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103
Annual Report of the London County Council, 1911.
The playground classes, then, certainty aid the children by their frequent exercises, bring out
their mental qualities and further their education without noticeably interfering with health ; beyond
this they help the children to maintain a struggle for health against the ill effects of home environment,
want of air, want of rest, want of clothes and food.
The open-air school, with its scheme of broken-up lessons and of rest and feeding, goes a little
further than the playground class. The merely debilitated child gains considerably, but the main
portion of the group of children who attend are not cured ; perhaps only a minority can be said to be
materially or permanently relieved. The children who run temperatures, the children with lung conditions
and with tuberculosis can be dragged along through school life, but they do not pass out fit.
The residential school of recovery first suggested seven years ago (Report, 1906, p. 44), is
becoming, with increasing knowledge, an absolute necessity as an adjunct to the public educational
system. Experience of one or two schools for 120 to 150 such children should now be obtained.
Whether they are treated as educational institutions, which would be best, or as public health institutions,
they are a necessity for the public provision for ailing childhood. As shown on p. 23, during
the ten years 1 have been in charge of the medical supervision of London elementary schools a third
of a million has been actually paid out for the education of children who died of tuberculosis before
they were out of their 'teens. If the expense of cripple schools and of hospital and other medical treatment
is added, the cost of this disease in school children in London in that time ran into a round million
of pounds. Yet, whilst the residential school of recovery would take the child out of its environment
of darkness or dirt or even tubercular infection and restore it to as healthy a condition as possible, it
cannot wipe out the results of a defective heredity, or entirely prevent the recurrence of effects on a
return to the old environment. The causes of most of the debility and ill-health seen among school
children are the social conditions arising from sweated land, bad housing and hopeless poverty. " "Prevention
is better than cure," wrote John Locke, " and much cheaper." If, however, prevention cannot
yet be accomplished, then the symptoms must be relieved. The school of recovery has not yet been
tried, but the open-air school and playground classes have beneficial effects on the few children who
have attended them. Improved housing is necessary in the schools themselves, and on these lines a
verv considerable extension of arrangements for manv more, children is ne.nessfl,rv in the near future.
Kensal Housi
Tuberculosis
School.
The novel idea of a tuberculosis school, weighed and considered for several years,
has ultimately taken shape in Kensal House. Towards the end of 1907 attention was drawn
to the action of the Paddington Dispensary for the Prevention of Consumption in their efforts
o avoid the spread of tubercle among the school children. Some instructions regarding tubertular
cases were issued to managers of the Paddington schools early in 1908. A scheme for a tuberculosis
school was drawn up during the year, and submitted in February, 1909. A year later, March,
c910, the Council agreed to open this school, which was done in March, 1911. Kensal House stands
In its own grounds of over three-quarters of an acre in extent, abutting on the Paddington Canal. It
ihas large rooms, and the premises are accessible from the whole district of Paddington and North Kensington.
The accommodation used for school purposes is confined to the ground, first floor and garden.
Provision was estimated for 120 children, but at the end of the year this was cut down to 90, owing to
room being wanted for cooking. The school as first projected was for children suffering from or predisposed
to tuberculosis, or in an environment likely to infect them, and for children who have been
discharged from sanatoria. The children were to be watched and educated, especially in the value of
cleanliness, fresh air and exercise, and the dangers of tubercular contagion. This is the only logical kind
of tuberculosis school. The ideal could not be put to the test, as under the Act of 1899 the Board of
Education could not recognise the school unless they were satisfied that every child admitted was
actually suffering to such an extent from tuberculosis that it could not properly benefit from education
in the ordinary elementary school. The idea of the school as an educational instrument for prevention
in the case of those otherwise likely to become infected had to be abandoned, and it became
an institution for helping those already invalided from the ordinary schools. To make the best of the
circumstances an agreement was arranged with the Paddington Dispensary. The Committee of this
institution was to take the premises, carry out all alterations and repairs necessary, pay all rent, taxes
and other outgoings, provide gas and electric meters, and give the Council facilities for storing wood
and coal. The Council to provide furniture, books and other equipment, pay for teachers, heating,
lighting and cleaning, and if meals became necessary to provide service and preparation, whilst the
Dispensary Committee found the cost of food.
After a few weeks' work the occurrence of feverishness among the children called for notice.
The reason was that this tuberculosis school differs from all others in admitting children who are suffering
from active disease. Treatment in tubercular disease is mainly to obtain local rest, so that the
tissues may not become invaded by the toxic poisons of the tubercle bacillus. This auto-intoxication
has to be kept down whilst sufficient exercise is taken to sustain or improve physical condition.
The cases of active tubercular bone or joint disease attending the cripple schools have local
rest procured by immobilisation of the affected part in splints, or by the use of plaster jackets or supports,
so that any noticeable amount of fever among these tubercular children is comparatively rare.
In phthisis, or pulmonary tuberculosis, the lungs must move to keep up respiration and absolute
local rest is impossible. A relative amount of rest is only procurable by general rest. Formerly this
was accomplished by confining the patient to a bedroom, but now that the stimulating effect of fresh
air is better appreciated, such patients pass much time in the open air, and are allowed gentle walking
exercise so long as fever does not show. Any rise of temperature is taken as a guide to excess of
exercise. In the children's wards of consumption hospitals or sanatoria, experience shows that a good
deal of play is of advantage to spirits and health. Every now and then a child oversteps the mark,
sad so from day to day play has to be reduced for a time or even absolute rest prescribed.