# Labour and Childhood/The School Doctor in other Lands

CHAPTER X
THE SCHOOL DOCTOR IN OTHER LANDS
IT is clear that, in a sense, the school doctor has always existed. Wherever the inspired teacher was, there was he. For a long time, however, for more than a century, the voices of certain medical men have been crying in the wilderness that the condition of children should be observed and considered. There were such voices crying in England, and also in Germany; but little notice was taken of them in either country. At last in 1867 a German, Hermann Cohn, published notes on the vision of children, which went to show that the German nation was rapidly becoming short-sighted. Many doctors have since noted the sad effect of poverty and evil conditions on the eyesight. Cohn saw that the vision of children was threatened by one set of causes at home, and by others (such as bad lighting, small print, and so on) at school, and he put the result of all this before the public in such a way that he gained the ear of the authorities at last. He, with Erisman, ​shares the honour of being, perhaps, the greatest pioneer modern school doctor.
Nevertheless, Germany was slow to take action. She let other nations take the plunge before her. Thus, as Schubart, an eminent German school doctor, in his book Schubartzwesen points out, Brussels was the pioneer city in this work, for in 1874 she made provision for medical inspection in schools. Paris came next in 1879, Antwerp in 1882, Hungary in 1887, and Moscow in 1888.
The amount of inspection, and the nature of it, varied very much in these different places, yet they had all made a beginning of some kind before Germany or England took any practical steps at all.
Germany had a very good example of what real medical inspection can do to banish disease in her own army. During the first half of the nineteenth century 14 per thousand died in the Prussian army, and 10 per thousand of the civilians of like age. But in 1903 only 2·1 per thousand of the German army died, and among the civilians 5·2 per thousand.
"From the year 1873 to 1903," writes Hartmann, the chief school medical officer of Berlin, "the mortality of the people fell by two-thirds! In 1903 two and a half million 'sick list' days were saved, ​and seven hundred thousand of these would have been spent in hospital. That means a yearly saving of more than a million marks! And while the death rate was reduced by two-thirds, the amount of sickness was reduced by half. For instead of 6·7 per thousand of all the garrison being in hospital as formerly, there were now only three and a half. The hospital expenses too were lessened by one half. This happy result was attained only when an independent department for military sanitation—a department with a doctor at the head of it—was appointed. This, as the Report shows, gives quite obvious reasons why the development of sanitation in the army should be helped forward."
At the door of the school however the reformer hesitated long. The army results were good, but it was felt that to bring the doctor across the school threshold was a serious thing! To begin with, was it not an interference with parental rights? And then—the teacher! Was it not wrong to bring into the school a visitor who might interfere with him and make trouble? Ach Himmel! And finally, could not the teacher himself do all that was necessary instead of the school doctor? After all he, the teacher, perhaps knew something about Hygiene.
The first hesitations and objections are based ​in every land, it seems, on almost the same grounds, but it is noticeable that the Germans, though frugal, never raised the bugbear of expense. They knew, from the first, that if school doctoring was worth anything it would be worth a great deal. They knew, as every one knows who watches the exchequer, that disease is very costly indeed. And they held back only in order to make sure of their ground! At last, in 1891, Leipzic took the plunge, and engaged the first German school doctor. In 1893 Dresden followed her example. As a matter of fact Germany was not then more forward than England, for in 1891 the London School Board engaged its first school doctor, and in 1893, at Bradford, Dr. Kerr entered on his half time duties as medical adviser of the School Board of that city.
Germany then was not at that time in the van. On the contrary, she was in the rear of many nations, and in line only with England. It would seem also that, in spite of the teachings of Cohn, and of other pioneers, she had not followed very closely the work of physicians and medical teachers (such as Séguin) in other lands, for the ideas in vogue in Germany as to what a school doctor's duties should be were still very vague. It was supposed that he should begin by inspecting school buildings. And a very ​alarming kind of duty this was too, to make his entrance with. For suppose he condemned many even of the new and expensive schools just built, and all by a stroke of the pen! A school doctor it was supposed should pronounce on questions of heating, lighting, ventilation, sanitation. So far his duties were something like a plumber's! Over and above this he would have something to do in preventing the spread of infectious disease! Such were the duties of a school doctor according to public opinion even in Germany in what is now called the "pre-Wiesbaden epoch" (Vor Wiesbadener Epoche).
