Übe IRelation of tbe leal profession to Scbool Bbucation. WALTER CHANNING, M.D. Reprinted from Annals of Gyneecology and Pcediatry. BOSTON, 1897. flbe TRelatlon of the flfceblcal profession to School lEbucatlon. IRepnntefc from annals of ant) paMatn?. JKHalter Charming, HD,©. THE RELATION OF THE MEDICAL PROFESSION TO SCHOOL EDUCATION.* WALTER CHANGING, M.D. The hold of tradition on the human mind has a most marked illustration in school education. Though the child is better understood physically and mentally than he was fifty years ago, and his needs are more apparent and methods of instruction have vastly improved, we still retain much that is antiquated, as well as useless, and even pernicious. While we have some idea of what should be done, we seem to lack the capacity of practi- cally applying our knowledge. fifth of the time in some of the schools is devoted to spelling and penmanship, which is probably in excess of what is required. The trouble is that no satisfactory stan- dard of what the child actually needs to fit him for life has as yet been determined. There is no sufficient differentiation of what may be pri- mary, and what of secondary import- ance. It is theoretically believed that the primary school curriculum may be broadened without detri- ment to the three R’s, but how is this to be accomplished ? In a recent article, “ How shall the child be taught,” | Dr. J. M. Rice has shown that by a process of exclusion about fifty per cent of the time spent on the three R’s might, without detriment, be given up to other subjects, under the present school systems he argues, a great deal of time is wasted in the endeavor to teach the child details of subjects which can be of no practi- cal value. For instance nearly one- The conservatism, bred of tradi- tion and antiquated custom, which so hampers progress on the literary side of education, has up to the present time even more impeded development on the physical side. Can it with truth be said that it has ever received the careful study and attention that it deserves ? Is there such a thing as a general system of education which includes a comprehensive and practi- cable plan of physical training ? The •Read at the meeting ofi the Norfolk District Medical Society, Jan., 26,1897, t Forum} January, 1897. 4 WALTER CHANGING. Kindergarten, as projected by Froe- bel, certainly had such an aim in view, and the educational gymnastics of the Swedes have also been a valuable contribution to the subject, but can we say that the latter have been assimilated, correlated and made part of the frame-work of the education of our children? ance, and if we seek for a reason for tills ignorance, T fear we must acknowledge that we as physicians are largely responsible for it. I hold it to be true that in matters of healtli physicians must be the teachers of the people, but if we are ignorant ourselves, how can we be teachers ? As far as my own judgment goes, I should be obliged to answer in the negative, and say they have not. I regard it then as our first duty and at the present time perhaps our most important one, to investigate the subject of the influence of edu- cation on health. First we must know what a healthy child is. We should establish a standard of health at different ages demonstrable by measurements and tests, and not leave this matter to be half deter- mined by lay teachers in colleges and gymnasiums. Having established such standards, we should next make similar ones for defective children, so that in the end we might be able to classify and grade them. I do not deny that physical train- ing has forced itself for considera- tion on the attention of the commun- ity, and in the form of out-door sports, ami athletics has had an im- portant influence on the health and well-being of the people, and it must be further admitted that the schools themselves have from the outside been favorably reacted upon, and are visi- bly affected by the inflowing tide, and take a deep, active, and in- telligent interest in these things. I might go still a step further, and admit that set gymnastics are not now as important in some schools as they might have been twenty-five years ago, for the very reason that children now receive a vastly greater amount of physical training outside the school than formerly. This is a subject of interest however which I will not consider here. Making due allowance for these facts it is still true that the physical side of edu- cation receives comparatively little attention, and is little understood. It will not be enough for us to say “ that is not a healthy child, ” we must be able to prove it by rules, which, though simple and plain, will be accurate and capable of demon- stration. At first sight the problem may seem too difficult; surely we cannot become specialists in child-study, we are not psychologists. But this is not nec- essary, nor is the method of collective statistics or laboratory experiment the best one for our purpose. If we seek for a reason we are led to the conclusion that public