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School hygiene in Manchester
1908.
PUBLIC HEALTH.
SCHOOL HYGIENE iN MANCHESTER. Extracted from the Annual Report of the Education Committee of the Manchester Corporation for the Year 1906-7.
N E W departure has just been made in connection with the municipal schools by the establishment of a cottage eentl~ for the teaching of housewifery. For years such a course has been successfully faken by girls at the Manchester Jews' School. Provision has now been made in two eottages belonging to the Committee in St. Mary's Road, Newton Heath. These houses have been simply furnished and equipped with the cookery utensils, etc., suitable for a working-class house. The teacher lives in one of the houses, and classes of twelve girls at a time are taught. All the practical details o.f household management are dealt with, including the buying and cooking of food, bread-making, mangling, and washing of clothes, cleaning, dusting, etc., and all the other details of household management. By means of this provision about 120 girls in Newton Heath Schools will have the benefit of practical training, and in time there Mll be simple lessons given in hygiene and the tending and feeding of young children. If the Committee are encouraged by success in this new departure there will no doubt be similar provision made in various other parts of the city. To meet the Government requirements it is necessary that each girl admitted to the housewifery centre should have previously gone through a course of lessons in cookery and laundry work. If the last six months of a girl's life at school could be spent at such a centre, in training for the duties of keeping the home, there ean be no question but that avast improvement would be effeeted in the comfort and eeonomy o{ home life, and such provision would have a tendency to prolong the school life of the girls of the public elementary schools. Feeding and Tending of In/ants.--About five years ago the School Board appointed Miss M. G. Taylor to lecture to the children of the public elementary schools on the nursing, feeding, and tending of infants, and the work has been most efficiently carried on. During last year Miss Taylor gave a course of lectures to the t i e s in Standards V and upwaSds in seventy-seven schools, the number of girls amounting to 5,815. The course includes six lectures, and at the conclusion the girls write out an account of the lessons. Some of the papers written were extremely creditable. It takes about eighteen months for Miss Taylor to cover the whole of the schools, and with a view to bring this within the year the committee some time ago decided to appoint a second teacher. There has been some difficulty in obtaining a woman who, by her education and practical experience, is exactly fitted for the post. The committee, however, have no doubt that before long they will find a suitable woman, and an opportunity will then be given to every girl in the upper standards of receiving this valuable instruction before leaving sehooi.
A
1(;3
Physical Ezereises.--Under the control of the committee's instructor of physical exercises tllere is now applied to the whole of tile children attending the public eIementary schools an approved course of drill and physical exercises taught by class teachers. The scheme has been in operation about five years, and has proa-ed an entire success by contributing greatly to the health and improved physical conditions of the children. Each year classes are carried on out of school hours for the training of the teachers, and altogether the lessons have provided an efficient training in the various exercises contained in the scheme, which is so administered as not to produce an undue strain upon the strength of those who are under instruction. Bath~ing of School Children.--The Baths Committee of the Manchester City Council Public Elementary Schools admit children over seven years of age free to the second-class swimming baths any week day, except Saturday, when in charge of a teacher.* The season extents from April to September, 8 a.m. to 4.30 p.m., and from October to March, 9 a.m. to 4.30 p.m. The n m n b e r of visits paid by school children to the public baths has increased from 133,152 in 1897 to 573,599 in 1907. In thus affording to school children opportunities of cultivating the habit of personal cleanliness, the Baths and Washhouses Committee render very valuable assistance to the work of the Edueatiou Committee. In regard to the teaching of swimming, it is a pleasure to be able to record the very v a h a b l e help which the Royal Humane Society for the Hundred of Salford continue to render by the presentation of badges for competition in the schools. Country SchooL--The country school for Manchester children (situated at Mobberley, twel~,e miles from the city) is still carried on by the Voluntary Committee, and has had a most successful season during the summer of 1907. As explained in previous reports, this school, the only one of its kind in the country, was established through the generosity of the late Mr. Herbert Philips four years ago. During the past year proposal s have been approved by which the freehold of the site is to be transferred to the City Council, and the present site of five acres extended to ten acres. This has been rendered possible through the generosity of the David Lewis Trustees, who own the land. The council are to have the option of purchasing the entire ten acres at a most reasonable cost. During the year there have been considerable extensions carried out, partly at the cost of the Education Committee, and partly through the generosity of Mrs. Herbert Philips and other friends, who contributed towards the provision of spray baths and other improvements. The dormitories have been extended so as to accommodate 128 beds. New domestic offices and a teachers' sitting-room, in brickwork, have been added to the corrugated iron building erected by ~'The u s e of t o k e n t i c k e t s a n d t i l e r u l e as to a t t e n d a n c e of teacllel'g w a s temporarily suspended dur]ll N the midsulumer holidays of the s c h o o l s , s o a s t o a l l o w of c h i l d r e n m a k i n g l i l o r e h ' e q u e n t ~'isits i o t h e baths.