Wiesbaden, famous as a watering place, famous once also as a gambling den, was destined to make for itself a new kind of renown. Situated on the slope of Mount Taunus, surrounded by fertile valleys, wooded hills, and villages bright with gardens and vineyards, furnished too with hot springs, Wiesbaden draws thousands of sufferers every summer to breathe its mild and yet bracing air. The town has been a kind of shrine of health always. Perhaps the sight of the invalids arriving in a constant stream urged the educational authorities to save their own townspeople from suffering by making every school a kind of health centre. Perhaps the people, who number many boarding-house keepers, wanted to ​show strangers what health is! In any case, the school doctor was never regarded by them as a mere inspector of buildings and detector of infectious disease. From the very beginning—that is to say, from the year 1896—he was given the task of discovering the bodily and mental condition of every child entering school. But what is more, this new knowledge was made the basis of the future training and teaching provided for the children. Thus Wiesbaden inaugurated a new epoch in elementary education. So tactfully and yet so boldly was the new work begun and carried on that within a year some of the large cities began to form their system of medical inspection on the plan furnished by Wiesbaden. But, what is more wonderful, Germany, which had been, up till the time that Wiesbaden took action, very doubtful and slow in developing any system at all of medical school inspection, now started forward like a man whose eyes have been suddenly opened, and made rapid progress. In a few years many hundreds of school doctors were engaged. They number now in all between six and seven hundred! And through the length and breadth of the Fatherland, Wiesbaden's methods have become more or less the classic of these doctors. Some have improved on them in certain ​details, but Wiesbaden remains the centre of reference and comparison for a great part of the work. Finally this system was recommended in 1898 by the Prussian Ministry. For these reasons we may take it as the basis of all school medical inspections in Germany, and must give some details of it.
To begin with Wiesbaden not only respected the rights of parents; it began by taking them entirely into its confidence. A circular is sent out to every parent in the first year of every child's school life. It is really a long and confidential letter (very unlike the leaflets issued from time to time by the British educational authorities). It runs as follows:
"For the better protection of the health of children attending the public schools, school doctors have been engaged to undertake the medical inspection of children on entering school, to be responsible for their health as long as they attend the school, and responsible too for the building itself from the point of view of the scholars' health.
"These provisions will be of great use both to the children and their parents. In the course of his education, much will be learned with regard to the health and bodily condition of each child, and this new knowledge, which is being gained now for the first time, the school doctors will put at the disposal ​of the parents with whom henceforward they will work in the interests of the children.
"Parents who, however, do not wish that their children should be examined by school doctors have a right to exempt them, as the new provisions do not refer to educational matters that are in any way compulsory. Such parents however must furnish the necessary information from their own doctor."
They would be strange parents who would "take offence" on receiving such a letter as this. With this letter there is enclosed another, which requests, in case the examination is agreed to, the presence of the father, mother, or guardian.
Wiesbaden had not to create any precedent in so far as the details of this entrance examination is concerned. Already in 1887 Hungary had furnished her with a very good example. In the Hungarian Minute of twenty years ago it is set forth that "in the examination of new scholars, held at the beginning of every year, the doctor shall satisfy himself as to the health and condition of all children, more especially giving attention to the heart and lungs, and make known to the teachers whether children can take the usual physical exercises or drill, singing, etc. He will also test the eyesight, and the colour sense, examine ears, teeth, ​and report on any speech defect, also on any tendency to curvature. He will note the presence of any hair or skin disease," etc. Wiesbaden seems to have taken all this, but she added something of her own, for her formula of examination reads thus: "General constitution, height, weight, chest girth, chest and body organs, skin disease, spine and extremities, eyes and vision, ears and hearing power, mouth, nose, and speech, special remarks to teachers for the treatment in school, communications to the parents."
