The etiology and the effects of minor grades of anaemia in young children; studies at a group of war-time day nurseries.

Introduction. The etiological factors influencing the haemoglobin level of the community in this country and the effects of minor grades of anaemia are still incompletely known, and the present investigation represents an attempt to obtain data bearing on these subjects among children attending war-time day nurseries. Many of the inferences have, however, a wider application. Clinical material. The 913 children examined attended one or other ofeight war-time day nurseries in Islington in North London. Some, whose attendance was short, had one examination only; some had repeated haemoglobin estimations for over two years between August, 1942, and December, 1944. The capacity of the individual nurseries varied between 33 and 70 places, and the 8 nurseries could accommodate 441 children at any one time. As some children were always absent, and it was desired to keep the nurseries full, each matron was instructed to keep on her register 20 per cent. more children than the nursery had space for. The children's mothers were all wage-earners, nearly all full time, working in factories, shops, transport, etc. Breakfast, dinner and tea were provided for the children in the nurseries. These were at first open for twelve hours on six days a week: latterly the hours were reduced by closing on Saturday afternoons (Mackay, Dobbs and Bingham, 1945). During the time of the investigation the children received no iron treatment in the nurseries other than that set forth in the section below on the effect of iron therapy. Large-scale evacuation of children from London during the flying bomb attack in the summer of 1944 resulted in an exodus from the nurseries, and continuity of treatment and of observation were prevented after May, 1944. Technique. Estimates were made with a Haldane colour standard, the National Physical Laboratory B.S.I. correction being applied for colour tube and pipette, and a mean percentage correction for the diluting tubes: the technique was the same as that previously used by the writers (Mackay, Dobbs and Bingham, 1945). All three observers used the same colour standard.