opin- ion is not as yet alive to its import- Let us take the child as we find him and study him clinically, so to speak. Note physical characteristics, peculiarities, defects, and gradually SCHOOL EDUCAT I ON. 5 draw deductions from such facts as we find. A striking example of what can be done by pursuing such a course is furnished by Dr. Francis Warner, London. He found that nervous children presented certain rather uni- form indications of their condition, such as imperfect nutrition, bodily defects, and particularly “ nerve- signs,” as he called them, such as over-aching, or under-aching muscles, feeble coordination imperfect eye- sight and so on. He decided to ex- amine London school children for these indications and has given us the results in 100.000 children. There was nothing difficult or complicated in his method, and any one of us might use it—and it was rapid as well as accurate. His results however were important, as they showed that there was a considerable number of defective children in the London schools, and they have led to the estab- lishment of “ special classes ” for the education of such children. While we may not be able to achieve equally brilliant results, we can follow in his footsteps, and at least get a more defi- nite knowledge of what the child is in plain, simple, medical terms. whole, and leaves a vast gap in the student’s mind as to the relative value and relation of health to disease. Less time should be spent on the details and more on giving compre- hensive and broad and philosophic views of the human being as he is actually met with. To know him when sick, it will be of infinite advan- tage to have a standard of health to compare him with. 1 would not recommend taking more time for the purposes which I indicate, but make a different use of some of it. There should be a course in simple anthropometry, which would enable the student to make a record of bodily and mental conditions in healthy individuals, in this way call- ing his attention to various organic, or functional defects which now es- cape his notice. Elaboration would not be desirable, but rather a funda- mental training for systematic obser- vation. Were such courses given as the one 1 here indicate, I am sure that one result would be a better knowledge of physical training. For with an understanding of the organ- ism as a whole, would come a search for remedial or corrective measures, which would develop or modify its action, as a whole. It is a defect in the medical educa- tion of the present day that the whole time of the student is spent in first overloading his mind with a knowl- edge of elementary subjects far too detailed and minute, and then sec- ondly in counter-balancing this knowl- edge with an infinity of pathological and clinical minutiae Each set may have a value in its proper place, but it represents a part only, and not a When we consider how little the medical men actually know of the muscular, mental or nervous mechan- ism as an apparatus which can be operated as a unit, and made strong and powerful for the struggle for exis- tence, how can we expect him to un- derstand much about the practical 6 WALTER CHANNING. application of physical training ? He is very much like a man who tries to sail a ship, who has been told how one is built and what all her parts are, and what should be done in case of accident, but has never been taught practical seamanship or seen a vessel at sea under sail in all kinds of weather. No one would think of trusting such a man to actually sail a ship, until he has learned by observa- tion and experience how the ship as a whole acts and must be managed. health of the child, and if it is bad, what can be done to modify it. To find this out requires a knowl- edge of school education, and here again we are obliged to confess physicians have little, and often no idea of what modern school education really is. We often think we under- stand it, because we have once been school children ourselves, but that means hardly more than that we have a childish conception, or misconcep. tion, of its effect on one solitary indi- vidual. Experience at such an age is not quite the same teacher as later, when the mind can weigh and judge objectively, and without the prejudice and narrowness of its subjective side. It is pretty hard for a horse to realize why he must carry a burden, even if it is hay and grain for his own con- sumption, and so the child, laden down with his burden of studies and rules, can hardly be expected to ap- preciate the ultimate benefits which may result. What is true of anthropometry, if we choose to apply this phrase for our purpose, as the study of bodily conditions in the healthy individual, is also true of general hygiene, sanitation, and so on. There should be also in these subjects, spec- ial courses in our medical schools for the purpose of awakening interest and training medical men for a better understanding of the conditions under which the community lives. Assuming that the period finally arrives, when the