Such is the scope of the great entrance physical examination. It leaves the school doctor, if he be worthy the name, aware of the child's state and prospects. This light is gained at the very threshold of the child's school life. It is won in the presence of the mother or guardian, and to give it to her is the first and great duty of the German school doctor. No one who reads the records can ​be in any doubt on this point. Nearly every German writer on the subject turns aside to emphasise the importance of it—to show that here is one of the greatest opportunities that can ever be enjoyed by any citizen. "The education authorities of many cities have the desire to reach the parents," says Schubart. "They find a great and new opportunity in meeting them. A school doctor who sees the real scope of his work appreciates this fact." It seems that nearly all are eager to speak to the parents at the examination. And the acquaintance does not end here for they send out circular letters asking for information. They send out letters, too, throughout the whole of the child's school life, giving information or warning. Strange it is to see how prophesy has not been fulfilled, how just the opposite thing has happened to what was prophesied. It was foretold that parental responsibility would be wiped out. It is noted that parental responsibility is created and developed on a large scale—the supply answering wonderfully to the new demand.
Thorough as the entrance examination is, it is not assumed to be anything more than a general diagnosis. It does not, in case of illness, take the place of a full home examination. The immediate aims of the school doctor are to give warning, to prevent ​injury (through school work and life), and to safeguard the sick and also the healthy. They are, I admit, restricted. They are other than those of the home doctor who treats "a case" in the home or hospital. But the examination is thorough so far as it goes, and can be undertaken only by an expert. This is proved merely by the fact that a large number of children who appear quite well, and awaken no anxiety at all, even in the breasts of the most careful parents, betray to the eye of the doctor the signs of coming illness, the unsuspected symptoms of future trouble.
The school examination is carried out rapidly—though, of course, cases vary much as to the time required. The healthy children pass merrily through it in a very few minutes. Dr. Speiss, of Frankfurt, writes: "The examination of a child entering school takes from 7 to 9 minutes. In many cases, however, it takes less time. (Dr. Arkell, of Liverpool, finds that three minutes will do, which seems a very short time.) However, it appears certain that even the examination of a diseased child does not take long. It is the examination that follows on treatment, not the first general examination, that requires time and patience.
After the first examination each child gets a health ​card, which the teacher keeps. There are three orders of card— "Good," "Fair," and "Bad." The first card is that of the healthy children—the "good "group. In the second are the children in "fair" health. In the third or "bad" group are the children who suffer from some disease, or who are very weakly. These are all under "medical control," as their health card shows, and they are seen by the doctor at every class visit—that is, once a fortnight. Their growth and condition are always under his observation, and also, of course, under the teacher's, who knows more or less now what she is to expect from these children.
On the teacher falls also one important duty—that of recording at regular intervals the weight and stature of healthy and unhealthy children.
From the first Wiesbaden took the whole question of weighing and measuring very seriously. Dr. Paul Schubart declares in his book, The School Doctor in Germany, from which most of these facts are quoted, that weighing and measuring in school has for the school-doctor the same value, as a means of finding out the condition of children, as has the thermometer for the doctor who stands by a patient's sick-bed. "There is, however, one great difference between the thermometer and the measuring and weighing machine," says Schubart. "One cannot reckon on ​the absolute increase of either weight or of stature—but only on the increase of either in relation to the other in the course of the school life. The measuring and weighing must be accurate, and finally they must be done regularly, at equal intervals, so that a child who is weighed and measured in March and September one year, is not weighed and measured in April and October the next! If irregularly done the thing has no value, but well done, it gives indications so true and delicate that the weighing and measuring machines are looked on by some teachers as a kind of mental and moral barometer, rarely if ever at fault!
The Wiesbaden order on this point has been adopted by nearly all German towns. It runs as follows:—
"The weighing and measuring of children will be done by the class teachers. It is to be carried out half-yearly (measurement to half-centimetre and weight to one quarter of kilogramme). The doctor will measure regularly the chest girth of all children who are suspected of having lung disease, or whose constitution and health is such that they are under medical control."
The health sheet and the weighing and measuring machines bring home to teachers the fact that the ​healthy children are passing rapidly through certain stages of growth, and that in the course of time the contrast presented by them to the under-nourished and undergrown gets more and more marked. Never again will they have to attempt to make all toe the same line!
