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143
Report of the County Medical Officer—Education.
to some extent accentuated by the enforced confinement and special postures incident to school life.
Such children have Usually a poor physique and imperfect breathing powers. They appear flabby,
with rough skins, presenting with unusual frequency various forms of rashes indicative of local congestion
and unhealthy tissue changes. They consequently appear ill-nourished to a degree quite unwarranted
by the quantity and even quality of the food they have actually received. This is mainly the result of
an imperfect local or general circulation of the body fluids, the products of tissue change not being
swept away and replaced by fresh lymph laden with nourishment. The mucous surfaces are affected
in a similar manner to the skin, so that the children suffer from a condition of " stuffiness " with chronic
nasal, pharyngeal and bronchial catarrhs and indigestion primarily the expression of an ill-balanced
circulation, and only secondarily the result of microbic infection. Adequate resistance to the attacks
of micro-organisms is only possible when the exchange of body fluids is maintained at an efficient level.
This circulatory exchange depends only partially on the action of the heart, being to a large degree
established by the pumping action of the respiratory movements of the chest and by the movements
of the limbs.
In cases of pronounced illness an imperfect circulation is often aided by the employment of
massage in which the body fluids are driven from various organs by the stroking and squeezing movements
of an operator, while during the intervals of relaxation between each stroke fresh supplies of blood and
lymph nourish and enter to refresh the tissues. The physiological effects of muscular exercise are of
a similar nature. The effect of each muscular contraction is to squeeze out the contained
body fluids while the movements of the limbs as a whole tend to propel onwards both blood and lymph.
The effect on the circulation of the body fluids is the greater the more fully the muscle contracts, consequently
when movements are carried out regularly to their fullest extent, as in Swedish gymnastics,
better results are obtained than from ordinary uncontrolled exercises. Owing to this action certain
groups of massive movements taken in the course of physical exercises are sometimes termed nutritive
movements.
The degree of exercise taken by the normal child keeps his circulation in a condition adequate to
his needs; for such the ordinary drill class conducted under good conditions suffices to prevent the
under-development of any group of muscles, and avoids the onset of any deformity as a result of
the confined attitudes of school hours. In the weaker children, the adequate circulatory balance has
not been established, so that on the one hand their general health suffers, while on the other, when any
muscle group becomes relatively weaker, the movements in which this is concerned are not fully carried
out, so that the muscles suffer still further in nutrition and the unchecked action of opposing muscles
may lead to the appearance of some deformity. In the ordinary large classes it is difficult for the teacher
to ensure that every child shall carry out full movements, particularly as their exact nature is often
masked by the unsuitable nature of the costume worn. Also the movements suited to the average
member of a normal class may be in some points too severe for the weaker children, who substitute
automatically other and less complete movements, thus losing all benefit, or even producing harm. When
the retarded children are taken in small groups, and particularly when they can be exercised while suitably
clad, as for example, in a jersey, faults can be noted, full execution ensured, the circulatory balance
restored by progressive exercises affecting each part according to its needs, while the weakened muscles
can be built up by special corrective exercises, in which each muscle group acts in a more or less isolated
manner. All the necessary exercises occur in the ordinary syllabus, the only need is to draw up tables
of movements for individual classes of children. Early signs of improvement are noted in the carriage
and buoyancy of gait, while the skin can be observed to lose any roughness or eruption and resume the
normal texture of health. When a child goes to school at all, he is sure from time to time to exert himself
violently, even if this is physiologically undesirable, and it is better that his strength should be trained
gradually and his heart and muscles accustomed to increased exertions. Educational gymnastics can
fulfil this task effectively.
Breathing
exercises,
Special attention is often drawn to breathing exercises; breathing is an automatic movement
best ensured by general exercise. The only real breathing exercise is breathing itself, though the combination
of breathing with movements of the limbs or trunk in the same rhythm at appropriate places
in a table of exercises produces several useful effects. Deep breathing exerts an aspirating effect on the
lymph stream and also serves in some measure to provide automatic massage for the heart muscles.
At the commencement of a lesson, when none are out of breath and children are of approximately the
same age, the breathing may be performed to command, and taken by all to a uniform rhythm, but after
vigorous exercise, each must breathe in his own time, when the movement will serve to quiet the circulation,
and only later, when both functions are nearly normal, can it rightly be taken to an artificial
rhythm. Such exercises, after preliminary quieting movements, usually conclude a gymnastic lesson.
Breathing exercises in general physical education play a different role from those used to teach breath
control for speech or song ; they best take their places in a full table, but may be employed with other
simple movements in brief periods between lessons. Some doubt their value when taken by themselves,
and regard progressive general exercise as the best and only corrective mechanism for the respiratory
apparatus.
Nature of
Defects.
In the course of an experiment now to be reported upon, certain children selected by the
teachers and organisers in each of eight schools were submitted to one of the assistant medical
officers (Dr. Shrubsall) on his visit, when a final selection for each class was made. The
children in the class were examined prior to the commencement and at the expiration of
their subjection to the special course of exercises. The number, 125, on which this
report is based is a few short of the total, owing to absentees on the occasion of the
second visit, and the inclusion, during the progress of the experiment, of a few other
children under special circumstances. The chief defects noted were spinal curvature,