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SCHOOL
HYGIENE
yi? Monthly Review for Educationists
and Doctors.
x\o. II, Vol. II.
Price Qd. net.
November, 191 i
THE EDUCATION OF DEAF CHILDREN.
THE EXAMINATION OF MENTALLY DEFECTIVE
CHILDREN.
F. C. SHRUBSALL, M.D., D.P.H.
CONTROL OF ATTENTION.
F. C. LEWIS, M.D., D.P.H.
THE TREATMENT OF DEFECTS.
DR. VICTOR J. BLAKE.
MEDICAL INSPECTION IN AYRSHIRE.
A CLASS FOR INTERMEDIATE CHILDREN,
DR, FORBES and DR. LAMBERT.
DUST OF SCHOOL ROOM FLOORS,
DR. HERMANN PETERS,
MEDICAL REPORT ON MANCHESTER GRAMMAR
SCHOOL.
REVIEWS,
ABSTRACTS.
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M,D„ M.R.C.S.
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m, M.R.O.P,
A. Brown. M.B.. CM.
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Swift. W. J. C , M.R.C.S,, M.O,
Spokes, P S , M.R.C.S.
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Clahkb, Alfmd, M.D , M.R.C S
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Atjdzn, G. A.. M.D.
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CoLLiBR, W„ M A., M.D,, F.R.C.P.
Lambert, S. H. A., M,D., B.C., M.O
LEMrHiERK, L. R.. M.B.
MARrra, H. J. W., M.R.C S., L.S.A.
Nash, E. H., M.O.H.
Shrubsall, F. C, M, A„ M.D.. M.R.C.P.
SiMET, A. I., M.D., M.R.C.P.
Williams, R. P., M.D., D.P.H.
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SCHOOL HYGIENE
CONTENTS
No. II. November, 191 i
Page
r--
Thk Edvcation 01 Dkai Chii dren 601 • N t
Editorial Notks _ ... 604_/ ^ "
Tiii: ExAMixATiox 01- Mkxtai.i.y D>;ij;cTivK Gniia)Ri;N .T: ^--^
F. C. Shrubsall, M.A., M.D.. D.P.H^
CoxTROL OF Attkxtiok F. C. Lewis, M.D. (Lond.) , D.P.H. 6:
DrsT OF ScHooi, Room Floors Dr. Hermann Peters 625
Reviem- of the Metuods Available for the Treatment of Defects
Dr. Victor J. Blake
A Class for Intermediate Children at Brighton
Dr. Duncan Forbes and Dr. J. Lambert 634
Medical Inspection in Ayrshire 638
The Fihst International Congress on Child Study 641
The English Section at the International Hygiene Exhibition at Dresden 643
Far and Near 644
Cleansing o" Floor«— The School Ambulance— Boy Scout Sc ools.
Woolwich District Invalid Children's Committee and Ringworm 647
Reviews 648
The Deaf Child, by Dr. J. Kerr Love— Hygiene and Public Health, by
Sir Arthur Whitelegge and Sir George Newman— The Prevention of Dental
Caries, by Dr. J. Sim Wallace— Lateral Curvature of the Spine and Flat Foot,
by J. S. Kellett Smith, F.R.C.S.
Abstracts from Cvrrent Literature ... 654
Medical Inspection in France— Independence Day Tetanus — A Class Epidemic
of Diphtheria— The Exjerimental Study of General Intelligence— The Dangers
of the Cineiiiatogr< ph — How our Children Write— Hygiene Teaching in the
PublicNormal Schools of the United States — The Statistics of Infantile Paraly is
OiTKiAL Publications, etc 658
'. Manchester Grammar School, Dr. Alfred A. Mumford.
ii. Medical Inspection at the Hague, Dr. J. J. Pigeaud.
EDITORIAL NOTICE.
All communications relating to the Editorial business of School
Hygiene should be addressed to
The Editors, "School Hygiene,"
2, Charlotte Street, London, W.
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the name and address of the sender.
Articles and Letters^should be written on one side of the paper only.
The Editors will be glad to consider any manuscript submitted to
them. A stamped addressed envelope should be enclosed.
A System of English Terminology
(or Swedish Gymnastics.
ADOPTED AND PUBLISHED jBY
THE PHYSICAL TRAINING ^CLUB.
94 Diagrams. 48 pages. Royal 8vo. 1/- net. ; post 12.
This is the first complete English Terminology for
the Svredish System of Educational Gymnastics
that has been published.
PUBLISHER-CHARLES LUFF, SLOUGH, BUCKS.
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SCHOOL.
MYGIEN E
A Monthly Review for EdiLcaiionists
and Doctors,
No. ir Vol II. Novicmber, iqii.
The Education of Deaf Children
The education of the deaf child, probably one of the
most arduous branches of the teaching profession, has re-
ceived considerable stimulus, and no small amount of public
attention lately. Three causes have led to this, and it is to
be hoped that, now the matter has received so much attention
in a great public daily, the upward trend that is shown to be
taking place in deaf education in Great Britain may be
accelerated, and receive help from the education authorities.
Early in the year our contemporary, the Lancet, published
three notable articles by Mr. MacLeod Yearsley, whose ex-
perience has been gained in the work which he is doing in
the London County Council schools. These articles we
have already noticed in our October number, and, as we then
pointed out, the London deaf child owes to Mr. Yearsley a
number of important advances in the organisation of this
tuition. This fact was also appreciated by the Lancet in its
leading article on March nth. The Times, recognising the
great importance of deaf education to the community, then
took up the matter in a vigorous and well-argued leader in
its education supplement for April 4th. This led to an inter-
601
i.6o^.^..». . . . .-.SCHOOL HYGIENE
esting controversy, in which Dr. Kerr Love, Mr. J. O. White,
the Reverend Arnold Hill Payne, and Mr. Yearsley himself
took part, a controversy which was wound up by a judicious
summing-up in the supplement for October 3rd in favour of
Mr. Yearsley and Dr. Love. The dispute is one which we
have followed with interest and care, and we scarcely know
which to admire most : the clear logic and dispassionate argu-
ments of the physiologists, or the kangarco-like agility in
changing ground shown by one advocate of making the deaf
a race apart — silent and alone. The doctors have been told to
" stick to their business," and we may say that, even dis-
regarding the fact that the annihilation of pain is a part of
it, they have shown conclusively that in deaf education they
have the right to a place, that they have taken it, and intend
to stay therein.
The third of the causes to which we have alluded has been
the opportune publication of Dr. Kerr Love's valuable book,
reviewed on page 648, The Deaf Child, one of the most
important contributions to the literature of education
that has appeared for some time. Dr. Kerr Love
has long been known as an advccate for the deaf
child, and there is probably no man in the world, doctor
or layman, who has seen more of his subject, or obtained a
wider experience of the world's methods of instructing the
deaf. He knows, and Mr. Yearsley knows, the futility of
hard and fast systems, the narrow-mindedness of those who
say all should be oral, or all should be singing, or all should
be half and half — advocates of the so-called "combined
method." Dr. Love and Mr. Yearsley know that there is
but one possibility of deciding how the deaf child should be
taught, and that is by the study of the deaf child himself. In
a word, they are the advocates of the rational application of
physiological principles to deaf education, and are strenu-
ously opposed to the old idea of making deaf education a hard
and fast matter of systems evolved upon purely pedagogic
lines. We must say that the position occupied by Dr. Love
and Mr. Yearsley is a sure one, based upon sound and
scientific reasoning, and, as such, has come in for no little
abuse from its most fanatical opponents, or those who have
other axes to grind. The doctors' arguments are not destruc-
tive, or are only so to the limited extent of destroying what
is wrong; they are, on the contrary, largely constructive,
and they lead to the formulation of certain needs which, we
believe, must, if obtained, enormously enhance the efficiency
of deaf education in this country.
THE EDUCATION OF DEAF GillLDR.EN , jq':^^-.
Let us see what Dr. Love considers to be the needs cf
British schools for the deaf. They are : (i) A scientific classi-
fication based on clinical observation. (2) A restoration to
the mind of the British teacher of the deaf of Watson's belief
in speech as the best instrument of thought for the deaf. _ (3)
The extension of the school age from 16 to 18 years. (4) The
extension of the day-school system. (5) The transference of
the schools for the deaf from the control of boards of directors
to that of the ordinary school authorities. (6) The encourage-
ment of teachers of the deaf to visit other schools, both at
home and abroad. (7) The establishment of a training college
for teachers of the deaf. (8) The preliminary training of very
young deaf children. Space will not permit of our entering
into the discussion of these eight needs, and we can but refer
the reader to the conclusive arguments which Dr. Kerr Love
uses to support them. One or two of them, however, we
mav notice briefly. Classification, based upon clinical
grounds, must be the classification of the future. Many
attempts have been made to classify the deaf child, and those
which most fulfil his needs are clinical. Of these, we incline
most to that wider and more comprehensive classification
which has been advocated by Mr. Yearsley, and which, as
he has pointed out, must be the inevitable outcome of efficient
school medical inspection. It includes and provides for the
proper training of every deaf child, from the very slightly
deaf, who can be taught in a hearing school, to the defective
deafmute, whose life detention in an institution must, as legis-
lation progresses, become an accomplished fact.
It is important to note how strikingly coincident are the
writings of Dr. Love and Mr. Yearsley, save, perhaps, for
one or two minor and unimportant details. Both favour
clinical classification, both advocate the early education of
the deaf child. The arguments upon which these two
points are based are, we repeat, of so strictly scientific a
character that such unanimity in men who think scientifically
is not surprising. Dr. Love's experience of deaf education
is wider, and of longer duration than Mr. Yearsley's, and he
is thus able to speak with greater authority upon matters
more extra-physiological. His opinions upon the latter show
such sound common sense that they must command respectful
attention. We earnestly commend to every educational
authority, and especially to the officials of the Board of
Education, a careful perusal of the writings of these two
gentlemen. What they advocate must come, and the sooner
it comes the better for deaf education in Great Britain.
Editorial Notes.
When a Cabinet Minister is found to possess rather less
than what counts for competence among Ministers, above all,
when he has got his department into something of a mess,
the gentleman transfers himself to some other department
(which bears the same salary). Fortunately, our country has
a never-failing supply of gentlemen to fill the gaps. Mr. J. A.
Pease, who, no cne doubts, possesses all the qualifications of
his predecessors, is the new President of the Board of Educa-
tion (to which a salary of ^2,000 a year is attached). It is
conceivable that an able President with a knowledge of the
people's wants might do some good at the Education Office.
Dr. F. G. Haworth, in a letter to the British Medical
Journal (October 21st), backs up our own plea not to with-
hold an occasional lollipop from the children. He believes
that the " desire of children for sweets rests on a physiological
basis," and that " it would be not only unkind to the children
but absolutely contrary to physiology to withdraw pure sweets
from them." It is pleasant to find medical men in these
days who are not prepared to advocate every departure from
tradition. We are sure that violent alterations in traditional
habits must not be effected without considerable discussion
and careful thinking. The vegetarians not long since pro-
mised full health and long life to all non-meat eaters. Find-
ing that ill-health attached itself as much to a diet of lentils as
to one of beef we have had the purin-free craze, Fletcherism,
no breakfast, 40 days starvation, and the host of other cures.
One of the latest is the mazadar system which enjoins deep
breathing and raw carrot munching- — the tw^o processes to be
carried on simultaneously. The fact is the vast majority of
the human race can ensure quite tolerable health (and no one
should desire more — the man who has never had a day's
illness is a horrid person) on almost any kind of diet. Religion
and aesthetics, pockets and enterprise, should determine the
kind. But the enterprise should be self-limited. No kind of
reform should in the first place be imposed upon the children
just because it is " so simple."
604
EDITORIAL NOTES 605
The National Educational Association, in its annual report,
maintains that the exploitation of child labour is increasing.
It calls attention to the danger attending the demand for
" industrial training."
" The great difficulty which arises in all these discussions
is an eagerness in many quarters to make all education in
public elementary schools a training for manual labour only,
whereas a national need, greater than the need for efficient
training of artisans, is the need to open wide the doors for
the intellectual development of every child by an elementary
preparation for any career which he has the capacity to follow.
This pressure to substitute industrial training for all other
forms of education for the ' elementary school child ' re-
ceives encouragement in England and Wales from the Board
of Education, and too many local authorities, by the per-
sistent ' delimitation ' of the public elementary school as
regards the leaving age of scholars and the liberality of its
curriculum."
The difficulty really arises from sometliing much more
profound. The working classes — not, be it understood, " re-
presentative working men " — have never been asked as to the
education they require for their children. In this, as in so
many other matters, they have been treated as cyphers.
Official and well-meaning, but often quite ignorant, well-to-
do people have laid down the education which they consider
right for the poor man's child.
The Child Study Society has an attractive series of lectures
for this session. Two have already been given on " The
George Junior Republic," and " Co-education during adoles-
cence." On November 2nd Mr. Holman will speak on
" Psychology and Grammar " ; November 9th, Professor W.
Rippmann, on " Psychology of Speech "; November 23rd,
Mr. T. G. Tibbey, on " Psychology of Reading." The last
lecture will be given by Professor W. Brown on December
7th, " Psychology of Mathematics."
The Froebel Society has arranged a course of six lectures on
To>s, Games and Constructive Handwork, and their use m
teaching of form and number; three will be given by Miss
Mildred Swannell, and three by Mr. J. G. Hamilton. On
November 24th Miss Nancy Catty will lecture to the Froebel
Society on " Children's Literature."
The Incorporated Association of Hospital Officers has also
resumed its discussions. The paper which Mr. EI. G. Barker
will give, " Medical Treatment of L.C.C. School Children,"
6o6 SCHOOL HYGIENE
on November 17th, will interest many of our readers. Ad-
mission can be obtained on application to the hon. secretaries,
32, Sackville Street, W.
The appeal of the Galton Laboratiry Committee for
;£"i5,ooo cannot but bring a smile to those who recall Prof.
Karl Pearson's hint that " the endowment of research " often
means only "the research for endowment." Eugenics
seemed very nicely endowed by the will of Sir Francis
Galton ; there ought not to be any difficulty, however, in
raising the further necessary funds among rich people. The
object of eugenics, disguised in all kinds of ways by its many
exponents. Prof. Pearson, Dr. Saleeby, the Dean of St.
Paul's, the Rev. R. J. Campbell, is, bv destroying the
virtues and valour of the poor, to make them the slaves of
the rich.
Though the uns amdness of so much of the work ground
out at the Francis Galton Laboratory has been demonstrated,
we have no reason t ) suppose that the future work will be
more trustworthy ; so far as we are aware, none of the past
untrustworthy memoirs, etc., has been recalled. How utterly
out of touch with Christian or any other sentiment the advo-
cates of eugenics are may be seen in a letter in the October
number of the Eugenics Review, which we will quote in
full : —
Native Customs.
