3
1
.6
ANEMIA.
Obviously, mere inspection of the mucous membranes for pallor
furnishes no accurate guide as to the degree of anemia; but in this
type of study blood examinations are not feasible. However, the
results here recorded coincide somewhat closely with those of more
accurate clinical methods.
Nearly 8 per cent of the group were considered anemic. There
was very slight difference in this respect between boys and girls, but
pallor was more common in the older children. In both sexes a very
notable increase in the percentage of pale children appeared after
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
40
PHYSICAL STATUS OP PRESCHOOL CHILDREN.
the fifth year, and a marked increase during the seventh year, when
16.7 per cent showed unusual pallor.
The percentage of anemic children was slightly higher among the
children of foreign-born parentage (8.6) than among those of native
white parentage (6.2). The colored children showed the highest
percentage (11.3).
Children in the families of income groups below $1,450 showed a
slightly higher percentage of anemia (8.4) than children in the
families of the groups where earnings were $1,450 and over (6.5).
While pallor is generally considered a fairly constant sign in malnu
trition, in this study only 13.9 per cent of the most seriously under
weight children were considered anemic.
VACCINATION.
Unless the mother was with the child, no history as to age or
success of smallpox vaccination was obtainable, and the presence of
a scar was the evidence on which vaccination was checked.
T a b l e V III .— Vaccination, by age and sex; children 2 to 7 years o f age given physical
examination.
Not vaccinated.
Vaccinated.
Age and sex.
Both sexes.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
Boys.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
Total
children.
3,125
2,358
75.5
8.6
29.2
37.1
38.2
467
421
436
470
428
136
91.4
84.9
79.4
70.5
62.8
61.8
23.7
1,184
76.1
101
126
36
13.5
17.5
30.0
37.7
36.7
238
217
225
234
208
62
91.2
86.5
82.1
69.4
62.3
63.3
394
25.1
1,174
74.8
21
8.4
16.7
22.9
28.5
36.5
39.3
229
204
211
236
220
74
91.6
83.3
76.7
71.5
63.2
60.7
44
75
111
195
253
84
1,555
368
Girls.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
24.4
762
511
496
549
667
682
220
261
251
274
337
334
98
250
245
275
330
348
122
Not
reported
whether
vacci
Number. Per cent. Number. Per cent. nated.
23
34
48
41
63
94
127
48
15.1
20.2
Of all the children examined, only 24.4 per cent had been vacci
nated. Early vaccination, i. e., by 1 year of age, appears not to
have been the rule,'for only 8.6 per cent of the children between
2 and 3 years of age had been vaccinated. The percentage increased
with each year of age, however, and reached 37.1 b y the seventh year,
indicating that the school-entrance requirement was the principal
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
41
PHYSICAL FINDINGS.
factor influencing vaccination. About one-sixth (14.6 per cent) of
the 1,581 children who had not entered school had been vaccinated,
while of the 1,544 attending school more than one-third (34.4 per
cent) had been vaccinated.
T a b l e I X .— Vaccination, time o f vaccination, and entrance in school, by color and
nationality o f mother; children 2 to 7 years o f age given “physical examination.
Children of —
Total
children.
Native white For^ Ì ° rn
Vaccination, time of vaccination, and
entrance in school.
Negro
mothers.
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
dis
dis
dis
dis
ber. tribu ber. tribu ber.
tribu- ber. tribu
tion.
tion.
tion.
tion.
Moth®rs
whose
nationality
was
not re
port
ed.
Total...................... .......
3,125
100.0
1,151
100.0
71 100.0
7
Not yet in school....................
Vaccinated........................
Not vaccinated.................
Not reported.....................
In school..................................
Vaccinated.......................
Before entering school
After entering school.
Not reported..............
Not vaccinated................
Vaccination not reported.
1,581
231
1,348
50.6
7.4
43.1
596
56
540
51.8
4.9
46.9
949
175
772
50.1
9.2
40.7
32
45.1
4
32
45.1
4
1,544
531
142
71
318
49.4
17.0
4.5
2.3
555
149
40
36
73
406
48.2
12.9
3.5
3.1
6.3
35.3
947
374
99
33
242
570
3
49.9
19.7
5.2
1.7
39
7
54.9
9.9
3
2
1,010
3
.1
10.2
32.3
.1
1,896 100.0
2
.1
12.8
30.1
2
2
3
32
2.8
2.8
4.2
45.1
1
1
2
.2
A comparison by nationality shows that 28.9 per cent of the chil
dren of foreign-born white mothers and 17.8 per cent of those of
native white mothers had been vaccinated.
It was impossible to get entirely accurate figures as to how many
of the school children were vaccinated before and after entering
school, on account of the large number of cases in which no report on
this subject was made. However, an analysis of the few cases where
an answer to this question was obtained revealed the fact that
among 132 children of foreign-born white parentage, three times as
many were vaccinated before entering school as after entering, 99
as compared with 33; while among 76 children of native white
parentage, almost as many were vaccinated after entering school as
before entering, 36 as compared with 40.
The fact that in the mother countries people are accustomed to
compulsory vaccination probably accounts for the greater frequency
and earlier ages of vaccination among the children of foreign-bom
parentage.
HEAD.
While anthropometric head measurements were not made in this
study, observations were recorded as to apparent abnormalities in
size in 76 cases. More than twice as many boys as girls had abnor
mally shaped heads, the square or rachitic head being the most preva
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
42
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
lent type. Open fontanelles ranging in diameter from 1 centimeter
to 2\ centimeters persisted in 13 children in this group, of whom
one was past 3 years of age.
EYES.
It was possible to test vision in only about two-thirds (2,044 cases)
of the children who were given physical examinations, since only the
exceptional child under 3 years of age comprehended the test at all
and only a very small number (124) of children under 4 years did so.
Out of the 2,044 children given vision tests, slightly more than
one-third (36.1 per cent) showed defective sight of varying degree,
with apparently no significant relation to age, although the fifth
year showed a slightly higher per cent than any of the others (39).
T a b l e X .— Defect o f vision, by age; children 2 to 7 years o f age given ■physical examination.
Total
children.
Defect of vision.
3 years,
under 4.
4 years,
under 5.
5 years,
under 6.
1
1 6 years,,
under 7.
7 years,
under 8.
2
1
Per years,
Per
Per
Per
Per
Per
under
cent
Num distri 3.1 Num cent Num cent Num cent Num cent Num cent
distri
distri
distri
distri
distri
ber.
ber.
ber.
ber.
ber.
ber.
bu
bu
bu
bu
bu
bu
tion.
tion.
tion.
tion.
tion.
tion.
Total............. 3,125
Vision tested............ 2,044 100.0
Vision normal....... 1,306 63.9
Vision defective.. . 738 36.1
Both slightly defective.............
461 22.6
Both seriously
defective.......... 108 5.3
One normal, one
slightly defee-'
tive.................
76 3.7
One normal, one
seriously defective.............
29
1.4
One slightly defective, other
seriously de-,
fective.............
61
3.0
Blind in one or
both eyes.........
3
.1
Vision not tested___ 1,081
511
4
3
1
1
507
496
549
667
682.
220
124 100.0
85 68.5
39 31.5
403 100.0
248 61.5
155 38.5
631 100.0
385 61.0
246 39.0
663 100.0
414 62.4
249 37.6
219 100.0
78 1
171
48. 21.9
29
23.4
101
25.1
163
25.8
142
21.4
25
11.4
3
2.4
18
4.5
32
5.1
44
6.6
11
5.0
3
2.4
20
5.0
22
3.5
27
4.1
4
1.8
4
1.0
6
1.0
16
2.4
3
1.4
12
3.0
22
3.5
19
2.9
1
36
.2
I
19
_2
3
2.4
1
372
.8
146
2.3
1
1 Per cent distribution not shown where base is less than 50.
The degree of visual abnormality varied from slight defect of one
eye to serious defect of one or both, and even blindness.
In 108 cases vision was seriously defective in both eyes and the
need for glasses imperative, as shown by the test and corroborated
by the specialist. Of these children, only 10 per cent were wearing
glasses; the other 90 per cent were not even cognizant of the need
for them.
Strabismus was found in 2.4 per cent of all the children, but cor
rective glasses for this defect were being worn by only about oneseventh of the children with this defect. While fewer boys (33) than
girls (43) had strabismus, it is worthy of comment that of the 11
children having strabismus and wearing glasses only 1 was a boy.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
43
PHYSICAL FINDINGS.
Eye diseases and defects other than those of vision were found in
7.8 per cent of all the children; but twice as large a proportion of
those with poor vision (12.6 per cent) as of those with normal vision
(6.4 per cent) had other eye defects or diseases.
T a b l e X I .— Vision, by sex and eye disease or other defect; children 2 to 7 years o f age
given physical examination.
Vision and sex.
Total
children.
With eye disease or
defect other than
Without
vision.
eye
disease.
Number. Per cent.
Both sexes............................................................................
3,125
245
7.8
2,880
Vision tested...................................................................................
Normal.....................................................................................
Defective..................................................................................
Vision not tested............... .............................................................
2,044
1,306
738
1,081
177
84
93
68
8.7
6.4
12.6
6.3
1,867
1,222
645
1,013
1,555
127
8.2
1 428
Vision tested...................................................................................
Normal.....................................................................................
Defective..................................................................................
Vision not tested............................................................................
998
643
355
557
91
46
45
36
9.1
7.2
12.7
6.5
907
597
310
521
Girls.........................................................................................
1,570
118
7.5
1 452
1,046
663
383
524
86
38
48
32
8.2
5.7
12.5
6.1
960
625
335
492
Vision tested..................................................................................
Normal.....................................................................................
Defective...................................................................................
Vision not tested............................................................................
On the whole, slight difference was found between the eye con
ditions of the children of native and of foreign-born white parentage.
Among the latter, the highest percentage with defective vision was
found among the children of Italian parentage. The colored children,
although few in number, were freer from eye defects than any other
group of children, only 1 out of 71 (1.4 per cent) having eye defect.
T a b l e X I I . — Eye disease or defect other than o f vision, by color and nationality o f
mother; children 2 to 7 years o f age given physical examination.
Color and nationality of mother.
Total
children.
With eye disease
or defect other
than of vision.
Without
eye
disease.
Number. Per cent.
Total.................................................................................
White.......................................................................
Native................. ..........................................................
Foreign-born....................................................
Serbo-Croatian..............................................................
Slovak..............................................................
Polish............................................................
Magyar.............................................................................
Italian..............................................................
German............................................
Lithuanian.................................... ...............
All other.......................................................
Negro......................................................................
Not reported.........................................................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
3,125
245
7.8
2,880
3 047
i' Ï5Î
1,896 N
321
313
224
176
157
139
83
483
71
' 7
244
86
158
27
32
13
17
19
11
4
35
1
8.0
7.5
8.3
8.4
10.2
5.8
9.7
12.1
7.9
4.8
7.2
1.4
2 80?
L065
1,738
'294
281
211
159
138
128
79
448
70
7
44
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
EARS.
It was not possible to test successfully as many children for hear
ing as for vision, as sufficiently quiet quarters could not always be
obtained. The total number examined was about 200 less than the
number tested for vision. The total number of cases of defective
hearing, including slight and serious defect of one or both ears, was
only 25, or 1.4 per cent of those examined.
Aside from defective hearing, the other ear defects noted were 25
cases of otorrhea and 258 cases of retracted ear drums.
M O U TH .
Teeth.
The most conspicuous single defect in the entire preschool group
was carious teeth. This condition was found in 64.7 per cent of the
children examined, the percentages increasing from 21.1 in the 2- to
3-year-old children to 87.7 in the 6- to 7-year-olds. In the entire
group, 83 children had decayed permanent teeth.
T a b l e X I I I . — Decayed teeth, by age and sex; children 2 to 7 years o f age given physical
examination.
With decayed teeth.
Age and sex
Total
chil
dren.
Without
decayed
teeth.
Total.
Temporary Temporary Permanent
and
only.
only. permanent.
Num Per Num Per Num Per Num Per Num Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Both sexes.......................
2 years, under 3..............................
3 years, under 4.........................
4 years, under 5.........................
5 years, under 6..................
6 years, under 7.........................
7 years, under 8......................
3,125 1,104
511
49(5
549
667
682
220
B oys........................................ 1,555
2 years, under 3.........................
3 years, under 4..................
4 years, under 5..............................
5 years, under 6.........................
6 years, under 7.........................
7 years, under 8.........................
261
251
274
337
334
98
Girls....................................... 1,570
2 years, under 3............................
3 years, under 4............................
4 years, under 5............................
5 years, under 6..............................
6 years, under 7..............................
7 years, under 8..............................
250
245
275
330
348
122
35.3 2,021
403 78.9
278 56.0
185 33.7
134 20.1
84 12.3
20
9.1
548
35.2 1,007
62.0
80
2.6
3
0.1
108 21.1
218 44.0
363 fifi. 1
520 78.0
555 81.4
174 79.1
1
13
41
25
1.9
6.0
11.4
2
1
.3
.5
64.8
976
62.8
31
2.0
57
115
182
273
293
87
21.8
45.8
66.4
81.0
87.7
88.8
57 •21.8
115 45.8
181 66.1
266 78.9
279 83.5
78 79.6
1
7
14
9
.4
2.1
4.2
92
35.4 1,014
64.6
962
61.3
49
3.1
3
.2
20.4
42.0
66.2
78.8
87.6
92.6
51
103
182
254
276
96
20.4
42.0
66.2
77.0
79.3
78.7
o
27
16
1 ft
7.8
13.1
2
1
.6
.8
204 78.2
136 54.2
92 33.6
64 19.0
41 12.3
11 11.2
556
64.7 1,938
108 21.1
218 44.0
364 68.3
533 79.9
598 87.7
200 90.9
199 79.6
142 58.0
93 33.8
70 21.2
43 12.4
9
7.4
51
103
182
260
305
113
V*
Information regarding previous dental attention showed that only
3.2 per cent had had any teeth filled, such a very small proportion
at once indicating ignorance regarding the importance of dental
attention for temporary teeth. One child under 3 years of age had a
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
45
PHYSICAL FINDINGS.
filled tooth, but 108 between 2 and 3 years had decayed teeth which
had not been filled. The lack of dental care was almost as serious
among the older children, 95 per cent of those between 6 and 7
with decayed teeth having received no attention whatever.
Other mouth defects.
Gum abscesses and malocclusion were the other most frequent
mouth defects, 3.2 per cent showing the former and 11 per cent the
latter defect. Malocclusion showed only slight variations by sex,
but a decided increase with age, especially marked after the fifth
year. This defect was found to occur approximately three times as
often among children with positive diagnosis of adenoids as among
others.
N ASOPH ARYNX.
Defects of the nasopharynx were the most common type of defect
noted in this preschool group, occurring in 69 per cent of all cases,
while the defects of the mouth claimed second place with 66.9 per
cent. On the whole there was a slightly higher per cent of boys with
nasopharyngeal defects than of girls, 71.9 and 66.2 per cent, respec
tively. The highest per cent of nasopharyngeal defects for both
sexes (78.1 per cent) appeared in the sixth year.
T a b l e X I V .— Nasopharyngeal defect, by age and sex; children 2 to 7 years o f age given
physical examination.
