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CHAPTER XXIV.
REPORT OF THE SCHOOL MEDICAL OFFICER (SIR WILLIAM HAMER)
FOR THE YEAR 1923.
Introductory Note.
Some of the early advocates of elementary education clearly realised that
beyond immediately recognisable benefits certain others could be dimly discerned
in the background, and time has fully justified anticipations which might at first
sight have seemed almost visionary. For example, Wordsworth, when he wrote, in
1814, in " The Excursion," of the " coming of that glorious time " when this imperial
realm would " bind herself by statute to secure the rudiments of letters for all
her children," expressly had in view the influence to be exerted by national education
in the years to come upon difficulties arising from rapid growth of population ;
and he clearly appreciated that the whole question of meeting such difficulties was
bound up with the problem of imperial expansion. He further declared, with
remarkable foresight, that if the national system of education were well founded,
there would be no danger of the " prevention of all healthful growth, through
material injury," for they whose lot it was to dwell in crowded cities, without fear
would five " studious of mutual benefit." Here he would seem to have been
hinting at the nineteenth century development of preventive medicine, and perhaps
even at the twentieth century evolution of the school medical service.
Whether this be so or not, the influence of the schools upon health gradually
germinated almost unnoticed by the general public, and it was not until twenty
or thirty years ago that it was thrust upon the attention even of those who were
in a position favourable for seeing it. The earliest discernible indications were
those emerging in connection with prevention of infectious disease and of the spread
of verminous conditions.
Then, soon after 1900, a curious statistical paradox became strikingly apparent.
While the general death rate had fairly steadily and continuously fallen during the
preceding forty years, presumably owing largely to greatly improved environmental
conditions, a corresponding influence had only begun to affect infant mortality at
the beginning of the present century. It was suggested in the Annual Report for
1914 (vol. III., p. 10), that the explanation of this seeming anomaly was to be
found, in a lapse of the time needed for the upgrowth of a generation of parents
comparing favourably in many respects, and particularly in that of showing a
lessened mortality from disease, with preceding generations.
In the Annual Report for 1916 (vol. III., p. 4) the case was more accurately
stated by ascribing the fall in infant mortality since 1900 mainly to the fact that
by that date the majority of mothers had enjoyed the advantages of elementary
education. Moreover, the percentage of mothers thus favoured was increasing
year by year. The mother may be regarded, indeed, as practically constituting
the environment of the infant. Dr. James Wheatley, Medical Officer of Health
of Shropshire, in a carefully argued address, read at Portsmouth last summer
before the British Medical Association, established beyond all doubt the thesis that
the predominating influence in promoting decline in infant mortality has been
the Education Act of 1870.
If, however, the public elementary schools are to be held largely responsible
for this fall, a corresponding movement in death-rates at school ages should also
be demonstrable. The figures bear this out. Examination of deaths, at ages,
in England and Wales during successive decennial periods (Reg. Genl. Ann. Rep.,
1920, p. 9) shows that on the whole the most marked improvement in mortality
during the 50 years 1861-1910 has been at ages 5-14—the school ages—the decline
being 55 per cent. It should be noted, however, that ages 20-24 show an even
more rapid rate of decline in the earlier decennia, presumably largely owing to the
influence of migration. Again in 1911-20, the fall has been more marked at 0-4