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CHAPTER XXII.
REPORT OF THE SCHOOL MEDICAL OFFICER (SIR WILLIAM HAMER)
FOR THE YEAR 1924.
Introductory Note.
The health of the child population in 1924 was almost as good as in 1923, the
latter being the record year. It has become apparent for some time past that,
the marked decline in mortality at school and pre-school ages, which began with
the new century, and which has continued with but little interruption even during
the period of the War, is to be regarded as due, in the main, to education—operating
directly and indirectly upon the school child, and indirectly upon infant mortality
through the influence of parents who had themselves been school children in their
time.
Sir John Simon, the first holder of the Central Medical Officership at Whitehall,
had already clearly recognised at least thirty-five years ago, that from the health
standpoint education is " the one far reaching true reformer." He meant, of
course, education in the full sense of the word, not mere reading, writing and
arithmetic, "but the education which completes, for self help and for social duty,
by including wisdom and goodness among its objects—the education which teaches
standards of moral right and wrong, gives height to character and aim, acts orthopaedically
on the twisted mind, and applies its own hygienic discipline to the shaking
palsy of purposeless life."
Criticism of this claim as to the wide reaching effect of education, so far as
the health of children of school age is concerned, has not been forthcoming, and,
indeed, cannot be sustained in the face of the evidence from a cloud of witnesses,
for example, the headmasters and headmistresses who sent in to Sir Robert Blair
their impressions regarding the changes which had taken place within their knowledge
in the physical conditions of the children under their charge (see Annual
Report for 1912, vol. IV., chapter XXXIX.). The existence of a corresponding
indirect effect of education (operating through the parents and particularly the
mothers) upon infant mortality has, however, been challenged, and the rival
claims of the work of infant welfare centres and of health visitors, of improved
milk supply, of better standards of living, of improvement of general sanitation,
of decline in the birth rate, of ante-natal causes, of increased national sobriety, of
wet and cold summers, and finally of lessened horse traffic and tarred roads have
all been voiced; indeed, each of these several factors has been deemed, by one
and another authority, the prime factor concerned in the decline of infant mortality.
Tho whole question was (as noted last year) examined by Dr. James Wheatley,
Medical Officer of Health of Shropshire, at the Annual Meeting of the British
Medical Association at Portsmouth in 1923, and he concluded that general education
has been the paramount influence, and that it has operated mainly by developing
"the sense of responsibility of parents for the health and lives of their children."
The suggestion that increased national sobriety has been the prime factor was,
a year later, argued with much persuasiveness by Dr. Gibson, Medical Officer of
Health of the North Riding Combined Districts (Public Health, vol. XXXVII.,
May, 1924). Dr. Gibson places at the head of his paper a quotation from Richard
Browne, a 17th century writer; "From these three things, Infection, Negligence
and Ignorance, the accidents of old age come on." He claims that this quotation
"is equally apposite to the accidents of all ages and is a useful mental clue in the
labyrinth of causation." His charts strikingly exhibit the fact that (a) deathrates
at ages 45-54, (b) infant mortality and (c) the amount of alcohol consumed
per head of population, all show a steep decline from 1900 onwards, after having
been maintained, though to somewhat varying extents, at a higher level throughout