Total children. 2 years, under 3. 3 years, under 4. 4 years, under 5
Nasopharyngeal defect, and sex.
Num
ber.
Both sexes............................
Per
Per
Per
Per
cent
Num
cent
Num
cent
Num
cent
distri
ber.
distri
distri
distri
ber.
ber.
bution.
bution.
bution.
bution.
3,125
100.0
511
100.0
496
100.0
With nasopharyngeal defect..........
2,157
Defective tonsils only............
711
Adenoids only.............
342
Defective tonsils with adenoids...
915
High-arch palate only...............
179
Other nasopharyngeal defect........
10
Without nasopharyngeal defect.........
968
69.0
22.8
10.9
29.3
5.7
.3
31.0
250
154
19
49
27
1
261
48.9
30.1
3.7
9.6
5.3
.2
51.1
312
165
34
89
23
1
184
62.9
33.3
6.9
17.9
4.6
.2
37.1
1,555
100.0
261
251
100.0
274
100.0
With nasopharyngeal defect........
1,118
Defective tonsils only..............
348
Adenoids only...................
188
Defective tonsils with adenoids...
488
High-arch palate only...................
91
Other nasopharyngeal defect........
3
Without nasopharyngeal defect......
437
71.9
22.4
12.1
31.4
5.9
.2
28.1
135
79
10
31
15
72.6
29.6
9.9
29.9
3.3
48.3
66.1
33.1
8.0
19.5
5.2
.4
33.9
199
81
27
82
9
126
166
83
20
49
13
1
85
75
27.4
1,570
100.0
250
100.0
245
100.0
275
100.0
With nasopharyngeal defect.............
1,039
' Defective tonsils only...................
363
Adenoids only................
154
Defective tonsils with adenoids... *427
High-arch palate only...................
88
Other nasopharyngeal defect.. . . .
7
Without nasopharyngeal defect....
531
66.2
23.1
9.8
27.2
5.6
.4
33.8
115
75
9
18
12
1
135
46.0
30.0
3.6
7.2
4.8
.4
54.0
146
82
14
40
10
59.6
33.5
5.7
16.3
4.1
99
40.4
196
84
27
72
12
1
79
71.3
30.5
9.8
26.2
4.4
.4
28.7
. Boys.............................¿a
Girls.............................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
m o
51.7
30.3
3.8
11.9
5.7
549
395
165
54
154
21
1
154 .
100.0
71.9
30.1
9.8
28.1
3.8
.2
28.1
46
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
Table XIV.— N asoph aryn geal
defect, by age and s e x ; children 2 to 7 years o f age given
ph ysical exa m in a tion —Concluded.
5 years , under 6. 6 years, under 7. 7 years, under 8.
Nasopharyngeal defect, and sex.
Num
ber.
Per
Per
Per
cent
Num
cent
Num
cent
distri
ber,. distri
ber.
distri
bution.
bution.
bution.
Both sexes.................................................
667
100.0
With nasopharyngeal defect...........................................
Defective tonsils only...............................................
Adenoids only...................... ..................................
Defective tonsils with adenoids...............................
High-arch palate only...............................................
Other nasopharyngeal defect....................................
Without nasopharyngeal defect.....................................
521
111
97
266
42
5
146
78.1
16.6
14.5
39.9
6.3
.7
21.9
Boys...........................................................................
337
100.0
With nasopharyngeal defect...........................................
Defective tonsils only...............................................
Adenoids only...........................................................
Defective tonsils with adenoids...............................
High-arch palate only...............................................
Other nasopharyngeal defect....................................
Without nasopharyngeal defect.....................................
274
45
53
153
22
1
63
Girls...........................................................................
With nasopharyngeal defect...........................................
Defective tonsils only...............................................
Adenoids only...........................................................
Defective tonsils with adenoids...............................
High-arch palate only...............................................
Other nasopharyngeal defect.................................. .
With nasopharyngeal defect...........................................
682
100.0
220
100.0
75.8
12.0
15.5
41.5
6.5
.3
24.2
162
34
32
74
22
73.6
15.5
14.5
33.6
10.0
58
26.4
334
100.0
98
100.0
81.3
13.4
15.7
45.4
6.5
.3
18.7
268
40
62
143
22
1
66
80.2
12.0
18.6
42.8
6.6
.3
19.8
76
20
16
30
10
77.6
20.4
16.3
30.6
10.2
22
22.4
330
100.0
348
100.0
122
100.0
247
66
44
113
20
4
83
74.8
20.0
13.3
34.2
6.1
1.2
25.2
249
42
44
140
22
1
99
71.6
12.1
12.6
40.2
6.3
.3
28.4
86
14
16
44
12
70.5
11.5
13.1
36.1
9.8
36
29.5
517
82 •
106
283
44
2
165
Adenoids.
Adenoids were definitely diagnosed in one-third (33.6 per cent)
of all children examined, while an additional 6.6 per cent were con
sidered as probably having adenoids, this being indicated by the
presence of one or more suggestive signs, viz., mouth breathing, nasal
discharge with excoriation of the nares, high-arch palate, adenoid
facies, etc.
Table XV .— A d en oid con dition ,
by age and sex ; children 2 to 7 years o f age given physical
exam ination.
Total children. 2 years, under 3. 3 years, under 4. 4years,under5.
Adenoid condition, and sex.
Num
ber.
Per
Per
Per
Per
Num
Num
cent
cent
cent
Num
cent
ber.
ber.
distri
distri
distri
ber.
distri
bution.
bution.
bution.
bution.
3,125
100.0
511
100.0
496
100.0
549
100.0
W ith adenoids (definite).................... 1,050
207
With adenoids (suspected).................
Without adenoids................................ 1,868
33.6
6.6
59.8
34
34
443
6.7
6.7
86.7
76
47
373
15.3
9.5
75.2
164
44
341
29.9
8.0
62.1
100.0
Both sexes................................'
1,555
100.0
261
100.0
251
100.0
274
With adenoids (definite)............... .
With adenoids (suspected).................
Without adenoids................................
570
106
879
36.7
6.8
56.5
18
23
220
6.9
8.8
84.3
42
27
182
16.7
. 10.8
72.5
88
21
165
G irls.............................................
1,570
100.0
250
100.0
245
100.0
275
100.0
With adenoids (definite)................. ..
With adenoids (suspected).................
Without adenoids................................
480
101
989
30.6
6.4
63.0
16
11
223
6.4
4.4
89.2
34
20
191
13.9
8.2
78.0
76
23
176
27.6
8.4
64.0
Boys.................. ........... . — . —
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
-
32.1
7.7
60.2
47
PHYSICAL FINDINGS.
Table X V .—Adenoid condition, by age and sex; children 2 to 7 years o f age given physical
examination— Concluded.
5 years, under 6. 6 years, under 7. 7years, under 8.
Adenoid condition, and sex.
Num
ber.
Per
Per
Per
cent
Num
cent
Num
cent
distri
ber.
distri
ber.
distri.
bution.
bution.
bution.
Both sexes.................
667
100.0
682
100.0
220
100.0
With adenoids (definite)............
With adenoids (suspected).......
Without adenoids.............
315
48
304
47.2
7.2
45.6
361
28
293
52.9
4.1
43.0
hkT
6
114
isTi
2.7
51.8
Boys................................
337
100.0
334
100.0
98
100.0
187
19
131
55.5
5.6
38.9
191
14
129
57.2
4.2
38.6
44
2
52
44.9
2.0
53.1
330
100.0
348
100.0
122
100.0
128
29
173
38.8
8.8
52.4
170
14
164
48.9
4.0
47.1
56
4
62
45.9
3.3
50.8
With adenoids (definite)....................
With adenoids (suspected)............
Without adenoids...................
Girls.....................................
With adenoids (definite)..............
With adenoids (suspected)..........
Without adenoids......................
Adenoids were more prevalent among boys, throughout all the pre
school years. Only 6.7 per cent of the children under 3 years of age
had adenoids definitely diagnosed and an equal number had sus
pected” ones. The number of cases of positively diagnosed adenoids
increased with age, reaching a maximum of 52.9 during the seventh
year, while the maximum in “ suspected” cases was reached during
the fourth year. Whether adenoids are often present in younger
children, and, if present, whether they are of such slow growth that
their effects are not manifested by symptoms until the sixth or seventh
year, is a question inviting further observation and scientific investi
gation.
Only insignificant differences in the prevalence of adenoids between
the children of native and of foreign-born white mothers were found,
the percentages being 34.3 and 33.8, respectively. The highest per
cent of adenoids (41) was found in the children of German parentage,
the lowest per cent (19.7) in the colored children.
Symptoms suggesting adenoids.
(a) Mouth breathing.—Oi the entire group of children examined,
39.4 per cent were mouth breathers. Mouth breathing proved a
remarkably constant symptom of adenoids, being present in 99.6
per cent of the cases. Only four cases of adenoids in which the
child was apparently not a mouth breather were recorded and in
six cases mouth breathing persisted after the removal of adenoids.
It became a more pronounced habit or defect with age; 12.7 per cent
of the children 2 to 3 years of age, and 56.2 per cent of those 6 to 7
years of age were mouth breathers. This symptom or defect was
more common among boys, showing 43.1 per cent as compared with
35.8 per cent among girls.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
48
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
Malocclusion and high-arch palate apparently had a direct relation
to mouth breathing, since 62.4 per cent of the children with malocclu
sion and 65.4 per cent of those with high-arch palate were mouth
breathers.
(6) Nasal discharge.— Nine and six tenths per cent of all children
had what was considered a chronic nasal discharge, 10.1 per cent of
the boys and 9 per cent of the girls.
(c) Nasal obstruction.—Thirty-eight and two-tenths per cent of the
children showed nasal obstruction. Of the cases of malocclusion
59.8 per cent showed nasal obstruction, as compared with 35.5 per
cent of those without malocclusion.
(d) High-arch 'palate.—According to the observations of the
examiners, practically one-third of all the children, 1,027 out of
3,125, showed high-arch palate. This condition prevailed in more
than half (57.4 per cent) of the cases of malocclusion, and in a still
higher percentage (59.5) of the positive cases of adenoids.
(e) Ear drums.— Retracted drums, which were considered a cor
roborative sign of adenoids, were found in 258 of the cases examined
by the specialist. This is probably an understatement, since not
all children were observed by the specialist. In 94.6 per cent of the
children with retracted drums, adenoids were also found.
Hearing appears to have been only slightly impaired by retracted
drums either with or without adenoids, since it was found to be
defective in only 8, or 3.5 per cent, of the 231 cases of retracted ear
drums in which hearing was tested, as compared with 1 per cent in
the rest of the group.
(/) Adenoid facies.— So-called typical adenoid facies were observed
in slightly more than one-third (37.2 per cent) of the children having
adenoids. This symptom was more common in boys and showed an
increase with age to the seventh year.
Tonsils.
A little less than half (45.4 per cent) of the total number of children
examined had tonsils which would generally be considered normal,
since they showed no enlargement or evidence of disease. More than
half (56.3 per cent) the children with abnormal tonsils also had
adenoids. Of the entire group 2.5 per cent, or 1 in 40, gave a history
of having had tonsils removed.
Slight enlargement of the tonsils was far more common than other
tonsillar affections, being found in slightly more than one-third
(34.9 per cent) of the children. The maximum of simple enlargement,
which increased in prevalence with each year of age, was reached
during the fifth year, and thereafter a steady and even decrease was
shown. Possibly these findings suggest that enlargement without
disease may be merely a hyperplasia of lymphoid tissue, normal at
this period of life.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
49
PHYSICAL FINDINGS.
T able X V I .— Condition o f tonsils, by age and sex; children 2 to 7 years o f age given
physical examination.
Total
children.
2 years, under 3. 3 years, under 4. 4 years, under 5.
Condition of tonsils, and sex.
cent
Per cent
Per cent
Per cent
Num Per
distri Num distri Num distri Num distri
ber. bution.
ber. bution. ber.
bution. ber. bution.
Both sexes.................................. 3,125
100.0
511
100.0
496
100.0
549
100.0
Tonsils:
Normal.............................
1,420
Defective....................................... 1,626
Enlarged only........................ 1,091
Greatly enlarged only............
129
Diseased..................................
406
Enlarged...........................
266
Greatly enlarged..............
134
Not enlarged....................
6
Removed.......................................
79
45.4
52.0
34.9
4.1
13.0
8.5
4.3
.2
2.5
308
203
188
5
10
5
5
60.3
39.7
36.8
1.0
2.0
1.0
1.0
237
254
211
10
33
21
12
47.8
51.2
42.5
2.0
6.7
4.2
2.4
223
319
244
20
55
31
23
I'
40.6
58.1
44.4
3.6
10.0
5.6
4.2
B oy s.............................................. 1,555
100.0
261
100.0
251
100.0
274
100.0
671
836
574
61
201
132
65
4
48
43.2
53.8
36.9
3.9
12.9
8.5
4.2
.3
3.1
151
110
101
3
6
3
3
57.9
42.1
38.7
1.1
2.3
1.1
1.1
115
132
110
5
17
10
7
45.8
52.6
43.8
2.0
6.8
4.0
2.8
108
163
126
8
29
16
12
1
39.4
59.5
46.0
2.9
10.6
5.8
4.4
1,570
100.0
250
100.0
245
100.0
275
100.0
749
790
517
68
205
134
69
2
31
47.7
50.3
32.9
4.3
13.1
8.5
4.4
.1
2.0
157
93
87
2
4
2
2
62.8
37.2
34.8
.8
1.6
.8
.8
122
122
101
5
16
11
5
49.8
49.8
41.2
2.0
6.5
4.5
2.0
115
156
118
12
26
15
11
41.8
56.7
42.9
4.4
9.5
5.5
4.0
Tonsils:
Normal................................
Defective.......................................
Enlarged only.........................
Greatly enlarged only............
Diseased..................................
Enlarged...........................
Greatly enlarged..............
Not enlarged....................
Removed..................................
Girls..................................
Tonsils:
Normal.........................
Defective.......................
Enlarged only........................
Greatly enlarged only............
Diseased...........................
Enlarged...........................
Greatly enlarged..............
Not enlarged....................
Removed........................
1
1.5
5 years, under 6. 6 years, under 7. 7 years, under 8.
Condition of tonsils, and sex.
Both sexes.
Tonsils:
Normal...............................
Defective............................
Enlarged only.............
Greatly enlarged only.
Diseased......................
Enlarged...............
Greatly enlarged..
Not enlarged.........
Removed...........................
Boys...................................
Tonsils:
Normal..............................
Defective............................
Enlarged only.............
Greatly enlarged only.
Diseased......................
Enlarged...............
Greatly enlarged..
Not enlarged.........
Removed...........................
108178°—22----- 4
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
cent
Per cent
Per cent
Num Per
distri Num distri Num distri
ber. bution.
ber. bution. ber.
bution.