164
PUBLIC
Mr. Herbert Philips. Water has been laid on from the Stoekport Corporation mains, and many improvements tending to perfect the saldtary condition of the school have been completed. The entire premises now consist of : Two dormitories (with sixty-four beds in each), each being commanded by a window in a teacher's roont. ~ Six single bedrooms for the staff, including the teachers. Two cloak-rooms. One boot-room, with a locker for each child. One sitting-room for the matron. One sitting-room for the teachers. One dining-room for seating accommodation for 150 ehildren.-~ A special bathroom with ten shower-baths, with hot and cold water supply for each child foot basins in separate compartments. In this room there is also an ordinary bath for the staff. A dressing-room adjoins the bathroom. T h e s a n i t a r y arrangements consist of pail closets, and the waste water from closets, bath, etc., is pumped on to the garden land. The lavatory is an open shed in quadrangle of main building, where the children wash in boMs on wooden tables. There is an ample playing field of about threeand-a-half acres of grass, provided with swings, etc. It is on this playing field that the tents for the extension of the accommodation have stood during a part of the summer. The instruction and control of the children is undertaken by the teachers who accompany the various batches (one teacher to forty scholars), the teachers belonging to the day schools in Manchester ordinarily attended by the children. Of course, the salaries of these teachers, paid by the Education Committee, run during the period of residence in the country school. The staff consists of matron and assistant, two women servants, and two men. The dietary is unrestricted, and with slight modifications is as follows : Breakfast (8 a.m.): Porridge with milk and sugar (three or four days a week.) ]Kilky tea, cocoa, or pure milk. Bread and butter ad lib.
Dinner (12 noon): Soup containing meat, or meat (l-lb. provided for each child) with potatoes and one vegetable ad lib. Pudding daily (milk, currant, ~nd raisin, treacle, tarts, and stewed fruit). Tea (4.30) : Bread and butter. MiIk, or milky tea. Jam, treacle, and cake alternately. (7.30) : Slice of bread and butter and half-pint of milk. Each scholar has three-quarters of a pint Of milk daily. The time table is as follows, but is subject to ~ B y m e a n s of t e n t s t h e n u m b e r of c h i l d r e n w a s e x t e n d e d d u r i n g t h e m i d d l e of t h e s u m m e r t o 269--128 i n t h e d o r m i t o r i e s a n d 132 i n t h e tents. ~;During the smnmer months the meals are served in a covered play g r o u n d , a n d h e r e it i s p o s M b l e to s e a t 2c0 c h i l d r e n a t o n e t i r o s ,
HEALTH.
JuN~,
variations according to the weather, etc. : - 6.45 a.m. Rise. 8 ,, Breakfast. 9.12 ,, School (in schoolroom). 12 noon Dinner. 4.30 p.m. Tea (o1" later on return excursion). 8 ,, Supper. 8.30 ,, Bed. 9 ,, Lights o~t.
from
The following additional particulars will be of interest. The school receives relays of children during the summer (April to October) from the public elementary schools, principally of the poorer districts of Manchester. Each batch of children stays for a fortnight. They are accompanied by their ordinary day school teachers, and are boarded, lodged, and taught during the period. Prior to admission, the children are invariably inspected in Manchester by the medical officers of the Education Committee, and through information in the hands of the School Attendance Department a clean bill of health for at least one month prior to admission is secured. There is no break whatever in the continuity of the teaching. T h e school is thoroughly equipped with all needful material for instruction, and the ordinary routine of the town school is continued. Actually nothing is changed save the local habitation of the children, and such alterations in t h e time table as are necessary to secure to the children the complete benefit of their rural surroundings. The scheme for the establishment of the country ,school was approved by the Board of Education some three years ago, and permission was given to reckon the attendanees made thereat in connection with the town schools from which the children are sent.
During the period in which the school was open this year, about 1,600 children and teachers have been received. Each child pays the stun of 7s. for the fortnight's stay, and this includes the charge for railway fares to and from Mobberley. The balance of the cost, establishment charges, etc., is met by vohmtary contributions. The success of the experimen% has been unmistakable. The scheme would have been fully justified if it did no more than provide the children once a year with a complete change of environment, for it must be remembered that for the bulk of these children there is no other possibility of a yearly holiday from home. Most of them are hopelessly debarred from the advantages to body and mind which come of such a change. But much more than the simple provision of a holiday is undertaken. The children benefit by the orderly routine of a well-arranged home. Besides being under daily instruction, they are well fed and most comfortably housed--too often in marked contrast to their feeding a n d housing at home. They are brought into touch with the influences of country life, and under skilful direction are taught some understanding and
PUBLIC
1908.
appreciation of the beauties of nature, not under any conditions to be learnt in their home surroundings. That the children benefit both in body and mind by their residence at the country school is the experience of all who come into contact with them. Having testimony to this effect on all hands from managers and teachers, and from the medical officers, the Manchester Education Committee have heartily supported the work of the Country School Committee, and have done everything in their power to make the operations effective, and extend them to as large a number of children as possible. ~'~EDICAL INSPECTION.
Sh~:n 1)isease,~, etc.---During the past year considerably more has been done with regard to the presence in our sctn)ols of children suffering from ringworm or having verminous heads. A nmnber of children have been sent to hospital for the treatment of ringworm, and the task of eradicating grossly verminous eases have been begun, a large number of cases having already been dealt with. The number of eases of ringworm affecting school children and treated at the Skin Hospital within the last twelve months was about 300. Leaflets containing information with regard to ringworm, infectious'sores, itch, and vermin, and special forms for exclusion of children suffering from those.complaints, have been drawn up, and are now m use. The children affected are excluded for definite periods. Parents are supplied with information regarding the complaints, and the attendance officers follow up the cases and endeavour to ensure adequate treatment. Eyesight.--During the last school year the nmnber of children whose eyesight was tested is 32,614, and of those, 2,037 were found to be suffering from defects of such gravity as to warrant the parents being notified. The scheme for the supply of glasses in eases where the parents were nnable to pay the cost, or could only afford part of it, has been in operation throughout the year, and 384 pairs of glasses were so provided. It having been found, that in many cases through indifference, neglect, or prejudice, the parents had not, even after having had circulars sent to them repeatedly, taken any steps to have their children's defective vision remedied, an attempt was made through the attendance officers to induce such parents to take action. The outcome of this work was fairly satisfactory, and the application for provision of a large number of pairs of glasses followed immediately after the visitation. There are, however, a large number of eases in which no amount of persuasion appears to have any effect, and the question arises as to whether eases of marked defect should not be excluded from sehool and further action taken. Although the weather interfered very greatly with the eyesight testing during the spring and summer months, an attempt was made to mitigate the pressure put on the honorary staffs at the eye hospitals through the influx of large numbers of e,hildren in short periods. This was found possible by arranging for the testing being made in alterhate districts, by so wording the circulars that the
HEALTII.
