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of cases, however, the children did not seem to be drawn from the very poorest classes of labourers,
but from that of artisans or small tradespeople. Living conditions may be overcrowded, but
the homes are not usually actually in very bad repair or definitely damp. There is usually, too,
so far as can be judged, not so much an actual lack of food, as lack of the right kind of food—
bad feeding rather than actual starvation.
The district in which, perhaps, these statements are most exemplified is Hammersmith.
Here the children attending the rheumatism supervisory centre are drawn from the families of
small tradespeople earning £2 to £3 weekly. There is only one slum area, by the river, in this
district, and the children coming from this are not to be found among those suffering from
rheumatism. In many schools, too, it has been found, in a most marked fashion, that the children
suffering from rheumatism are notably of a different and much better type than the others.
It has been suggested that this may be partly because children of this better type are more
" fussed over " by their mothers, that, as there is sufficient money to clothe the children fairly
well, they are given too many clothes, and that it is particularly in this class of family that the
house is over-heated and badly-ventilated. The poorest classes, of course, live in a very much
colder atmosphere, and the upper ones are much better educated in health conditions.
Certainly it does not appear that cold and damp are, as once thought, the great predisposing
causes of rheumatism. Many headmistresses and school nurses suggest that these are lack of
sleep, bad feeding, and psychological excitement; and it would appear that rheumatism is a social
disease, physical disability being caused by poor living conditions in general. Damp, however,
it would seem, must be regarded not as the major cause, but merely as a " symptom "
demonstrating the unsatisfactory housing accommodation in general.
Home conditions vary enormously with different districts, and even with different children
in the same school. Living-rooms, bedrooms and beds are usually overcrowded, and there are
very few amongst the children who sleep alone. Conditions vary, however, from that of the most
appalling slums, in which one may find three boys of 21, 19 and 18, and three girls of 15, 13 and
10 years sleeping in two double beds in one tiny room, to that of good middle class, where two
sisters may be occupying twin beds in a large well-furnished and well-ventilated room.
Insufficiency of sleep is, however, to be found in practically every case ; none of the children
seem to go to bed early enough, or to obtain sufficient sleep even after having gone to bed. Very
few children go before 9 or 10 o'clock. In cases where many people are sharing a room, or where
the child's room may also be the living-room or kitchen, it is, of course, impossible to go to sleep
even after going to bed. It is useless to ask or expect the other members of the family—who
may be all adult—to keep quiet after the child has gone to bed, or to avoid its being wakened
when they also retire. The result is that, in many cases, where sleeping accommodation is very
limited, children do not go to bed until everyone in the house is also retiring.
It is found that there is a great deal of deception about this question. Both children and
parents persistently deny that the child goes to bed too late, and this is a point over which school
and home authorities are constantly at loggerheads.
Although children are made to rest in school, it is found that parents continually complain
that it is impossible to make them do so at home, and that they are always dashing about. It
is a constant source of worry to the school authorities that their work and care in school seems
to be nullified out of school hours. Setting aside the parents who deliberately use the child to
run errands, wash the floor, or mind the baby—of whom there are unfortunately far too manyparents
seem to be able to exercise very little control over their children. Although, in some
cases this is, perhaps, the result of a lack of interest, in others it appears to be more the lack of any
systematic training or discipline.
Examples serve to emphasise this extraordinary difference between home and school treatment.
One boy with a very bad heart, who was always carefully brought from home, and sent
back, by ambulance, was usually back outside the school, chasing up and down the street on roller
skates within ten minutes ; another boy was carefully set down outside the front gate, over which
he used to vault clear before rushing up the stairs ; while numerous boys, who have bicycles,
tear round and round the streets near their homes as soon as they are released from school.
Many school authorities have suggested that the school discipline, although undoubtedly
advantageous from a purely medical point of view, perhaps defeats its own purpose by being
too rigorous, and suppressing too far the energy of the children. It is felt that if they were allowed
to be a little more energetic in school, and were not forced to rest so much, there would
be less likelihood of their " working off" their energy in this really insane fashion as soon as
they return home. One finds, perhaps, here a feeling that has been strongly emphasised by one
headmistress, in dealing with the psychology of the child, an indication that some doctors are
possibly too prone to consider the child simply as a heart case, and not as a human being.
The lack of parental discipline amongst children, to which some reference has already been
made above, is a point that is stressed by many of tho school authorities. Children seem, in a
very large number of cases to do precisely as they please, to stay out late, and only to go to bed
when they wish to do so. The children are not trained as babies to go to bed at any regular
hour, to have their meals at regular times, or to evacuate the bowels regularly.
The poorer mothers seem to have no idea of teaching their children either physical or moral
discipline, and it is therefore almost impossible to train these children into really good habits
when they reach school at the age of five years old or so. It is felt by many that a very strong
effort must be made to induce mothers to train their babies from the very first, but it is extremely