667
100.0
682
100.0
220
100.0
263
377
221
42
414
78
34
2
27
39.4
56.5
33.1
6.3
17.1
11.7
5.1
.3
4.0
285
365
176
39
150
99
49
2
32
41.8
53.5
25.8
5.7
22.0
14.5
7.2
.3
4.7
104
108
51
13
44
32
11
1
8
47.3
49.1
23.2
5.9
20.0
14.5
5.0
.5
3.6
337
100.0
334
100.0
98
100.0
123
198
112
27
59
41
16
2
16
36.5
58.8
33.2
8.0
17.5
12.2
4.7
.6
4.7
132
183
98
15
70
49
21
39.5
54.8
29.3
4.5
21.0
14.7
6.3
19
5.7
42
50
27
3
20
13
6
1
6
42.9
51.0
27.6
3.1
20.4
13.3
6.1
1-0
6.1
50
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
T a b l e X V I .— Condition o f tonsils, by age and sex; children 2 to 7 years o f age given
physical examination— Concluded.
5 years, under 6. 6 years, under 7. 7 years, under 8.
Condition of tonsils, and sex.
Percent Num Per cent
Num Percent
distri Num
distri
distri
ber. bution.
ber. bution.
ber. bution.
Girls...........................................................................
330
100.0
348
100.0
122
100.0
Tonsils:
Normal......................................................................
Defective...................................................................
Enlarged only.....................................................
Greatly enlarged only........................ ...............
Diseased....... ............ .........................................
Enlarged......................................................
Greatly enlarged..........................................
140
179
109
15
55
37
18
42.4
54.2
33.0
4.5
16.7
11.2
5.5
50.8
47.5
19.7
8.2
19.7
15.6
4.1
11
3.3
44.0
52.3
22.4
6.9
23.0
14.4
8.0
.6
3.7
62
58
24
10
24
19
5
Rem oved..................................................................
153
182
78
24
80
50
28
2
13
2
1.6
Greatly enlarged tonsils, i. e., those nearly filling the throat, were
found in only 8.4 per cent of the children; in one-half these cases the
tonsils were also diseased. This degree of enlargement also showed
definite increase with age.
Tonsils considered “ diseased” were found in 13 per cent of all the
children in the group and showed a steady increase from 2 per cent
in the 2- to 3-year group to 22 per cent in the 6- to 7-year group.
Practically all “ diseased” tonsils showed some enlargement; in
only six cases were the tonsils recorded as “ diseased” but not “ en
larged.” Approximately two-thirds of the “ diseased” tonsils were
associated with slight enlargement, the other third being recorded as
“ greatly enlarged.”
The standards adopted in this study for the recommendation of
the removal of tonsils 17 compelled a rather conservative viewpoint,
but in spite of this it was considered by the specialist that removal
was required in 39.3 per cent of the 1,626 cases of tonsillar defect.
Parents were instructed to keep the throats of the remaining number
under observation.
Removal was recommended more commonly among the older chil
dren, the percentages based upon total number of children having de
fective tonsils ranging from 6.9 at 2 to 3 years, to 61.9 at 6 to 7 years.
Removal of both tonsils and adenoids was recommended in 57.3
per cent of the cases in which both conditions were present. Re
moval of tonsils alone was necessary in but 7.1 per cent of all cases
of defective tonsils.
Table X V II indicates a definite relation between diseased tonsils
and age, but apparently shows little relation between decayed teeth
and diseased tonsils.
i? See p. 25.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL FINDINGS.
T able
51
XVII.— P revalence
o f diseased to n sils, by presence o f decayed teeth ; children 2 to
7 years o f age given p h ysical exam ination.
Children without decayed
teeth.
Age.
Children with decayed teeth.
With diseased
tonsils.
Total.
With diseased
tonsils.
Total.
Number. Per cent.1
2 years, under 3
3 years, under 4.
4 years, under
5 years, under 6.
6 years, under 7.
7 years, under 8.
403
278
185
134
84
20
8
16
15
26
18
2
2.0
5.8
8.1
19.4
21.4
Number. Per cent.1
108
218
364
533
598
200
2
17
40
88
132
42
1.9
7.8
11.0
16.5
22.1
1 Not shown where base is less than 50.
There appeared to be no striking difference in the condition of the
tonsils of the children of native and foreign-born white parentage;
defective tonsils were found in 51.5 per cent of the latter as against
53.2 per cent of the former. The highest per cent found in any na
tionality group was 57.9 in the Serbo-Croatians, while the lowest per
cent (47.9) was found among the colored children.
Correlations with earnings did not even suggest that the children
of well-to-do parents had fewer tonsillar defects than those of poorer
families, except that a larger per cent in the higher income groups
had had tonsils removed.
GLANDS.
The condition of the superficial external lymphatic glands as to
size and associated infection is shown in Table X V III.
Since a certain degree of swelling and hyperplasia is considered
normal during early childhood, only glands described as “ enlarged”
or “ greatly enlarged” were in this study considered as defects.
However, in 17.6 per cent of the children glands were not even
palpable,” and for this reason further observation seems necessary
to determine whether or not palpability should be considered normal
even at this period of life.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
52
PHYSICAL STATUS OP PRESCHOOL CHILDREN.
T a b l e X Y I I I .— Condition o f glands, by age and sex; children 2 to 7 years o f age given
'physical examination.
Total children. 2 years under 3. 3 years, under 4. 4 years, under 5.
Condition of glands, and sex.
Per cent Num Per cent Num Per cent
Num Percent
distri
distri
distri
distri Num
ber. bution.
ber. bution.
ber. bution.
ber. bution.
3,125
100.0
511
100.0
496
100.0
549
100.0
550
1,667
908
Enlarged or greatly enlarged.......
Without associated infection.
143
765
With associated infection.......
17.6
53.3
29.1
4,6
24.5
195
250
66
26
40
38.2
48.9
12.9
5.1
7.8
131
289
76
17
59
26.4
58.3
15.3
3.4
11.9
87
312
150
20
130
15.8
56.8
27.3
3.6
23.7
1,555
100.0
261
100.0
251
100.0
274
100.0
260
806
489
74
415
16.7
51.8
31.4
4.8
26.7
99
131
31
12
19
37.9
50.2
11.9
4.6
7.3
68
128
45
11
34
27.1
55.0
17.9
4.4
13.5
32
160
82
11
71
11.7
58.4
29.9
4.0
25.9
1,570
100.0
250
100.0
245
100.0
275
100.0
290
861
419
69
350
18.5
54.8
26.7
4.4
22.3
96
119
35
14
21
38.4
47.6
14.0
5.6
8.4
63
151
31
6
25
25.7
61.6
12.7
2.4
10.2
55
152
68
9
59
20.0
55.3
24.7
3.3
21.5
Glands:
Glands:
Enlarged or greatly enlarged.......
Without associated infection.
With associated infection.......
Glands:
Enlarged or greatly enlarged.......
Without associated infection.
With associated infection.......
5 years under 6. 6 years under 7. 7 years, under 8.
Condition of glands, and sex.
Per cent Num Per cent
Num Per-cent
distri
distri
distri Num
ber. bution.
ber. bution.
ber. bution.
667
100.0
682
100.0
220
100.0
10.6
51.9
37.5
With associated infection___
71
346
250
34
216
32.4
47
370
265
28
237
6.9
54.3
38.9
4.1
34.8
19
100
101
18
83
8.6
45.5
45.9
8.2
37.7
Boÿs...............................................
337
100.0
334
100.0
98
100.0
36
165
136
119
17
10.7
49.0
40.4
5.0
35.3
18
168
148
13
135
5.4
50.3
44.3
3.9
40.4
7
44
47
10
37
7.1
44.9
48.0
10.2
37.8
330
100.0
348
100.0
122
100.0
35
181
114
17
97
10.6
54.8
34.5
5.2
29.4
29
202
117
15
102
8.3
58.0
33.6
4.3
29.3
12
56
54
8
46
9.8
45.9
44.3
6.6
37.7
Glands:
Glands:
Nonpalpable..................................
Palpable........................................
Enlarged or greatly enlarged.......
Without associated infection.
With associated infection___
Girls...............................................
Glands:
With associated infection...................................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
-
PHYSICAL FINDINGS.
53
T a b l e X I X .— Condition o f cervical glands, by condition o f tonsils and teeth; children 2
to 7 years o f age given physical examination.
Condition of cervical glands.
Condition of tonsils and teeth.
Total
chil
dren.
Nonpalpa
ble.
Palpable.
Enlarged.
Greatly en
larged.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
3,125
898
28.7
1,986
63.6
233
7.5
8
0.3
With decayed teeth or diseased tonsils...................................................... 2,106
Decayed teeth................................ 1,700
Diseased tonsils.............................
85
B oth...............................................
321
Without decayed teeth or diseased
tonsils................................................ 1,019
476
407
24
45
22.6
23.9
28.2
14.0
1,438
1,155
56
227
68.3
67.9
65.9
70.7
186
133
5
48
8.8
7.8
5.9
15.0
6
5
.3
.3
i
.3
422
41.4
548
53.8
47
4.6
2
.2
Total...........................................
The highest per cent of “ palpable ” glands (58.3) was found among
children in their fourth year. This was a considerable increase over
the 48.9 per cent found among children in their third year. Only a
slight diminution in palpability was noticeable in the succeeding
age groups.
Definite “ enlargement,” sufficient to be considered pathological,
was observed in 29.1 per cent of the cases; and all but about 15.7 per
cent of this number showed an associated infection causing the en
largement.
“ Enlarged” glands, with or without associated infection—while
present in nearly 13 per cent at 2 to 3 years of age— showed num
bers steadily increasing with age, and no tendency to diminution
even during the seventh year. As with most other defects, there
was a slightly higher per cent in boys.
The submaxillary and cervical glands were by far the most com
monly “ enlarged,” and showed associated infection more frequently
than any other group. While not so many children had “ palpable”
submaxillary glands (43 per cent) as had “ palpable” cervical glands
(63.6 per cent), a larger number—nearly three times as many—had
“ enlarged” submaxillary glands (20.9 per cent) than had “ enlarged”
cervical glands (7.5 per cent). A very definite form of infection, such
as decayed teeth or diseased tonsils, was associated with 84.3 per cent
of the cases of “ enlarged” glands.
In 14 per cent of the children with both decayed teeth and diseased
tonsils, the cervical glands were not even “ palpable;” and 21.2 per
cent of the children with these defects had “ nonpalpable ” submaxil
lary glands.
Inguinal glands were “ palpable” in 1,028 children, or 32.9 per cent
of all those included in the study, and “ enlarged” in 49 children— 36
boys and 13 girls. No associated infection was reported with any
condition of this group of glands.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
54
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
Twenty-one boys and 39 girls were found to have thyroid enlarge
ment, a condition unusual for children of these ages, although fairly
common at later ages in the Great Lakes region.
Apparently little significance can be attached to the findings in
regard to the other gland groups. Occipital glands were “ palpable”
in only 21 cases (0.7 per cent) and “ enlarged” in only 2. Theaxillary group of glands were “ palpable” in 3.2 per cent of the cases,
and enlarged in only 0.4 per cent. “ Palpable” epitrochlear glands
were reported in 2 boys.
Correlations to determine any existing relations between the
condition of the glands and other physical factors were made. There
appeared to be no connection between glandular enlargement and
underweight; in fact, a higher percentage (20.1) of those 10 per cent
or more underweight had normal glands than of those of average or
above average weight (17.6). Similarly, a higher percentage (29.1)
of “ enlarged” glands was found in children of average weight, or
above, than in those 10 per cent or more below average (27.4 per cent).
Of 243 pale or anemic children, 133 (54.7 per cent) had “ palpable”
glands and 98 (40.3 per cent) had “ enlarged” glands.
Glandular defects showed more striking difference according to
nationality than did other defects, being found in 32.5 per cent of the
children of foreign-born parentage and in only 23.5 per cent of those
of native. parentage. The highest percentage having glandular
defects (47) was found among the Lithuanians.
T able
X X .—
C on d ition o f glands, by color and n a tion a lity o f m oth er; children 2 to 7
years o f age given p h ysical exam ination.
Condition of glands.
Enlarged or greatly enlarged.
Total
Color and nationality of mother. chil
dren.
N onpalpable.
Palpable.
Total.
With
associated
infection.
Without
associated
infection.
Num Per Num Per Num Per Num Per Num Per
ber. cent.1 ber. cent.1 ber. cent.1 ber. cent.1 ber. cent.1
Total.....................................
W hite.............................................
Native......................................
Foreign-born...........................
Serbo-Croatian..................
Slovak...............................
Polish................................
Magyar..............................
Italian...............................
German.............................
Lithuanian.......................
Allother...........................
Negro..............................................
3,125
3,047
1,151
1,896
321
313
224
176
157
139
83
483
71
7
1 Not shown where base is less than 50.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
550
544
254
290
39
52.
37
18
16
26
7
95
5
1
17.6 1,667
17.9 1,617
22.1
627
15.3
990
12.1
168
16.6
160
16.5
113
10.2
102
10.2
94
74
18.7
8.4
37
19.7
242
46
7.0
4
53.3
53.1
54.5
52.2
52.3
51.1
50.4
58.0
59.9
53.2
44.6
50.1
64.8
908
886
270
616
114
101
74
56
47
39
39
146
20
2
29.1
29.1
23.5
32.5
35.5
32.3
33.0
31.8
29.9
28.1
47.0
30.2
28.2
765
752
236
516
96
92
60
44
32
34
32
126
12
1
24.5
24.7
20.5
27.2
29.9
29.4
26.8
25.0
20.4
24.5
38.6
26.1
16.9
143
134
34
100
18
9
14
12
15
5
7
20
8
1
4.6
4.4
3.0
5.3
5.6
2.9
6.3
6.8
9.6
3.6
8.4
4.1
11.3
PHYSICAL FINDINGS.
55
Colored children showed a higher per cent of “ palpable” glands
than any other racial group; a per cent of “ defective” glands midway
between those of the children of foreign-born white parentage and of
native white parentage; and a decided lack of “ associated infection”
with all degrees of enlargement.
LUNGS.
A comparatively small number of children showed symptoms of
respiratory disease. Positive diagnoses on one examination were
possible in only 11 cases (0.4 per cent), the majority of these being
bronchitis. An additional 21 cases (0.7 per cent) were considered
suspicious, and were referred for medical supervision. A slightly
higher percentage (18.8) of diseased tonsils was found in children
with lung disease (definite and suspected) than in those without such
disease (12.9 per cent).
HEART.
A positive diagnosis of organic heart disease was possible in only 14
cases, or 0.4 per cent of all. A group of 85 cases (2.7 per cent) were
reported as “ suspected heart disease” and requiring observation,
since it was impossible to make a definite diagnosis on only one
examination. Functional murmurs without other heart symptoms
were reported in 68 cases (2.2 per cent). Only 2 cases of functional
murmur were reported as early as the third year, but the number
steadily increased with age, reaching 25 during the seventh year.
SKIN.
Under this subject were included not only definite skin diseases but
pediculosis as well. This latter condition far exceeded all other skin
affections, being found in 4.6 per cent of all the children. Pediculosis
was three times as frequent among girls as among boys, and its preva
lence increased steadily with age, so that by far the larger number
of cases was found among children over 5 years of age. The number
of cases of pediculosis of the body was practically negligible.
Of the skin diseases, eczema was most common, occurring in 80
cases (2.6 per cent). There were also 67 cases of infected sores; 2b of
ringworm, chiefly of scalp and face; 9 cases of scabies; and 8 cases of
impetigo. With the exception of infected sores and ringworm these
diseases were more commonly found in the later ages, i. e., those over
5 years.