165
children attended at different hospitals and on definite days, and by the spreading of attendances of children over a much longer period. The number of cases of defective near vision reported during the last year was again unsatisfactory, but steps have been taken to ensure in the future a proper return of children with this defect. Heari'~,g.--Hitherto the returns of children suffering from defective hearing have been comparatively small, and although the method of dealing with such eases has been organised and in work, it has been beyond the power of your medical officers to deal adequately with this matter. This year, however, a further step has been taken, amt from the lists now sent in there is evidence that a much larger number of children will have to be tested. During the past year 999 were reported as suffering from defective hearing, and of these, in 316 the defects were so grave as to warrant the notification of the parents. As in previous years, a large nmnber of the remainder had their ears blocked with wax, and in the majority of cases the advice by the teachers to the parents was sufficient to bring about proper attention to the matter. AS;~entee,~.--The number of absentee scholars referred to your medical ot~eers for examination continues to grow. These children are brought to the office by the attendance officers on Saturdays, and are mostly eases in which there is no medical eertifica.te, or in which the attendance officers have some doubt as to the vallidity of the excuses given, while some have been referred by the rota. A record of such cases is now being kept, and out of eighty-seven so recorded since January 1st, twenty-one were certified as being fit for attendance at school at once, ten were certified fit after a period of a few days, and the remainder, from various causes, were either exempted for an indefinite period or until further report, or, as in eases of pronounced phthisis, etc., taken off the books. Provis~
PUBLIC HEAL)'H.
166
medical officer, who at the same time elicits such information as is possible regarding the home conditions, etc. Some urgent cases are provided with tickets at once, but the majority are referred for investigation through the attendance officers. The attendance officers' reports and the medical officers' notes are then compared, and tickets issued" to those found eligible. The following table shows the attendance at the various centres. The numbers will no doubt be largely increased as the winter advances, and with the opening of fresh centres to cover that portion of the poverty area not yet provided for : - P r ( ~ J e u s ~o S u m m eaq~c ' i "ays. ~'ul~b@r (Sept. g0,
N a m e df C e n t r e . Highest Number.
Lowest Nlll~lbel/
]
1907).
I
Albert Street
...
47
14
33
All Saints'
...
60
26
63
Chorlton Street ...
50
26
44
Great Jones Street
88
36
103
Mill Street
...
42
24
67
New Islilagton
...
161
82
164
38
14
35
Shakespeare Street
!
The diet provided for the children is, while inexpensive, both nourishing and palatable, due regard having been paid in each day's diet to the constituents necessary for the provision of a satisfactory meal. The children are at present provided with an alternation of eight varieties of diet. Your medical officer is in a position to assert from persona] observation, and from the reports of the teachers, that the provision of meals to badly nourished children has in m a n y cases already resuited, net only in improved physical condition, but in the raising of the standard of the children's capability for school work, of their powers of attention, and of their amenability to discipline.
Lectures on Hygiene to Pupil Teaehersi--The course of lectures given by your medical officer to the pupil teachers were continued this year. ']2he number of students attending the course was 10t, and these were divided into two classes. Each division attended a course of thirteen lectures, and each pupil was provided with a set of notes and diagrams explanatory of m a n y important items in the course of instruction, and with a copy of your medical officer's " Notes on Hygiene for Teachers," printed by the eommittec in 1905. Eaeh pupil received in addition, as a guide to the lectures, a syllabus of the course printed by the comm~tee last year. As previously explained by your medical officer, the syllabus was drawn up for a course of twenty to twenty-four lectures, and deals
Ju~E,
with subjects considered necessary for the imparting to students of the amount of knowledge adequate to render them efficient aid in the medical supervision of schools. Hitherto it has only been found possible to arrange for twelve or thirteen lectures of one hour's duration, As reported last year, your medical officer is of opinion that a course of at least twenty lectures is necessary. The pupils have had no previous tuition which would enable the lecturer to eliminate some of the preliminary knowledge necessary for the understanding of t h e lectures on hygiene proper, and the time available in a course of twelve lectures is quite inadequate. In view of the fresh development in medical inspection of schools which will undoubtedly take place in the near future, and of the extreme value of teaehers both in minimising the cost and increasing the efficiency of such inspection, your medical officer would again strongly urge that due provision be made for the proper carrying out of this work, which he considers of urgent importance.
