A Lesson from Medical Inspection of Schools
- Author:
George H. Martin, Litt.D.,
Secretary State Board of Education, Boston, Mass. IS Medical inspection of school children has been continued long enough and has become sufficiently widespread to justify some rather sweeping generalizations. No large group of children has ever been examined without finding numerous physical defects and disabilities, serious enough not only to affect their school work but to form, a real handicap in their after efforts to secure a livelihood.
These results have been so universal as to warrant the assertion that a community which has not provided through its proper authorities for a thorough-going inspection of its schools is guilty of criminal negligence.
The aggregate amount of discomfort and pain experienced by school children is enough to awaken universal sympathy. The hindrances to school advancement and the consequent waste of effort and of money are matters of serious concern, but the ignorance which lies back of it all and causes it all is a matter of much greater moment.
When by school inspection it is discovered that of more than 400,000 children examined in the schools of Massachusetts, 81,000 are defective in vision and 22,000 in hearing; when it is stated on reliable authority that 90 per cent of the school children of Germany have defective teeth and examination shows the same proportion in American towns; when 137 cases of adenoids are reported for a single city; when whole schools are infected with head-lice; we get much new light on school problems, on the subject of backward children, and, perhaps, of delinquent children. Then we consign the unfortunates to the care of the family physician, send them to the public dispensary or the public clinic, _ or send the school nurse to look after the cases in the home and by these means we patch up a few. Some glasses are provided, some teeth cleaned and filled, some adenoids removed, some heads shaved and petroleumized, and many children begin to know the joy of living.
All this is good. It is worth many times what it has cost. But is it enough ? Have school people done all their duty when they have admitted the school physician and the school nurse to the sacred precincts of the school room, when they have sent out the warning notices to the parents ?
Supposing that all defects have been discovered and. remedied, so that school life goes on without aches and pains. Must we go all over it next year and the next and forever? The Massachusetts law says that every child shall be examined annually for defects and disabilities. There is no statute of limitations. Is there any hope of limitation? Is there any mode of limitation? Or is the social mill to go on grinding out diseased and enfeebled children by the thousands indefinitely!
This is a more fundamental question than how we shall modify and adapt school work and school life to these defectives. That is an immediate and important question. But it deals only with symptoms, while it leaves the disease itself untouched. The disease isi ignorance complicated by wilful neglect. That the ignorance of the laws and conditions, of health is less dense than it once was is undoubtedly true. The standard of intelligence in these matters has been slowly rising. When Horace Mann wrote his Sixth Report, in which he urged the necessity of instruction in physiology and hygiene, he satirized a school girl of the period:
“Shall a young miss of sixteen, elated with the idea that she is just finishing her education, study rhetoric, and analyze scraps of the speeches of Grecian and Roman orators, when she does not know that the fumes of burning coal will destroy life; and thinks, because she swallows her food and inhales her breath through her neck, that they both pass on to one common cavity in the chest, and hence concludes that respiration and digestion are functions of the same organ? Neither of the above is an imaginary or an extreme case.”
Perhaps we are warranted in thinking that such school girls are not to be found.
When twenty years later Herbert Spencer sent out his hook on education everybody knew that his gibes at the English country gentleman were based on facts, and that he might have included American gentlemen as well. ITe said: “When the country gentleman has paid his daily visit to the stable, and personally inspected the condition and treatment of his horse; when he has glanced at his minor live stock and given directions about them; how often does he go up to the nursery and examine into its dietary, its hours, its ventilation?
‘’The raising of first-rate bullocks is an occupation on which men of education willingly bestow much time, inquiry and thought. The bringing up of fine human beings is an occupation tacitly voted unworthy of their attention.”
There is 110 doubt, that more thought is being1 given to personal and domestic hygiene. There are more bath tubs and tooth brushes and clinical thermometers in family use; more family dietaries are prepared with regard to the laws of health; architects are more willing to make concessions in the matter of ventilation of public and private buildings. Wells for the family water supply are more remote from sink spouts and privies and barn yards. Communities are more critical as to their water supply and the disposal of their waste, and there is more belief in the necessity and efficiency of pure food laws.
