Meals for the Malnourished

I should be clear that efforts to combat childhood malnutrition did not emerge suddenly after 1904. English doctors had been collecting anthropometric data, especially in schools, for decades prior to 1904. Although these studies often tended to be localized, the results were often just as alarming to local doctors as the 1904 Report was to the nation. For example, an 1889 study in London found that 43,000 children attending Board schools were “inadequately fed,” which was stunting their growth and inhibiting their mental capacity for education.2“Feeding the Hungry Children,” 1295. In 1892, Francis Warner, a physician at the London Hospital, reported in the British Medical Journal that it was easy to identify these malnourished children. They were “thin, pale or delicate-looking.” Abnormalities in cranial development (21 inches in circumference at age seven was considered average), spinal development (measured by the curvature of the spine and symmetry of the head balance), or nervous defect (such as eye twitches or hand imbalance) were all indications of malnourishment.3Warner, “Abstracts of the Milroy Lectures,” 538.

Contemporaries worried that malnourishment inhibited physical development and made children too weak to seriously benefit from their education. Shortly after the 1880 Education Act made school attendance compulsory, one essayist in the British Medical Journal feared that lengthening the school day would only have deleterious effects on the “pale and feeble and depressed” child and their “badly nourished brains,” by exacerbating “all the most depressing influences of sanitary neglect.” Another essayist commented in Review of Reviews in 1891 that sending “children into school in order to fill their heads when they have nothing in their stomachs is like pouring water into a sieve: unless you stay the vacuum in the stomach the knowledge will not remain in the head.”4“Food-Aided Education,” 618. J. Milner Fothergill, who, we might recall, was one of Cantlie’s earliest supporters, warned in The Town Dweller about the physical and mental dangers associated with school life. According to Fothergill, to “drive children like a flock of sheep, through a certain series of examinations” while they were in poor health and malnourished did more harm than good. Fothergill believed that a proper education was “a capital thing” but “a system of education, which kills off the weak children, is [of] doubtful advantage.”5Fothergill, The Town Dweller, 92–93. Lauder Brunton offered a similar assessment. In 1906 he argued that “children cannot be taught unless they are fed.”6Manchester & Salford Sanitary Association, Physical Deterioration, 7. And even as late as 1916, James Kerr, while updating Arthur Newsholme’s textbook on School Hygiene, added that “questions of education are but vanity . . . if these things stand in the way of remedying the ill-nutrition of the child.”7Kerr, Newsholme’s School Hygiene, 196.

While it is abundantly clear that medical authorities understood the importance of a nutritious diet for children’s physical development in theory, the challenge they faced was how to ensure the child was receiving a sufficient diet in practice. One commentator in the British Medical Journal offered some interesting food for thought in 1892. They observed that “‘an army fights upon its stomach’; and the manhood of a nation may be greatly made or marred by the habits of imperfect nutrition contracted and practiced in its youth.”8“The Schoolboy’s Meals,” 700. This comment is particularly intriguing because it forewarned of the important connection between a healthy childhood and the capacity for effective military service in later life – an argument made all the more important after the seemingly disastrous British experience during the Second Anglo-Boer War. Proper nourishment set the youth on the path towards healthy “manhood” (military preparedness), while malnourishment doomed them to unfitness. And, as we know, a significant minority of the English population was deemed unfit a decade after this essay was published.

British soldiers’ diets were carefully controlled since the Crimean War, when the Army Sanitary Commission expressed deep concerns about the low quality and quantity of the soldier’s daily ration. The Commission reminded British military leaders that it was their responsibility to keep the rank and file healthy.9McGuffie, Rank and File, 34. In 1889, the British army reformed its dietary regulations, and made officers personally responsible for the quality of food supplied to their troops.10Duffet, The Stomach for Fighting, 34. A decade later, Quartermaster-General J.A. Boyd issued the Supply Handbook for the Army Service Corps, which attempted to standardize and formalize military catering procedures. While this text did not set specific caloric values (as such metrics were still in development), it did attempt to standardize military rations, emphasizing the continued staples of meat and bread or the hardtack biscuit and noting the importance of fresh vegetables and a weekly ration of jam and bacon.11Duffet, The Stomach for Fighting, 35.

