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The Sleeping Hours of Schoolboys.
THE SLEEPING HOURS OF SCHOOLBOYS.
168
THE LANCET. LONDON:
The
SATURDAY, JULY 15, 1905.
Sleeping
Hours of
10 P.M. is probably the usual, and certainly a convenient, time for bed, and only the upper forms should be allowed to postpone the time of "lights out"to any later Breakfast could here be at 7.30 without undue hour. Of course it must be recognised that all stress of work. the time between the hour of going to bed and that of breakfasting is not spent in actual sleep, so that in order to secure as much sleep as possible it is necessary, at all events with younger boys who occupy dormitories in I common, to prevent talking and ’skylarking" going on It is also advisable to arrange when the lights are out.
Schoolboys.
hurry and bustle there that younger and older boys do not share the same is a tendency to begrudge an expenditure of time upon sleeping rooms, lest the little ones, who go to bed early, such apparently unprofitable things as rest and recuperation, may be disturbed by the subsequent entrance of the and for the busy man as well as for the pleasure-seeker seniors. Very closely connected with the question of the hours devoted to sleep are cut down to the irreducible sufficient sleep is,that of lessons before breakfast, and we minimum. We have heard of a society in America are strongly of opinion that it is wrong on physiological the members of which bound themselves to curtail more grounds to expect boys to start brain-work in the early and more the period of slumber till most of them morning Breakfast should be on empty stomachs. managed to do with only four or five hours in the the first event of the day and should be followed by a It was never recorded, so far as we know, what short interval, 24. for obvious reasons, before assembly IN the
present
strenuous age of
the average life of these poor victims. Our ancestors had an adage that six hours’ sleep was the proper quantity for a man, seven for a woman, and eight for a fool. Whether it is that the strenuous life of the present day is akin to foolishness or whether it is a simple phenomenon of evolution, it is certain that many of our busiest men find the last-mentioned allowance none too long for them. The quality of a man’s work soon deteriorates if he takes insufficient rest and a regard for real as contrasted with apparent profits should compel attention to conBut if sleep is requisite for the siderations of health. more so is it indispensable for growing how much adult, children ? Rapid growth and the abundant energy characteristic of the young imply rapid multiplication of cells and renovation of tissue, and sleep is the time for both growth and repair. Yet it is a feature of child life to which our educational authorities seem to have paid but little attention. Here, as in other educational matters, America is ahead of us, much more adequate periods of rest being allowed in the schools in the United States than in this country. Dr. T. D. ACLAND has done good service in calling attention to the subject in his paper read before the Medical Officers of Schools’ Association, which appears at p. 136 of our present issue. He has collected a mass of weighty opinions which should carry conviction to his hearers and readers. It is, perhaps, not very easy to lay down definite rules which shall apply to all children even at the same age, since individuals differ in this as in other
was
But there seems to be a striking agreement medical and scientific writers that at present we among err on the side of deficient allowance of sleep. Schoolboys may be roughly divided into those of public school age and those still in the preparatory stage, the latter
respects.
between the ages of nine and 13 and the former from 12 to 18 years. For little boys who have just left home for the first time ten hours of sleep are probably none too much, and this amount would be obtained pretty accurately by
being
upon their going to bed at 9.30 and having breakfast at 8. The elder boys still at a private school might be allowed to sit up until 10 o’clock. At public schools
insisting
in the class-rooms. One of the most of education is the inculcation of
second nature. pointed by Dr. T. B. HYSLOP, is to some degree a matter of habit, but it is doubtful how far it is one which need be much impressed upon children who seldom sleep badly unless they are definitely ill or overworked. The occurrence of sleeplessness in them is always a symptom which needs careful attention as it may afford a danger signal pointing to the onset of nervous maladies or to the existence of over-pressure in school work. It may seem curious that so late in the history of the world as the beginning of the twentieth century it is necessary to insist upon the allowance of proper time for sleep, but the fact may be readily explained. On the one hand, the old and not yet obsolete theory of education as a means of stocking boys’ memories with as large as possible a number of facts and endowing them with certain fashionable accomplishments rather than as training the minds of the young in such a way that they may best adapt themselves to the circumstances of after life, has led to the multiplication of hours of instruction, to the neglect in many instances of the laws of health. On the other hand, it is only in recent years that these laws have been recognised by the general public with anything like intelligent appreciation, and the traditions of school life are guarded with a curiously jealous conservatism which renders change of any kind specially difficult to carry out. Hence, some of our great schools are in certain respects behind the times in their health arrangements, while parents are often sadly ignorant of all that pertains to the upbringing of children. There are signs that the schools, especially the English public schools, are becoming awake to their shortcomings and are setting their houses in order. The chief opposition now comes from those who see in all attempts to make life at school more healthy a proof of soon
become
features good habits which Sleep indeed itself, as
important
a
out
yielding
to the
softer,
not to say
more
effeminate, spirit
of modern times. This cry is raised even over the question of longer hours for sleep, as Dr. ACLAND points out.
