Health and Development Supervision of The Public Schools of California
The Psychological Clinic Copyright, 1910, by Lightner Witmer, Editor. Vol. IV. No. 2. April 15, 1910. :Author: George L. Leslie, Director in fJharge of Psychological Clinic and Development Work, Los Angeles, Gal.
When the recent legislature of California passed a law1 establishing Health and Development Supervision in the public schools of the state, the term “Health and Development Supervision” was chosen instead of “Medical Supervision/’ or “School Hygiene,” because that term expressed most clearly the purpose of the work in the schools. The California law authorizes boards of education or boards of school trustees:
(1) To establish annual physical examinations of school pupils, with a follow-up service to secure the correction of defective development, thus maintaining continuous supervision of the health and growth of children and youths.
(2) To require physical examination of all candidates for teachers’ positions in the public schools, to determine their vitality and efficiency; to make such further examination of teachers as may be advisable to determine their continued fitness for work; and to determine what amount of work shall be required of the teaching force of the schools, consistent with efficiency and continued service. (3) To adjust school activities to health and growth needs and development processes of pupils. (4) To study mental retardation and deviation of pupils in the schools. (5) To exercise expert sanitary supervision. (6) To organize a corps of educators, experts in physiology, ^he complete text of this law was published in The Psychological Clihic, Vol. Ill, No. 4, June, 1909, p. 117. (33) hygiene, and practical psychology, who can skilfully diagnose defective growth and development, and take more intelligent steps to conserve children and youths. The law provides for the cooperation of this class of educators with skilled physicians. (7) The law by implication leaves to city boards of health all matters pertaining to contagious and infectious diseases as a matter of public health. It implies the close cooperation of boards of health and education.
The law is permissive, not mandatory. Undoubtedly the next legislature will make this law compulsory, and add whatever amendment two years of practical application of the law may show to be advisable. It was intentionally made permissive in order that an educational period should precede its compulsory enactment. The state laws of this character thus far enacted are more or less excellent, and experience in their application will sooner or later demonstrate what provisions are most helpful. The California law emphasizes the need of this work and gives power to accomplish it.
The physical examinations specified are complete or may be made complete. A skilled and careful examiner is not restricted, but is left free to uncover any and all causes which interfere with the health, growth, and efficiency of pupils and teachers. That these examinations should be given in all schools under the control of boards of education, is self-evident. To establish them simply requires time and the education of the public. While an annual examination is advisable and sufficient for the majority of pupils, yet in many cases these examinations need to be more frequent, and in other instances may be less so.
The department carrying on this work in California is given the power not only to examine and diagnose, but also to adjust school activities to health and growth needs and to development processes. This adjustment should be a part of the educational work of the teaching force; but as schools are generally conducted, the adjustment is either most unskilfully made, or not made at all. Educational work has been done too largely with the purpose of conveying information, and not of developing the pupils. There is very great need of placing the supervision of such adjustment in the hands of skilled experts, who will help the schools to be more nearly equal to the oversight of growing children and youths. It is agreed by everyone that health and growth examinations’ of pupils, wherever they have been well conducted, have shown the presence of many pathological conditions of developHEALTH AND DEVELOPMENT SUPERVISION. * 35 merit, both in activities and in environment, which deplete the health, growth, and vigor of children and youths, making easy the destructive work of the microbes of disease, and bringing about more or less inefficiency and degeneracy in adult life. To quote from a paper by Mr. George E. Johnson, Superintendent of the Playground Association of Pittsburgh,2 “It would take four disasters like that at Cleveland every school day in the year to keep pace with the march of death among school children of our land… . And this loss, inconceivably great as it is, is largely within our power to prevent.” “More than one-half of all the children born into the world die before they have reached man’s estate; and seventy per cent of school children suffer some physical handicap, more or less serious, at the very threshold of life’s opportunities.” “It is not the death rate during the school age, however great or small, that is the significant thing for us. The significant thing is whether in these years of Nature’s smiles, strength or weakness is being laid by for future years.”