An interestini,'- letter reaches us irorti Mr. Mather Smith of the
Transvaal, of which we think the lollowing- extract is of eugenic
interest :
" The destruction of the ' unfit ' is an old-established custom of
the Zulus of South Africa and their kindred tribes, and 1 have often
thouo^ht that we who send our missionaries to teach them the better
way, migfht ourselves learn a great deal from them.
** As far as I can learn the ^latabele, No'zengele, and I think the
Shangaans, all offshoots of the Zulus, destroy all deformed
children, albinos, and the weaker of twins at birth. From enquiries
I have made the Zulus do not now destroy the weaker twin, but I
feel certain that they must have done so at one time, as all their
kindred tribes still do, and 1 have heard that the Matabele destroy
both twins.
'* The Swazis, also akin to the Zulii^, do not appear to destroy
albinos, as there are quite a number of albino Swazis in this
district
" These customs are still adhered to. A weaker twin was
destroyed on a farm within five miles of this mine less than a year
ago, and yet children mean wealth in all of these tribes.
*' I have never, in Zululand or on the mines, si en a deformed
Zulu, Shangaaii, Swazi, or No'zengele, and if a man of one of
these tribes gets disabled on the mines he will not, if he can help
it, go back to his own country.'
EDITORIAL NOTES 607
With much relief does one turn from all -this pretence at
scientific investigation, from this debased teaching of
eugenics, to such a book as Mr. George Bourne's The Bei-
tesworth Book, or to Mr. Stephen Reynolds's A Poor Man's
House. "If, for instance, Mrs. Widger came down^earlier
and scrupulously swept the house, her temper would suffer
later on in the day. If she did not sometimes ' let things rip,'
and take her leisure, her health and with it the whole delicate
organisation of tire household, ' would go wrong." What
Galton Laboratory, Eugenics Education Society, Minority
Report, or other device would have discovered, as Mr. Rey-
nolds discovered, this or any organisation in the Widger
h'nisehold ?
In the summary of Dr. Kerr's annual report, presented to
the Education Committee of the London County Council, it
is stated that as the results of 37,420 complete examinations
during 1910, 12,656 children, cr ;^;^ per cent., were found to
require treatment. In all, 172,619 children were examined
in 1910, and 52,954 children, or 32.6 per cent., received advice
cards. The proportion of children who would be selected by
the doctors after careful examination and given advice cards
could be fixed now, on the basis of the last two years, as
65,610 out of 210,039 — that is, 32 per cent, of those examined.
Of the 172,619 children recorded, 81,151 were returned as
normal — that is, free from any definite organic defect. Bad
defects of vision or eye diseases were recorded in 18,923 cases.
Children with defects of throat or nose numbered 29,927 ; of
ears or hearing, 9,499; skin diseases, 2,913 — this included
453 ringworm cases found by the doctors, ringworm cases
being generally excluded by the nurses. Other diseases were
recorded in 15,296 cases. As regards " state of nutrition,"
46.7 per cent, of the children were classified as of " good
condition," 41.8 per cent, as " moderate," and 11.5 per cent,
as "bad." During 19 10 some beginnings were made with
dental treatment, but so little had the public realised the value
of this service that its developments must necessarily be slow.
Medical inspection was now carried out in the Council's
secondary schools, training colleges, trade and technical
schools. It was just as important in these institutions as in
the elementary schools, and from the economic point of view
probably more important. In the secondary schools special
attention was given to curvature of the spine. A review of
1910 revealed a striking diminution in the incidence of scarlet
6o8 SCHOOL HYGIENE
fever and diphtheria ; measles, on the contrary, had been
unusually prevalent.
The first of the special series of twelve lectures on illumina-
tion, arranged to take place at Battersea Polytechnic, was
delivered by Professor J. T. Morris on Tuesday, October
17th. On this occasion the lecturer dealt with incandescent
glowlamps, laying stress on the enormous progress of the
last few years and the extraordinary difficulties that had been
successfully overcome in making metallic filament lamps.
The gradual evolution of the carbon filament, Nernst, Tung-
sten, and Tantalum lamps, the methods of attaching the fila-
ments, and making allowance for the " sag," were illustrated
by a series of lantern slides. The actual filaments used in
various types of carbon and metallic filament lamps were
mounted intact on one of these slides and thrown upon the
screen in order to show their comparative thinness, and the
lecturer subsequently showed that even these fine wires could
support a tension of a 2 lb. weight without snapping. A
great variety of the latest types of lamps was also shown,
including the latest 200 v. 16 c.p. Osram lamps and the new
drawn-wire Mazda lamps. A series of life curves on metallic
filament lamps (the latest tests of the National Physical
Laboratory) also attracted much attention.
The Examination of Mentally
Defective Children.
From the report presented to the Committee* on Mental and
Physical Factors involved in Education.
By Dr. F. C. SHRUBSALL.
{Continued from page 576.)
Graded Tests for Developmental Diagnosis : de Sanctis'
Tests.!
De Sanctis uses the following material. Five wooden
balls painted in distinctive colours, three wooden pyramids,
two wooden parallelepipeds, five wooden cubes all of the same
size, twelve cubes of varying sizes, a small black cube, and a
test card on which are painted triangles, squares, and rectangles
to represent the outlines of the pyramid, cubes and parallelo-
pipeds. The tests are : —
(i) The five balls are placed on the table and the ob-
server says " give me a ball." The time taken in
responding is noted on the stop watch.
(2) The same five balls are again shown and the observer
says : " Which ball did you give me? " The time
is again noted.
(3) The five identical cubes, the three pyramids, and the
two parallelopipeds are mixed up on a table screened
from the child. A cube not very different in size is
shown to the child, who is asked to pick out all the
bits of wood on the table which look like it. The
screen is then removed, and the time of the perform-
ance and any errors noted.
(4) The child is shewn the test card of forms and the
small black cube, and is asked : " Look at this piece
of wood ? Is there anything on the card which
looks like the piece of wood?" and if correct is
Section L. Meeting of the British Association at Portsmouth, 1911.
n Man
itrose '
609
t The description is abbreviate I from Manual of Mental and Physical Tests by
Guy Montrose Whipple.
6io SCHOOLv HYGIENE
directed to "pick out all the things that look like it."
Whipple suggests he may be asked alternatively to
" pick out all the squares on the card." The time
and errors are recorded.
(5) The twelve cubes of various sizes are put on the
table at different distances from the child, who is
told, "Here are bits of wood like the things you were
picking out on the card. Look at them carefully,
and tell me how many there are, which is the big-
gest, and which is farthest away from you." The
time taken and the errors are recorded.
(6) All the test materials being concealed the child is
asked four questions, each being answered before
the next is asked.
(a) " Are big things heavier or lighter than small
things? "
(b) " How does it happen that small things are some-
times heavier than big things? "
(c) Which looks bigger, a thing that is close by or a
thing that is far away? "
(d) " When things are far away, do they just look smaller
or are they really smaller? "
The times of response are recorded, and the answers taken
down verbatim. De Sanctis considers that ability to pass Nos.
I and 2 only indicates intellectual defect of a high degree,
ability to pass Nos. i to 4 or 5 with many errors indicates a
moderate defect, ability to pass Nos. i to 5 but not No. 6
indicates a slight degree of mental insufficiency, while ability
to pass all in normal time indicates a normal intelligence.
Yet even such a child may rate as "backward" pedagogi-
cally. Goddard, however, thinks training comes into play,
and that a child with a go:d training may pass even No. 6
and yet be feeble-minded.
The principle employed in these tests has in part been
utilised, but not the exact method. In particular the time
required for response has not been noted. This applies to
all the other tests. One reason is that whilst the child is
thinking, the time is used in getting points of history, etc.,
from parent or teacher, at the admission examinations, or in
noting the performance of some other child at a centre. The
conditions under which the work must be done require a
considerable number to be passed in a short time. This must
be borne in mind in evaluating the opinions of the schcol
medical officers. Occasionally there is the opportunity for
more. We have, however, no such standard set of objects as
MENTALLY DEFECTIVE CHILDREN 6ii
de Sanctis suggests to carry about, desirable as it would be
from a comparative standpoint; but perhaps some commen-
tary from the methods, having a similar aim, which have
gradually grown up in use quite independently of the Italian
authority, may be pertinent. _ _
Test I . — This is tried in almost every low-grade case at an
admission examination, and with shy or nervous children
generally, as it so resembles a game that a response can
usually be obtained. Very few refuse. Of these, some are
obstinate, and in nearly every case will respond later, if
necessary, with the aid of the teacher. The rest turned out
to be imbeciles or ineducable.
Test 2. — Tried less often, as, unless distinctly coloured
objects are available, it is out of the question. I have tried
a similar test showing various objects, including the one the
child had previously picked up.
Not having anticipated at any time that I should want to
refer in detail to the results obtained by these tests, I find my
notes are too brief to allow of an analysis. But I am confi-
dent the response was quicker and more accurate when
different objects were used than when the recognition de-
pended on colour. Errors in colour certainly arose, particu-
larly between a deep yellow (some might call it an orange)
ball, and a rather dirty, light vermilion ball. The response
to this was generally good.
Test 3. — Only tried with a limited range given by wooden
bricks, and actually not very often. (I might point out that
when a test must statutorily be made on a certain day and
time the postulates of the general directions cannot be
ensured, and the children are not all comparable in the matter
of comfort, fatigue, mental attitude towards the test and the
observer. This from a diagnostic, as opposed to the experi-
mental psychologist's standpoint, can be reasonably, though
not entirely, discounted by appropriate allowances of time,
encouragement, etc. Repetition after a day or two is im-
possible.)
Response is, generally speaking, good even in low-grade
cases, who, however, take very much longer and want to
stop and play with the bricks instead of finishing collecting
those that resemble the one indicated. It gives indications
of observation, attention, and perseverance, and is very
useful, but as time presses it is not used for the better grade
of case.
Test 4. — Only tried with letter-cards and pictures of
animals as used in vision testing, etc. Then ask. Show me
6i2 SCHOOL HYGIENE
the E's or the cats, as the case may be. But are these cases
comparable ?
Test 5. — Tried with bricks or any similar objects of varying
size, and without reference to the foregoing. Out of ques-
tions asked singly, to elucidate ideas of number, size, and
distance, the order of correctness seems ordinarily to be dis-
tance, size and number. But if differences are only slight the
estimate size falls off more than that of distance, both being
diminished in accuracy and rate of response very materially,
while the estimate of number was unimpaired. The majority
of the grade at which this was used touched and counted the
objects. There was, unfortunately, no attempt at timing.
Test 6. — These and similar questions seem more adapted
to better-grade children. They are useful to detect backward-
ness, for a child who can answer them at all readily is bright
and intelligent, or well trained. Now, if a child could answer
such questions, yet could not read or write, and had attended
school to a reasonable extent, that child must have some
specialised defect. If, on the other hand, it had not had any
opportunity of education, then it may be expected to progress
rapidly, and would be regarded as merely backward, because
of the comparative rarity of specialised defects associated
with a quite bright general response. Such cases do, how-
ever, exist; e.g., there is a distinguished draughtsman and
inventor who cannot letter his drawings.
The general method of de Sanctis' tests is of high value,
■especially in dealing with those who cannot read or write, or
whose powers in that direction are very limited. Tests i
to 5 should be passed by the child of seven to eight, as
should Tests 6 (a) and (c). Test (a) yields a more doubtful
response, as the child hardly grips what is meant, but if time
be allowed, and the object put in the new position, it will
be done.
Older children can answer it quickly, but the defectives
take much longer. Out of six of these two at least failed.
The Binet-Simon Tests : 1905 Series.*
Visual Co-ordination.
I. Never tried with a match, but frequently by asking child
to follow movements of the finger while keeping his head
still. Accessory test tried in various forms.
* See School Hvgiene, Vol L, pp. 102-108.
MENTALLY DEFECTIVE CHILDREN 613
Co-ordination of Grasp, Object put in Contact with Hand.
2. Always tested, though not usually with direct intent,
but any failure to co-ordinate movements would be noted.
Co-ordination of Grasp when Object is only Offered.^
3. As above. Failure with these leads to an examination
along physically defective lines — i.e., more strictly medical,
with a view to a provisional diagnosis. Invaliding the almost
certain result.
Cognisance of Food and other Desirable Objects.
4. Tried in so far that the offer of a sweet or a halfpenny
is sometimes tried as a last resource with a very low-grade or
obstreperous case. Conclusions seem sound.
Seeking of Food when a Difficulty is Interposed. The Child
is Offered a Chocolate Wrapped up in Paper.
5- Tried unintentionally, much as described, with a
caramel. One unwrapped it, the other threw it at me. The
test I have tried is to give the child a simple knot to untie, but
not done often enough to have more than the general im-
pression that all but the lower grades attempt it correctly.
Execution of Simple Orders. Imitation of Gestures.
6. Always tried. See earlier remarks. A very useful
test, as all not defective at seven to eight can pass this.
Those that cannot, usually ineducable.
A Knowledge of Real Objects by Name.
7. Very useful ; always directly or indirectly tried, usually
the latter. In a definite test on about 400 children in special
schools about 5 per cent, failed to. point to their mouths.
These were recent admissions in the lower classes.
Knoivledge of Names of Objects in a Picture.
8. Always tried.
Naming Objects in a Picture. Always tried. Binet says this
gives a line between idiocy and imbecility.
Q. This does not seem to give the line between idiocy and
imbecility at any age; 6 is nearer my experience. The
question involves a good deal, and the response is by no
means always obtained in the lower classes of normal infants'
schools. See also the 1908 series.
6i4 SCHOOL HYGIENE
Comparison of Lines.
10. Tried. 1 agree in the main with the text. I have
never used lines of known length.
Auditory Memory for Three Digits.
11. Tried. General agreement as to result. Have never
laid stress on it. In asking this, and similar questions, or
others, echolalia may be noted.
Comparison of \]' eights.
12. 13. Not tried in a reasonably comparable manner. Dis-
crimination o£ weights is taught in some special schools.
Definition of Familiar Objects.
14. See note on " What is a cat ? "
Immediate Memory for Sentences. Sixteen Syllables in the
Shortest.
15. Tried. No defective child at an admission examina-
tion could do such ling sentences, except, perhaps (i). I
have not used the examples quoted. Yet the child may
know a verse of a popular comic song.
Differences Between Familiar Objects Recalled in Memory^
e.g., a Fly and a Butterfly.
16. Tried. Usually looked on as a catch, and so is apt to
spoil the examination. Many stick to " don't know." I am
not sure a response, unless quite to the point, is a good sign.
17-25. Not tried.
Sentence Building.
26. Tried with older children. More often by listening to
the spelling lessons actually in progress. Serve the purpose,
but more convenient methods.
Replies to Problem Questions, e.g.. What is the thing to do-
when you feel sleepy?
27. In some form often tried, especially at later examina-
tions. Questions must not be abstract or the mentally
deficient fails.
Interchange of Clock Hands.
28. Quite satisfied if a mentally deficient child at later
stages can tell the time at all. If a child passed this at
MENTALLY DEFECTIVE CHILDREN 615
admission should hesitate over saying mentally deficient, save
for special defect; e.g., word-blindness.