Lectures to Parents and Teaehers.--During the last year permission was given to~ your medical officer to make the experiment of giving a series of addresses to parents. The meetings to be organised b y the teachers and held in the school buildings, and the addresses given by the medical officer. Three such addresses were given during the last winter, and in each case, owing to the enthusiastic work of the teachers, the meetings were eminently successful. The numbers of parents attending, of exactly the class desired, were very satisfactory, and the reports by the teachers of the result of the addresses have been highly gratifying. It is proposed to continue the series during the coming winter. Your medical officer has been requested by many teachers to repeat the course of lectures given to teachers in 1904, and should applications be recMved in a sufficient number this work will be again taken up. Stammerers.--During the last year your medical officers have examined ninety-six and submitted for treatment eighty-four stammerers, who were dealt with in eight classes, conducted by Miss Clay and her assistant (Miss Atkinson), and your medical officers have been highly satisfied with the successful result of these courses. Special Inves~igations.--Your medical officers have conducted an investigation with regard to the condition of the teeth of the children attending Duke Street Girls" School and St. Mark's Boys' School. Investigations have also been carried out with regard to the physical measurements, state of health, mental ability, and home conditions, etc., of the children attending the following schools : St. Peter's, Bengal Street ; St. James-the-Less and St. Michael's, Ancoats. This work has been completed at too recent a date to allow of a full report on the results, but a few of the Nets already extracted from the records made may be interesting. Teeth.--The teeth of 508 girls attending Duke Street School were examined, and it was found that
PUBLIC HEALTIt.
1908.
of these 439 had one or more decayed teeth. The average number of decayed teeth per child is 2"8, and the incidence of the numbers of decayed teeth and the number of children with nutrition below the normal are shown by the following table :---
167
So far as the analysis of the investigation has been carried out, your medicai officers are unable to state that the condition of the teeth is necessarily reflected in the physical condition of the child, but further investigation of this point is required.
NUMBER OF ~IRLS WITH DECAYED TEETH. I
Number of decayed teeth
...
Number of girls
...
...
1 ~ 2
93
3
4
5
6
7
8
9
10
11
12
13
89 ~ 85
83
42
21
7
9
4
1
3
1
1
11
9
4
1
1--
Nutrition below normal N O T E S ON T H E M I D W I V E S ' ACT.
THE
question of Supply of Midwives is the chief topic of action in the philanthropic bodies associated with midwifery, it being feared that through lack of sufficient certified midwives either the enforcement of the Act in 1910, prohibiting the practice of uncertified women, will cause suffering to poor women, especia]iy in scattered districts ; or the Act will be allowed to become a dead letter; or an Amending Act will be introduced, postponing the operation of the Act. It is contended that the latter will postpone indefinitely the incentive to the provision of midwives, and, if the Act be not amended, it is obviously essential to the efficiency and credit of local government that it should not be allowed to become a dead letter. It is not always realised that these philanthropic bodies, having their headquarters in London, can only be in touch with those districts that are represented on their associations or are in a position to bring the needs to the association's notice ; that, in short, they cannot reach many o f the districts that are most in need of midwives and have no " Lady Bountiful" or active M.O.H. to take up their cause. A policy of deeentralisation is therefore needed. The establishment of County Nursing Associations meets this need and is a policy much to be commended and supported b y ourselves. That nm;sing is of value to the individual health, that it offers a large and suitable field to the employment of women, that it is of considerable importance. especialiy as an educational factor, in the promotion and maintenance of the public health, are axioms that require no proof. Local authorities require an authoritative body with which to deal in approaching working questions and from which to learn facts collectively and in proportion. In the matters of midwifery and of school health, in which nursing can most assist local administration, the local authority is the County Council. The area for the representative body of nursing should similarly be the county. This policy has been actively promoted by the Queen Vietoria's Jubilee Institute for nurses, which now report s the existence of eighteen such County Associations in touch with the Institute. l
--
1
The Institute is sometimes able to make a grant toward the early expenses of such associations and is at all times ready to assist with information or otherwise in the formation of new associations. Its area includes Great Britain and Ireland; its offices are at 120, Victoria Street, London, S.W. ~, 29, Castle Terrace, E d i n b u r g h ; and 12, Upper Pembroke Street, Dublin; and it employs six inspectors for England, one for Wales, and superintendents for Scotland and Ireland, with a general superintendent in Miss Amy Hughes at their head. The Institute reeognises two types of n u r s e - the fully-trained Queen's nurse, costing a local association from £85 to £100 a year, and the village nurse, with a year's training in midwifery and general district nursing, at an annuaI cost of from £45 to £60. In the Report for 1907, the Institute records the work of 600 loeal associations in England, Wales and Ireland, and 200 in Scotland, employing 1,500 Queen's nurses, as wetl as a large number of village nurses. The establishment of county nursing associations may well engage the attention of county medical offeers, who will find little difficulty in arousing the interest of the leading county ladies for a scheme to serve an obviously benevolent and useful purpose. The advance made by the nursing profession in public recognition is evidenced by two Bills before Parliament this session. The Bill for State Registration, introduced into the House of Commons, has not yet been discussed. " The Official Directory of Nurses Bill,,' however--Mr. Sydney Holland's Bill--was introduced into the House of Lords by Lord Balfour of Burleigh, who moved the second reading on May 6th. The proposed directory was to be compiled from official sources giving such particulars as the Privy Couneii might think necessary. Every nurse, except those only trained in an institution carried on for private gain, would be entitled to have his or her name entered. The number .was estimated at from 40,000 to 60,000. Lord Ampthill moved the rejection of the Bill, as being a red herring drawn across the track of State Registration, and the second reading was lost b y fifty-three votes to twenty. There can be little doubt that The Midwives' Act is oni[7 the first step in the establishment of 13
PUBLIC HEALTH.
SCHOOL HYGIENE iN MANCHESTER. Extracted from the Annual Report of the Education Committee of the Manchester Corporation for the Year 1906-7.
N E W departure has just been made in connection with the municipal schools by the establishment of a cottage eentl~ for the teaching of housewifery. For years such a course has been successfully faken by girls at the Manchester Jews' School. Provision has now been made in two eottages belonging to the Committee in St. Mary's Road, Newton Heath. These houses have been simply furnished and equipped with the cookery utensils, etc., suitable for a working-class house. The teacher lives in one of the houses, and classes of twelve girls at a time are taught. All the practical details o.f household management are dealt with, including the buying and cooking of food, bread-making, mangling, and washing of clothes, cleaning, dusting, etc., and all the other details of household management. By means of this provision about 120 girls in Newton Heath Schools will have the benefit of practical training, and in time there Mll be simple lessons given in hygiene and the tending and feeding of young children. If the Committee are encouraged by success in this new departure there will no doubt be similar provision made in various other parts of the city. To meet the Government requirements it is necessary that each girl admitted to the housewifery centre should have previously gone through a course of lessons in cookery and laundry work. If the last six months of a girl's life at school could be spent at such a centre, in training for the duties of keeping the home, there ean be no question but that avast improvement would be effeeted in the comfort and eeonomy o{ home life, and such provision would have a tendency to prolong the school life of the girls of the public elementary schools. Feeding and Tending of In/ants.--About five years ago the School Board appointed Miss M. G. Taylor to lecture to the children of the public elementary schools on the nursing, feeding, and tending of infants, and the work has been most efficiently carried on. During last year Miss Taylor gave a course of lectures to the t i e s in Standards V and upwaSds in seventy-seven schools, the number of girls amounting to 5,815. The course includes six lectures, and at the conclusion the girls write out an account of the lessons. Some of the papers written were extremely creditable. It takes about eighteen months for Miss Taylor to cover the whole of the schools, and with a view to bring this within the year the committee some time ago decided to appoint a second teacher. There has been some difficulty in obtaining a woman who, by her education and practical experience, is exactly fitted for the post. The committee, however, have no doubt that before long they will find a suitable woman, and an opportunity will then be given to every girl in the upper standards of receiving this valuable instruction before leaving sehooi.
A
1(;3
Physical Ezereises.--Under the control of the committee's instructor of physical exercises tllere is now applied to the whole of tile children attending the public eIementary schools an approved course of drill and physical exercises taught by class teachers. The scheme has been in operation about five years, and has proa-ed an entire success by contributing greatly to the health and improved physical conditions of the children. Each year classes are carried on out of school hours for the training of the teachers, and altogether the lessons have provided an efficient training in the various exercises contained in the scheme, which is so administered as not to produce an undue strain upon the strength of those who are under instruction. Bath~ing of School Children.--The Baths Committee of the Manchester City Council Public Elementary Schools admit children over seven years of age free to the second-class swimming baths any week day, except Saturday, when in charge of a teacher.* The season extents from April to September, 8 a.m. to 4.30 p.m., and from October to March, 9 a.m. to 4.30 p.m. The n m n b e r of visits paid by school children to the public baths has increased from 133,152 in 1897 to 573,599 in 1907. In thus affording to school children opportunities of cultivating the habit of personal cleanliness, the Baths and Washhouses Committee render very valuable assistance to the work of the Edueatiou Committee. In regard to the teaching of swimming, it is a pleasure to be able to record the very v a h a b l e help which the Royal Humane Society for the Hundred of Salford continue to render by the presentation of badges for competition in the schools. Country SchooL--The country school for Manchester children (situated at Mobberley, twel~,e miles from the city) is still carried on by the Voluntary Committee, and has had a most successful season during the summer of 1907. As explained in previous reports, this school, the only one of its kind in the country, was established through the generosity of the late Mr. Herbert Philips four years ago. During the past year proposal s have been approved by which the freehold of the site is to be transferred to the City Council, and the present site of five acres extended to ten acres. This has been rendered possible through the generosity of the David Lewis Trustees, who own the land. The council are to have the option of purchasing the entire ten acres at a most reasonable cost. During the year there have been considerable extensions carried out, partly at the cost of the Education Committee, and partly through the generosity of Mrs. Herbert Philips and other friends, who contributed towards the provision of spray baths and other improvements. The dormitories have been extended so as to accommodate 128 beds. New domestic offices and a teachers' sitting-room, in brickwork, have been added to the corrugated iron building erected by ~'The u s e of t o k e n t i c k e t s a n d t i l e r u l e as to a t t e n d a n c e of teacllel'g w a s temporarily suspended dur]ll N the midsulumer holidays of the s c h o o l s , s o a s t o a l l o w of c h i l d r e n m a k i n g l i l o r e h ' e q u e n t ~'isits i o t h e baths.
164
PUBLIC
Mr. Herbert Philips. Water has been laid on from the Stoekport Corporation mains, and many improvements tending to perfect the saldtary condition of the school have been completed. The entire premises now consist of : Two dormitories (with sixty-four beds in each), each being commanded by a window in a teacher's roont. ~ Six single bedrooms for the staff, including the teachers. Two cloak-rooms. One boot-room, with a locker for each child. One sitting-room for the matron. One sitting-room for the teachers. One dining-room for seating accommodation for 150 ehildren.-~ A special bathroom with ten shower-baths, with hot and cold water supply for each child foot basins in separate compartments. In this room there is also an ordinary bath for the staff. A dressing-room adjoins the bathroom. T h e s a n i t a r y arrangements consist of pail closets, and the waste water from closets, bath, etc., is pumped on to the garden land. The lavatory is an open shed in quadrangle of main building, where the children wash in boMs on wooden tables. There is an ample playing field of about threeand-a-half acres of grass, provided with swings, etc. It is on this playing field that the tents for the extension of the accommodation have stood during a part of the summer. The instruction and control of the children is undertaken by the teachers who accompany the various batches (one teacher to forty scholars), the teachers belonging to the day schools in Manchester ordinarily attended by the children. Of course, the salaries of these teachers, paid by the Education Committee, run during the period of residence in the country school. The staff consists of matron and assistant, two women servants, and two men. The dietary is unrestricted, and with slight modifications is as follows : Breakfast (8 a.m.): Porridge with milk and sugar (three or four days a week.) ]Kilky tea, cocoa, or pure milk. Bread and butter ad lib.
Dinner (12 noon): Soup containing meat, or meat (l-lb. provided for each child) with potatoes and one vegetable ad lib. Pudding daily (milk, currant, ~nd raisin, treacle, tarts, and stewed fruit). Tea (4.30) : Bread and butter. MiIk, or milky tea. Jam, treacle, and cake alternately. (7.30) : Slice of bread and butter and half-pint of milk. Each scholar has three-quarters of a pint Of milk daily. The time table is as follows, but is subject to ~ B y m e a n s of t e n t s t h e n u m b e r of c h i l d r e n w a s e x t e n d e d d u r i n g t h e m i d d l e of t h e s u m m e r t o 269--128 i n t h e d o r m i t o r i e s a n d 132 i n t h e tents. ~;During the smnmer months the meals are served in a covered play g r o u n d , a n d h e r e it i s p o s M b l e to s e a t 2c0 c h i l d r e n a t o n e t i r o s ,
HEALTH.
JuN~,
variations according to the weather, etc. : - 6.45 a.m. Rise. 8 ,, Breakfast. 9.12 ,, School (in schoolroom). 12 noon Dinner. 4.30 p.m. Tea (o1" later on return excursion). 8 ,, Supper. 8.30 ,, Bed. 9 ,, Lights o~t.
from
The following additional particulars will be of interest. The school receives relays of children during the summer (April to October) from the public elementary schools, principally of the poorer districts of Manchester. Each batch of children stays for a fortnight. They are accompanied by their ordinary day school teachers, and are boarded, lodged, and taught during the period. Prior to admission, the children are invariably inspected in Manchester by the medical officers of the Education Committee, and through information in the hands of the School Attendance Department a clean bill of health for at least one month prior to admission is secured. There is no break whatever in the continuity of the teaching. T h e school is thoroughly equipped with all needful material for instruction, and the ordinary routine of the town school is continued. Actually nothing is changed save the local habitation of the children, and such alterations in t h e time table as are necessary to secure to the children the complete benefit of their rural surroundings. The scheme for the establishment of the country ,school was approved by the Board of Education some three years ago, and permission was given to reckon the attendanees made thereat in connection with the town schools from which the children are sent.
During the period in which the school was open this year, about 1,600 children and teachers have been received. Each child pays the stun of 7s. for the fortnight's stay, and this includes the charge for railway fares to and from Mobberley. The balance of the cost, establishment charges, etc., is met by vohmtary contributions. The success of the experimen% has been unmistakable. The scheme would have been fully justified if it did no more than provide the children once a year with a complete change of environment, for it must be remembered that for the bulk of these children there is no other possibility of a yearly holiday from home. Most of them are hopelessly debarred from the advantages to body and mind which come of such a change. But much more than the simple provision of a holiday is undertaken. The children benefit by the orderly routine of a well-arranged home. Besides being under daily instruction, they are well fed and most comfortably housed--too often in marked contrast to their feeding a n d housing at home. They are brought into touch with the influences of country life, and under skilful direction are taught some understanding and
PUBLIC
1908.
appreciation of the beauties of nature, not under any conditions to be learnt in their home surroundings. That the children benefit both in body and mind by their residence at the country school is the experience of all who come into contact with them. Having testimony to this effect on all hands from managers and teachers, and from the medical officers, the Manchester Education Committee have heartily supported the work of the Country School Committee, and have done everything in their power to make the operations effective, and extend them to as large a number of children as possible. ~'~EDICAL INSPECTION.
Sh~:n 1)isease,~, etc.---During the past year considerably more has been done with regard to the presence in our sctn)ols of children suffering from ringworm or having verminous heads. A nmnber of children have been sent to hospital for the treatment of ringworm, and the task of eradicating grossly verminous eases have been begun, a large number of cases having already been dealt with. The number of eases of ringworm affecting school children and treated at the Skin Hospital within the last twelve months was about 300. Leaflets containing information with regard to ringworm, infectious'sores, itch, and vermin, and special forms for exclusion of children suffering from those.complaints, have been drawn up, and are now m use. The children affected are excluded for definite periods. Parents are supplied with information regarding the complaints, and the attendance officers follow up the cases and endeavour to ensure adequate treatment. Eyesight.--During the last school year the nmnber of children whose eyesight was tested is 32,614, and of those, 2,037 were found to be suffering from defects of such gravity as to warrant the parents being notified. The scheme for the supply of glasses in eases where the parents were nnable to pay the cost, or could only afford part of it, has been in operation throughout the year, and 384 pairs of glasses were so provided. It having been found, that in many cases through indifference, neglect, or prejudice, the parents had not, even after having had circulars sent to them repeatedly, taken any steps to have their children's defective vision remedied, an attempt was made through the attendance officers to induce such parents to take action. The outcome of this work was fairly satisfactory, and the application for provision of a large number of pairs of glasses followed immediately after the visitation. There are, however, a large number of eases in which no amount of persuasion appears to have any effect, and the question arises as to whether eases of marked defect should not be excluded from sehool and further action taken. Although the weather interfered very greatly with the eyesight testing during the spring and summer months, an attempt was made to mitigate the pressure put on the honorary staffs at the eye hospitals through the influx of large numbers of e,hildren in short periods. This was found possible by arranging for the testing being made in alterhate districts, by so wording the circulars that the
HEALTII.
165
children attended at different hospitals and on definite days, and by the spreading of attendances of children over a much longer period. The number of cases of defective near vision reported during the last year was again unsatisfactory, but steps have been taken to ensure in the future a proper return of children with this defect. Heari'~,g.--Hitherto the returns of children suffering from defective hearing have been comparatively small, and although the method of dealing with such eases has been organised and in work, it has been beyond the power of your medical officers to deal adequately with this matter. This year, however, a further step has been taken, amt from the lists now sent in there is evidence that a much larger number of children will have to be tested. During the past year 999 were reported as suffering from defective hearing, and of these, in 316 the defects were so grave as to warrant the notification of the parents. As in previous years, a large nmnber of the remainder had their ears blocked with wax, and in the majority of cases the advice by the teachers to the parents was sufficient to bring about proper attention to the matter. AS;~entee,~.--The number of absentee scholars referred to your medical ot~eers for examination continues to grow. These children are brought to the office by the attendance officers on Saturdays, and are mostly eases in which there is no medical eertifica.te, or in which the attendance officers have some doubt as to the vallidity of the excuses given, while some have been referred by the rota. A record of such cases is now being kept, and out of eighty-seven so recorded since January 1st, twenty-one were certified as being fit for attendance at school at once, ten were certified fit after a period of a few days, and the remainder, from various causes, were either exempted for an indefinite period or until further report, or, as in eases of pronounced phthisis, etc., taken off the books. Provis~
PUBLIC HEAL)'H.
166
medical officer, who at the same time elicits such information as is possible regarding the home conditions, etc. Some urgent cases are provided with tickets at once, but the majority are referred for investigation through the attendance officers. The attendance officers' reports and the medical officers' notes are then compared, and tickets issued" to those found eligible. The following table shows the attendance at the various centres. The numbers will no doubt be largely increased as the winter advances, and with the opening of fresh centres to cover that portion of the poverty area not yet provided for : - P r ( ~ J e u s ~o S u m m eaq~c ' i "ays. ~'ul~b@r (Sept. g0,
N a m e df C e n t r e . Highest Number.
Lowest Nlll~lbel/
]
1907).
I
Albert Street
...
47
14
33
All Saints'
...
60
26
63
Chorlton Street ...
50
26
44
Great Jones Street
88
36
103
Mill Street
...
42
24
67
New Islilagton
...
161
82
164
38
14
35
Shakespeare Street
!
The diet provided for the children is, while inexpensive, both nourishing and palatable, due regard having been paid in each day's diet to the constituents necessary for the provision of a satisfactory meal. The children are at present provided with an alternation of eight varieties of diet. Your medical officer is in a position to assert from persona] observation, and from the reports of the teachers, that the provision of meals to badly nourished children has in m a n y cases already resuited, net only in improved physical condition, but in the raising of the standard of the children's capability for school work, of their powers of attention, and of their amenability to discipline.
Lectures on Hygiene to Pupil Teaehersi--The course of lectures given by your medical officer to the pupil teachers were continued this year. ']2he number of students attending the course was 10t, and these were divided into two classes. Each division attended a course of thirteen lectures, and each pupil was provided with a set of notes and diagrams explanatory of m a n y important items in the course of instruction, and with a copy of your medical officer's " Notes on Hygiene for Teachers," printed by the eommittec in 1905. Eaeh pupil received in addition, as a guide to the lectures, a syllabus of the course printed by the comm~tee last year. As previously explained by your medical officer, the syllabus was drawn up for a course of twenty to twenty-four lectures, and deals
Ju~E,
with subjects considered necessary for the imparting to students of the amount of knowledge adequate to render them efficient aid in the medical supervision of schools. Hitherto it has only been found possible to arrange for twelve or thirteen lectures of one hour's duration, As reported last year, your medical officer is of opinion that a course of at least twenty lectures is necessary. The pupils have had no previous tuition which would enable the lecturer to eliminate some of the preliminary knowledge necessary for the understanding of t h e lectures on hygiene proper, and the time available in a course of twelve lectures is quite inadequate. In view of the fresh development in medical inspection of schools which will undoubtedly take place in the near future, and of the extreme value of teaehers both in minimising the cost and increasing the efficiency of such inspection, your medical officer would again strongly urge that due provision be made for the proper carrying out of this work, which he considers of urgent importance.
Lectures to Parents and Teaehers.--During the last year permission was given to~ your medical officer to make the experiment of giving a series of addresses to parents. The meetings to be organised b y the teachers and held in the school buildings, and the addresses given by the medical officer. Three such addresses were given during the last winter, and in each case, owing to the enthusiastic work of the teachers, the meetings were eminently successful. The numbers of parents attending, of exactly the class desired, were very satisfactory, and the reports by the teachers of the result of the addresses have been highly gratifying. It is proposed to continue the series during the coming winter. Your medical officer has been requested by many teachers to repeat the course of lectures given to teachers in 1904, and should applications be recMved in a sufficient number this work will be again taken up. Stammerers.--During the last year your medical officers have examined ninety-six and submitted for treatment eighty-four stammerers, who were dealt with in eight classes, conducted by Miss Clay and her assistant (Miss Atkinson), and your medical officers have been highly satisfied with the successful result of these courses. Special Inves~igations.--Your medical officers have conducted an investigation with regard to the condition of the teeth of the children attending Duke Street Girls" School and St. Mark's Boys' School. Investigations have also been carried out with regard to the physical measurements, state of health, mental ability, and home conditions, etc., of the children attending the following schools : St. Peter's, Bengal Street ; St. James-the-Less and St. Michael's, Ancoats. This work has been completed at too recent a date to allow of a full report on the results, but a few of the Nets already extracted from the records made may be interesting. Teeth.--The teeth of 508 girls attending Duke Street School were examined, and it was found that
PUBLIC HEALTIt.
1908.
of these 439 had one or more decayed teeth. The average number of decayed teeth per child is 2"8, and the incidence of the numbers of decayed teeth and the number of children with nutrition below the normal are shown by the following table :---
167
So far as the analysis of the investigation has been carried out, your medicai officers are unable to state that the condition of the teeth is necessarily reflected in the physical condition of the child, but further investigation of this point is required.
NUMBER OF ~IRLS WITH DECAYED TEETH. I
Number of decayed teeth
...
Number of girls
...
...
1 ~ 2
93
3
4
5
6
7
8
9
10
11
12
13
89 ~ 85
83
42
21
7
9
4
1
3
1
1
11
9
4
1
1--
Nutrition below normal N O T E S ON T H E M I D W I V E S ' ACT.
THE
question of Supply of Midwives is the chief topic of action in the philanthropic bodies associated with midwifery, it being feared that through lack of sufficient certified midwives either the enforcement of the Act in 1910, prohibiting the practice of uncertified women, will cause suffering to poor women, especia]iy in scattered districts ; or the Act will be allowed to become a dead letter; or an Amending Act will be introduced, postponing the operation of the Act. It is contended that the latter will postpone indefinitely the incentive to the provision of midwives, and, if the Act be not amended, it is obviously essential to the efficiency and credit of local government that it should not be allowed to become a dead letter. It is not always realised that these philanthropic bodies, having their headquarters in London, can only be in touch with those districts that are represented on their associations or are in a position to bring the needs to the association's notice ; that, in short, they cannot reach many o f the districts that are most in need of midwives and have no " Lady Bountiful" or active M.O.H. to take up their cause. A policy of deeentralisation is therefore needed. The establishment of County Nursing Associations meets this need and is a policy much to be commended and supported b y ourselves. That nm;sing is of value to the individual health, that it offers a large and suitable field to the employment of women, that it is of considerable importance. especialiy as an educational factor, in the promotion and maintenance of the public health, are axioms that require no proof. Local authorities require an authoritative body with which to deal in approaching working questions and from which to learn facts collectively and in proportion. In the matters of midwifery and of school health, in which nursing can most assist local administration, the local authority is the County Council. The area for the representative body of nursing should similarly be the county. This policy has been actively promoted by the Queen Vietoria's Jubilee Institute for nurses, which now report s the existence of eighteen such County Associations in touch with the Institute. l
--
1
The Institute is sometimes able to make a grant toward the early expenses of such associations and is at all times ready to assist with information or otherwise in the formation of new associations. Its area includes Great Britain and Ireland; its offices are at 120, Victoria Street, London, S.W. ~, 29, Castle Terrace, E d i n b u r g h ; and 12, Upper Pembroke Street, Dublin; and it employs six inspectors for England, one for Wales, and superintendents for Scotland and Ireland, with a general superintendent in Miss Amy Hughes at their head. The Institute reeognises two types of n u r s e - the fully-trained Queen's nurse, costing a local association from £85 to £100 a year, and the village nurse, with a year's training in midwifery and general district nursing, at an annuaI cost of from £45 to £60. In the Report for 1907, the Institute records the work of 600 loeal associations in England, Wales and Ireland, and 200 in Scotland, employing 1,500 Queen's nurses, as wetl as a large number of village nurses. The establishment of county nursing associations may well engage the attention of county medical offeers, who will find little difficulty in arousing the interest of the leading county ladies for a scheme to serve an obviously benevolent and useful purpose. The advance made by the nursing profession in public recognition is evidenced by two Bills before Parliament this session. The Bill for State Registration, introduced into the House of Commons, has not yet been discussed. " The Official Directory of Nurses Bill,,' however--Mr. Sydney Holland's Bill--was introduced into the House of Lords by Lord Balfour of Burleigh, who moved the second reading on May 6th. The proposed directory was to be compiled from official sources giving such particulars as the Privy Couneii might think necessary. Every nurse, except those only trained in an institution carried on for private gain, would be entitled to have his or her name entered. The number .was estimated at from 40,000 to 60,000. Lord Ampthill moved the rejection of the Bill, as being a red herring drawn across the track of State Registration, and the second reading was lost b y fifty-three votes to twenty. There can be little doubt that The Midwives' Act is oni[7 the first step in the establishment of 13