169
early rising may be insidiously it would undermined, seem, and slothful habits induced. Perhaps it is difficult in all cases to hit the golden
The old-fashioned virtue of
and
mean
conflicting practice.
theories
take
time
to
adjust
themselves in
Still there is no reason why sanitary houses, proper food, and adequate sleep should have anything but a good influence upon the rising generation of young Englishmen. The tendency to spare the rod is probably carried too far in deference to false
ignorant outcry, but we do not wish to bring good old " days of fighting and bullying, of semistarvation, dirt, and cold. These may have been potent means of natural selection in their day but times are changed and other qualities are demanded than mere muscle, animal spirits, and aggressiveness. There is no evidence that the products of our public schools have less average capacity for work in the world than those of past generations, though statements to the contrary are often made. Outstanding be fewer the because just general level has examples may been raised rather than lowered, but we fancy that the total production of good is increased. At any rate, wisdom seems to lie in removing visible obstacles to physical health so far as can be done and counteracting any tendency to resulting softness, should such really exist, by other means than conditions of barbarism. Dr. ACLAND’S paper will, we hope, have the excellent result of convincing some of our scholastic authorities that a growing boy is more hungry for sleep even than for food.
these qualities in others and to acquire them for himself. His teachers and his surroundings, in a word, must make him not
merely
estimable
man.
As many of
our
readers
about in London.
will be
ment of the financial
THE
of how best to regulate the early years of medical student life in London is not the least of the difficulties created by the embarrassed financial position of metropolitan hospitals and their affiliated schools. It is an
problem
educational problem of the
concerned it
an
changed coming teaching of prethis is, in our a
years is
desirable.
are
Years.
preliminary
effected, and Moreover, so far as some of is imperative, having regard to
liminary subjects
sentiment and
Early
doubtless aware,
A concentration of the
back the "
Medical Students’
are
the student’s
arrangement of
opinion,
competent practitioner but also
a
the schools the curtail-
hospital grant to its school. Will this scheme of amalgamation, when it has taken shape, influence in any way unfavourably the desirable effects of hospital life ? We think that it will not, but we know that this view is not shared by some hospital authorities who see in the removal of the student at the beginning of his career from the influences of a hospital school a considerable source of danger. We believe that these fears
are
medical
help
ill-founded. student is
which
can
a
It must be remembered that the no
longer in
in many instances hospital that the
even
exert, and these
many and
a
the
schoolboy,
nor
is he
relation to his Oxford or of undergraduate Cambridge is to his college. A considerable proportion of the medical students in London have, in fact, passed through their undergraduate stage at Oxford or Cambridge Yet amongst these very men, or some other university. the men who have passed through perhaps their most impressionable days before they ever entered hospital, are to be found supporters as keen, as loyal, and as devoted of the hospitals to which they have attached themselves as amongst any other class of student whatsoever. It is probable that all the good influences which a hospital can same
of
real, can be, and are, as well and as successfully brought to bear upon the thirdyear man as upon the student who begins as well as finishes and importance, his education on the premises of a London hospital. Is it
greatest interest not only to those particularly concerned with medical education but also to the public at large. As the medical student is, so to a large extent will be the medical practitioner, and
are
rational to suppose then that because in the future this student will have studied physics and chemistry, anatomy and physiology at the University of London, therefore when
through his clinical education at a metropolitan good influences and traditions with which that hospital, and well-informed young men a body of sensible, honest, hospital has enveloped so many generations of students will and industrious practitioners. The needs of the exceptional have an effect that is unavailing or diminished in his case ? all that the management of medical education shall tend to create from a body of high-spirited
it
concerns us
may put on one side. It is the average young whom we have to consider and how the highest average
student man
we
he goes
the
The effects upon conduct and upon character that are wrought by the student’s life within the walls of a hospital