The Wiesbaden school doctors make a further examination of children in the third year of their school life—yet another in the fifth year. Finally, in the eighth and last year, just before the child leaves school, there is a final examination. The doctor has by this time his health card during school life before him. He has had opportunities of watching his progress, and has the teachers' report to help him. Thus he is more or less in a position to give advice to the parents which should be of use to them in choosing his future trade or career in life. And to do this is his parting service to pupil and parent.
But these great bi- and tri-ennial examinations are not the only occasions when the school doctor makes his rounds. Over and above them he has what are called his speech or consultation hours (Sprechstunde) ​at very short intervals. On these school visits he takes special note of all the children with "bad" health sheets. He looks into various parts of the building, and notes the lighting, warming and ventilation, and sanitation. It may be well to quote part of the Minute in the Wiesbaden scheme in which his duties are indicated.
"Every fourteen days the school doctor will hold a School Consultation at an hour fixed by doctor and head teacher. A certain room is to be placed at his service. … The first half of the hour will serve for a visit of from 10 to 15 minutes to be paid to from two to five Classes, during the time when the scholars are being taught.
Every class shall, if possible, be visited twice in every half-year. On these occasions all the children will be inspected, the teacher giving his observations and receiving the doctor's. If some of the children appear to be in need of special medical care, this fact is to be made known at these consultations.
On these visits the doctor can also take note of the sanitary conditions, the ventilation, heating. He will also note the bearing of the children. In making any remarks on the methods of the teacher, he will take care to avoid saying anything that can give offence. … The second half-hour will be spent in a more strict examination of certain cases. … The ​health sheet of every child will be inspected by the doctor. The teacher will be present.
The giving of notices to the classes and assembling of the children will be done, of course, by teachers. (On the previous day the teacher will have observed what children should be examined, and will have sent out notices.)
If medical treatment appears to be necessary the parents are to receive information to that effect. They—the parents—are at liberty to choose what doctor they will employ, but the letter should contain a recommendation of any specialist treatment which may be required in any case. Older children may take this kind of information home and report it by word of mouth; but in the case of younger children, or where the word of mouth report has not been attended to, a printed letter (for which there is a form), should be filled in and sent. This is to be done, of course, only in cases of real illness and where the interest of the child and of the school demands it. In the filling in of these forms great care is to be taken not to give offence through hardness or roughness of expression."
The earnest effort of the Wiesbaden authorities to get in touch with parents, to enlighten without estranging them, has certainly met with wonderful success. About forty towns have adopted the ​Wiesbaden scheme in toto. A great many other towns and districts have, as we have said already, adopted the general scheme, but altered the details. In some of these the consultation (or speech hour) is held only once in three months or once in six months. Doctors everywhere appear to be in touch with parents, to send full reports to them, and to invite their co-operation. Take, for example, a quotation from the letter sent by the Giessen school authorities to the parents of children in whom the first signs of spinal curvature have been noted by the school doctor: "The school teachers will take full notice of these symptoms in the school work for the future; we, however, entreat you to consult your own doctor and to help us, so that a permanent curvature may be averted."
Whether it be the result of the tact and gentleness of the method or whether due to some spontaneous awakening, it is hard to say. But certain it is that all over the Fatherland parents have responded and placed themselves on the side of the school doctor. The response comes, not only from the big towns; it is most hearty and practical in some of the little out-of-the-way villages.
In fact, the desire for this new Eye in the school seems to have asserted itself and freed itself from the spirit of mere officialism, so that the movement develops here and there in most unexpected ways, and even shows in some places great freedom and originality. It is a people's movement, born in a state-governed country. In ten years one-fifth of all the German people have caused their children to be educated under the eyes of a school doctor. The whole movement seems to have united a great boldness with great confidence on the part of the people and of the school authorities. As evidence of the confidence, there is the fact that, though examination by the school doctor is not compulsory, barely 4 per cent of all the parents have preferred to have their children examined at home, and even this percentage was reached only because 9·5 per cent of the middle-class (Burgherschule) withdrew their children. Only 1·1 per cent of the working people have withdrawn their children. And the information they receive is not flung away. Leipzic reports that three-fourths of all the parents of delicate and ​diseased children act at once on the advice offered. Only 3·5 per cent neglect a second warning. In some cities—in Mulhausen and Berlin at least—they (the parents) are invited to the conferences of teachers and doctors. Schubart sums up the position by saying: "Of any serious objection on the part of parents to the school doctor nothing is heard."