Under “ other conditions” were listed scars, with their causes when
these could be ascertained. A surprisingly large number, 165, or
5.3 per cent, were found to have scars of one kind or another. “ Un
reported causes ” was recorded for the majority, but the most common
ly reported causes were bums (26.7 per cent) and operations (15.2
per cent). Doubtless many of the scars, the causes of which were
unreported, were in fact the result of bums or other accidents.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
56
PHYSICAL STATUS OP PRESCHOOL CHILDREN.
Abnormal skin conditions were more common in the older children,
14.1 per cent in the seventh year or later as compared with 4.9 per
cent during the third year.
No marked relation was shown between underweight and abnormal
skin condition, but malnutrition, plus skin defects, was found to be
accompanied by a high per cent of anemia. The increase in skin
defects was from zero among the “ excellent” to 21.6 per cent among
the “ good, ” 27.3 per cent among the “ poor, ” and 60 per cent among
the “ very poor. ”
Children of foreign-bom mothers were more commonly subject to
abnormal skin conditions than those of native parents, the percent
ages being 13.2 and 4.9, respectively. The groups in which the per
centage of this defect most nearly approached that of the native
white group were the German, with 5.8 per cent; and the Polish, with
7.1 per cent; a maximum of 22.9 per cent was reached among the
Italian and the Lithuanian.
Correlations with incomes show definitely that the children of the
more prosperous families were freer from abnormal skin conditions
than those in the lower-income groups; the percentage of children in
whom such conditions were found decreased from 1.6.4 among families
where the father earned less than $850 to only 5.6 in the group where
the fathers earned $2,250 or more. Low standards of living, including
lack of bathing facilities, ignorance as to proper care and habits of the
body and proper food, etc., prevailed to a greater degree among the
families of the low-income groups.
ABDOM EN.
Abdominal distension was most frequently observed in the younger
children, being present in 19.8 per cent of those in their third year of
age. A gradual decrease in the prevalence of this defect was notice
able in each succeeding age group. This condition was evenly dis
tributed according to sex.
Distended abdomen was more commonly observed in children with
rachitic defects (23.1 per cent) than in nonrachitic children (11 per
cent).
T able
XXI .— D istended
abdom en, by age and sex ; children 2 to 7 years o f age given
ph ysical exam ination.
Age and sex.
Total
children.
With distended
abdomen.
Without
distend
ed abdo
Number. Per cent.
men.
Both sexes.............................................................................
3,125
423
13.5
2,702
2 years, under 3...............................................................................
3 years, under 4..............................................................................
4 years, under 5...............................................................................
5 years, under 6...............................................................................
6 years, under 7...............................................................................
7 years, under 8...............................................................................
511
496
549
667
682
220
101
75
70
77
74
26
19.8
15.1
12.8
11.5
10.9
11.8
410
421
479
590
608
194
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL FINDINGS.
57
T able X X I .—Distended abdomen, by age and sex; children 2 to 7 years o f age given
physical examination— Concluded.
Age and sex.
Boys.............................................
Total
children.
Without
distend
ed abdo
Number, Per cent. men.
1 Ì85
214
261
251
274
337
334
98
50
35
40
42
32
15
1 570
200
250
245
275
330
348
122
51
40
30
35
42
11
2 years, under 3...................................
3 years, under 4............................................
4 years, under 5..............................
5 years, under 6 ............................................
6 years, under 7..............................
7 years, under 8.............................
Girls....................................................
With distended
abdomen.
2 years, under 3............................................
3 years, under 4 ............................................
4 years, under 5........................................
5 years, under 6 ..............................
6 years, under 7............................................
7 years, under 8...............................................
19.2
13.9
14.6
12.5
9.6
15.3
211
216
234
295
302
83
20.4
16.3
10.9
10.6
12.1
9.0
199
205
245
295
306
111
Of the children of average weight or above, 19.5 per cent had
abdominal defect, while smaller percentages— 11.4, 10.5, and 12.5—
of the children in the underweight groups showed this defect.
There were 11 cases of enlarged liver— 0.4 per cent of all exam
ined— and none of enlarged spleen.
Hernias were found in 47 cases, 36 umbilical and 11 inguinal, only
1 of the latter variety being in a girl. Four boys had operations for
this condition.
B O NY AND MUSCULAR SYSTEM S.
A simple enumeration of bony and muscular defects is given in
General Table 7, page 69. One defect of the bony and muscular
system appeared in 41.9 per cent of the children. Distribution of
these defects by age showed a gradual increase from 24.9 per cent in
the third year to 56.2 per cent in the seventh year.
T a b l e X X I I .—Defects o f bony and muscular system, by age and sex; children 2 to 7 years
o f age given physical examination.
Age and sex.
Both sexes............................................................
2 years, under 3............................................................
3 years, under 4 ................................................................
4 years, under 5 ..................................................
5 years, under 6 ......................................................................
6 years, under 7......................................................
7 years, under 8..............................................................
Boys..............................................................................
2 years, under 3.............................................................
3 years, under 4.....................................................................
4 years, under 5.....................................................................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Total
children.
With defects of Without
bony and mus defects
cular system.
of bony
and muscular
Number. Per cent. system.
3,125
1,308
41.9
1,817
511
496
549
667
682
220
127
144
204
324
383
126
24.9
29.0
37.2
48.6
56.2
57.3
384
352
345
343
299
94
1,555
709
45.fi
261
251
274
68
76
111
26.1
30.3
40.5
193
175
163
58
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
T able
XXII .— D efects
o f bo n y and m uscular system , by age and sex ; children 2 to 7
years o f age g iven p h ysica l exa m in a tion —Concluded.
Age and sex.
Total
children.
With di fects of Without
bony and mus- deieccs
cular s ystem.
of bony
and mus
cular
Number. Percent. system.
5 years, under 6 ...............................................................................
6 years, under 7...............................................................................
7 years, under 8...............................................................................
337
334
98
183
208
63
54.3
62.3
64.3
154
126
35
Girls..... ........................................................................... ; ___
1,570
599
38.2
971
2 years, under 3...............................................................................
3 years, under 4...............................................................................
4 years, under 5................................................: ...........................
5 years, under 6...............................................................................
6 years, under 7...............................................................................
7 years, under 8 ...............................................................................
250
245
275
330
348
122
59
68
93
141
175
63
23.6
27.8
33.8
42.7
50.3
51.6
191
177
182
189
173
59
On the whole, the percentage of boys (45.6) with defects of the
bony and muscular systems, exceeded that of girls (38.2).
In general, the incidence of these defects in the various weight
groups was not sufficiently uniform to suggest any definite correlation
with weight. (See general Table 5, p. 68.)
Bony defects of rachitic origin.
Since a large number of the bony defects were considered to be
of rachitic origin, tabulations based on this causative factor were
made.
Bony defects tabulated as “ unquestionably” the result of rickets
were: Beaded ribs, Harrison’s groove, enlarged epiphyses, pigeon
breast, craniotabes, and lumbar kyphosis if it was accompanied by
one of the group of “ probable signs” of rickets such as large square
head or open fontanelle after 18 months of age. Bowlegs or knockknees were considered as merely additional evidence of rickets and,
unless other rachitic signs appeared with them, were disregarded.
In combination with lumbar kyphosis they were called unquestion
able signs of rickets.
Three hundred and eighty-eight children (12.4 per cent) were con
sidered as having defects definitely the result of rickets, while an
additional 79 children (2.5 per cent) had defects “ probably of rachitic
origin,” bringing the total of those having defects possibly due to
early rickets to 14.9 per cent.
Rickets is usually conceded to be a disease of infancy, the symp
toms of which disappear early under proper dietary and hygienic
conditions; hence the prevalence and persistence of these excessively
high percentages probably due to rickets lead to the inference that
the corrective measures of diet, hygiene, and environment had not
entered into the lives of this preschool group. This conclusion is
perhaps further substantiated by the fact that these defects showed
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
PHYSICAL FINDINGS.
59
no tendency to diminish., even in the older children, but increased
steadily.
Correlations between bony defects of rachitic origin and the con
dition of the teeth showed a higher per cent (75.2) of decayed teeth
in the children with such bony defects than in those without (62.8).
Slightly more than half (54.2 per cent) of the children with rachitic
bone defects were found to have defective tonsils as compared with
51.7 per cent of children without such defects.
Children without rachitic bone defects had a much higher per cent
of nonpalpable lymphatic glands (19.4 per cent) than those with
such defects (7.3 per cent).
The prevalence of rachitic defects was greater among the children
of foreign-born white parentage (17.7 per cent) than among those of
native white parentage (10.4 per cent). Of the former, the SerboCroatians had the highest per cent (22.1 per cent). Contrary to the
general impression, the colored children, although a small group,
showed only 14.1 per cent with rachitic defects, a per cent slightly
less than the average for the entire group (14.9 per cent).
While rachitic defects appeared to be slightly associated with
underweight, their incidence increased only from 13.1 per cent in the
“ above average” group to 18.8 per cent in the group most seriously
underweight. (See general Table 5, p. 68.) On the other hand, only
12.2 per cent of the children with rachitic defects as compared with
9.3 per cent of the nonrachitic showed 10 per cent or more deviation
from average weight for height.
Postural defects.
Included in this group were the defects due to lack of muscular
development, namely, round shoulders, winged scapulae, scoliosis
and lordosis, and, when not associated with rickets, bowlegs and
knock-knees.
The total number of children with one or more postural defects
was 793, or 25.4 per cent of all those examined. In children 6 to 7
years of age the number increased to over one-third of the total.
This at first appears to be an excessively high percentage; but to
what extent the conditions may be interpreted as actual defects is
perhaps debatable, considering that between the ages of 2 and 6 years
muscular development is poor and muscle tonus practically lacking.
This characteristic lack of muscular development probably explains
in part the frequency of winged scapulae in this study. The percent
age of children having this defect was 14.5 for the whole group, and
was noticeably higher after the fourth year. The increase in scoliosis
appeared more prominently after the fifth year.
Postural defects, on the whole, appeared to bear some relation to
underweight; for 28.7 per cent of the children 10 per cent or more
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
60
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
below average weight for height had one or more postural defects, as
contrasted with 20.4 per cent of those whose weight was average or
above.
T a b l e X X I I I .— Postural defects, by age and sex; children 2 to 7 years o f age given physical
examination.
Age and sex.
Total
children.
With postural de
fects.
Number. Per cent.
Both, sexes......................................
2 years, under 3..............................................
3 years, under 4............... ....................
4 years, under 5................................
5 years, under 6 ...................... ..............
6 years, under 7...............................................
7 years, under 8.....................................
Boys..................................................
2 years, under 3 ....................................................
3 years, under 4 .....................................
4 years, under 5..................................
5 years, under 6............................................
6 years, under 7..............................
7 years, under 8...............................................
Girls....................................................
2 years, under 3..............................................................................
3 years, under 4...........................................
4 years, under 5.......................................................
5 years, under 6...............................................
6 years, under 7...............................................................
7 years, under 8.......................................................
Without
postural
defects.
3,125
793
25.4
2,332
511
496
549
667
682
220
56
68
117
220
255
77
11.0
13.7
21.3
33.0
37.4
35.0
428
432
447
427
143
1 fitô
418
261
251
274
337
334
98
30
40
56
125
131
36
11.5
15.9
20.4
37.1
39.2
36.7
231
211
218
212
203
62
1 570
375
23 Q
1 1<*5
250
245
■275
330
348
122
26
28
61
95
124
41
10.4
11.4
22.2
28.8
35.6
33.6
224
217
214
235
224
81
Among the colored the percentage of postural defects was veryhigh— 52.1; among the children of native white parentage it was
21.8, and among those of foreign-born white parentage it was 26.6.
The influence of environment and living standards upon develop
ment as reflected in faulty posture is shown by the incidence of the
highest per cent of postural defects in the lower wage group; this
per cent was 27.6 in families whose incomes were less than $1,450,
as contrasted with 22.1 per cent in families whose incomes were
$1,450 or over. (See General table 4, p. 67.)
Arch measurements.
Since there appeared to be no standard for grading flat foot, and
since anatomical data regarding arches in children’s feet were notably
lacking, the suggestion of a prominent orthopedist that the study
include a measurement of the height of the arches in children was
carried out. (See instructions, p. 20.) The results are herewith
given without any attempt at interpretation, since obviously other
and more detailed investigations on the subject must follow before
the material in this report can be evaluated.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
61
P H Y S IC A L F IN D IN G S .
Measurements were made on 3,064 children, and in only 65 cases
were the arch heights found to be unequal in the two feet. In com
puting median arch measurements these 65 cases were discarded.
The accompanying table gives median arch measurements ac
cording to sex and age:
Median arch measurements.
Age.
Both
sexes.
Inches.
a
i
i
i
14
i|
Boys.
Girls.
Inches.
Inches.
i1
1
1
if
}
1
1
l
1
1*
The increase in arch height with age probably parallels the mus
cular development in the feet, which, apparently increases with use.
Careful observations were made and recorded as to the relation of
the axes of the foot and leg while the child was walking. Of all the
children 81.3 per cent had what is commonly known as the “ straight’’
type of foot, i. e., they toed straight ahead, the axes of the foot and
leg making a right angle; 10.3 per cent were of the “ infiared” type
with the foot deflected in; while 6.9 per cent were the “ outflared”
type with the foot deflected out.
Correlations between the position of the foot and the median
height of the arch indicate that the deflections in and out increased
with the height of the arch, as the accompanying figures show:
Median arch measurements.
Age.
I n fla r e .
O u tfla r e .
Inches.
i
Inches. ‘
7
1
1
1
14
1
1
1
14
14
S tr a ig h t
fo o t.
Inches.
|
1
1
1
1
1
NERVOUS SYSTEM .
The prevalence of defects of the nervous system is shown in General
Table l .18 Of the entire group, nervous defects were noted in 75
children— only 2.4 per cent. Individual defects were too few to be
of definite value statistically, and the clinical findings are equally
valueless without a more detailed and thorough examination than
was possible in this study.
18 See p . 65.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
62
PHYSICAL STATUS OF PRESCHOOL CHILDREN-.
Functional speech defects were noted in 1.7 per cent of the children,
practically equally distributed according to sex. They were chiefly
stammering, stuttering, and lisping, with a few cases of poor articu
lation.
MENTAL CONDITION.
No mental tests were conducted in connection with this study. If the observations of the examining physicians or nurses led to even
a suspicion of abnormality, the observations were supplemented by
information gained from the teacher, the mother, or the school
physician who conducted mental tests. Nineteen apparent mental
defectives and 18 suspected cases came under the observation of the
physicians during the course of the study.
GENITALIA.
An astonishingly high per cent of genital defects was found in
boys, due almost entirely to adherent or contracted prepuce, there
being 437 cases (28.1 per cent) of the former and 289 (18.6 per cent)
of the latter. There were recorded only 22 cases (1.4 per cent) of
other abnormalities of the genitalia than of the prepuce.
The data from this study are submitted merely as the results of
careful routine physical examinations based upon somewhat stand
ardized methods.