29, 30. Not tried.
H)o8 Sn:Rii:s : (Conditions as Before, Three-year-olds).
Cognisance 0/ Real Objects by Name.
1. A little hard for many threes, or even fours, until some
time at school. French family life must involve far more
talking intelligently to the child — i.e., true educcition^ — than
obtains in many poor English homes. On this base a general
disagreement with Binet's standards as too high in the main ;
with some exceptions equally too low.
Memory for Sentences. Two to ten Syllables.
2. Varies. Few will do so long a sentence until some time
at school ; then they pick up quickly.
Memory for Digits.
3. All who respond could do two at least. I found all the
mentally deficients, seven to ten, could do digits, but not
always possible to understand what they said.
Description of a Picture.
4. See previous notes. I have never seen a three or four
who said " A man and a dog "j " Man-dog," or even " Man
and dog," I could more easily credit. (I confine myself
strictly to the elementary schools grade of child. Some four-
year-olds in good families can, and do, read the newspaper.)*
Knowledge of Fam,ily Name.
5. I think a three-year-old would give Tommy or Nelly,
not the family name. I have tried, but kept no exact re-
cords. Five per cent, of the younger mentally deficients,
seven to ten, did not know^ their names.
Four-year-olds.
Knowledge of Own Sex.
6. Agree ; 3 per cent, of mentally deficients did not know,
and as many said Yes to both " Are you a little girl ? " and
" Are you a little boy? "
* An imbecile might say cat or do«, but would add no descriptire word unless he had
had some more definite training than they have usually had when up for report.
6i6 SCHOOL HYGIENE
Naming Familiar Objects.
7. Agree in the main, but many threes would call any coin
" penny "or " farden " ; all mental deficients who answered,
recognised, and named the objects, though several confused
the halfpenny with other coins.
Mem^ory for Digits.
8. Agree; all the mentally deficients passed.
Com,parison of Two Lines of Differing Length.
9. Agree; all the mentally deficients passed.
Five-year-olds .
Comparison of Weights.
10. Not tried.
Copying a Square.
11. No certainty as to age level. Tried in mentally de-
ficients with a pencil ; the upper classes made successful
efforts ; about half the lower-class children failed. A simple
test of manual powers.
Counting Coins.
13. Fifteen per cent, of the mentally deficients failed to
count to five. I have no record of the counting to four
correctly but failing at five, but can recall two instances.
Six-year-olds.
Knowing Right from Left.
14. There are a good many failures at six and over in this.
In regard to the feet, or turning round, any drill mistress
could confirm this. The mentally deficients are far behind
the normal, but I have no figures.
Memory for Sentences. Sixteen Syllables.
-15. Mentally deficients, or the majority, cannot do it wnth
easier sentences.
Definition of Familiar Objects.
17. See " What is a cat ? " A useful test in good hands.
MENTALLY DEFECTIVE CHILDREN 617
Execution of a Trifle Order.
18. Done earlier than Binet suggests with normal
children. Of the mentally deficients almost all failed to
carry out more than two of the orders.
Knowledge of Own Age.
19. More than half the younger mentally deficients knew
their age.
Knowing Morning and Afternoon.
20. Three-quarters of the younger mentally deficients knew
whether it was morning or afternoon.
Seven-year-olds.
21. Not tried.
Writing from Copy.
23. See under Writing above. All sevens should be able
to do this unless pen and ink have not been allowed, and
then pencil could be substituted. At six and a-half infants
move to senior departments and learn to use ink. Of men-
tally deficients one-fifth utterly failed, many scrawled, and
half scarce! V intelligible.
Counting Thirteen Pennies.
27. See under 13.
Naming four Common Coins.
28. Of mentally deficients a quarter failed outright, and
another quarter made a mistake.
Eight- YEAR-OLDS .
Reading and Report.
29. The following passage is the American adaptation of
Binet's passage : —
Three Houses Burned.
Boston, September 5th. A serious fire last night destroyed
three houses in the centre of the city. Seventeen families
are without a home. The loss exceeds fifty thousand dollars.
In rescuing a child one of the firemen was badly burned
about the hands and arms.
After reading the child is asked to say what he has been
reading about. The time for reading the French passage
6i8 SCHOOL HYGIENE
was said to vary from 45 seconds at 8, to 25 seconds at 1 1
years.
Much too hard a passage for most eights in elemen-
tary schools, but varies directly with the home surroundings.
Too hard for most mentally deficients who are leaving. Time
certainly longer than given. An absurd test for imbecility
as understood for school purposes.
Counting Money.
30. Some younger mentally deficients could count two
simple coins ; the older ones varied. It is a good differential
test of a border case.
Namini{ Four Colours.
31. See previous notes. Most mentally deficients passed.
Counting Backwards from Twenty.
32. All mentally deficients failed, turning round and going
back to twenty at some stage or other. I should not use it
as a test ; too many normals fail at even older ages.
Writing from Dictation, e.g., the Pretty Little Girls.
S3> See previous notes. Children of eight can do more
than this.
Nine-year-olds.
Knowing the Date.
35. Known earlier, except, perhaps (4), the year. Mentally
deficients very variable at later stages; beyond them at
earlier, i.e., seven to ten.
Reciting the Days of the week.
36. Mechanically in order from Sunday, very much earlier.
Many passed as mentally deficients could do this. See note
on ' ' What is to-morrow ? ' '
Beyond this point Binet's tests pass out of the mentally
deficient range, or my experience. Some, as 47, 49, and 51,
could be easily tried, but ? diagnostic.
The tests included in this series closely resemble those we
actually use ; they may test school results more than intelli-
gence, perhaps, as some allege ; but that is one factor to be
borne in mind in deciding whether a child needs a special
school education. The best of them, from the school medical
officer's standpoint, will be included. The real point, I
suppose, is whether the series should be used in preference
MENTALLY DEFECTIVE CHILDREN 619
to others. If so, I should not care to give up the three types
of writing, the last of which, I believe, Binet does not include,
or the question of response to a written command. The last
is very useful, as where present the child does not need
special school training in the terms of the Act, excepting a
rare condition, as word-deafness, and this needs a modified
deaf training.
Size-weight Illusion.
Dumoor's test consists in presenting to the child two
objects of identical form and weight, but differing in size.
To persons of normal intelligence the smaller appears to be
the heavier when handled. It is claimed that mentally
defective children respond that the larger package is the
heavier. Dr. Thomas found in London mentally deficient
special schools that the test generally elicited a normal re-
sponse in the higher grades of children, but the defective
response in the lower grades. The test, therefore, divides
the defective children in the schools, roughly, into two classes,
one approximating to the dull and backward, the other to
the imbecile. He regards it as of considerable value.*
From the account of the various methods which have been
from time to time suggested, and tested in the course of
examinations, it might appear as if these were lengthy and
very detailed inquiries, lasting, say, three-quarters of an hour
each. This is not the case. All the tests are never used at
any one time, and eighteen to twenty-two children are sup-
posed to be dealt with in two hours. If one takes a long
period, say, fifteen to twenty minutes, the time is made up on
the others. Most of the points dependent on observation are
noted in the course of tests, in which they appear as accidents,
or necessary concomitants of the action in the test itself. 1 he
central feature is to confirm or to controvert the teacher's
estimate of backwardness, and if this is present to endeavour
to apportion its cause. The distinction required is to divide
backwardness from mental causes from backwardness due to
lack of opportunities, ill-healthy or physical defect, and in
particular to arrive at anything remediable. Research into
mental conditions is not a primary point, and the opportuni-
ties, in point of time, for so doing, are distinctly limited.
With more time a finer classification might be possible, but
this would be of little use without a far more elastic curricu-
lum than at present exists.
* Dr. Myers points out that the 'defect' occurs in normal' very young children.
" Control of Attention."
By F. C. LEWIS, M.D., Lond., D.P.H.
It is sufficiently well known that most of the organs of
the body are innervated by nerves, or by communications
from nerves, which at some spot immediately adjacent, or in
many instances far removed, reach the surface of the body as
a nerve of ordinary sensation. This was established by
Head, and Head's areas have long been a guide to physicians
in localising remote and deep-seated lesions.
A further evidence of the intimate association between
sensation and mental states of activity, or the reverse, is
afforded by hitherto little regarded observations of Dr. Stod-
dart on the anaesthetic and hypersesthetic areas of the insane.
In many instances, especially of melancholia with associated
intestinal delusions, areas of anaesthesia were found persist-
ently present over the region indicated by Head as most
intimately associated in nerve supply with the viscus which
was the seat of the delusion.
The same was found even more marked in melancholic
cases with sexual delusions.
Again, as Dr. Stoddart points out, the muscular activities,
and consequently, therefore, the Sensations conveyed to the
nerve centres of the highest levels are altered in abnormal
mental conditions. The well-known rigidity of the melan-
cholic, a rigidity which affects chiefly the large joints of the
trunk and extremities, leaving the smaller ones of fingers,
etc., unaffected, is well known.
It is from these and similar abnormal conditions that one
is led to consider the possibilities that finer variations may
occur in health, and which are so slight and gradual in
their outset as to remain unrecognised, until the more ap-
parent alteration of mental status has altogether masked them.
From observation on children, more especially in those of
what is called the backward type, one gathers that motor —
physical sensations produced as the result of repeated move-
% 620
CONTROL OF ATTENTION 621
ment at the peripheral end of the nerve-muscle or nerve-joint
connection, must precede mental recognition and its psychic
mental co-ordination.
A class of young children may be taken, and bj means of
carefully selected exercises graduated to the chilclren's
physical development and nutrition, the mental attainments
will be seen to increase as the physical range and control
of movement.
This is a truism, but I do not think even yet sufficient
stress is laid on purely physical methods in the course ot
ordinary education. In the case of the feeble-minded or
mentally defective it is now generally recognised, and is made
the basis of any system of education ; but in the case of the
more fortunately placed, they are handicapped at the start
by the lack of appreciation still shown by teachers for ordinary
physical stimuli as a means of education.
Physical education, as I understand it, does not mean the
routine performance of a table of Swedish exercises. It
means, or should mean, the gradual establishment of a control
through the nerve centres over every joint and muscle of the
body, at first gained by means of definite willed exercises
requiring active attention and recognition on the part of the
pupil J later, when the stimulus has been perceived, and the
meaning of it indelibly registered, active attention is un-
required and can be safely dropped, to be recalled if necessary.
As a result, the movement and co-ordination necessary drops
to the lower grade of automatism.
The aim of the physical educationalist should be to pro-
duce a complete sympathy and sureness in the range of every
movement, in the performance of every action.
In achieving this he will find he has achieved in the child
something more, he will have established a co-ordination of
ideas in the brain, as well as of movements in the body.
Nothing is more remarkable and more constant in human
degrees of development among the purely normal than the
exactness of the relationship which exist between the degree
of bodily mobility and intelligence.
Muscular strength and development alone is something
quite different, often-times being merely the result of muscles
hypertrophied out of all proportion, and is to be avoided.
Co-ordination of muscles and movements produces inevitably
a brain that is mobile, and co-ordinated in the ever-increasing
power of association of ideas.
I have advisedly said the sane, by which I mean people or
children of ordinary all round possibilities of perception and
622 SCHOOL HYGlEiNE
execution. The case of the abnormal, whether of mental or
physical proclivities, cannot be included, though it is probably
true that the musical brain has its origin in a greatly in-
creased and trained auditory, i.e., physical, power of per-
ception in the first instance. Likewise an over-development
of the motor side, as occurs in hypertrophied muscles, means
a slowness of thought and action.
The reason why the wrestler of huge proportions is more
likely to be a fool than a sage is probably more owing to
the fact that he gained his bulk by means which stimulated
the muscle, but never brought into play the quality of atten-
tion which is necessary for mental grow^th to coincide with the
physical.
With this explanation I would consider closely related a
condition, which though of recent discovery among psycholo-
gists, and as yet vague and ill-defined in its beginnings, is
of very real moment to the student of mental states. I refer
to the disease known as " dementia praecox."
A recent writer, and high authority on education and educa-
tional phases, has declared that it is probable that every
adolescent at or near the mature age suffers in s^me slight
degree from this affection.
The abnormal mental activity which obtains at this period
of life, brought about by the widespread and deep-seated
physical stimuli emanating from bodily growth and develop-
ment, finds its counterpart in a lowered reaction to extraneous
objects. More, there is often a marked disinclination to
physical exertion of any sort, the organism being so en-
grossed with the internal calls upon it that it fails to
respond to external stimulation.
As always, the prolonged disuse causes atrophy, and there
follows an actual diminution of the power of perception, and
of attention on which it depends.
The resulting condition is the first stage of " dementia
praecox," which, if encouraged, results ultimately in a condi-
tion of dementia or even amentia, in which the nervous
system reacts unequally or not at all to physical and mental
stimulation.
The condition is one which, as a rule, corrects itself in a
normal adolescent as soon as the excessive, internal, physical
disturbance of adolescence . has settled down into the more
ordered and controlled conditions of maturity.
But in an individual with a nervous disability of self-
control, either due to inherited or other causes (e.g., mode of
CONTROL OF ATTENTION 623
life, environment, etc.), it persists, and is aggravated into a
truly abnormal, mental condition.
Occupation, which means control of the attention, is the
only remedy. By controlling the attention it is possible to
prevent the increased internal, physical stimulation, and
those concomitant mental co-ordinations arising to con-
sciousness. They persist, but without active attention being
directed to them they are u-nregistered as memories in the
highest level of brain cells, and so do not later play a domi-
nant part in the formation of mental processes and habits
of thought.
It is usually advised that the occupation of the individual
at this stage should be manual, if possible ; but it is probable
that mental would equally meet the case if it was sufficiently
interesting to distract the attention, and to hold it. Manual
occupation is far preferable ; for, in addition to occupying the
mind, it also provides from its nature a greater degree of
physical health, which is what the organism requires. For
just as in most cases there is a tendency to concentrate too
much on physical education of the child making it an end
in itself instead of the means to higher mental development,
so at the later age of adolescence there is a similar tendency
on the part of the individual himself to disregard the physical
for the mental.
In both instances alike natural proclivities, if present in
excess, should be restrained, or at least made the vehicle of
higher co-ordinated brain growth. The child, naturally
anxious for physical exertions of all sorts — a savage— is fittle
apt to register the impressions of muscular co-ordination unless
trained to do so ; while the adolescent, tumultuous amidst the
new powers of mind developed, or rather awakened within
him by reason of his physical growth, and consequently, in-
creased range of receptive and perceptive powers, is prone to
let the extraneous, physical world without go by in oblivion,
so engrossed is he in the new mysteries of life within him-
self.
That the physical requires attention at this as much as at
the earlier period of life is evident by the appearance at this
age of many so-called automatisms, or excessive and uncon-
trolled actions, which, if allowed to persist, become fixed —
in the case of the body producing often deformities ; in the
case of the brain, obsessions.
Even in later life certain frames of mind occur approaching
melancholia, or its reverse mania — not severe enough to be
624 SCHOOL HYGIENE
called such but which, if studied attentively, are allied to
these conditions, both in the mental state and its physical
manifestations.