What the schools are doing to conserve the efficiency of school children who in a few years will become adult citizens, may be judged from Mr. Ayres’ discussion of “repeaters” in fifty-five American cities,3 in which he shows that out of 1,900,000 pupils, 300,000 are passing through a grade for the second, third, or even fourth time, at a total cost of $14,000,000 annually, an expenditure which is largely wasteful. One may well add to this report that while repetition, elimination, and retardation are good barometers of school efficiency, they do not measure at all the failure of the schools to bring the health and vigor and efficiency of youth to a possible maximum. These conditions are too serious to be ignored in the future work of the schools.
It is not physical defects alone which cause all the retardation exhibited by pupils in the schools. A more far-reaching cause is the wrong adjustment of school work to health and growth needs and to development processes. Physical and mental activities sire poorly proportioned, and there is a lack of sufficient motor exercise and sense training to develop normally the nervous centers. Special development periods are little heeded. Our system of education does not take into adequate account the inherited powers and tendencies of pupils. Nascent periods, Nature’s develThb Psychological Clinic, Vol. Ill, No. 1, March, 1909, p. 14. ?Ayres, Leonard P. The Money Cost of the Repeater. The Psychological opmient opportunities, are neglected. Physiological age, upon which, weight, height, strength, endurance, and scholarship primarily depend, is largely disregarded by our educational programme, which takes into consideration chronological age solely. In most high schools the pupils are treated most unintelligently at the age of puberty in the adjustment of school work to their physical and mental endurance. At a time when physical and functional development is the most urgent need of the pupil, the high schools draw too largely upon the strength and vitality reserved by 1STature for growth, and apply it to forced intellectual advancement. By this short-sighted course of action they limit the future intellectual and moral possibilities of many young lives. Pupils who have inherited tendencies to weakness are too little guarded at transition periods, when any undue stress and strain may bring disaster. The large amount of juvenile crime and insanity which makes its appearance between twelve and fifteen years of age is full of significance to educators.
Prom the standpoint of building a sound nervous system, pupils are not treated with sufficient intelligence by the schools. It makes no practical difference whether the pupil knows a little more or a little less of the informational subjects of the curriculum. It makes all the difference in the world whether the school activities are building a sound nervous system and a normal mind, whether the routine of home and school is such as to call forth the best possible development in youth and prepare for the highest efficiency in adult life. When we do this well, we will not only attend to defective physical development, but will adapt physical and mental activities to meet development needs.
In order that the schools may be equal to their opportunity to “grow” boys and girls intelligently, educators must be trained to make careful physical examinations and such mental examinations and tests as may be practical, utilizing the results of these examinations for their guidance in a more intelligent handling of the pupils.
The services of skilled physicians are, of course, most valuable in the schools, and can be made still more effective by the cooperation of trained educators. Why should a physician, whose work necessitates the highest skill in surgery and in the treatment of diseases where life and death hang in the balance, be expected to spend his entire time in making physical examinations at school, when in fact a large part of his technical knowledge is needed only in special phases of the work and in special cases? It may be held that this is a field of prophylaxis in medicine. It is also a field of prophylaxis in education, and is common to education, sociology, and medicine.
It would be far more economical of human effort for educators skilled in this work to occupy this field jointly with physicians, the latter taking charge of special cases where a more extensive knowledge of disease is called for, and the educators conducting all the other examinations of growth and development necessary for the intelligent treatment of children and youths. Educators who do this work must be thoroughly trained in physical and mental diagnosis, “in physiology and applied hygiene and in clinical psychology. Such training would not necessarily lead to the degree of M.D. Indeed, the best training in this regard would prepare, not for the practice of medicine, but for the practice of essential and vital work in education. To this end special courses of training at universities and normal schools should be inaugurated which will meet the need of the hour.