general and of medical excellence is to be arise mostly from the nature of the work and from its obtained. We say general excellence advisedly, for although tendency to make him take a thoughtful and a sympathetic the medical school, strictly speaking, offers nothing but view of human affairs, both bodily and spiritual. It is medical education, yet actually each school prides itself not an effect that will be produced upon impressionable only on the proficiency which it offers to its members in the minds, a seed which will grow in the proper soil, whether various branches of medical science and art but also on it is planted to some extent from the earliest years of a the spirit with which tradition and a continuous series medical student’s life or whether, on the other hand, it is of enthusiastic physicians and surgeons have furnished withheld until his entry into the wards only to be sown it. To impart the desirable qualities of keenness, of good then in a fuller abundance. Moreover, it will be the duty sense, of responsibility, and of laudable ambition there can of hospital authorities to see that the student reaps even be no regulated system of instruction. They spring from during his preliminary years such benefits as a sense of the atmosphere of a hospital and from the imitation comradeship and of belonging to an honourable institution He will have joined the ranks of fine examples. There are, and can be, no classes can confer upon him. in manners, in kindness, and in the proper way to talk of a hospital before his work takes him habitually to the to patients. It is none the less an essential part of the building, and when the time comes for him to be there as medical student’s education that he shall be able to watch dresser and as resident we have no fears that the regivte of standard of
168
THE LANCET. LONDON:
The
SATURDAY, JULY 15, 1905.
Sleeping
Hours of
10 P.M. is probably the usual, and certainly a convenient, time for bed, and only the upper forms should be allowed to postpone the time of "lights out"to any later Breakfast could here be at 7.30 without undue hour. Of course it must be recognised that all stress of work. the time between the hour of going to bed and that of breakfasting is not spent in actual sleep, so that in order to secure as much sleep as possible it is necessary, at all events with younger boys who occupy dormitories in I common, to prevent talking and ’skylarking" going on It is also advisable to arrange when the lights are out.
Schoolboys.
hurry and bustle there that younger and older boys do not share the same is a tendency to begrudge an expenditure of time upon sleeping rooms, lest the little ones, who go to bed early, such apparently unprofitable things as rest and recuperation, may be disturbed by the subsequent entrance of the and for the busy man as well as for the pleasure-seeker seniors. Very closely connected with the question of the hours devoted to sleep are cut down to the irreducible sufficient sleep is,that of lessons before breakfast, and we minimum. We have heard of a society in America are strongly of opinion that it is wrong on physiological the members of which bound themselves to curtail more grounds to expect boys to start brain-work in the early and more the period of slumber till most of them morning Breakfast should be on empty stomachs. managed to do with only four or five hours in the the first event of the day and should be followed by a It was never recorded, so far as we know, what short interval, 24. for obvious reasons, before assembly IN the
present
strenuous age of
the average life of these poor victims. Our ancestors had an adage that six hours’ sleep was the proper quantity for a man, seven for a woman, and eight for a fool. Whether it is that the strenuous life of the present day is akin to foolishness or whether it is a simple phenomenon of evolution, it is certain that many of our busiest men find the last-mentioned allowance none too long for them. The quality of a man’s work soon deteriorates if he takes insufficient rest and a regard for real as contrasted with apparent profits should compel attention to conBut if sleep is requisite for the siderations of health. more so is it indispensable for growing how much adult, children ? Rapid growth and the abundant energy characteristic of the young imply rapid multiplication of cells and renovation of tissue, and sleep is the time for both growth and repair. Yet it is a feature of child life to which our educational authorities seem to have paid but little attention. Here, as in other educational matters, America is ahead of us, much more adequate periods of rest being allowed in the schools in the United States than in this country. Dr. T. D. ACLAND has done good service in calling attention to the subject in his paper read before the Medical Officers of Schools’ Association, which appears at p. 136 of our present issue. He has collected a mass of weighty opinions which should carry conviction to his hearers and readers. It is, perhaps, not very easy to lay down definite rules which shall apply to all children even at the same age, since individuals differ in this as in other
was
But there seems to be a striking agreement medical and scientific writers that at present we among err on the side of deficient allowance of sleep. Schoolboys may be roughly divided into those of public school age and those still in the preparatory stage, the latter
respects.
