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109
Report of the Medical Officer (Education).
No general experience had, however, been obtained of a tubercular school where the children
had active, although not acute, disease. For those whose disease is in an active condition the tuberculosis
school is more of a medical and remedial nature than educational, and schooling proper has, therefore,
to be guided and varied according to the medical requirements shown by temperatures. Although
it was not necessarily an open-air school yet the arrangements made at Kensal House were on the basis
of such schools, and provided work, rest and play, but no feeding. Some of the children had not only
a long walk twice daily between home and school, but repeated this in going also to and from dinner
each day. Much rest had to be provided, and all physical exercise of a violent nature avoided. The
games in such a school should be so regulated that any child reacting unfavourably can be withdrawn
from undesirable exertion. The manual work also must not be too heavy.
Medical supervision has to be continuous. There is a great advantage in the Paddington
scheme in home conditions being known, and the source of infection, apparently almost always an
adult, being traced. The child and all the members of its family are examined, and on admission to the
school a very exact record of each pupil's condition is made. With such a population as London to
work among each suspected child ought to be inspected under X-rays, as physical signs are ra.ely
marked in these children, and without the knowledge of environment it would be very uncertain work
to attempt positive diagnosis in the best cases for this educational treatment. Recent work in Mannheim,
indeed, showed that 42 per cent, of the 236 children suspected in school of tuberculosis, failed
to react to Von Pirquet's tuberculin test, and were consequently to be taken as free from this disease.
The nurse records the temperature of each child morning and afternoon and the weight once a
week. Children who show a morning temperature of 99 deg F. or more, rest on a couch for the rest
of the day. An afternoon temperature of the same amount puts them on the resting list for next day.
Children who reach 100 deg. F. are to remain in bed at home till seen by the dispensary doctor. At
school the children are medically examined from time to time, the report cards gone over and the
parents invited to be present and confer with the doctor.
On 29th June, 1911, a report was received from the Board of Education dealing with the school,
setting forward the idea that it should be conducted more on the lines of an open-air school, and complaining
of the lack of opportunity for adequate meals. These two last points are of very considerable
importance. It would probably be better to assimilate such a school to open-air school practice
as much as possible. The question of feeding the children is of supreme importance and will be discussed
later.
The medical officer in reporting on the school could, therefore, only confirm the criticisms of
the Board. The children attending had now been divided into three groups:—
(i.) Those whose temperature in the preceding week had exceeded 99 deg. F. in the morning
or 100 deg. F. in the afternoon.
(ii.) Those above normal, but not above the limits of the first group.
(iii.) Those never above normal (98.4 deg. F.).
Badges were worn : blue, green (now replaced by red), and white, to distinguish the children of each
group. The first group have to rest all day, and their education is confined to oral methods or silent
reading. The second group can do ordinary lessons, but must be considerably restricted in physical
exercise, drill, or play. The third group are the ordinary open-air school children. Were it not that
being at home really means playing, sometimes, indeed, violently and excitedly, in the street, the first
class of cases should not be in the school; they are only suitable for a school sanatorium. The home
journey to and fro, till recently often duplicated in the dinner hour, was entirely harmful to them.
Nevertheless, the oral teaching and silent reading in school do much to check the moral evils which may
spring up through the negative features of the usual treatment.
The provision of meals was much discussed. In many cases parents insisted on children, even
with fever, going home to dinner. This was discouraged, with the approval of the Board of Education
who still pressed for the provision of a suitable and substantial dinner for all the children, followed by
a rest of two hours.
The clashing of different authorities, often viewing the same subject from a different standpoint
and with differing purpose, the intense interest which each authority took in this pioneer work, made
it difficult to get smooth working.
The Board of Education requirements, the Council s desire to meet them, and yet to aid the
Dispensary Committee in carrying out their scheme, and this Committee's desire to work on certain
definite lines in conformity with the rest of their general plan, led to numerous conferences and suggestions.
It was finally decided that the medical work should be regarded as chief, the educational as
subsidiary, and that medical treatment should be carried out in its entirety by the Dispensary Committee.
The managers were also to take responsibility for feeding. In November the Board of Education
considered it essential that the children should not be allowed to go home or to bring their own
dinners, but that a satisfactory meal should be furnished at the school for all the children. This is
now arranged. All children rest from 11.30 a.m., dinner has to be in two batches, boys 11.55 to 12.30,
girls 12.30 to 1.5; all the children resting till 2 p.m. Each child, therefore, has one and a half hours'
rest during the mid-day interval of school.
The results of the school cannot yet be set out in figures or even in qualitative assertions.
Probably they will not nearly come up to the first expectations with which the school was proposed.
The records, however, have already enabled an indication of the seasonal variation in growth
n weight already referred to on p. 17, to be obtained. Oil visiting the school in the tenth week of
1912, the nurse drew attention to the fact that since school feeding had begun the children were not
increasing weight at anything like the rate they had done previously. This was probably, however,
merely seasonal and not due to school feeding.