What is the result of medical inspection? We may perhaps ask the question of Wiesbaden, since Wiesbaden has attempted to do the work so thoroughly. She has a population of only 86,000. Yet Wiesbaden has seven school doctors for her nine or ten thousand children, whereas London has twenty or twenty-one doctors, but nearly all of them are not even half-timers, but give only a quarter of their time to the half a million of children in her schools. The countries who have hesitated long will want, then, to ask the question: What is the result of all your courage and labour? The answer seems, briefly, to be as follows:—
In a matter of this kind results on paper, if fully and accurately worked, would have a great value. But no one can pretend that these can be had in a moment. To begin with, there is no standard of comparison between children to-day who ​have gone through the eight years of school life and children of the same age in 1896, when school doctor's work was fairly started. And then it is well known that through the eight years of elementary school life—say from six to fourteen—children do grow out of certain weaknesses, and the life risks are getting less. Infancy's miseries wither in this impulse; they are sloughed off like a withered sheath, in the children who escape. So the following table, though it is interesting and clearly indicates that school life has strengthened rather than (as in old days) injured the scholars, does not, of course, offer the full and complete evidence which will be, we believe, soon forthcoming. (The classes are numbered, it seems, in the reverse order of ours. Thus our ex-seventh and highest standard is called the first here, and the lowest—our first standard—is called the eighth.)
​So much for the well-to-do children, who would seem from this table to get the better of disease entirely by the time they are nine or ten, though, as a matter of fact, this is not exactly what happens. What happens is that the sickly or defective do not go forward. Still, the table is cheering as showing how vigorous, on the whole, and how bold, is the upward swing of life.
The same upward movement is found in the elementary school, though it is not, unhappily, so striking there.
What part school doctoring has played in helping this upward movement we cannot yet learn—absolutely. There are other means of marking it, however, than the gathering of statistics, important as these are. Happily there is no need to wait long, no need to be an expert, in order to make every-day observations. These are made, and they are after all so reliable, generally speaking, that we all live and ​move, and are here to improve our methods of registering changes simply because, from our birth, and long before it, people were making observations and getting "results" that were trustworthy and acting on these. "Science" is only an extension or refinement of common sense and common observation, and to know the effect of the school doctor's work in Germany, we may take this kind of witness as well as the other. It appears, then, that medical inspection has had the effect of lightening, in many respects, the work of the teachers. On the whole it has lightened it so much that, even when all the new work is reckoned, it has brought, not a strain, but relief. The compulsion to attempt to make all children, sick or well, ill or well endowed, normal or abnormal, toe the line and reach one standard is given up. Moreover, if a child fails to-day, it is no longer at once surmised that the teacher is at fault. All this constitutes such a relief from the thrall of blind Power that the mere weighing, measuring and observing of children is a small burden in comparison.
To come now to more definite instances of successes attained through new departures for which the doctor is responsible.
At Mannheim there are "Hilfsklasse," or classes ​for backward children. We have already seen how from 10 to 20 per cent of all children go to these for a shorter or longer time; and how, at Mannheim, many are more than ready after a time to go back to the ordinary school. This kind of "result" is being welcomed all the time by doctor, teacher, and parent, and it is altogether the result of training that is largely treatment. For in such schools the doctor is in a sense the head master, inasmuch as he is responsible for the order of the teaching, and all the details of the work, in a very special way.
