PHYSICAL EDUCATION 
IN CHILDREN. 
Read before the Section on Pediatrics, Newport, June 25,1889. 
BY 
A. II. P. LEUF, M.D., 
Director of Physical Education at the University of Pennsylvania. 
[Reprinted from the Archives of Pediatrics, Septewiber, 1889.] PHYSICAL EDUCATION IN CHILDREN. 
It is my object in this paper only to call attention to the value 
of physical education in children for the prevention and cure 
of disease. But before this is done, it is best to consider very 
briefly the physical constitution of children. 
Bones.-The bones of children are imperfectly formed. 
Many are semi-cartilaginous, while others consist of different 
segments held together by intervening cartilage. They are 
elastic and full of blood and fat. The periosteum is thicker 
than in adults and richly supplied with vessels. The connec- 
tive tissue of young bone is tender, and hence has not as firm 
a union with tendinous and ligamentous attachments as is 
found in adults. The cartilaginous union of the shafts of 
bones with their epiphyses makes violent exercise dangerous, 
because it is likely to cause their separation. 
Muscles.-The muscles of children are in less of a develop- 
mental state than bone, though the muscle-elements are not as 
firmly bound together as in adult bodies. Their nutritive 
supply is very libera], and they are generally surrounded by a 
liberal layer of fat. They contain a larger proportion of 
water than those of adults, and therefore are not firm and 
hard. 
Blood-vessels.-These are all relatively large in children 
and liberally supplied to'nearly all parts of the body. They 
are more susceptible to impressions at this time of life than in 
later years. I mean that it is easier to develop them in child- 
hood than in adult life, for they respond more readily to in- 
creased pressure and have a relatively better nutritive supply. 
Oxygenation in children is also better than in adults, because 
the freshly aerated blood has a much shorter distance to travel 
from the heart to the remotest parts of the body. 2 
Leuf : Physical Education in Children. 
Nervous system.-While the nervous system is undergoing 
considerable development in children, it presents quicker re- 
flexes than in adults, probably largely due to shortness of the 
peripheral nerves, thus consuming less time in the transmission 
of afferent and efferent impulses. But a child's nervous centres 
are more sensitive to stimuli and irritations, as is shown in their 
common reflex convulsions and febriculse almost always readily 
controlled by the administration of nervous sedatives, notably 
the bromides. Shortness of limb, entirely aside from the rapid 
transmission of nervous impulses, is very conducive to the 
rapidity of movement so noticeable in children. 
The viscera.-The largeness of the liver and the relatively 
small lungs are prominent anatomical features in the child. 
The stomach and intestines are proportionally large, causing 
a decided abdominal bulging. The viscera of the child have 
a softness and vascularity in marked contrast to the same 
organs in the adult. All in all, they are a much more delicate 
organism, and require a correspondingly greater amount of 
care. 
Digestion.-The imbibition, digestion, and absorption of 
food in the child consists of a most interesting and important 
series of phenomena, without a thorough understanding and 
appreciation of which the proper physical education of chil- 
dren at any time is impossible. Too much stress cannot be 
laid upon this point, and it must always be remembered that 
no fixed dietary will do for any large number of children. 
Growth and development.-The child is undergoing constant 
changes of growth and development, all its processes being 
generally more active than those of adults. The associations 
of its organs are new, and more apt to be impressed by ex- 
ternal influences than in older organisms. What would produce 
a moderate effect upon an older organism might be powerful 
in its influence upon a younger one. Adult organisms undergo 
but little further development, while in children many changes 
have yet to occur. It follows, therefore, that more care must 
be exercised in the direction of children's exercises than those 
of grown men and women. 
At first sight it does not appear that exercises can have 
much effect upon the growth of bone, but the facts of experi- Leuf : Physical Education in Children. 
