- Email: [email protected]
HYGIENE IN THE ELEMENTARY SCHOOL: PRECEPT AND PRACTICE.
1173 The
place
elementary hygiene now has a curriculum ; but when the school consuch as have been described, the oral
teaching in the
of
ditions are lesson is so much waste of time. NOEL PATON and LEONARD FINDLAY have recently shown that the greatest single factor in healthy childhood is efficiency of the mother. Legislation has delivered the future LONDON: SATURDAY, DECEMBER 4, 1926. parents of the race into the hands of the State at an impressionable age, and though satisfactory education of their intellect may be impossible in our elementary HYGIENE IN THE ELEMENTARY SCHOOL: schools for many years to come, the education of their bodies is practical politics-an ideal infinitely PRECEPT AND PRACTICE. easier to realise. And personal health, often made IN his report! for 1925 to the Board of Education and easier conditions, will Sir GEORGE NEWMAN says that " it is common know- possible by higher wages to the maternal far promote efficiency which ought ledge that a considerable number of schools throughout go to give children of the next generation a better start. the country fail to reach a minimum standard of Such a start is profoundly important, but even though health and sanitation." He cites one county where we cannot secure ideal homes for the children of there are 51 schools with no water-supply at all ; we can at small cost ensure tolerably healthy 97 whose old and unhygienic desks require replace- to-day, school conditions and there instil, by example more ment ; 62 in which the playgrounds are unsuitable than precept, the knowledge of much that is essential in size, position, or surface ; and 35 with no other to health and happiness. From the psychological sanitary accommodation than privy middens. Referpoint of view good surroundings are as necessary as ence to the reports of school medical officers will suitable and sufficient food, fresh air and sunlight, show that in many urban districts conditions are exercise and rest, and a child once accustomed to One of these officers, for instance, writing no better. conditions that are bright, airy, clean, and wholeof a county borough with a population of 9],000, some will grow intolerant of what is mean, dirty, makes the following statements ’— and squalid. In hundreds of schools, however, it "the majority of the schools were erected prior to is the mean, the dirty, and the squalid that are put certain school buildings are out of repair, 1880 the roof gutters and exterior walls being defective and before the children’s eyes. Overcrowding leads to damp in places.... Many of the schools are provided a loss of self-respect, prevents the development of with trough closets and it is quite common to find individuality, encourages filth, vermin, and infectious them in a foul condition.... At almost every school or diseases, and renders ventilation more the urinals are not provided with flushing apparatus, difficult. Many schools are dirty. Little imagination - and complaints have been received of the stench and less science are shown in the dusting, brushing, arising from these conveniences. The major portions and scrubbing that go on fitfully ; the surroundings of the playgrounds at several schools are unpaved- and the playground (if any) are often nothing more becoming pools of water and mud in wet weather." than patches of mud, much of which the children These conditions are not exceptional ; the criticisms bring into school on their boots. The walls of apply to elementary schools all over the country. rooms are made of bare brick, or have dull, rough But to tell the truth in plain language is often surfaces ; the rooms themselves are filled with old, impolitic when a medical officer is faced by a committee unnecessary, dusty furniture, and decorated with which has false standards of economy, is versed in uninspiring pictures. Even to-day there are practical procrastination, is ignorant or unheedful of sound exponents of the hot-air system of heating and hygiene, and glad to accept as sufficient the minimal ventilation ; even to-day the draught and open requirements of the Board of Education. This window are unintelligently handled, lights are illcountry has little to be proud of in tolerating class- placed, and windows grimy. rooms which allow a floor space of only 10 square’ The present drop in the school population gives feet per child-less than is permitted by any other an excellent opportunity for closing structurally .great nation. Everyone who cares for preventive unsuitable schools and for bringing down the numbers medicine must agree with Dr. JAMES KERR, whose of children in class-rooms. These measures would text-book we review on another page, that " ite be a big step in the right direction. Improved cleanis time to give up the squalid ideals in relation to. liness can be secured by supervising the work of the elementary school-room." The moment may caretakers and cleaners, and by removing useless be wrong for the wholesale outlay of money on newr furniture or impedimenta; walls should be made buildings or on radical alterations of structure, bute smooth and painted in flat colours-bright, but not it is not wrong for the correction of definite nuisances; glaring-so as to be readily washed, whilst floors and dangers to health, and measures to this endmay be treated with dust-allaying oil. The formation must take precedence of newer schemes, howeverrof smaller classes lessens the difficulty of ventilation ; picturesque and attractive. The whole position is9the children respond better to discipline, and desks disappointing. In his report for 1918 Sir WILLIAMz can be spaced to meet the need for light and air. HAMER said : "It may be assumed that a quarterr Heating and ventilation in schools admittedly present of a million school-children in London are broughtt difficult problems, requiring much careful thought’, up in ignorance of, and without the possibility of, but there are few systems in existence—-however that minimum of attention to hygienic requirements9inefficient in themselves-that could not be better, which should now be necessary in every civilised1 and probably more ecoomically, run if a little .community." The same holds good to-day, not onlyr more intelligent supervision were given to them, in London, but throughout the country, and thfTwo hold open-air classes does not necessarily effects of school inspection and treatment are largelyY require much ingenuity or special provision ; nullified by allowing inimical influences full play ir1 the shed in the playground may give ample the school-room. protection even in cold weather, and simple exercises at intervals not only keep up the. necessary 1 Report for 1925 of the Chief Medical Officer to the Board off heat, but bring about adaptation in the Education. London: H.M. Stationery Office.
THE
LANCET.
...
contagious
,
.
,
,
adequate
1174 whole mechanism of the child. Perhaps the gravest seizure and detention of stray dogs and their destrucof heat occurs through sodden footwear, tion by the police, if unclaimed, after a proper interval which many children have to wear throughout the and after due notification to the owner, a register day during wet weather. As a source of debility being kept with a brief description of every dog thus. this is probably of great importance, yet the provision seized and detained. The humanitarian zeal shown of simple slippers-which can be made by senior by some propagandists, and the distrust of medicine girls at little expense and with some educational shown by others, procured the insertion of a subbenefit-is the exception in most school areas. The section (Section 3, Subsection 5) enacting that no dog so seized shall be given or sold for the purpose midday hour, especially in country districts, may well be utilised in giving the children a hot meal. of vivisection." This clause, Prof. HILL suggests, It is sometimes possible to use the opportunity for should be repealed, but we fear that the attempt to teaching plain cookery and dietetic principles to the do so would rally once more those who have supported. bigger girls, and if efficiently supervised, a meal can the kindly but narrow views of the promoters of a be made into an occasion for imparting cleanly and series of Dogs’ Protection Bills. There are as many dog-lovers in the medical orderly table habits. Again, the play instinct of children largely determines their growth, so that the profession as in any other. We shall all agree that. lack or unsuitability of playground accommodation experiments upon dogs and cats should be restricted cries out for immediate reformWashing arrangements to the minimum. There would probably be scant -for the most part inadequate-now exist in most professional opposition to a regulation that these schools, but often the water will be found to be turned animals should not be used for demonstrating to off, " as the children make such a mess." One, or students accepted observations which need no furtherperhaps two, roller towels are used for the removal of confirmation, but that is a very different thing from dirt both from sweating or perhaps hastily soused enacting by law that no canine subjects should be hands and faces, and from boots. There is no need to employed in any capacity for medical research. The refer to septic conditions of the skin, nose, mouth, ears, reasons for using the dog for experiments devoted and eyes. It is not enough to have wash basins ; to the diminution of human and animal pain were there must be soap, preferably in receptacles from fully and fairly stated in the memoranduml issued which only a small quantity can be taken at one time. by the Medical Research Committee in 1919. It Paper towels are satisfactory and not expensive, was there shown how such experiments had led to in view of their advantages. Some responsible person the prevention of disease and suffering in matters, should always be present during the times of ablution. such as rickets, disorders of the teeth, the effects Erection of spray or shower baths may be somewhat of alcohol and diseases of the heart, and how much expensive, but in the long run it is cheaper than the the experiments had contributed to our knowledge present involved system of compulsory cleansing, and of blood circulation. It is probable that some who the moral value is beyond calculation. Swimming are ready to take a prominent part in what theybaths are a luxury, excellent as they are. As for the consider to be a defence of the dog have never studied condition of sanitary conveniences, that is something this document, which should be supplemented by that must be faced before any pretence is made to Dr. C. H. BEST’S letter on p. 1192 in the matter cf inculcate the principles of hygiene. Till these abuses insulin research, while many who now assume that are dealt with there is little need to consider the all experiments classed as vivisection necessarily broader aspects of structural alteration, building involve disregard of pain do not read the Inspeetor’s sites, exposure, and surroundings ; but enough reports prefixed to the annual Home Office return has been said to show the immediate necessity for under the Act of 1876. That Act makes animal public bodies, educationists, and medical men to experiments legal, subject to an elaborate system of make further efforts to improve the- conditions licensing, regulation, and inspection. Inspecting of elementary schools. officers pay frequent visits, usually without previous
leakage
"
to all places registered for experiment. In the latest report, that for 1925, the inspectors found all animals suitably lodged and well cared for, and the licensees generally attentive to the requirements of the Act and the conditions attached by the Home Office to their licences. They report only two cases of irregularity in the year. One of these was the unlicensed immersion of trout in polluted water under a misunderstanding of the scope of the Act ; immediate steps were taken by the offender to obtain a licence and the appropriate certificate. The other irregularity concerned certain simple inoculations made in the ase of cats ; the inoculator held Certificate A but lot Certificate E ; it was clear that he had erred mwittingly, and it was considered sufficient to admonish him. The importance of the report is that t shows how large a proportion of experiments are )ainless, and how great is the care taken to prevent he suffering of pain. However reassuring an Inspector’s report may be, here will still be dog-lovers who look upon every esearch worker as a ghoul, while forgetting that ’eterinary medicine owes a debt to medical research. fr. STEPHEN COLERIDGE inserts in a letter to the /M6.9 the observation that "it is, of course, id:J to.
notice,
EXPERIMENTS ON ANIMALS. A CHARGE of alleged dog-stealing led recently to the conviction of a dealer who has supplied animals to the University College School of Physiology ; the episode has been followed by prompt inquiry on the part of the authorities, by whom an official statement has now been issued. The episode has raised questions concerning the most satisfactory method of securing an adequate supply of animals for the purpose of research. Presumably it would not be impossible for the Medical Research Council to undertake the breeding of those required, though there is potential material already in existence. In a letter to the Times Prof. A. V. HILL has pointed out that over 50,000 stray, homeless, and unwanted dogs are annually sent to the lethal chamber, and the diversion of some of these to the service of scientific research would solve the problem imply and sensibly. But though this solution of the difficulty is adopted inAmerica and elsewhere, in England it is barred by the law. In 1906 Parliament passed a Dogs Act, concerned with divers matters such as the liability of dog-owners for injury to cattle, the compulsory dogcollar, and the exemption of sheep-dogs from licence duty. One -section of this measure dealt with the
1
THE
LANCET, 1919, i., 947.
place
elementary hygiene now has a curriculum ; but when the school consuch as have been described, the oral
teaching in the
of
ditions are lesson is so much waste of time. NOEL PATON and LEONARD FINDLAY have recently shown that the greatest single factor in healthy childhood is efficiency of the mother. Legislation has delivered the future LONDON: SATURDAY, DECEMBER 4, 1926. parents of the race into the hands of the State at an impressionable age, and though satisfactory education of their intellect may be impossible in our elementary HYGIENE IN THE ELEMENTARY SCHOOL: schools for many years to come, the education of their bodies is practical politics-an ideal infinitely PRECEPT AND PRACTICE. easier to realise. And personal health, often made IN his report! for 1925 to the Board of Education and easier conditions, will Sir GEORGE NEWMAN says that " it is common know- possible by higher wages to the maternal far promote efficiency which ought ledge that a considerable number of schools throughout go to give children of the next generation a better start. the country fail to reach a minimum standard of Such a start is profoundly important, but even though health and sanitation." He cites one county where we cannot secure ideal homes for the children of there are 51 schools with no water-supply at all ; we can at small cost ensure tolerably healthy 97 whose old and unhygienic desks require replace- to-day, school conditions and there instil, by example more ment ; 62 in which the playgrounds are unsuitable than precept, the knowledge of much that is essential in size, position, or surface ; and 35 with no other to health and happiness. From the psychological sanitary accommodation than privy middens. Referpoint of view good surroundings are as necessary as ence to the reports of school medical officers will suitable and sufficient food, fresh air and sunlight, show that in many urban districts conditions are exercise and rest, and a child once accustomed to One of these officers, for instance, writing no better. conditions that are bright, airy, clean, and wholeof a county borough with a population of 9],000, some will grow intolerant of what is mean, dirty, makes the following statements ’— and squalid. In hundreds of schools, however, it "the majority of the schools were erected prior to is the mean, the dirty, and the squalid that are put certain school buildings are out of repair, 1880 the roof gutters and exterior walls being defective and before the children’s eyes. Overcrowding leads to damp in places.... Many of the schools are provided a loss of self-respect, prevents the development of with trough closets and it is quite common to find individuality, encourages filth, vermin, and infectious them in a foul condition.... At almost every school or diseases, and renders ventilation more the urinals are not provided with flushing apparatus, difficult. Many schools are dirty. Little imagination - and complaints have been received of the stench and less science are shown in the dusting, brushing, arising from these conveniences. The major portions and scrubbing that go on fitfully ; the surroundings of the playgrounds at several schools are unpaved- and the playground (if any) are often nothing more becoming pools of water and mud in wet weather." than patches of mud, much of which the children These conditions are not exceptional ; the criticisms bring into school on their boots. The walls of apply to elementary schools all over the country. rooms are made of bare brick, or have dull, rough But to tell the truth in plain language is often surfaces ; the rooms themselves are filled with old, impolitic when a medical officer is faced by a committee unnecessary, dusty furniture, and decorated with which has false standards of economy, is versed in uninspiring pictures. Even to-day there are practical procrastination, is ignorant or unheedful of sound exponents of the hot-air system of heating and hygiene, and glad to accept as sufficient the minimal ventilation ; even to-day the draught and open requirements of the Board of Education. This window are unintelligently handled, lights are illcountry has little to be proud of in tolerating class- placed, and windows grimy. rooms which allow a floor space of only 10 square’ The present drop in the school population gives feet per child-less than is permitted by any other an excellent opportunity for closing structurally .great nation. Everyone who cares for preventive unsuitable schools and for bringing down the numbers medicine must agree with Dr. JAMES KERR, whose of children in class-rooms. These measures would text-book we review on another page, that " ite be a big step in the right direction. Improved cleanis time to give up the squalid ideals in relation to. liness can be secured by supervising the work of the elementary school-room." The moment may caretakers and cleaners, and by removing useless be wrong for the wholesale outlay of money on newr furniture or impedimenta; walls should be made buildings or on radical alterations of structure, bute smooth and painted in flat colours-bright, but not it is not wrong for the correction of definite nuisances; glaring-so as to be readily washed, whilst floors and dangers to health, and measures to this endmay be treated with dust-allaying oil. The formation must take precedence of newer schemes, howeverrof smaller classes lessens the difficulty of ventilation ; picturesque and attractive. The whole position is9the children respond better to discipline, and desks disappointing. In his report for 1918 Sir WILLIAMz can be spaced to meet the need for light and air. HAMER said : "It may be assumed that a quarterr Heating and ventilation in schools admittedly present of a million school-children in London are broughtt difficult problems, requiring much careful thought’, up in ignorance of, and without the possibility of, but there are few systems in existence—-however that minimum of attention to hygienic requirements9inefficient in themselves-that could not be better, which should now be necessary in every civilised1 and probably more ecoomically, run if a little .community." The same holds good to-day, not onlyr more intelligent supervision were given to them, in London, but throughout the country, and thfTwo hold open-air classes does not necessarily effects of school inspection and treatment are largelyY require much ingenuity or special provision ; nullified by allowing inimical influences full play ir1 the shed in the playground may give ample the school-room. protection even in cold weather, and simple exercises at intervals not only keep up the. necessary 1 Report for 1925 of the Chief Medical Officer to the Board off heat, but bring about adaptation in the Education. London: H.M. Stationery Office.
THE
LANCET.
...
contagious
,
.
,
,
adequate
1174 whole mechanism of the child. Perhaps the gravest seizure and detention of stray dogs and their destrucof heat occurs through sodden footwear, tion by the police, if unclaimed, after a proper interval which many children have to wear throughout the and after due notification to the owner, a register day during wet weather. As a source of debility being kept with a brief description of every dog thus. this is probably of great importance, yet the provision seized and detained. The humanitarian zeal shown of simple slippers-which can be made by senior by some propagandists, and the distrust of medicine girls at little expense and with some educational shown by others, procured the insertion of a subbenefit-is the exception in most school areas. The section (Section 3, Subsection 5) enacting that no dog so seized shall be given or sold for the purpose midday hour, especially in country districts, may well be utilised in giving the children a hot meal. of vivisection." This clause, Prof. HILL suggests, It is sometimes possible to use the opportunity for should be repealed, but we fear that the attempt to teaching plain cookery and dietetic principles to the do so would rally once more those who have supported. bigger girls, and if efficiently supervised, a meal can the kindly but narrow views of the promoters of a be made into an occasion for imparting cleanly and series of Dogs’ Protection Bills. There are as many dog-lovers in the medical orderly table habits. Again, the play instinct of children largely determines their growth, so that the profession as in any other. We shall all agree that. lack or unsuitability of playground accommodation experiments upon dogs and cats should be restricted cries out for immediate reformWashing arrangements to the minimum. There would probably be scant -for the most part inadequate-now exist in most professional opposition to a regulation that these schools, but often the water will be found to be turned animals should not be used for demonstrating to off, " as the children make such a mess." One, or students accepted observations which need no furtherperhaps two, roller towels are used for the removal of confirmation, but that is a very different thing from dirt both from sweating or perhaps hastily soused enacting by law that no canine subjects should be hands and faces, and from boots. There is no need to employed in any capacity for medical research. The refer to septic conditions of the skin, nose, mouth, ears, reasons for using the dog for experiments devoted and eyes. It is not enough to have wash basins ; to the diminution of human and animal pain were there must be soap, preferably in receptacles from fully and fairly stated in the memoranduml issued which only a small quantity can be taken at one time. by the Medical Research Committee in 1919. It Paper towels are satisfactory and not expensive, was there shown how such experiments had led to in view of their advantages. Some responsible person the prevention of disease and suffering in matters, should always be present during the times of ablution. such as rickets, disorders of the teeth, the effects Erection of spray or shower baths may be somewhat of alcohol and diseases of the heart, and how much expensive, but in the long run it is cheaper than the the experiments had contributed to our knowledge present involved system of compulsory cleansing, and of blood circulation. It is probable that some who the moral value is beyond calculation. Swimming are ready to take a prominent part in what theybaths are a luxury, excellent as they are. As for the consider to be a defence of the dog have never studied condition of sanitary conveniences, that is something this document, which should be supplemented by that must be faced before any pretence is made to Dr. C. H. BEST’S letter on p. 1192 in the matter cf inculcate the principles of hygiene. Till these abuses insulin research, while many who now assume that are dealt with there is little need to consider the all experiments classed as vivisection necessarily broader aspects of structural alteration, building involve disregard of pain do not read the Inspeetor’s sites, exposure, and surroundings ; but enough reports prefixed to the annual Home Office return has been said to show the immediate necessity for under the Act of 1876. That Act makes animal public bodies, educationists, and medical men to experiments legal, subject to an elaborate system of make further efforts to improve the- conditions licensing, regulation, and inspection. Inspecting of elementary schools. officers pay frequent visits, usually without previous
leakage
"
to all places registered for experiment. In the latest report, that for 1925, the inspectors found all animals suitably lodged and well cared for, and the licensees generally attentive to the requirements of the Act and the conditions attached by the Home Office to their licences. They report only two cases of irregularity in the year. One of these was the unlicensed immersion of trout in polluted water under a misunderstanding of the scope of the Act ; immediate steps were taken by the offender to obtain a licence and the appropriate certificate. The other irregularity concerned certain simple inoculations made in the ase of cats ; the inoculator held Certificate A but lot Certificate E ; it was clear that he had erred mwittingly, and it was considered sufficient to admonish him. The importance of the report is that t shows how large a proportion of experiments are )ainless, and how great is the care taken to prevent he suffering of pain. However reassuring an Inspector’s report may be, here will still be dog-lovers who look upon every esearch worker as a ghoul, while forgetting that ’eterinary medicine owes a debt to medical research. fr. STEPHEN COLERIDGE inserts in a letter to the /M6.9 the observation that "it is, of course, id:J to.
notice,
EXPERIMENTS ON ANIMALS. A CHARGE of alleged dog-stealing led recently to the conviction of a dealer who has supplied animals to the University College School of Physiology ; the episode has been followed by prompt inquiry on the part of the authorities, by whom an official statement has now been issued. The episode has raised questions concerning the most satisfactory method of securing an adequate supply of animals for the purpose of research. Presumably it would not be impossible for the Medical Research Council to undertake the breeding of those required, though there is potential material already in existence. In a letter to the Times Prof. A. V. HILL has pointed out that over 50,000 stray, homeless, and unwanted dogs are annually sent to the lethal chamber, and the diversion of some of these to the service of scientific research would solve the problem imply and sensibly. But though this solution of the difficulty is adopted inAmerica and elsewhere, in England it is barred by the law. In 1906 Parliament passed a Dogs Act, concerned with divers matters such as the liability of dog-owners for injury to cattle, the compulsory dogcollar, and the exemption of sheep-dogs from licence duty. One -section of this measure dealt with the
1
THE
LANCET, 1919, i., 947.