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HOMEWORK
1358 accidents. It is, or should be, the ideal aimed at in the prevention of accidents in factories and mines, a matter to which Dr. Vernon devotes close and reasoned attention.
protecting the general public from
HOMEWORK EARLY last year, after a parliamentary debate on the harm done by homework to the health of schoolchildren,l the President of the Board of Education said that the Government were determined to see that whatever was wrong was remedied and that the Board was actually in the middle of "a comprehensive inquiry into the whole question." The results of this inquiry have now been published2 and throw light on the merits and demerits of homework as it affects three classes of schools-elementary, secondary, and junior technical. The only weakness of the report lies in the fact that the investigators did not include a medical man, so that the physiological and neurological aspects are not as fully considered as they might have been. From the evidence provided it is clear that the problem of homework is not one problem but many, for it differs in different localities and in different schools. The opinions of teachers and parents are correspondingly heterogeneous, but it is perhaps significant that teachers who are also parents are less convinced than most of their colleagues that homework, as at present understood, is a desirable institution. Parents replying to questionnaires were almost equally divided on whether homework has any adverse effect on health, with a small majority in the negative ; but when the homework had been reduced a great majority testified to the benefit of the change. Consciously or unconsciously, the parent is often swayed by social or financial considerations, and the greatest incentive to strenuous homework is undoubtedly the desire of teachers, parents, and the children themselves for success in examinations ; indeed in one area parents pay teachers to coach pupils out of school hours, while others ask for extra work to be provided. This practice is at its worst in junior schools in preparation for special-place and scholarship examinations, and could be checked if it were known that examinations in school subjects have been replaced by the use of intelligence tests for which coaching is futile. But hope of examination success is not the only factor influencing parental wishes and opinions. In one home it may be much easier to provide for undisturbed evening study than in another; one parent may wish the child to have much free time for activities beneficial to himself or to the household, while another may prefer the child to have 11 something to occupy his mind " or to 11 keep him out of mischief." One of the few medical opinions quoted in the report is that of an assistant school medical officer, that " during April and May there is every year a marked rise in the number of cases of nervous and physical disorders brought to his notice "-a rise which he attributes to anxiety over the examinations. The investigators’ own conclusion is that no homework should be set to children under 12 years of age. In the secondary and junior technical schools the trouble, where it exists, is thought to be due primarily to defects of organisation and arrangement, and for these older pupils some reservations are made; but in general it is that homework or its preparation-i.e., thought 1 See Lancet, 1936, 1, 454. Homework. Board of Education Educational Pamphlets No. 110. London: H.M. Stationery Office. 1937. Pp. 72. 1s. 3d. 2
alternatives-should not be done on more than five nights a week and preferably on four only, and that the hours per night should be limited to one for those under 14 and to one and a half for those above that age.. The absence of medical experience is again almost the only fault to find in a book3 which describes inquiries at the City School, Lincoln, and contains a striking chapter on the good effects of substituting preparation at school for the ordinary work done at home. The medical aspect becomes especially obvious when one thinks of the needs of individual children suffering from myopia or some other disability likely to be increased by too strenuous a pursuit of higher
education. SURGERY OF ADHERENT PERICARDIUM
IT is
thirty years since Delorme first proposed separation of an adherent pericardium from the heart by open operation, and almost as long since Rehn and also Sauerbruch first successfully excised the pericardium ; but it was not until the comprehensive paper of Volhard and Schmieden4 that operative indications and methods were clearly defined. Paul White,5 in his St. Cyres lecture more
than
the
1935, also gave a full clinical account and described, among others, ten cases of resection by E. D. Churchill, of which six were comof
cured and one benefited considerably. Mr. Pilcher’s excellent result described on p. 1323 should stimulate the more frequent diagnosis of a syndrome which, though admittedly rare, must still claim victims in this country as well as in America and on the Continent. A patient showing chronic congestive heart failure with ascites and swelling of the legs, and with a heart that is radiologically smaller than normal or at the most not grossly,
pletely
enlarged, probably has constrictive pericarditis ; if there is also a constant increase of the venous pressure in both upper and lower extremities the diagnosis may be made with confidence. In the early stages the process may be arrested and natural compensation may be effected, but too long a delay before operation may present the surgeon with an insoluble problem, for the pericardium may be so adherent that separation is quite impossible. Johnson6 has’ recently written on the use of kymography-which demonstrates the mode of contraction of the heartin the early diagnosis of the syndrome, and this method of investigation would have the additional advantage of distinguishing between intrapericardial obstruction of the cava and that due to some process beneath the diaphragm. Cranfield and his associates have reported7 an interesting autopsy in which the condition was associated with tuberculosis of the lungs. Although they could find no active tuberculous foci in the pericardial scar it may be mentioned that the onset of a generalised tuberculosis has sometimes spoilt the good immediate results of separation. The risks of operation must not be minimised, but of the important dangers can now be avoided as a result of Schmieden’s work. When it is remembered that he could show patients leading active lives six years and four years after pericardectomy, some
3 Experiments in Homework and Physical Education. By A. Sutcliffe, M.A., B.Sc., Head Master, the City School, Lincoln : and J. W. Canham, M.A., Science Master at the School. London : John Murray. 1937. Pp. 194. 4s. 6d. 4 Volhard, P., and Schmieden, V. (1923) Klin. Wschr. 2, 5. 5 White, P. D. (1935) Lancet, 2, 539, 597. 6 Johnson, S. E. (1935) Surg. Gynec. Obstet. 61, 169. 7 Cranfield, H. V., Gwyn, N. B., Anglin, G. C., and Norwich, A. C., Canad. med. Ass. J. 1937, May, p. 449.