3 
ence teach that it is so. The explanation is simple. Young 
bone is but a connective-tissue framework, filled with bone- 
cells, or osteoblasts, and cartilage, and this blends directly 
with the surrounding periosteum, thus forming a continuous, 
direct, and intimate fibrous connection of the periosteum and 
the entire interior of the bone. In the same way can muscles 
be described as consisting of a connective-tissue framework 
supporting muscle-cells and their vessels and nerves. This all- 
pervading connective tissue begins to predominate over the 
muscle elements as it nears the end of the muscle to become 
modified into a tendon. This tendon loses itself into the 
periosteum and bone, to which it is attached in very much the 
same way as its other end is to the muscle. Thus a muscle 
tendon is inserted into the very heart of the bone and not into 
its superficial layer as is so commonly and erroneously sup- 
posed and unfortunately too often taught. 
From the intimate relations that I have indicated as existing 
between the connective tissue of bone and muscle and inter- 
vening tendinous structures, it follows that forcible or sustained 
muscular contractions that pull upon a bone act upon its deeper 
parts as well as upon its surface. It also follows that the 
depth at which this strain is felt in any bone depends upon 
the severity and duration of the force exerted. 
It is a well-known law in physiology that increased func- 
tional activity of a part causes an increased supply of blood. 
Suppose now that a child is doing considerable exercise, and 
we have at once an increased blood-supply in its acting muscle 
and strained bone. If this is kept up for a long enough 
time, the increased blood-current leads to a higher nutrition 
of the part,-growth,-and should the bone be in the develop- 
mental stage, it will modify its development. As a proof of 
this effect of exercise upon bone I will only call attention to 
the readiness with which anatomists usually distinguish bones 
of the male from those of the female because of their larger 
size and the more decided markings of their ridges for muscular 
attachment. " This, must have been a powerful man" is an 
expression often enough heard coming from teachers when 
looking over a skeleton with prominent ridges and tuberosities. 
In my paper on base-ball pitcher's arm I had the opportunity 4 
Leuf : Physical Education in Children. 
to first call attention to the fact that bone-growth in the adult 
is caused by excessive exercise.* 
My sole object in being so explicit about the effect of exer- 
cise upon bone is to show that it is a potential agent capable 
of doing either much good or harm according to its proper or 
improper application. With this example well in mind, it is 
hardly necessary to demonstrate the equally potential power 
of exercise upon all the other parts of the body, when it has 
been conclusively proven to have so decided an effect upon the 
nutrition and growth on as hard and unyielding and relatively 
passive a substance as bone. 
Now, what are the general effects of moderate and violent 
exercise in health ? 
Moderate exercise in health.-When judiciously taken, mod- 
erate exercise, in ordinary health, increases the general nutri- 
tion of the body by increasing the heart's action, expanding 
the blood-vessels, increasing the secretions and excretions, and 
subsequently inducing tranquil and refreshing sleep. Besides 
this, it increases the vigor of the respirations, and thus the 
oxygenation of the blood. The body is pervaded by a healthy 
glow that remains for several hours and is followed by a feel- 
ing of added strength without any subsequent reaction. 
Violent exercise in health.-By violent exercise I mean any 
physical work that is felt as a decided tax. All such is sure 
to induce local congestion at the seat of strain, and if persisted 
in will cause inflammation and hypertrophy. None of the 
organs subjected to these strains escape this inevitable result. 
On the young, it may even cause epiphyseal separations, tear- 
ing of the periosteum, and rupture of muscle. It follows from 
this that moderate exercise is better adapted for general use 
among children than the more active and dangerous variety. 
For some purposes, though, the latter is the more desirable, 
but it must be used with caution. 
Therapy of the exercise of children.-Under this head I 
wish simply to mention some of the circumstances under 
which it is possible to benefit children by exercise, either in- 
stead of or in conjunction with other means. Of these condi- 
* Medical News, July 16, 1887. Leuf: Physical Education in Children. 