No attempt has been made to draw conclusions, since the findings
point very definitely to the need for further consecutive study of the
child before correlations between existing physical defects and their
possible causes may be determined. Studies of racial, economic,
and environmental factors, breast feeding, growth, intercurrent dis
eases, diet, sleep, and recreation, correlated with the objective
findings of periodic physical examinations covering the period from
birth to school age, would undoubtedly add a great deal to the present
knowledge of the physical development of the child and the factors
which modify it. Such studies would also in time afford a means
of evaluating present efforts in the field of child hygiene.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
APPENDIX A. GENERAL TABLES ON PHYSICAL FINDINGS OF
THE PRESCHOOL CHILD.
T able 1.— Prevalence o f defects, by sex; children 2 to 7 years o f age given 'physical
examination.
Both sexes.
Summary of defects.
Boys.
Girls.
Num
ber.
Per cent
distri
bution.
Num
ber.
Per cent
distri
bution.
Num
ber.
Total.............................................................
3,125
100.0
1,555
100.0
1,570
100.0
Without defects.....................................................
With defects...........................................................
Underweight (10 per cent and over).............
Anemia............................................................
Head defects....................................................
Eye defects......................................................
Defective vision........................................
Other defect..............................................
Ear defects.......................................................
Defective hearing.....................................
Other defect..............................................
Mouth defects............... •.................................
Nasopharyngeal defects..................................
Enlarged glands..............................................
Heart defects...................................................
Lung defects....................................................
Abnormal skin condition................................
Abdominal defects..........................................
Defects of bony and muscular system...........
Bony defects of rachitic origin.................
Postural defects........................................
Defects of nervous system..............................
Defects of mentality........................ ...............
Defects of genitalia..........................................
149
2,976
303
243
163
1890
738
245
*48
25
25
2,091
2,157
908
99
32
318
464
1,308
467
793
75
37
769
4.8
95.2
9.7
7.8
5.2
28.5
2 36.1
7.8
1.5
<1.4
.8
66.9
69.0
29.1
3.2
1.0
10.2
14.8
41.9
14.9
25.4
2.4
1.2
24.6
48
1,507
140
113
105
437
355
127
30
14
17
1,043
1,118
489
48
21
137
234
709
304
418
42
26
732
3.1
96.9
9.0
7.3
6.8
28.1
*35.6
8.2
1.9
4 1.6
1.1
67.1
71.9
31.4
3.1
1.4
8.8
15.0
45.6
19.5
26.9
2.7
1.7
47.1
101
1,469
163
130
58
453
383
118
18
11
8
1,048
1,039
419
51
11
181
230
599
163
375
33
11
37
6.4:
93.6
10.4
8.3
3.7
28.9
»36.6
7.5
1.1
41.2
.5
66.8
66.2
26.7
3.2
.7
11.5
14.6
38.2
10.4
23.9
2.1
.7
2.4
Per cent
distri
bution.
1 In 1,081 cases vision was not tested; hence this number does not include all possible cases of defective
vision.
2 Per cent based on 2,044 eases tested, 998 boys and 1,046 girls.
* In 1,279 cases hearing was not tested; hence this number does not include all possible cases of defective
hearing.
4 Per cent based on 1,846 cases tested, 901 boys and 945 girls.
T able 2.— Specified defects, by age and sex; children 2 to 7 years o f age given physical
examination.
Age and sex.
Total
chil
dren.
With
anemia.
Under
weight (10
per cent
and over).
With
decayed
teeth.
With
defective
tonsils.
With
adenoids,
positive
and
suspected.
Num Per Num Per Num Per Num Per Num Per
ber. cent. ber, cent. ber. cent. ber. cent. ber. cent.
Both sexes............................ 3,125
2 years, under 3 ........... ..................
3 years, under 4..............................
4 years, under 5..............................
5 years, under 6..............................
6 years, under 7..............................
7 years, under 8..............................
108178°— 22------5
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
511
496
549
667
682
220
243
7.8
303
5
3
21
67
114
33
1.0
.6
3.8
10.0
16.7
15.0
85
59
56
44
48
11
9.7 2,021
16.6
11.9
10.2
6.6
7.0
5.0
64.7 1,626
108 21.1
218 44.0
364 66.3
533 79.9
598 87.7
200 90.9
52.0 1,257
203 39.7
254 51.2
319 58.1
377 56.5
365 53.5
108 49.1
68
123
208
363
389
106
65
40.2
13.3
24.8
37.9
54.4
57.0
48.2,
66
P H Y S IC A L
S T A T U S OF P R E SC H O O L C H IL D R E N .
T able 2.—Specified defects, by age and sex; children 2 to 7 years o f age given 'physical
examination— Concluded.
Total
chil
dren.
Age and sex.
Under
weight (10
per cent
and over).
With
anemia.
With
W ith
decayed v decayed
tonsils.
teeth.
With
adenoids,
positive
and
suspected.
Num Per Num Per Num Per Num> Per Num Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Boys........................................ 1,555
113
'7.3
140
261
251
274
337
334
98
2
1
10
32
53
15
.8
.4
3.6
9.5
15.9
15.3
43
29
28
16
20
4
Girls......................................... 1,570
130
8.3
163
2 years, under 3.............................
4 years, under 5..............................
5 years) under 6 .............................
6 years) under 7.............................
7 years) under 8.............................
2 years, under 3.............................
4 years, under 5.............................
6 years) under 7.............................
7 years) under 8.............................
3
2
11
35
61
18
250
245
275
330
348
122
enlarged
glands.
Age and sex.
1.2
.8
4.0
10.6
17.5
14 8
9.0 1,007
836
53.8 . 676
43.5
110 42.1
132 52.6
163 59.5
198 58.8
183 54.8
50 51.0
41
69
109
206
205
46
15.7
27.5
39.8
61.1
61.4
46.9
10.4 1,014
64.6
790
581
37.0
51
103
182
260
305
113
20.4
42.0
66.2
78.8
87.6
92.6
93 37.2 * 27
54
122 49.8
99
156 56.7
157
179 54.2
184
182 52.3
60
58 47.5
10.8
22.0
36.0
47.6
52.9
49.2
42 16.8
30 12.2
28 10.2
8.5
28
28
8.0
7 5.7
With
abnormal
skin
condition.
64.8
57 21.8
115 45.8
182 66.4
273 81.0
293 87.7
87 88.8
16.5
11.6
10.2
4.7
6.0
4.1
50.3
With bony and muscular defects.
Total.
Of rachitic
origin.
Postural.
Num- Per Num- Per Num- Per Num- Per Num- Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Both sexes.
908
29.1
318
10.2
1,308
41.9
467
14.9
793
25.4
2 years, under 3 ..
3 years, under 4 ..
4 years, under 5 ..
5 years, under 6 ..
6 years, under 7 ..
7 years, under 8 ..
J 66
76
150
250
265
101
12.9
15.3
27.3
37.5
38.9
45.9
25
27
50
80
96
40
4.9
5.4
9.1
12.0
14.1
18.2
127
144
204
324
383
126
24.9
29.0
37.2
48.6
56.2
57.3
54
42
73
106
148
44
10.6
8.5
13.3
15.9
21.7
20.0
56
68
117
220
255
77
11.0
13.7
21.3
33.0
37.4
35.0
489
31.4
137
8.8
708
45.6
304
19.5
418
26.9
31
45
82
136
148
' 47
11.9
17.9
29.9
40.4
44.3
48.0
11
16
23
38
32
17
42
6.4
8.4
11.3
9.6
17.3
68
76
111
183
208
63
26.1
30.3
40.5
54.3
62.3
643
33
22
48
75
98
28
12.6
8.8
17.5
22.3
29.3
28.6
30
40
56
125
131
36
11.5
15.9
20.4
37.1
39.2
36.7
419
26.7
181
11.5
599
38.2
163
10.4
375
23.9
35
31
68
114
117
54
14.0
12.7
24.7
34 5
33.6
44.3
14
11
27
42
64
23
5.6
4.5
9.8
12.7
18.4
18.9
59
68
93
141
175
63
23.6
27.8
33.8
42.7
50.3
51.6
8.4
21
20
8. 2
25
9.1
31
9.4
50 • 14 4
16
13.1
26
28
61
95
124
41
10.4
11.4
22.2
28.8
35.6
33.6
Boys.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
Girls.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
T able 3.
67
,
G EN ER AL TABLES.
Specified defects, by color and nationality o f mother; children 2 to 7 years o f
age given physical examination.
Children of—
Total chil
dren.
Defect.
Total.........................
Anemia........L___
Underweight (10 per cent and over).
Eye disease or defect other than of
vision...................
Defective tonsils..........
Adenoids (definite and suspected)__
Enlarged glands...............
Abnormalsldn condition...........
Bony defects of rachitic origin.
Postural defects.........
Native white Foreign-bom
wfdte
mothers.
mothers.
Moth
ers
whose
na
tional
ity
was
Num Per
not
re
ber. cent.
port
ed.!
Negro
mothers.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
3,125
100,0
1,151
100.0
1,896
100.0
71
100.0
243
303
7.8
9.7
71
114
6.2
9.9
164
182
8.6
9.6
8
7
11.3
9.9
245
7.8
1,626
52.0
1,257
40.2
908 , 29.1
318
10.2
467
14.9
793 25.4
86
612
473
270
56
120
251
7.5
53.2
41.1
23.5
4.9
10.4
21.8
158
976
761
616
250
336
505
8.3
51.5
40.1
32.5
13.2
17.7
26.6
1
34
22
20
12
10
37
1.4
47.9
31.0
28.2
16.9
14.1
52.1
7
4
1
2
1
1 Per cent not shown where base is less than 50.
T able 4.
Specified defects, by earnings o f chief breadwinner; children 2 to 7 years o f aqe
given physical examination.
Earnings of chief breadwinner.
Total chil
dren.
Under $1,450.
$1,450 and
over.
Not re
ported.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
3,125
100.0
1,767
100.0
1,178
100.0
180
100.0
243
303
245
1,626
1,257
908
318
467
| 793
7.8
9.7
7.8
52.0
40.2
29.1
10.2
14.9
25.4
149
176
141
938
714
533
214
296
487
8.4
10.0
8.0
53.1
40.4
30.2
12.1
16.8
27.6
76
111
87
602
476
322
80
149
260
6.5
9.4
7.4
51.1
40.4
27.3
6.8
12.6
22.1
18
16
17
86
67
53
24
22
46
10.0
8.9
9.4
47.8
37.2
29.4
13.3
12.2
25.6
Defect.
Total.....................
Anemia.................
Underweight (10 per cent and over)..
Eye disease or defect other than of vision
Defective tonsils..............
Adenoids (definite and suspected)........
Enlarged glands................
Abnormal skin condition...........
Bony defects of rachitic origin..
Postural defects.......
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
gg
P H Y S IC A L
S T A T U S O P P R E S C H O O L C H H tD R E H .
T able 5 — Per cent o f children with specified defects, bydeviationfrom average weight fo r
height; children 2 to 7 years o f age given physical examination.
Relation of weight to height.
Below average.
Total
children. Average
and
Less than 7 per cent, 10 per
above.
less than cent and
7 per
over.
10.
cent.
Defect.
Total............... - ..........................
Anemia.................................. .........
Eye disease..............................— —
Decayed teeth......................................
Naso-pharyngeal defects........ .. - ........
Defective tonsils, no adenoids......
Adenoids, no defective tonsils----Defective tonsils and adenoids....
Diseased tonsils............................
Other............................................
Enlarged glands..................................
Abdominal defects........... - - ........- —
Defects of bony and muscular system,
Bony defects of rachitic origin...
Postural defects........................ - -
100.0
100.0
100.0
100.0
100.0
7.8
5.0
64.7
69.0
22.8
11.0
29.3
13.0
6.0
29.1
14.8
41.9
14.9
25.4
5.5
4.4
66.7
70.5
23.1
11.8
30.4
13.0
5.2
29.1
19.5
37.6
13.1
20.4
7.9
5.4
66.9
70.0
21.9
11.8
29.4
13.0
6.9
29.1
11.4
45.2
16.2
28.6
10.8
6.2
61.0
64.1
21.4
9.0
28.2
15.2
5.6
30.3
10.5
42.1
14.2
30.7
13.9
5.0
51.2
64.0
26.1
6.6
25.1
10.9
6.3
27.4
12.5
47.2
18.8
28.7
T able 6.— Specified skin diseases, by age and sex; children 2 to 7 years o f age given physical
examination.
Children with—
Age and sex.
Total
chil
dren.
Eczema.
Pediculosis. Impetigo.
Infected
sores.
Ringworm.
Scabies.
Per
Num Per Num Per Num- Per Num- Per Num- Per Number. cent. ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Both sexes.
2 years, under 3..
3 years, under 4..
4 years, under 5..
5 years, under 6..
6 years, under 7..
7 years, under 8..
Boys.......
rs, under 3.
rs, under 4.
rs, under 5.
rs, under 6.
rs, under 7.
rs, under 8.
jirls.
2 years, under 3.
3 years, under 4.
4 years, under 5.
5 years, under 6.
6 years, under 7.
7 years, under 8.
3,125
80
2.6
145
4.6
511
496
549
667
682
220
6
2
16
21
27
8
1.2
.4
2.9
3.1
4.0
3.6
2
6
12
40
56
29
.4
1.2
2.2
6.0
8.2
13.2
1,555
49
3.2
35
2.3
261
251
274
337
334
98
2
2
9
13
19
4
.8
.8
3.3
3.9
5.7
4.1
1
1
3
15
5
10
.4
.4
1.1
4.5
1.5
10.2
1,570
31
2.0
110
7.0
250
245
275
330
348
122
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
4
1.6
7
8
8
4
2.5
2.4
2.3
3.3
1
5
9
25
51
19
.4
2.0
3.3
7.6
14.7
15.6
8
0.3
3
.4
3
.2
5
3
.3
.9
67
2.1
29
0.9
9
0.3
11
11
17
12
12
4
2.2
2.2
3.1
1.8
1.8
1.8
5
6
3
7
6
2
1.0
1.2
.5
1.0
.9
.9
4
2
3
■ .7
.3
.4
35
2.3
18
1.2
5
.3
6
6
8
6
6
3
2.3
2.4
2.9
1.8
1.8
3.1
1
6
2
3
4
2
.4
2.4
.7
.9
1.2
2.0
2
1
2
.7
.3
.6
32
2.0
11
.7
4
.3
2.0
2.0
3.3
1.8
1.7
.8
4
1.6
1
4
2
.4
1.2
.6
2
1
1
.7
.3
.3
5
5
9
6
6
1
-
T able 7.— Condition o f specified glands, by sex; children 2 to 7 years o f age given physical examination.
Children with specified glands in specified condition.
Occipital
glands.
Submax illary
glands.
Axillary
glands.
Cervical
glands.
Epitrochlear
glands.
Inguinal
glands.
Thyroid
gland.
Condition of glands, and sex.
Percent Num Per cent Num Per cent Num Per cent Num Percent
cent
cent
Per
Num- Per
distri
distri
distri
distri
distri Num
distri Num
distri
ber. bution.
ber. bution.
ber. bution.
ber. bution.
/ her. bution.
ber. bution.
ber. bution.