That this improvement is general is shown by the reduction of the number of cases of diphtheria and typhoid fever and tuberculosis,?preventable diseases. More hopeful still is the changed attitude of mind towards diseases. Some cobwebs of superstition have been brushed away and some theologic mists have been dispersed. Probably nowhere to-day, even in the churches which adhere most closely to the ancient formulas, would we hear the lines by Watts found in all the old hymn books:
Diseases are Thy servants, Lord; They come at Thy command.* The educational forces by which this general uplift has come are many. The medical profession has devoted itself with the finest public spirit to the enlightenment of the people. The campaign against tuberculosis is a splendid example of the energy, the ingenuity and the self-sacrificing ardor of the doctors. The press has had a powerful influence in this direction. There are few magazines and few newspapers which do not discuss with great, frequency and, on the whole, with intelligence and force, questions which pertain to public and personal health. Discussions in women’s clubs and parents’ associations of various kinds liave helped.
To all these must be added the influence of the public schools. Physiology and hygiene have been included in the curriculum of many schools for many years, and some of the instruction given has been well selected, well arranged and well presented. To this extent the schools are entitled to credit. *This hymn was marked, ” For Sickbed Devotions.” But when we have admitted all this and congratulated ourselves upon the improvement, the disclosures made through medical inspection still confront us and call for action. The lesson which I have learned is that, in addition to all the other forces making for a better understanding of health conditions, it is the imperative and immediate duty of the schools of all grades to broaden and make more vital their teaching of physiology and hygiene.
Compulsory laws exist in nearly all the states, making instruction in these subjects obligatory, but unfortunately the circumstances under which these laws were enacted left the conservative school people everywhere irritated and cold. The law in its purpose and scope was too narrow, limited as it was to the effects of alcohol and narcotics, and the methods prescribed in most states tended to make the work abortive.
The opportunity now exists, and the results of medical inspection furnish the argument, for a now propaganda in favor of health instruction. It should begin in the lowest grade, because the little children not only need to be taught how to care for themselves, but how to care for children still younger. The majority of children of the poorer families, especially of the more recent foreign immigration, have the burden early laid on them of “minding the baby”. The following facts are typical: In a class of fifty children, thirty have the daily care of younger children.
That such care is inevitable is shown by the fact that, in the families represented by these fifty children, thirty-four have four or more children.
The instruction here needs to be simple, direct and sympathetic, absolutely free from technical anatomy and technical physiology. To instruction should be added insistence upon practice, for the end sought is the early formation of right habits. The results of the right sort of teaching will not be found in answers to questions, but in clean hands, faces, teeth, bodies and clothes, in clear eyes and a responsive brain, in a frame erect and elastic, with all the signs of an abundant supply of good red blood. The teaching will also show itself in the luncheons the children bring and in the way they spend their pennies.
In the higher grades the same ends are to be sought, but the instruction should be less purely dogmatic, and knowledge of the organs of the body and their function should furnish a rational basis for hygienic rules. Anatomy should still be kept subordinate. The hygiene of the home and its relation to personal health should be taught. The personal habits of the pupils must still be an object of the teacher’s success.
It ought not to be true in any school, as the reports of a school physician show was true in one set of schools, that the pupils in every grade up to the senior class in the high school had on an average four or more decayed and decaying teeth, and the teachers did not know it.
It ought to be said to all teachers and said with emphasis,? “These things ought ye to have done at the risk of leaving some other things undone.” We hear much about “essentials” in school education. A sound body kept sound by right living is the essential which underlies and conditions all the rest. In the high schools now a most anomalous condition exists. Not only is physiology not included in the course of study in many high schools, but when it is included it is not required of college preparatory students. So that these people who are to represent the superlative culture of the times are left in ignorance of the means by which they acquire all their learning. They are expected to translate the maxim of Solon, TvcoOi seavroy into “Know thyself,” and never to obey it. The instruction is less intelligent than that of Mr. Squeers: Bottiney, noun substantive, a knowledge of plants. When he has learned that bottiney means a knowledge of plants, he goes and knows em. ^ No school system can justify itself, if it fails to require as a major subject in high schools the study of human physiology. It should be so based on the other sciences and so correlated with them as to appeal to the intelligence of the most advanced students, and its relations to sociology should be shown through public hygiene to be so intimate as to fill it with genuine human interest.
Two hindrances have been found to the successful prosecution of this work in the schools. The text-books have been poor, and many of the teachers uninstructed. Text-books are improving and normal schools are making personal and school hygiene more prominent in their training. Much, however, remains to be done.
To-day the physicians, general and special, are more alive to the needs of the times than are the school people. o permanent results of the present agitation for better sanitary conditions, domestic and public, can be hoped for unless the schools cooperate with all the other agencies. The universal need is for a higher order of intelligence respecting all the things that make for health, and the foundation of such intelligence must be laid in the schools.
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