5 
tions one of the most prominent and important are spinal 
curvatures not dependent upon osseous disease. Several plans 
for relief of this class of cases are now in vogue, but all seem 
to me more or less seriously defective. It is very generally, 
and I believe justly, supposed that these curvatures result 
from muscular weakness. Yet one plan is to treat them by a 
fixed plaster jacket or by metallic braces. The defect of this 
treatment is that while it may hold the column straight, it 
does not strengthen the weak muscles which should be able to 
hold the column in its proper position. Another method is to 
prescribe certain exercises that will develop certain muscles 
until they are strong enough to obliterate the curves by their 
contraction. This plan is also defective in that it develops only 
certain muscles while others equally as important are over- 
looked. Sufficient success may, and often does, result from 
such treatment in so far as it pleases the patient by evident 
improvement. But the physician's work does not stop at this 
point. His business is to permanently restore abnormal con- 
ditions to a normal state. Special development of certain 
muscles does not do this, for by following such a plan one 
simply replaces one deformity by another. No treatment of 
deformities by physical exercise is devoid of serious error that 
does not effect the symmetrical development of the body. 
For instance, in a dextral dorsal curvature, due to muscular 
feebleness, the fashionable physical culture treatment now in 
vogue would compel the daily exercising of the muscles of the 
left side of the chest, for the purpose of pulling out the ribs and 
reducing the concavity of the spine of that side. So far the 
utility and correctness of this treatment cannot be assailed, but 
it practically stops at this point, or with a few additional exer- 
cises, causing a bending of the trunk so as to antagonize the 
objectionable curve. The method is defective by omission. 
Of what avail is it to have a straight spinal column with muscles 
on one side much stronger than those on the other ? A muscular 
deformity succeeds one that was bony. This is not all, for in 
the course of time the stronger side predominates and the curve 
returns, but is the reverse of what it was in the former instance. 
What is absolutely requisite to a permanent cure is general 
exercise for both sides, and a few supplementary exercises to 6 
Leuf : Physical Education in Children. 
help reduce the deformity without unnecessary delay. These 
may be of the calisthenic variety, or by means of dumb-bells, 
clubs, or pulley-weights. I prefer the last at all times when 
convenient. A suitable machine can be obtained for the mod- 
erate sum of ten dollars. I consider Reach's " O K" machine 
by all odds the most useful in the market, and it is the cheap- 
est, especially when one takes into consideration the numerous 
exercises to which it can be adjusted. 
A lady who has just left for her home was under my care 
for a week, receiving instructions in calisthenic and pulley- 
weight exercises for two purposes: one series to antagonize a 
dorso-lumbar curve, and the other to equally strengthen all 
the muscles of her back, and thus enable her to hold herself as 
erect as was intended by nature. She has a machine at home, 
and will continue her work until it is no longer needed. In 
her case the cure will be permanent. Had she received in- 
structions in only those exercises which antagonize her curves, 
she would have made a temporary recovery only to lapse into 
a reversed curvature. 
Club-foot, due to muscular weakness, as in cases due to ante- 
rior poliomyelitis, are best treated with special exercises. One 
plan is to have such a club-foot in leather and steel, thus 
forcing the foot into proper position without any direct effort 
to regenerate the lost muscle-power. Everything is left to 
time and the curative powers of nature. But this is neither 
scientific nor for what the physician receives his pay. The 
muscles actually atrophy to such an extent while braces are worn 
that they can never recover their functions. Another method, 
most ingenious, less unsightly than the former, and somewhat 
better, though also defective, is that which uses the artificial 
rubber muscle. If I am not mistaken, this was introduced a 
decade ago by the ingenious Dr. V. P. Gibney, of New York. 
But the serious objection to the rubber muscle is that it also 
largely destroys the functional activity of the affected muscle, 
by doing for it all its work. The plan of treatment which I 
advocate in all such cases is to use the brace when it is neces- 
sary to guard against accidental dislocation. The patient should 
only wear them when obliged to be on the feet, especially in loco- 
motion. The rubber muscle should be worn when braces are Leuf : Physical Education in Children. 
7 
not necessary and when for aesthetic reasons it is desired to 
hide the deformity, but at all other times the foot should be 
permitted to fall into a natural position while exercises are 
practised to develop the affected muscle. They should also be 
faradized while the cord should be moderately galvanized. 
I, of course, only refer to those cases in which all motive power 
has not been lost. 