It is a truism to say tliat the weary, bored man needs exer-
cise, that the overworked anaemic shop girl needs further
stimulation, new sensations — but how often is it seriously
attempted? But that is not all, or even the most important
requirement. What both need is a physical or mental
stimulus which will arouse '* attention."
Weariness and boredom in civilised life of to-day come
rather from monotony than overwork. Indeed, one of the
chief causes of so-called fatigue to-day is in reality exactly
the opposite — under employment of mind, and the consequent
fatigue, the expression of unused and aberrant excessive
mental energy.
If persisted in the condition becomes permanent, atrophy
of power of concentration takes place, requiring many weeks
and months of endeavour to recall it.
Attention implies expenditure of energy. The easiest and
pleasantest way of arousing it, and controlling it when
aroused, is by defmite, purposely graduated movements of
the body or the brain. Physical exercise and brain exercise
should go together. In a properly adjusted combination of
the two, viz., willed graduated movements under the direct
and careful application of the attention, combined with some
equally definite and willed use of mental powers — such as
many writers, especially in America, have advocated — lies
the alleviation of what is popularly known as " nerves."
Dust of School Room Floors.
By Dr. Hermann Peters (Brunn).*
In the erection of new school buildings great attention is
now being paid on all sides to the demands of hygiene,
sufficient light, air, and proper ventilation.
It was interesting to ascertain through bacteriological ex~
periment whether these influences had affected the bacteria of
the dust in the schoolrooms.
Two schools were selected. An old one, a private house,
which was later converted into a school building, and which
must necessarily leave much to be desired from a hygienic
point of view. The other school was a new one, built in 1906,
where hygienic considerations had received every care. The
experiments were, in both cases, conducted on one of the
schoolrooms and the gymnasium hall.
In the old school the contents of the room were 284.16 cubic
metres ; with a class of 60, giving each child 4.73 cubic metres
of air. There are four windows, each 2.40 metres high and
1.33 metres wide, with louvred panes. The flooring is made of
long boards prepared with dustless oil. The room has a
stove, and for artificial lighting Auer's light. The gymna-
sium is 262.30 cubic metres, and has three windows.
The fifth classroom of the new school is 266 cubic metres, the
children number 57, so that each child has 4.66 cubic metres
of air. There are four windows, each 2.5 by 1.20 metres, with
louvred panes. There are besides fresh air shafts. It has a
central heating by hot water tubes (Rock's system). The
flooring is of hard boards — not oiled. Artificial lighting in
use is diffused Auer light. The gymnasium is 819 cubic
metres, with eight windows.
The following experiments were carried out. The dust
collected from the flooring was examined for cultures and
injected into guinea pigs, both subcutaneously and intro-
peritoneally. Agar plates were placed for an hour during
lessons in different parts of the room. The experiments were
carried on during fourteen days in the autumn in cloudy,
* From the AUgemeine Wiener medizioische Zeitung.
625
626 SCHOOL HYGIENE
rainy weather, at a time when colds were very prevalent in the
town. The rooms were neither aired nor dusted before the
dust was collected.
Two loopfuls of the dust were transferred to liquid agar and
plated. The particles of dust made the counting of the
organisms difficult, so that later on the dust was- mixed with
equal parts of sterilised salt solution ; this was well shaken
and filtered ; 30 cubic centimetres of the filtrate was plated on
agar or gelatine. The organisms were counted and their
varieties determined after twenty-four hours. In one experi-
ment a larger quantity of the dust was treated with antiformin,
and the sediment examined for tubercle bacilli. This c peri-
ment was not repeated, as there was no adequate solution of
the dust in the antiformin.
As the table shows, the number of organisms was, on the
whole, not very high, although, as we have said, the weather
was cloudy and rainy, and thus much dirt must have been
brought into the rooms, which were neither aired nor
swept. In nearly every case there were fewer organisms in
the old school than in the new.
Date
Old School
New School
23.11
Agar
1,075
1,4^8
24.1 I
Agar
66C-700
700-800
25.11
Agar
784-800
935-1,000
29.11
Gelatine
iP45
756
30.11
Agar
255-300
50-70
I. £2
|Agar
(Gelatine
200
1,102
300
1,334
2.12
Agar
Foo
1,192
3-12
Gelatine
1,624
1,890
6.12
Agar
216
325
7.12
Agar.
Gelatine
915
1,798
1,812
2,362
10.12
Agar
1,320
2,408
In the determination of the organisms the same kind were
always found; various sarcinae, mesentericus, subtilis, B.
fluorescens, some moulds, and other varieties common in the
air.
In the single experiment with antiformin treatment of the
dust for tubercle bacilli none was found. The plates used
during lessons showed the same organisms, but the numbers
varied according to the place where they had been collected.
In the new school the numbers found in plates from a seat were
3,400, floor 3,300, chest 2,400, whilst on the teacher's seat
DUST OF SCHOOL ROOM FLOORS 627
the number was only 1,070. In the gymnasium hall of this
school all the plates showed about the same numbers, 550
to 600.
In the schoolrooms of the old school the number~on the
plates was about 2,300 to 2,400. In the gymnasium hall
there were some slight differences. The plates at the window
and stove showed 300, and those at the clothes'-props 500.
The inoculated animals remained well and gained weight.
They were killed six to eight weeks later and their organs
found to be quite normal. To some extent these experiments
agree with the culture observations, although too much stress
must not be laid upon the former as they were only carried
out once.
The cultures are of great value as they were repeated for
several days, and yet no pathogenic organisms were found.
It is of interest that the number of organisms was almost
invariably less in the old school than in the new. This must
be, without doubt, attributed to the use of dustless oil, which
makes the boards smoother, and leaves less cracks and joins
for the dust to collect in.
Our experiments show that bacteriologically the dust in an
old and in a new school showed no great differences. We
may conclude that even under not quite favourable hygienic
conditions excellent sanitary results can be obtained by proper
sanitary method — cleanliness, airing of the rooms, and use of
some preparation to the floors.
Review of the Methods Employed or
Available for the Treatment of
Defects.*
No plan of treatment for the various defects and diseases
found on examination of the school children has as yet been
•established in Portsmouth other than the system of notifying
the parents of existing defects in their children, and request-
ing them to obtain the necessary treatment.
Although some good has been accomplished, I cannot say
that I am impressed by the value of the results obtained by
this method, nor do I consider it advisable to continue on the
same lines with a system which so palpably shows more or
less ineffective working for good results, and which is devoid
•of proper administrative power, by which means only can
good value be obtained in this special branch of the depart-
ment.
A perusal of the following facts will make my meaning
clear. In the year 1909, out of a total of 1,815 cases recom-
mended for treatment, 604 received treatment, leaving 1,21^
•cases. Of these latter, 653 received no treatment, there being
no record obtainable of the remaining 558.
In the year 1910, out of a total of 1,752 cases recommended
for treatment, 38.1 received treatment, leaving 1,371 cases.
Of these i^^Ji cases, 900 received no treatment, there being
no record obtainable of the remaining 471.
Apart from the percentage of children receiving treatment,
any system which, in two years, will enable 1,029 cases out
of a total of 3,567 to pass out of sight without any record
being available, and to further allow 1,553 to remain with-
out receiving treatment, is at once and for all time futile and
worthless.
• From the Report for 1910 of Dr. Victor J Blake, School Medical Officer to the
Portsmouth Education Committee.
628
METHODS FOR TREATMENT OF DEFECTS 629
The ultimate end and object of school medical inspection is
the prevention and alleviation of disease. Before methods
can be adopted to deal with this problem, the work of medical
inspection must first be thoroughly consolidated and -per-
fected. This, I think, I can reasonably claim, has been ac-
complished in Portsmouth.
Also the requirements of the area have to be ascertained,
i.e., the number of children suffering from defects and ail-
ments : the character and degree of these, and the help to
be obtained from local existing agencies in dealing with
these. After two years and four months' work in this area,
I am prepared to submit a statement of the requirements of
the area, and need not burden you with them in this report —
a statement which can be furnished at any time to a Com-
mittee dealing with the matter.
The question then remains that, having obtained these
factors, and having obtained the residue to be treated, how
the authority '' can supplement or render the existing agencies
more effective, or devise such measures as will stop the enrol-
ment of child recruits in the great army of the physically
unfit, and thus diminish the burden which the maintenance
of that army imposes on the nation." (Chief Medical Officer
Board of Education.)
This, in mv opinion, necessitates the provision of a simple
and effective organisation which shall deal with matters not
only relating to the treatment of defects themselves, but with
miatters relating to the general administration of school
medical service work.
The need of a separate office and clerical assistance at the
present time is a great handicap in the requisite administra-
tion of affairs — especially as with increased staff and increas-
ing work the details become daily more intricate and search-
ing.
The whole of the work at present requires centralising, and
I think the only satisfactory solution will be found to be the
f^stablishment of a vSchool Clinic in a central position, prefer-
ably by means of purchasing or renting a small house and
converting the same into the necessary ofiices and rooms,
which School Clinic shall be in character :
(i) Administrative.
(2) Advisory.
(3) Remedial.
%
630 SCHOOL HYGIENE
(i) ADMINISTRATIVE.
This will perform a dual function.
(a) By providing the necessary central offices for the
work of the School Medical Officer in connection with
the storage of cards for medical inspection, clerical
work in connection with same, and for all general
details associated with the various branches in the
administration of this work.
(b) By /centralising what may be termed the outside
spheres of the work of Medical Inspection which, at
present, from lack of offices, are not dealt with, or if
so, in only a very inefficient manner.
The following phases of school life would then be properly
organised :
(i) All Attendance Officers would present for examina-
tion on certain days all cases absent from school
without sufficient or valid reason, or without evidence
of medical attention if absent on the excuse of illness.
(2) Cases excluded from school on account of verminous
condition would not be permitted to return to school
without first presenting themselves at the School
Clinic, and satisfying the School Medical Ofiicer that
they were in a fit condition to be re-admitted.
(3) All cases of ringworm absent from school would be
made to report themselves regularly to see that they
were receiving treatment apart from any so treated at
the Clinic, and no case would be allowed to return to
school without first satisfying the School Medical
Officer by microscopical examination that he or she
was free from infection.
(4) No case of infectious disease would be permitted to
return to school without having first satisfied the
School Medical Officer that he or she was free from
infection.
(5) Head Teachers would submit any suspicious cases of
skin or other disease for advice.
METHODS FOR TREATMENT OF DEFECTS 631
(6) All cases requiring further examination than that
afforded by ordinary inspection at school would
attend for a more detailed examination at the~01tnic>
i.e., lung (examination of sputum), ringworm (micros-
copic examination), kidney (examination of urine)>
syringing of ears (for use of aural speculum).
(7) All cases which at medical inspection have been
notified for treatment, and have failed to secure this
within a reasonable time, would be made to attend ihe
Clinic, and pressure brought to bear upon the
parents to obtain the necessary treatment such as the
provision of glasses, treatment of tonsils and adenoids^
etc., where these parents are known to be able to afford
treatment.
By this means a proper grip would be established upon
such important details, preventing leakage in many ways^
and lacking now only through want of proper centralised
control from a central office.
(2) ADVISORY.
(a) Many parents would avail themselves of the oppor-
tunity of seeking advice as to the proper course to
pursue in many cases, apart from any treatment being
provided for them.
(i) Re provision of tickets for hospital or eye treat-
ment.
(2) Re convalescent homes or sanatoria.
(3) Re mental or physically defective children.
(4) Re examination of children for blind and deaf
schools.
(b) In cases ordered to obtain treatment, and told to
return within a week to report as to what has been
done, this would enable the School Medical Officer
to insist more strongly on the treatment being ob-
tained, and to see that some steps had been taken in
this direction, either by calling in medical practi-
tioners, or making use of hospitals, dispensaries, etc.
These functions of a School Clinic, embodying as they do a
central office for clerical, administrative, and advisory work.
632 SCHOOL HYGIENE
seem to me to be an absolute necessity for the future efficient
and proper working of the department, apart from the next
point to be considered, viz. :
(3) REMEDIAL TREATMENT.
In presenting this branch of the Clinic, it is necessary to
discuss :
(a) The class of defects met with under three broad
headings. These fall naturally into :
(1) Special cases and conditions —
(a) Refraction work (eyes).
(^ Tonsils and adenoids. Mastoid disease.
(c) Dental work.
(2) Ordinary diseases met with, such as bronchitis,
infectious disease, nervous diseases (such as St.
Vitus' dance), heart disease, which are gener-
ally attended to by general practitioners.
(3) A class of cases generally known as minor
ailments, such as skin diseases, including ring-
worm, sore eyes, discharging ears, sore heads,
verminous cases, etc.
Class 2 may be eliminated as requiring attention at a School
Clinic except in so far as has been mentioned before — in
supervising and seeing that such cases obtained the required
and necessary treatment.
This leaves the group of cases known as :
(i) Special cases.
(2) Minor ailments
which therefore need to be dealt with.
It may here be asked, but why need a School Clinic when
there exist such local agencies as the Eye and Ear Infirmary,
and the Royal Portsmouth Hospital, which can be utilised
for treatment.
My answer is (i) that these hospitals, and their out-patient
departments especially, are already taxed to their utmost in
dealing with the general diseases incident to the civil members
of so large a community as Portsmouth, and would be more
than overtaxed by dealing with the large numbers of children
METHODS FOR TREATMENT OF DEFECTS 633
found defective during School Medical Inspection, a great
number of whom have already endeavoured to obtain^tickets
for treatment there.
(2) The authorities and staff of these hospitals themselves
discountenance the treatment of school children, contending
that the Local Education Authority, who provide education,
free meals, etc., for the children, and who, through the Board
of Education, now have School Medical Inspection instituted,
should provide for the treatment of those children found
defective themselves.
(3) Because, during the time since School Medical Inspec-
tion was commenced here, viz. : September, 1908, these
agencies have been, and are, totally unable to cope with the ^
demand for treatment of the children who require it, and, r
furthermore, that there is a large class of Cases who require
a type of treatment for which hospitals were never intended,
and for which they should not be asked to treat, nor could
be expected to cater for.
The large proportion of children shown previously in the
report who have had no treatment of any kind, cannot be
explained wholly on the ground of " indifference of the
parents." It is the daily experience of the School Medical
Officers to have children, and parents of children willing to
obtain treatment, but unable to do so on account of poverty,
and inability to obtain hospital treatment.
The establishment of a Schcol Clinic should be solely for
the very purpose of supplying treatment for the needs and
wants of the necessitous poor — those who from circumstances
of life are in low water, and unable to provide the means by
which their children can be attended to. In this way the
School Clinic would be a means of assistance to the hospitals
by relieving them of an unnecessary burden ; to the general
practitioners themselves by safeguarding their interests in
dealing simply with those who financially are of no service tO'
them ; and also of benefit to them by the fact that many cases
— -whose parents are able to afford treatment — are being, and
will be constantly brought to them for treatment by the in-
sistence and notices of the School Medical Officers to these
parents to obtain the required treatment.
A Class for Intermediate Children
The Brighton Education Committee adopted the sug-
gestion made in 1909 by its medical oflicers to establish a
special class for children intermediate between backward and
mentally defective. This was opened last April, for 25-30
boys between the ages of 11 and 12 at the Richmond Street
Boys' School.
A circular was sent to the head teachers of six schools,
drawing attention to the proposed new class; the teachers
were asked to select for examination by the school doctor such
boys as they thought would benefit by the proposed training.
All boys entered on these lists were then medically ex-
amined, and 30 were chosen for the class. A few of these
were selected, as it w^as desirable that their mental condition
should be ascertained more exactly over a period of prolonged
observation.
A letter was written to the parents, pointing out the back-
wardness of the child, and the advantages to be gained by
entering the child in the practical class. The parents ex-
pressed themselves in almost all instances as being very glad
to avail themselves of the offer.
Arrangements were made for the use of a special room in
Richmond Street School ; this was fitted up partly for manual
and partly for ordinary school work. The arrangements and
the details of the curriculum were completed by Mr. Mul-
renan, the head master, in conjunction with Mr. Walter, an
assistant appointed especially for the class. A great deal of
care has been taken to prevent any stigma falling upon the
boys in the class. For this reason it is known as a " practi-
cal " not a " special " class. The boys of this class join
with the others at prayers, opening and closing of school
sessions, scripture, and play. A monthly report is sent home
to the parents, detailing the conduct of the boy and his pro-
gress.
Manual work of some kind forms about one-half of the
training. As far as possible all subjects are taught in a
• From the Annual Report for 1910 by Dr. Duncan Forbes and Dr. J. Lambert.
^34
A CLASS FOR LNTERMEDIATE CHILDREN 635
practical manner, and combined with manual work. The
aim of the class is to ''make the curriculum fit the boy,"
and owing to the smaller number in the class, for some in-
dividuals, modification of the training can be introduced
without disturbing the routine of the class as a wholeT "The
development of the powers of observation and initiative is
an important part of the training. The average age of the
class at the commencement was 12 i-i2th; this is Somewhat
high, and one would prefer in establishing other classes to
make the average age 10.
The average ability of the class was that of Standard IL;
a few were incapable of work above Standard L — one or two
of these were found to be mentally defective after subsequent
examinations.
The class started with 27 boys, and now contains that
number ; one boy left the district, one was removed owing to
definite mental deficiency, and one, a constant truant, was
sent back to his former school ; three boys were admitted in
place of these. The average attendance has been 25.5 out
of 27 ; the boys have attended well ; most of the absences have
been due to illness.
The work done throughout the year has been encouraging,
more especially the manual portion, which is readily taken up
by the boys ; with the exception of three or four cases, there
has been general improvement. The class has been of use
as an observation centre for certain mental cases, enabling a
more definite diagnosis to be given of the degree of defici-
ency. There are at present in the class one or two high-grade
mental defectives, and it may be necessary to draft these
into the special school.
The scheme of work and time-tables (supplied by the head
master) are given below. It will be noted that half an hour
daily is devoted to physical exercises and games | this was
considered advisable, as most of the boys in attendance come
from poor districts, and are markedly below the average
height and weight; they do not, as a rule, display the activity
and energy of the normal child, and hence any training
tending to the development of these qualities is advantageous.
One of the most noticeable features of this group of
children, while in the ordinary elementary school classes, is
the apathy with which they regard most of their lessons.
They take no interest in a lesson of which they understand
nothing; they become resigned to repeated correction by
their teacher ; and after being a source of annoyance to the
teacher and a drag on the remainder of the class, they are
636
SCHOOL HYGIENE
generally left to get on as best as they may, ignored by the
teacher, who cannot spare time for them if his class- is to
progress at a normal rate.
A child of this group generally passes through the school
career, and leaves at 14, having done little or no manual
work ; the usual system is that manual work is only done by
boys in the upper standards ; as these boys of the inter-
mediate class never get beyond Standard HI. or Standard
IV., they lose the training which would be of most value to
them in their work after 14, and which would appeal to and
rouse their interest during school life.
It is interesting to notice that the children in the practical
class display far more interest in their work, and show much
less apathy than formerly, when they were the outcasts of
other classes.
Scheme of Work.
Important, — Every subject, wherever possible, is
practically and in manual form.
:aught
Arithmetic
Simple exercises in mental and written work, including
practical work in money, length, weight, capacity,
time.
All numbers to be small.
Reading
Good, simple, continuous stories.
One Geography and one History Reader.
Spelling.
Writing
Copy books, simple dictation and composition.
Geography
and History
The world generally, taught by clay modelling, reading,
and pictures.
Singing
Voice training. Simple songs
Object
Lessons
Nature study of plant, animal, and insect life.
Common things : air, water, etc.
Hygiene, ventilation, food, etc.
This subject experimental where possible.
Drill
Half-hour each day. Official course of exercises and
organised games.
Drawing and
Manual Work
Includes clay modelling and work in cardboard, paper,
and wood.
A CLASS FOR LNTERMEDIATE CHILDREN 637
It is necessary to point out that the work in arithmetic,
geography and object lessons is largely of a manual nature,
Plasticene clay being frequently used.
The experiment and the method of teaching has~^been
favourably commented upon by H.M. Inspector; it un-
doubtedly owes its initial success to the personal care and
supervision of the head master, Mr. Mulrenan, and the carry-
ing out of the scheme by Mr. Walter.
An experiment is at present being made at Hanover Ter-
race Girls' School, where 25 of the intermediate and very
backward types have been formed into a special class, and
have received special instruction from the head teacher,
Miss Baker, in such subjects as reading, writing, and practi-
cal arithmetic, and are distributed among other classes for
training in domestic work, needlework, nature study, and
object lessons. Practical lessons are given in such matters
as the hygiene of the body. It is proposed to teach these
children especially home vianagenient and infant care in as
practical a way as possible. A new teacher has just been
appointed for the special supervision of this class. The
average age of the class is about 12, and the average mental
capacity Standard I [.-III.
Medical Inspection in Ayrshire.
Verminous Children.
It is too early to gauge the results of medical inspection
Dr. Macdonald remarks, but there is already much improve-
ment in cleanliness of head and of body. This is something
positive which can be put to the credit of medical inspection.
When a verminous child is found at school he recommends
that the house be inspected, " and if found dirty and the other
inmates verminous, as is usually the case, the whole family
be removed to reception or isolated rooms until the house and
clothing of the persons of the household be thoroughly dis-
infected and cleansed."
The Overclothed.
Dr. J. King Patrick, the Medical Inspector for the schools
in the Northern district (all the school boards in this area have
now joined in the scheme), remarks : —
"It is somewhat difficult to judge of the true character of
the clothing in a routine inspection, as the parents, being
notified that the inspection will take place, take care to have
their children ' got up ' for the occasion. On the occasion of
surprise visits to the schools marked difference is often noticed
with regard to cleanliness and state of clothing. Clothing
may be deficient in respect to cleanliness, suitability, and state
of repair, and quite often young children are overburdened
with a mass of clothing altogether in excess of their require-
ments. This is most often the case of children who are
regarded by their parents as ' delicate,' or who are con-
valescing from some form of chest affection. It is just in these
cases that the baneful effect of overclothing is most to be
feared, as the weight of clothes impedes respiratory action and
interferes with the proper discharge of the functions of the
skin. The parents so clothe their children that they may not
catch cold, little realising that the procedure they adopt is
the one best calculated to make the child liable to chill. The
638
MEDICAL INSPECTION IN AYRSHIRE 639
state of the child's clothing is often a very sure index of the
capacity of the mother. Among the routine children examined
373 were found to have no boots. It must be remembeiecLthat
the figures refer to the whole year, and that the most of those
found were in the summer. It is certainly desirable that all
children should wear boots in the winter, and in the summer
also some protection should be given for the feet. I think that
at any time the absence of boots is no more serious than the
presence of boots in bad repair. In fact, I think I would be
inclined to prefer no boots to bad boots."
Overworking the Schoolroom.
In the Kilmarnock district Dr. Stevens finds that :
" A few schools are used as churches on Sunday, which is a
practice to be deprecated. It is a serious menace to the health
of the children. The scholars instead of entering a fresh room
on the Monday, when the dust has had time to settle, enter one
which has been tenanted by all sorts of people the day before —
some coming from infected houses and some with infection
on them.
" In some small remote country schools of the barn and
cottage type sanitary conveniences are necessarily primitive,
but only care and attention are required to prevent any
nuisance.
" With regard to lavatory accommodation, this is on the
whole good, but some quite large schools provide neither soap
nor towels. How are children to become inculcated with the
principles of personal cleanliness unless they have appliances
at school for keeping their hands and faces clean ? Think of
the result of a sewing class where the girls take up their white
work with dirty hands ! "
Malnutrition.
In the Ayr and Carrick district Dr. Wm. Barr found
among his 2,645 children examined, 113 cases of malnutrition.
" This number may appear large, but under this heading
the medical ofificer has included all cases of ansemia, as this
condition is in the majority of instances due to errors in
dietetics. Whenever the child manifested signs of anaemia
and bad feeding the ' food history ' was enquired into. The
usual story was that tea, potatoes, bread and jelly formed the
bulk of the child's feeding, and that the foods requisite for a
growing organism were a rarity. Even in the most rural
schools anaemia was met with. There the cases were usually
children whose homes were far from the school and who had to
640 SCHOOL HYGIENE
make a ' piece ' of bread and jelly serve for dinner. It is for
these latter children that the establishment of soup kitchens
would be of great benefit, and already in some schools children
can have a plate of soup for a small sum."
Special Classes for High Myopia.
Dr. W. F. Brown, in the Burgh of Ayr, has made a special
enquiry into children with severe eye defects.
" In reporting on those children who have such deficient
sight that they are unable to take advantage of the ordinary
school education offered them, and yet who are not fit subjects
for a blind school, I beg to state that on May i8th I visited
several schools in Glasgow, including Dovehill and St.
George's Road Schools, where I learned that the methods
there adopted for dealing with such children were Braille
reading and writing, taught under the supervision of a visiting
teacher. In fact, the teaching is such as is carried on in the
ordinary blind school.
" Under the London County Council special arrangements
have been made for dealing with such children, due chiefly to
the efforts of Mr. Bishop Harman. Indeed^, the special classes
referred to are the only classes of the kind in the world. I
know of no other place where they are conducted. I had the
great advantage of Mr. Harman 's personal advice and guid-
ance in looking- into this matter, and to him I owe my best
thanks. I must confess that I was much impressed with the
good work done and the results obtained.
"I may state that most eye surgeons to whom I have spoken
are impressed with the value of such special teaching and the
necessity of insisting on the danger of ordinary education in
such cases. Then, as often happens, such children are
excluded from educational advantages. These special classes,
while providing for their education, yet prevent all work likely
to be dangerous to their eves."
The First International Congress on
Child Study.
HELD AT BRUSSELS AUGUST i2TH-i8th.
There was much of interest to educationists at this Congress ;
unfortunately the attendance was not sufficiently represen-
tative to justify the term international. Professor de Sanctis,
Dr. Hoesch-Ernst, Dr. T. Smith, of Clarke University, were
almost the only non-Belgian visitors of well-established
reputation. The Congress was, indeed, an enthusiastic
gathering of Belgian school-teachers and educationists. The
members of the Congress met with a most cordial reception,
vins d'honneur and the rest, at Brussels, Antwerp, and Char-
leroi. Indeed, the receptions were on so magnificent a scale at
Antwerp that our correspondent protests that it w^as difficult
to see any work. Dr. Joteyko's laboratory at Brussels was
transferred to the exhibition. At Antwerp facilities were
given for visiting the elementary and secondary schools, and
for an inspection of Professor Schuyten's laboratory.
Among the interesting features was a demonstration of
rhythmical gymnastics for children based on the Jaques-
Dalcroze system by Mdlle. Rose Guilliaume. The method is,
perhaps, better adapted for ensuring grace and flexibility
than for the correction of physical defects and unhappy
postures. At all events such faults were exhibited by many
of those who took part in the display. Considerable excite-
ment was shown in the discussion of Dr. Van Wayenburg's
paper on " Fatigue." Dr. Van Wayenburg asserted that the
'' threshold of twoness " in aesthesiometry was pure chance
dependent on the areas being supplied by more than one
spinal segment; when these overlap *' twoness " can occur
at short or long distances; " twoness " does not occur when
there is no overlapping. The challenge was taken up by
several speakers, who claimed that aesthesiometry had given
wonderful results; others maintained that the conclusions
were quite untrustworthy. There was some little difficulty in
641
642 SCHOOL HYGIENE
following that discussion, because, although not more than
three persons spoke at the same time, each of them used a
different language. Mr. J. Gray, in his paper on " Anthro-
pometry and Aptitude," drew attention to his revolving mirror
for the measurement of the persistence of perceptions due to
colour images. When the revolutions reach a certain rate
the colours fuse ; the rate varies in different persons, and is
an index of mental character. Dr. Hoesch-Ernst doubted
whether the test could be applied to children, w^hilst Professor
de Sanctis considered that the correlation was a spurious one.
Professor de Sanctis's own paper on " Abnormal Children "
dealt chiefly with the diagnosis by the tests he has devised.
Apart from these he said there were certain practical methods
of ready application and considerable value. A test of the
child's knowledge and powers of application combined with
its past history and a brief physiological examination would
differentiate the abnormal child. Good results were also
obtained by the psychological analysis outlined by Sommer
and Ferrari. One of the most valuable papers sent in was
Dr. Spearman's " On the Correlation between Aptitudes."
Dr. Spearman pointed out that as investigation proceeded the
problem had been discovered as one of extreme difficulty.
Unfortunately many investigators had not yet arrived at that
stage, and so much of their work was wasted. Statisticians
without psychology were even more dangerous than psychol-
ogists without statistics. Psychologists have now discarded
" general intelligence," still believed in by statisticians and
amateurs; for the psychologist, however, "the individual of
greatest general intelligence was surely he who happens to
excel in the greatest number of performances." A brief and
useful resume of 25 papers was presented to the members of
the Congress, but not all of these were read. Some were of
much value, and we hope to refer to them when they are
published in full.
The English Section at the Interna-
tional Hygiene Exhibition at Dresden
Although English exhibitors have been handicapped in com-
parison with those from other countries by the absence of
official support, the resultant collection, whilst small, is well
worthy of the country, and reflects great credit on the industry
and persuasive skill of Dr. Armit, the secretary of the English
section. The exhibits cover the whole range of hygiene.
Infant care is exceptionally complete under the auspices of
the St. Marylebone General Dispensary, the Birmingham
Infants' Health Society, and the St. Pancras School for
Mothers. This section attracted considerable attention, and
the demonstrations by the skilled representatives of the St.
