CHILDREN'S HEALTH

Auckland Star, Volume LXVI, Issue 231, 1 October 1935, Page 5

CHILDREN'S HEALTH

INCREASE IN GOITRE. STARTLING CHANGE IN TARANAKI. "MALNUTRITION" QUESTION. From having the lowest incidence of goitre in New Zealand, the children in Taranaki, in three years, have come to show the highest. . . . Recent reports j indicate a general increase in goitre throughout the Dominion. These statements are made by a medical practitioner who has had im- j usual opportunities of studying the incidence of malnutrition, dental caries and goitre. In a letter to the "Auckland Star" he emphasises that the public is mistaken in believing that simple goitre may be easily prevented or cured. His letter, signed "M.8." for the purposes of publication, follows:— The daily Press lias revealed in the last few months an amazing contrast of opinion amongst the "authorities" as to the extent of unfitness in our children. To take two examples alone, goitre and malnutrition have been the subject of the most diverse statements. I make 110 apology for coupling these conditions together, as they are, undoubtedly, closely allied in their origins. As one with some knowledge of both conditions in New Zealand I would point out that the degree to which either is said to be present or absent depends very largely upon the personal opinion of the examiner. Where the examiner has worked in one district for a number of years it is possible for him to arrive at conclusions of some, value as to whether any cliang-e in the incidence of either of tiiese conditions has actually taken place. Taranaki's Experience. There is no doubt, for instance, that in the period from 1928 to 1932 Taranaki (and a not very clearly delimited zone around it) showed an extraordinary change in the number of children found to have a. simple goitre. I'xom having

the lowest incidence of goitre in New < Zealand the children, in three years, ( came to show the highest. The commencement of this increase in goitre incidence was first reported in 1929. This change took place without any i equivalent change being noted in the food, the purity of the water supply, or any of the other factors which are supposed to influence the development of simple goitre. So far as was known no similar rapid change in the incidence of goitre has been recorded elsewhere in the world. One peculiar feature of the inquiry was the fact that the consumption of iodised salt had undergone a marked increase during the years in which the change took place. (lodised salt is supposed to prevent and, to some extent, i remove or cure simple goitre.) From recent statements in the Press it is obviously thought that the spread of simple goitre can be prevented. However, the experience of Taranaki | shows that we have a small amount, if any, of control over the spread of some forms of simple goitre. It is that Taranaki oilers a more fruitful field, at the present time, for the scientific study of goitre than any other (lis-) trict in New Zealand, though other more recent reports indicate a general increase in goitre throughout the whole country. What Is Malnutrition? Malnutrition in children is so difficult to define that it is hard to find two observers who will agree on the standards to be accepted. The American school relies chiefly on the weight of the child being below the normal for its height and age. This standard, however, has not proved of such great value in actual practice and recent observers have not laid so much stress upon it. The more modern view of malnutrition I is to assess it by the degree of the I child's resistance to disease or infection. ! Judged by this latter standard the I health and nutrition of children in New I Zealand have undergone no improvement in the last two decades. The incidence of dental caries has, if anything, increased over the last 14 years, in the opinion of one observer. It is, furthermore, more than probable that an analysis of sickness rates in children would show a proportionate increase in the number of cases of certain diseases such as diabetes, appendicitis, other digestive disturbances and a greater ; , liability to contract suck conditions as

ostco-myclitis or pneumonia. The susceptibility of the child to certain infectious and other diseases is now admitted to bear a close relationship to certaiu deficiencies or "wants" in its diet. Milk, Vegetables, Fruit. In other words, faulty diet is at the back, of many, if not most, of the common disorders which the physician or surgeon is called upon to treat. Whether there has been a marked increase in the number of cases of this "malnutrition" it is difficult to say. There has . almost certainly been no change for the better in the last 14 years. It is obvious that our present knowledge of what constitutes adequate nutrition is enough, if acted upon, to make a very great improvement m the children's and, therefore, in the community's health. An increase in the average milk ration to at least 1A- pints daily, a greater use of the "salad" vegei tables and more fruit in the daily ration ' would together effect a very considerable improvement in the control of "malnutrition." There are, of course, many other steps which might be taken to improve the individual child's health. •The economic aspect of this problem forms another story, but we may yet have to accept the necessity for a cheaper, or even a free, distribution of milk to all children shown to be in need of it. "Malnutrition" is, therefore, more a matter of the ignorant or thoughtless feeding of children. Apart from the relatively high cost of the special group of foods mentioned it ia seldom, in New Zealand, the result of insufficient food.

It is, therefore, witliin our power tl largely eradicate malnutrition and it( attendant disorderss. On the other hanf there is no such easy path to the prevcw tion or cure of simple goitre.