100.0
3,125
100.0
3,125
100.0
3,125
100.0
3,125
100.0
3,125
100.0
3,125
100.0
99.3
.7
.1
1,076
1,345
654
47
607
50
3
47
34.4
43.0
20.9
1.5
19.4
1.6
.1
1.5
898
1,986
233
33
200
8
1
7
28.7
63.6
7.5
1.1
6.4
.3
3,009
101
14
12
2
1
1
96.3
3.2
.4
- .4
.1
3,123
2
99.9
.1
2,046
1,028
49
49
65.5
32.9
1.6
1.6
3,065
98.1
58
58
1.9
1.9
2
2
.1
.1
2
2
.1
.1
.2
Boys.................................................................................. 1,555
100.0
1,555
100.0
1,555
100.0
1,555
100.0
1,555
100.0
1,555
100.0
1,555
100.0
Glands:
Nonpalpable........................................................................ 1,538
16
1
1
98.9
1.0
.1
.1
516
656
354
23
331
29
•3
26
33.2
42.2
22.8
1.5
21.3
1.9
.2
1.7
417
995
137
20
117
6
1
5
26.8
64.0
8.8
1.3
7.5
.4
.1
.3
1,488
55
11
10
1
1
1
95.7
3.5
.7
.6
.1
.1
.1
1,553
2
99.9
.1
944
573
36
36
60.7
36.8
2.3
2.3
1,534
98.6
20
20
1.3
1.3
2
2
.1
.1
1
1
.1
.1
100.0
1,570
100.0
1,570
100.0
1,570
100.0
1,570
100.0
1,570
100.0
1,570
100.0
1,564
5
1
99.6
.3
.1
481
991
96
13
83
2
30.6
63.1
6.1
.8
5.3
.1
1,521
46
3
2
1
96.9
2.9
.2
.1
.1
100.0
1,102
455
13
13
70.2
29.0
.8
.8
1,531
97.5
.1
35.7
43.9
19.1
1.5
17.6
1.3
1,570
1
560
689
300
24
276
21
38
38
2.4
2.4
.1
.1
1.3
2
.1
1
1
21
Girls...................................................................... ........... 1,570
Glands:
Nonpalpable.......................................................................
1
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
{
-
1
G EN ER AL TABLES.
Both sexes........................................................................ 3,125
Glands:
Nonpalpable........................................................................ 3,102
21
2
1
1
T a b l e 8. —Specified defects o f bony and muscular system, by age and sex; children 2 to 7 years o f age given physical examination.
^
Children with defects of Bony and muscular system.
Total
children.
Harrison’s
groove.
Enlarged
epiphyses.
Pigeon
breast.
Num- Per
ber. cent.
Num- Per
ber. cent.
Num- Per
ber. cent.
Num- Per
ber. cent.
16
250
2
275
330
348
122
1
2
5
1
5 years, under 6..........
6 years’, under 7..........
7 years, under 8..........
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1.0
33
10
.6
92
5.9
193
12.4
.8
2.8
3.6
5.3
6.3
4.1
1
6
25
83
96
27
.4
2.4
9.1
24.6
28.7
27.6
1
1
2
8
13
2
.4
.4
.7
2.4
3.9
2.0
1
2
5
1
.4
.8
1.8
.3
1
1.0
10
14
16
29
19
4
3.8
3.1
2
7
10
18
21
4
5.6
5.8
8.6
5.7
4.1
31
28
26
51
34
23
11.9
11.2
9.5
15.1
10.2
23.5
1.0
41
2.6
214
13.6
30
1.9
6
.4
102
6.5
107
6.8
2
2
11
13
10
3
.8
.8
4.0
3.9
2.9
2.5
2
3
31
59
91
28
.8
1.2
11.3
17.9
26.1
23.0
1
2
1
9
11
6
.4
1
.8
.4
2.7
3.2
4.9
.4
1
3
1
.3
.9
.8
11
9
22
31
21
8
4.4
3.7
8.0
9.4
6.0
6.6
23
15
22
19
18
10
9.2
6.1
8.0
5.8
5.2
4
4
6
6
15
1.5
1.6
2.2
1.8
4.5
8.2
4.2
4.8
8.4
11.0
13.5
18.4
3
4.0
63
4.0
15
7
7
2.8
2.9
7
’4
14
11
17
7
5.1
3.3
4.9
5.7
11
10
21
7
4.0
3.0
6.0
5.7
.6
1.4
.8
12
1.7
11
12
23
37
45
18
.8
2. n
3.6
27
5.0
3.6
6.6
9.2
9.9
2.8
2.9
7
1
1
8
4
1
9.6
54
43
48
70
52
15.3
13
9
18
31
33
8
63
30Ó
4.1
4.6
^4
.4
2.4
1.1
.8
3.5
6.9
9.0
8.2
C H IL D R E N ,
Girls................... 1,570
6.2
21
23
38
60
40
238
2.4
•8 . I
OF P R E S C H O O L
98
194
4.0
1.7
STATU S
5 years! under 6..........
2.5
.4
.4
.9
.3
.4
.9
3.2'
38
.8
.8
1.8
.9
261
251
274
337
0.5
2
2
5
62
9.4
2
2
5
3
2 years, under 3..........
3 years! under 4 ..........
16-
.4
.6
.5
5.9
5.5
146
15
1.8
2
3
3
17
24
8
2
3
2
7.2
1.0
57
Per
cent.
9
56
142
187
55
112
15
14.5
Number.
1.8
3.8
4.6
4.5
31
31
7
Boys................... 1,555
7 years’ under 8..........
452
_
Num- Per
ber. cent.
9
21
1.0
1.3
2.1
2.8
1.8
16
32
42
50
Per
cent.
10.6
8.7
8.7
10.5
7.6
15.0
3.2
5.8
6.3
7.3
6.8
1.4
1.1
.7
1.2
.5
Number.
.6
1.8
10.2
21.3
27.4
25.0
4
5
7
14
19
4
4
7
6
5
8
1
Per
cent.
Per
cent.
Ts
53
in r
3.8
6.2
7.0
9.7
11.4
511
496
549
667
682
220
Number.
Per Numcent. ber.
Bowles’s.
3.3
6.7
18
19
34
47
66
25
20”
Knock-knee.
r
209
IT
Winged
scapulae.
103
5.6
1.0
2 years, under 3..........
3 years! under 4..........
4 years, under 5..........
5 years! under 6 ..........
Number.
ju T
175
31
Both sexes......... 3,125
Round
shoulders.
Beaded
ribs.
P H Y S IC A L
Age and sex.
71
G EN ER AL TABLES.
T a b l e 9. — R ela tion o f w eight to height, by age and sex ; children 2 to 7 years o f age given
ph ysical exam ination.
Total children. 2 years, under 3. 3 years, under 4. 4 years, under 5.
Relation of weight to height and sex.
cent
Per cent Num Per cent Num Per cent
Num Per
distri Num
distri
distri
distri
ber. bution.
ber. bution.
ber. bution.
ber. bution.
Both sexes.................................. 3,125
100.0
511
100.0
496
100. 0
549
100.0
Weigh#for height:
Average and a b o v e ...................... 1,319
Below average............................... 1,806
Less than 7 per cent .............. 1,180
7 per cent, less than 10...........
323
10*per cent and o v e r ..............
303
42.2
57.8
37.8
10.3
9.7
188
323
172
66
85
36.8
63.2
33.7
12.9
16.6
194
302
184
59
59
39.1'
60.9
37.1
11.9
11.9
223
326
222
48
56
40.6
59.4
40.4
8.7
10.2
Boys..............................................
1,555
100.0
261
100.0
251
100.0
274
100.0
Weight for height:
Average and a b o ve ............ ..........
Below average...............................
Less than 7 per cent..... ..........
7 per cent, less than 10...........
10 per cent and over...............
618
937
627
170
140
39.7
60.3
40.3
10.9
9.0
95
166
91
32
43
36.4
63.6
34.9
12.3
16.5
94
157
95
33
29
37.5
62.5
37.8
13.1
11.6
99
175
119
28
28
36.1
63.9
43.4
10.2
10.2
Girls...............................................
1,570
100.0
250
100.0
245
100.0
275
100.0
Weight for height:
Average and above........................
Below average...............................
Less than 7 per cent...............
7 per cent, less than 10__ ___
10 per cent and over...............
701
869
553
153
163
44.6
55.4
35.2
9.7
10.4
93
157
81
34
42
37.2
62.8
32.4
13.6
16.8
160
145
89
26
30
40.8
59.2
36.3
10.6
12.2
124
151
103
20
28
45.1
54.9
37.5
7.3
10.2
5 years, under 6. 6 years, under 7. 7 years, under 8.
Relation of weight to height and sex.
cent
Percent Num Percent
Num Per
distri Num
distri
distri
ber. bution.
ber. bution.
ber. bution.
Both sexes......................
667
100.0
682.
100.0
220
100.0
Weight for height:
Average and above............
Below average...................
, Less than 7 per cent...
7 per cent, less than 10.
10 per cent and over...
284
383
277
62
44
42.6
57.4
41.5
9.3
6.6
320
362
239
75
48
46.9
53.1
35.0
11.0
7.0
110
110
86
13
11
50.0
50.0
39.1
5.9
5.0
Boys.................. ................
337
100.0
334
100.0
98
100.0
Weight for height:
Average and above............
Below average....................
Less than 7 per cent...
7 per cent, less than 10
10 per cent and over...
135
202
152
34
16
40.1
59.9
45.1
10.1
4.7
147
187
132
35
20
44.0
56.0
39.5
10.5
6.0
48
50
38
8
4
49.0
51.0
38.8
8.2
4.1
Girls „ ................................
330
100.0
348
100.0
122
100.0
149
181
125
28
28
45.2
54.8
37.9
8.5
8.5
173
175
107
40
28
49.7
50.3
30.7
11.5
8.0
62
60
48
5
7
50.8
49.2
39.3
4.1
5.7
Weight f6r height:
Average and above............
Below average....................
Less than 7 per cent...
7 per cent, less than 10.
10 per cent and over...
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
72
P H Y S IC A L S T A T U S OF P R E S C H O O L
C H IL D R E N .
T a b l e 10.—Relation o f weight to height, by color and nationality o f mother; children 2
to 7 years o f age given 'physical examination.
Relation of weight to height.
Below average.
Average
Color and nationality of mother. chil and above.
dren.
Less than 7 per cent, 10 per cent
7 per cent. less than 10. and over.
Total.
Num Per Num Per Num Per Num Per Num Per
ber.. cent.1 ber. cent.1 ber. cent.1 ber. cent.1 ber. cent.1
.
Total.................................... 3,125 1,319
3,047 1,284
466
1,151
1,896
818
321
144
102
313
90
224
176
76
157
89
139
58
47
83
212
483
71
33
7
2
42.2 1,806
57.8 1,180
37.8
323
10.3
303
9.7
42.1 1,763
40.5
685
43.1 1,078
177
44.9
211
32.6
134
40.2
43.2
100
68
56.7
81
41.7
36
56.6
271
43.9
38
46.5
5
1,150
439
711
121
137
89
66
52
49
22
175
26
4
37.7
38.1
37.5
37.7
43.8
39.7
37.5
33.1
35.3
26.5
36.2
36.6
317 10.4
132 11.5
9.8
185
8.7
28
40 12.8
22
9.8
23 13.1
7
4.5
11 7.9
9.6
8
46
9.5
5 7.0
1
296
114
182
28
34
23
11
9
21
6
50
7
9.7
9.9
9.6
8.7
10.9
10.3
6.3
5.7
15.1
7.2
10.4
9.9
57.9
59.5
56.9
55.1
67.4
59.8
56.8
43.3
58.3
43.4
56.1
53.5
i Not shown where base is less than 50.
T able 11.—
P revalence o f specified defects, by deviation fr o m average w eight f o r height;
children 2 to 7 years o f age given p h ysical exam ination.
Deviation from aver Total
age weight for ] chil
dren.
height. 1
With
decayed
teeth.
With
diseased
tonsils.
With
postural
defects.
With bonv
defects of
rachitic
origin.
With
anemia.
Num Per Num Per Num Per Num Per Num Per Num Per
ber. cent. ber. cent. ber. cent. ber. cent. ber. cent. ber. cent.
Total............... 3,125 2,021
4£ pounds or more
below average. . . . .
3J and 4 pounds be
low average...........
3 pounds below aver
age .........................
pounds below
average..................
2 pounds below aver
age .........................
1J pounds below
average..................
1 pound below average.........................
§ pound below aver- age.........................
Average....................
J pound above aver• âge.........................
1 pound above averâge.........................
1J pounds above
“average..................
2 pounds above average.........................
24 pounds above
average..................
3 pounds above average.........................
34 and 4 pounds
above average..’...
44 pounds or more
above average.......
Not classified______
With
adenoids.
64.7 1,050
33.6
406
13.0
885
28.3
467
14.9
243
7.8
84
51
60.7
31
36.9
12
14.3
33
39.3
17
20.2
20
23.8
99
68
68.7
35
35.4
19
19.2
30
30.3
23
23.2
15
15.2
110
69
62.7
37
33.6
20
18.2
41
37.3
19
17.3
17
15.5
126
72
57.1
33
26.2
23
18.3
37
29.4 • 19
15.1
16
12.7
177
100
56.5
55
31.1
10
5.6
50
28.2
20
11.3
15
8.5
188
126
67.0
56
29.8
22
11.7
59
31.4
32
17.0
21
11.2
255
158
62.0
74
29.0
32
12.5
79
31.0
42
16.5
17
6.7
241
270
154
185
63.9
68.5
85
39
30
16.2
11.1
73
71
30.3
26.3
43
39
17.8
14.4
16
14
6.6
88
35.3
32.6
234
144
61.5
84
35.9
22
9.4
62
26.5
26
11.1
13
5.6
259
160
61.8
93
35.9
32
12.4
70
27.0
40
15.4
18
6.9
217
135
62.2
70
32.3
25
11.5
51
23.5
36
16.6
13
6.0
185
114
61.6
59
31.9
19
10.3
46
24.9
28
15.1
10
5.4
146
96
65.8
51
34.9
18
12.3
40
27.4
17
11.6
10
6.8
119
80
67.2
41
34.5
21
17.6
37
31.1
16
13.4
6
5.0
159
114
71.7
53
33.3
23
14.5
39
24.5
21
13.2
4
2.5
207
49
153
42
73.9
85.7
89
16
43.0
32.7
28
11
13.5
22.4
53
14
25.6
28.6
20
9
9.7
18.4
14
4
6.8
8.2
5.2
i
In this table, the average weights for height of the Children’s Y ear series were taken as standard. See
Statures and Weights of Children under Six Years of Age, Children’s Bureau Publication No. 87, p. 29.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
73
GENERAL TABLES.
T able
12.— A n n u a l
earnings o f ch ief breadw inner, by color and n a tiv ity o f m other;
children 2 to 7 years o f age given p h ysical exam ination.
Color and nativity of mother.
Total
children.
Annual earnings of chief
breadwinner.
White.
Total.
Native.
Foreign
born.
Negro.
Per
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
Num cent
disdisdisdisdisber.
tribu- ber. tribu- ber. tribu- ber. tribu- ber. tribution.
tion.
tion.
tion.
tion.