If regulating diets worked for soldiers, surely public health could do something similar for children, especially if chronic malnutrition inhibited their education and weakened their development, making them unfit for military service later in life. Schools, it seemed, were the obvious place for such interventions. In schools, students were similarly supervised as soldiers in the military. The supervision just came from School Medical Officers rather than superior ranking officers. Just as soldiers’ diets could be shaped by military officers, surely children’s diets in schools could be shaped by School Medical Officers. One essayist in the British Medical Journal certainly thought so, when they argued that in schools children could be provided a diet that included the “greatest possible variety” of foods, especially a healthy supply of fresh vegetables to prevent malnourishment.12“The Schoolboy’s Meals,” 700. Providing meals in schools was not only good for children’s health, but it was also an economically efficient approach to promoting public health. Evidence from the towns showed that for the cost of as little of nine pence a week a child could be provided bread and milk for breakfast and a filling midday meal at school. As a result, contemporaries believed that children could not only be saved from “wasting away, or growing up into a more or less dilapidated and worthless member of the community” but also better equipped with a “capacity to learn.”13“Food-Aided Education,” 618.

Unsurprisingly, though, putting a concept into practice was easier said than done. Much like health visiting, the work of providing meals to schoolchildren was initially left to private charity. Organizations like the London School Dinner Association and the School Board Children’s Free Dinner Association provided at least three meals a week, but only to children referred to them by teachers. The Birmingham Schools Dinner Society began a campaign to provide meals to the poor children in schools beginning in 1882.14Briggs, History of Birmingham, 244. Directed by W.H. France, operated by some two hundred ladies dispensing food, funded by private subscriptions, and freely using nine premises granted by the School Board as cooking centers, this program was able to provide roughly 200,000 free dinners each school year, which extended from mid-October through the end of May. Offering meals five days a week, the Birmingham Schools Dinner Society had an average daily attendance of around seven hundred at its largest center. The cost for operating the program in 1888–89 was less than £600, and Osmund Airy, Her Majesty’s Inspector of Schools and Chairman of the Birmingham Fund, praised the program’s benefits relative to its low costs (no more than a halfpenny per meal).15“Food-Aided Education,” 620–21. A more expensive breakfast scheme, which fed children selected by teachers five days per week year-round in fourteen schools in the poorest districts was launched in 1901.16Winder, The Public Feeding of Elementary School Children, 3. It fed 1,600 to 1,700 children daily in the winter, and 800 to 900 children in the summer by 1904.

Private charities in Liverpool and Manchester also provided free or low-cost meals in schools as well. By the turn of the twentieth century, the Food and Betterment Association in Liverpool supplied 200,000 meals to school children (an estimated two-thirds of malnourished children).17Report of the Inter-departmental Committee on Medical Inspection and Feeding of Children, 1:39. During the winter of 1903−04 schools in Manchester provided 275,065 free meals. Nearly half the funding was raised by subscription to charity or fundraising by school events and teachers, with the other half contributed by the School Banks Reserve Fund.18Reynolds and Wyatt, Second Annual Report of the Education Committee, 1903–1904, 30. The following year, nearly half the funding for winter meals was provided by the Lord Mayor’s Fund, and teachers volunteered to undertake the work of providing the meals.19Reynolds and Wyatt, Third Annual Report of the Education Committee, 1904–1905, 36.

However, the sheer number of hungry children in these large Victorian cities made it practically impossible for private charities to provide meals for them all. Members of the British Medical Association urged schools and the School Board to take charge of feeding malnourished children in their care. One essayist in the British Medical Journal argued in 1903 that “when those in control of the school are directly responsible for the feeding of the children . . . there is no excuse for the diet being other than sufficient in quantity and suitable in quality.”20“The Food Factor in Education,” 424 They continued, noting that there “can be little doubt that one of the chief causes of this degeneracy in young people is to be found in the insufficient food on which it seems to be expected that the hard work of school life should be performed.” Thus, it was paramount to provide a diet that was “good for boys” so that they might “reach the highest possible physical and mental development.”21“The Food Factor in Education,” 424.