Then the school bathing has had results. It has even results on paper. For it is found that only 1·8 per cent of all the children have to be classed as not clean. (Contrast this with our figures in Britain—the dreadful fact that one English doctor estimates that only 30 per cent of our children are clean and that nearly 35 percent are in a horrible state; that another writes that in some districts 45 per cent are very dirty, and only 12 per cent clean; and that yet another declares that taking an average roughly including children from various districts, 1 in 5 is very dirty.) Thus the class rooms have almost suddenly become safe and healthy places in comparison to what they once were, and in every city where the baths are installed there is a crowd of ​witnesses to tell how the children have grown brighter and fitter for work since this new subject was added to the curriculum.
Good results too seem to have followed the opening of special classes, especially of those for children who stammer. These receive speech and other physical training and many quickly get over their difficulties.
A word too, must be added, on the subject of the out-of-door school. It would appear that this really is in some respects the most promising departure of all! It is such, not merely because a large number of all the children who enter this kind of school recover health and strength. This is one "result"—but there are others, which are in the nature of a revelation! It seems that all the subjects have a new meaning for the children when they are taken out-of-doors. Arithmetic and geometry are no longer a kind of torture when they are studied as they were studied by the first mathematicians and reckoners, and when the foot, the hand, the arm, are again used as means of measurement. The first problems are solved on the grass or in the sand. The writing lesson becomes simple and easy. Writing is a tempting occupation outside, as one can see by looking at rocks and out-door seats. The little ones ​draw out-of-doors with a will, as the Bushmen drew, and as the great Eastern artists still sometimes draw. Even the first "R" is learned rapidly outside. (In many a church and chapel magazine, missionaries tell how quickly the Red Indians and others learn reading in the open.) Out in the open, doubtless, every little hand would eagerly project itself. There everything invites, impels even, to self-projection. There tools are made eagerly. There the whole value of play declares itself, and exercise does not consist in formal walking or mere aimless running! In short, out of doors the healthy child finds (in good weather, at least) the ideal school! It is not easy to see how it can quickly be restored to all, or even to many. Who knows how many years may pass before we can even give a roof playground to all the pale-faced children of the cities? For a long time, as it appears, we must be content, in our climate, to build schools for rude weather, to think of fog, and frost, and rain, and trust a very great deal to the power of pictures, of good ventilation, and of symbols.
Already however the sickly children gathered out of the school population of Charlottenburg and Mulhausen are at their beneficent work. They are showing, as the feeble have always shown, where the new light falls. They are drawing us back, as is ​their wont into the far, far past—and are pointing also with their pale fingers, into the far future. Only weakness can be so bold and so convincing.
It is strange but true, that thoughts seem to pass like a wind from one civilized country to another, or rather to encircle them all in one mysterious and rapid movement. The recent sudden awakening as to the needs of child life in every country is a case in point. The first school doctors were formally engaged in England and in Germany in the same year, 1891. The first American school doctor was formally appointed at Boston in 1894. In 1896 the first steps were taken at Wiesbaden to put medical inspection of schools in Germany on a firm basis. In 1897 the first Cleansing Committee was formed in England. In 1896 the first Board of advice for School Hygiene was instituted by an Imperial Ordnance in Japan. In the same year the New World of the West roused herself suddenly like a young eagle. For seven years New York had been putting her huge house in order as regards school children's health and conditions with such fiery haste and zeal that everything one writes on the subject seems to be old before the ink is dry. She is ​hurrying past all the time. "In a few years," her senior school doctor cries to us gaily, "we shall, so far at least as physical conditions are concerned, have no lower classes."
That is a very cheering thing to hear. And the best of it is that it appears to be true. America is the country where huge fortunes are quickly make, and quickly lost. Its citizens have something of the ardour of the South, and also something of the sense of impermanency in all things, that distinguishes the far East. So they make haste to grow rich, and being rich do not as a rule hug their gold tightly. Rich men are found in numbers who will endow costly institutions and schools, and pay for new public experiments. So money was no bar, once the idea had occurred to the city fathers to make the young citizens clean and healthy. In 1897 New York actually engaged a hundred and fifty doctors, each of whom would have the care of only three to five schools. A corps of nurses was also engaged, and a health squad formed in the police force to go round and visit homes where there were infectious cases. Such measures as these do not re-create a race, or make everyone healthy. But they certainly are designed to give a rude set-back to infectious diseases and to lift the incubus that results from ​neglect, off the lives of myriads. They lift it as suddenly as one raises a stone and sets the creatures below into a panic: and this, apparently, is what happened in New York. The Report of Dr. Thomas Darlington, Commissioner of Health for 1905 (a copy of which is kindly lent to me by Mr. T. Sykes), shows that whereas in 1903 there were 32,525 children excluded for eye diseases, the number fell in 1905 to 8883—that the number of cases of contagious skin diseases fell from 4000 to 2018; and that whereas 21,100 were in a sadly neglected state in 1905 only 4692 were still doomed to live as human beings should not live. In short, the number of excluded children fell from 65,294 to 18,844; though the school population must have increased. All this seems to bear out the claim of the senior school doctor.