Total.............................. .
Under $6 50.................................
$650-$849....... 1............................
$850-$1.049.....................................
$1,050-11,249................................
$1,250-$1,449..............................
$1,450-$l,849.................................
$l,850-$2,249................................. .
$2,250 and over..............................
No chief breadwinner and no
earnings......................................
Not reported............ ....................
3,125 100.0 3,047 100.0 1,151 100.0 1,896 100.0
110 3.5
240
7.7
412 13.2
491 15.7
456 14.6
613 19.6
262
8.4
303
9.7
102
229
396
477
448
606
259
300
3.3
7.5
13.0
15.7
14.7
19.9
8.5
9.8
58
180
57
173
1.9
5.7
1.9
5.8
i Per cent distribution not shown where base is less than 50.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
19
1.7
34
3.0
69
6.0
146 12.7
154 13.4
313 27.2
151 13.1
194 16.9
19
52
1.7
4.5
83
195
327
331
294
293
108
106
4.4
10.3
17.2
17.5
15.5
15.5
5.7
5.6
38
121
2.0
6.4
71 100.0
8 11.3
11 15.5
15 21.1
14 19.7
8 11.3
6
8.5
1
1.4
1 1.4
1
6
1.4
8.5
Not
reported.i
7
1
1
2
2
1
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
APPENDIX B. RESULTS OF PHYSICAL EXAM INATIONS
CHILDREN UNDER TW O YEARS OF AGE.
OF
Source of material.
During the conferences held in connection with this study, exami
nations were made of 994 infants, the same standards being observed
in making the physical examinations and tabulations as were used
in the preschool group. Since rather interesting differences in the
incidence of defects in the two age groups were found, a brief state
ment of the results is here appended.
Findings in general.
Of the entire group of 994 infants, 28.3 per cent were found to have
no defects; less than half (40.2 per cent) of those under 6 months
of age were without defect. More boys than girls showed defects,
as only 12 per cent of the former were without defect in contrast to
46.4 per cent of the latter.
I.— N u m ber
T able
o f defects, by age and sex ; children under 2 years o f age given ■physical
exam ination.
Total
children.
Number of defects, and sex.
Under
6
months.
6 months,
under
1 year.
1 year,
under
if' years.
1£ years,
under
2 years.
Per
Per
Per
Per
Per
cent Num cent
cent
cent
cent
Num distri
distri Num
distri Num
distri Num distri
ber.
ber.
ber.
ber.
ber.
bu
bu
bu
bu
bu
tion.
tion.
tion.
tion.
tion.
Both sexes.
994
100.0
214
100.0
278
100.0
245
100.0
257
100.0
With defects___
Less than 5..
1.............
2 ....
5 to 9.............
10 to 14.;.......
Without defects..
713
676
318
205
114
39
34
3
.281
71.7
68.0
32.0
20.6
11.5
3.9
3.4
.3
28.3
128
128
87
31
6
4
59.8
59.8
40.7
14.5
2.8
1.9
182
179
104
52
18
5
3
65.5
64.4
37.4
18.7
6.5
1.8
1.1
191
180
69
61
39
11
11
78.0
73.5
28.2
24.9
15.9
4.5
4.5
212
189
58
61
51
19
82.5
73.5
22.6
23.7
19.8
7.4
86
40.2
96
34.5
54
22.0
45
17.'5
Boys..............
524
100.0
113
100.0
146
100.0
128
100.0
137
100.0
With defects.......
Less than 5..
1............
2 ....
4 ........
5 to 9........
10 to 14........
Without defects..
461
435
188
137
81
29
24
2
63
88.0
83.0
35.9
26.1
15.5
5.5
4.6
.4
12.0
96
96
61
26
6
3
85.0
85.0
54.0
23.0
5.3
2.7
127
125
65
41
14
5
2
87.0
85.6
44.5
28.1
9.6
3.4
1.4
115
106
35
36
28
7
9
89.9
82.8
27.3
28.1
21.9
5.5
7.0
123
108
27
34
33
14
89.8
78.8
19.7
24.8
24.1
10.2
17
15.0
19
13.0
13
10.2
2
14
10.2
Girls..............
470
100.0
101
100.0
132
100.0
117
100.0
120
100.0
With defects.......
Less than 5...
1..............
2 ....
3 .........
4 .........
. 5 to 9............. .
10...................
Without defects..,
252
241
130
68
33
10
10
1
218
53.6
51.3
27.7
14.5
7.0
2.1
2.1
.2
46.4
32
32
26
5
31.7
31.7
25.7
5.0
55
54
39
11
4
1
.8
65.0
63.2
29.1
21.4
9 4
3. 4
1.7
74.2
67.5
25.8
22.5
1
76
74
34
25
11
4
2
89
81
. 31
27
1.0
41.7
40.9
29.5
8.3
3.0
5
42
41
35.0
1
3f
25.8
3
........
4 ......
3
.......
69
6a 3
77
sa 3
75
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
76
P H Y S IC A L
S T A T U S OE P R E S C H O O L C H IL D R E N
An analysis of the kinds of defects as given in Table II shows
a fairly even distribution as to sex except in defects of *the genitalia,
where a marked difference between boys and girls occurs.
T a b l e I I . — Prevalence o f disease or defects, by sex ; children under 2 years o f age given
p h ysical exam ination.
Disease or defect.
Total.
Without defect.........................................
With disease or defect..............................
General:
Underweight (10 per cent and over).
Anemia...............................................
Head.
Abnormal shape................... .............. - - - - - Open fontanel (children 1J to 2 years of age)
Eyes:
.
, . ,
Diseases and defects other than of vision...
Conjunctivitis......................................... ,
Blepharitis.............- ................................
Stye..........................................................
Ptosis.................. ....................................
Corneal opacities.....................................
Strabismus..............................................
Blindness (one eye)................................
Ears.
Acute otorrhea...
Chronic otorrhea.
Mouth........................
Decayed teeth—
Malocclusion.. . .
Naso-pharynx...........
Defective tonsils.
Adenoids (definite). .
Adenoids (suspected).
Glands:
Enlarged or greatly enlarged............
Submaxillary.....................................
Cervical..............................................
Axillary......... ....................................
Inguinal............................................ .
Heart....................................................... .
Heart disease....................................
Questionable heart disease..............
. Lungs......................................................
Lung disease......................................
Questionable lung disease...............
Skin.........................................................
Eczema.............................................
Im petigo................. .........................
Infected sores....................................
Ringworm........................................
Scars..................................................
Abdomen................................................
Distended abdomen.........................
Enlarged liver..................................
Hernia...............................................
Bony and muscular system............ —
Beaded ribs.......................................
Pigeon breast.................................. .
Harrison’s groove.............................
Enlarged epiphyses..........................
Round shoulders..............................
Winged scapubn...............................
Lordosis....... ....................................
Knock-knee......................................
Bowlegs.......................................
Clubfeet.............................................
Arthritis.........................- .................
Paralysis...........................................
Mentality........................................ - —
Defect apparent...............................
Defect suspected..............................
Genitalia: Boys......................................
Prepucial defects..............................
Defects other than those of prepuce.
Genitalia: Girls:
V aginal discharge
..................- - ■
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Per
cent.
Num
ber.
Girls.
Boys.
Both sexes.
Per
cent.
Num
ber.
Per
cent.
Num
ber.
994
100.0
524
100.0
470
100.0
281
713
28.3
71.7
63
461
12.0
88.0
218
252
46.4
53.6
262
172
25
49
26.4
2.2
17.3
2.5
4.9
152
13
89
16
25
29.0
2.5
17.0
3.1
4.8
110
9
83
9
24
23
3
2
2.3
.3
.2
14
3
2.7
.6
.2
23.4
1.9
17.7
1.9
5.1
M
1.9
2
2
13
.2
.2
1.3
8
2
.8
.2
.6
22
1
1
6
26
16
12
225
182
.1
2.6
1.6
1.2
22.6
31
38
16
22
1
5
3
1
2
9
4
5
26
14
2
10
1
2
150
121
1
38
135
11
2
10
8
3
1
4
1
121
2
2
1
7
2
5
3.8
1.6
2.2
.1
.5
.3
.1
.2
.9
.4
.5
2.6
1.4
.2
1.0
.1
.2
15.1
12.2
.1
3.8
13.6
1.1
.2
1.0
.8
.3
.1
.4
.1
12.2
.2
.2
.1
.7
.2
.5
.4
1.1
.2
1.5
.1
18.3
2.2
3.1
22
1
6
15
10
5
129
101
17
17
23
9
14
1
2
2
1
1
7
4
3
14
7
2
5
1
1
71
56
1
19
81
7
2
8
5
2
1
3
1
72
1
2
1
4
2
2
374
371
7
L0
1.0
.6
.4
.2
2.3
1.3
1.5
20.4
17.2
2.9
1.9
1.0
24.6
19.3
3.2
3.2
4.4
1.7
2.7
.2
.4
.4
.2
.2
1.3
.8
.6
2.7
1.3
.4
1.0
.2
.2
13.5
10.7
.2
3.6
15.5
1.3
.4
1.5
1.0
.4
.2
.6
.2
13.7
.2
.4
.2
.8
.4
.4
71.4
70.8
1.3
1.1
3.0
15
7
8
3.2
1.5
1.7
3
.6
1
1
.2
.2
2
.4
2
7
.4
2.6
1.5
5
1.1
1
79
65
.2
16.8
13.8
19
64
4
4.0
11.5
.9
2
3
.4
49
1
10.4
.2
3
.6
12
1
1
.6
.2
.2
à....... "6
2
.4
EXAM INATION OF CHILDREN UNDER TWO YEARS OF AGE.
77
Irrespective of age, the average number of defects of all infants
examined was 2.2 for boys and 1.9 for girls.
The incidence of defects according to age increased steadily in
both sexes from 6 months to 2 years, but the rate of increase was
much higher in girls. For instance, 85 per cent of the boys under
6 months of age had defects, in contrast to 31.7 per cent of the girls;
while at 2 years of age the defects had increased to 89.8 per cent
and 74.2 per cent for boys and girls respectively.
Height and weight.
The average heights and weights of all white infants are recorded
by months in Text Table IV. As in the case of the preschool child,
these averages are somewhat lower throughout than those used as
standards in the examinations.
Nutrition.
More than a quarter (26.4 per cent) of all children under 2 years
of age were more than 10 per cent below average weight for height,
in contrast with 9.7 per cent of the children 2 to 7 years of age.
This marked difference, in the two homogeneous groups classified
by age, rather suggests that a range greater than 10 per cent below
average weight for height would be a fairer standard during infancy.
The age group, 6 months to 1 year, showed the highest per cent
(14) graded “ excellent” as to nutrition, and the higher age group,
1 to 1| years, had the highest per cent (35.9) underweight. In
fact, the proportion of children 10 per cent or more below the average
weight for height increased steadily with age up to 18 months;
but in the 6 month period following, a decidedly better condition
was apparent, only 21 per cent of these children being 10 per cent
or more underweight.
T a b l e I I I . — Grade o f n utrition , by age and sex; children under 2 years o f age given
physical exam ination.
Grade of nutrition.
Age and sex.
Total
chil
dren.
Excellent
Good.
Poor.
Very poor.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
Both sexes...................................
994
94
9.5
638
64.2
242
24.3
20
&0
Under 6 f n o n t h s ..............................
6 months, under i year ; ......................
1 year, under l i years...........................
li' years, under 2 years.........................
Boys...............................................
214
,278
245
257
524
10
39
20
25
61
4.7
14.0
8.2
9.7
11.6
159
164
137
178
311
74.3
59.0
55.9
69*3
59.4
38
72
85
47
141
17.8
25.9
34.7
18.3
26.9
7
3
3
7
11
3.3
l.i
1.2
2.7
2.1
Under 6 months...................................
6 months, under 1 year.......................
1 year, under l i years...........................
l i years, under 2 years.........................
Girls................................................
113
146
128
137
470
6
28
12
15
33
5.3
19,2
9.4
110.9
7.0
79
75
65
92
327
69.9
51.4
50.8
67.2
69.6
24
41
50
26
101
21.2
28.1
39.1
19.0
21.5
4
2
1
4
9
3.5
1.4
.8
2.9
1.9
Under 6 months...................................
6 months, under 1 year........................
1 year, under l i years...........................
li' years, under 2 years.........................
101
132
117
120
4
11
8
10
4.0
8.3
6.8
8.3
80
89
72
86
79.2
67.4
61.5
71.7
14
31
35
21
13.9
23.5
29.9
17.5
3
1
2
3
3.0
.8
1.7
2.5
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
78
P H Y S IC A L
S T A T U S OF P R E S C H O O L C H IL D R E N .
A table showing the amount of deviation from average weight for
height in children under 2 years of age is given for purposes of com
parison with the preschool group.
T able
IV .—Deviation from average weight fo r height, by age and sex; children under 2
years o f age given physical examination.
Total
children.
Deviation from average weight
for height.
Under 6
months.
6 months, less 1 year,less
14 years, less
than 1 year. than 1J years. than 2 years.
Per
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
Num cent
dis
dis
dis
dis
dis
ber. tribu ber. tribu ber. tribu ber. tribu ber. tribu
tion.
tion.
tion.
tion.
tion.
Both sexes......................
994
100.0
214
100.0
278
100.0
245
100.0
257
100.0
Average and above..................
Below average......... '...............
Less than 7 per cent..........
7 per cent, less than 10___
10*per cent and over..........
307
687
279
146
262
30.9
69.1
28.1
14.7
26.4
96
118
49
24
45
44.9
55.1
22.9
11.2
21.0
86
192
73
44
75
30.9
69.1
26.3
15.8
27.0
57
188
63
37
88
23.3
76.7
25.7
15.1
35.9
68
189
94
41
54
26.5
73.5
36.6
16.0
21.0
Boys...................................
524
100.0
113
100.0
146
100.0
128
100.0
137
100.0
Average and above..................
Below average..........................
Less than 7 per cent..........
7 per cent, less than 10___
10 per cent and over..........
165
359
139
68
152
31.5
68.5
26.5
13.0
29.0
42
71
29
14
28
37.2
62.8
25.7
12.4
24.8
51
95
29
23
43
34.9
65.1
19.9
15.8
29.5
28
100
34
15
51
21.9
78.1
26.6
11.7
39.8
44
93
47
16
30
32.1
67.9
34.3
11.7
21.9
Girls...................................
470
100.0
101
100.0
132
100.0
117
100.0
120
100.0
Average and above............... ..
Below average..........................
Less than 7 per cent..........
7 per cent, less than 10___
10 per cent and over..........
142
328
140
78
110
30.2
69.8
29.8
16.6
23.4
54
47
20
10
17
53.5
46.5
19.8
9.9
16.8
35
97
. 44
21
32
26.5
73.5
33.3
15.9
24.2
29
88
29
22
37
24.8
75.2
24.8
18.8
31.6
24
96
47
25
24
20.0
80.0
39.2
20.8
20.0
Anemia.
Of the children .under 2 years of age, only 2.2 per cent showed suf
ficient pallor to be considered anemic. Pallor increased with age, as
did the number of defects, and was more common in boys than in
girls. The percentage was also higher in underweight children.
