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from skin infestation, malnutrition and deformities were only too common ; and
particularly any medical observer, familiar with the vermin infested rooms of his
midwifery experiences in the slums of London, or with the sight of the skins of
children in out-patient departments, many of which were peppered with hundreds of
flea marks : such an one, if he will stand and look at the scholars trooping into
school nowadays will realise that the main cause of improved sickness and mortality
statistics among the child population in the London of to-day is to be found in the
heightened sense of parental responsibility, aroused in a generation of parents who
have themselves passed through the schools.
It is something like half a century since elementary education became compulsory
and universal in this country. Like the air we breathe, it is now regarded
—or disregarded—as so much a part of our environment that its manifold reactions
on all the affairs of life pass almost unnoticed and unrecorded. In common with
every other aspect of social progress, that of public health has benefited also, both
by the indirect and by the direct effects of the great education service.
The indirect effects are those produced by the substitution of a reading and
discriminating for an illiterate and ignorant public. Although intelligence has
not necessarily been increased, knowledge has grown and spread. A public opinion
has been created which stands behind the efforts of the sanitarian, without which
his would still be a voice crying in the wilderness. A single example of the overwhelming
importance of the indirect effects of the education system is seen in the
remarkable fall of infant mortality and the saving of child life, which came about
as a younger generation, after passing through the primary schools, became in due
course the parents of a new generation. Thus the indirect results of the education
system are truly incalculable.
The direct effects of the education service on the health of the child and adolescent
are, of course, plain for all to see. Thirty years ago school places had been
found for all children of school age ; the habit of school attendance was almost
completely acquired, although " truant schools " still formed part of the system ;
there was a sufficiency, in London at any rate, of trained teachers to staff the schools ;
and a reasonably efficient elementary education was imparted to the children.
These were great results to have been attained in 25 years.
But up to this point little or no regard was paid specifically to physical conditions.
There were no school nurses, no school doctors, no school dentists, no
system of special schools, no proper physical education, no children's baths, no
school hygiene, no school feeding. There was scarcely an indication of that movement
towards physical care of the school child which has been such a predominant
feature in the later history of the education system.
The position in the last five years of the nineteenth century in regard to the
physical care of school children in London was as follows:—The School Board for
London had in 1890 appointed a part time medical officer (Sir William R. Smith);
Mrs. Humphrey Ward had established a "cripple " school in Tavistock Place on
a voluntary basis, and the striking results of this experiment had interested the
School Board, with the result that special schools for defective children were being
established. The Act providing for the education of blind and deaf children had
already been passed in 1893, but in 1899 the Defective and Epileptic Children
(Education) Act gave the School Board the power to deal with these children, and
regularised the position of special schools. Dr. Shuttleworth and Dr. Dickinson
Berry had been appointed as part time medical officers to assist in the certification
of special school children. The establishment of health courses in the evening
schools had made the appointment of doctors as lecturers possible and Sir John
Collie was engaged as advisor on these subjects.
During the early years of the present century, however, the need for more
general extension of children's care was beginning to be apparent. Eminent