Public health leaders, like George Newman, in his capacity as Chief Medical Officer of the Board of Education, took concerns about school meals very seriously.22Ashby to Newman, February 6, 1904. So too did James Kerr, the first School Medical Officer in the country, who believed that “the feeding of a starving child is not a charity, but a duty of the State towards a future citizen.”23Kerr, Newsholme’s School Hygiene, 201. But the seemingly obvious solution to invest more public funding into providing free or low-cost meals in public schools was in reality politically contentious. Members of the Social Democratic Federation argued that all children, not just the destitute and malnourished, should be not only fed but “altogether maintained” at the expense of the state. Labour leaders saw such a program as “excessive.”24Davin, Growing Up Poor, 209. The Conservatives were even more resistant, and rebuffed any form of state-sponsored, general provisioning of school meals, which they feared would “would appreciably diminish the influence of home life.”25Anson, “Provision of Food for School-Children in Public Elementary Schools,” 182.

Sir William Anson, who served as the first Parliamentary Secretary to the Board of Education from 1902 to 1905, argued that any governmental program to provide school meals would have to be carefully managed and targeted toward truly malnourished children and utterly impoverished families. Anson feared that determining the conditions that necessitated feeding, which children would be selected, and determining who would pay for their food, would be difficult. Thus, while Anson proposed that children “whose parents are selfishly callous or selfishly neglectful” deserved to be fed at school, developing a system to identify these children would still be difficult.26Anson, “Provision of Food for School-Children in Public Elementary Schools,” 183. Metrics that defined poverty had to be considered. While poverty was increasingly attributed to “impersonal economic and cultural forces” rather than individual character by the turn of the twentieth century, Anson believed that parents who could repay the cost of school-provided meals should be made to do so.27Szreter, Fertility, Class and Gender in Britain, 229. Anson believed that meals should be provided gratis only in the cases of “genuine occasional poverty.” Therefore, he remained skeptical of the significant need for state funding. He believed that the “cost of provision” ought “not to be more than voluntary and charitable agencies can meet.”28Anson, “Provision of Food for School-Children in Public Elementary Schools 184.

So, by 1904, the question of how (or if) to publicly fund the provision of free or low-cost meals remained unanswered. But the importance of providing meals to malnourished children in schools appeared to be beyond dispute. This was the historical context in which the 1904 Report of the Inter-departmental Committee on Physical Deterioration offered its findings. As described in the previous chapter, the Report centered the problem of unfitness on food and drew greater national attention to the severity and pervasiveness of malnourishment among English children, while also suggesting a need for further state intervention.29Atkins, “School Milk in Britain,” 396.

While Parliament was slow to act nationally, the responsibility for promoting public health, including combating malnutrition, continued to fall to local authorities. The city of Bradford, where James Kerr was appointed School Medical Officer in 1893, was the first to act. In the fall of 1904, Kerr, along with School Board member Margaret McMillan and city councilor Fred Jowett, introduced a proposal for the first municipally funded free school meals, creating a model for other cities to follow.30Vernon, Hunger, 161. Even though it would provide only one meal a day, and was built upon the foundation laid out by the Cinderella Club, which had since 1890 established “social and educational clubs for slum children,” the Bradford program was forcefully rejected by Bradford Liberals. They feared the program would undermine “traditional” approaches to relieving the effects of poverty – the Poor Laws and private charity. Yet, within a few years, between the limitations of private charity (the Cinderella Club estimated in 1905 that between 2,000 and 5,000 children were constantly underfed in Bradford, but that it was able to provide meals to only around 1,350 children per day) and popular support for free school meals within the Labour Party, the pressure to enact municipal reforms was too strong to ignore.31Laybourn, “The Issue of School Feeding in Bradford, 1904–1907,” 30–32.