protecting the general public from
HOMEWORK EARLY last year, after a parliamentary debate on the harm done by homework to the health of schoolchildren,l the President of the Board of Education said that the Government were determined to see that whatever was wrong was remedied and that the Board was actually in the middle of "a comprehensive inquiry into the whole question." The results of this inquiry have now been published2 and throw light on the merits and demerits of homework as it affects three classes of schools-elementary, secondary, and junior technical. The only weakness of the report lies in the fact that the investigators did not include a medical man, so that the physiological and neurological aspects are not as fully considered as they might have been. From the evidence provided it is clear that the problem of homework is not one problem but many, for it differs in different localities and in different schools. The opinions of teachers and parents are correspondingly heterogeneous, but it is perhaps significant that teachers who are also parents are less convinced than most of their colleagues that homework, as at present understood, is a desirable institution. Parents replying to questionnaires were almost equally divided on whether homework has any adverse effect on health, with a small majority in the negative ; but when the homework had been reduced a great majority testified to the benefit of the change. Consciously or unconsciously, the parent is often swayed by social or financial considerations, and the greatest incentive to strenuous homework is undoubtedly the desire of teachers, parents, and the children themselves for success in examinations ; indeed in one area parents pay teachers to coach pupils out of school hours, while others ask for extra work to be provided. This practice is at its worst in junior schools in preparation for special-place and scholarship examinations, and could be checked if it were known that examinations in school subjects have been replaced by the use of intelligence tests for which coaching is futile. But hope of examination success is not the only factor influencing parental wishes and opinions. In one home it may be much easier to provide for undisturbed evening study than in another; one parent may wish the child to have much free time for activities beneficial to himself or to the household, while another may prefer the child to have 11 something to occupy his mind " or to 11 keep him out of mischief." One of the few medical opinions quoted in the report is that of an assistant school medical officer, that " during April and May there is every year a marked rise in the number of cases of nervous and physical disorders brought to his notice "-a rise which he attributes to anxiety over the examinations. The investigators’ own conclusion is that no homework should be set to children under 12 years of age. In the secondary and junior technical schools the trouble, where it exists, is thought to be due primarily to defects of organisation and arrangement, and for these older pupils some reservations are made; but in general it is that homework or its preparation-i.e., thought 1 See Lancet, 1936, 1, 454. Homework. Board of Education Educational Pamphlets No. 110. London: H.M. Stationery Office. 1937. Pp. 72. 1s. 3d. 2
alternatives-should not be done on more than five nights a week and preferably on four only, and that the hours per night should be limited to one for those under 14 and to one and a half for those above that age.. The absence of medical experience is again almost the only fault to find in a book3 which describes inquiries at the City School, Lincoln, and contains a striking chapter on the good effects of substituting preparation at school for the ordinary work done at home. The medical aspect becomes especially obvious when one thinks of the needs of individual children suffering from myopia or some other disability likely to be increased by too strenuous a pursuit of higher
education. SURGERY OF ADHERENT PERICARDIUM
IT is
thirty years since Delorme first proposed separation of an adherent pericardium from the heart by open operation, and almost as long since Rehn and also Sauerbruch first successfully excised the pericardium ; but it was not until the comprehensive paper of Volhard and Schmieden4 that operative indications and methods were clearly defined. Paul White,5 in his St. Cyres lecture more
than
the
1935, also gave a full clinical account and described, among others, ten cases of resection by E. D. Churchill, of which six were comof
cured and one benefited considerably. Mr. Pilcher’s excellent result described on p. 1323 should stimulate the more frequent diagnosis of a syndrome which, though admittedly rare, must still claim victims in this country as well as in America and on the Continent. A patient showing chronic congestive heart failure with ascites and swelling of the legs, and with a heart that is radiologically smaller than normal or at the most not grossly,
pletely
enlarged, probably has constrictive pericarditis ; if there is also a constant increase of the venous pressure in both upper and lower extremities the diagnosis may be made with confidence. In the early stages the process may be arrested and natural compensation may be effected, but too long a delay before operation may present the surgeon with an insoluble problem, for the pericardium may be so adherent that separation is quite impossible. Johnson6 has’ recently written on the use of kymography-which demonstrates the mode of contraction of the heartin the early diagnosis of the syndrome, and this method of investigation would have the additional advantage of distinguishing between intrapericardial obstruction of the cava and that due to some process beneath the diaphragm. Cranfield and his associates have reported7 an interesting autopsy in which the condition was associated with tuberculosis of the lungs. Although they could find no active tuberculous foci in the pericardial scar it may be mentioned that the onset of a generalised tuberculosis has sometimes spoilt the good immediate results of separation. The risks of operation must not be minimised, but of the important dangers can now be avoided as a result of Schmieden’s work. When it is remembered that he could show patients leading active lives six years and four years after pericardectomy, some
3 Experiments in Homework and Physical Education. By A. Sutcliffe, M.A., B.Sc., Head Master, the City School, Lincoln : and J. W. Canham, M.A., Science Master at the School. London : John Murray. 1937. Pp. 194. 4s. 6d. 4 Volhard, P., and Schmieden, V. (1923) Klin. Wschr. 2, 5. 5 White, P. D. (1935) Lancet, 2, 539, 597. 6 Johnson, S. E. (1935) Surg. Gynec. Obstet. 61, 169. 7 Cranfield, H. V., Gwyn, N. B., Anglin, G. C., and Norwich, A. C., Canad. med. Ass. J. 1937, May, p. 449.