Vaccination.
Only 24, or 2.4 per cent, of the children under 2 years of age had been
vaccinated.
Head.
Measurements showed only 13 heads of abnormal size, 7 small and
.6 large, in the 994 children of this age group, a percentage of 1.3.
Special attention was given to the palpation of fontanels. Four
cases of completely closed fontanels were noted in infants under 6
months, and 15 in the period 6 months to 1 year. There were 49
cases of open fontanel in infants between 18 months and 2 years of
age.
Eyes.
Obviously, it was impossible to obtain data regarding vision in this
group; but 23 infants, or 2.3 per cent, showed eye defects, the pro
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
E X A M IN A T IO N
OF C H IL D R E N
UNDER TW O
Y E A R S OF A G E .
79
portion steadily increasing with age from 0.9 per cent among infants
under 6 months to 3.1 per cent among those 1| to 2 years of age.
Ears.
Ear defects in this group of infants were confined to 8 cases of
otorrhea.
Mouth.
A careful examination of the mouths revealed little of significance
beyond the fact that only 5 infants, or 2.3 per cent of those under
6 months of age, had one or more teeth, while 11.2 per cent had com
pleted teething under 2 years of age. Sixteen infants (2.4 per cent)
18 months of age or over had decayed teeth, and 12 cases (1.2 per
cent) of malocclusion were found.
Nasopharynx.
The most common defects of infancy, as of the preschool age,, were
those of the nasopharynx, although these defects were about onethird as prevalent in infancy as in the preschool period. Boys
slightly predominated in all types of nasopharyngeal defects, show
ing 24.6 per cent in contrast to 20.4 per cent among the girls. The
incidence of nasopharyngeal defects among infants under 6 months
of age was noticeably slight, but a marked and gradual increase in
the number of defects with age was found.
T a b l e V . — Nasopharyngeal defects, by age and sex; children under 2 years o f age given
physical examination.
Age and sex.
With mouth
With highWith defec
With ade
breathing.
arch palate. tive tonsils.
noids.
Total
chil
dren. Num Pèr
Num Per Num Per Num Per
ber. cent. ber. cent. ber. cent. ber. cent.
Both sexes..................................
994
Under 6 months...................................
6 months, under 1 year........................
1 year, under 1£ years...........................
1$ years, under 2 years.........................
214
278
245
257
55
5.5
30
3.0
182
18.3
53
5.3
10
19
26
3.6
7.8
10.1
1
6
11
12
.5
2.2
4.5
4.7
io
30
60
82
4.7
10.8
24.5
31.9
11
17
25
4.0
6.9
9.7
34
6.5
16
3.1
101
19.3
34
6.5
.9
2.7
4.7
3.6
5
16
32
48
4.4
11.0
25.0
35.0
8
11
15
5.5
8.6
10.9
3.0
81
17.2
19
4.0
1.5
4.3
5.8
5
14
28
34
5.0
10.6
23.9
28.3
3
6
10
2.3
5.1
8.3
Boys...............................................
524
Under 6 months...................................
6 months, under 1 year........................
1 year, under 1£ years...........................
1£ years, under 2 years.........................
113
146
128
137
7
11
16
4.8
8.6
11.7
1
4
6
5
Girls................................................
470
21
4.5
14
Under 6 months...................................
6 months, under 1 year........................
1 year, under 1£ years...........................
l j years, under 2 years.........................
101
132
117
120
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
3
8
10
2.3
6.8
8.3
2
5
7
80
PHYSICAL STATUS OF PRESCHOOL CHILDREN.
Mouth breathing increased from 3.6 per cent in the 6 months to 1
year period to 10.1 per cent in the 18 months to 2 years period.
High-arch palate showed a gradual development after 6 months
of age, the majority of cases being pronounced enough for recording
only after 1 year of age.
Tonsils.— Enlargement of tonsils increased with age from 4.7 per
cent under 6 months to 31.9 per cent from 18 months to 2 years.
To what extent the so-recorded “ enlarged tonsils” may have been a
normal hyperplasia of lymphoid tissue needs to be verified by further
observations; but only 1 infant in the group was considered to
have greatly enlarged tonsils and only 1 had diseased tonsils.
Removal of tonsils was advised in only 4 cases of the 182 defective,
3 of these being accompanied by adenoids.
Adenoids.— The prevalence of adenoids increased with age, even
during the period of infancy. Adenoids were definitely diagnosed in
22 cases (2.2 per cent), and symptoms such as mouth breathing and
high-arch palate led to a diagnosis of “ suspected or probable” ade
noids in 31 cases (3.1 per cent); thus the number of infants having
definite or probable adenoids amounted to 5.3 per cent.
Removal tif adenoids was recommended in a total of 9 cases, 6
being combined with defective tonsils. Only 1 case of adenoids
requiring removal was found in a child under 1 year of age.
Glands.
In 66 per cent of the entire group of infants the glands were not
even “ palpable,” and only 3.8 per cent had actually “ enlarged”
glands.
T a b l e V I .— Condition o f tonsils, by age; children under 2 years o f age given physical
examination.
Total
children.
Condition of tonsils.
Under 6
months.
1 year, under 1J years,under
6 months,
2 years.
under 1 year.
1£ years.
Per
Per
Per
Per
Per
cent Num cent Num cent Num cent Num cent
Num distri
distri ber. distri
distri
distri
ber.
ber.
ber.
ber.
bu
bu
bu
bu
bu
tion.
tion.
tion.
tion.
tion.
994
100.0
214
100.0
278
100.0
245
100.0
257
100.0
811
1
182
180
1
1
81.6
.1
18.3
18.1
.1
.1
204
95.3
248
89.2
185
75.5
10
10
4.7
4.7
30
29
10.8
10.4
60
60
24.5
24.5
174
1
82
81
1
67.7
.4
31.9
31.5
.4
1
.4
That the size of the glands gradually but markedly increased with
age is shown by the percentage “ palpable,” as follows: 7.9 per cent
under 6 months, 25.5 per cent from 6 months to a year, 38.4 per cent
from 1 year to 18 months, and 45.9 per cent from 18 months to 2
years.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
E X A M IN A T IO N
OF C H IL D R E N
UNDER TWO
Y E A R S OF A G E .
81
T a b l e V I I .— Condition o f glands, by age and sex; children under 2 years o f age given
physical examination.
Total
children.
Condition of glands, and sex.
Num
ber.
Under 6
months.
6 months, un 1 year, under 1} years, un
der 1 year.
1£ years.
der 2 years.
Per
Per
Per
Per
Per
cent Num cent
Num cent
Num cent
Num cent
dis
dis
dis
dis
dis
tribu ber. tribu ber. tribu ber. tribu ber. tribu
tion.
tion.
tion.
tion.
tion.
Both sexes......................
994
100.0
214
100.0
278
100.0
- 245
100.0
257
100.0
Normal...............................
Palpable............................
Enlarged and greatly enlarged..............................
With associated infeotion...........................
Without associated inf ection......................
656
300
66.0
30.2
195
17
91.1
7.9
206
71
74.1
25.5
141
94
57.6
38.4
114
118
44 4
45.9
38
3.8
2
.9
1
.4
10
4.1
25
9.7
21
2.1
1
.5
.8
18
7.0
17
1.7
1
.5
1
.4
8
3.3
7
2.7
Boys...................................
524
100.0
113
100.0
146
100.0
128
100.0
137
100.0
Normal..............................
Palpable............................
Enlarged and greatly enlarged..............................
With associated infection..........................
Without associated infection......................
325
176
62.0
33.6
101
11
89.4
9.7
104
41
71.2
28.1
67
55
52.3
43.0
53
69
38 7
1
.9
1
.7
6
4.7
15
10.9
Girls...................................
Glands:
Normal..............................
Palpable............................
Enlarged and greatly enlarged..............................
With associated infeo
tion...........................
Without associated infection......................
23
4.4
12
2.3
11
2.1
1
.9
1
.7
5
470
100.0
101
100.0
132
100.0
331
124
70.4
26.4
94
6
93.1
5.9
102
30
77.3
22.7
15
3.2
1
1.0
9
1.9
1
1.0
6
1.3
11
«A
3.9
4
2.9
117
100.0
120
100.0
74
39
63.2
33.3
61
49
50.8
3.4
10
1
.9
8.3
5.8
2.6
Heart.
Only one case of positive, organic cardiac disease and two question
able cases were found in the total of 994 infants.
Lungs.
The slight incidence of respiratory disease in this group of infants
is interesting, as shown by only four positive diagnoses and five
questionable cases.
Skin.
A. comparatively small percentage of infants showed any abnormal
skin condition— only 26, or 2.6 per cent.
Abdomen.
Distended abdomen was found in 121 cases, or 12.2 per cent, this
condition being slightly more prevalent among girls.
The presence of hernia was noted in 3.8 per cent of the group.
In both sex groups umbilical herniae predominated. ‘ Inguinal hernia
was observed in 7 cases, of which 6 were boys. The largest number
of herniae by age was found in the 18 months to 2 years groups.
Enlarged liver occurred in the case of one boy.
108178°— 22------ 6
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
82
P H Y S IC A L
S T A T U S OF P R E SC H O O L C H IL D R E N .
Bony and muscular system.
Positive signs1 upon which definite diagnoses of rickets were
based were found in 22 cases (2.2 per cent). Fifty-three additional A
cases having one or more suggestive signs were recorded “ probably
rachitic.” 2 No cases were noted in the group under 6 months of age;
7 of the children classified as rachitic were between 6 months and
1 year, 9 were between 1 year and 1£ years, and 59 (78.7 per cent
of all those with rickets) were over 18 months.
Of the rachitic children 12.1 per cent had defective tonsils, as
compared with 6.6 per cent of those showing no evidence of rickets.
T a b l e V III .—Rickets, 'by age and sex; children under 2 years o f age given physical
examination.
With probable
rickets.
With rickets.
Age and sex.
ITotal
children.
Both sexes....................................
994
6 months, under 1 year..........................
1 year, under 1$ years............................
1J years, under 2 years...........................
214
278
245
257
Boys.................................................
524
Per
cent.
Num
ber.
-1
Num
ber.
Per
cent.
919
92.5
3
3
47
1.1
1.2
18.3
2ÏT
271
236
198
100.0
97.5
96.3
77.0
27
5.2
483
92.2
100.0
96.6
96.1
77.4
53
4
6
12
1.4
2.4
4.7
14
2.7
2.2
Num
ber.
5.3
,
22
Per
cent.
Without rickets.
6 months, under 1 year..........................
1 year, under 1£ years............................
1 years, under 2 years...........................
113
146
128
137
3
4
7
2.1
3.1
5.1
2
1
24
1.4
•8
17.5
113
141
123
106
Girls..................................................
470
8
1.7
26
5.5
436
92.8
6 months, under 1 year..........................
1 year, under 1£ years............................
1J years, under 2 years...........................
101
132
117
120
.8
1.7
19.2
101
130
113
92
100.0
98.5
96.6
76.7
1
2
5
.8
•1.7
4.2
1
2
23
T a b l e I X .— Rickets, by condition o f tonsils; children under 2 years o f age given
physical examination.
With rickets.
Condition of tonsils.
Total
children.
Num
ber.
Per
cent.1
With probable
rickets.
Num
ber.
Per
cent.1
Without rickets.
Num
ber.
Per
cent.1
Total............... ...........................
994
22
2.2
53
5.3
919
92.5
N orm al..................... ............................
811
1
182
180
1
1
16
2.0
37
4.6
93.5
6
6
3.3
3.3
16
16
8.8
8.9
758
1
160
158
1
1
Defective.................................................
Enlarged only............... .........................
87.9
87.8
1 Not shown where base is less than 50.
Of the rachitic children 10.7 per cent showed “ enlarged” glands,
38.7 per cent “ palpable” glands, 50.7 per cent nonpalpable glands,
as compared with 3.3 per cent, 29.5 per cent, and 67.2 per cent,
respectively, of the nonrachitic children.
1 For signs, see page 58.
1 See page 58.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
E X A M IN A T IO N
OF C H IL D R E N
UNDER TW O
YEARS OF AG E.
83
T able X .— Condition o f glands, by presence o f rickets; children under 2 years o f age
given physical examination.
Total
children.
Condition of glands.
W ith rickets
or probable rickets.
Without rickets.
With
With prob
rick- ' able
rick
ets.
Per cent
Percent
Per
cent
ets. Num distri
Num distri Num distri
ber. bution.
ber. bution. ber. bution.
994
100.0
75
100.0
22
53
919
100.0
300
38
21
17
66.0
30.2
3.8
2.1
1.7
38
29
8.
2
6
50.7
38.7
10.7
2.7
8.0
8
9
5
30
20
3
3
3
618
271
30
19
11
67.2
29.5
3.3
2.1
1.2
Bowlegs were more common among the boys than among the
girls, 13.7 of the boys and 10.4 per cent of the girls being thus
deformed. All other rachitic signs were also more noticeable in the
boys than in the girls.
Arch measurements.
Arch measurements were taken on 552 infants and the median
height was found to be the same, %inch, up to 18 months, but increased
to f inch in infants from 18 months to 2 years.
Mental condition.
Two cases of apparent and five cases of suspected mental defectives
were noted during the course of the study.
Genitalia.
A very large per cent of defects of genitalia, chiefly contracted or
adherent prepuce, was found among boys— 71.4.
A summary of defects found in children under 2 years of age, as
compared with those found in the preschool group, is here given.
T a b l e X I .— Comparison o f the prevalence o f defects in children under 2 years o f age and
children 2 to 7 years o f age given physical examination.
Summary of defects.1
Children under
2 years of age.
Children 2 to
7 years of age.
Number. Per cent. Number. Per cent.
Total......................................................................................
994
100.0
3,125
100.0
Underweight (10 per cent and over).............................................
262
22
172
23
8
26
225
38
3
9
26
150
135
26.4
2.2
17.3
2.3
.8
2.6
22.6
3.8
.3
.9
2.6
15.1
13.6
303
243
163
245
25
2,091
2,157
908
99
32
318
464
1,308
9.7
7.8
5.2
7.8
.8
66.9
69.0
29.1
3.2
1.0
10.2
14 8
41.9
Head defects...................................................................................
Eye diseases and defects other than of vision...............................
Ear defects other than of hearing..................................................
Mouth defects..................................................................................
Naso-pharyngeal defects....................................... ........................
Enlarged glands..............................................................................
Heart defects...................................................................................
Lung defects........................... ........................................................
Abnormal skin condition................................................................
Abdominal defects..........................................................................
Bony and muscular defects............................................................
1 For specific defects see Text Table II, p. 29, and Appendix Table II, p. 76.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
84
P H Y S IC A L
Ch a r t
S T A T U S OF PR ESCH O O L
C H IL D R E N .
V . Per cent of children having one or more defects, from birth to 6 years of age.
Per cent.
Boys
Girls
ADDITIONAL COPIES
OP THIS PUBLICATION M AY BE PROCURED PROM
THE SUPERINTENDENT OF DOCUMENTS
GOVERNMENT PRINTING OFFICE
WASHINGTON, D . C.
AT
15 CENTS PE R COPY
V
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Sil
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
@FedFRASER