The following year, in 1905, another Inter-departmental Committee was formed to study the “Medical Inspection and Feeding of Children Attending Public Elementary Schools.” This committee, chaired by H.W. Simpkinson, Assistant Secretary of the Board of Education, and composed of Dr. H. Franklin Parsons, Assistant Medical Officer to the Local Government Board, Cyril Jackson, Chief Inspector of Elementary Schools under the Board of Education, Maude Lawrence, Chief Woman Inspector of the Board of Education, R. Walrond, Senior Examiner for the Board of Education, and E.H. Pelham, Junior Examiner of the Board of Education, sought to determine how to select which children should receive subsidized or free meals, the manner of serving food to the children, and what food the children should be provided. The Committee advised that a relief committee, rather than teachers, should select which children would receive meals (although teachers’ recommendations were encouraged); that permanent and regular feeding of children most in need would do much greater good than feeding a larger number of children irregularly; that meals should be provided every school day and throughout the year; and that meals should be properly served to train in both manners and suitably prepared food.32Report of the Inter-departmental Committee on Medical Inspection and Feeding of Children, 1:60–78. Thus, the Inter-departmental Committee on Medical Inspection and Feeding of Children offered a plan of action on a problem identified the preceding year by the Inter-departmental Committee on Physical Deterioration.

Ideas about school meals turned into actions in 1906, when Labour MP W.T. Wilson and Liberal MP Thomas Macnamara introduced the 1906 Education (Provision of Meals) Act, which allowed public elementary schools to provide meals to necessitous children – and either recover the costs by billing the parents or use public funds from the Board of Education.33Education (Provision of Meals) Act, 1906, 6 Edw. 7, c. 57. Atkins, “School Milk in Britain,” 400, acknowledges that due to “popular skepticism” the impacts of the Act were limited, especially due to the efforts to recover costs of school meals from parents. The voluntary nature of the Act made it acceptable across political lines.34Vernon, Hunger, 162. To appease Conservative dissenters, George Newman later explained, the Board of Education program primarily intended to be a supplement to home feeding to ensure that the child received “sufficient and stable food.” School meals were not intended as an act of an overreaching state, but were an effort to prevent “disability, defect or weakness, physical or mental – threatening or actual – of the child’s body.” Newman believed that the school meals program was not intended to be a new form of poor relief (even though malnutrition was often the symptom of poverty), but, rather, a part of a growing system of public health promoting children’s health.35Newman, The Building of a Nation’s Health, 332–33.

The 1906 Education (Provision of Meals) Act brought the issue of school feeding into what historian Keith Laybourn calls a “parliamentary melting-pot” that was deliberating on the role of the state in providing relief to the consequences of the urban penalty.36Laybourn, “The Issue of School Feeding in Bradford, 1904–1907,” 34. When Parliament gave its assent by passing the 1906 Education Act, no matter how tepid the Act might have been in providing more financial and administrative support for the expanding school meals programs, I see this as indicative of a post-1904 shift in the history of public health. The 1906 Education Act is an important example of more serious attention being paid to the health of English children by national elites as well as local medical experts.

Still, the permissive nature of the Act made its adoption uneven across Great Britain. Statistics on school meals were kept unevenly; selection criteria for eligible children varied across local education authorities; rural areas often had less access to school meals; and meals were often not provided during school holidays.37Welshman, “School Meals and Milk in England and Wales, 1906–1945,” 9–10. In Birmingham and Manchester, however, education authorities followed the Bradford model. Local authorities in these two cities quickly expanded organized school meal programs from their charitable origins to increase the number of children receiving relief.

Take Manchester, for example. Before the passage of the 1906 Education (Provision of Meals) Act, the city was already funding some relief for malnourishment. For example, over the course of twelve weeks during the winter of 1904–05, the city of Manchester funded 108,060 school meals at the total cost of £1,007. But the process was not uniform.38Report of the Inter-departmental Committee on Medical Inspection and Feeding of Children, 1:37. After the passage of the Education Act in 1906, the city of Manchester changed the way it provided meals to needy children in two significant ways: first, meals were provided at seven feeding centers (on Albert Street, All Saints’, Chorlton Street, Great Jones Street, Mill Street, New Islington, and on Shakespeare Street) rather than in the schools themselves, and, second, the School Medical Officer, Dr. A. Brown Ritchie, was tasked with determining which students required free meals. In the first year after the passage of the Education (Provision of Meals) Act, Ritchie identified 1,208 children in need of free meals due to malnourishment. Of these, 1,026 of their parents accepted the aid of the Education Committee. Logistics notwithstanding, the public health benefits were immediately apparent. Ritchie proudly reported that “the provision of meals . . . not only [resulted in the children’s] improved physical condition, but in the raising of the standard of the children’s capability for school work, of their powers of attention, and their amenability to discipline.”39Reynolds and Wyatt, Fifth Annual Report of the Education Committee, 1906–1907, 65–66. By 1911, 4,518 children were receiving intermittent feeding through the school meals program in Manchester as more necessitous children were identified and as more parents submitted applications for aid.40Reynolds and Wyatt, Ninth Annual Report of the Education Committee, 1910–1911, 223. A year later, in 1912, the number of children receiving meals had further risen to 5,407.41Wyatt, Tenth Annual Report of the Education Committee, 1911–1912, 187.

