The Parents' Review

A Monthly Magazine of Home-Training and Culture

Some Medical Aspects of Education, Part 2

[Dr. Percy G Lewis was a general practitioner at Victoria Hospital, Folkestone, Kent. He wrote a manual of exercises for scoliosis called "The Relief and Cure of Spinal Curvatures," 1897. His home at No. 21, Manor Road was destroyed in WWI.]

(Continued from age 673)

School-room work should not be commenced too early. No child should do lessons before the age of six. The neurotic child should begin much later; for the neurotic brain is like a hyper-sensitive instrument which easily gets out of gear. If treated roughly it soon wears out. Now a child of this disposition requires keeping back, rather than pushing forward. It will learn very quickly if left to itself. Many children of this temperament have taught themselves to read, to draw, and to do many other things which would seem impossible: they may in reason be encouraged to teach themselves. Pictures and simple games they should have in plenty, but not puzzles, chess, or other brain games. Outdoor exercise is best for them. But even in outdoor exercise, excitement should be carefully avoided. For instance, a long walk in the country with a dull nurse and a dog would be far better than a romp in a garden with children as excitable as themselves. Neurotic children, without being condemned to a dull time, require very little amusing, because their restless brains very easily amuse themselves. But the question of companionship is important, for all children require other children of about the same age as companions. Neurotic children should not have children of the same temperament to play with. The best companions for neurotics are lethargics, and as the converse is also true, the one temperament neutralises and benefits the other. It is often observed in schools that the neurotics select the lethargics as friends, and in adult life the same thing is noticed. With husbands and wives, too, the same thing often seen, but as all the world does not consist of neurotics and lethargics, so these contrasts are not met with at every corner. Many children, without being typically neurotic or lethargic, may have a tendency to one or other of these dispositions.

The lethargic brain should, on the contrary, be pushed forward, interested, and carefully roused, but not overworked. It is not capable of much effort at one time, but it can work "little and often." At first it requires games that exercise the mental faculties; draughts, puzzles, and later on, chess, can be added. Such an one must be educated chiefly by educating the senses. In particular, such children should be taught all sorts of manual exercises, carpentering, clay modelling, and such like things. But, above all, care should be taken to let them see some result of their work. By all means encourage them to make things, even if they be only paper boxes, and bows and arrows. I do not wish to open the question of the ethics of punishment here, but merely to state in passing that corporal punishment, justly administered, benefits lethargics but harms neurotics. As the child grows older and more muscular, all forms of outdoor exercise, even such as football, rowing, cricket, bicycling, may be indulged in, without fear of them being done to excess. Though neurotics, too, may go in for these recreations, they must always be watched, in order that they may not practise them to excess.

[Draughts - checkers]

Again variety, but not bewildering variety, is of great importance in connection with children after the first year of life. Monotony in diet leads to bad nutrition. The meat and pudding should vary each day, and such variety as is judicious should appear in the breakfast and tea. Walks, lessons, games, all these should differ each day as much as possible. The advance always made by a boy in the first term at school, is seen in a less degree when children go to stay with relations for a short time. A visit to a new place, even if accompanied by his family, gives him new ideas and new experiences. The fresh surroundings give novel interests, and correspondingly stimulate the growth of the brain. But though variety is charming to the child, monotony has its claims, especially in the fixed times of meals, of lessons, of going out and coming in, and in many other things. Order and regularity should be conspicuous even in the midst of variety.

We have seen that both lethargic and neurotic children have some undeveloped or diseased condition, that is to say, they are either not properly developed, or else their systems are more or less choked with waste products. The one or the other of the foregoing conditions is that of most backward children. They may be backward simply from small inefficient and undeveloped brains, with the rest of the body normal, or, on the other hand, they may be backward simply from their nutrition being interfered with by some diseased condition. Occasionally one may meet a genius with a feeble or diseased body, but these are mostly neurotics, able to get along for a period by being placed under favourable conditions.