between the ages of nine and 13 and the former from 12 to 18 years. For little boys who have just left home for the first time ten hours of sleep are probably none too much, and this amount would be obtained pretty accurately by
being
upon their going to bed at 9.30 and having breakfast at 8. The elder boys still at a private school might be allowed to sit up until 10 o’clock. At public schools
insisting
in the class-rooms. One of the most of education is the inculcation of
second nature. pointed by Dr. T. B. HYSLOP, is to some degree a matter of habit, but it is doubtful how far it is one which need be much impressed upon children who seldom sleep badly unless they are definitely ill or overworked. The occurrence of sleeplessness in them is always a symptom which needs careful attention as it may afford a danger signal pointing to the onset of nervous maladies or to the existence of over-pressure in school work. It may seem curious that so late in the history of the world as the beginning of the twentieth century it is necessary to insist upon the allowance of proper time for sleep, but the fact may be readily explained. On the one hand, the old and not yet obsolete theory of education as a means of stocking boys’ memories with as large as possible a number of facts and endowing them with certain fashionable accomplishments rather than as training the minds of the young in such a way that they may best adapt themselves to the circumstances of after life, has led to the multiplication of hours of instruction, to the neglect in many instances of the laws of health. On the other hand, it is only in recent years that these laws have been recognised by the general public with anything like intelligent appreciation, and the traditions of school life are guarded with a curiously jealous conservatism which renders change of any kind specially difficult to carry out. Hence, some of our great schools are in certain respects behind the times in their health arrangements, while parents are often sadly ignorant of all that pertains to the upbringing of children. There are signs that the schools, especially the English public schools, are becoming awake to their shortcomings and are setting their houses in order. The chief opposition now comes from those who see in all attempts to make life at school more healthy a proof of soon
become
features good habits which Sleep indeed itself, as
important
a
out
yielding
to the
softer,
not to say
more
effeminate, spirit
of modern times. This cry is raised even over the question of longer hours for sleep, as Dr. ACLAND points out.
169
early rising may be insidiously it would undermined, seem, and slothful habits induced. Perhaps it is difficult in all cases to hit the golden
The old-fashioned virtue of
and
mean
conflicting practice.
theories
take
time
to
adjust
themselves in
Still there is no reason why sanitary houses, proper food, and adequate sleep should have anything but a good influence upon the rising generation of young Englishmen. The tendency to spare the rod is probably carried too far in deference to false
ignorant outcry, but we do not wish to bring good old " days of fighting and bullying, of semistarvation, dirt, and cold. These may have been potent means of natural selection in their day but times are changed and other qualities are demanded than mere muscle, animal spirits, and aggressiveness. There is no evidence that the products of our public schools have less average capacity for work in the world than those of past generations, though statements to the contrary are often made. Outstanding be fewer the because just general level has examples may been raised rather than lowered, but we fancy that the total production of good is increased. At any rate, wisdom seems to lie in removing visible obstacles to physical health so far as can be done and counteracting any tendency to resulting softness, should such really exist, by other means than conditions of barbarism. Dr. ACLAND’S paper will, we hope, have the excellent result of convincing some of our scholastic authorities that a growing boy is more hungry for sleep even than for food.
these qualities in others and to acquire them for himself. His teachers and his surroundings, in a word, must make him not
merely
estimable
man.
As many of
our
readers
about in London.
will be
ment of the financial
THE
of how best to regulate the early years of medical student life in London is not the least of the difficulties created by the embarrassed financial position of metropolitan hospitals and their affiliated schools. It is an
problem
educational problem of the
concerned it
an
changed coming teaching of prethis is, in our a
years is
desirable.
are
Years.
preliminary
effected, and Moreover, so far as some of is imperative, having regard to
liminary subjects
sentiment and
Early
doubtless aware,
A concentration of the
back the "
Medical Students’
are
the student’s
arrangement of
opinion,
competent practitioner but also
a
the schools the curtail-
hospital grant to its school. Will this scheme of amalgamation, when it has taken shape, influence in any way unfavourably the desirable effects of hospital life ? We think that it will not, but we know that this view is not shared by some hospital authorities who see in the removal of the student at the beginning of his career from the influences of a hospital school a considerable source of danger. We believe that these fears
are
medical
help
ill-founded. student is
which
can
a
It must be remembered that the no
longer in
in many instances hospital that the
even
exert, and these
many and
a
the
schoolboy,
nor
is he
relation to his Oxford or of undergraduate Cambridge is to his college. A considerable proportion of the medical students in London have, in fact, passed through their undergraduate stage at Oxford or Cambridge Yet amongst these very men, or some other university. the men who have passed through perhaps their most impressionable days before they ever entered hospital, are to be found supporters as keen, as loyal, and as devoted of the hospitals to which they have attached themselves as amongst any other class of student whatsoever. It is probable that all the good influences which a hospital can same
of
real, can be, and are, as well and as successfully brought to bear upon the thirdyear man as upon the student who begins as well as finishes and importance, his education on the premises of a London hospital. Is it
greatest interest not only to those particularly concerned with medical education but also to the public at large. As the medical student is, so to a large extent will be the medical practitioner, and
are
rational to suppose then that because in the future this student will have studied physics and chemistry, anatomy and physiology at the University of London, therefore when
through his clinical education at a metropolitan good influences and traditions with which that hospital, and well-informed young men a body of sensible, honest, hospital has enveloped so many generations of students will and industrious practitioners. The needs of the exceptional have an effect that is unavailing or diminished in his case ? all that the management of medical education shall tend to create from a body of high-spirited
it
concerns us
may put on one side. It is the average young whom we have to consider and how the highest average
student man
we
he goes
the
The effects upon conduct and upon character that are wrought by the student’s life within the walls of a hospital
general and of medical excellence is to be arise mostly from the nature of the work and from its obtained. We say general excellence advisedly, for although tendency to make him take a thoughtful and a sympathetic the medical school, strictly speaking, offers nothing but view of human affairs, both bodily and spiritual. It is medical education, yet actually each school prides itself not an effect that will be produced upon impressionable only on the proficiency which it offers to its members in the minds, a seed which will grow in the proper soil, whether various branches of medical science and art but also on it is planted to some extent from the earliest years of a the spirit with which tradition and a continuous series medical student’s life or whether, on the other hand, it is of enthusiastic physicians and surgeons have furnished withheld until his entry into the wards only to be sown it. To impart the desirable qualities of keenness, of good then in a fuller abundance. Moreover, it will be the duty sense, of responsibility, and of laudable ambition there can of hospital authorities to see that the student reaps even be no regulated system of instruction. They spring from during his preliminary years such benefits as a sense of the atmosphere of a hospital and from the imitation comradeship and of belonging to an honourable institution He will have joined the ranks of fine examples. There are, and can be, no classes can confer upon him. in manners, in kindness, and in the proper way to talk of a hospital before his work takes him habitually to the to patients. It is none the less an essential part of the building, and when the time comes for him to be there as medical student’s education that he shall be able to watch dresser and as resident we have no fears that the regivte of standard of