While the public health benefits were obvious, expanding school meal programs did create new administrative challenges. Determining which children should be fed became a significant challenge under the new legislation. Under the old charitable system teachers often determined which children would be fed. But that too created several problems. First, teachers were often bullied by parents to let their child have a free meal. Second, teachers had little knowledge of the home conditions that might contribute to the malnutrition of a child. Under the new state system, the task of determining which children should be fed often fell to a separate “Canteen Committee.” In Birmingham, this committee was a subcommittee of the Board of Education.42Winder, The Public Feeding of Elementary School Children, 19–21. The Birmingham Canteen Committee employed a “poverty test” and used familial income as its primary criterion to determine which children should be fed. In families with a household income (after rent) of less than 2s. 9d. per head from Michaelmas to Easter, children selected to receive school meals were fed for free. Teachers could also petition the Board of Education based on their own observations, or at the request of parents, for why a child needed free meals. Once an application was submitted, an attendance officer would visit the home of the family to collect information about parental employment, income, rent, and any previous charitable aid. Parents were instructed to appear before the Committee for an interview before a final determination was made. Between 1909 and 1911, 22,753 applications were submitted, and 15,164 were accepted.43Winder, The Public Feeding of Elementary School Children, 26–27. Four common criteria often resulted in providing meals: “1. Distress due to lack of employment. 2. Distress due to sickness or disablement. 3. Incomplete families – father dead, deserted, or in prison. 4. Families where the father was in full work, distress being due to the size of family or the lowness of wage.”44Winder, The Public Feeding of Elementary School Children, 45. City officials in Manchester employed a similar “poverty scale” to determine which children should be provided with free school meals.

Educational authorities administering school meals also faced the additional difficult question of not only who should be fed but what to feed poor English children to improve their physical condition. Nineteenth-century nutritional science focused heavily on the amount of protein necessary to do labor and work, and, of course, the numbers varied based on the type of work.45Guggenheim, Basic Issues of the History of Nutrition, 94–95, 97–98. For example, in his 1843 Treatise on Food and Diet, Jonathan Pereira, a professor at the Aldersgate Medical School in London, emphasized the importance of a varied diet, which consisted of both nitrogenous and non-nitrogenous food (starches and sugars) as well as a regular sampling of fruits and vegetables to ensure that the body received sufficient quantities of the thirteen “essential” elements (carbon, hydrogen, oxygen, nitrogen, phosphorus, sulfur, iron, chlorine, sodium, potassium, calcium, magnesium, and fluorine).46Pereira, A Treatise on Food and Diet. In 1875, Carl Voit, a professor of physiology at University of Munich, proposed that an average, well-muscled worker should consume 118 grams of protein, 56 grams of fat, and 500 grams of carbohydrates (at least half of which should come from animal sources) daily.47Carpenter, Protein and Energy, 89. By 1904, Russell Chittenden, the first professor of physiological chemistry at Yale University, challenged Voit’s dietary requirements, suggesting that a healthy, “average” man would need only about 64 grams of protein per day, cutting Voit’s calculations roughly in half.48Carpenter, Protein and Energy, 112.

After the experience in the South African War drew greater attention to national fitness, efforts to quantify and regulate soldiers’ diet and nutrition played a central role in assessing soldiers’ health. In May 1900, the British Medical Journal reported that “if a soldier on active service is to keep physically efficient . . . his rations must not be reduced, at any rate for any long period.” At a minimum, his diet should consist of at least 300 grams of nitrogen (approximately 19.44 grams of protein) and 10 ounces of carbon, along with salt and water, per 24-hour period. This required at least 22 ounces of dried food per day. Only in the event of an emergency should he be allowed to subsist on less.49“Emergency Rations,” 1243.

