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The pediatrician and the teacher
T H E P E D I A T R I C I A N AND T H E T E A C H E R ERNEST O, MELBY, e" P H . D . , EVANSTON, ILL.
probably be more or less futile and perhaps presumptuous I TforW OmeU LtoD report any educational research which would make any very significant contributio n to y o u r thinking about either the problems of education or problems t h a t are essentially medical. It seems to me, however, that the thing that I might do that would be of greatest help to you would be to indicate some of the ways in which I think medical people and educators might work together in areas in which they have a common interest. I can do that best, not by telling you about your faults and shortcomings (a subject on which I certainly am not competent to speak) but perhaps by telling you about the faults and shortcomings of teachers in schools, because I believe t h a t if you, as p e d i atricians and medical workers, understood exactly how m a n y difficulties schools and teachers face and just what our weaknesses are, perhaps you could fit your strength and contribution into that p i c t u r e more effectively than you otherwise would. I t h i n k I need not tell pediatricians about the enormous amount of maladjustment that is brought about by the wrong kind of educational practice and the failure of the school to meet the needs of individual children. You as medical men have from time immemorial thought of your practice in individual terms. The v e r y phrase "adjustment of the child to school" sounds bad to you. You would much r a t h e r have us talk of the adjustment of the school to the child. It does not sound any better to you to talk about the adjustment of the child to the school than it would for me to talk about the adjustment of the patient to the hospital, an idea which to you would, of course, seem an utter monstrosity. Nevertheless educators have thought so long in terms of practice which emphasized subjects to be learned and programs to be followed rather than personalities to be developed that we have an extremely difficult battle within the profession to get teachers and schools to see that schools are for children, and we have a very h a r d time within the teaching profession to get teachers to see that boys and girls are worth more than books. Ordinarily their assumption is that books are more important than boys and girls. In medicine you have so long stressed individual diagnosis that you have become more sensitive to the needs of individual personalities than teachers have. As doctors, and especially as obstetricians and pediatricians, you have one great advantage over us. You make y o u r entry into the life of the child so much earlier. The average child enters school at the age of six and by that time so much conditioning has taken Presented at the meeting of Region III of the American Academy of Pediatrics,
Chicago, May, 1941. *Dean of the School of Education, Northwestern ]Jniversity. 672
MELBu
PEDIATRICIAN AND TEACHER
673
place that we have a very difficult time achieving results. Obstetricians and pediatricians enter the life of the child either v e r y soon after birth or in the early stages of pregnancy. I t may even be that you are called into consultation on matters of family planning a n d family relationships even before conception. The importance of personality growth and development in the educational life of the child does not need to be stressed here, but we should think together about some of the researeh which is coming out of the child development centers and which is throwing light on the kind of elhnate which is necessary for maximum growth and development on the p a r t of children. We find, for example, t h a t children who are b r o u g h t up in an orphanage make slower intellectual and emotional adjustment than children who are brought up in an individual home. We find that affeetion, seeurity, and freedom are the influences which are most effective in promoting the growth of children intellectually, emotionally, and in all-around personality development. Now if that is true, is it not perfectly clear that the emotiohal factors, the social adjustment factors, in short, the human relationships which operate in this climate for the growth of the child, are of the greatest importance? Is it not likely that the child's parents have, either for good or for ill, made certain adjustments to one another, perhaps long before the child enters the school, and that out of those adjustments, good or bad as they m a y be, certain personality conditioning has already taken place ? In other words, when we teachers get the child it is often too late to do anything, or at least much harm has already resulted. Not only do medical men and women come into the scene years earlier, but the parents are much more likely to listen to you than they are to us. You have achieved for yourselves throughout decades a certain professional regard. I do not know whether I should say here that this may in part be due to the fact that the parent has tb pay for your advice and that he gets ours for nothing. We will not debate that, but in a a y case I think that y o u r influence is more effective. I t i s more effective perhaps for another reason. The coming of a child into:a family is an event of great emotional significance in the relationship of husband and wife, and the coming of the child is a great center of interest; when you talk to parents at that period y o u are in a very strategic position. &ll of which leads up to a point of view that I have held for a long time. I believe that the practice of medicine is essentially an educational job, and I believe that e v e r y doctor is a n educator in the true sense of t h e word, and I think he should have equipment to be an educator: Let us leave the medical scene for a moment to look back at the teaching profession. Within the teach~ng profession we have stressed sub/ ject-matter learning. More than that, we have stressed mass learning, and we have carried on our enterprise on a mass basis. Now the few