It is often contended that educators can not acquire the skill essential for physical and mental diagnosis in this field of physiology, hygiene and practical psychology, and at the same time acquire the pedagogical qualifications of an educator. Then let those educators who hold such views take for all time a position of inferiority to physicians, who stand ready not only to take possession of this field, but also at the same time to render their services in the field of technical medicine. Why should educators, of whom the public has a right to demand skill in training boys and girls, be largely unequipped in this essential branch of work? Not all grade teachers, nor all principals and even superintendents, may be able with the informational and executive work required of them, to attain to special skill in this larger field,?the field of child psychology in its most useful form,?but the way should be opened to those who choose to develop in this direction. Until this ideal state of affairs is attained, physicians will continue to occupy this field in the schools, giving such help and time as may be practical to superintendents, principals, and teachers, whose ability, however great in other ways, is markedly deficient in this essential field of education. It is certainly important that educators skilled in these matters should be licensed by the state, with the same legal right of examination and diagnosis as is accorded to physicians, so that the educator and the physician may work on an equal footing in the prevention of inefficiency and degeneracy and to some extent of disease also, in so far as examinations and diagnoses of growth and development can serve this end. The educator’s field would be the hygiene of instruction and environment, that of the physician surgery and the expert treatment of diseases. So far as the writer knows, California is the first state in the Union to give legal recognition to this function of the skilled educator, thereby extending and making more effective the work of experts in education, and bringing about a heartier cooperation between educators and physicians. The third clause under “purposes of health and development supervision” in the California law provides for the study of mental retardation and deviation in the schools. This special study begins with a complete physical examination of the retarded pupil, giving a basis upon which to adjust school activities to the health and growth needs and development processes of the individual child. It emphasizes the fact that the school room is a psychological laboratory, where the causes of retardation and degeneration are to be found and remedied. The prevention and cure of retardation and degeneration must be undertaken by the teaching force of the schools. Much of the sickness, untimely death, defect, inefficiency, and degeneracy in the world, is unquestionably due to unfortunate inheritance, but childhood is a period of latency in which hygienic environment and hygienic activity can overcome heredity and make possible a useful and normal adult life. It is the opportunity of the schools to deal skilfully with this problem, and to educate parents to cooperate with them in removing the barriers to normal development of the young. By the enactment of the law under discussion the California legislature has emphasized the value of this work.
The California law further provides for all work generally included in sanitation, for expert supervision in the construction of school buildings, etc. In the wording of the law the term “Health and Development Supervision” represents a broader interpretation of school hygiene. The law throws a safeguard around the work by requiring both educators and physicians to take out health and development certificates. These certificates are issued by county boards of education to educators who hold life diplomas, and to physicians who are authorized to practice medicine and surgery. Both educators and physicians must hold in addition a recommendation of special fitness, issued by the state board of education. Discretionary power lies with the state board of education, upon whom rests the responsibility of molding the type of men and women who shall conduct the work specified by the law in the schools of the state. The work is administrative and directive for all departments of education. A department of health and development is an administrative body essential to every city school system. For county schools, the county superintendent’s office should be the headquarters of the work. When the law becomes mandatory, as it undoubtedly will in a few years, a state department must be organized under the immediate control of the state superintendent of public instruction, who will see that city and county superintendents carry out the provisions of the law. Departments of health and development have been established at Los Angeles, Pasadena, Berkeley, Oakland, Pomona, Redlands, Hollywood, Monrovia and probably by this time in other cities. It is but fair to Los Angeles to mention that the enactment of the present law was largely due to the initiative of the educators and physicians who make up the department in this city.
A special course of training for educators in the subjects indicated in this paper is now in preparation by the department of education of the University of Southern California. Work of a similar character but less extensive, has been undertaken by the State Normal School at Los Angeles, and also by the Cumnock School of Expression in the same city, for the training of teachers, but not for the training of expert examiners.
Stanford University is ready to give a thorough training to those who wish to become examiners, and the State University of California has inaugurated an admirable course of lectures on school hygiene.
In the past, while universities everywhere have been offering courses in education, in psychology, and in medicine, it is nevertheless true that these courses have not been organized in such a way as to give adequate training for practical work in this most vital field of education. The work of universities and normal schools must be recast and so directed as to turn out men and women who are competent to establish and carry on the work of growth and development supervision.
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