Studies of nutrition in soldiers eventually trickled down to considerations about childhood nutrition as well. With regards to children’s nutrition, doctors placed less emphasis on quantifying the calories necessary for military service, and a greater emphasis on nutritional value and ensuring that the food was appealing to children’s tastes.50However, as Weatherall, “Bread and Newspapers,” 190, notes, the Education (Provision of Meals) Act did adopt a scientific standard for meals, developed by the American chemist Wilbur Olin Atwater: that a working person should consume 127 g of protein, 500 g of carbohydrates, and 56 g of fat per day. Speaking in Manchester in 1906, Lauder Brunton advised that school meals must be appetizing and nourishing, or else the child might “starve and pine in the midst of plentiful food, because they either will not take it from lack of appetite or cannot assimilate it from defective digestion.” Too often, Brunton added, children “crave for things that are bad for them, and they do not care to take the things that would nourish them.”51Manchester & Salford Sanitary Association, Physical Deterioration, 7–8. A few years later, George Auden, who served as the Medical Superintendent of the city Education Committee in Birmingham, suggested that meals must provide the proteins and fats that malnourished children’s diets often lacked; that meals should balance palatability and variety to avoid undue pressure on the stomach and bowels; that meals should be served warm to provide the heat that the child’s body lost more rapidly than an adult; and that meals must be digestible but still require mastication. A breakfast of porridge with treacle or sugar, heated before distribution, and served with milk was, according to Auden, a “perfect meal.” Rice pudding, which contained less fat, but which contained a large amount of milk was a suitable alternative if served with stewed fruit. Finally, pea soup was another appropriate, inexpensive meal.52Annual Report to the City of Birmingham Education Committee for the Year 1910, 46–48. Serving any of these types of meals in schools was an effective and easily implemented public health tool that helped to save British children from the possibility of “physical deterioration.”

Schools became a site to offer this critical intervention, where meals could be systematically provisioned on a regular basis. However, as Phyllis Winder, a member of the Birmingham Women’s Settlement who studied and published on the practice of public feeding, argued, the “meals themselves are only a palliative; the real solution of the problem of the ill-nourished child can only come very slowly with more knowledge and better conditions in the homes.”53Winder, The Public Feeding of Elementary School Children, 76. The Birmingham Women’s Settlement was an eclectic gathering space for women of diverse traditions and interests established in 1899. Among its important charitable work, the Settlement formed several committees to offer medical aid to ailing children. The organization worked particularly closely with five Birmingham schools, acting as liaison between Medical Care Committees, parents, and school clinics. Matheson, “Birmingham Women’s Settlement,” 24, 26–27. Winder remained convinced that schools were well positioned to detect many of the healthcare needs of English children and thus could play an important role in growing a social safety net for the sake of the children, but the program needed to expand in tandem with the other systems of public health.

J. Dixon Mann, the chairman of the Manchester and Salford Sanitary Association, agreed. In a letter addressed to Minister of Education Augustine Birrell in 1906, Mann wrote that “the period of school life in children affords great opportunities for permanently raising the standard of public health.” Mann believed that making “the laws of health a prominent subject in the scholastic curriculum, is one of the most effective means of securing the best possible educational results, and of materially combating physical deterioration at an early age.” This, along with the “appointment of Medical Officers for Schools,” proved “instrumental in effecting the desired reforms in Manchester.” Mann believed that Manchester could serve as a model for other cities to follow and urged Birrell to “make provision for securing compulsory appointment by all Education Authorities of Medical Officers to inspect all schools in their respective districts, and to supervise the physical condition of children on entering school and during their stay there.”54Manchester & Salford Sanitary Association, Physical Deterioration, 3–4. Mann was not alone in calling on the Board of Education to take greater action to ensure that children were protected during their school-age, early childhood development. A provocative letter from the National League for Physical Education argued that “the children of the poor should have the same chances in life as those of the rich by having their bodies improved by feeding where necessary and by physical training, so that they may be able to utilize, in the struggle for existence, the mental training which the State has already decided to be necessary for every child.”55National League for Physical Education and Improvement to the Board of Education, February 27, 1906.

Based on her study of the causes of malnutrition in Birmingham, Winder urged School Medical Officers and local Medical Officers of Health to form closer partnerships. She wrote that: