LIBRARY 
 
 OF THE 
 
 UNIVERSITY OF CALIFORNIA. 
 
 Class 
 
THE HEALTH OF THE 
 SCHOOL CHILD 
 
THE HEALTH OF THE 
 SCHOOL CHILD 
 
 BY 
 
 W. LESLIE MACKENZIE, M.A., M.D. 
 
 D.P.H., M.R.C.P.ED., F.R.S.E. 
 
 MEDICAL MEMBER OF THE LOCAL GOVERNMENT BOARD 
 FOR SCOTLAND 
 
 METHUEN & CO. 
 
 36 ESSEX STREET W.C. 
 
 LONDON 
 
First Published in 1906 
 
PREFACE 
 
 THE papers here reprinted are offered as a con- 
 tribution to the practical side of the medical 
 inspection of schools. In every civilised country the 
 doctor and the school child are coming closer together. 
 In Scotland, no less than in England, the interest 
 is widespread and intense. This must be my 
 apology for the present papers. 
 
 The first paper was read at a Congress of sanitary 
 administrators, official and unofficial. The second 
 was read at a Congress of the Parents' National 
 Union, where the majority were in a position to 
 choose for their children the best education afforded 
 by our present-day schools. The third was read 
 before the Royal Society of Edinburgh, by whose 
 kind permission it is now printed. On all three 
 occasions, I found, as indeed in many places else- 
 where in Scotland, that the Royal Commission on 
 Physical Training (Scotland) and the Committee 
 of Physical Deterioration had aroused the minds 
 of every class of the community to the importance 
 of personal hygiene in schools. The medical super- 
 vision of school children appeals to every class of 
 the community. It is responded to by every class. 
 It is no longer a topic for special pleaders. It is 
 
 164911 
 
vi PREFACE 
 
 already " on the town," and parents everywhere are 
 either asking for it or preparing themselves to accept 
 it. In the Education Bill now before Parliament, a 
 clause has been inserted to make medical inspection 
 obligatory in all English State-aided schools. Mr. 
 Tennant, M.P. for Berwickshire, who moved the 
 clause, must have been greatly gratified at the 
 amazing unanimity of the House. 
 
 It seems worth while to give some detail of the 
 methods followed in two German cities, if only to 
 show that the medical examination of school 
 children is after all a very simple matter, and does 
 not involve any reconstruction in our theory of the 
 State or of its relation to local authorities. If we 
 force the child to school, we have no right to force 
 him to read with defective eyes, or to expect him 
 to hear with defective ears. I have never met a 
 single parent that disputes this proposition. On the 
 contrary, I have met scores that, on having their 
 attention called to the importance of good eyes and 
 ears, have forthwith taken their children to the 
 doctor to learn whether things were all right. 
 
 I have to thank the Council of the Royal Society 
 of Edinburgh, the Council of the Incorporated 
 Sanitary Association of Scotland, and the Council 
 of the Parents' National Education Union for 
 permission to print the papers prepared for their 
 respective Societies. 
 
 W. L. M. 
 
 EDINBURGH, October 1906. 
 
CONTENTS 
 
 PAGE 
 
 THE HYGIENE OF SCHOOL LIFE . i 
 
 NORMAL GROWTH IN THE SCHOOL AGES . .21 
 
 MEDICAL EXAMINATION AND SUPERVISION OF 
 SCHOOLS AND SCHOOL CHILDREN . . 49 
 
 THE SCHOOL DOCTOR IN GERMANY . . 88 
 
 (a) WIESBADEN . . . . .89 
 
 (b) NUREMBERG . . . . 101 
 
 NOTE ON RE- VACCINATION OF SCHOOL CHILDREN 
 IN GERMANY . . . . . 115 
 
 NOTE ON THE PLAN OF A GERMAN ELEMENTARY 
 SCHOOL . . . . . .119 
 
THE HEALTH OF THE 
 SCHOOL CHILD 
 
 THE HYGIENE OF SCHOOL LIFE 1 
 
 i. WHY is THE HYGIENE OF SCHOOL LIFE 
 IMPORTANT ? 
 
 THE answer is as easy as it is conclusive. In 
 the school age the child for the first time is 
 subjected to definite responsibilities. Up till now 
 he has been his own master. His every day was a 
 holiday. He wakened in the morning to no duty 
 prescribed. He went to sleep at night with no duty 
 done. In this day of freedom he was allowed to 
 grow in body and in mind much as accident deter- 
 mined. When his parents were good, he was 
 cleaned, clothed, fed, and educated. When his 
 parents were bad, he remained dirty, ragged, hungry, 
 and untaught. And the goodness of his parents to 
 him was not all their virtue, nor their badness to him 
 all their blame. If he was one of six, his nurture 
 
 1 Opening paper of discussion on " The Hygiene of School Life " at 
 the Annual Congress of the Incorporated Sanitary Association of 
 Scotland ; held at Inverness, September 1905. 
 I 
 
2 THE HEALTH OF THE SCHOOL CHILD 
 
 had to fall off as his years increased. If he was an 
 only child, he was over-petted, mentally and phys- 
 ically. In the one case, the social currents of the 
 immediate neighbourhood became his principal 
 schoolmasters. In the other, the sentimentalism of 
 half-trained minds, or the conscientious labour of the 
 tenderest love, became his support in every moment 
 of his day. How many types might we sketch out 
 of the endless chaos of evil, or degenerate, or drunken, 
 or ignorant, or incompetent, or idle, or overdriven, or 
 poor parents ! How many more types out of all 
 their contraries ! From the good or from the bad 
 the school child emerges when the school bell rings. 
 His holiday from the beginning of time has ended. 
 His duty to the end of time has begun. He will 
 never know " glad, confident morning again." He 
 has now another outlook, another programme, 
 another destiny. He keeps touch, indeed, with his 
 parents, but he can no longer rest in his home. He 
 goes where he will learn the knowledge of a wider 
 world, the duties of a greater community, the secrets 
 of the old and new gospel of work. Tender, timor- 
 ous, mysterious, the "heir of all the ages," he is 
 taken by the hand for reasons he cannot know, to 
 enter a kingdom he can never all explore, to learn a 
 lesson he can never all understand, to live a life he 
 can never all explain. He is the hope of his father 
 and mother, he is the problem of his teacher, he may 
 become the despair of himself. 
 
 In the Tate Gallery in London, in a corner of one 
 of the rooms, you will find a picture of the " last 
 night at home." It is an English scene more than 
 
THE HYGIENE OF SCHOOL LIFE 3 
 
 a Scottish, but it has its like in every country where 
 there are fathers and mothers, and children leaving 
 for school. It is the last night. Everything is 
 ready for the journey of the morning. There are 
 sisters, there is the mother, and there stands the 
 father by the sideboard ; there, too, stands the boy. 
 To-night they will be all as happy as they can be. 
 They will drink a parting glass together. The little 
 man in knickerbockers looks up at his father, and 
 the sparkle in his glass is not brighter than the 
 tender smile in his eyes. The father, too, all smiles, 
 raises his glass, and the mother smiles with them. 
 You cannot tell how long it will last ; for love is 
 drinking the wine of its parting sacrament, the heart 
 is bursting, the whole of what joy is and love is and 
 sorrow is plays there with its last moments of life. 
 To-morrow, their hands will be at their lips bidding 
 adieu to that which can never be recalled. A new 
 life in the armour of love and sacrifice has fared 
 forth into the world. Is there anything more sad, 
 more beautiful, more holy? 
 
 But these are the visions of the ideal. The child, 
 we know well, does not always come from an 
 atmosphere like this. Yet come he from the heights 
 or the depths, he has in him that which makes a man 
 great or small, good or evil, a citizen or a rogue. 
 He will be one of the men that make nations, 
 that make worlds, that make civilisations. He is the 
 greatest problem of his hour; he is the greatest 
 danger of his time ; he is the greatest product of 
 the world's energies. Is this language extravagant ? 
 Is it not, on the contrary, the sober, scientific truth ? 
 
4 THE HEALTH OF THE SCHOOL CHILD 
 
 Only look round and see. The peoples of every 
 land, East and West, Far East and Far West, are 
 awakening to the problem of the school child his 
 nurture, his education, his discipline. They have 
 already learned the first lesson of civilised progress 
 the parent is, indeed, the past and the present ; the 
 child is also the future. 
 
 2. THE SCHOOL AS FUNCTIONAL ENVIRONMENT 
 
 Why functional environment ? By this phrase I 
 wish to indicate that the primary thing to consider 
 in the hygiene of a school is the point where the 
 actual structure affects the living, actual child. From 
 nine in the morning to three or four in the afternoon, 
 the child is acting in the school, and the school is 
 reacting on the child. He must breathe. Is the 
 air over-night fresh ? He must move about. Have 
 the floors and forms been properly cleared of dust ? 
 He must sit down. Are the seats the correct 
 height ? He must write. Are the desks the correct 
 height for his size ? Are they too near him, or too 
 far from him ? He must read. Does the light 
 shine from his left side ? He must see the black- 
 board or the wall card. Is it placed in the correct 
 light for him to see ? He sits for most of an hour. 
 Is the room warm enough ? Are the heating appli- 
 ances in working order ? Has he on clothes enough ? 
 He reads aloud in his class, or shouts, or sings in 
 concert, he coughs, or sneezes, or otherwise clears 
 his air-passages ; in a thousand ways he fills the air 
 with pollutions from his mouth, nose, and lungs. 
 
THE HYGIENE OF SCHOOL LIFE 5 
 
 Are the walls cleaned? Are the maps cleaned? 
 He spits on his slate, if he is allowed to use one ; 
 he bites his pen ; he chews his pencil. Are slates, 
 are pens, are pencils cleaned? At the word of 
 command, he springs to his feet, marches, marks 
 time. Has he wiped his shoes on the mat ? Are 
 the floors cleaned ? Are the doors and windows 
 opened to keep the beaten room clear of dust ? He 
 swings his arms, he creates a thousand currents 
 round his body. Are his clothes clean ? Is his 
 head clean ? Are his hands clean ? So, through 
 the whole day he is in living touch with some part 
 of the school. He is continually using and abusing. 
 He is collecting and redistributing dirt and dust all 
 day long. I say nothing of the major matters 
 lavatories, water supplies, closets, drainage ; these 
 are all to be assumed. They need the most stringent 
 supervision, and they do not always get it. What I 
 should wish to paint is the restless, growing, skin- 
 shedding, mucus-shedding, dust-distributing, spitting, 
 coughing, and shouting demon that the school boy, 
 at his worst and best, always is. Where one boy 
 is, it takes a woman to keep the house clean. Where 
 a thousand boys are, it takes a local authority. 
 
 That is what I mean by functional environment ; 
 it is the environment that the boy captures and 
 handles as his own in the school. When you think 
 of it thus in detail, you have no difficulty in under- 
 standing why we are, in season and out of season, 
 insisting on the necessity for fitting the boy to the 
 school and the school to the boy. Let there be 
 water, drainage, lavatories, cloak-rooms, systems of 
 
6 THE HEALTH OF THE SCHOOL CHILD 
 
 heating, systems of ventilation, fires, opening and 
 closing windows, under-floor ventilators, good walls, 
 good floors, good roofs, good playgrounds. But 
 let it be remembered that the health of the school 
 child depends on the use that he is able to make of 
 these appliances and the way they are adapted to 
 his needs. It is not ventilating appliances alone 
 that are wanted ; it is ventilation. It is not water 
 alone ; it is washing with water. It is not heating 
 pipes or fires alone ; it is heating with heat to the 
 degree necessary for the physical comfort of a 
 delicate, growing organism. In a word, it is not 
 only the statics of hygiene that we want ; it is the 
 dynamics as well. That is why the school and the 
 school child must be studied together as organism 
 and environment ; the needs of the one must find 
 an answer in the conditions of the other, the needs 
 of the child in the structure and management of 
 the school. 
 
 3. THE STRESSES OF SCHOOL LIFE 
 
 The primary stress of school life falls on the 
 nervous system ; for the primary business of the 
 school is to educate the incompletely developed 
 but rapidly maturing brain. Many children break 
 down at the outset ; many break down towards the 
 end ; many suffer in minor ways that are never 
 noticed at the time ; all are liable to suffer in growth 
 and in nutrition. This fact alone makes good 
 hygienic environment and good hygienic administra- 
 tion imperative. The stresses that more openly and 
 
THE HYGIENE OF SCHOOL LIFE 7 
 
 directly concern the sanitarian are the infectious 
 diseases, the skin diseases, the results of bad 
 atmosphere, and the results of filthy homes. The 
 diseases I leave alone. Two good topics for dis- 
 cussion are, how best to secure a good atmosphere, 
 and how to deal with dirty children. 
 
 4. VENTILATION 
 
 In town schools, the problem practically is, Should 
 a system of mechanical ventilation be installed, or 
 a differential temperature system ? Both systems 
 have advantages, and both have disadvantages. 
 The mechanical systems sometimes give satisfaction 
 in the working, sometimes not. So far as I am 
 aware, the highly favourable report made by 
 Professor Carnelley to the Dundee School Board in 
 1889 has not been overturned by any equally 
 thorough investigation of other systems. Dr. J. S. 
 Haldane has confirmed Carnelley's general results. 
 With the increased facilities for obtaining electric 
 power, mechanical systems have become more 
 practicable. But, as Dr. Kerr of the London 
 County Council Education Department has shown, 
 the engineering difficulties demand more thinking 
 out than they sometimes receive. The moving fan 
 is only one factor. The relation of inlet to outlet, 
 the dangers of short-circuiting, the size of ducts, the 
 methods of heating are all equally important. A 
 mechanical system needs a capable mechanic to 
 work it, and where it is properly worked the 
 results are excellent. 
 
8 THE HEALTH OF THE SCHOOL CHILD 
 
 Of the other systems it would be impossible to 
 speak with any detail. I always feel that our 
 attitude to ventilation is too much determined by 
 our foolish domestic habits. It is the custom to 
 take off coats " in the house " ; " you feel the good 
 of it when you go out." This time-and-custom- 
 honoured platitude is repeated thousands, millions 
 of times a year ; but I have long had a doubt of 
 it. It is based rather on our liking for warmth than 
 on our scientific knowledge of bodily temperature. 
 Three simple points it is well to remember first, 
 that in the coldest winter known to this country, 
 the air is never too cold to breathe ; secondly, that 
 children will remain healthier and physiologically 
 better through the school day if they are made to 
 keep their bodies warm and to breathe cool, fresh 
 air ; third, that where fires or other heating appli- 
 ances fail, warm coats and shoes may be a good 
 substitute. There is no law against wearing enough 
 clothes to maintain comfort. Further, training does 
 a great deal, and any person child or adult can 
 be systematically trained to tolerate floods of pure 
 cold air in the coldest weather. One important 
 fact, however, should never be forgotten a child's 
 body, being smaller, cools much more rapidly than 
 an adult's. 
 
 5. FILTHY CHILDREN 
 
 Later, in this paper, I shall indicate how filthiness 
 is prevented in German schools. Here, I should 
 like to say that on no point are parents more 
 sensitive than on the cleanliness or dirtiness of 
 
THE HYGIENE OF SCHOOL LIFE 9 
 
 their children or their children's clothes. This is 
 reasonable and honourable. I am satisfied that 
 when, as was proposed in the recent Education 
 Bill, the children are placed under systematic 
 medical supervision, dirtiness of children and 
 clothing will tend to vanish. When every school 
 has adequate washing facilities, the dirt will grow 
 still more rapidly less. 
 
 6. TEETH 
 
 Is there still any educated person that does not 
 believe in the hygiene of the mouth ? There may 
 be yet a few in practice ; in theory, there should be 
 none. For in this limited and well-worked field the 
 facts are all one way, and there can be no dispute. 
 It is a plausible speculation that we are, as a race, 
 beginning to lose our teeth permanently ; but it is 
 admitted that some millions of generations will yet 
 appear before the normal man will emerge toothless. 
 In the meanwhile we have time enough to clean the 
 teeth we have and to keep them clean. Doubtless, 
 some varieties of food tend to make decay come on 
 faster. But that is only a reason for more care at 
 the earlier ages. Doubtless, too, some children show 
 decay more rapidly than others, and possibly the 
 condition of the nervous system has something to 
 do with the vanishing of the teeth. But this is only 
 a still stronger reason for ensuring that the teeth, 
 such as they are, get every protection we can give 
 them. It is now accepted among dentists that the 
 decay of teeth is due to micro-organisms, acting 
 
io THE HEALTH OF THE SCHOOL CHILD 
 
 most readily in certain acid conditions of the mouth 
 and eating away the enamel. At once we infer that 
 if you protect the teeth against those micro-organ- 
 isms, you 'delay, or arrest, or prevent decay. And, 
 on the whole, this is true. But the mouth is an 
 ideal incubator for germs, and nothing short of a 
 thorough toilet once or twice a day will answer the 
 purpose. But all the same, daily cleansing of teeth 
 and washing out of the mouth can do a great deal. 
 The dentist will do the rest. From the appearance 
 of the teeth right through the period of the milk- 
 teeth and continuously through life the teeth should 
 be attended to daily. This is a counsel of perfec- 
 tion ; but the school can do something either by 
 systematic teaching or by practical drill. For my 
 part, I am always glad to see a good figure and 
 well - proportioned muscle, but if it is a choice 
 between good muscle at school and good teeth, I 
 prefer good teeth. The muscles will assert their 
 rights without too much stimulation ; good guidance 
 in a scientific system of training is all they want. 
 But on the teeth the whole growth and nutrition of 
 the body depend. It is now the exception to find, 
 at the age of ten or twelve, a whole mouthful of 
 sound teeth. And in other countries the tale is the 
 same. I have seen the mouths of some two hundred 
 German children, and the conditions were practically 
 a repetition of what our own country produces. If 
 this be so, is there anything absurd in suggesting 
 tooth inspection and tooth-brush drill ? 1 We should 
 
 1 If it be said, a dirty, germ-laden tooth-brush is worse than none, 
 and may spread disease among the teeth, we may at once agree. But 
 
THE HYGIENE OF SCHOOL LIFE n 
 
 find fewer toothless recruits for all our services if the 
 recruits at school were well looked after. 
 
 7. MISCELLANEOUS 
 
 There were other points that I intended to touch, 
 but they would load the discussion too heavily. The 
 hygiene of school life is now vast enough to justify 
 an International Congress by itself. The first Con- 
 gress, which met at Nuremberg last year, resulted in 
 four large volumes, containing a total of more than 
 2000 pages of investigation and discussion. As a 
 further result, an international magazine of school 
 hygiene has been inaugurated. Every civilised 
 country was represented at the Congress, and the 
 magazine represents a body of workers now numbered 
 by thousands. It is hopeless even to attempt to in- 
 dicate the enormous range of subjects that bear on 
 the hygiene of the school. I have selected only one 
 or two for a passing remark. As an instance of the 
 growing importance and complexity of the problems, 
 I may note one book, the Enzyklopaedisches Hand- 
 buck der Schulhygiene, which reckons among its 
 contributors many of the foremost physiologists 
 and educational thinkers of the world. The book 
 runs to 1055 double-column, closely printed pages. 
 The bibliographies appended to the articles show 
 
 means should always be present to disinfect the brush. An American 
 dentist declares it to be practically impossible to disinfect a dirty tooth- 
 brush, and recommends pieces of sterile cotton for rubbing the teeth 
 clean. But I do not grant the contention that a brush cannot be 
 disinfected. 
 
12 THE HEALTH OF THE SCHOOL CHILD 
 
 the enormous variety and amount of work devoted 
 to the school careers of our children. 
 
 8. A VISIT TO Two GERMAN ELEMENTARY 
 SCHOOLS 
 
 In Wiesbaden last summer, I had the privilege of 
 going on two occasions with a school doctor to make 
 one of the fortnightly visits to an elementary school. 
 I was anxious to see how medical supervision of 
 public elementary schools is conducted in a town 
 where the system has been in force for more than 
 nine years. And I found the system, as one 
 naturally expects in Germany, working smoothly, 
 simply, unpretentiously. As one of the doctors 
 said, " It is our policy in everything ; we must. It 
 is different in England." The German "thorough- 
 ness " (Gruendlichketi) was as manifest in the 
 medical supervision of the schools as in so many 
 other departments of their great organisations. 
 Whether the ultimate results will be better than 
 our own I cannot tell ; but I felt we had something 
 to learn from them, and I did my best to learn it. 
 
 One morning, at nine o'clock, I went with one of 
 the school doctors to an elementary school in one 
 of the poorest quarters of Wiesbaden. The poverty 
 is unmistakable, but, unlike our poverty, it is not 
 chiefly manifested in dirty children dirtily clothed. 
 It is difficult to discover either a dirty child or a 
 dirty mother on the Wiesbaden streets, even their 
 meanest streets, and we have seen most of these. 
 This school, like all the Volksschulen^ or elementary 
 
THE HYGIENE OF SCHOOL LIFE 13 
 
 schools, of the town, is large enough to accommodate 
 1 300 children or thereby. The work of this 
 particular morning was to examine some 35 new 
 entrants that is, children just turned six years of 
 age. The school year begins at Easter, and these 
 were probably part of the annual influx. 
 
 We proceeded direct to the department where 
 the infant boys were. The class teacher, a man, 
 had already received notice of the visit. He had, 
 in a simple portfolio, a series of schedules, printed 
 back and front. On these schedules he had already 
 entered the names, addresses, ages, names of parents, 
 occupations, class, the height and weight, and one 
 or two other particulars. The portfolio was handed, 
 with some explanations, to the doctor, who forthwith 
 proceeded to examine the children in their order. 
 He did so in the class-room, for in this school there 
 is not a doctor's room. He had meanwhile secured 
 from a higher class two boys, whose duty it was to 
 assist in undressing and re-dressing the children. 
 He examined first the general condition, and I must 
 say most of the children were thin. They did not 
 seem to me any better nourished than our own 
 children of the same grade ; but, as simple inspection 
 is very deceptive, I make this remark subject to the 
 correction afforded by the heights and weights. 
 The doctor recorded the nature of the constitution 
 as good, medium, bad. He examined the throat 
 and teeth, using a separate piece of wood as a 
 tongue depressor for each child, and throwing it 
 away to be burned afterwards. He examined nose, 
 ears, eyes, skin, bones, joints, spine, heart, lungs, 
 
14 THE HEALTH OF THE SCHOOL CHILD 
 
 ascertained the presence or absence of hernia 
 (rupture), measured the chest, tested the speech by 
 making the child repeat certain test words, tested 
 the eyesight roughly, and the hearing roughly. In 
 suspected cases, eyes and ears are afterwards 
 examined more thoroughly. Any defects requiring 
 correction or further expert examination are referred 
 to the parents, who receive either a verbal or a 
 written message saying that the child should be 
 taken to the family doctor. Where the parents are 
 very poor, they are directed to take the child to 
 the town hospital or an eye dispensary. To this 
 dispensary the Municipality contributes a certain 
 sum in payment of the work undertaken. Similarly 
 with every other condition requiring treatment, the 
 parents are advised, inquiry is afterwards made as 
 to the steps taken, and if nothing has been done 
 further inquiry is made, and the child is ultimately 
 attended to. The purpose of the immediate inspec- 
 tion is not to treat, but to discover. But indirectly 
 the steady pressure put on the parents ultimately 
 results in treatment. Every defect discovered is 
 entered on the schedule, with the date of the 
 examination. The portfolio of schedules is then 
 handed back to the teacher, who is responsible for 
 its safe keeping. He hands it on to the teacher of 
 the next class when the time comes for the passing 
 of the class to the next stage. 
 
 So far the entrants. Those found not fit are not 
 permitted to proceed. The parents are com- 
 municated with and advised. As to those just 
 leaving school, a similar examination is undertaken. 
 
THE HYGIENE OF SCHOOL LIFE 15 
 
 They have been under supervision all through their 
 school course. The doctor is familiar with their 
 history. He has already examined them at least 
 twice. He now examines them a last time. He 
 advises as to their fitness for this or that trade, and 
 consults with the parents if need be. Education 
 does not wholly stop at thirteen or fourteen, as with 
 us. The child must attend, at least part of the day, 
 at a continuation school or technical school, where 
 the elements of the crafts are taught. He must be 
 certified fit for this work, which is a sort of parallel 
 to our " half-time " system. With us, however, the 
 technical part of the training is carried out in the 
 factory ; with the Germans, it is carried out in the 
 school. In both countries there may be wage- 
 earning ; but I formed the impression that with the 
 Germans the educational side was primary. 
 
 After we had thus scrutinised some thirty-five 
 children, taking about an hour and a half to the 
 process, we hurriedly looked through the sanitary 
 arrangements of the school ; the dining-place, where, 
 from charitable funds, free breakfasts and dinners 
 are given in the winter-time or other times of stress ; 
 the heating and ventilating appliances, and the 
 shower baths. These I touch on again. 
 
 A week later, I was able to visit a somewhat 
 superior and more recently built school. This time 
 I went with another school doctor on his regular 
 fortnightly visit. He received from the chief master 
 a sheet containing some sixteen names. These 
 were marked as from different classes. We took 
 them in order. The doctor went direct to each 
 
1 6 THE HEALTH OF THE SCHOOL CHILD 
 
 room, received from the teacher the schedules of the 
 particular children that in that class required exam- 
 ination, picked out the children and directed them 
 downstairs to the doctor's room. The collection of 
 the sixteen children from some six different classes 
 in different rooms was the work of a few minutes. 
 Two senior boys, as before, attended as assistants. 
 Each child was taken, his complaint examined, and 
 advice given as before ; eyes, ears, etc., of any new- 
 comers were also investigated. Two children were 
 to be examined with a view to having six weeks in 
 a holiday school in the forest some miles away and 
 higher up country. Two or three cases of eyes 
 were referred to the eye dispensary. A case of skin 
 disease was diagnosed, and the boy requested to 
 inform his father (who wanted to know) that the 
 disease was not infectious. There were one or two 
 very young children showing signs of feeble- 
 mindedness or backwardness. And so on through 
 the day's list. This is done every fortnight. The 
 doctor assured me that once a month or once in 
 two months would be quite enough ; the short 
 period of a fortnight was somewhat exacting to a 
 man in medical practice, and was sometimes apt to 
 give occasion for trivial complaints. But practically, 
 on any one occasion, an hour suffices. 
 
 In both schools it was easy to see that the doctor 
 was an ordinary and accepted part of the school 
 service. He seemed to be readily welcomed by the 
 teachers, and was sometimes waited for by the 
 parents, who wished to get his personal opinion of 
 their children. So simply and unostentatiously and 
 
THE HYGIENE OF SCHOOL LIFE 17 
 
 rapidly were the cases disposed of that one wonders 
 why there ever should be any objection to such 
 systematic inspection. 
 
 Afterwards I was taken to see the children in 
 the bathroom. In Wiesbaden, as in Nuremberg, 
 the elementary schools, and the higher schools 
 too, are all fitted with shower baths. Pipes 
 are carried round at a height of about seven feet 
 from the floor. The floor itself is tiled. In some 
 cases an area is sunk about a foot deep, con- 
 stituting a shallow large bath. To the pipes are 
 attached shower-roses six or eight in all. Each 
 rose gives a shower sufficient to serve three to five 
 boys. They stand under on a wooden board about 
 3j feet square, and wash themselves thoroughly 
 with soap. The temperature of the water is regu- 
 lated by an attendant, who, through a window, 
 commands a full view of the bathroom, and turns 
 on warm, mixed, and cold water at the right stages. 
 The apparatus is simple. The water is supplied 
 strictly in accordance with the thermometer. When 
 the washing is sufficient a cool shower is given, and 
 the boys proceed to the drying-room. There each 
 has a towel. There are lockers or other places for 
 the clothes. Undressing, washing, and re-dressing 
 occupy about half an hour. On the occasion of my 
 visit thirty-four boys were washing at once. They 
 were certainly clean. They certainly enjoyed the 
 game. Those suffering from any ailment may be 
 exempted from the baths. In no case are they 
 forced to bathe against the wish of the parents or 
 the certificate of the family doctor. The whole 
 
1 8 THE HEALTH OF THE SCHOOL CHILD 
 
 matter is directly under the control of the school 
 doctor. The two lowest classes, which contain the 
 very young children, are not subjected to the shower 
 bath at school. But it is obvious that cleanliness 
 is an ideal much sought after, for in the fifty or 
 more children carefully examined only two were 
 found not clean, and they were new-comers, who 
 had not yet come under the spell. Among the 
 children higher than the lowest two classes, there 
 was no such thing as an unclean child, and unclean 
 clothing was conspicuous by its rarity. 
 
 Of the six upper classes all the children have a 
 washing shower bath once a week. In an ordinary 
 elementary school in Wiesbaden there are normally 
 about 900 such children. At the rate of 160 a 
 day these can all be washed with clean water in 
 a week. As we have seen, 34, or, say, 35, can 
 be washed effectively in half an hour, that is 70 
 in an hour. In three hours of each day, with one 
 male and one female attendant, the whole work can 
 be done with perfect ease and without hurry. 
 
 The shower bath has many advantages over the 
 ordinary bath it is cheap, it is practically self- 
 cleansing, it can be controlled for a large number 
 at one time, it can be gone through more rapidly, 
 and the water is current and therefore always clean. 
 It has been found that it is an advantage to have 
 the children passed through in groups rather than 
 singly. The interest is greater, they help one 
 another, and the number overtaken is greater. In 
 some German schools there is also a swimming 
 pond ; but this is for exercise, not for cleansing. 
 
THE HYGIENE OF SCHOOL LIFE 19 
 
 The installations in Nuremberg were more luxurious 
 than those of Wiesbaden, but all on the same funda- 
 mental plan. Obviously, the system has been found 
 a good one. The results were certainly admirable. 
 In the report for 1903 I find that in one of the 
 Wiesbaden schools the shower baths were regularly 
 used by 36 per cent, of the boys and 33 per cent, 
 of the girls ; in another, by 62 per cent, boys and 
 83 per cent, girls; in another, by 84.7 per cent, 
 boys and 44 per cent, girls ; in another, by 74 per 
 cent, of the school; in another, by 80 per cent, 
 boys and 14 per cent, girls. The two lowest classes 
 are excluded from those figures. 
 
 How much does the service of school doctors 
 cost ? A relatively trifling sum. In the elementary 
 schools of Wiesbaden, a town of 98,000 or thereby, 
 there are approximately 10,000 elementary school 
 children. The amount allowed for the work of 
 medical inspection is 5000 marks, or 250 a year. 
 This is divided among seven doctors, there being 
 seven main schools and two small schools. Each 
 doctor has a school. He examines systematically 
 all entrants and all pupils leaving ; he examines in 
 each year the whole children of the third, fifth, and 
 eighth classes ; he visits the school once a fortnight 
 to deal with current cases. He has many other 
 duties, such as supervision of the lavatories, ventila- 
 tion, heating, bathing. He receives for this from 
 30 to 50 a year, and no one can say that he 
 is overpaid, even as payment goes in Germany. 
 
 The Wiesbaden schools are only a type of what 
 is done, in some degree or another, in every German 
 
20 THE HEALTH OF THE SCHOOL CHILD 
 
 State and in most European and American States. 
 Japan is perhaps more advanced than any of the 
 Western States in the detailed care given to her 
 population. I have no doubt that, as already in 
 London and many of the great English towns, so 
 in Scotland we shall in a short time have the school 
 doctor as one of the most important officers of the 
 school service welcomed by the teacher and waited 
 for by the parent. And the figures rapidly ac- 
 cumulating from Glasgow, from Edinburgh, from 
 Aberdeen, from Dundee are already demonstrating 
 to us that the less we delay this improvement in 
 our methods, the better for the individual children 
 themselves and for the State, whose life-blood 
 they are. 
 
NORMAL GROWTH IN THE SCHOOL AGES 1 
 
 i. WHAT is GROWTH? 
 
 WHAT is growth ? What is the school age ? 
 What is normal growth? Why do we 
 select the school ages ? 
 
 If we consider the life of the human being from 
 the cradle to the grave, we find it roughly divided 
 into a period of growth, a period of maturity, and a 
 period of decay. The period of growth may be set 
 down as the first twenty- one years of life. And this 
 is the period we wish to study. If we were thinking 
 of the race, we should have to date from long before 
 the cradle to long after the grave ; for, with very 
 little reflection, we should discover that the individual 
 has a history as old as the race, which is as old 
 as the world. But growth in its widest sense we 
 cannot here consider. We are thinking only of the 
 short sections from five to fifteen, which is the ele- 
 mentary school age, and from fifteen to eighteen, 
 which is the secondary school age. Scotland and 
 England differ somewhat in this matter ; for in 
 Scotland, at least in the North, we habitually think of 
 the elementary school as passing into the secondary 
 
 1 Read to the Edinburgh Meeting of the Parents' National Educa- 
 tional Union, 1904. 
 
 21 
 
22 THE HEALTH OF THE SCHOOL CHILD 
 
 school, and of the secondary school as passing into the 
 University. In Edinburgh, however, we are becoming 
 more accustomed to the conceptions prevalent in the 
 great English schools, which reckon the school age 
 practically as from ten to eighteen or nineteen. In 
 the Merchant Schools of Edinburgh, both for boys 
 and for girls, the school age would run to seventeen 
 or eighteen. Similarly with the other secondary 
 schools. But I am less concerned with a rigid limit 
 of years than with the leading fact that the school 
 age on the whole coincides with the age of growth. 
 
 2. THE STRESS OF SCHOOL LIFE 
 
 The school is an artificial environment devised to 
 teach the child how to abstract, how to select from 
 the chaos of the world some guiding lines for his 
 future life. Unlike the family, which is the focus of 
 so many diverse purposes, the school has been 
 devised for one sole purpose to direct, to develop, 
 to mould, in a word, to educate. Even the phrase 
 " to educate " is too wide ; for the school is only one 
 among many agencies designed to prevent the 
 scattering and the wasting of character. In a society 
 like ours, it may be regarded as a specialisation of 
 one function of the family. It assumes that the 
 individual is incapable in his short lifetime of himself 
 attaining to the best that the race has achieved ; 
 that, if left to himself, he may develop, but the 
 development will so diverge from the good and the 
 useful that the ultimate result to him is futility for 
 himself and evil for the race. To prevent this 
 
NORMAL GROWTH IN SCHOOL AGES 23 
 
 relapse, to economise the energies, to make the most 
 of him for the short time that he has to live, to 
 enable him, in a word, to realise himself to the best 
 purpose, we place him in restraint, we put upon him 
 heavy burdens, we check, we curb him, we break him 
 under the yoke of civilisation pain, sacrifice > duty. 
 We drive him into system ; we catch in him what is 
 good and preserve it ; we restrain what is evil and 
 blot it out ; we order his day that he shall learn in 
 the shortest time, by the quickest method, with the 
 least effort, all that we conceive for him of the good 
 and the beautiful and the true. For these ultimate 
 aims and for nothing less, we place him tender, 
 fragile, variable, full of mysterious activities in a 
 new world full of difficulties and depressions and 
 disciplines and broken hopes. The school is the 
 novitiate for the Service of Man. Is it a wonder if we 
 begin to ask fundamental questions about growth ? 
 Are we not right to inquire whether the task be not 
 too great, the strain too terrible, the trial too pro- 
 longed, for a personality so mysterious and so delicate, 
 for a mind so bursting with impulses, for a nervous 
 system so fluid ? Is it not well that we should 
 know how the strains and stresses and burdens fit 
 the needs of growth ? 
 
 It is in the school age that this life normally 
 begins. It is, therefore, our business to discover how 
 the child should grow during this period, how he 
 should develop, what we should provide for, what 
 encourage, what prevent. I assume, too, that 
 whether he remain at home or go abroad into the 
 world, every child comes to his school age, the age 
 
24 THE HEALTH OF THE SCHOOL CHILD 
 
 when the family is too small, too inadequate for the 
 unfolding mind. And the school age passes. Soon 
 or late, a day comes when Freedom, which is re- 
 sponsibility, sounds the trumpet-call, and the novice 
 passes out to his post. Then there is anguish, there 
 is breaking of hearts, but the division of child and 
 parent is accomplished. To every regret, to every 
 tender remonstrance, to every entreaty, each in his 
 own dialect utters the same reply : " Woman, wist 
 ye not that I must be about my Father's business ? " 
 
 3. BRAIN AND MUSCLE 
 
 The primary intention of the school is to train 
 the mind. In an era of predominant muscle-worship 
 this may sound like a paradox. But by the mind, 
 I understand the whole character as it is influenced 
 by the discipline of intelligence applied to life. 
 In this wide sense everyone will accept the view. 
 But at the basis of the prevailing practice there 
 seems to lurk the suspicion that the specific work of 
 school, the exercise of the brain and the formation 
 of mental habits, has in it something hostile to 
 physical development. It is quite true that the 
 neglect of the general organism may result in condi- 
 tions that make good mental work impossible. It 
 is equally true that, on occasion, the healthy boy or 
 girl whose time is taken up mainly with the care of 
 physique, with the exercise of muscle, with the 
 direct improvement of every organ except the brain 
 and nervous system, may pass in the race many that 
 care only for mental work, or in physical language, 
 
NORMAL GROWTH IN SCHOOL AGES 25 
 
 the improvement of the brain. But so far as my 
 observation goes, the danger of long continued mental 
 work is largely imaginary. Nor am I prepared to 
 accept the idea that no young mind should ever be 
 put on the strain. I cannot understand why, with- 
 out the slightest reproof, a boy may play all day long 
 to his own hurt, but he may not work for a few 
 hours without the risk of observation or comment 
 from the parent or the friend. All work and no 
 play is said to make a dull boy. It may be so. But 
 the most interesting boys of my acquaintance have 
 all been workers, and some of them played a good 
 deal. These half-expressed truths are apt to be the 
 cover for laziness. They can never be a sound 
 guide for school life. I doubt if anything has been 
 done anywhere to show by definite scientific proof 
 that the amount of work done in any of the ordinary 
 schools, whether regulated by Code or by the demands 
 of the special class for whom the school is provided, 
 affects seriously the physical growth of any boy or 
 girl. It is very difficult to bring those notions to 
 the test of facts, but the experience of the great 
 school physicians, like Dr. Clement Dukes, of Rugby, 
 should go some way to dissipate our fears. I am 
 inclined to think that more physical damage results 
 from excess of physical exercise, or erroneous pressure 
 of exercise, under unskilled management than from 
 any excess of head-work. If we always have re- 
 gard to the symptoms of fatigue and act promptly 
 upon them, the risk of excessive head-work in boys 
 of school age is small. I do not see why high 
 pressure should be quite an expected thing in games, 
 
26 THE HEALTH OF THE SCHOOL CHILD 
 
 a thing to work up to, to train for, to guide the life, 
 while strain of the head, the same head that manages 
 the muscles, isvreprobated as dangerous. It is so 
 easily forgotterl that muscular fatigue means also 
 indirectly ceretAl fatigue. It is the same brain that 
 works the muscles as works the senses. It is 
 governed by similar limits whether the exercise be 
 predominantly of the motor centres or of the sensory 
 centres. Whatever can be properly named " work," 
 whether it be muscular or whether it be purely 
 cerebral, involves cerebral exhaustion as its ultimate 
 stage. 
 
 4. WORK, PLAY, AND GROWTH 
 
 The relation of growth to work is very complex, 
 because the children that " work " (in the ordinary 
 economic sense of work for a living) are the poorer 
 children ; their nurture in every respect is less 
 adequate than the children of the richer classes 
 enjoy, and it is consequently difficult to disentangle 
 how much of their defective growth is due to labour 
 and how much to deficient or incorrect food or bad 
 housing or want of sleep. But broadly, it is proved 
 that the working children at any given age up to 
 the cessation of growth are smaller in stature and 
 lighter in weight than the children of the leisured or 
 richer classes. It is hardly necessary to prove by 
 figures a fact that has been established in almost 
 every civilised country, not least conclusively in 
 Britain itself. The causes of the differences are, as 
 I have indicated, manifold ; but broadly they may 
 be summed up in this that the children of the 
 
NORMAL GROWTH IN SCHOOL AGES 27 
 
 poorer classes do more work and the children of 
 the richer classes have longer play. Perhaps it 
 would be nearer the truth to sa# that both the 
 parents and children of the richer passes have more 
 play, they have better houses, they.an arrange that 
 their children shall have better food, more sleep, a 
 longer period of irresponsibility. 
 
 5. THE RELATION OF GROWTH TO NUTRITION 
 
 " Growth is in some way and in some degree 
 influenced by nutrition, that is, by the food and 
 air supply of the organism. It is a question for 
 evidence whether a child badly nourished in the 
 early years of life ever attains to the same stature 
 as it would have attained to had its nourishment 
 been sufficient. Some have maintained that early 
 starvation does not ultimately affect growth, provided 
 the food is sufficient in the later growing years. 
 Others, on the contrary, maintain that where nutri- 
 tion in early life is bad the full stature is never 
 attained. It is certain that, whatever be the effect of 
 nutrition on the ultimate limit of growth, the rate of 
 growth varies, according as nutrition is sufficient or 
 insufficient " (Med. Inspect, of School Children, p. 206). 
 
 " Influence of Nutrition on Growth. There has 
 been much discussion on the influence that nutri- 
 tion, or alimentation, or the social condition, may 
 have. As far back as 1829, Villerme' declared 
 that the stature is higher and growth more active 
 in the communities that are richer, better nourished, 
 and better protected against inclement weather. 
 
28 THE HEALTH OF THE SCHOOL CHILD 
 
 Quetelet gave out the same opinion, and the 
 majority of those that have studied the questio 
 come to the same conclusion'; for example, Cowe 
 (1883), who has compared the statistics of I of 
 factory children and of 228 children of the leisui 
 classes ; Bowditch also, but with him the defec 
 conditions of existence act more on the hei 
 than on the weight, and this is seen in the fact ti 
 children of the working classes are heavier, heig. 
 for height, than children of the leisured classes 
 these latter being absolutely taller and heaviei 
 On the other hand, opinions diverge ; Boudin doe, 
 not quite believe in the nutritional conditions, anc 
 maintains that there is a considerable race effect 
 Donaldson admits certain action, but maintains 
 that this affects the male sex more than the female. 
 Porter admits that a considerable difference in social 
 condition and in material prosperity may exist 
 without much influence on growth up to the 
 acceleration that precedes puberty. Key says that 
 want prolongs the period of feeble growth anterior 
 to puberty, and that the period of rapid development 
 consequently supervenes at a later epoch. . . . On 
 the whole, there would be a delay in time ; but the 
 final condition would not be altered. Roberts comes 
 to a different conclusion from the establishment 
 of puberty, growth is more active in the non-working 
 classes, ceasing at nineteen or twenty years of age ; 
 in the artisan class, growth is more uniform, and 
 continues up to twenty-three or thereby. Still he 
 points out a fact analogous to that spoken of by 
 Key. For him, the growth that precedes puberty 
 
NORMAL GROWTH IN SCHOOL AGES 29 
 
 begins a year or two earlier in the leisured class, 
 "nd in these the average stature is greater. The 
 nthropometrical Committee of England admits 
 so that the leisured classes are, at every age, taller 
 d heavier than the working classes. Gussler and 
 Mitch have compared the children of the Burger- 
 ale of Fribourg with those of the inhabitants of 
 ; surrounding country, and they have found that 
 " stature at the same age the former exceed the 
 tter. The figures following indicate the excess 
 i size of the pupils of the Burgerschule over the 
 hildren of both sexes of peasants (in centimetres) : 
 
 [ Age . . 6| 7 8 9 10 ii 12 13 
 
 Boys . . .2.4 2.7 2.3 5.1 2.7 2.3 3.8 4.7 
 
 Girls . . .3.9 3.6 2.8 3.8 4.5 3.9 3.1 5.1 
 
 ? 
 
 . " Hence the conclusion that ( the children of 
 the peasant females are, on the average, and with- 
 out exception, smaller ; the children of the Burger- 
 schule are greater than the average of the whole. 
 [t seems, then, permissible to conclude that the 
 different social conditions in which the children 
 live exercise an essential influence on their physical 
 development ' " (Diet, de Physiologie Richet, art. 
 " Croissance "). 
 
 How far this difference in growth is to be counted 
 a gain mentally or physically is a question that may 
 well be debated. It may be forced growth and, like 
 all forcing, may carry with it certain dangers. The 
 boy of the professional classes grows more rapidly 
 than the poorer boy, but ceases to grow at an earlier 
 age. It would be wrong to say that he goes to leaf 
 
30 THE HEALTH OF THE SCHOOL CHILD 
 
 rather than to seed ; but there is always that danger. 
 In any given case, this would be extremely difficult 
 to establish. One must take account of so many 
 factors : first and mainly, the size and growth of the 
 parents; next, the total physical capacity of the child 
 as tested by his total output of work, mental and 
 physical. It is not enough that the bigger and 
 stronger boy should have more staying power on 
 the football field. He must prove his superiority 
 also in the schoolroom, in his college classes, in his 
 profession. In Scotland, we are not inclined to 
 admit that the greatest mental capacity and the best 
 physical form are uniformly found together, or that 
 the one is a necessary index of the other. We 
 delight to see fine physical development in men and 
 women, but we delight still more in seeing the fine 
 flower of all development, the clear head, the endur- 
 ing will, the capacity to devote oneself day by day, 
 year by year, for a lifetime, to the realisation of 
 lofty purposes, to the slavery of the ideal. I do not 
 say one word against the fine results we sometimes 
 see from the muscle-worship of the present hour; 
 but I cannot help wondering whether it is always 
 informed of the same spirit or a breath of it that 
 made great the lives of two men for whom we 
 still mourn, Professor Alexander Bain and Herbert 
 Spencer. These two, almost from the cradle to the 
 grave, consecrated their every activity to the Service 
 of Man, cultivating every organ, yet living a life of 
 the most severe asceticism, and leaving to the world 
 a great inheritance of thought ordered and made. 
 They were, it is true, giants of a great breed ; but 
 
NORMAL GROWTH IN SCHOOL AGES 31 
 
 they lived their long lives because they applied in- 
 tellect to their every day. We cannot expect the 
 same severity to become very common ; but it is 
 more common than we are apt to think, and if we 
 could be sure that the fine form of the public schools 
 did, even on the average, do something to encourage 
 these greatnesses of character, these potencies of 
 will, these finer issues of the spirit, we should utter 
 not one carping word against the games and the 
 races and the exacting disciplines that the sons of 
 our richer orders are made to follow for the whole 
 of the growing ages and sometimes for long after. 
 Even then, the final test is not the immediate growth 
 in form. The test is the life lived through and the 
 work done. And that has its measure in the in- 
 surance offices, not in the standard tables of heights 
 and weights. If you want to prove to me that the 
 training of your son has been good, let me see him 
 cross the bar of middle age without mischance or 
 exhaustion. We know but too well that, in the 
 poorer orders, middle age and pauperism often mean 
 one and the same fact. We know that, in the artisan 
 order, middle age is the time of great peril. It is 
 so also with the richer orders ; but I am willing to 
 be persuaded that the early training in the field 
 does in some measure prolong the age of maturity 
 as it certainly hastens the age of growth. " A sound 
 mind in a healthy body " is what the whole world 
 is striving for ; but mind as much as muscle is the 
 product of function. It has to be made. It must 
 be built up by exercise of its proper organs. Thoughts 
 are made by thinking, not by waiting for inspiration 
 
32 THE HEALTH OF THE SCHOOL CHILD 
 
 from trained muscles. And a " healthy body " does 
 not always mean a muscular body, nor is a highl 
 developed muscular system a necessary condition r 
 sound thinking. It is sometimes, on the contrary, 
 hindrance. These passing remarks are made hf 
 only as a qualification to the undoubted fact tl. 
 properly regulated physical exercise not only prc 
 motes growth, but is essential to it. And by exei 
 cise, I mean irresponsible exercise, which is " play " 
 not responsible muscular labour, which is " work." 
 
 6. HEIGHT AND WEIGHT AS EVIDENCE 
 OF GROWTH 
 
 If a human being were a jelly-fish, we shoul 
 have to test his growth not by measuring tbr 
 height and weight, but by taking the specific gravit 
 and measuring the total volume. But as he is 
 vertebrate, we have a simple means of testing b' 
 growth from year to year. For this purpose, it is 
 a convenient accident that after a certain age the 
 boy stands upright. We therefore call it a measure- 
 ment of height. But all this means is that the 
 bony skeleton grows slowly, and forms a convenient 
 rigid framework for measurement. Every skeleton 
 is normally " padded round with flesh and fat," which 
 also grow with more or less regularity to a possible 
 maximum. Measurement of height alone would be 
 a good index of progress in growth. The measure- 
 ment of weight is an important supplement. If we 
 have boys enough, and if we measure and weigh 
 them, we are able to fix roughly certain standards 
 
NORMAL GROWTH IN SCHOOL AGES 33 
 
 of height and weight for every age, and so constant 
 
 re the averages that we are able to make useful 
 
 ractical tables whereby to test the individual's 
 
 -owth at any given period of his life. In these 
 
 ^asurements, we exclude the deformed and those 
 
 ffering from acute disease. We consider mainly, 
 
 I not solely, healthy children. Let us look at a 
 
 2w figures compiled for us by the great authorities. 
 
 -n order not to confuse our minds with too many 
 
 quantities, we shall keep to the figures for boys and 
 
 iris of ages from five to twenty-two, and we shall 
 
 e for our illustrations figures collected by the 
 
 nthropometrical Committee of the British Associa- 
 
 on (see Report of the Royal Commission on 
 
 .'hysical Training (Scotland), p. 64). 
 
 BOYS. 
 
 Age. 
 
 5 
 6 ' 
 
 7 
 8 
 
 9 
 10 
 ii 
 
 12 
 13 
 14 
 15 
 
 16 
 
 17 
 18 
 
 19 
 20 
 
 21 
 22 
 
 Average Height in inches. 
 41.03 
 
 Increase in i 
 
 . 2.57 
 
 2.Q7 
 
 
 I.Q7 
 
 
 1.08 
 
 49.70 
 51.84 . 
 53.50 
 54-99 
 
 C6.QI 
 
 . . 2.65 
 
 . 2.14 
 
 . 1.66 
 . 1.49 
 
 I.Q2 
 
 
 
 
 
 64.31 
 66.24 
 66.96 
 67.29 
 67.52 
 
 . . 67.63 . . 
 
 67.68 
 
 . 2.07 
 . 1.93 
 
 .72 
 
 33 
 .23 
 .11 
 .oz 
 
34 THE HEALTH OF THE SCHOOL CHILD 
 
 GIRLS. 
 
 Age. 
 
 5 
 6 
 
 7 
 8 
 
 9 
 10 
 ii 
 
 12 
 13 
 14 
 15 
 
 16 
 
 17 
 
 18 
 
 19 
 20 
 
 21 
 22 
 
 These figures show, for the general population of 
 town and country, averages based on somewhat 
 limited observations, but corresponding with figures 
 subsequently collected. It is to be noticed that the 
 increase in height is not constant. It amounts 
 almost to three inches in the year from five to six. 
 It sinks to about one inch in the year seven to eight. 
 It rises again to nearly three inches at the year 
 eight to nine, falls to a little over two inches at the 
 year nine to ten, to one and a half inch at the year 
 ten to eleven and eleven to twelve. It rises to 
 nearly two inches at the age twelve to thirteen, to 
 two and a half inches at the age thirteen to fourteen, 
 to almost three inches at the age of fourteen to 
 fifteen. From that period onwards the rate of 
 
 Average Height in inches. 
 
 Increase in i 
 
 40.55 
 
 2.22 
 
 42.88 
 
 2.33 
 
 44.45 
 
 1-57 
 
 46.60 
 
 . 2.15 
 
 48.73 
 
 . 2.13 
 
 Si-OS 
 
 . 2.32 
 
 53-iQ 
 
 . 2.05 
 
 . . 55-66 . . 
 
 . . 2.56 
 
 57-77 
 
 2. 1 1 
 
 59-So . 
 
 . 2.03 
 
 60.93 
 
 . I.I3 
 
 61.75 
 
 .82 
 
 62.52 
 
 .77 
 
 62.44 
 
 
 
 62.75 
 
 .23 
 
 62.98 
 
 .23 
 
 63.03 
 
 . .05 
 
 62.87 
 
 . 
 
NORMAL GROWTH IN SCHOOL AGES 35 
 
 increase in height gradually slows down until, at the 
 year twenty-one to twenty-two, the increase is only 
 one-twentieth of an inch. This is for boys. The 
 first great acceleration after infancy is towards the 
 end of the first seven years ; the second acceleration 
 is about the years of nine to ten ; and the third 
 great acceleration is about the years of thirteen to 
 fifteen. Thus, at the beginning of school life, and 
 at the end of the elementary school course, we have 
 two great periods of expansion. 
 
 With girls, the rate of increase is somewhat more 
 uniform. Growth begins to slow down at the age 
 of twelve. By the age of seventeen, it has sunk to 
 less than one inch in the year. 
 
 Let us now turn to weight. For the correspond- 
 ing ages in boys, the average weights in pounds are 
 given below : 
 
 Age. A\ 
 
 5 - 
 
 6 . 
 
 7 
 
 8 . 
 
 9 
 
 10 . 
 
 11 . 
 
 12 . 
 
 13 
 
 14 . 
 
 is 
 
 16 . 
 
 17 
 
 18 . 
 
 19 . 
 
 20 . 
 
 21 . 
 
 22 . 
 
 : Weight in Ibs. 
 
 Increase in Ibs. 
 
 39-9 
 
 . 2.6 
 
 44-4 
 
 . 4.5 
 
 49-7 
 
 5-3 
 
 54-9 
 
 . 5-2 
 
 60.4 
 
 5-5 
 
 67-5 - 
 
 . 7.1 
 
 72.0 
 
 4-5 
 
 76.7 . 
 
 . 4.7 
 
 82.6 
 
 5-9 
 
 92.0 
 
 . 9-4 
 
 102.7 
 
 . 10.7 
 
 119.0 
 
 . 16.3 
 
 I30-9 
 
 . 11.9 
 
 137-4 
 
 . . 6.5 
 
 139-6 
 
 . 2.2 
 
 143-3 
 
 3-7 
 
 145-2 
 
 
 146.2 
 
 1.0 
 
36 THE HEALTH OF THE SCHOOL CHILD 
 
 The corresponding figures for girls are : 
 
 Age. 
 
 Average Weight in Ibs. 
 
 Increase in Ibs. 
 
 5 
 
 39-2 
 
 . 3.1 
 
 6 
 
 4L7 
 
 . 2.5 
 
 7 
 
 47-5 
 
 5-8 
 
 8 
 
 52.1 
 
 . . 4-6 
 
 9 
 
 55-5 
 
 3-4 
 
 10 
 
 62.0 
 
 . . 6.5 
 
 ii 
 
 68.1 
 
 . 6.1 
 
 12 
 
 76.4 
 
 8 7 
 
 13 
 
 . 87.2 . . 
 
 . 10.8 
 
 14 
 
 . 96.7 
 
 9-5 
 
 15 
 
 106.3 
 
 . . 9-6 
 
 16 
 
 113. i 
 
 . 6.8 
 
 17 
 
 . II5-5 
 
 . 2.4 
 
 18 
 
 121. 1 
 
 . 5-6 
 
 10 
 
 * " 
 
 12^.8 
 
 2.7 
 
 20 
 
 . 123.4 
 
 
 21 
 
 . 121. 8 
 
 . 
 
 22 
 
 . 123.4 
 
 . 
 
 From these tables we observe that, in boys, the 
 increase in weight roughly follows the increase in 
 height. The two increases do not, however, move 
 precisely together. There seems first to be a spurt 
 of growth, then a spurt of increase in weight. A 
 great expansion takes place in the years between 
 twelve and sixteen. 
 
 With girls, the great expansion takes place in the 
 years between twelve and fourteen. 
 
 If, with these averages for the whole country, we 
 compare averages for the labouring classes, we find 
 that, on the whole, for boys, the labouring classes, 
 even in the country, are equal to the averages for 
 the ages from five to ten, and almost equal for the 
 ages up to fourteen. The number of observations, 
 
NORMAL GROWTH IN SCHOOL AGES 37 
 
 however, is very small, and little importance can be 
 placed on this comparison. The female children of 
 town artisans, again, are distinctly below the average 
 height at all ages up to sixteen. 
 
 If, on the other hand, we take the professional 
 classes in town and country, we find that for such 
 of the ages as are recorded in these tables (age nine 
 upwards) the heights of boys are distinctly above 
 the average at all ages. Girls of the same classes 
 are also distinctly above the average at all ages. 
 
 If we consider weight, we find that on the whole 
 the same relation holds, the labouring classes in 
 the country being about equal to the average, and 
 the artisans of the towns perceptibly lower than the 
 average. The same is true both of boys and girls. 
 On the other hand, the professional classes come 
 out distinctly over the average in weight ; but the 
 difference in favour of the girls of the professional 
 classes is not so marked in weight as it is in height. 
 
 Among the commercial classes of the towns, it 
 is found that the deviation from the average height 
 is perceptible both in boys and girls. But the in- 
 crease is not very striking; sometimes the com- 
 mercial classes are even below the average. In 
 weight, boys of the commercial classes vary con- 
 siderably, being sometimes a little above the average 
 and sometimes perceptibly below. The girls, on 
 the whole, approach to the average weights, but tend 
 to fall a little below. 
 
 These figures, and the multitudes like them that 
 have been accumulated in many countries, must be 
 studied very minutely if they are to yield guidance 
 
38 THE HEALTH OF THE SCHOOL CHILD 
 
 in practical life. Here it is enough to emphasise the 
 broad fact that the richer classes show greater height 
 and weight. From this we may draw the general 
 inference that good nurture promotes growth. As 
 we have already pointed out, however, we must not 
 assume that growth is entirely a matter of height 
 and weight. We must check these two indicators 
 by the health and capacity of all the organic 
 systems. 
 
 It would be difficult to prove that these differences 
 are radical differences in biological capacity. They 
 are probably only differences due to differences of 
 economic condition. It is probable that the poorer 
 child suffers from long before birth, because the 
 mother is not permitted to rest during pregnancy. It 
 suffers after birth from all the causes that we deplore 
 under the names of bad housing, bad feeding, over- 
 crowding, over-stimulation, over-work. Whatever 
 be the final and complete account of these facts, 
 the broad contrast is there the public school boy 
 grows more rapidly and grows more than his relative 
 of the other orders. 
 
 7. DIET AND GROWTH 
 
 So much for the general relation of good nutrition 
 to growth. Let us specialise a little to indicate 
 what the actual diet of a school boy should aim at. 
 As Dr. Burney Yeo points out : " It should be 
 remembered that the education of the mind is, and 
 should be, a ' lifelong ' process there is no need 
 of hurry, but that the development of the body is 
 
NORMAL GROWTH IN SCHOOL AGES 39 
 
 strictly limited to a certain period of existence, 
 and becomes finally and irrevocably arrested at a 
 given date" (Food in Health and Disease, p. 268). 
 Our chief authority here again must be Dr. Clement 
 Dukes, whose thirty years' experience of Rugby 
 gives him a unique title to our attention. Dr. 
 Dukes insists that the likes and dislikes of school 
 children should be considered. Fats and starches 
 are essential, but fat is very frequently repulsive to 
 children. It is possible that education might reduce 
 the revulsion, and certainly the effort should be 
 made ; but, failing this, more sugar is essential. 
 For the younger boys, Dr. Dukes recommends meat 
 in some form at least once a day. For the public 
 school boy proper, who is growing rapidly, he 
 recommends meat twice a day. What quantities ? 
 Here Dr. Dukes' figure sounds high to our Scottish 
 ears. He insists that in the twenty-four hours, the 
 meat or nitrogenous food supplied " should be one 
 pound of uncooked meat, including fat, which means 
 20 per cent, of weight of bone, 20 per cent, of 
 weight which is lost in cooking, therefore giving 
 60 per cent, of fat and lean cooked meat, or 
 9.6 ounces" (The Book of Health, p. 693, art. 
 " Health at School "J. 1 He adds : " I have given the 
 full amount of meat that is wholesome for the 
 strongest and biggest boys, or those who are 
 growing rapidly. I have done this purposely, 
 though I am aware that younger and less robust 
 boys could not get through the amount I have 
 
 1 See also The Essentials of School Diet, by Clement Dukes, M.D., 
 B.S., Lond. Rivingtons, London, 1899. 
 
40 THE HEALTH OF THE SCHOOL CHILD 
 
 specified ; for them the three-quarters of a pound 
 of uncooked meat is the usual amount required." 
 Fish he strongly recommends. But though he 
 wrote twenty years ago, he might repeat his lament 
 that this excellent food is yet waiting an adequate 
 means of distribution. Vegetables he also, of course, 
 insists upon. He found that in the autumn and 
 winter, when fresh vegetables fell off, there was 
 always " plenty of eczema." I am inclined to 
 question which was the chief factor in producing 
 the eczema the excess of meat or the deficiency 
 of vegetables. The two chief meals of the day 
 must be breakfast and mid-day dinner. Otherwise, 
 the working capacity of the boy is seriously inter- 
 fered with. In this, most workers with the brain 
 will agree. Nothing can well be less scientific than 
 loading the stomach in the evening with a staple 
 meal and then expecting the brain to turn on its 
 full power. Where heavy meals are taken late, 
 the sleep cannot be good, and the head-work will 
 be worth little or nothing. It was Professor Bain's 
 custom for over fifty years to do his intellectual 
 work at least several hours after he had had food 
 on a fasting stomach, in fact. The brain works 
 best when the stomach has least to do. Even in 
 growing boys this is true. From all I can gather, 
 the chief danger of many schools is the danger of 
 over-feeding. But on this matter I speak without 
 authority. 
 
 For those that would study more fully the diet 
 of the growing school boy, no better guide can be 
 found than the writings of Dr. Dukes. As I have 
 
NORMAL GROWTH IN SCHOOL AGES 41 
 
 said, he takes the strong English view of meat and 
 its substitutes. Perhaps it is our Scottish training 
 that makes us hesitate on the point, but I 
 cannot help feeling that meat occupies too large a 
 place in the economy of every public school, as, indeed, 
 in most other economies. It is right to add, 
 however, that Dr. Dukes intends his " pound of 
 meat " to be rather the standard for " nitrogenous 
 food " than an absolute prescription of so much ox- 
 flesh (see Essentials of School Diet, 2nd edition, 
 p. 185). In this, as in other matters, Dr. Dukes' 
 opinions are based on extended concrete experience, 
 checked by scientific theory. 
 
 8. ALCOHOL AND GROWTH 
 
 It is, I believe, the custom in some English public 
 schools to supply the boys with beer or other such 
 alcoholic drink for supper. I do not know whether 
 any Scottish boarding-school follows this custom 
 or not. Stimulants of all kinds doubtless affect 
 growth in some way, but the parent that imagines 
 alcohol in any form to be essential to boys of any 
 age from five to fourteen, or for that matter from 
 five to twenty-five, should be recommended to study 
 elementary physiology for a few days. If, after 
 that, and after reading what Dr. Clement Dukes x 
 has to say on the topic, he still persists in his 
 curious opinion, he should consult his family 
 physician in his own, if not in his child's, interest. 
 
 1 Alcohol and Childhood, Church of England Temperance Publication 
 Depot, 9 Bridge Street, Westminster, price one halfpenny. 
 
42 THE HEALTH OF THE SCHOOL CHILD 
 
 There may be forms of beer or wine that do boys 
 little harm, but I have not yet met with them, and 
 if their use is sanctioned by custom anywhere, it is 
 a " custom more honoured in the breach than the 
 observance." At any rate, if the parent, knowing 
 what the results are, feeds his boy on beer, he might 
 at least spare us the hypocrisy of lamenting the 
 vicious consequence of his prescription. 
 
 9. SLEEP AND GROWTH 
 
 What relaxation is to the muscles, sleep is to the 
 brain. For the growing boy, abundant sleep is 
 essential ; for the growing boy whose brain is under 
 training, sleep is still more essential. Boys of ten, 
 according to Dr. Dukes, " require eleven hours of 
 sleep, and the best time for it is, except on the very 
 hottest nights in summer, from 8.30 p.m. to 7.30 
 a.m. For boys under thirteen years of age, ten 
 hours and a half should be set apart, from 9 p.m. 
 to 7.30 a.m. For boys above thirteen, the eight 
 and a half or nine hours permitted, but never 
 obtained, are not too much, if enough, considering 
 their active period of growth, and the amount of 
 bodily and mental exercise they undergo. In bed 
 at 10 p.m., which means sleep not much before 11 
 p.m., and called at 6.30 a.m. for chapel at 7 or 7.30 
 a.m., is, I believe, the rule in most public schools. 
 With only this amount of sleep boys seem weary, 
 and look as if they did not get sufficient rest " 
 (Book of Health, p. 688). 
 
 It seems to me that a simple rule for all boys is 
 
NORMAL GROWTH IN SCHOOL AGES 43 
 
 that, given good health and vigour, they should 
 sleep when they are sleepy, never attempt mental 
 work when drowsy, rise early only if they can do 
 so with vigour and not without too great unwilling- 
 ness. One mother known to me has a very tall son 
 of sixteen years of age. He is a hard head-worker 
 and a fairly hard player. He has often pleaded to 
 be permitted to sit up late to his work, but per- 
 mission has been refused until he shows signs of 
 being ready to get up in the morning when called. 
 It is, I quite recognise, a severe test ; but it is 
 physiologically sound, and boys brought up on that 
 principle will go farther and, in the end, do more 
 than those whose natural appetite for sleep is com- 
 pelled to conform to the occasionally morbid habits 
 of their parents. If there is no disease, the 
 appetites of the organism are a safer guide for 
 practice than the theories of any school. 
 
 10. SOME DANGER POINTS 
 
 The saints of sport are not long-lived. They 
 have consecrated themselves to the worship of 
 muscle. They forget that the same brain that 
 should enable them to think is equally exhausted 
 by the discipline of the muscles and the discipline 
 of the mind. Persistent stimulation to muscular 
 exertion has its dangers for the growing youth. 
 Dr. Clement Dukes, to whom, in so many ways, 
 this country owes so much, has shown by concrete 
 facts that at the onset of adolescence there is great 
 danger to the kidney, and that the indiscriminate 
 
44 THE HEALTH OF THE SCHOOL CHILD 
 
 indulgence in the hard physical sports of the public 
 schools results very frequently in temporary or per- 
 manent damage to it. The reason he offers is 
 simple and convincing. It ought to be in the mind 
 of the careful parent when his son or daughter is 
 passing into the expansive age. It is this As 
 adolescence supervenes, the heart grows rapidly. 
 This is not all. It grows more rapidly in propor- 
 tion than the other blood vessels. The result is 
 that it is for the time too strong a pump for the 
 size of the vessels it has to keep filled. The result 
 of this is too great pressure in the vessels of the 
 kidney, and the result of this, in turn, is inflamma- 
 tion or congestion. This he has found very 
 common among the boys at public schools. The 
 damage done by excessive exercise when this 
 condition threatens can hardly be over-estimated. 
 It may mean lifelong enfeeblement. It may mean 
 damage not to the kidney alone, which would be 
 bad enough, but to the heart also and the organs 
 directly and indirectly depending on it. I do not 
 particularise this to alarm, but it is a fact of 
 experience, and it should be always kept in mind 
 as among the possibilities of development. That 
 Dr. Dukes should be able to record case after 
 case is proof sufficient that we are dealing with a 
 fairly common result of the ordinary school exercises J 
 of our great schools. Doubtless the headmasters 
 of the schools are alive to these facts, but the 
 parents should equally know them and have them \ 
 for a guide. 
 
 I am not able to give parallel facts of the dangers 
 
NORMAL GROWTH IN SCHOOL AGES 45 
 
 that attend the onset of adolescence in the girl. 
 These are perfectly well known, but it is open to 
 question whether they are always handled with 
 perfect wisdom. 
 
 n. GENERAL TESTS OF HEALTHY GROWTH 
 
 How shall we tell whether a boy is growing at 
 the correct rate? How are we to know whether 
 his life at school interferes with the increase of his 
 muscles, his bones, his nervous system ? The parent 
 cannot always be consulting tables of height and 
 weight. He cannot be always weighing his child, 
 week by week, to see whether he is maintaining his 
 pace upwards. Neither can he be for ever calling 
 in the doctor. He should I not rather say she, 
 for it is normally to the mother that this work falls 
 she ought to have some guide safe enough to 
 enable her to prevent injury to the child. Does 
 physiology offer any such guide ? I think it does. 
 
 Let us assume that a child of competent parents 
 has come to the age of five, that he has had all 
 the advantages of good food, cleanliness, good air, 
 freedom of play, in a word all that constitutes good 
 nurture as it is organised by the parent devoted to 
 the scientific care of children. The parents are 
 confronted with the problem Shall we send him 
 to school ? How shall the problem be answered ? 
 If it were put to me, I should recommend the 
 following course. 
 
 Let the child be examined with minute care by 
 the family physician, who knows the family history, 
 
46 THE HEALTH OF THE SCHOOL CHILD 
 
 the family habits, what reliance can be placed on 
 the parents' undertaking, what ailments the child 
 has passed through, what in reason he may yet have 
 to encounter, what rate his mental and physical 
 development has maintained. Let there be a 
 detailed examination of the whole body, both in its 
 general aspects and in its particular organs. Let 
 the physician observe and record the state of 
 development, the state of the nutrition, the sufficiency 
 of fat, of muscle, the condition of the blood, the 
 condition of bones, joints, skin, glands, heart and 
 circulation, lungs and respiration, eyes and vision, 
 ears and hearing, nose and nasal respiration, throat, 
 teeth, digestion, capacity for action, capacity for 
 sensation. Let him ascertain what sleep is taken, 
 what the readiness for play is, what the mental 
 capacity in general as shown by the child's history. 
 Whatever defects in any of these relations he may 
 discover, he should, as far as possible, rectify before 
 the child enters on the new life. Let us assume 
 that he has found certain defects of eye and ear and 
 throat. He must either have them forthwith rectified 
 or so inform the parent that the defect may be 
 watched to an issue and not permitted to interfere 
 with development. Let the parent study the record. 
 Let it be the guide at every stage. If the child is 
 found fit for school, let the experiment be tried. 
 Let the effects on his nervous system be watched. 
 If it be found that he maintains his vigour, his 
 nutrition, his diet, his sleep, his readiness to play, 
 then he does not find the load too heavy. If the 
 new life results in restlessness, if the child grows 
 
NORMAL GROWTH IN SCHOOL AGES 47 
 
 nervous, if he readily breaks down, if he shows signs 
 of fatigue, if he cannot sleep peacefully for the full 
 time, if he dreams of his lessons, if he acts in his 
 sleep the work of the day, if he complains of 
 headache, if he has no disposition for play, if he 
 grows pale, if he loses appetite, if he loses fat, then 
 once more the physician should be consulted. We 
 have assumed that the school he attends is hygienic- 
 ally good, that the air-space during work-time is 
 adequate, that work is kept at a fitting quantity. 
 If any of these symptoms persist, let the child be 
 freed from every care and permitted to play. If, on 
 the contrary, he shows none of these signs, it may 
 be inferred that the new life will not touch his 
 growth. But as a safeguard he should be examined 
 at least once, if not twice, in every school year, in 
 the detailed way I have indicated. So long as the 
 physiological systems work well, the rate of growth 
 is of little consequence. 
 
 12. CONCLUSION 
 
 Did time permit, I should have wished to go a 
 little farther along these tracks. I should like to 
 analyse the concept of growth as it is manifested in 
 some of the individual organs of the body. I 
 should like to show how the heart increases ; how 
 the brain grows in complexity ; how the muscles 
 keep up a perpetual rhythm in response to the 
 demands of mind ; how the intellect grows synthetic- 
 ally from its first germs to its final revelations in 
 science and action and institutions ; how, in a sense, 
 
48 THE HEALTH OF THE SCHOOL CHILD 
 
 the whole world we live in is of our own making 
 and is our own. But were I to follow these lines of 
 speculation, I should have to call my paper by 
 another name; although I should still be but 
 showing forth the relations of the infinitely subtle 
 mind of the child to the world he has come awake 
 in, to the world where he will one day fall asleep 
 again, leaving to it his work, evil or good. 
 
 "They are but sailing foam-bells 
 
 Along Thought's causing stream, 
 And take their light and sun-colour 
 From Him that sends the dream." 
 
MEDICAL EXAMINATION AND SUPERVISION 
 OF SCHOOLS AND SCHOOL CHILDREN 1 
 
 INTRODUCTORY 
 
 I THANK the Council of the Royal Society of 
 Edinburgh for inviting me to lecture on the 
 Medical Examination and Supervision of Schools 
 and School Children. It is always an honour and 
 a privilege to be permitted to address so distinguished 
 a Society. It is also a great responsibility. Where 
 the exact sciences are in the ascendant, where the 
 traditions of clear thinking are so powerful, any man 
 naturally hesitates to bring forward any proposition 
 not capable of direct verification by experiment, or 
 any practice not founded on fully thought out 
 scientific concepts. Still more naturally may he 
 hesitate when his subject is taken from the confused 
 world of actuality, where the isolation of facts is 
 difficult, where exact observation is almost impossible, 
 where coherent science is still a distant ideal, where 
 nevertheless concrete problems of immeasurable 
 importance are pressing for solution. If I have 
 dared to bring before you matters that are not yet 
 scientific, it is because the presenting of crude facts 
 
 1 Afternoon Lecture before the Royal Society of Edinburgh. De- 
 livered, by request of the Council of the Society, I3th March 1905. 
 
 4 
 
50 THE HEALTH OF THE SCHOOL CHILD 
 
 to a scientific Society may hasten the application of 
 scientific methods to one immediate social problem 
 What can the practice of medicine do to develop 
 the mental and physical potentialities of the rising 
 generation ? 
 
 The present universal ferment of social ideas is 
 not without a meaning. If any clear issue at all 
 has yet emerged, it is that we are entering on an era 
 of Personal Hygiene. As the beginning of the last 
 century witnessed the great movement towards an 
 improved environment, so the beginning of this 
 century is witnessing a movement towards the im- 
 provement of the organism. It has taken a century 
 to persuade the ordinary citizen that his environment 
 of house and street and atmosphere is after all in 
 some measure his own creation, a thing plastic and 
 manageable, a form answering to his will. Perhaps, 
 with the greater pace of to-day, it may take less 
 than a century to persuade him that when he has 
 put his house in order, it is then his duty to fit him- 
 self to live in it. The vastness of the problem need 
 not appal us. Time is on our side, and many little 
 things point the way to practice. One truth we 
 have already realised if we would fit the man for 
 his environment, we must begin with the child. 
 " The child is father of the man." 
 
 Two years ago the Physical Training Commission 
 (Scotland) presented its Report. Last year the 
 Physical Deterioration Committee presented its 
 Report. Neither of these Reports professed to be 
 exhaustive. The Scottish Commission started with 
 the intention of discovering how the youth of the 
 
MEDICAL EXAMINATION 51 
 
 country could best be physically trained into an 
 athletic manhood, and ended with a proposal for 
 further investigation of the facts. The Deteriora- 
 tion Committee started with the question, Is racial 
 dererioration a fact? and likewise ended with a 
 demand for further investigation. In both Reports 
 the school child is the focus of interest. This is 
 not because the younger children or the adults 
 are in themselves less interesting, or present more 
 difficult problems ; but because the school child 
 has for a generation been under the direct control 
 of the State in one of his many relations. And 
 the school child, easily seen, easily examined, 
 easily described, has enabled us to crystallise the 
 conception of personal hygiene and to test the 
 possibilities of remedial measures. I may say at 
 once that I have no fears for the present or the 
 future of our races. It has not been demonstrated 
 that racial degeneration in the true sense has 
 assumed to-day greater proportions than in any 
 past period. Such deterioration as the various 
 investigators have discovered is less a matter of 
 inheritable defects than of defective environment. 
 It is mainly a generational degeneration, and does 
 not destroy the potency of the races to recover any 
 ground they may have, for the moment, lost. It 
 is the natural tendency of social reformers to look 
 for a remedy before they have understood the 
 disease. It is well to know that the facts will 
 now be subjected to the criticism of cool science, 
 and it is well to remember that the high priest did 
 not fare well when he " trembled for the ark of God." 
 
52 THE HEALTH OF THE SCHOOL CHILD 
 
 In the matter of school children, the need for 
 facts is paramount. By an accident it fell to me 
 to have a share in the examination of 1200 
 children, of whom 600 belonged to Edinburgh 
 schools. When the facts, such as they were, first 
 became known, we were freely accused of gross 
 exaggeration. Because we said that some children 
 were dirty when they were dirty, and others thin 
 when they were thin, and others deaf when they 
 were deaf, and others undergrown when they were 
 undergrown, we were adjudged guilty of scientific 
 heresy. When further, for one reason or another, 
 the 600 children from Aberdeen showed a smaller 
 proportion of the same defects, we were declared 
 to have traduced the community we live in. This 
 afternoon, I propose to put before you some leading 
 facts of those investigations, and some facts even 
 more striking from Glasgow, London, Manchester, 
 Bradford, and Dundee. The charges of exaggera- 
 tion, of gross error, of sensational misapplication of 
 common knowledge, may or may not be true ; it 
 is certain that up to the present those charges have 
 been founded in prejudice and want of knowledge. 
 The only way to disprove alleged facts is to produce 
 other equivalent facts obtained by more exact 
 methods. So far, as I think I shall persuade you, 
 any facts obtained have rather confirmed than con- 
 troverted the results published by the Royal 
 Commission on Physical Training (Scotland). 
 
 One word more in introduction. Such results 
 as the various investigators have been able to 
 produce have already persuaded the Parliamentary 
 
MEDICAL EXAMINATION 53 
 
 mind. In their Scottish Education Bill of last year 
 (1904) the Government included provision for the 
 medical examination and supervision of school chil- 
 dren. In England, the new education authorities 
 have similar powers. The examination of school 
 children is, therefore, no longer a question of doubt- 
 ful politics. If it were, I should not have chosen 
 this subject for a lecture. It has now all but passed 
 into the region of administration, and that is why 
 I offer you some suggestions towards practical 
 administrative methods. 
 
 i. MEDICAL SUPERVISION OF SCHOOL BUILDINGS 
 
 It is proper to separate the medical supervision 
 of schools from the medical inspection of school 
 children. The separation of the two is founded 
 on one important practical consideration. Already, 
 the Public Health Acts provide for the medical 
 inspection of school buildings. Without any in- 
 crease of powers, it is already possible practically 
 to secure that the structure of school buildings is 
 in accord with the latest hygienic ideas, and that 
 the premises are kept in a sanitary condition. The 
 local authority for public health has the same 
 control over schools as it has over dwelling-houses. 
 The local authority is ultimately responsible to the 
 Local Government Board, who can enforce within 
 certain limits a sufficient sanitary inspection. Further, 
 school buildings are scrutinised by My Lords of the 
 Scotch Education Department, who satisfy them- 
 selves both in general and in detail that the plans 
 
54 THE HEALTH OF THE SCHOOL CHILD 
 
 are executed on hygienic lines. It is true that 
 many schools, especially in the rural districts, are 
 unsatisfactory ; but it is equally true that the local 
 authorities and their officers are steadily pressing 
 modern views of sanitation on all those responsible, 
 and I have no doubt that, with the extension of the 
 School Board areas, there will come an increased 
 acceleration of school improvement. In cities 
 there are few points of structure that need really 
 give the administrator serious concern ; but there 
 are many points of management where a closer 
 medical scrutiny would result in improvement. 
 Later, I shall mention one or two points ; but I 
 refer to the matter here merely to indicate that 
 administratively we are already in a position to 
 deal with school buildings. 
 
 2. INFECTION AND DISINFECTION OF SCHOOLS 
 
 Perhaps it is well here also to dispose of infection 
 and disinfection. Already, the powers of the Noti- 
 fication and Public Health Acts are entirely adequate. 
 If the medical officer of health suspects that infection 
 exists in any school, he has the right to enter and 
 to examine the children. If a school child is notified 
 as suffering from any notifiable infection, or discovered 
 to be suffering from any infection whether notifiable 
 or not, he must be excluded from school until the 
 medical officer of health or a medical practitioner 
 certifies him free from disease and infection, and certi- 
 fies that the house and everything in it exposed to 
 infection have been disinfected to his satisfaction. At 
 
MEDICAL EXAMINATION 55 
 
 the same time, the parent is under obligation to pro- 
 cure the certificate ; the teacher is under obligation to 
 exclude the child from school until the parent produces 
 the certificate ; both parent and teacher are under a 
 penalty of 2 for failing in these duties. As to dis- 
 infection, the school is a house within the meaning 
 of the Act,andwhat applies to an infected house applies 
 equally to an infected school. In the rural districts 
 a good deal of administrative difficulty has resulted 
 from these drastic clauses ; but, on the whole, the 
 results have been excellent. 
 
 There is room for improvement and adjustment 
 between the local authority for public health and 
 the School Boards ; but this is a matter of detail, 
 not a matter of principle. In Germany, the public 
 health and the education authorities are practically 
 one and the same. The ad hoc principle there 
 applies rather to officials than to Corporations. In 
 England, by the recent Act the public health and 
 the school authorities are also practically identical ; 
 but in many cases the officers are specialised for 
 public health purposes or for school purposes. In 
 Scotland, as I have indicated, the public health 
 authority already has in a limited number of places 
 the control of buildings, and has everywhere the 
 control of infection and sanitation. The Bill intro- 
 duced last year made no difference in this principle. 
 
 What then remains to do? There remains the 
 inspection of the school child, not for infectious 
 diseases alone, but for all the diseases and conditions 
 that in any degree unfit him for school life. How 
 in practice are we to realise this end ? 
 
56 THE HEALTH OF THE SCHOOL CHILD 
 
 3. GENERAL SCHEME OF MEDICAL INSPECTION 
 
 The recent investigation made for the Royal 
 Commission on Physical Training was directed to 
 one special object to ascertain whether there was 
 any substantial ground for advising medical inspection. 
 The schedule of particulars offers a model that, with 
 a little adaptation, may be made suitable for routine 
 inspection. The schedule, it is right to record, was 
 primarily devised by Professor Matthew Hay of 
 Aberdeen ; it was discussed by both investigators, 
 and finally approved by the Commission. It in- 
 cluded a large number of anthropometrical measure- 
 ments, which could not well be expected from a 
 routine inspection, but form nevertheless a valuable 
 item in a general physical census of children. I 
 refer to this schedule for two reasons, first, to 
 indicate the scope of the particular inquiry, and 
 second, to indicate how much is practicable in regular 
 and periodic inspection. 
 
 4. ROUTINE SCHEDULE 
 
 On the basis of the Commission's Schedule, I 
 have devised another, which has been subjected to a 
 fairly severe test in Edinburgh, in Glasgow, and in 
 Dundee. 1 It has been used to guide the examina- 
 tion of over 3000 children. It is comprehensive, 
 but not exhaustive. It indicates what is actually 
 possible within school conditions in Scottish schools. 
 It has been objected to as rather elaborate for 
 
 1 See Medical Inspection of School Children, p. 73 and Appendix. 
 
MEDICAL EXAMINATION 57 
 
 routine purposes ; but the objectors have always 
 difficulty in saying what ought to be left out. 
 
 The schedule aims at treating the child as related 
 at once to the home and to the school. If we are 
 to secure the full advantage of medical inspection of 
 school children, we must maintain a perfectly definite 
 relation between the School Boards and the public 
 health authorities. That is the primary purpose of 
 relating the school child to his home. In Glasgow 
 it has been found, as the result of the examination 
 of 750 children, that many conditions discovered in 
 the school inspection have the most direct bearing 
 on the cleanliness, the ventilation, the lighting, and 
 the overcrowding of the homes. In Dundee the 
 experience has been the same. Although, therefore, 
 a number of the headings are not medical, they 
 have a medical or hygienic reference. For these 
 reasons I have suggested that whether used at the 
 moment or not, they should be retained in any 
 adequate system of examination. The school child 
 is not an abstraction. He carries with him every- 
 where the evidences of his daily nurture. He is 
 well-fed or ill-fed, he is well- cleaned or ill-cleaned, 
 he is well-clad or ill-clad, he is well-slept or ill-slept, 
 and he is always one or the other because the home 
 he comes from is wealthy or poor, clean or dirty, 
 overcrowded or uncrowded, quiet or noisy. These 
 facts offer an immense field for scientific study. 
 The fitness of a child to begin a day's work at nine 
 o'clock depends on his hours of sleep, on the food 
 he has eaten, on the air he has breathed within 
 the preceding twelve hours. One broad result 
 
58 THE HEALTH OF THE SCHOOL CHILD 
 
 emerges the house that suits the eating and sleep- 
 ing necessities of the adult father and mother does 
 not suit the necessities of the school child from five 
 to fourteen. This fact at once opens up the 
 question of nervous fatigue and its measurement. 
 On this matter, I have no results to show ; but any 
 physiologist would, I think, agree that school fatigue 
 is, in mathematical terms, a " function " of the 
 home life. 
 
 The other items of the schedule bear on the 
 life at school regularity of attendance, physical 
 exercises, height, weight, etc. As I am able to give 
 illustrations on some of the other headings, I need 
 not discuss them generally now. 
 
 5. MEDICAL INSPECTION IN NUREMBERG 
 
 In many localities of Germany, Austria, and 
 Switzerland, medical examination of children has 
 proceeded for many years. I take a single illustra- 
 tion from Nuremberg. The schedule and certificates 
 (pp. 110-114) indicate at once the duties of a school 
 doctor and the range of his examination. On the 
 whole, the ground covered is much the same as it is 
 in our own schedules. Nuremberg is a city of some 
 270,000 inhabitants. It has fifteen school doctors, 
 who give part of their time to the examination of 
 children admitted, and the periodic re-examination 
 of the children in attendance. The school doctor 
 subjects each child of school age to a full examina- 
 tion height, weight, chest measurement, eyes, ears, 
 throat, heart, lungs, muscular condition, spine, bones, 
 
MEDICAL EXAMINATION 59 
 
 nervous system, mental condition, degree of develop- 
 ment, etc. The parent receives notice of the day of 
 examination and may be present. If the child, 
 though of school age, is not fit for school duty, he is 
 not admitted. If he is found to have any defect, he 
 is recommended for treatment. If, though suffering 
 from some slight defect, he is found fit to begin work, 
 he is kept under supervision from year to year. 
 All the children are kept under general supervision 
 through their whole school life. Infectious diseases 
 are dealt with much on the same lines as we deal 
 with them in this country. 1 In the recent Report by 
 Mr. Andrews, H.M. Inspector of Schools, on the 
 Examination of .Schools at Charlottenberg and 
 Berlin, similar details are recorded, and from the 
 Report of the International Congress on School 
 Hygiene at Nuremberg, 1904, many more illustra- 
 tions might be derived. 
 
 It is nowhere suggested that the medical inspector 
 of a school should be responsible for treatment. 
 Each country develops its own method of dealing 
 with this problem. Parents frequently know nothing 
 of defects in the eyes or ears or throats of their 
 children, and, as is recorded in the Dundee Report, 
 have been found only too glad to be informed. 
 Many parents will of course remain indifferent. But 
 many children suffering from defects will find their 
 way to the dispensaries and the hospitals. There 
 will, however, be a small remnant of children that, 
 with our defective administration of charities, are 
 not at present provided for, and may have to be 
 1 See p. 106. 
 
60 THE HEALTH OF THE SCHOOL CHILD 
 
 dealt with by some new organisation the School 
 Board or another. But my impression is that, in 
 most localities, the remnant of diseased or defective 
 children whose treatment is unprovided for will be 
 small. In any case, it is our duty to discover how 
 large or how small it is. The experience of London 
 is that the work of the medical officer of the 
 School Board has to be supplemented by the visits of 
 trained nurses. New York has moved on the same 
 lines. 
 
 As a type of the child unprovided for, I single 
 out the case of the child with scabies. The 
 hospitals as a rule do not admit this disease. The 
 dispensaries cannot conveniently treat the case to a 
 finish. The parents are usually too ignorant or too 
 ill-trained or too dissipated to carry out the cure. 
 The public health authorities do not, for the present, 
 accept the burden except in special cases. The 
 result is that cases may become chronic and school 
 departments become infected. In actual fact, how- 
 ever, the amount of scabies in Scotch schools has 
 not been found great; but it ought to be better 
 provided for than our present machinery makes 
 possible. The same is in greater or less degree true 
 of favus, ringworm, and impetigo, which usually 
 occur among the poorly nourished and poor children. 
 
 6. INSTRUCTION OF TEACHERS 
 
 In the three schedules I have mentioned it is pre- 
 supposed that the teacher must play a primary part 
 in any system of medical inspection. This is too 
 
MEDICAL EXAMINATION 61 
 
 obvious to need enforcing. All over Scotland the 
 teachers themselves have given evidence of a strong 
 desire to become familiar not only with the general 
 hygiene of school buildings, but with the more 
 obvious signs of unfitness in the children as well. 
 The School Boards, the Normal Training Colleges, 
 and the Scotch Education Department have in 
 their several ways responded to this desire. For 
 many years the Department has required some 
 instruction in the Laws of Health as part of the 
 curriculum of the Training Colleges. At present all 
 the Training Colleges in Scotland are arranging or 
 have arranged such courses of instruction both 
 theoretical and practical. These courses are speci- 
 ally designed to put the teacher in a better position 
 to scrutinise the class for obvious defects of eye- 
 sight, hearing, breathing, and the like. It goes 
 without saying that the teacher's interest in the 
 physical and mental growth of the child is thus 
 intensified. If the labour of the school is for the 
 moment made greater, the value of the teaching is 
 not made less. The more the teacher knows about 
 the health of the children entrusted to him, the 
 simpler and the easier will the work of medical 
 inspection become. And it may be said at once 
 that without the co-operation of the teacher the 
 organisation of medical inspection is impossible. 
 
 In the course of my observation I have found 
 abundant proof that the teachers will welcome the 
 installation of a regular medical inspection. Apart 
 from the Normal Training College courses referred 
 to, several School Boards have arranged courses for 
 
62 THE HEALTH OF THE SCHOOL CHILD 
 
 acting teachers. In one city some 300 teachers 
 are at present (1905) attending a course of exposi- 
 tions covering all the important points where the 
 teacher is concerned with the health and fitness of 
 the child. Doubtless these courses will be multi- 
 plied everywhere, until every teacher has had an 
 opportunity of becoming familiar with the practical 
 aspects of school hygiene and the health of school 
 children. Now that, in Scotland, the training of 
 teachers has been placed on a national footing, we 
 may reasonably expect that the movement already 
 begun will be developed with greater precision and 
 detail. It is right also to add that a general 
 inspector of physical training for the whole of 
 Scotland has been at work for a considerable time. 
 He is organising the collection of general facts 
 about height, weight, occupation, and certain defects 
 of eyes, ears, etc. The beginnings thus made are 
 preparing the way for the more elaborate physical 
 examination that the new Education Act will 
 make possible. 
 
 7. MEDICAL INSPECTOR'S ROOM 
 
 At present, our school plans do not provide for 
 a special medical inspector's examination room. 
 Until such a room is provided, on the same lines as 
 the headmaster's room and others, the work of 
 medical inspection' will tend to cause a certain dis- 
 turbance in the daily work of the school. Such 
 disturbance will be reduced to a minimum when the 
 medical room is a recognised functional part of the 
 
MEDICAL EXAMINATION 63 
 
 school. In Nuremberg I have not found any 
 evidence that a medical room is provided; but 
 Professor Burgerstein of Vienna, a leading authority 
 on school hygiene, informed me that in the new 
 schools of Austria a medical doctor's room will be 
 provided. 
 
 8. NUMBERS OF SCHOOL CHILDREN TO BE 
 EXAMINED 
 
 The number of school children attending Board 
 schools in Scotland is over 800,000. We cannot 
 hope to see this large army of civil recruits examined 
 all at once. But if we assume that the new ad- 
 missions amount to 10 per cent, that is 80,000, the 
 task of examination becomes much less formidable. 
 The majority of those children attend town schools, 
 where medical service of every variety is easily 
 obtained. When you distribute 80,000 children 
 into small parcels varying from five or ten up to 
 200, and spread their examination over half a year, 
 the practical difficulties begin to disappear. In the 
 town of Zurich in the year 1902, 2994 had 
 attained school age. These were all examined on 
 admission, and 4.7 of them were rejected as still 
 unfit. What a town like Zurich finds to be possible, 
 the towns and districts of Scotland will find to be 
 equally possible. A detailed examination of children 
 on admission will steadily reduce the amount of 
 defects found among the older children, and the 
 work of medical supervision will steadily become 
 easier. 
 
64 THE HEALTH OF THE SCHOOL CHILD 
 
 9. STARTING-POINT OF THE RECENT 
 INVESTIGATIONS 
 
 In Britain the study of the school child owes 
 an incalculable amount to the thirty years' labour of 
 Dr. Francis Warner. He gives us a summary of 
 his results with 50,000 London school children. 1 
 The facts he details so minutely in his books have 
 been lying before us for nearly a generation. The 
 popular interest in them was stimulated once more 
 by the lament over the results of the recruiting 
 agencies. The table now shown indicates the 
 grounds for these complaints and the causes of the 
 many rejections. 1 
 
 It is natural to inquire whether the defects found 
 in the recruits of the righting army may not be 
 common to the recruits of all armies, and whether 
 the facts incidentally revealed by the examination 
 for war do not point the way to an examination for 
 the ends of peace. 
 
 10. ILLUSTRATIONS OF RESULTS 
 
 So far the form and organisation of medical 
 inspection. I shall now indicate some of the 
 results already obtained. 
 
 ii. HEIGHT AND WEIGHT 
 
 In Appendix XIX. to the Report of the Inter- 
 Departmental Committee on Physical Deterioration, 
 
 1 See Report of Royal Commission on Physical Training (Scotland), 
 pp. 45 et seq. 
 
MEDICAL EXAMINATION 65 
 
 Dr. Alfred Eichholz, of the English Board of 
 Education, has given a series of valuable and in- 
 teresting charts to illustrate the physique of school 
 children. These charts he has constructed on a 
 basis of height measurements. He has found that 
 " height curves are easier to obtain, and display dis- 
 crepancies better than weight curves. They are, 
 therefore, preferable for purposes of statistical 
 examination." This, no doubt, is generally true ; 
 but, as I shall show you, the weight curve where it 
 can be obtained is of extreme significance as a test 
 of immediate nutrition. Before showing you some 
 selected curves from this series, I should say that 
 Dr. Eichholz's general conclusions are these : 
 
 1 . " London shows greater extremes of excellence 
 and superiority than provincial towns. The differ- 
 ence between the good and the poor types is very 
 grave. 
 
 2. "The best children are practically equally 
 good in all towns. 
 
 3. "In the case of younger children, the worst in 
 London are lower in stature than the worst else- 
 where Manchester, Salford, Leeds. 
 
 4. " The curves in Manchester and Salford are 
 flatter than elsewhere, due possibly to the wider 
 prevalence of rickets, but associated also probably 
 with the Celtic strain in the population." 
 
 12. SELECTION OF STANDARD 
 
 A good type of London school Honeywell Road 
 Board School, Wandsworth Common was taken as 
 5 
 
66 THE HEALTH OF THE SCHOOL CHILD 
 
 a standard. In this school physical exercises were 
 a speciality in all departments. The rate of growth 
 was found more uniform than in either of the 
 country schools compared with it, and as the 
 selection of children seemed to represent a good 
 quarter, the results were taken as a basis of com- 
 parison. One small country town from the South 
 and another from the North showed distinct devia- 
 tions from the standard. The Southern town 
 showed heights distinctly lower up to the age of 
 eight, and perceptibly higher from age eight to age 
 thirteen. The Northern town showed, for most of 
 the available ages, heights slightly lower than the 
 standard. These curves are based on the average 
 height of twenty children of each year of school age. 
 The heights shown are an average of boys and girls. 
 This somewhat impairs the charts for the purpose 
 of comparison, but the differences as shown are 
 sufficiently striking. 
 
 13. A Low GRADE TOWN SCHOOL IN A 
 NEGLECTED DISTRICT (LONDON) 
 
 In comparison with the standard, Johanna Street 
 Board School, representing this district, showed 
 " irregular growth and severe retardation of a very 
 grave nature." This is in entire conformity with 
 observations taken in Edinburgh, Glasgow, and 
 elsewhere. In another school, St. Clement's Road 
 Board School, which represented a criminal and 
 neglected area of London, the same general retarda- 
 tion in growth was conspicuous. 
 
MEDICAL EXAMINATION 67 
 
 14. MANCHESTER 
 
 In Manchester, two schools were compared with 
 the standard. One, Ducie Avenue Board School, a 
 school of the best type, on the whole held its own 
 with the standard. Another school, Sharp Street, 
 a notably bad slum area, fell distinctly below the 
 standard at all ages. The curve serves to show 
 that " good population in Manchester is practically 
 as good as best in London. Apparent falling off in 
 Ducie Avenue at later ages probably associated with 
 the transference of the best children to the Central 
 Higher Grade School and other higher schools." 
 In comparing schools, it is always important to 
 remember causes of variation such as these. 
 
 In Salford and Leeds the same general difference 
 was found to prevail. In a poor grade school in 
 Bethnal Green, where the London County Council 
 have been erecting modern dwellings, the heights 
 of the children were found at the earlier ages to be 
 as good as the best, and at the later ages to be 
 little short of the best. We are not to suppose 
 that the erection of dwellings is in itself a cause 
 of improved heights in the children. Rather we 
 must assume that the better dwellings attract the 
 better class of people. 
 
 15. ELTRINGHAM STREET BOYS' SCHOOL, 
 WANDSWORTH 
 
 This school is situated in a poor industrial neigh- 
 bourhood ; but for twelve years drill exercises and 
 
68 THE HEALTH OF THE SCHOOL CHILD 
 
 organised games appear to have been maintained. 
 Towards the later years of school life the increase in 
 height seems to approach the standard. One hesitates 
 to assign this improvement in growth to the improve- 
 ment in physical discipline ; but possibly, in general, 
 this will be found associated with better feeding, and 
 may on the whole be accepted as a factor in 
 improved growth. 
 
 In a Board school frequented by alien immigrants 
 (Jewish), Dr. Eichholz found a high grade rate of 
 growth. For the earlier ages up to eight, this 
 school was perceptibly above the standard. For 
 the other ages, it was a shade below. 
 
 1 6. A SCHOOL FOR FEEBLE-MINDED CHILDREN 
 
 Dr. Eichholz has had special experience of feeble- 
 minded children in London schools. In one school, 
 St. Clement's Road Centre, Nottinghill, he found 
 conditions that indicated irregular and much retarded 
 growth. Children of ten years of age show nearly 
 five inches of deficiency in height. The curve of the 
 feeble-minded is very irregular, and suggests sudden 
 alterations in the rate of growth. 
 
 17. WEIGHT CURVES 
 
 As an illustration of differences in weight, a 
 country school (Ripon), a good town school 
 (Brudenell School, Leeds), and a poor town school 
 (St. Peter's, in Sweet Lane, Leeds) were compared. 
 Generally, the weight curve shows the same 
 
MEDICAL EXAMINATION 69 
 
 differences as height curves. The poor children are 
 always lighter as they are smaller. The rural schools 
 on the whole approach the better town schools. 
 
 1 8. SCOTCH SCHOOLS EDINBURGH, GLASGOW, 
 ABERDEEN 
 
 These charts indicate generally what we have 
 recently found verified among the school children of 
 Scotland. In the investigation made for the Royal 
 Commission on Physical Training, the numbers of 
 children chosen from Aberdeen and Edinburgh were 
 admittedly too small to form an adequate statistical 
 basis for general conclusions ; but, so far as the 
 figures go, they follow the same general trend as 
 those I have described. Recently, Dr. Chalmers, 
 the Medical Officer of Health for Glasgow, has 
 completed and recorded a physical and medical 
 examination of 750 Glasgow children. The general 
 result has been the same. In the poorer quarters 
 the children are smaller and lighter than in the better 
 quarters. In at least one of the Glasgow schools 
 the children were found distinctly smaller and lighter 
 than in Edinburgh. In the Report of the Physical 
 Training Commission you will find a comparative 
 table made from the British Anthropometric Com- 
 mittee's standard, the Boston standard, and the 
 results of the Aberdeen and Edinburgh investigations. 
 Both for boys and girls, the heights of the Edin- 
 burgh children are almost uniformly lower than the 
 standard either of the Anthropometric Committee or 
 of Boston. The Aberdeen children run much the 
 
70 THE HEALTH OF THE SCHOOL CHILD 
 
 same course as the standard, but perceptibly below 
 Boston. 
 
 I do not here raise any question of the validity of 
 these figures as representing either the Edinburgh or 
 Aberdeen children. Nor do I need to emphasise 
 the fact that the British standard and the Boston 
 standard are based on an examination of many 
 thousands of children, whereas the Aberdeen and 
 Edinburgh figures are based on an examination of 
 600 children for each city. It is beyond question 
 that both Aberdeen and Edinburgh can show children 
 of all ages to reach the British standard ; but it is 
 equally certain that both towns contain children that 
 fall distinctly below. Edinburgh, as the larger city, 
 naturally contains a greater aggregate of poorer 
 children, and this fact naturally is manifested in any 
 given school in a more striking way than in 
 Aberdeen. Glasgow, again, has a still greater 
 aggregate of poor children, and, as I have said, the 
 heights for the poor areas fall perceptibly below 
 Edinburgh. 
 
 The weight curve follows closely the same course 
 as the height curve. At the higher ages, the 
 Aberdeen and Boston figures shoot upwards, but in 
 Aberdeen at least this is probably due to the small 
 numbers examined. The Edinburgh girls of thirteen 
 and upwards rise rapidly above the standard. This 
 also is probably due to the error of small numbers. 
 
 Perhaps it is more instructive to compare the 
 Edinburgh schools with one another. Naturally, 
 the curves are somewhat more irregular, because the 
 numbers compared are smaller. But the same 
 
MEDICAL EXAMINATION 71 
 
 general truth is made manifest children from the 
 better quarter are taller and heavier than children 
 from the poorer quarter. The two extremes are 
 Bruntsfield School, a higher grade school, drawing 
 its pupils from a varied and good population, and 
 North Canongate, drawing its pupils from a very 
 poor population. The children from Bruntsfield 
 School on the whole maintain the same level as the 
 British standard, occasionally surpassing it. The 
 children of this school are much more properly 
 comparable with the children of Aberdeen. They 
 do not, of course, represent the wealthier classes of 
 Edinburgh, which would more properly be shown 
 in the Merchant Company's schools and in the 
 Academy. Incidentally, it is gratifying to learn 
 that recently the Edinburgh Merchant Company 
 have appointed two lady doctors to examine the 
 girls in their Girls' Colleges. I do not happen to 
 have figures for the children of the wealthier classes 
 in Edinburgh, but I have little doubt they will show 
 the same general superiority as elsewhere. More 
 money means better nurture. 
 
 19. DUNDEE SCHOOLS 
 
 In the excellent Report just issued by the Social 
 Union of Dundee, we find another mass of con- 
 firmatory observations. In the tables of height and 
 weight the " median " average is used instead of the 
 arithmetical mean. This makes it inadvisable to 
 compare the small numbers at any one age in 
 Edinburgh, Aberdeen, or Glasgow with the figures 
 
72 THE HEALTH OF THE SCHOOL CHILD 
 
 from Dundee. 1 But, as the tables indicate, the 
 contrasting figures within the city of Dundee itself 
 are enough to show that there also the same general 
 truth is verified. The children of the elementary 
 schools are perceptibly less in height and weight 
 than the children of the Harris Academy. In 
 some respects the conditions found seem to have 
 been distinctly worse than either in Edinburgh or 
 in Glasgow. 
 
 These figures, being so uniform, in various 
 localities, even though they are so small, cannot be 
 accidental. It is to be hoped that before long we 
 shall have a much more extended basis of com- 
 parison. The returns now being organised by 
 Captain Alan Foster, Inspector for Physical Educa- 
 tion in Scotland, will enable us to build up more 
 reliable averages. I trust that the teachers and 
 School Boards everywhere will extend to Captain 
 Foster's work the cordial co-operation that is 
 indispensable to the success of it. 
 
 I have given you these illustrations of heights 
 and weights not so much for their individual 
 interest, as to point the way for much more ex- 
 tended records. The Grammar School in Aberdeen, 
 for example, maintains a physical register such as 
 I should wish to see in every other Board school. 
 There is room here for a wholesome rivalry among 
 schools. Height and weight, it should always be 
 remembered, are fundamental facts both in growth 
 
 1 But on working out the Edinburgh figures by the " median " method, 
 I found that the differences between the " median " and the arithmetical 
 mean were always merely fractional. 
 
MEDICAL EXAMINATION 73 
 
 and in nutrition. They are the first step to medical 
 examination. Every teacher knows how to record 
 them. Every school should have its weighing 
 machine and its measuring standard. Every school 
 should have its charts of height and weight for all 
 ages. In Nuremberg, I noticed that the measuring 
 standard was fixed on the side of the door of every 
 class-room. This is also necessary for fitting the 
 children to the desks. There the measuring of the 
 children is a matter of routine. Before many months 
 are over I hope it will be a matter of routine in every 
 Scottish school. If by taking thought we cannot 
 add a cubit to our stature, we may at least take 
 means to discover where the cubit is wanting. 
 
 20. MENTAL CAPACITY AND THE SENSES 
 
 In every school there is a certain percentage of 
 mentally deficient children. The School Board have 
 under the present Code some powers of dealing with 
 the mentally defective. The powers may need 
 extension. But the percentage of the really defective 
 in our Board schools is small. The percentage of 
 dull children, however, is considerable. The dis- 
 covery of the causes of mental dulness and retarda- 
 tion is one of the most important purposes of 
 medical inspection. The teacher does not take 
 long to find out that there is an intellectual better 
 and an intellectual worse in every class, even if 
 the class number but two or three. It is not so easy 
 to prove that, in a vast number of such cases, the 
 dulness is due to some defect of the primary senses 
 
74 THE HEALTH OF THE SCHOOL CHILD 
 
 of eye and ear. But that such defects account for 
 a great deal of mental backwardness is beyond 
 question. As a concrete instance, let us look at 
 the results of the Dundee investigation. Out of 
 the thousand children examined, not less than 87, 
 that is 8.7 per cent., were returned by the teachers 
 as mentally dull. They were found by the medical 
 examiners to be suffering from defects of eye and 
 ear or both. That list alone is enough to justify 
 the instituting of a systematic medical inspection. 
 How shall the half-blind be taught to read, or the 
 deaf to understand ? 
 
 Is it quite fair that a child should be handicapped 
 for life because in his nine years at school he found 
 no one to suggest that an oculist should examine 
 his eyes and an aurist his ears ? What a waste of 
 public money it is to keep teachers working lamed 
 senses like these ! 
 
 Into the general question of the testing of mental 
 capacity, I do not enter. It is a matter for the 
 specialist in insanity and the educational psycholo- 
 gist. There is material enough for them both. 
 
 21. GLANDS 
 
 Why is it important to examine glands ? The 
 question hardly needs answering. If you look at 
 a picture showing the superficial glands of the neck, 
 and another picture showing the deep glands of the 
 neck, you will see at once why the examination of 
 glands is indispensable. The glands are the sentinels 
 of the lymphatic system. The lymphatic system is 
 the absorptive system of the body. You cannot 
 
MEDICAL EXAMINATION 75 
 
 prick the skin anywhere without entering some 
 branch of a lymphatic vessel or canal. In vaccina- 
 tion, for example, a few superficial scratches of the 
 skin may, without drawing a drop of blood, pene- 
 trate to the lymphatics and secure the absorption of 
 the vaccine. The neck glands are of two orders 
 deep and superficial. Some lie more to the front of 
 the neck, others more to the back. Where the teeth 
 are bad, the front neck glands are readily affected. 
 Further, where the tonsils are inflamed, or the back 
 of the throat, the glands associated with those 
 regions forthwith become inflamed. Absorption by 
 the glands, therefore, is of primary importance. 
 They are the first halting-place of all infectious 
 organisms entering from the surface. They may 
 soften and break down, as commonly occurs when 
 they are infected with tubercle. They may become 
 hard and painful, as in acute inflammations of the 
 throat or tonsils. They may become chronically 
 enlarged, as is common in feeble and ill-nourished 
 children. In short, they are always, either positively 
 or negatively, a good indicator of the physical 
 conditions. Among well-fed children, whose teeth 
 are good, whose skins are clean, whose heads are 
 free from vermin, whose throats are free from 
 chronic inflammation, neck glands are very rarely 
 enlarged. They are almost always enlarged to 
 some degree in children whose teeth are bad, 
 whose heads are verminous, whose skins are dirty, 
 whose throats are inflamed. In one of the 
 Edinburgh schools only seven cases of enlarged 
 glands were found in 160 children. In another, 
 
76 THE HEALTH OF THE SCHOOL CHILD 
 
 some 45 cases of enlarged glands were found in 
 the same number. All over, 18 per cent, were 
 found in Edinburgh schools. In one Glasgow 
 school 29 per cent, were found, and in the best 
 school there the percentage was 12. For Aberdeen 
 children the percentage was 2. In the best Edin- 
 burgh school the percentage was about 4. In 
 Dundee the percentage was 37.3 among boys ; 
 2 among girls. In the best Edinburgh school none 
 worth recording occurred among girls. Swollen 
 glands are so easily observed that every teacher is 
 capable of observing them. 
 
 22. DEFECTS OF RESPIRATION ENLARGED 
 TONSILS AND ADENOIDS 
 
 The normal child breathes through the nose. If, 
 when not excited, he usually or even occasionally 
 breathes through the mouth, it is because he is 
 suffering from some obstruction of the nasal 
 passages or from some defect in the shape of 
 the mouth or palate. It is not to be assumed 
 that every child with an open mouth breathes 
 through the mouth ; for the tongue may press 
 against the roof of the mouth while the lips remain 
 open, and thus the mouth-breathing is sometimes 
 only apparent. As a rule, however, mouth-breathing 
 indicates some degree of nasal obstruction. Ob- 
 struction may be due to enlarged tonsils, to chronic 
 inflammation of the nose, to the narrowness of the 
 nasal openings, to the overgrowth of the nasal 
 septum, or, more commonly, to the overgrowth of 
 
MEDICAL EXAMINATION 77 
 
 the delicate lymph tissue lining the back parts of 
 the nose and throat. Such growth of lymph tissue 
 is now familiarly known to everyone as adenoids (or 
 gland-like growths), or nasal vegetations. They vary 
 in degree from an almost imperceptible elevation of 
 the tissue to large hanging masses that entirely ob- 
 struct the nasal passages. The results to the child 
 are serious. He is backward in development. He 
 is t stupid. He is liable to repeated colds. He is 
 more open to infection. His speech is affected. 
 His hearing is affected. His whole nutritional tone 
 is affected. Here I should like to show you the 
 nose as it would appear from behind in a bad case 
 of adenoids. It is obviously impossible through so 
 small an opening to transmit freely the air necessary 
 for correct respiration. I should like also to show 
 the tonsils in their normal development. Very fre- 
 quently adenoids go with increased size of tonsils. 
 The chronic inflammation that leads to enlarged 
 tonsils inflames also the back of the throat and 
 blocks the air tube between the throat and the 
 middle ear (the Eustachian tube). The result is 
 that the air within the middle ear is not renewed 
 as often as it should be ; on the contrary, it becomes 
 absorbed, and then, by the pressure from the outer 
 air, the ear drum is forced inwards. Technically, 
 this is known as retracted membrane. Retraction 
 of the membrane affects the hearing for all purposes. 
 It may result in absolute deafness. It usually results 
 in dulness of hearing. It probably, almost cer- 
 tainly, interferes with the perception of musical pitch. 
 A " bad ear " for music may be literally a bad ear. 
 
78 THE HEALTH OF THE SCHOOL CHILD 
 
 If these be some of the consequences that flow 
 from enlarged tonsils and adenoids, it is surely more 
 rational to waste a little time in medical diagnosis 
 and treatment than to waste the teacher's voice in 
 compelling the infant to hear. Enlarged tonsils and 
 adenoids are so common in some communities that 
 they are by many physicians reckoned practically 
 normal. Normal in one sense they may be they 
 are the results of structural defects or wrong habits 
 in breathing or in nurture. But whatever the cause, 
 it is usually possible to apply some remedy. It is 
 fortunate that nasal obstruction so rapidly leads to 
 a feature so easily observed by the teacher as mouth- 
 breathing must always be. If I were a teacher, my 
 first scrutiny of my class every morning would be a 
 scrutiny for mouth-breathers. My first order would 
 be, " Shut your mouths." Any child that cannot 
 breathe freely and easily with his mouth shut ought 
 to be set aside for the medical inspector. 
 
 23. ASPECT DUE TO ADENOIDS 
 
 When a child is cured of adenoids the open 
 mouth and the somewhat stupid expression give 
 place to the closed mouth and a look of greater 
 intelligence. Even in adults the removal of nasal 
 obstructions seems occasionally to work a similar 
 transformation. 
 
 24. TEETH 
 
 The question of bad teeth has been agitated so 
 long, and the resulting issues are so grim, that I 
 
MEDICAL EXAMINATION 79 
 
 may pass the subject with a word. Elsewhere, at 
 the risk of appearing ridiculous, I have suggested 
 tooth-cleansing drill as a possible addition to the 
 innumerable disciplines of the school. The sug- 
 gestion would be ridiculous did we not know that 
 all the digestive functions, which involve the whole 
 nutrition of the body, depend on the teeth. Nor 
 this only. It is known that infective germs may 
 live in the teeth and produce chronic ill-health. In 
 one city, the mention of tooth - cleansing drill 
 resulted in a proposal to establish prizes for the 
 best and the cleanest teeth. Good and clean teeth 
 are at least as worthy of a prize as well-developed 
 muscle. A clean mouth means a great deal to the 
 child. However long the school medical inspector 
 may be delayed, the school dental surgeon should 
 certainly be hastened. 
 
 An English dental surgeon, with whom I visited 
 two orphanages at Nuremberg, assured me that he 
 could keep the teeth of each institution right at an 
 expenditure of thirty shillings a year on material. 
 He had had large experience of Poor Law schools in 
 England. 
 
 25. EARS AND HEARING 
 
 The teacher has endless opportunities of testing 
 the hearing. Every hour of the day he is applying 
 the voice test. He should have no difficulty in 
 knowing every case of defective hearing in his class. 
 If a child cannot hear the words "twenty-two" 
 whispered clearly at twenty feet distance, he ought 
 to be carefully examined. If he cannot hear a 
 
8o THE HEALTH OF THE SCHOOL CHILD 
 
 watch ticking at a foot away from the ear, he is 
 certainly deaf. Before a child is assumed to be 
 feeble-minded or backward, his eyes and ears should 
 be examined. Unfortunately, the conditions of 
 school work make it difficult to apply precise tests 
 to the hearing ; but the teacher, as I have said, is 
 always applying a test that is of the highest value. 
 He should be able at least to pick out the grosser 
 cases of defective hearing. 
 
 26. EYES AND VISION 
 
 A short time ago I was consulted by a school- 
 master who suffered all day from headaches. He 
 had suffered for years. He suffered most when he 
 read most. He had consulted a physician, who 
 prescribed sedatives, possibly bromides. The head- 
 aches occasionally disappeared when the drug was 
 taken, but only at the expense of great nervous 
 depression. He awoke every morning in the same 
 dull, aching condition. The first thing I asked him 
 was, " Can you see properly ? " He thought he 
 could. I set up before him the usual test types at 
 twenty feet distance. With one eye, he was able 
 to read what was normal for his age. With the 
 other eye, he could scarcely read at all without 
 some straining for distant vision and a great deal 
 of straining for nearer vision. I found that the 
 defect in his defective eye was due in part to a 
 small inflammatory adhesion dating from the time 
 when he had measles, about the age of three. As 
 a boy he had suffered slightly. As a student he 
 
MEDICAL EXAMINATION 8r 
 
 had suffered a good deal. As a teacher he had 
 suffered enough to compel him to act rationally. 
 I took him to a nerve specialist, who carefully 
 examined his whole system, and found nothing but 
 this trifling defect to account for the facts. Nothing 
 except one thing I had discovered that he heard 
 very badly, and on examining his ears I found him 
 suffering from great retraction of the membranes. 
 His deafness had supervened on a bad throat cold 
 two years before. He had himself attributed it to 
 advancing years, and for the first time I learned that 
 a teacher regards himself as old before he is forty- 
 five ! His ears, indeed, turned out to be worse than 
 his eyes. I took him to an ear specialist, who did, 
 with only partial success, all that modern aural 
 surgery could suggest. As for the eye, it was 
 ultimately fitted with proper spectacles, and the 
 teacher became a new man. 
 
 This is an extreme case. The eye defects 
 became most troublesome in adult life. But when 
 one reflects that from twenty to thirty per cent, of 
 our school children in Scotland suffer from eye 
 defects needing correction or attention, we have no 
 difficulty in imagining the sum total of misery that 
 school work must entail. Every oculist will enter- 
 tain you with scores upon scores of eye troubles in 
 children, whose days and nights have been made 
 wretched, whose health has been impaired, whose 
 career at school has suffered, whose adult life has 
 been permanently handicapped. 
 
 Dr. Kerr, of the London County Council, found that 
 with a little care the teachers were able to find out 
 6 
 
82 THE HEALTH OF THE SCHOOL CHILD 
 
 almost all the children that suffered from eye defects. 
 The percentage discovered by the teacher and the 
 percentage verified by the oculist came very near 
 each other. It is not intended that the teacher 
 should become a skilled oculist, but he ought to 
 know enough about eyes to tell when something is 
 decidedly wrong. He ought at least to know that 
 an eye defect may be at the root of his own 
 headaches. 
 
 27. SKIN DISEASES 
 
 The skin diseases that give the teacher most 
 trouble are ringworm, favus, impetigo, and itch. 
 Fortunately, a specific diagnosis is rarely necessary. 
 Each of these skin diseases constitutes so striking 
 an abnormality that no one can miss it. 
 
 28. INFECTIOUS DISEASES 
 
 Probably no diseases of school life are better 
 understood by the teacher than scarlet fever, 
 diphtheria, measles, chickenpox, mumps, and whoop- 
 ing-cough. Every sanitary student ought to be 
 familiar with the early symptoms of these diseases. 
 He should not be required to use the clinical 
 thermometer ; but he ought to know that the normal 
 temperature is 98.4 Fahrenheit, and that departures 
 from it upwards or downwards are indicated by 
 specific symptoms, such as pallor or flushing, 
 depression or excitement, sickness, rapid pulse, rapid 
 respiration. He should know the dangers of the 
 various infections, the common modes of diffusion, 
 
MEDICAL EXAMINATION 83 
 
 the chief symptoms. He should know how to direct 
 the cleaning of a school, and the more he knows 
 about the methods of disinfection the better for his 
 own peace and the health of his children. 
 
 29. HEART AND CIRCULATION 
 
 How should the teacher know anything of the 
 child's heart and circulation ? It is not easy to give 
 practical directions here. But a teacher may at 
 least observe whether a child is too pale, or suddenly 
 flushes up, or easily goes short of breath, or faints, or 
 exhibits the blue, unhealthy look of feeble circulation. 
 It is not desirable that his pulse should be frequently 
 felt, nor can any teacher be expected to diagnose 
 defects of the heart that often puzzle the experienced 
 physician. But sometimes in the schoolroom, and 
 frequently in the gymnasium, symptoms of heart 
 feebleness may appear. Fortunately, the percentage 
 of serious heart disease in school children is not very 
 great ; but still it amounts to from I to 6 per cent., 
 and I know of no sure method of discovery short of 
 examination with the stethoscope at the hands of a 
 competent medical man. Slight ailments of the 
 heart and circulation are common enough, and 
 they are usually indicated by the poor nutrition 
 of the children. 
 
 30. VENTILATION AND HEATING 
 
 It goes without saying that every teacher should 
 know what good ventilation is, what the usual means 
 
84 THE HEALTH OF THE SCHOOL CHILD 
 
 of securing it are, and how every ventilation mechan- 
 ism in a school is operated. He should also know 
 what the correct temperature for a schoolroom is, 
 in summer and in winter, and he should know how to 
 regulate his own and his pupils' feelings by the 
 thermometer. He should remember the difference 
 in size between himself and his pupils. He should 
 know that a small body exposes a greater radiating 
 surface proportionally than a large one. The air 
 cannot be too fresh, and if the choice lies between 
 cool fresh air and warm foul air, the cool fresh air 
 must have the preference. But teachers and children 
 naturally complain of cold. Let it, therefore, be 
 understood that it is no disgrace to wear the clothing 
 necessary to keep the body warm. In the poorer 
 schools, certainly it would contribute both to comfort 
 and to work if, in the cold weather, the children 
 systematically wore clothing suited to a cold room. 
 It is, I think, accepted generally that cool air is 
 preferable to warm, and no air can be too cold for a 
 healthy person to breathe. If, therefore, the body 
 is kept warm, the air may be of any degree of cool- 
 ness without risk to the person. To my mind, the 
 secret of comfortable rooms and schoolrooms is 
 warm floors, warm walls, warm furniture, bathed in 
 free draughts of cool air. The air, you will remember, 
 cools an object much more slowly than the radiant 
 heat of a fire warms it. 
 
 In Dr. Kerr's last annual Report you will find 
 excellent illustrations of the variations that occur 
 in the air of a schoolroom during the hours of 
 work. 
 
MEDICAL EXAMINATION 85 
 
 31. LIGHTING 
 
 The lighting of the schoolroom is a difficult 
 problem, but it is rarely within the power of the 
 teacher to improve it. He usually has to accept 
 what the school architect chooses to give him. He 
 should, however, concern himself to secure as far as 
 possible that the children's faces are not set directly 
 to the light, which, of course, should come from the 
 left side. Beyond this, it is difficult to give any 
 general direction. In certain Swiss schools, I am 
 told, a form of blind has been devised to preserve the 
 light and yet exclude the rays of the sun when these 
 are too strong. The mechanism I mean is simply 
 this, the blind-roller instead of being fixed at the 
 top of the window is fixed at the bottom, and the 
 blind, instead of being pulled down, is pulled up as 
 far as necessary. The general light of a schoolroom 
 may thus be maintained and the offending rays at 
 the same time excluded. 
 
 Experts have worked very minutely over this field, 
 and their results will ultimately find their place in 
 the administrative mind. If the choice of school 
 sites were unlimited, to secure good lighting would 
 be an easy enough problem. But in cities the 
 school must often be adapted to the small area 
 available ; the design suffers, and the architect 
 sacrifices lighting to other considerations. 
 
 32. SCHOOL SEATS 
 
 It is impossible to discuss all the problems 
 associated with school desks and school seats. At 
 
86 THE HEALTH OF THE SCHOOL CHILD 
 
 the Nuremberg Congress this was one of the points 
 that excited the keenest discussion. The market 
 has been flooded with patterns of every variety. 
 In the Nuremberg schools the favourite seemed to 
 be the school bench that accommodated two children 
 and could be tilted over to make the cleaning of the 
 floor easy. In most cases the desks were not 
 adapted for standing. In order to stand, the children 
 had to step out into the gangway. But whatever 
 be the form of desk, the business of the teacher is to 
 see that the child sits straight when he is sitting. 
 I know it is the ideal of the teacher to make the 
 child sit still, straight, and uniform. Personally, 
 I hope that ideal will remain permanently unrealised. 
 Attempts have been made to give the child a mov- 
 able seat. But if the child is not allowed to move, 
 the movable seat will not help him physiologically. 
 Dr. Kerr, whose experience of school hygiene entitles 
 him to be heard, strongly favours the isolated in- 
 dividual seat. Of course, the sizes must be adjusted ; 
 but the main point is that the individual seat allows 
 greater liberty of movement to the child and greater 
 facility for adjusting himself to his neighbour. 
 
 33. GENERAL SANITATION OF THE SCHOOL 
 
 The teacher ought to know something of school 
 sanitation. This, it is true, is on the whole well 
 provided for under the Public Health and Education 
 Acts. But the teacher ought to know generally as 
 much about lavatories and drains as will enable him 
 to report any defects that may occur. Fortunately, 
 
MEDICAL EXAMINATION 87 
 
 in the modern school all sanitary appliances are so 
 simple, and so easily managed, that the town teacher 
 has little trouble with them. Still, I have known 
 of a Higher Grade school of the most modern design 
 where, for want of a little effective supervision by 
 a responsible official, the sanitary conveniences had 
 passed into a state of such unspeakable filth as to 
 be a danger to the whole school. This condition 
 is not so rare as we should all wish it to be. 
 
 34. CONCLUSION 
 
 Many other points remain ; but we cannot be 
 exhaustive in a single paper. Every teacher will 
 naturally study the proper division of the day into 
 periods of work, of rest, of recreation. He will 
 want to know the physiology of fatigue, the rise and 
 fall of nervous energy through the twenty-four hours, 
 the relation of acquisitive capacity to the meal-times, 
 what work to require when the mind is fresh, what 
 routine to order when the attention flags, what limits 
 to place on muscular exercise. But these problems 
 are rather problems of physiology than of medicine, 
 and in any case they are too difficult to be dealt 
 with in a phrase. 
 
 If, in what I have said, some things appear to 
 you trivial, do not let this be your last thought 
 about them. From the right point of view, there is 
 nothing unclean or common. And the Service of 
 Man knows no holier ritual than the nurture of the 
 child. " Inasmuch as ye have done it unto the least 
 of these, My brethren, ye have done it unto Me." 
 
THE SCHOOL DOCTOR IN GERMANY 
 
 AN ounce of example is worth a pound of 
 description. For this reason, I here translate 
 two sets of Regulations for School Doctors. These 
 Regulations have in them nothing vague, nothing 
 doubtful. They contain certain points that concern 
 Germany alone, and do not concern any British 
 organisations. But those points may be neglected, 
 and they are given here only to preserve the sets of 
 Regulations complete. 
 
 Of the two sets, the Nuremberg set is the more 
 formal ; the Wiesbaden set, the more practical. But 
 the actual work is much the same in each town. The 
 Regulations, with the Health Schedule and Certificate 
 forms, constitute a Code of duties for School 
 Doctors. 
 
 If for the " Magistracy " we substitute the School 
 Board or the Education Authority, we may apply 
 almost every one of these rules to an English or a 
 Scottish system of Medical Inspection. The essential 
 points are always the same general constitution, 
 height, weight, chest, heart, eyes, ears, etc. 
 
 Ten years of practice in Wiesbaden and seven 
 years in Nuremberg, not to speak of the years of 
 systematic examination in many other cities, show 
 that Medical Inspection may be carried out in great 
 
THE SCHOOL DOCTOR IN GERMANY 89 
 
 detail within the ordinary conditions of school life. 
 The Regulations require nothing excessive. They 
 are strictly practical. They combine general hygiene 
 with personal hygiene. I have seen them at work 
 in Wiesbaden, and I can say that they are there 
 applied with the simple thoroughness that seems to 
 mark the best German work everywhere. 
 
 The Wiesbaden Health Schedule seems to me 
 the better adapted for its purpose. The subject- 
 headings run across the top of the paper ; the 
 school years run downwards. Both back and front 
 of the schedule are used. The single sheets are 
 easily arranged and preserved in a leather portfolio. 
 This passes on from class teacher to class teacher. 
 The schedules lie quite loose in the portfolio, and 
 thus are easily removed and replaced. They are 
 large enough not to go readily amissing. 
 
 For the information obtained in Wiesbaden, I 
 have to thank Dr. Cuntz, Senior School Doctor, 
 Member of the Town Council and Medical Repre- 
 sentative on the School Commission, and also Dr. 
 August Strieker, School Doctor. I was able to 
 accompany each of those gentlemen one, at an 
 examination of new entrants ; the other, at a general 
 fortnightly inspection (see pp. 1 2 et segj). 
 
 REGULATIONS FOR THE SCHOOL DOCTORS AT- 
 TACHED TO THE MUNICIPAL ELEMENTARY 
 AND MIDDLE SCHOOLS OF WIESBADEN 
 
 It is the duty of the School Doctors to supervise 
 the conditions of health of the pupils assigned to 
 
90 THE HEALTH OF THE SCHOOL CHILD 
 
 them, to co-operate in the medical examination of 
 the rooms and installations belonging to the school, 
 and to execute in this regard all the orders of the 
 Magistracy. 
 
 In particular, the following rules must be carried 
 out : 
 
 I. The School Doctors must carefully examine the 
 bodily condition and the health condition of all 
 newly entered pupils, in order to determine whether 
 they require a prolonged medical supervision or 
 special attention during instruction at school, e.g. 
 exclusion from instruction in particular branches, 
 e.g. gymnastics and singing, or limitation in time 
 given to instruction, assigning of a special seat on 
 account of defects in sight or hearing, etc. 
 
 Besides this detailed examination, which must be 
 undertaken in the first four to six weeks of the 
 school year, the newly entered pupils must, within 
 the first two to three days, be subjected to an 
 external examination for communicable diseases 
 and vermin. 
 
 For each child examined a health schedule must 
 be filled up, and this must accompany the pupil 
 through his whole school period. If a child appears 
 to require constant medical supervision, the entry 
 Medical Supervision " must be made on the top 
 right corner of the first page. The column " general 
 constitution " is to be filled up at the entering 
 examination of each child, the categories " good," 
 " middle," and " bad " being used. 
 
 Children whose general constitution is entered 
 as " bad " are to be treated as under medical super- 
 
THE SCHOOL DOCTOR IN GERMANY 91 
 
 vision until the School Doctor enters them expressly 
 on the health schedule as no longer in need of 
 supervision. 
 
 (The term " good " is to be used only in perfectly 
 sound health conditions, and " bad " only in pro- 
 nounced dispositions to disease or chronic illnesses.) 
 
 The other headings are to be rilled up only in 
 case of necessity and that at the entering examina- 
 tion, or in the case of illnesses supervening in the 
 course of the later school years. The weighing and 
 measuring are undertaken by the special class 
 teacher in charge, and must be entered for each 
 half year in the appropriate column, correct to half 
 a centimetre (less than a quarter of an inch), and a 
 quarter of a kilogramme (about half a pound). The 
 measurement of the chest is taken by the Doctor, 
 but only in children that are suspected of lung 
 disease or whose general constitution has been 
 entered in the health schedule as " bad." 
 
 2. In the same way as has been described 
 under Section I for the detailed examination of new 
 entrants, the School Doctors have to examine the 
 whole children of the third, fifth, and eighth school 
 year. These examinations are to be carried through 
 in the month of October or November. 
 
 Here it is expressly to be noted and entered 
 in the health schedule whether and in what way 
 diseases noted at an earlier period have altered. 
 The constitution and its alterations are to be given 
 in each case. 
 
 It is desirable that, after the examination of the 
 pupils of the eighth year that are ending their term 
 
92 THE HEALTH OF THE SCHOOL CHILD 
 
 at school, a final opinion on the total development 
 of the child during the school period be entered 
 on his school schedule and, in particular, a reference 
 made to any noteworthy illnesses that have occurred 
 during that time. These are to be noted in the last 
 column by the class teachers. 
 
 On these examinations of the later school years 
 a special report must be filled up in the form used 
 at the first examinations and transmitted to the 
 Senior School Doctor in terms of Section 9. 
 
 3. Every fortnight, and more frequently if in- 
 fectious diseases are prevalent, the School Doctor 
 holds a consultation at the school with the School 
 Director on a day previously arranged ; for example, 
 the first and third Thursday of the month. Time : 
 at ten o'clock in the forenoon, and not later than 
 twelve o'clock. For this purpose, if at all possible, 
 the Doctor should have a special room put at his 
 disposal. 
 
 If the Doctor wishes to visit the school on a day 
 other than that previously arranged, he must 
 intimate the fact to the School Director at least 
 three days in advance. 
 
 If any unforeseen difficulties occur, the day of 
 visit should be postponed till the following week. 
 The first half of the consultation should consist of 
 a visit of ten to fifteen minutes' duration to Classes 
 2 to 5, while instruction is going on. 
 
 Each class must, if possible, be visited twice 
 during the half year. At those visits the whole of 
 the children should be subjected to an external 
 inspection. When any special observations suitable 
 
THE SCHOOL DOCTOR IN GERMANY 93 
 
 for immediate discussion are made, information is 
 asked from the teacher, and given him, in return, if 
 he wishes. 
 
 If, on those occasions, individual children appear 
 to require more precise examination, this is afterwards 
 undertaken in the Doctor's room. 
 
 At the same time, those visits serve for the 
 inspection of the school premises and their arrange- 
 ments, as well as for the supervision of the ventila- 
 tion, heating, deportment of the children, etc. 
 
 In reference to the teaching, the Doctor is warned 
 that he should tactfully avoid all exposure of a 
 teacher before his class. 
 
 At the second part of the consultation, any 
 necessary investigations of a more precise kind are 
 to be undertaken. 
 
 Further, children from classes other than those 
 visited on the particular day are to be brought to the 
 Doctor, but only in really pressing cases, and especi- 
 ally where there is a suspicion of illness from 
 infectious disease. 
 
 The health schedules of all the children to be sub- 
 mitted for examination must be laid before the 
 Doctor or sent to him by the class teacher. The 
 teacher concerned must, if at all possible, be present 
 at the medical examination. For the notification of 
 the other classes and the provision for the care 
 of the children concerned, the School Director is 
 responsible. This is best done by circulating 
 among all the classes, a day in advance, a form 
 on which the individual teachers note whether any 
 children and how many require medical examination. 
 
94 THE HEALTH OF THE SCHOOL CHILD 
 
 The medical treatment of sick children is not the 
 business of the School Doctor. If such treatment 
 appears necessary, the parents concerned are to be 
 advised of the fact. To them is left the choice of a 
 doctor ; but it is recommended that where necessary 
 in special cases (eyes, throat, nose, etc.) any 
 necessary directions to specialists be given. With 
 the older children this can be done verbally. 
 
 If an intimation of this sort is without result, 
 and always in younger children, the printed report 
 forms are to be filled in. 
 
 But this is to be done only in serious and import- 
 ant illnesses, where the interest of the child or of 
 the school necessitates energetic measures. 
 
 In the filling in of the particular form, all harsh- 
 ness and rudeness of expression are to be avoided. 
 
 The School Director is responsible for sending the 
 form to the parents concerned. 
 
 4. The health schedules for each class are to 
 be preserved in a durable portfolio and remain in 
 the school so long as they are not required by the 
 School Inspector. 
 
 The schedules with the entry " Medical Super- 
 vision " are to be laid before the Doctor at every visit 
 to the class. If a child passes into another school, 
 his health schedule must be sent thither by the 
 School Director. 
 
 5. The School Doctors must, at the request of 
 the School Director, examine individual children in 
 their homes in order to ascertain whether, in cases 
 where the parents bring no other satisfactory medical 
 evidence, absence from school is justified. 
 
THE SCHOOL DOCTOR IN GERMANY 95 
 
 6. The School Doctors must at least once in the 
 summer and once in the winter inspect all the rooms, 
 lobbies, etc., and their fittings and furnishings. At 
 this, as at other visits, any appropriate observations 
 on the condition of the matters to be supervised, as 
 well as'on the maintenance of the cleansing, ventilation, 
 heating and lighting, also any recommendations 
 arising out of these observations, are to be entered 
 by the School Doctors in the book kept by the 
 School Director for the purpose. 
 
 7. The School Doctors have no authority to give 
 any direct instructions to the School Directors or 
 Teachers or to the Janitors or other school servants. 
 If they consider that any recommendations made by 
 them in relation to the treatment of the children or 
 the hygiene of the premises have not been satis- 
 factorily carried out, they must report their com- 
 plaints to their Representative on the Health 
 Committee. 
 
 In pressing cases, they may also give intimation 
 to the Town School Inspector, and, as regards 
 nuisances that require the attention of the sanitary 
 police, they give intimation also at the same time to 
 the Imperial District Medical Officer. 
 
 8. With a view to regular and rapid procedure, 
 the Representative of the School Doctors on the 
 Health Committee will summon his colleagues to 
 general consultations, to which the Imperial District 
 Medical Officer of Health is to be specially invited 
 if there is any question of the health conditions of 
 the premises. In winter, the School Doctors will, at 
 the teachers' meetings, as far as desirable and prac- 
 
96 THE HEALTH OF THE SCHOOL CHILD 
 
 ticable, give short contributions on the most important 
 questions of school hygiene. 
 
 9. The School Doctors must, by the I5th of 
 May at the latest, send to the Senior School Doctor 
 a written report on their work during the school 
 year just ended. 
 
 The Senior School Doctor must, by 1st June at 
 the latest, present to the Magistracy these individual 
 reports with a short critical general report. In the 
 preparation of the reports the following seven points 
 are to be attended to : 
 
 (1) Tabular numerical statement of the results 
 
 of the examinations of the entering 
 classes, and on a special form the ex- 
 aminations of all the later years. 
 
 (2) The number of the consultations held or 
 
 medical visits made to the classes. 
 
 (3) The number and nature of the more im- 
 
 portant cases of illness that have been 
 submitted for examination at the con- 
 sultations. 
 
 (4) Any resulting special medical orders (limita- 
 
 tion of hours of instruction, of gymnastics, 
 etc.). 
 
 (5) The number of the written reports sent to 
 
 the parents and the result. 
 
 (6) The number of school children remaining 
 
 under medical supervision. 
 
 (7) A summary of the defects recorded in the 
 
 hygiene book in reference to the rooms, 
 etc. 
 
 10. If a School Doctor has to leave the city for 
 
THE SCHOOL DOCTOR IN GERMANY 97 
 
 more than a week, except during the time of school 
 holidays, he must report the fact at the time to the 
 Magistracy, and provide at his own expense a suit- 
 able deputy. 
 
 1 1 . The School Doctors, besides a fixed yearly 
 honorarium payable in quarterly instalments, receive 
 from the Town Treasury also an amount calculated 
 according to the number of school children examined 
 in the third, fifth, and eighth years. The account 
 must be presented in the month of December. 
 
 12. The Magistracy may at any time, on proof 
 of negligence, dismiss the School Doctor. In other 
 cases, the engagement can be terminated only on 
 the giving of three months' notice by School Doctor 
 or Magistracy. 
 
 1 3. The Magistracy reserve the right to alter or 
 extend this order. 
 
 WIESBADEN, 2nd January 1903. 
 
 [TABLE 
 
98 THE HEALTH OF THE SCHOOL CHILD 
 
 (Front) HEALTH SCHEDULE 
 
 For Son Daughter of 
 
 Born 19... School from 19.. 
 
 Vaccinated 19... 
 
 Re-vaccinated 19 ... 
 
 Date 
 and 
 School 
 Year. 
 
 General 
 Constitu- 
 tion. 
 
 .1 
 <u 
 
 Cm. 
 
 ."> 
 <u 
 
 Kg. 
 
 O Chest Mea- 
 P surement. 
 
 Chest and 
 Abdomen. 
 
 Skin 
 Diseases 
 (Para- 
 sites). 
 
 Spine and 
 Extremi- 
 ties. 
 
 M. 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 
 TT 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 
 TV 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 v 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 VT 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 
 VTT 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
 M. 
 
 \7TTT 
 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 
THE SCHOOL DOCTOR IN GERMANY 99 
 
 (Back] 
 
 Date 
 and 
 School 
 Year. 
 
 Eyes and 
 Acute- 
 ness of 
 Vision. 
 
 Ears 
 and 
 Hear- 
 ing. 
 
 Mouth, 
 Nose, 
 and 
 Speech. 
 
 Special Obser- 
 vations and 
 Directions for 
 Treatment in 
 School. 
 
 Reports 
 to 
 Parents. 
 
 Remarks 
 of 
 Teacher. 
 
 M. 
 
 T 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 It. 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 
 TV 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 v 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 VT 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 VII 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
 M. 
 VTTT 
 
 
 
 
 
 
 
 F. 
 
 
 
 
 
 
 
ioo THE HEALTH OF THE SCHOOL CHILD 
 
 REPORT TO PARENT ON POSTPONEMENT OF 
 SCHOOL ATTENDANCE 
 
 The medical examination ordered by the Magis- 
 tracy in regard to the supervision of your child 
 
 born 
 
 has shown that he (she) 
 
 is suffering from 
 
 For the health of your child, as well as in the in- 
 terest of the school, it is urgently necessary that 
 
 WIESBADEN 189 . 
 
 The Magistracy, 
 
 To 
 
 REPORT TO PARENT ON DISCHARGE OF CHILD 
 FROM SCHOOL 
 
 By the medical observation of your child 
 
 born 
 
 it has been ascertained, 
 
 as shown on the Health Schedule, that your child's 
 health is not very good ; in particular that 
 
 On the approaching discharge of your child from 
 school attendance, you are recommended to take 
 
THE SCHOOL DOCTOR IN GERMANY 101 
 
 medical advice on the selection of an occupation 
 for him. 
 
 WIESBADEN, 
 
 School Doctor. 
 
 REGULATIONS FOR THE SCHOOL DOCTORS OF 
 THE TOWN OF NUREMBERG 
 
 1 . It is the duty of the School Doctors, on the 
 order of the Magistracy and the School Authority, to 
 co-operate with the Imperial District Physician in the 
 general health inspection prescribed by the State for 
 municipal schools as well as for private educational 
 institutions, infant schools, and kindergartens. 
 
 2. The School Doctors must visit the public and 
 private schools assigned to them at least three times 
 a year, and particularly before Christmas, before 
 Easter, and before the Summer holidays. On these 
 occasions, they must pay attention to the proper 
 condition of all the arrangements for the health of 
 the children and teachers, above all to the arrange- 
 ments for warming, lighting, ventilating, and cleansing 
 of the schoolrooms, including the gymnasiums, 
 school-baths, and lavatories. 
 
 Further, they have to observe the deportment of 
 the children, and to record their observation as to 
 whether each child has had assigned to it the 
 school desk corresponding to its size. 
 
 In the schools assigned to them, they must also, 
 
102 THE HEALTH OF THE SCHOOL CHILD 
 
 on invitation, take part in the regular yearly visita- 
 tions of the Municipal School Committee. 
 
 Of their official actions and their observations at 
 their visits, they must on every occasion make short 
 notes on the prescribed form. These, along with 
 the statistical information, are submitted at Christ- 
 mas, Easter, and the close of the year, for the inspec- 
 tion of the Magistracy, who, as occasion requires, 
 have copies prepared, and send back the originals 
 for preservation in the records of the School Doctor. 
 
 3. The School Doctors must visit all the infant 
 schools and kindergartens in their district at least three 
 times a year and at the same intervals as they visit the 
 town schools, and if any neglect is found to exist, they 
 must report it as soon as possible to the Magistracy. 
 
 4. The School Doctors must, further, subject all 
 new entrants to a detailed examination in order to 
 ascertain which of them requires special supervision 
 during instruction (assigning of a place in the front 
 benches, relief from instruction in particular branches 
 and the like), or medical supervision during the school 
 period. This examination is divided into three parts. 
 
 The first is undertaken at the beginning of the 
 school year, and must be completed by the end of 
 the month of September. It consists of an external 
 inspection of the children, and its object is to ascer- 
 tain whether those fit for school that is, according 
 to their bodily and mental development can undergo 
 instruction at school without injury and with satis- 
 factory results. If the School Doctor, in agreement 
 with the teacher, finds that, in the interest of the 
 child himself, as well as in the interest of the 
 
THE SCHOOL DOCTOR IN GERMANY 103 
 
 general school teaching, it is necessary to postpone 
 school attendance for a year, he records this in a 
 certificate, of whose contents the relatives of the 
 particular child are informed through the Inspectorate, 
 who are responsible for the further measures necessary. 
 
 The second examination must be completed by 
 the close of the Winter half year that is, by Easter. 
 
 For the carrying out of this examination the 
 children must be presented to the School Doctor with 
 the upper part of the body exposed, so that it shall 
 be possible to examine precisely their bodily 
 development and their health condition. 
 
 To this second examination, which may be con- 
 ducted either in the class-room or in another special 
 room, and in the case of boys in the presence of the 
 class teacher, in the case of girls in the presence of 
 the class mistress or her representative, the mothers 
 of the children are invited. It is accordingly 
 necessary that a definite day be agreed upon 
 between the teacher and the School Doctor, and 
 that this be intimated to the mothers concerned. 
 
 This examination is recorded on the health 
 schedule provided, in the columns of which the 
 teacher has already entered the personal facts con- 
 cerning the child, and the School Doctor adds in the 
 shortest possible way the condition of each child. 
 
 The third examination is to be undertaken in the 
 Summer half year, and must be finished by the 
 beginning of the summer holidays. The children 
 must have their hearing and eyesight tested. On 
 the defects and diseases found the School Doctor 
 must enter a brief remark in the health schedule. 
 
104 THE HEALTH OF THE SCHOOL CHILD 
 
 5. The health schedule is to be attached to the 
 register and preserved with it. 
 
 The health schedule of those children that on 
 account of their unhealthy condition require repeated 
 inspection by the School Doctor is to be marked 
 " Medical Supervision," and submitted by the teacher 
 to the School Doctor at the subsequent visits. This 
 is to be continued until the School Doctor relieves 
 the child from his supervision. The note referred 
 to is then scored out. 
 
 6. At his visits to the school, the School Doctor, 
 in addition to the children under medical supervision, 
 must also examine those children whose examina- 
 tion appears to him necessary or is proposed by the 
 teacher. The results of the examination are briefly 
 noted in the health schedule. In a given case a 
 new schedule is to be used. 
 
 7. Where on examination a child is reported to 
 be suffering from serious disease or defect, the 
 parents are informed by a printed report and re- 
 quested to put the child under medical treatment. 
 This report is to be signed by the School Doctor and 
 the School Inspector and sent to the parents by the 
 latter. 
 
 8. No examination of the children is made by 
 the School Doctor if an examination by the family 
 physician has been recorded on the proper form and 
 the corresponding certificate produced by the parents. 
 
 9. A detailed examination of the girls from the 
 fourth school year onwards can be undertaken by the 
 School Doctor only with the consent of the parents. 
 
 On the other hand, the boys in the last quarter 
 
THE SCHOOL DOCTOR IN GERMANY 105 
 
 before removal from the ordinary school must, if the 
 parents so wish, be subjected to a detailed examina- 
 tion, in order that special advice in relation to the 
 choice of a profession may be given. 
 
 10. Besides the provisions contained in Sections 
 4 and 6, examinations are to be undertaken by 
 the School Doctor : 
 
 (a) When it is desired to admit a child to the 
 ordinary school before the end of the sixth 
 year, or when, in the case of boys of the 
 ordinary or preparatory school, and girls 
 of the ordinary or girls' Sunday school, it 
 is proposed on account of their health to 
 set them free before they are of school age ; 
 (ft) When, in the case of individual children, it 
 is desired to keep them back from school 
 for a year or to free them from taking 
 part in special branches of study ; 
 
 (c) When, in the case of children that have con- 
 
 tracted infectious disease, it is necessary to 
 bring a certificate that they can be again 
 admitted to school without danger to the 
 other pupils ; 
 
 (d) When there is a doubt whether absences 
 
 from school are really due to illness ; 
 
 (e) When there is reason to suppose that a child, 
 
 reported by its relatives as ill without a 
 more precise description of the illness, is 
 suffering from an infectious disease. 
 These investigations take place on the order of 
 the acting School Inspector. They do not, however, 
 take place when medical certificates are produced. 
 
io6 THE HEALTH OF THE SCHOOL CHILD 
 
 In specially pressing cases, the teachers are 
 authorised to propose to the Inspectorate special 
 examinations of individual children in their classes. 
 These examinations may be undertaken during the 
 consultation hour of the School Doctor attached to 
 that school. 
 
 If, notwithstanding the presence of a medical 
 certificate, a request for medical examination of a 
 child is made, this can be undertaken through the 
 Inspectorate only with the sanction of the Magistracy. 
 
 The certificate of the examination by the School 
 Doctor is to be preserved with the schedule of the 
 particular child ; in the town trade schools it is pre- 
 served with the rector's records. 
 
 1 1 . On the occurrence of measles, scarlet fever, 
 diphtheria, and typhoid fever in the municipal and 
 private schools, as well as in the infant schools and 
 kindergarten, a report must be made to the School 
 Doctor by the teacher or the head of the institution, 
 and more especially when only one case of a par- 
 ticular illness has occurred. On receiving such a 
 report, the School Doctor must forthwith proceed to 
 make a thorough examination of all the children 
 present in the particular class or institution, and as 
 soon as possible report the result direct to the 
 Imperial District Medical Officer. On receiving this 
 report, the latter will give the necessary instructions 
 to the district police authority for example, the 
 temporary closing of particular classes. In these 
 investigations the School Doctor is entitled to send 
 home from school such children as he finds to be suffer- 
 ing from infectious disease or suspicious symptoms. 
 
THE SCHOOL DOCTOR IN GERMANY 107 
 
 The occurrence of German measles and whooping- 
 cough is to be reported by the teacher and attended 
 to by the School Doctor in the manner given above 
 only when several cases of these illnesses occur in 
 rapid succession or simultaneously. 
 
 The occurrence of cerebro-spinal meningitis is to 
 be reported by the teacher in every individual case. 
 
 Children that have passed through one of the 
 diseases named in the last three paragraphs may be 
 again admitted to school only when it is certified 
 by medical certificate that the resumption of school 
 work can be undertaken without danger to other 
 children (Ministerial Orders of I5th February 
 1844, 1 6th January 1867, and 8th June 1875). 
 According to the local regulation of 22nd March 
 1903, the certificate in the case of scarlet fever 
 must state that desquamation over the whole body 
 is complete, and in the case of whooping-cough that 
 the convulsive cough has ceased. When no other 
 medical certificate can be produced, the certificate 
 is to be given by the School Doctor. 
 
 12. Wholesale examinations of school children 
 for the purpose of settling scientific questions can 
 be undertaken by the School Doctors only when the 
 Magistracy, by agreement with the Imperial District 
 Medical Officer and the Local School Commission, 
 have given permission. 
 
 13. The School Doctors have no authority to give 
 independent instructions. At the same time, it is 
 their duty, on discovering any defect in the health 
 conditions and arrangements of schoolrooms, to 
 direct the attention of the Inspectors, the senior 
 
io8 THE HEALTH OF THE SCHOOL CHILD 
 
 teachers, the teachers, and the house masters to the 
 conditions discovered. Further, on any requests or 
 complaints that may be made to them in regard 
 to the health conditions, as well as on any defects 
 observed by themselves, they must report forthwith 
 to the Magistracy. 
 
 14. The School Doctors must also take a regular 
 part in the conferences summoned by the Imperial 
 District Medical Officer. These are to take place, 
 as a rule, three times a year, and questions affecting 
 the health service of the school, and particularly the 
 observations made at the visits to the schools, come 
 up for discussion. 
 
 They must further attend the conferences of the 
 Royal School Inspectorate when summoned. They 
 have a consulting voice in those deliberations. 
 
 15. At the end of every school year, and at latest 
 by the 1st of September, the School Doctors must 
 send to the Magistracy a written report on their 
 work. This report must contain 
 
 (1) The number of ordinary and extraordinary 
 
 visits made to the classes of the schools 
 assigned to them. 
 
 (2) A general statement of the number of 
 
 children examined in the regular way 
 and of the results of the examinations, 
 classified according to the individual years. 
 
 (3) A similar statement of the number of 
 
 children examined for special reasons in 
 the schools named, in institutions and at 
 home, and the results of these. 
 
 (4) The number of medical certificates issued. 
 
THE SCHOOL DOCTOR IN GERMANY 109 
 
 (5) The number of reports sent to the parents. 
 
 (6) The number of school children remaining 
 
 under medical supervision. 
 
 (7) A short statement of proposals made. 
 
 (8) Any general remarks. 
 
 On the basis of the yearly reports made by the 
 individual School Doctors there is prepared a general 
 report. Of this report a Doctor permanently en- 
 trusted with this work prepares the purely medical 
 part, giving in particular a general exposition of the 
 examinations made. 
 
 1 6. Medical treatment of the school children ex- 
 amined constitutes no part of the School Doctor's duty. 
 
 17. For their official actions the School Doctors 
 must keep a day-book, which is preserved along 
 with all official documents. The entries made by 
 them are preserved as official minutes, and accord- 
 ingly are the property of the Magistracy. They are 
 to be preserved by each School Doctor, and in the case 
 of resignation they are transferred to his successor. 
 
 1 8. If, during a school year, a School Doctor is 
 obliged to go off duty, he must receive leave of 
 absence from the Magistrate. 
 
 In his application for leave, it must be stated 
 which of the other School Doctors undertakes his 
 duty during the period of his leave. 
 
 19. The School Doctors are appointed by the 
 Magistracy for three years, subject on both sides 
 to three months' notice. They may, however, at 
 the end of their term be re-elected. 
 
 NUREMBERG, ist December 1903. 
 
no THE HEALTH OF THE SCHOOL CHILD 
 
 FORMS OF CERTIFICATES, NOTICES, AND 
 HEALTH SCHEDULES 
 
 (l) POSTPONEMENT CERTIFICATE 
 
 You are hereby informed that the child 
 
 must, on account of a certificate granted 
 
 by the School Doctor, be kept back from school for 
 a year, since he (or she), in view of his present 
 development, does not yet appear to be fitted for 
 school attendance. 
 
 NUREMBERG, 
 
 Government Inspectorate. 
 
 (2) INVITATION TO EXAMINATION 
 
 On the * a medical 
 
 examination of the child takes 
 
 place in the school You are 
 
 hereby invited to be present personally at the 
 examination. 
 
 NUREMBERG, 19 . 
 
 Class Teacher. 
 
THE SCHOOL DOCTOR IN GERMANY 1 1 1 
 
 (3) HEALTH SCHEDULE 
 
 Medical Supervision, or not. 
 
 For son, daughter, of. 
 
 Born on vaccinated on 
 
 Admitted to school on re-vaccinated on.. 
 
 No. 
 
 Subject. 
 
 ISt 
 
 School 
 Year. 
 
 and 
 School 
 Year. 
 
 3rd 
 School 
 Year. 
 
 4 th 
 School 
 Year. 
 
 5th 
 School 
 Year. 
 
 6th 
 School 
 Year. 
 
 7 th 
 School 
 Year. 
 
 
 
 Class. 
 
 Class. 
 
 Class. 
 
 Class. 
 
 Class. 
 
 Class. 
 
 Class. 
 
 i 
 
 General bodily condition. 
 
 
 
 
 
 
 
 
 2 
 
 Height in cm. 
 
 
 
 
 
 
 
 
 3 
 
 Chest measure in cm. 
 
 
 
 
 
 
 
 
 4 
 
 Lung, Heart, Abdominal organs. 
 
 
 
 
 
 
 
 
 5 
 
 Skin and Parasitic diseases. 
 
 
 
 
 
 
 
 
 6 
 
 Spinal Column and Extremities. 
 
 
 
 
 
 
 
 
 7 
 
 Eyes and Acuteness of Vision. 
 
 
 
 
 
 
 
 
 8 
 
 Ears and Hearing. 
 
 
 
 
 
 
 
 
 9 
 
 Mouth, Nose, and Speech. 
 
 
 
 
 
 
 
 
 10 
 
 Special observations or directions 
 for treatment in school. 
 
 
 
 
 
 
 
 
 ii 
 
 Date of Examination. 
 
 
 
 
 
 
 
 
 
 Signature of Doctor. 
 
 
 
 
 
 
 
 
 12 
 
 Reports to Parents (date). 
 
 
 
 
 
 
 
 
 13 
 
 Remarks of teacher, especially 
 on the mental development 
 and on any special physical 
 peculiarity of the child. 
 
 
 
 
 
 
 
 
H2 THE HEALTH OF THE SCHOOL CHILD 
 
 REMARKS 
 
 a. The general statements, as well as the designa- 
 tion of the class (at the head of the table) and the 
 columns corresponding to the Nos. 2, 12, and 13, 
 are to be filled in by a teacher; the remaining 
 columns are to be filled in as far as possible by 
 the School Doctor, with the assistance of the teacher. 
 
 b. No. i. The general bodily condition is to be 
 indicated by numbers: I (good), 2 (medium), 3 
 (bad). Thus, by I when the condition is perfectly 
 healthy, by 3 when there is definite evidence of 
 disease or chronic ailment, by 2 in all other cases. 
 Continued medical supervision must be exercised 
 over all whose bodily condition is marked 3. Where 
 necessary, the words " Medical Supervision " are to 
 be entered in the closed space at the right-hand 
 corner of the schedule. 
 
 c. No. 2. Height taken with shoes on. 
 
 d. No. 3. Expiration and inspiration with arms 
 hanging, to be measured at the level of the nipple 
 and the middle of the scapula. 
 
 e. No. 4. Suspected tuberculosis, hernia. 
 
 f. No. 6. Curvature of breast, loins, spinal column. 
 Extremities ; club foot, flat foot, shortening, diseases 
 of the bones, congenital dislocation of hip, paralysis. 
 
 g. No. 7. Test of acuteness of vision for each 
 eye separately by means of test letters. 
 
 h. No. 8. Whispering at 6 metres. Test of 
 right and left ears separately. 
 
 i. No. 9. Breathing through the nose, stuttering, 
 stammering, audible and distinct utterance. 
 
THE SCHOOL DOCTOR IN GERMANY 113 
 
 (4) CERTIFICATE OF ILLNESS 
 
 The examination of your child 
 
 by the School Doctor 
 
 has shown that (or she) is suffering from 
 
 You are urgently recommended to place the child 
 as soon as possible under medical treatment. 
 
 Signature 
 
 School Doctor. 
 
 Signature 
 
 Government Inspector. 
 NU REMBERG, 1 9 . 
 
 (5) CERTIFICATE OF INFECTION 
 
 NUREMBERG, 19 . 
 
 Notice as to Illnesses from Infectious Diseases of 
 Children. 
 
 Remarks. In measles, scarlet fever, cerebro- 
 spinal meningitis, typhoid, and diphtheria, each 
 separate illness is to be reported. 
 
 Inspection district 
 
 Class 
 
 School locality (street, storey, and number of class- 
 room) 
 
 Number of child (boy or girl) in class 
 
 8 
 
ii4 THE HEALTH OF THE SCHOOL CHILD 
 
 On the child 
 
 was reported as suffering 
 
 from 
 
 Any observations on the dwelling-house of the 
 children, 
 
 Signature of intimating Teacher 
 
 To the Municipal School Doctor, 
 
 NU REMBERG, 1 9 . 
 
 To the Imperial District Medical Officer, 
 
 Dr... 
 
 The class was visited to-day by the undersigned, 
 and the following report made. 
 
 Signature 
 
 (6) CERTIFICATE OF FREEDOM FROM INFECTION 
 
 has recovered from 
 
 his (or her) illness, and may from (date) 
 
 again attend school. 
 
 Remark i (in illness from scarlet fever). The 
 desquamation is complete over the whole body. 
 
 Remark 2 (in whooping-cough). The attacks of 
 convulsive coughing have completely ceased. 
 
 NUREMBERG, 19 . 
 
 Signature of the Doctor 
 
 N.B. In case of other illnesses, Remarks I and 2 
 are to be struck out, 
 
NOTE ON RE-VACCINATION OF SCHOOL 
 CHILDREN IN GERMANY 
 
 ERMAN school children are re-vaccinated just 
 before they leave the elementary school. 
 Through the good offices of Dr. Bruce Low, of 
 the English Local Government Board, I was able 
 to be present at the re-vaccination of some seventy 
 school children from a Wiesbaden elementary school. 
 The vaccinator was Dr. August Strieker, to whom 
 I have been indebted for much information on the 
 practical aspects of medical inspection. 
 
 The children, on this occasion girls only, were 
 assembled in a room of the Municipal Buildings. 
 They were in charge of a teacher, who directed the 
 necessary exposure of the arms. There was also 
 in attendance a Nursing Sister, who cleansed with 
 ether the arms to be vaccinated. The cleansing 
 was done immediately before the operation, and, as 
 the ether evaporates in a few seconds, no trace of 
 antiseptic was left to disturb the effect of the lymph. 
 
 Meanwhile, the two clerks had prepared a com- 
 plete list of the children. Forms of certificate were 
 at hand and partly filled in, ready for signature. 
 
 Then the doctor appeared. He took from his case 
 a conserve of calf lymph and emptied it into a small 
 glass saucer. He next opened a piece of aseptic 
 gauze, which contained about one hundred small lancets. 
 
 115 
 
ii6 THE HEALTH OF THE SCHOOL CHILD 
 
 The lancet deserves a word of description. It 
 was made by a firm of steel-pen makers at Bonn. 
 It consisted of a flat piece of steel, two inches long, 
 about half an inch broad at one end, tapered to 
 an arrow-head shape at the other. The edges of 
 the arrow-head are thinned, but not sharp. The 
 whole is kept rigid by a depression round the margin 
 and passing right to the tip. This lancet can be used 
 for superficial scratching with the edge of the arrow- 
 head or for puncture with the point. All these 
 lancets had been sterilised. A lancet was provided 
 for each child. Each lancet after use was thrown 
 into an antiseptic solution, and would be afterwards 
 cleaned for future use. 
 
 The method of vaccination was superficial blunt 
 scratches on the left arm. Each scratch was about 
 an inch long. The lancet was dipped into the 
 lymph ; the arm was grasped firmly and the skin 
 thus stretched ; four longitudinal scratches were 
 made with pressure sufficient to penetrate to the 
 lymphatics, and the arm then let go. A reasonable 
 time was given to dry. The vaccination and check- 
 ing off of the lists took rather less than an hour, and 
 might have taken much less but that the vaccinator 
 explained to us as he went along his whole mode of 
 procedure. 
 
 A week later I had the privilege of seeing all 
 those cases again. Any induration that could be 
 distinctly felt was recorded as positive. Where no 
 reaction of any kind had occurred, the patient was 
 instructed to reappear for re-vaccination in the follow- 
 ing year. 
 
NOTE ON RE- VACCINATION 117 
 
 In the great mass of cases the children showed 
 good marks of primary vaccination. In many 
 cases, particularly those vaccinated in the town of 
 Wiesbaden, there were six good marks three on 
 each arm. Four good marks were the rule. In one 
 child, who had come from Switzerland, there was no 
 mark. In one or two, the marks were indifferent. 
 Of the seventy children, seven showed no reaction on 
 re-vaccination. They were certified accordingly, and 
 would come up again in the following year. 
 
 One could not but be impressed with the pre- 
 cision, simplicity, quietness of the whole proceeding. 
 The children were all clean and well-nourished. 
 None of them, either on their own behalf or on 
 their parents' behalf, offered any objection. The most 
 scrupulous care was taken to prevent infection, and 
 in no single case was there a " bad arm " either 
 from accidental infection or from the specific action 
 of lymph. This was a decisive testimony at once 
 to the thoroughness of the primary vaccination and 
 to the asepticity of the re-vaccination. 
 
 I append a translation of directions issued to the 
 parents. 
 
 If it be said that the orderliness of these and 
 the other proceedings of German school children is 
 due to the predominance of military discipline, 
 I am not concerned to deny the fact. But I have 
 formed the impression that if military discipline 
 predominates in the civil life of Germany, it is 
 because it finds in the German character a suitable 
 medium. Probably the military system is as much 
 an expression of the German sense of order as a 
 
u8 THE HEALTH OF THE SCHOOL CHILD 
 
 creator of German orderliness. Some other nations 
 are as military, but not as orderly. I am inclined, 
 therefore, to think that we habitually attribute more 
 influence to military discipline as such than it deserves. 
 
 PRECAUTIONS FOR RE-VACCINATED CHILDREN 
 
 1. No children must come for re- vaccination on 
 the ordinary day from any house in which there 
 are infectious diseases, such as scarlet fever, measles, 
 diphtheria, croup, whooping-cough, typhus, erysipelas, 
 or small-pox. 
 
 2. At the time of vaccination, the children must 
 appear with clean skin, clean linen, and clean 
 clothing. 
 
 3. After vaccination the greatest care must be 
 taken that the child is kept as clean as possible. 
 
 4. The development of the vaccination mark takes 
 place in from three to four days, and as a rule is 
 attended with so slight disturbance of the general con- 
 dition that absence from school on that account is 
 not necessary. Only when exceptional fever comes 
 on is the child to remain at home. If the vaccina- 
 tion marks show excessive redness and swelling, 
 they are to be treated with dressings soaked in 
 cold water previously boiled. The dressings must 
 be frequently changed. The children may continue 
 their usual bath. The physical exercise must be 
 dropped from the third to the fifth day in all those 
 that show vaccination vesicles. The vaccination 
 marks, so long as they are not healed, must be care- 
 fully protected from dirt, scratching, and bruising, as 
 
NOTE ON RE- VACCINATION 119 
 
 well as from the rubbing of tight clothing and from 
 external pressure. Communication with persons suf- 
 fering from running sores, skin eruptions, or erysipelas, 
 and all objects used by them, must be avoided. 
 
 5. In every illness coming on after vaccination 
 the doctor is to be called in ; the vaccinator is to be 
 informed of every illness that occurs before re- 
 inspection or within fourteen days after it. 
 
 6. On a day to be fixed at the time of vaccination, 
 the vaccinated child must appear for reinspection. 
 If a child, on account of serious illness or the exist- 
 ence of infectious disease in the house (Section i), 
 cannot attend at the vaccination station on the day 
 of inspection, the parents or their representatives 
 must intimate this at latest on the vaccination day. 
 
 7. The vaccination certificate is to be carefully 
 preserved. 
 
 NOTE ON THE PLAN OF A GERMAN 
 ELEMENTARY SCHOOL 
 
 To judge by the schools of Wiesbaden and 
 Nuremberg, the favourite plan of a German 
 elementary school resembles the letter E, with the 
 plain side of the letter facing the south-east, the 
 three wings projecting to the north-east. Some- 
 times the long wings of the E are either very short 
 or lopped off. In the basement are the school 
 baths, the heating and ventilating plant, cleansing 
 stores, and the like. 
 
 On the ground floor are the administrative rooms, 
 the school inspector's room, the director's room, the 
 
120 THE HEALTH OF THE SCHOOL CHILD 
 
 teachers' rooms, and some of the class-rooms. The 
 front door is in the centre of the block. When you 
 pass right through the hall, you come to the main 
 corridor, which runs the whole length of the building 
 and continues into the wings. On this corridor, 
 which is lit by the back windows of the school, are 
 doors opening into the class-rooms. The central 
 limb of the E contains, on the ground floor, the 
 gymnasium ; on the first floor, the drawing room. 
 
 The second and third floors contain the remainder 
 of the class-rooms, cooking- rooms, and the " career," 
 or solitary confinement room. 
 
 Each flat is provided with lavatories and water- 
 closets. 
 
 Each class-room is seated for sixty pupils. In 
 every case the school desks are so arranged that 
 the light comes from the left side. 
 
 The ordinary method of ventilation is a system 
 of ducts fitted with steam pipes. All the ducts pass 
 into a ventilation tower, which is also fitted with a 
 forest of steam pipes. The whole system is regulated 
 from the basement. 
 
 What impresses one most is the roominess of the 
 stairs and corridors. 
 
 The schools accommodate from 1000 to 1500 
 children. 
 
 It is forbidden to enter a class-room while a lesson 
 is in progress ; but entry is possible by order. 
 
 Protestants and Catholics are accommodated in 
 the same school, but in separate class-rooms. 
 
 Printed by MORRISON & GIBB LIMITED, Edinburgh. 
 
THE 
 MEDICAL INSPECTION 
 
 OF 
 
 SCHOOL CHILDREN 
 
 A TEXT-BOOK FOR MEDICAL OFFICERS OF SCHOOLS 
 
 MEDICAL OFFICERS OF HEALTH 
 SCHOOL MANAGERS AND TEACHERS 
 
 BY 
 
 W. LESLIE MACKENZIE. M.A., M.D. 
 
 M.R.C.P.E., D.P.H., F.R.S.E. 
 MEDICAL MEMBER TO THK LOCAL GOVERNMENT BOARD FOR SCOTLAND 
 
 ASSISTED BY 
 
 EDWIN MATTHEW, M.A., M.B., C.M. 
 
 F.R.C.P.E. 
 
 ASSISTANT PHYSICIAN, LEITH HOSPITAL', CLINICAL TUTOR 
 EDINBURGH ROYAL INFIRMARY 
 
 Demy Svo, pp. xviii. 455. Price lo/. 6d. net 
 
 SOME PRESS OPINIONS 
 
 The Times. "This comprehensive text -book . . . Professor 
 Matthew Hay and Mr. Gray contribute descriptions and illustrations 
 of their anthropometrical appliances." 
 
 The Glasgow Herald. " A text-book that leaves little to be desired, 
 and fully demonstrates the philosophic grasp with which Dr. Mac- 
 kenzie has tackled his subject. ... It deserves, and will doubtless 
 obtain, a place among the books of reference of everyone, be he 
 teacher, School Board member, medical officer, or otherwise interested 
 in the education of our children, who desire the improvement of the 
 race." 
 
SOME PRESS OPINIONS 
 
 Saturday Review. " We agree with the authors of this admirable 
 text-book in the necessity for compulsory and regularised medical 
 inspection in all State schools. . . . What strikes us most in the 
 book is the immense aid such school inspection as is here described 
 would render to sociological inquiries and vital statistics ; and hardly 
 less than this, the vast unlocked for extension of State action which 
 is implied in the existence of compulsory education. In all its phases, 
 whether social or political or medical, the subject is as interesting as it 
 is important." 
 
 Dundee Advertiser. "A valuable work. . . . Should be in the 
 hands of everyone who is interested in the welfare of school children, 
 and especially of those who are particularly concerned with their 
 education." 
 
 Education. " This important work, which deals with the subject 
 in a broad and statesmanlike manner. . . . We must for the present 
 content ourselves with heartily recommending it to the serious con- 
 sideration of the various education authorities and their officers. It 
 contains a vast amount of valuable and authoritative information." 
 
 The Lancet. " Will be valued as one of the few standard works 
 that have appeared on this subject." 
 
 The Scottish Medical and Surgical Journal. " This book is a very 
 useful and practical one, and the authors are to be congratulated on 
 having produced a work which can be so cordially commended to 
 those to whom it is addressed." 
 
 The British Medical Journal. " This book can be commended to 
 all who are interested in medical knowledge as a sociological factor." 
 
 The Sanitary Record. " The time has come for a systematic medical 
 inspection of school children being undertaken, and Dr. Mackenzie's 
 work is intended to lay the foundations for such a system. The 
 endeavour to present a complete system of the character indicated 
 is breaking new ground, and Dr. Mackenzie has accomplished the 
 task in a manner that leaves little to be desired." 
 
 The County and Municipal Record. " For Dr. Mackenzie's book 
 we have nothing but praise. It is extremely well written, and is full 
 of mature thoughts and reflections. After reading it carefully, one 
 will at once conclude that Dr. Mackenzie has cleared a way through 
 a forest of difficulties. One can see daylight beyond, and the subject 
 of medical inspection of school children has had a great and even 
 alluring interest added to it by his excellent work." 
 
 Internationales Archiv fur Schulhygiene. "The most important 
 book of the year on subjects of school hygiene." 
 
 From La Lutte contre la Ddgenerescence en Angleterre, issued by 
 VInstitut de Sociologie, Brussels. " La traite . . . est un livre vraiment 
 neuf sur 1'hygiene scolaire . . . il contient d'ide"es fort interessantes, 
 originales et genereuse . . . nous pensons que tout medecin-inspecteur 
 y trouvera un guide precieux et une veritable mine de renseignements." 
 
A CATALOGUE OF BOOKS 
 
 PUBLISHED BY METHUEN 
 
 AND COMPANY: LONDON 
 
 36 ESSEX STREET 
 
 W.C. 
 
 CONTENTS 
 
 PAGE 
 
 General Literature, . . 2-20 
 
 Ancient Cities, . . 20 
 
 Antiquary's Books, . 20 
 
 Arden Shakespeare, . 20 
 
 Beginner's Books, . . 21 
 
 Business Books, . . 21 
 
 Byzantine Texts, . . 21 
 
 Churchman's Bible, . 22 
 
 Churchman's Library, . 22 
 
 Classical Translations, 22 
 
 Classics of Art, . . 23 
 
 Commercial Series, . 23 
 
 Connoisseur's Library, 23 
 
 Library of Devotion, . 23 
 Illustrated Pocket Library of 
 
 Plain and Coloured Books, 24 
 
 Junior Examination Series 25 
 
 Junior School-Books, . 26 
 
 Leaders of Religion, . 26 
 
 Little Blue Books, . 26 
 
 Little Books on Art, . 26 
 
 PAGE 
 
 Little Galleries, ... 27 
 
 Little Guides, .... 27 
 
 Little Library, ... 27 
 
 Little Quarto Shakespeare, 29 
 
 Miniature Library, . . 29 
 
 Oxford Biographies, . . 29 
 
 School Examination Series, 29 
 
 School Histories, ... 30 
 
 Textbooks of Science, . . 30 
 
 Simplified French Texts, . 30 
 
 Standard Library, ... 30 
 
 Textbooks of Technology, . 31 
 
 Handbooks of Theology, . 31 
 
 Westminster Commentaries, 32 
 
 Fiction, 32-37 
 
 The Shilling Novels, . . 37 
 
 Books for Boys and Girls, 39 
 
 Novels of Alexandre Dumas, 39 
 
 Methuen's Sixpenny Books, 39 
 
 FEBRUARY 1907 
 
A CATALOGUE OF 
 
 MESSRS. METHUEN'S 
 
 PUBLICATIONS 
 
 Colonial Editions are published of all Messrs. METHtJEN's Novels issued 
 at a price above zs. 6d. , and similar editions are published of some works of 
 General Literature. These are marked in the Catalogue. Colonial editions 
 are only for circulation in the British Colonies and India. 
 
 I.P.L. represents Illustrated Pocket Library. 
 
 PART I. GENERAL LITERATURE 
 
 Abbot (Jacob). See Little Blue Books. 
 Abbott (J. H. M.). Author of 'Tommy 
 
 Cornstalk.' AN OUTLANDER IN 
 
 ENGLAND: BEING SOME IMPRESSION^ OF 
 
 AN AUSTRALIAN ABROAD. Second Edition. 
 
 Cr. 8v0. 6s. 
 
 A Colonial Edition is also published. 
 Acatos (M. J.). See Junior School Books. 
 Adams (Frank). JACKSPRATT. With 24 
 
 Coloured Pictures. Super Royal ibmo. zs. 
 Adeney (W. F.), M.A. See Bennett and 
 
 Adeney. 
 
 /Eschylus. See Classical Translations. 
 /Esop. See I.P.L. 
 
 Ainsworth ( W. Harrison). See I. P. L. 
 Alderson (J. P.). MR. ASQUITH. With 
 
 Portraits and Illustrations. Demy 8v0. 
 
 vs. 6d. net. 
 Aldis (Janet). MADAME GEOFFRIN. 
 
 HER SALON, AND HER TIMES. 
 
 With many Portraits and Illustrations. 
 
 Second Edition. Demy 8v0. 10*. 6d. net. 
 
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 37 
 
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MESSRS. METHUEN'S CATALOGUE 
 
 ANGEL. 
 
 JOHANNA. 
 
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 Doyle (A. Conan). ROUND THE RED 
 
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 THOSE DELIGHTFUL AMERICANS. 
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 Gallon (Tom). RICKERBY'S FOLLY. 
 Qaskell (Mrs.). CRANFORD. 
 MARY BARTON. 
 NORTH AND SOUTH. 
 Gerard (Dorothea). HOLY MATRI- 
 MONY. 
 
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 THE CROWN OF LIFE. 
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 THE KLOOF BRIDE. 
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 Grimm (The Brothers). GRIMM'S 
 
 FAIRY TALES. Illustrated. 
 Hope (Anthony). A MAN OF MARK. 
 A CHANGE OF AIR. 
 THE CHRONICLES OF COUNT 
 
 ANTONIO. 
 PHROSO. 
 
 THE DOLLY DIALOGUES. 
 Hornung (E. W.). DEAD MEN TELL 
 
 NO TALES. 
 Ingraham (J. H.). THE THRONE OF 
 
 DAVID. 
 Le Queux (W.). THE HUNCHBACK OF 
 
 WESTMINSTER. 
 Levett- Yeats (S. K.). THE TRAITOR'S 
 
 WAY. 
 
 Linton (E. Lynn). THE TRUE HIS- 
 TORY OF JOSHUA DAVIDSON. 
 Lyall (Edna). DERRICK VAUGHAN. 
 Malet (Lucas). THE CARISSIMA. 
 A COUNSEL OF PERFECTION. 
 Mann (Mrs. M. E.). MRS. PETER 
 
 HOWARD. 
 A LOST ESTATE. 
 THE CEDAR STAR. 
 ONE ANOTHER'S BURDENS. 
 Marchmont (A. W.). MISER HOAD- 
 
 LEY'S SECRET. 
 A MOMENT'S ERROR. 
 Marryat (Captain). PETER SIMPLE. 
 JACOB FAITHFUL. 
 Marsh (Richard). THE TWICKENHAM 
 
 PEERAGE. 
 THE GODDESS. 
 THE JOSS. 
 A METAMORPHOSIS. 
 
 Mason (A. E. W.). CLEMENTINA. 
 
 Mathers (Helen). HONEY. 
 
 GRIFF OF GRIFFITHSCOURT. 
 
 SAM'S SWEETHEART 
 
 Meade (Mrs. L. T.). DRIFT. 
 
 Mitford (Bertram). THE SIGN OF THE 
 
 SPIDER. 
 
 Montresor (F. F.). THE ALIEN. 
 Moore (Arthur). THE GAY DECEIVERS. 
 Morrison (Arthur). THE HOLE IN 
 
 THE WALL. 
 
 NesbitfE.). THE RED HOUSE. 
 Norris(W. E.>. HIS GRACE. 
 GILES INGILBY. 
 THE CREDIT OF THE COUNTY. 
 LORD LEONARD. 
 MATTHEW AUSTIN. 
 CLARISSA FURIOSA. 
 Oliphant (Mrs.). THE LADY'S WALK. 
 SIR ROBERT'S FORTUNE. 
 THE PRODIGALS. 
 Oppenheim (E. Phillips). MASTER OF 
 
 MEN. 
 Parker (Gilbert). THE POMP OF THE 
 
 LAVILETTES. 
 
 WHEN VALMOND CAME TO PONTI AC. 
 THE TRAIL OF THE SWORD. 
 Pemberton (Max). THE FOOTSTEPS 
 
 OF A THRONE. 
 I CROWN THEE KING. 
 Phillpotts (Eden). THE HUMAN BOY. 
 CHILDREN OF THE MIST. 
 *'Q. THE WHITE WOLF. 
 Ridge (W. Pett). A SON OF THE STATE. 
 LOST PROPERTY. 
 GEORGE AND THE GENERAL. 
 Russell (W. Clark). A MARRIAGE AT 
 
 SEA, 
 
 ABANDONED. 
 
 MY DANISH SWEETHEART. 
 HIS ISLAND PRINCESS. 
 Sergeant (Adeline). THE MASTER OF 
 
 BEECHWOOD. 
 BARBARA'S MONEY. 
 THE YELLOW DIAMOND. 
 THE LOVE THAT OVERCAME 
 Surtees (R. S.). HANDLEY CROSS. 
 
 Illustrated. 
 MR. SPONGE'S SPORTING TOUR. 
 
 Illustrated. 
 
 ASK MAMMA. Illustrated. 
 Valentine (Major E. S.). VELDT AND 
 
 Walford (Mrs. L. B.). MR. SMITH. 
 
 COUSINS. 
 
 THE BABY'S GRANDMOTHER. 
 
 Wallace (General Lew). BEN-HUR. 
 
 THE FAIR GOD. 
 
 Watson (H. B. Marriot). THE ADVEN- 
 
 TURERS. 
 
 Weekes (A. B.). PRISONERS OF WAR. 
 Wells (H.G.). THE STOLEN BACILLUS. 
 White (Percy). A PASSIONATE 
 
 PILGRIM. 
 
,X,YERSITY OF CALIFORNIA LIBRARY 
 
 THIS BOOK IS DUE ON THE 1A DATE 
 
 
 30rn-6,'14 
 
LJ