Common causes of backwardness are rickets, scrofula [tuberculosis of the lymph nodes], chronic tuberculosis in its protean forms, bad teeth, indigestion, and the host of diseases produced by food, wrong in quantity or in quality. This, however, is a subject too large for this paper. Then again there are the diseases due to want of fresh air, such as anæmia, not to mention diseases such as rheumatism due to insufficient clothing. The latter is a condition very common with the children of the well-to-do classes. But very frequent causes of ill-health and consequent backwardness, are the various chronic catarrhs [congestion] which may be excited by any of the above causes. I especially mention these because they are complaints of which parents often fail to recognise the gravity, and they thus allow the organs affected to suffer irremediable damage before medical advice is sought. The child "always has a cold in its nose," is mentioned quite casually to a doctor. Yet chronic nasal catarrh, if neglected, may become a very grave condition, and be the cause of many serious complaints. For a chronic nasal catarrh does not go on long without involving the upper part of the throat. The congestion and thickening which ensue soon block up the nose, and so cause the child to breathe through its mouth, instead of through its nose. Soon the tonsils become enlarged, and the so-called adenoid vegetations form in the back of the nose and upper part of the throat, keeping up a chronic inflammatory condition there. This is just where the air tubes from the ear open into the throat. These become inflamed, and the inflammation, extending to the ear, causes deafness or abscess, possibly destroying the ear in a very short time, or the abscess may even reach the brain. Another evident result of this blocking of the nose is that cold air, instead of warm air, is inspired into the lungs. Thus a bronchial catarrh is set up, and a chronic cough, or consumption the result. So it will be seen that a chronic cold in the nose is always a source of ill-health, and always requires treatment. If then this is necessary for a cold in the nose, how much more so for a chronic gastric or bronchial catarrh?

Many children are backward from some imperfections in the organs of sense. Thus, some are short-sighted. This defect, if not suitably corrected by glasses, produces a chronic headache, from the constant efforts to see plainly. A daily headache will render brain development difficult. Again, other children are backward or stupid, simply from being partly deaf. They do not hear all their instructions, and therefore really lose a large part of the work spent upon them. Anæmia is a common cause of backwardness, especially in girls. This complaint depends on the absence of the normal quantity of iron from the blood. It is by means of this iron compound, that oxygen is carried to the tissues, and carbonic acid gas removed from them. An anæmic child is therefore deprived of a large proportion of the oxygen which is necessary for her vital processes. These processes are therefore below par. She is therefore listless and disinclined for exercise, suffers from indigestion, and when she makes any exertion is very short of breath. If by a determined effort of the will she goes for a long walk, plays tennis, or performs other physical feats, she suffers excessively from muscular fatigue. Correspondingly, the brain suffers if she is made to perform the usual intellectual exercises for which she is now unfit. Very severe complications of anæmia are apt to appear, which make it important that it should be cured as soon as possible. Gastric ulcer, which often kills girls with alarming suddenness, is one of these.

Sooner or later, in the case of all healthy children, whether boys or girls, the question of school arises. That school is the right and proper thing for every child of ordinary health and intelligence, admits from a medical point of view of no argument. Those who think otherwise, or who have any doubt on this matter, I would refer to the works on schools, by Dr. Dukes. The objections chiefly arise on the fancied score of expense, or from the parents' natural wish not to be parted from their children, and also from those people who are quite ignorant of the present conditions of school life, but who have in their minds the schools of forty years ago.

School represents life in miniature, and the sooner a child commences to get experience of it, the more prepared he or she will be to fight the real battle of life later on. A child kept at home and protected from all the little troubles and discomforts of childhood, never can learn how to meet the greater trials of life. Keeping them at home because of possible dangers, is like keeping visitors from one's house in case they should bring the measles. The best defence against danger is to start them with a healthy mind and body.

Education is now not only an art, but is gradually approaching an exact science. As the medical and physiological knowledge of the brain and nervous system increases, so does the art of its development become more sure and certain. Of one thing we may be quite sure, namely, that the impressions obtained and the habits formed when the brain is developing, last with little modification the whole of life. The impressions we receive of people, and especially of near relations, seldom change as one grows up. The friendships of childhood, and especially those made at school or college, surpass, as a rule, those made later on in life. The usual remark made when one has met an old school or college friend after many years is, "He is just the same sort of fellow he was at school." That there are certain dangers at school must of course be admitted; but it must also be remembered that there are no less dangers from keeping a child at home. At school there is the danger of forced over-work, which, though it ensures a brilliant school or college career, leaves the boy worn out. He never does anything afterwards, he has, in fact lived his life. He has gone up like a rocket, and come down like a stick. Examples of this are unfortunately quite common. The danger of over-work is a real one. All children have not the same brain capacity. And it therefore becomes an extremely difficult thing for a master or mistress to diagnose a lazy pupil form one worked beyond his capacity. One cannot well be a teacher and a doctor too. The next matter for consideration is the choice of a school, and in this matter the question of possible over-work should always be kept in mind, and medical aid invoked. It would be by far the best plan for the family doctor to inspect the pupil on going or returning to school, and also whenever he comes home. At such times an accurate record of height and weight should be taken. By thus having opportunities for watching the child's development, he will very early detect the insiduous symptoms of over-work. If a child loses weight at school, there is something wrong somewhere. If he gains very much more flesh in the holidays than when at school, there must equally be some defect. If, in addition to this, the school doctor or a medical officer of health makes periodic inspections, not only of the pupils, but of the class-rooms, bedrooms, cooking and sanitary arrangements, it seems to me that every precaution has been taken to ensure the safety of the child's health, and the early detection of over-work, illness, or its causes.

An inspection such as this, properly conducted, would probably be welcomed by all teachers, and could but increase the confidence the parents repose in them. The teachers would receive valuable advice upon lighting and ventilation, upon proper and improper seats, and the proper position of these as regards the source of light, upon the avoidance of strain upon the eye or upon the fingers in writing, and they would receive viá the association of medical officers of schools, information of the latest improvements in school administration and school appliances.

The next question is: Should delicate children be sent to school? This is a question best settled by the family doctor or an expert, and indeed it is generally so done. But a question which requires just as gentle handling is, "When a delicacy has developed in a child at school, should the child be retained or removed?" Take such a common complaint as a curvature of the spine developing in a girl at school. Now, curvature of the spine is caused by weak muscles, and weak muscles, we have seen, are a cause of ill health. As the removal of a child from school is a serious matter, the best solution to my mind, for a case such as this, is to keep the child at school, but cut down the usual amount of work to a minimum. In this manner the child will attain the healthy influence of school life, and the necessary treatment may at the same time be proceeded with. Or, again, a child previously quite well, begins to show signs of nervous breakdown, such as sleep-walking, calling out at night, being easily moved to tears by causes which have previously been powerless to do so. Should he or she remain at school or not? The answer is, that such a case has to be decided on its merits. If the symptoms have been early noted, and the child is otherwise in good health, it may be sufficient to reduce his work to a minimum, giving him outdoor rest or exercise instead. For instance, give him no work after his one o'clock meal, but let him spend most of the remainder of the day out of doors, and go to bed early. In this way he will still have the advantage of routine and regularity, and will not miss the other good effects of school life. On the other hand, much may depend on the sort of home he has and the kind of attention he is likely to receive there. To keep him at school under the conditions mentioned would be better than to send him to a home in London, where the many social duties of the parents prevent them looking after their children. But often, better even than remaining at school would be such a complete change of surroundings as would be obtained by sending him to a farm house to live for a month or so. The life here being healthy and quite different to school or home life, would, by acting on a different part of the brain, give rest to that which had been over-worked, and the change would be a tonic to the brain, by improving the general health.

Curvature of the spine brings us to another class of children, viz., overgrown children. These children are not developed in proportions that Nature intended. They are the result of abnormal energy, and like the potato growing in the cellar, this abnormality is caused by their not being under proper conditions. What these abnormal conditions are, have for each case to be found out. Generally this condition is accompanied by weak undergrown muscles, and, therefore the growing force should be hastily diverted into this channel, so that they tend to grow in breadth rather than height. The brains of overgrown children, like their muscles, are weak and flabby, and their brain work must be regulated accordingly.

In conclusion, the growth and development of the brain have been very aptly compared to the growth and development of a town. The main features exist at the very first, and continue without change during its whole existence. Very early in its growth, the principal streets and main buildings are marked out. These too, mostly persist, and are only very little modified by calamities, such as fire or earthquake. But the smaller buildings and side streets are constantly being altered, rebuilt, or improved.

In the brain, the main features are represented by hereditary tendencies, and cannot be altered, though they may be obscured as growth proceeds. The principal streets represent the characteristics of the individual formed very early in life, and practically always persisting, being little altered as a rule by fevers or great shocks. The smaller buildings and side streets represent the way in which knowledge and ideas become altered by experience as time proceeds. When the main streets of the child brain are being laid out, how very careful we ought to be in choosing the architect and surveyors.

In this paper I have tried to draw your attention to some of its possible sanitary defects, and the principles which should guide you in repairing them.

Proofread by LNL, Sept 2020