It has quite aptly been said that a child is a small savage 
undergoing civilization. It is irregular in its habits, and 
tends to gormandize, as well as eat and drink without regard 
to the wholesomeness of what is within its reach. Regular 
physical exercise teaches it system, care, and discipline. Many 
children have a defective digestion due to many causes, com- 
mon among which are defective circulation, defective nervous 
force, and defective muscle-power in the stomach and belly 
wall. These are all remedied by proper exercise. Many 
forms of indigestion, we all know, yield kindly to suitable ex- 
ercise, and in no class of individuals is this more so than in 
children. 
Some children are morose, some have mental torpor, some 
are lazy, and so I could go on through a list of ailments refer- 
able to the tone of the central nervous system. Now, a fact 
that is still but little appreciated is that physical exercise is a 
nervous stimulant and tonic of the highest order,-in fact, I 
believe it to have no peer ; and this conviction is the result of a 
large unbroken series of practical clinical observations. I know 
of no better demonstration of this effect of exercise in sharpen- 
ing the wits than that given by Dr. Hamilton D. Wey, in his re- 
ported experiments with series of dullard criminals in the New 
York State Reformatory, at Elmira. It has the same bene- 
ficial effect in improving the disposition. For I have seen 
many disagreeable children become cheerful and good-natured 
after becoming actively interested in a course of physical edu- 
cation. The exceptions are temporary and due to conceit 
growing out of distinctions earned by superior accomplish- 
ments in contests. As a rule this condition does not last. 
Systematic physical exercise is impossible without personal 
cleanliness. Children who are brought up familiar with the 
gymnasium or track are clean and regular in their habits. To- 8 
Leuf : Physical Education in Children. 
gether with a weak body there is nearly always associated a 
high degree of backwardness due to false modesty, and also 
considerable lack of confidence. Now these are almost inva- 
riably lost after one or two years of gymnasium and out-door 
athletic work. That this is a valuable change for those who 
in later years must fight the world's great battle cannot be 
gainsaid. 
As physicians, we all know the objections to the customary 
drinking of intoxicants and the use of tobacco. Their em- 
ployment is most positively conflicting with good athletic 
work of any kind. Any early physical training of children 
compels them, or at least urges them, to dispense with intoxi- 
cating drinks and any form of tobacco. This alone would be 
reason enough to justify a demand for the early physical train- 
ing of our children if there were no other. No' athlete can 
get along without fresh air and wholesome food. Therefore 
greater care in the acquirement of both these would inevitably 
result from proper physical exercise. 
The Physical Education Society of Pennsylvania has so far 
directed its main efforts towards introducing into the public 
schools of the State a system of compulsory physical education. 
It now exists in some parts of the country, notably in Mil- 
waukee, where the German Turners are doing so much good 
for the rising generation. It is confidently hoped that within 
less than another year Pennsylvania will be enrolled among 
those few States that have made a systematic effort at the phys- 
ical as well as mental education of their children. 
I can think of no better conclusion to this paper than by 
quoting from a former paper of mine upon this subject, and if 
I have interested those of the profession of this country whose 
special business it is to look after the welfare of the young 
sufficiently to obtain their aid in developing the physical 
remedy, physical education, I shall feel deeply gratified with 
the result of the labors of which this paper is the outcome. 
1. The object is to develop the material body, and with it, 
of necessity, the mind and morals. 
2. Like most potent agencies, it is much abused and far too 
little understood. 
3. It absolutely forbids smoking. Leuf : Physical Education in Children. 
9 
4. It absolutely forbids the drinking of alcoholic or malt 
beverages. 
5. It insists upon the necessity of regularity in living, espe- 
cially as regards the time of sleeping, eating, exercise, and 
recreation. 
6. It enforces a good substantial dietary that will never be 
forgotten. 
7. It discountenances all kinds of vice. 
8. It is rigid in discipline without seeming so to those dis- 
ciplined, and develops implicit and willing obedience to 
advisers. 
9. It has a marked effect upon the growth of the body and 
mind. 
10. It develops to a high degree the valuable qualities of 
hope, confidence, courage, deference, obedience where proper, 
independence, perseverance, ambition, temperance, and deter- 
mination. 
11. It is, in short, the most valuable preparation of the 
young for the cares and trials of adult life, and aids young 
and old alike to ward off disease and mitigate its effects. ARCHIVES OF PEDIATRICS 
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