674
TItE
JOURNAL
OF
PEDIATRICS
examples of progressive schools that s t u d y their ehildren individually and carry f o r w a r d their educational p r o g r a m s on the basis of diagnostic procedure are exceptions perhaps t h a t prove the rule. Moreover within the teaching profession, we have more or less ignored the emotional development of the ~ehild, a n d we have not concerned ourselves with total personality development nearly as much as we should. Now notice what h a p p e n s in the life of a child. F o r the vast m a j o r i t y of American children the services of pediatricians are not available, so that the service which you people could render with such s a l u t a r y results just is not available to millions of children. We as teachers and school people have neither the equipment, the knowledge, nor the skill, n o r the point of view to do t h a t job as we should, and moreover we enter the scene about six years too late to do our most i m p o r t a n t job. Now, p u t t i n g all of these things together, I believe t h a t teachers should have f a r greater knowledge of the h u m a n organism, of the emotional elements in personality; in short, teachers should know a great deal of what you know. They do not w a n t to take y o u r jobs a w a y f r o m you, but they should know something of what you know about h u m a n beings so they can be more sensitive to the factors which enter into a satisfactory climate for h u m a n growth and development in the school. Then I think, if you do not already know it, you should know some of what teachers know, so t h a t you can take advantage of influencing the first six years of the child's life. You will influence older children also, but I am thinking p a r t i c u l a r l y of t h a t period when we have no chance at the parents or the children. The research which has been done in medicine and in education points in the same direction. I t indicates t h a t total personality should be our main concern, educationally speaking and medically speaking. Isolated medical treatment, if I read some of y o u r literature correctly, is not viewed as being v e r y acceptable, nor is isolated learning of subject matter apart f r o m personality development viewed as acceptable praetiee in modern education. Both you and we need to be concerned with the broader aspects of personality development. We are both interested in the development of a climate f o r ereative living on the p a r t of all human beings. Now let us examine the school to see how our cooperative endeavor is actually going on. M a n y seh0ols in this country have no school physicians. M a n y schools have few teacher's who are really familiar with the nature of the h u m a n organism, its growth and development or its behavior. Millions of American children are going to sehool in places where there is really no person who is competent to advise on problems of maladjustment or who is competent to arrange an environment which is desirable for m a x i m u m growth and development of individual children. E v e n where there are school physicians I wonder if we are using those school physieians in the best way. Is it not true t h a t a great
MELBY:
PEDIATRICIA_N AND T E A C H E R
675
deal of the effort which these people can put forth has to do with the control of contagious disease, with the correction of physical defects, the removal of tonsils, and so on, and that very little of the school physician's effort goes into the problems of emotional and personality adjustment ? Have we trained school physicians in the best way? Is it possible that physicians generally, because of the nature of medical practice, have found it necessary to emphasize the pathologic and abnormal rather than the normal, and that the average schooI physician is better equipped to take care of physical defects and to deal with the control of health generally in a social way than he is to deal with the problems of personality adjustment on the part of individual children? Now if that is true, then perhaps we need modifications not only in the training of teachers, but also in the training of those who are to serve as school physicians. In fact, I wonder whether it is not going to be incumbent upon us to merge in some measure the activities of these two groups of people. I f I could influbnce the work of these two professions I would bring them much closer together than they are at the present time. There should be teachers here listening to these programs. The previous speaker said some things that might well have been heard by every teacher in Chicago. Every teacher in Chicago should have heard the comments which the previous speaker made on ' the question of sex education alone, but it is not only the matter of our hearing what should be done; we should know something about the scientific basis for the things that we ought to do, and I am glad personally that I came in early enough to hear some earlier parts of this paper which were used by the speaker as a basis for the advice which he later gave to teachers, and if I may be presumptuous enough, I shotild like to suggest that I think there are things going on in educational cfrcles which would be worth while for you people to hear. Maybe we should have joint meetings of pediatricians and physicians and teachers where we could concern ourselves with the problems of human growth and development, of child development, 'of education. Education is one of our oldest professions and it is one which intrudes itself upon the life of everyone and yet it is one that is most misunderstood. When we attend parent-teacher meetings the questions which laymen bring to us are a simultaneous evidence of the interest of the layman in educational problems and of his lack of understanding. You have that problem, too, but I think so far you have probably done a little better job of familiarizing the layman with your profession than we have. I think we both, however, have the job of helping parents and people generally to a better understanding of the problems of child care and development and education. May I illustrate? The biologist tells us that every human organism is unique. For example, of all the people in this room no
676
THE JOURNAL OF PED~ATR]EC~
two of y o u are alike. More t h a n that, if I t a k e a n y one of you there has never been a person like you in the world before and there is never going to be one again. E v e r y child that enters y o u r practice presents a unique problem t h a t neither you nor a n y other pediatrician has ever faced before or will ever face again a f t e r that child has made his exit f r o m the world. E v e r y h u m a n being is a unique phenomenon. He possesses creative powers which no other h u m a n being possesses. I f he becomes a p a i n t e r he will p a i n t a picture t h a t nobody else could paint. I f he is a musical composer he will write a s y m p h o n y t h a t nobody else.could write. No m a t t e r what his endeavor m a y be, he is a unique personality. The problem of education, you see, is the problem of giving each of these unique personalities the o p p o r t u n i t y to develop as a unique personality and to make t h a t contribution to society as a whole which t h a t personality alone can make. Now it is the glory of the democratic way of life that it alone of all the social p a t t e r n s holds out to individual h u m a n beings the right to be themselves and the right to be unique personalities. You m a y not have thought of it but when you as a physician or as a pediatrician go into a home and help the parents to create for an individual child a really favorable climate for t h e growth and development of t h a t child as a unique personality, you are practicing democracy in one of the real ways in which it can be p r a c t i c e d as opposed to totalitarianism. I f we believe in totalitarianism we would take that child and shape him for whatever purposes we had in mind and ignore his unique personality characteristics. I do not, therefore, see how you people can ever be converted to totalitarianism no m a t t e r what happens to the rest of us, because I believe t h a t everything in y o u r medical science is in conflict f r o m a social a n d a philosophical point of view w i t h the t o t a l i t a r i a n concept of life. I mention that because I should like to leave with you the idea that there is a relationship between education and social patterns o f v a r i o u s kinds. T h e r e is a relationship between science and social patterns of various kinds. W h e n we are practicing these professions of education and medicine, we are working out the principles of our w a y of life. Our way of life has an impact upon our profession and the spirit in which we conduct it, and I think that you, as members of the medical profession, and we, a s members of the teaching profession, have a joint responsibility to create in schools and in homes and in communities the kind of environment which will help individual children to make the most of their capacities a n d in t u r n to make the greatest contribution to the social structure as a whole. T h a t is democracy, that is good teaching, and, with y o u r permission, t h a t is good practice of medicine.
probably be more or less futile and perhaps presumptuous I TforW OmeU LtoD report any educational research which would make any very significant contributio n to y o u r thinking about either the problems of education or problems t h a t are essentially medical. It seems to me, however, that the thing that I might do that would be of greatest help to you would be to indicate some of the ways in which I think medical people and educators might work together in areas in which they have a common interest. I can do that best, not by telling you about your faults and shortcomings (a subject on which I certainly am not competent to speak) but perhaps by telling you about the faults and shortcomings of teachers in schools, because I believe t h a t if you, as p e d i atricians and medical workers, understood exactly how m a n y difficulties schools and teachers face and just what our weaknesses are, perhaps you could fit your strength and contribution into that p i c t u r e more effectively than you otherwise would. I t h i n k I need not tell pediatricians about the enormous amount of maladjustment that is brought about by the wrong kind of educational practice and the failure of the school to meet the needs of individual children. You as medical men have from time immemorial thought of your practice in individual terms. The v e r y phrase "adjustment of the child to school" sounds bad to you. You would much r a t h e r have us talk of the adjustment of the school to the child. It does not sound any better to you to talk about the adjustment of the child to the school than it would for me to talk about the adjustment of the patient to the hospital, an idea which to you would, of course, seem an utter monstrosity. Nevertheless educators have thought so long in terms of practice which emphasized subjects to be learned and programs to be followed rather than personalities to be developed that we have an extremely difficult battle within the profession to get teachers and schools to see that schools are for children, and we have a very h a r d time within the teaching profession to get teachers to see that boys and girls are worth more than books. Ordinarily their assumption is that books are more important than boys and girls. In medicine you have so long stressed individual diagnosis that you have become more sensitive to the needs of individual personalities than teachers have. As doctors, and especially as obstetricians and pediatricians, you have one great advantage over us. You make y o u r entry into the life of the child so much earlier. The average child enters school at the age of six and by that time so much conditioning has taken Presented at the meeting of Region III of the American Academy of Pediatrics,
Chicago, May, 1941. *Dean of the School of Education, Northwestern ]Jniversity. 672
MELBu
PEDIATRICIAN AND TEACHER
673
place that we have a very difficult time achieving results. Obstetricians and pediatricians enter the life of the child either v e r y soon after birth or in the early stages of pregnancy. I t may even be that you are called into consultation on matters of family planning a n d family relationships even before conception. The importance of personality growth and development in the educational life of the child does not need to be stressed here, but we should think together about some of the researeh which is coming out of the child development centers and which is throwing light on the kind of elhnate which is necessary for maximum growth and development on the p a r t of children. We find, for example, t h a t children who are b r o u g h t up in an orphanage make slower intellectual and emotional adjustment than children who are brought up in an individual home. We find that affeetion, seeurity, and freedom are the influences which are most effective in promoting the growth of children intellectually, emotionally, and in all-around personality development. Now if that is true, is it not perfectly clear that the emotiohal factors, the social adjustment factors, in short, the human relationships which operate in this climate for the growth of the child, are of the greatest importance? Is it not likely that the child's parents have, either for good or for ill, made certain adjustments to one another, perhaps long before the child enters the school, and that out of those adjustments, good or bad as they m a y be, certain personality conditioning has already taken place ? In other words, when we teachers get the child it is often too late to do anything, or at least much harm has already resulted. Not only do medical men and women come into the scene years earlier, but the parents are much more likely to listen to you than they are to us. You have achieved for yourselves throughout decades a certain professional regard. I do not know whether I should say here that this may in part be due to the fact that the parent has tb pay for your advice and that he gets ours for nothing. We will not debate that, but in a a y case I think that y o u r influence is more effective. I t i s more effective perhaps for another reason. The coming of a child into:a family is an event of great emotional significance in the relationship of husband and wife, and the coming of the child is a great center of interest; when you talk to parents at that period y o u are in a very strategic position. &ll of which leads up to a point of view that I have held for a long time. I believe that the practice of medicine is essentially an educational job, and I believe that e v e r y doctor is a n educator in the true sense of t h e word, and I think he should have equipment to be an educator: Let us leave the medical scene for a moment to look back at the teaching profession. Within the teach~ng profession we have stressed sub/ ject-matter learning. More than that, we have stressed mass learning, and we have carried on our enterprise on a mass basis. Now the few
674
TItE
JOURNAL
OF
PEDIATRICS
examples of progressive schools that s t u d y their ehildren individually and carry f o r w a r d their educational p r o g r a m s on the basis of diagnostic procedure are exceptions perhaps t h a t prove the rule. Moreover within the teaching profession, we have more or less ignored the emotional development of the ~ehild, a n d we have not concerned ourselves with total personality development nearly as much as we should. Now notice what h a p p e n s in the life of a child. F o r the vast m a j o r i t y of American children the services of pediatricians are not available, so that the service which you people could render with such s a l u t a r y results just is not available to millions of children. We as teachers and school people have neither the equipment, the knowledge, nor the skill, n o r the point of view to do t h a t job as we should, and moreover we enter the scene about six years too late to do our most i m p o r t a n t job. Now, p u t t i n g all of these things together, I believe t h a t teachers should have f a r greater knowledge of the h u m a n organism, of the emotional elements in personality; in short, teachers should know a great deal of what you know. They do not w a n t to take y o u r jobs a w a y f r o m you, but they should know something of what you know about h u m a n beings so they can be more sensitive to the factors which enter into a satisfactory climate for h u m a n growth and development in the school. Then I think, if you do not already know it, you should know some of what teachers know, so t h a t you can take advantage of influencing the first six years of the child's life. You will influence older children also, but I am thinking p a r t i c u l a r l y of t h a t period when we have no chance at the parents or the children. The research which has been done in medicine and in education points in the same direction. I t indicates t h a t total personality should be our main concern, educationally speaking and medically speaking. Isolated medical treatment, if I read some of y o u r literature correctly, is not viewed as being v e r y acceptable, nor is isolated learning of subject matter apart f r o m personality development viewed as acceptable praetiee in modern education. Both you and we need to be concerned with the broader aspects of personality development. We are both interested in the development of a climate f o r ereative living on the p a r t of all human beings. Now let us examine the school to see how our cooperative endeavor is actually going on. M a n y seh0ols in this country have no school physicians. M a n y schools have few teacher's who are really familiar with the nature of the h u m a n organism, its growth and development or its behavior. Millions of American children are going to sehool in places where there is really no person who is competent to advise on problems of maladjustment or who is competent to arrange an environment which is desirable for m a x i m u m growth and development of individual children. E v e n where there are school physicians I wonder if we are using those school physieians in the best way. Is it not true t h a t a great
MELBY:
PEDIATRICIA_N AND T E A C H E R
675
deal of the effort which these people can put forth has to do with the control of contagious disease, with the correction of physical defects, the removal of tonsils, and so on, and that very little of the school physician's effort goes into the problems of emotional and personality adjustment ? Have we trained school physicians in the best way? Is it possible that physicians generally, because of the nature of medical practice, have found it necessary to emphasize the pathologic and abnormal rather than the normal, and that the average schooI physician is better equipped to take care of physical defects and to deal with the control of health generally in a social way than he is to deal with the problems of personality adjustment on the part of individual children? Now if that is true, then perhaps we need modifications not only in the training of teachers, but also in the training of those who are to serve as school physicians. In fact, I wonder whether it is not going to be incumbent upon us to merge in some measure the activities of these two groups of people. I f I could influbnce the work of these two professions I would bring them much closer together than they are at the present time. There should be teachers here listening to these programs. The previous speaker said some things that might well have been heard by every teacher in Chicago. Every teacher in Chicago should have heard the comments which the previous speaker made on ' the question of sex education alone, but it is not only the matter of our hearing what should be done; we should know something about the scientific basis for the things that we ought to do, and I am glad personally that I came in early enough to hear some earlier parts of this paper which were used by the speaker as a basis for the advice which he later gave to teachers, and if I may be presumptuous enough, I shotild like to suggest that I think there are things going on in educational cfrcles which would be worth while for you people to hear. Maybe we should have joint meetings of pediatricians and physicians and teachers where we could concern ourselves with the problems of human growth and development, of child development, 'of education. Education is one of our oldest professions and it is one which intrudes itself upon the life of everyone and yet it is one that is most misunderstood. When we attend parent-teacher meetings the questions which laymen bring to us are a simultaneous evidence of the interest of the layman in educational problems and of his lack of understanding. You have that problem, too, but I think so far you have probably done a little better job of familiarizing the layman with your profession than we have. I think we both, however, have the job of helping parents and people generally to a better understanding of the problems of child care and development and education. May I illustrate? The biologist tells us that every human organism is unique. For example, of all the people in this room no
676
THE JOURNAL OF PED~ATR]EC~
two of y o u are alike. More t h a n that, if I t a k e a n y one of you there has never been a person like you in the world before and there is never going to be one again. E v e r y child that enters y o u r practice presents a unique problem t h a t neither you nor a n y other pediatrician has ever faced before or will ever face again a f t e r that child has made his exit f r o m the world. E v e r y h u m a n being is a unique phenomenon. He possesses creative powers which no other h u m a n being possesses. I f he becomes a p a i n t e r he will p a i n t a picture t h a t nobody else could paint. I f he is a musical composer he will write a s y m p h o n y t h a t nobody else.could write. No m a t t e r what his endeavor m a y be, he is a unique personality. The problem of education, you see, is the problem of giving each of these unique personalities the o p p o r t u n i t y to develop as a unique personality and to make t h a t contribution to society as a whole which t h a t personality alone can make. Now it is the glory of the democratic way of life that it alone of all the social p a t t e r n s holds out to individual h u m a n beings the right to be themselves and the right to be unique personalities. You m a y not have thought of it but when you as a physician or as a pediatrician go into a home and help the parents to create for an individual child a really favorable climate for t h e growth and development of t h a t child as a unique personality, you are practicing democracy in one of the real ways in which it can be p r a c t i c e d as opposed to totalitarianism. I f we believe in totalitarianism we would take that child and shape him for whatever purposes we had in mind and ignore his unique personality characteristics. I do not, therefore, see how you people can ever be converted to totalitarianism no m a t t e r what happens to the rest of us, because I believe t h a t everything in y o u r medical science is in conflict f r o m a social a n d a philosophical point of view w i t h the t o t a l i t a r i a n concept of life. I mention that because I should like to leave with you the idea that there is a relationship between education and social patterns o f v a r i o u s kinds. T h e r e is a relationship between science and social patterns of various kinds. W h e n we are practicing these professions of education and medicine, we are working out the principles of our w a y of life. Our way of life has an impact upon our profession and the spirit in which we conduct it, and I think that you, as members of the medical profession, and we, a s members of the teaching profession, have a joint responsibility to create in schools and in homes and in communities the kind of environment which will help individual children to make the most of their capacities a n d in t u r n to make the greatest contribution to the social structure as a whole. T h a t is democracy, that is good teaching, and, with y o u r permission, t h a t is good practice of medicine.