Marylebone Dispensary were generally welcomed. Under
schools and school hygiene is classed a very full series of
photographs illustrating all phases of school life in London —
work, rest and play, medical inspection and treatment in the
Deptford and otherclinics,open-airschools,and special schools
for the defective. The arrangement of the myopia classes
attracted, perhaps, the greatest attention. The Sheffield and
Bradford and Arlington open-air schools sent characteristic
photographs, while Treloar's Cripple Home and College, at
Alton, provided an exhibit of photographs and apparatus
which attracted the notice of all medical visitors.
The tuberculosis section showed fully the arrangements for
controlling the disease by means of dispensaries, hospitals,
and sanatoria. Under the latter the development of the idea
of work, and the control of the self-infection of the patient
which has been generally adopted after the lead of the
Frimley sanatorium, can be followed by a series of photo-
graphs and designs.
Manchester supplies an exhibit showing the care taken to
ensue the purity of the food supplies of the county. Liver-
pool and some private architects fully illustrate the latest
ideas in town planning. Whilst the exhibits for Glasgow,
Liverpool, and London in tropical medicine, and especially
the remarkable collection of the Imperial Cancer Research
Fund alone are worth the journeying to Dresden.
643
From Far and Near.
Cleansing of Floors. — During the year experiments have
been carried out in the treatment of schcol floors with various
dustless oils. These oils have been applied to the labora-
tory and to the gymnasium at the Pupil Teacher Centre, to
certain classrooms at Bow Street Council School, and the
Crofts Council School.
The following objections may be made to the use of these
preparations : —
(i) The increased slipperiness of the floors results in
people falling. This statement is true, but falls will
not occur if people learn to walk properly.
(2) The clothing of the children becomes dirty if they sit
on the floor ; teachers' dresses will also become dirty
if they come in contact with the oily surface. With
reference to the soiling of the children's clothing, it
would perhaps be as well not to apply oil to the floors
of babies' rooms. The second objection is not of
much importance, for skirts should be worn short
enough to avoid their touching the floor.
(3) Oiled floors become dark, and in that way a certain
amount of reflected light is lost in the room. This
may be an important objection in schools situated in
dark streets.
(4) The dirty appearance of oiled floors has been noticed
and commented on unfavourably, unless oils of a
very pale colour be used. This is certainly of im-
portance from the educational point of view, as
children seeing dark and apparently dirty floors in
school may think that floors at home should be of
the same colour.
The question really resolves itself into one of expense. It
is certainly preferable to wash the floors at least twice a term
(as is done in some other towns) instead of four times a year,
which is the practice in Sheffield. This would entail very
considerable additional expense in labour. With regard to
the oiled floor the preparation is applied at the beginning of
each term and afterwards only requires to be wiped over with
a wet cloth. The dust falls and is prevented from rising
again by the oily surface from which it is periodically re-
moved. In other words the dust, instead of being inhaled
by the children, remains entangled on the oily surface of the
floor.
644
FAR AND NEAR 645
This statement is borne out by the small amount of dust
found on shelves, pictures, etc., in rooms the floors of which
have been treated with an oily preparation.
By the kindness of Dr. J. Martin Beattie, Professor of
Pathology in the university, I have been able to carry out
some bacteriological examinations of the air in certain class-
rooms.
Gelatine plates were exposed for six minutes in
(a) A classroom, the floor of which had been treated
with oil.
(b) A classroom where oil had not been used.
Plates were exposed whilst the children were at rest, and
other plates when the children were walking round the room.
It was found that the number of colonies of bacteria (each
of which represented a particle of dust) growing on the
different plates were as follows : —
(a) Room with oiled floor (children walking round
the room) ... ... ... ... ... ... 60
(b) Room with untreated floor (children walking-
round the room) 270
This is a rough test, but it shows conclusively that the
amount of dust thrown up when children move about is very
much less with oiled floors than is the case, under the same
conditions, with untreated floors.
I recommend that the experiments with dustless oils be
extended in certain schools during the year. I also consider
that the untreated floors should be scrubbed more frequently ;
especially does this refer to babies' rooms. — Dr. Ralph P.
Williams' Report to the Sheffield Education Committee,
igio.
The School Ambulance. — An ambulance for first aid was
recently placed in one of the schools by one of the managers.
The headmaster, in thanking him for the box, assured the
donor that it was really very useful, but he did not intend it
to be used. He would put the key in his pocket — as an
ambulance was too dangerous. " If I were to apply arnica
to a bruise and some eruption broke out, or some splints to a
fracture which was, perhaps, already compound or became so
on the journey, suppose I did my best with a wound and yet
it became poisoned, or if I gave some simple medicine to a
child taken ill, which turned out to be the commencement of
something serious, who would be blamed but the master, and
by the very parents who would have every consideration for a
quack? If the child had to remain in bed, if he were lamed
for life, or if, unfortunately, he were to die, a suit would be
646 SCHOOL HYGIENE
brought against me. I should have all kinds of worries,
perhaps lose the case. The ambulance box will remain
closed.
" You say that the parents are not all so absurd. Well, I
tell you it would be always the headmaster's fault. It would
have been nothing if it had been left alone — the child was ill
because he was made to swallow something — the child is de-
formed because the bandage was put on all wrong. .No, we
have trouble enough without that.
" No, I will not even put a cold water compress on a sprain,
lor if the child is later on attacked by white swelling I shall
always be blamed.
" No, I shall not mind explaining to the children the use
and advantages of the ambulance box in cases of accident.
But that's the only way I shall touch it." — Dr. Courgey in
La Medecine Scolaire.
Boy Scout Schools. — In Barry, the enthusiasm for " Boy
Scouting " has been made use of to secure the attendance
of these boys at three evening schools. The Scouts, who
number about 200, are most punctual and regular under their
patrol leaders and scout masters.
They are taught " investigation," which is really useful
knowledge, such as surveying and measuring, etc., history
and geography, singing, and " health talks," given by
medical men. These include : —
1. Structure of the body.
2. Disease — how spread.
3. Nature and variety of food and drink : digestive
organs.
4. Respiration : Value of open-air breathing exercises.
Schafer's method of restoration of the apparently
drowned.
5. Circulatory organs : Bleeding from arteries and veins,
etc.
6. Personal hygiene. The care of the body, the hair,
teeth ; clothing, baths, etc.
7. Hygiene of the home. Soils. Buildings, drains>
sewage, water supply, etc.
8. Germs. Infectious diseases.
9. Minor ailments, burns, etc.
In addition to this course, the boys are given lectures by
prominent townsmen, often with an optical lantern. — Dr.
W, Lloyd Edwards' Annual Report for 19 10 to Barry
Education Cornniittee.
Correspondence.
Woolwich District Invalid Children's Committee
and Ringworm.
Sir, — Few people, I think, realise the distress there is
amongst children on account of ringworm, and how little
there is being done to remedy this. So far as I am aware,
the Miller Hospital is the only place that children can attend
for the X-ray treatment, and there only two cases per week are
treated. I should like to give the following cases as
examples : —
Case No. i. — R. F., a little lame girl, aged 7, started with
ringworm in April. She was excluded from school. Her
mother tried her best to cure the ringworm, but without suc-
cess; consequently, by the end of June her sister and two
brothers were infected. A letter was then sent to the Educa-
tion Officer asking if they could be sent to the Miller Hospital
for X-ray treatment. A reply came saying the children should
have the necessary cards, but owing to the number of cases
waiting treatment it would be some time before an appoint-
ment could be made. On August 24th Mrs. F. reported she
had not heard anything from the L.C.C., and she was told
she would not hear until the holidays were over, and then no
doubt when she did hear she would have to take the children
one at a time. This she said was impossible. She cannot
get anyone to go in and look after the children, as they are
afraid of getting the ringworm, and when she left the three
children the other day to do some shopping she returned to
find her front room in flames. Her eldest boy had played
with the matches. Poor woman, she said it was really ter-
rible, as the children being away from school so long were
getting out of hand.
Case No. 2. — F. K., aged q, suffers badly from epileptic
fits, and has hardly been able to attend school at all. He was
a little better in March, so his mother sent him to school, but
after a fortnight only he started with ringworm, and has had
it ever since. Florence, the younger, sister, caught the ring-
worm from Fred ; both are now away from school, and are
likely to be, unless someone takes the matter up. In the case
of Fred and Florence, the exclusion from school is not the
worst point. Their father has been out of work for some
time, and, if at school, they would have free dinners, but as
they are excluded they have, of course, to go hungry.
Case Xo. 3. — L. M. has been absent from school two years
on account of ringworm.
If you have space to insert this in your next issue I shall
be very glad, and I hope all who read it will do their utmost
to press for a School Clinic in everv borough.
Yours faithfully,
H. F. Grinlixc.
647
REVIEWS
The Deaf Child, a Manual for Teachers and School
Doctors.
By James Kerr Love, M.D. Bristol : John Wright and
Sons, Ltd. 191 1. Pp. 192.
Dr. Kerr Love is, of all his profession, the man most en-
titled to write upon the subject of the deaf child. His book
is an attempt (as he modestly describes it) to introduce the
scientitic method into the study of deafness in children, and,
as a result of this, it lays down a clinical basis — the only safe
foundation — for the application of clinical methods. In his
introductory chapter the author sketches the history of deaf
education, dividing it into three periods : a sporadic, from the
time of Benet towards the end of the sixteenth century ; a
systematic, from 1760 to our own time, and a clinical period,
which is just beginning. Chapter IL deals briefly with the
physiology of hearing, and the causes of deafness ; and
Chapter IIL more fully with the operation of the language
centres in normal and abnormal children. This chapter is
one of the most important in the book, as it forms a powerful
argument for the oral system, and for the early education of
the deaf child. Deafness in the school child forms the sub-
ject of Chapter IV., and we are glad to note that Dr. Kerr
Love insists upon the human voice as the only test of practical
value in dealing with school children. Chapter V. gives an
interesting account of the present condition of the education
of the deaf, doubly valuable because the reader knows that
Dr. Kerr Love speaks only of what he has seen and knows. In
discussing our own country he recurs to what he endeavoured
to bring out in his introductory chapter, viz., the neglect of
the deaf child by the medical profession, and the rise of the
institution for the education of the deaf child, and writes
thereon at greater length. Whilst he fully appreciates and
praises the magnificent work done by the institutions for the
deaf in the past, he points out that there is yet no general
movement for the transference of deaf children from institu-
tions to day schools. This will be, however, the inevitable
outcome of progress in deaf education. Throughout this
648
REVIEWS 649
chapter one is gradually brought to the opinion that the^day-
school system is, and must be, the better. It is pleasant
to those who work under the London Ccunty Council to find
how Dr. Kerr Love appreciates the work of the deaf schools
imder the control of that body. The London County Council
arrangements, he says, show that it is possible to educate the
majority of deaf children efficiently without taking them from
their homes, that this efficient system costs less than the
institution system, and that the results at Oak Ledge and
Anerley, where the London deaf complete their education,
are amongst the best in the kingdom. Chapter VL deals
with methods of education, in which the needs of British
schools are so discussed as to convince the reader that the
postulates laid down are right. Chapter VI L very briefly
touches upon the surgical and educational treatment of deaf
children, and Chapter VIII. is devoted to lip-reading. The
book concludes with three appendices : upon the capacity of
the deaf for higher education, the condition of the eyes in
the deaf child, and stammering and cleft palate.
One seldom meets with a book in which so much informa-
tion, so much sound, logical reasoning, and so much care-
fully arranged personal experience is contained in so small a
number of pages. Dr. Kerr Love has given to the medical
profession, the educationist, and to the legislator, a book
w^hich, if taken rightly and acted upon, should bring about
enormous improvements in the condition of the deaf child
throughout the world. Macleod Yearsley.
Hygiene and Public Health »
By Sir Arthur VViiitelegge and Sir George Newman.
London : Cassell and Co., Ltd. 8s. 6d. net.
There is nothing to say about the twelfth edition of a text
book except that merit does occasionally meet its due reward
even in this imperfect world. The chapter on schools and
school hygiene naturally attractsour first attention. A very clear
account is given of the main features to be regarded in school
building, and of the chief regulations prescribed by the Board
of Education. The plenum system of ventilation, we are
glad to see, receives no recommendation. The useful memor-
andum issued in 1909 on the closure of schools is given ; per-
haps attention might have been drawn to the unfairness of
not compensating local authorities for the loss of grant when
closure is enforced. In measles epidemics unprotected
children, it is advised, should be excluded within nine or ten
650 SCHOOL HYGIENE
days of the first attendance of the initial case. In connection
with this the authors fix the lowest age limit of school
attendance at five years. If anything this errs by being too
low ; from every point of view, children should not be sent
into schoolrooms before six or seven years. Pneumonia is
now included among the specific diseases, but it is a pity no
place has been found there for the venereal diseases and for
rheumatic fever. We must demur to the view that
phthisis is rare among Jews. The authors consider that little
reliance should be placed upon the tubercular nature of the
m^ijority of the cases certified as deaths frcm tabes mesenterica
and tubercular meningitis, and they rightly urge that these
death certificates must not be regarded as evidence of the
extreme prevalence of tubercular disease. Nothing is said,
however, as to the evidence brought forward in the last few
years as to the prevalence of the tubercle bacillus amongst
children : Hamburger (Vienna) with his 94 per cent., Noth-
mann, 84.5 per cent. ; Ito (Japan) 48 per cent, and others with
an equally high percentage of positive reactions with Von
Pirquet's test. Of course, presence of bacillus and tuber-
culosis must not be regarded as like terms. But the figures
do rather lend support to some of Sir Almroth Wright's ap-
parent paradoxes. We would rather like to have had the
opinions of eminent public health authorities like the authors
on the situation. The chapter on fact^.ries and workshops
gives, as was to be expected, full abstracts of the regulations
and laws. The questions of leadless glaze and of zinc oxide as
a substitute for lead paint are not discussed, nor de we find
any mention of the recommendations of the recent report of
the departmental committee on the use of lead in the potteries.
But we must not forget that space is limited, and this revised
edition, containing a great deal of new matter, preserves the
pleasant and convenient format of the earlier editions.
Prom the title page no one would learn that one of the authors
is H.M. Chief Inspector of Pactories, and the other the chief
medical officer of the Board of Education. Of course,
authors and publishers can but submit to official regulations^
however pedantic.
The Prevention of Dental Caries.
By J. Sim Wallace, D.Sc, M.D., L.D.S. London: The
Dental Record, is. 6d. net.
The lamentable condition of the teeth of school children,
revealed by medical inspection, has brought the question of
REVIEWS 651
the prevention of dental decay into great prominence. So
much so, that Dr. Wheatley, at the recent meeting of the
British Medical Association, claimed that there was iiD_Dther
problem in public health the solution of which would do so
much for the physique of the nation. The researches of a
number of dentists, of whom G. V. Black, W. D. Miller, and
J. Sim Wallace are the most prominent, lead the latter to
say that : —
" The pathology of the disease and the nature of the im-
mediate or exciting cause is definitely and accurately known,
and, fortunately, beyond the limits of controversy. It is now
universallv admitted that dental caries results directly from
the fermentation of carbohydrates in the crevices of or be-
tween teeth."
Although, perhaps, other dentists might be easily found
who would lay more stress upon Dr. Wallace's antecedent
causes, viz., the shape and arrangement of the teeth, and
their relation to the gums, and perhaps even defend the thesis
that certain individuals have teeth more predisposed to caries
than others, yet in focussing attention upon one factor which
is easily tackled Dr. Wallace is doing a most admirable work.
The dentists of the new school, teaching as they do an entirely
novel system of dietitics, are, perhaps, inclined to be over
hasty with their medical colleagues. The views set forth
are the product of the last few years; they are, by Dr.
Wallace's confession, only set forth clearly in one text book
of Dental Surgery (J. F. Colyer), and some time must neces-
sarily elapse before the medical profession, as a whole, has
a.bsorbed them, and a much longer time before the general
public has been convinced. The difficulties of convincing
the public will be realised when the revolutionary character
of the suggestion is considered in detail. Thus in infant
feeding, on weaning, the giving of bread and milk, milk pud-
dings, and such like soft foods, is to be forbidden ; instead,
we have toast to gnaw, rusks, milk puddings made solid, fish,
and chicken, and. as soon as the temporary molars are
erupted three solid meals a day of substances requiring masti-
cation, so arranged as to end always with some fibrous cleans-
ing food, such as an apple or other hard fruit. The extension
of this diet to older children and to adults will evidently forbid
the conclusion of breakfast with bread and marmalade, of
lunch with soft bread and cheese, and of dinner with cooked
sweets. In fact, to a very large extent, the customary meals
of the people of this country will require rearranging. Such
a revolution must be the work of time, and the originators of
652 SCHOOL HYGIENE
it must not become impatient if progress is slow. Again, in
considering the artificial cleansing of the mouth we find that
antiseptics have a very limited use, that the toothbrush may
be positively harmful, and that tooth powders are only of use.
to keep the teeth white. In fact, we gather that all these
artificial methods are to be used mainly from the point of
view of ordinary cleanliness, and that for the prevention of
decay we must rely upon a properly arranged diet.
The eminent simplicity and good sense of this last-named
principle make it certain that the campaign, revolutionary
though it is, will ultimately be successful, and the outstanding
question is the best method of placing the now ascertained
facts of dental hygiene before the medical profession and the
public. A step was taken at the British Medical Association
this year in holding a joint meeting of the Dental and Public
Health Sections to discuss the question. It appears, how-
ever, that the attendance of the Medical Officers of Health
was poor. This is greatly to be deplored, for the medical
service of the country, more particularly in their capacity as
school medical officers, can do more, perhaps, than any others
to extend the knowledge of dental hygiene to the people at
large. It is to be hoped that some effort will be made to
have these new views expounded at the medical schools. The
present-day student of medicine is being taught to pay an
increasing attention to the existence of dental decay or
disease. It seems even more important that he should learn
of the possibility of preventing these conditions. Dr.
Wallace's book should be in the hands of every medical man,
more especially of every school medical officer. It is, un-
fortunately, rather too technical to be properly appreciated by
those without some medical knowledge ; but if these will
take the trouble to read it (it extends to only 45 pages) they
will at least understand the idea of the diet suggested, and
something of the reasons put forward. — R. C. E.
Lateral Curvature of the Spine and Flat Foot.
By J. S. Kellett Smith, F.R.C.S. Bristol : John Wright
and Sons.
Spinal curvatures are a constantly recurring theme in school
inspection, and the vast majority of curvatures found in school
children are slight in degree. So that this book, which sets
out frankly to discuss the causation and treatment of these
slight cases, and ignores the severer deformities, is attacking
a subject which is of great importance to school doctors. It
REVIEWS 653
cannot be said that the author has quite stuck to his intention.
Thus in the section on occurrence the proportion of cases of
lateral curvature in the sexes is given as seven females to
cne male; this is the proportion found in orthopoedic^cttnics
among the severe cases. School statistics all show that the
slighter cases are equally common in boys and girls. In
analysing the nature of the deformity, and in illustrating the
creeoing exercises, the author also figures cases of high-grade
scoliosis.
In discussing causation Mr. Kellett Smith falls into the
usual error of terming those attitudes which are thought to
assist in causing latteral curvature " bad " or " faulty." To
call such universal attitudes as the old stand-at-ease position
and lying upon one side " faulty " is evidently absurd. It is
the habitual use of the same attitude that is bad or faulty. As
the author himself says : " The attitude of erect spine is an
extremely trying one to maintain for any considerable time,
and the greater part of our lives is spent with the spine in a
curved position." What we have to see to is that the curves
assumed are not always the same ones. A careful and well-
illustrated examination is made of the curves produced by
many habits of standing, sitting, writing, lying, riding,
violin playing, carrying, etc. ; this is not only useful in itself,
but will be found a great assistance to the readers in con-
sidering the importance of other attitudes in the case of any
individual child. The section upon exercises for spinal
curvatures is brief, clear, and pays a proper attention to the
importance of the initial position before any exercise is carried
out; it also includes a short account of Klapp's creeping exer-
cises, which are so far comparatively unknown in this country.
The last sections give a short but clear and straightforward
account of flat foot and weak ankles, in which we are specially
glad to see the author differentiating between the two con-
ditions. The book is well printed, and the illustrations (for
the most part orieinal) are particularly good. It is a small
work which should certainly be useful to school inspectors
and to medical men in general. — R. C. E.
Abstracts from Current Literature
MEDICAL INSPECTION IN FRANCE.
Dr. Albert Mathieu, writing in L Hygiene Scolaire, admits
that there is some ground for the pessimistic views held by many
as to the establishment of a system of medical inspection in France.
" There is little doubt but that somp of the committees formed in
the provinces to promote public hygiene are only the painted cloth
fagade of a non-existent building." Still, one must not be unduly
depressed ; there are plenty of earnest people willing to work for
school hygiene, only they require some finding. The parents of
the children must be approached and their interest stimulated, and
pressure brought to bear upon the Government. Medical inspec-
tion is suffering from the general Ministerial unstability. In the
Chamber and in the Senate there is a strong group of men work-
ing for the views of the Ligue. As soon as Parliament has a
little time to give to other subjects than the Budget it will have
to consider the Bills introduced by M. Doumerque and M. Fer-
dinand Buisson on Medical Inspection and by M. Lachaud on
Physical Ftducation.
INDEPENDENCE DAY TETANUS.
A year ago we had occasion to refer to the annual trail of
disaster following the glorious Fourth of July celebution, and as
this national holiday just passed has left in its trail, like bloody
war, death and destruction, it is opportune to again call attention
to the stupendous holocaust. During the past ten years more
than 35,000 people have been killed and injured from accidents
resulting from the Fourth of July celebrations. True patriotism
should be encouraged, but Independence Day should not be made
a day of licensed lawlessness, a day of rough rowdyism, a day
of peril to life, limb and property, a day of noise, nuisance and
destruction — features too anarchistic to do credit to our national
intelligence or to reflect a genuine spirit of true patriotism.
When called to an accident resulting from celebrating the Glorious
Fourth, the physician's first duty is to inject anti-tetanic serum
containing 1,500 units. In the treatment of the disease, experi-
ence places the minimum dose of serum at 15,000 units and the
maximum at 30,000 units at such injections, which should be
given at intervals of six to twelve hours. The number of injec-
tions required to effect a cure range as high as twenty-five, though
the average, perhaps, does not exceed eight or ten. The prompt
employment of a preventive dose of serum (1,500 units) in all
cases should be made obligatory. All gunpowder, toy pistol and
fire cracker wounds, street, field, stable, wire fence, rusty nail,
654
CURRENT LITERATURE ABSTRACTS 655
and kindred wounds should probably be classed as suspicious, and
the physician who fails to promptly administer 1,500 units of anti-
tetanic serum is derelict in his duty to his patient, to the_ family,
and to the profession.- — Pediatrics. Augfust, 191 1.
A CLASS EPIDEMIC OF DIPHTHERIA.
On August 25th, 1910, a child was notified as suffering from
diphtheria ; another case occurred a few days later, but was not
notified. The school doctor held an inquiry on September 6th,
when it was found there had been several absences on account of
sore throat. Up till September 14th there were three cases of
diphtheria in the class, and it was resolved t& close the class for
a week. The class-room was disinfected, and as there had lately
been an increase in diphtheria in Berlin and for other reasons it
was resolved to make a bacteriological examination of all the
children when the class reassembled. On September 23rd, among-
forty-six girls there were three with diphtheria, who were excluded.
On September 26th, among forty-nine girls there were another
four with diphtheria bacilli ; on September 26th, another two
among forty-six. A swab from the teacher's throat was negative.
These nine children and the two children known to be suffering
from diphtheria were re-examined ; swabs were taken from each
child until three successive examinations were negative. The last
swabs were taken on November 4th-5th. Dr. R. Schultz, who
describes the epidemic, believes that a systematic examination in
all class epidemics should be carried out early, but if practised as
soon as one case is notified there would be a great deal of useless
work. He advises bacteriological examifiation when (i) there are
several cases in a class in quick succession ; (2) when there are
several cases of sore throat ; (3) distinction must be drawn between
times of epidemic and normal periods. The class should be closed
for a short time, 2-3 days, and the diphtheria carriers excluded.
These should be re-examined about once a wQek.—ZcitFchrift filr
Schulgesundheitspfiecre, No. 7, 191 1, p. 545.
THE EXPERIMENTAL STUDY OF GENERAL
INTELLIGENCE.
Mr. Cyril Burt thus concludes his valuable study : —
*' General intelligence exists, is definable, and can be measured.
It can be most readily measured by tests of the higher and more
complex levels of mental activity. It may be defined as all-round
innate mental efficiency ; for excellence at these tests and at tests
like them proves to be the expression of a mental property neither
merely specialised nor merely acquired, but something all-pervad-
ing, something inherited, something inborn. Lastly, we may have
no hesitation in assuming that such a capacity exists ; for its basis
may be pictured as a tendency to integration in the structure of
the central nervous system ; and hence that child will be the most
generally intelligent who inherits a brain which has been through-
out laid down for development along the most systematic lines.
"These conclusions are, it is true, still largely hypothetical.
But they form a hypothesis which is founded upon experiment.
And by experiment alone can they be firmly established, fully
extended, or finally overthrown." — C'tiihi Study. October, 191 1.
656 SCHOOL HYGIENE
THE DANGERS OF THE CINEMATOGRAPH FOR
CHILDREN.
Parents and teachers cannot be unconcerned about the popu-
larity the cinematograph theatre has lor the children. In Jena, out
of 1,050 children, 524 children had visited it during a period of
five weeks; some of the children went two or three times a week,
and some remained two or three hours in the theatre. The glit-
tering and zigzagging of the films are harmful to the eyes, the
retina having to be so rapidly reacting to an ever-changing series.
Pains in the eyes and shunning of light are natural consequences ;
nystagnus has been noticed. The air in these theatres is usually
bad, since there are continuous performances daily from tliree
o'clock till late at night. The performances are nearly always un-
suitable for children. Sensational and crude melodramas, murders
and other crimes are constant features ; the funny scenes showing
the humours of drunkenness are not exactly suitable for children.
Coarse love scenes, where dressing up and undressing are pro-
minent and suggestive are likely to do much harm. Dr. Gotze
gives instances of the harm done to the child visitors at these
shows. He concludes : " There is no doubt that we must regard
the cinematograph, with its prevalent sensational, crime-loving
programme and its glorification of the criminal on a level with
the Nick Carter and Sherlock Holmes type of fiction, as dangerous
material for the child mind." — Zeitschrift fur Kinderjorschiino-.
September, 191 1.
HOW OUR CHILDREN WRITE.
Shockingly, from every point of view, maintains Ernst Kranzow.
The letters are ugly, if not illegible, whilst more serious are the
crippling attitudes of the hand and body. The cause does not,
however, lie in the posture of the trunk in writing, as is frequently
maintained. It is the faulty position of the hand that leads to
faulty posture. The crumpled-up hand and crooked fingers hide
the writing from the child. Hence he moves his eyes sideways to
see the paper, and the result is the distorted head and back. \\>
must then start with the proper position of the hand. The hand
must be supported on the tips of ring and little fingers, so as
to leave a clear space under the hand ; the wrist hangs quite free
in the air, and the forearm rests on the writing table. The fingers
(ring and little) support the hand, but take no part in the move-
ments of writing, but they prevent any bending of the other three
fingers, and thereby any masking of the paper. Great care must
be taken at the beginning to get the correct position of the hand —
the rest will follow. Not only will the position be correct, but
the caligraphy will be clear and beautiful. The article is illustrated
by photographs showing the ''correct" and "incorrect" move-
ments of the hand, " bad " and " good " writing. — Zeitschrift fi'ir
Schulgesundheitspfiege. September, igii.
HYGIENE TEACHING IN THE PUBLIC NORMAL SCHOOLS
OF THE UNITED STATES.
Mr. A. Heche gives a report based upon a questionnaire ad-
dressed to 191 schools, and to which 84 answers were obtained.
The summary is : —
One-half of the 84 schools give either no hygiene at all or else
CURRENT LITERATURE ABSTRACTS 657
none aside from that ^iven incidentally in connection with
physiolog^y. Nine schools give neither physiolog^y nor hygiene,
and those giving physiology devote so little time to it ^Jisually
one-half or one-third of a year) that very little can be accomplished,
in hygiene. A good proportion of the instructors m physiology
and hygiene in these same schools have university or college
degrees, and are probably capable of doing better work than their
present allotment of time permits. Forty-two schools giving
hygiene courses separate from physiology do not do this work
at the expense of physiology, but by adding courses in personal
hygiene, school hygiene, school and home sanitation, prophylaxis,
clinical psychology, sex hygiene. Mental hygiene is receiving
scarcely any attention. Comparatively little is being done with
the problem of sex hygiene in the way of direct instruction, and
the normal schools are not making the best of their oppor-
tunity to train teachers who can use nature study and biology as
an approach to this subject. Fifty per cent! of the schools give
domestic-science courses in which some effort is made to emphasize
and exemplify the hygienic aspect, and the number is rapidly
increasing. In the field of practical hygiene nearly two-thirds of
the schools are aware of conditions that ought not exist. In-
adequate ventilation, improper lighting, poor boarding and room-
ing places, and overpressure are the chief conditions of injury
to health. Twenty-five per cent, of the schools do not have gymna-
siums in charge of physical directors. Medical inspection is being
rapidly adopted, but very few of our normal schools are
training student teachers to observe and to make preliminary tests
of children. Athletics and recreation do not receive the emphasis
they should in a majority of schools. Only one school at present
attempts to train special teachers of hygiene. — Journal of Educa-
tional Psychology. October, 191 1.
THE STATISTICS OF INFANTILE PARALYSIS.