medical profession have acquired as a part of their edu- cation some knowledge of the essen- tials of hygiene, sanitation and of physical training, that word being tised in its broadest sense as meaning the care and development of the en- tire organism, how will they be able to apply what they have learned to the schools? If we wish to learn what the under- lying principles of education are, and how they can best be ap- plied, we must bring ourselves into touch with those who carry on the schools, the teachers themselves and not only that; we must visit the schools, and see them in operation. It may sound a little affected to say so, but I really believe every medical student would make a better physi- cian, if he had to visit, under the direction of a teacher, as a part of his medical course, perhaps half a dozen schools. In this way he would be stimulated to enquire a little more This question must be answered by saying, that while they have been learning what a healthy child is, and how he can be kept so, they have also been trying to find out what influence the school exerts on the SCHOOL EDUCATION. 7 closely into the true meaning of edu- cation, than he is at present in the habit of doing. children, from those that are bright well and strong, and I believe that this is an obligation from which none of us can escape. We tend to segregation of profes- sions too much. What we need is harmonious cooperation, or correlation of interests; mutual dependence ; a nearer and consequently more intelli- gent insight into each other’s work. We shall never learn by shutting our eyes. The third question, of keeping the child healthy in the school, is too far reaching to go into in a few words like these. The recognition of contagious or infectious diseases > diseases of the lungs, skin, and so on, I will merely allude to in passing, as already they have occupied much at- tention. The problems of physical training are many, and not easy of solution, and will require years of patient study. As I have already intimated, physical training must mean the intelligent care and devel- opment of every portion of the or- ganism. Gymnastics, only as yet imper- fectly understood, and often poorly taught, while capable of accomplishing great results, are merely one side of the all round, general training to be sought after. Athletics and sports, in their ethical as well as in their physical as- pects require most careful investiga- tion. Who can tell us the nature and value of exercise ? What are the physiological indications for exercise, and what the contra-indications ? How does muscular work effect the brain, and how does mental work? Are pupils actually doing too much work in the schools or too little ? Are two school sessions better than one ? Are children dressed properly ? How long can they go without food ? What is the physiological effect of manual training? Having reached a point when we know what a healthy child is, and how he can he kept so, and what a school is, we shall be competent to decide: Ist, to what kind of aschool, if any, the child shall go ; 2nd, how he shall be graded when he gets there ; and 3rd, what shall be done to keep him healthy. To determine the first question will be no easy matter, for it includes a knowledge of proper school sites, size and arrangement of buildings, school desks, ventilation, plumbing and sani- tary science in general. Perhaps such things will necessarily fall into the hands of experts, but I believe some idea of them is requisite for a physician who is to have any direction or oversight of the health of school children, or even to pronounce opin- ions on these matters. The second question, of grading should be entirely in the hands of medical men, as far as physical condi- tion is concerned, and Dr. Warner, al- f ready referred to, has shown how this can readily be done. It is of the utmost importance that we should be able to promptly recognize and differentiate dull, apathetic, feeble-minded, nervous Such are a few of the problems in this one direction of physical train- 8 WALTER CHAINING. ing, which it appears to me medical men are in the near future bound to take up and study in a plain common- sense way. individual fibre. To us as physi- cians is entrusted the health of the people, and the time is not far distant, when we shall feel ourselves equally responsible with our educators for what the schools stand for, for in them we shall find our best opportu- nities for combatting transmitted ten- dencies and defects, which, in these modern days, environment tends to transform into actual potentialities of deterioration, if not degeneration. Education is the corner-stone upon which the success of the community rests, but health is of even greater im- portance, for it is the very rock- bottom underneath the corner-stone. Looked at broadly, education is some- thing vastly greater than mind culti- vation ; it is the very sap of the tree which influences the growth of every Brookline, Mass. HARVARD PRINTING CO., PRINTERS, CAMBRIDGE.