Dr. C. B. Hodgetts, as a result of replies received from 316
doctors, gives the histories of 658 cases that occurred in Canada
during twelve months. Out of 521 cases, 293 were males, 235
females. He give s the following comparative table of age
periods : —
From birth to 12 months inclusive
1 year old
2 years old
J ,, ,,
4 >) '>
5 M '> . ■ ■ ■ .
6 to 10 years inclusive
I to 20 years inclusive
21 to 30 years inclusive
31 to 65 years inclusive
As regards seasons y6 per cent, of the cases occurred in August,.
September, and October ; the winter months had fewest cases.
There were 46 deaths, a case mortality of seven per cent. —
— Pediatrics. September, 1911.
Canada.
Boston.
New York.
... 23
44
62
.. 69
93
221
... 105
121
180
... 66
90
106
... 62
60
63
••• 39
32
28
... 92
98
47
••• 55
46
19
... 29
21
2
... 14
10
I
official Publications, &c
MANCHESTER GRAMMAR SCHOOL.
Annual Medical Report.
Dr. illfred A. Mumford gives a general comparison of the
physical stamina of the whole school during the last five years
with the years 1881-1886 : —
" I find there has been a remarkable gain in nearly all direc-
tions, especially as regards height and weight, amounting to more
than one inch in height between the ages of 13 and 16, and to
an average increase of more than four pounds in weight. At
the age of 16 the boys are i^ inches taller and 8 lbs. heavier than
a generation ago. The improvement is less marked at 17 and
18 years of age, and disappears in those who stay till 19. These
calculations are based on over 6,000 measurements." (See the
table on page 659.)
The chief reasons for this change are ascribed to " the steady
diminution of postponement of early infectious diease in child-
hood," and the increased attention given to athletics and physical
exercise.
'' Other causes of the general improvement in physique are
the better housing, the increased knowledge and use of foods, and
a greater insight into the meaning of parental responsibility as
regards health, which is certainly affecting a considerable number
of homes in the present day. During the medical examination of
boys on their entrance to the school, I have many illustrations of
this in my conversations with parents, who have been glad to
have their attention drawn to any imperfection or weakness in
time to have them remedied.
" I have, however, to record chat there are also quite a con-
siderable number who cither do not realise their obligations, or
who, for some other reason, neglect their opportunities of render-
ing the school life of the boys under Lheir guardianship more
efficient. This is particularly the case where I have to report the
neglect of treatment of decaying teeth."
The Manchester Grammar School receives a considerable number
of scholarship children from the Public Elementary Schools.
Comparison based on 250 cases show that " though the ' free
scholar' was slightly smaller at 11, 12, and 13, yet by the age
of 14 he had equalled his companions in height, and in some cases
surpassed him."
Dr. Mumford urges that boys should com.e to the city at 13 years
of age, and should remain there at least four years if any real
benefit is to r^e obtained.
658
OFFICIAL PUBLICATIONS, ETC.
659
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66o SCHOOL HYGIENE
MEDICAL INSPECTION OF SCHOOL CHILDREN IN THE
HAGUE.
Dr. J. J. Pig-eaud, in his report for 1910 on the Medical In-
spection of School Children in the Hague district (the Hague and
Scheveningen), states that he has at length been able to carry into
effect his idea of making education of the mothers an essential
feature of medical inspection. Lectures, etc., to mothers could
not secure the requisite attendance and interest. The only methcd
is to discuss her children with each mother individually.
In the first place, a general visit of inspection is made to the
school, and the sight and hearing of newcomers tested. Later
on all the children attend with their mothers (or, if that is im-
possible, with female relatives) at the office of the School Medical
Officer. There, by means of various questions and inquiries, some
idea is obtained about the child and its family circumstances. If
the child requires to be kept under observation the particulars of
the case are recorded on a card. The remaining children pass.
Where advice is needed it is given immediately. The children
receiving a card, i.e., under observation, are required to attend
some months later (in the same school year) at the office of the
medical officer, accompanied by their mothers, for further examina-
tion, and in order to see whether the advice given has been
properly carried out. The examination of the children is thus
made a basis for educating the mothers in the proper rearing of
their children. In most cases the mothers attend.
In the Hague schools, out of 2,823 pupils 1,438 showed deviations
from the normal in a more or less serious degree. Some had more
than one defect. Of 470 children in Scheveningen, 211 received a
card. Twenty-five per cent, of the children were scrofulous, with
considerable anaemia. Tuberculosis manifest, 9 cases, suspected
.42. Oxyuris and ascaris 46 (mothers' complaints), 25 children
were mentally deficient. Quite abnormal tendencies were com-
plained of in two cases. Enuresis existed in 134 cases. There were
several cases of vulvovaginitis, some non-infectious; 188 cases
of squint, and 178 of myopia, astigmatism or hypermetropa,
150 children were more or less deaf. Most of these had
adenoids (total adenoids, 620). Otorrhea, 50 cases. Only one or
two cases of bad teeth; 154 children showed a tendency to scoliosis.
The results as to pediculosis are untrustworthy, the mothers
taking care the children are clean when attending for examination
at the office. (Female teachers are more observant than male
teachers in this respect.)
Not only mothers, but teachers of both sexes are frequent callers
during the medical officer's consultation hours. This is very
\aluable, as the teachers are often able to give useful particulars,
and in turn they learn, quite by the way, many things in con-
nection with school hvgiene.
Women's Industrial Council
7. JOHN STREET, ADELPHI. LONDON, W.C.
RECENT PUBLICATIONS. - _
Price 3d. for 13 (postage 4d.) ; 5s. for 100 (carriage in London 6d., country 8d.)
PENNY PAMPHLETS.
Postage j^d. each.
Trade schools for girls By n. adlkr.
SEPARATE COURTS OF JUSTICE FOR CHILDREN, AND PROBATION AND
PROBATION OFFICERS. By N. Adlkr.
WORKING WOMEN AND THE POOR LAW. By B. L. Hutchins.
LABOUR LAWS FOR WOMEN AND CHILDREN IN THE UNITED KINGDOM.
By E. C. Hakvkt.
NEWSPAPER AND CITIZEN CLASSES AND HOW TO HOLD THEM, WITH
SPECIMEN LliSSO.NS.
REPORT ON THE UNEMPLOYMENT OF WOMEN. 1907.
THE CASE FOR AND AGAINST A LEGAL MINIMUM WAGE.
WOMEN'S WAGES IN ENGLAND ITS THE 19th CENTURY. ByB. L. Hctchins.
LABOUR LAWS FOR WOMEN IN AUSTRALIA & NEW ZEALAND. By B.L.Hutchins.
LABOUR LAWS FOR WOMEN IN THE UNITED STATES. By J. O. Goldmakk.
WOMEN IN FRANCE. By B. L. Huxcmxs.
WOMEN IN GERMANY. By Alice Salomon, Ph.D.
WOMEN IN ITALY. By Mrs. T. Okey.
HOUSE. By M. Fjcddex.
LABOUR LAWS FOR
LABOUR LAWS FOR
LABOUR LAWS FOR
HOW TO CLEAN A
HOW TO COOK A SIMPLE .MEAL. By M. Fjcuden.
HALFPENNY PAMPHLETS.
WOMEN LAUNDRY WORKEUS AND LEGISLATION.
WOMEN WORKFRS AND THE FACTORY ACT.
SUMMARY OF THE FACTORY ACT. SUMMARY OF THE TRUCK ACT.
THE LING ASSOCIATION
Of Trained Teachers of Swedish Gyninaslics).
Founded 1899. Hon. Sec: Miss Hankinson,
67, Shaftesbury Road, Crouch Hill;
Examinations held for Swedish Gymnastic
Teachers' Diploma and Swedish Drill Certificate
for Teachers in E ementary Schools and Kinder-
gartens. List of Certificated Oymnastic and
Games Ali -tresses kept. For Terms of Member-
ship, Conditions of Fxamination. Entrance Forms,
Syllabus, etc., apply to tlie lioN. Sec.
" GOOD AND BAD SCHOOL POSTURES."
Published by the Ling Association. A series of ten
drawings, showing the effects of faulty positions in
stan<liiig, writing, sewing, etc. JS'o School siiould
be without them. Alountcrt on cards, 15 in. by
20 in., with cords ready for lianging. Price 6s. 6d.
per set, post free, from
Messrs. SHEREATT & HUGHES,
33. Soho Sauare. London, W.
THE CARE OF INVALID
<5 CRIPPLED CHILDREN
^ ^ ^ IN SCHOOL. r# ^ ^
Lectures delivered to School Nurses, etc., by
R. C. ELMSLIE,M.s.. F.R.c.s.
Medical Officer (Invalid Schools)
L.C C. Education Committee, etc.
Is. net. post free, from
SCHOOL HYGIENE,
2, Charlotte St., London, W.
THE TIMES AND TALENTS NEWS.
Published by Simpkin, Marshall, Hamilton, Kent & Co.
A Quarterly Magazine for Girls of Education and Leisure.
36pp.
Price 4d. net.
To be obtained from any Bookseller.
Articles by well-known writers are contributed on the religious, missionary, and social
problems of the day. Reviews of books which can be confidently recommended to
girls, and political notes are special features of the magazine.
RECENT OPINIONS.
"Whoever reads 'The Times and Talents News' \sill find in small compass and in
attractive form Religion, Poetrv, Criticism, Science, and the leading topics of the day."—
Rt. Hon. G. W. E. Rnssell.
" The articles are quite worthy to take their stand side by side with those which Ave find
in other magazines, and to be acceptableto a variety of readers."— Miss P^lizabeth Wordsworth.
" I strongly recommend 'The Times and Talents News.' It is a capital magazine and
gives so many helpful ideas."— Miss Soulsby.
"It seems to fill a place which no other magazine fills or is desigTied to fill." —
Bislio]* of Durliaui.
HONORARY EDITORIAL COMMITTEE.
G. A. AUDEN, M.A.. M.D., M.R.C.P.. D.P.H., Medical Super-
intendent, Education Committee, Birmingham.
S. BARWISE. B.Sc, M.D., D.P.H.. County Medical Officer,
Derbyshire.
J. C. BRIDGE, F.R.C.S.E., M.R.C.S.. L.R.C.P. Lond., D.P.H.,
Medical Inspector School Children, Dunfermline.
D. A. CARRUTHERS, M.D., D.P.H.. Late Education Medical
Officer, Buckinghamshire.
PROFESSOR CARSTAIRS DOUGLAS, M.D., D.Sc, F.R.S.E.,
Lecturer on School Hygiene, Glasgow Provincial College.
W. LLOYD EDWARDS, D.P.H.. School Medical Officer, Barry.
PROFESSOR J. A. GRtEN. M.A., Professor of Education,
University of Sheffield.
J. KERR LOVE, M.D., Aural Surgeon, Royal Infirmary, Glasgow.
W. LESLIE MACKENZIE, M.A.. M.D., D.P.H. F.R.C.P.E.,
F.R.S.E., Medical Member of the Local Government Board
for Scotland.
MISS MARGARET McMILLAN, London.
HELEN MACMURCHY, M.D., Toronto.
MISS MICHAELIS, M.A., Lecturer on Hygiene, King's College for
Women.
E. H. T. NASH, D.P.H., Medical Officer of Health and Medical
Officer Education, Wimbledon.
MISS RAVENHILL, F.R.S.I.
HUGH RICHARDSON, M.A.. Bootham School, York.
E. T. ROBERTS, M.D., Chief Medical Officer. School Board of
Glasgow.
C. E. SHELLY, M.A., M.D, M.R.C.P., Consulting Medical Officer,
Haileybury College.
C. J. THOMAS. B.Sc, M.B., D.P.H.. Secretary, Medical Officer
of Schools Association.
L. A. WILLIAMS. M.D., D.P.H.. Medical Superintendent. City of
Bradford Education Committee.
PROFESSOR RALPH P. WILLIAMS, M.D., B.S., D.P.H.,
Professor of Public Health, University of Sheffield, and
Medical Officer. Sheffield Education Committee.
A. S. WOODWARK, M.D., B.S., M.R.C.P., London.
Joint Editors, :-U. D. EDER. R. C. ELMSLIE
PUBLICATIONS ISSUED BY THE
Medical Officers of Schools
Association.
Price, Is- net each,
A Code of Rules for the Prevention of Infectious
and Contagious Diseases in Schools.
The Treatment of the Exanthemata by the so-
calCed Antiseptic Inunction. A Paper read before the Association
oif Junelnh 1894, by H. G. Armstrong, Medical Officer, Wellington
College. With Plate.
Football impetigo: An Inquiry Into a Con-
famous Affection of the Skin. A Paper read ^f^^^^e
As.^ciatiou on December 10, 1895, by H. G. Armstrong, Medical Officer, I
Wellington College. IVtth Plate.
The Physical Examination and Development
of Public School Boys. A Paper read before the Association on
April 4, 1899, by Cecil Hawkins, M.A. With Chart.
Ventilation as a Dynamical Problem. A Paper
read before a Meeting of the Medical Officers of Schools Association on
February 6, 1902, by W. N. Shaw, F.R.S.
" Football Injuries." A Paper read before the Association
by R. H. Anglin Whitelocke F.E C.S., Surgeon to the Eadcliffe Infirmary
at Oxford.
The Diagnosis and Management of Doubtful
Cases of Diphtheria. A Paper read before the Association by
F FooRD Caiger M.D.. F R C P., Medical Sui>ermtendent of the South-
Western Fever Hospital, Stockwell.
On the Hours of Sleep at Public Schools. By
T. D. AcLAND, M.D., F.R.C.P., Physician to St. Thomas' Hospital.
The Infectivity and Management of Scarlet
FeverT By W T. G. Pugh, M.D., Medical Officer, Metropo'itan
Asylums Board.
A Preliminary Inquiry Concerning the Milk
Supplyof Sc^^^ c" E. Shelly. M.D., M.R.C.P., Consulting
Medical Officer, Haileybury College.
The Use of Shower Baths in Schools in England
««Tl ftU the Continent. By Frederick Rose, Ph.D., Assistant
Educational Adviser to the Education Department of the London County
Council.
On Physical Training in Schools, and the
^"influe^t; on National Tife of ^^'^^^^J^^'^'^^'!:,l:^
Schools. By W. P. Herringham, M.D., F.R.C.P., and T. C. Horsfall.
The Need Objects, and Method of the Medical
Insptctiin of Primary Schools. By B H Crowle.. MD ,
M^R C P., Medical Superintendent, Bradford Education Committee.
School Athletics and Boys' Races- By William
Collier, M.D., F.R.C.P., Physician to Redcliffe Infirmary.
The Care of the Teeth during School Ufe. By
f. dSison PEDLET. F.R.C.S.Ed., L.D.S.Eng., President of School
Dentists' Society.
The Educational Treatment of Stammering
Children. By TuoMAsJjr^cHArnE, M.D.
Pnbr.fbed by J. and A. CHURCHILL. 7, Great Marlborcmgh Street. ^
UNIVERSITY OF CALIFORNIA LIBRARY
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MAY 131911
ne
*P/? 3
NOV 7 'f-a -
DEC U 1992
1936
{ER.
5Mar52HL
l4ian'53FA
NTS ARE:
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