However, we need not dwell here on the American system—bold as it is. Let us turn from the West, with its courage and its gold, to the Far East, with its modest standard of life, and its soaring ideal! Japan has been in the whirlwind of reform. She begins however by an open confession. "We want school doctors," says the Education Report from Japan of 1903-4, "but we have not got enough trained men. We cannot make provision yet for all." Still, she ​has made a beginning. In 1899 the number of school doctors in Japan was 2906. But in 1903-4 the number had risen to 4941. The allowances for school doctors seem very small. The salary of the permanent medical adviser of the Government Board of Hygiene is 500 yen, or about £100. The Government grant in 1899 was only 27·20 yen per head, and in 1903 this was raised to 29·13 yen. That is to say, the government makes a grant for medical school inspection of over £32,000 per annum.
This is a small sum, and the payment made by local bodies is doubtless on the same scale. And what does medical inspection of schools in Japan consist of? It would seem that the doctors undertake many of the duties that are performed by European school doctors. They examine eyes and test vision. They measure and weigh pupils and advise as to the treatment of the diseased and defective, and they send reports to the minister of state for education who, in his turn places them before a board appointed to consider matters of school hygiene. On this board of nine members there are three doctors—that is to say there is a medical staff at headquarters. So it appears that Japan, in spite of her gentle disclaimers, is ahead of us in some respects.
​Yet their task must be other than is that of the Western doctors! To begin with, they have not to face dreadful conditions of body, and uncleanness. It seems that in Japan even the poorest are clean, and the care of the skin and of the hair is not only brought to perfection, but it is quite general. It is an instinct of the entire race. The little dainty houses, too, that look like toys, are clean, and only the rich attempt to bar out the light and air a little. Everything is renewed continually, and Nature's changes and upheavals are always in evidence. Terrible spring cleanings are Nature's in Japan. There is a regular course arranged in every town for the study of earthquakes and volcanic eruptions, and the scholars learn how to build a little house that will rock safely without falling. Hygiene is already so far advanced in some ways that one might feel the people had little to learn. Yet in spite of all there is a shadow side. The diet, the feeding of infants, seem to leave a great deal to be desired. It is hinted that the Japanese physique is a thwarted product—like their miniature trees!
In a Report published in 1904, the doctors' report ​of a very large number of Japanese school children examined, runs: —
42·1 per cent of good constitution 50·8 per cent of fair or medium constitution  7·1 per cent of weak constitution.
In a later Report, published in 1906, the figures are:—
53·5 per cent strong 43·3 per cent medium  3·0 per cent weak.
Another Report, in which the two sexes are not grouped, gives the following result:—
Of eye diseases we hear nothing at all; but short-sightedness is common there as here, more especially among boys and men. The figures given in the last Report are:—
The Reports are scanty, and give no details. They seem to show that improvement in physique may be ​rapid; that the people may respond quickly to the new impulse to evolve new muscular power, since muscular power is wanted. Every one who visits Japan notes this great flexibility, a quickness and delicacy of response to the call of the hour. It reminds one of their own paper windows that reflect every shadow. Responsive and flexible, they sway now towards a new order of physical development, and that they are capable of this is shown by the great differences of stature found among even the children. And the impulse that has come is strong—as witness the rapid increase in the number of physicians, the demand for more trained doctors, the teaching of hygiene to girls, etc.
Thus East and West are rising at last to fight disease, and to deal with defects of every kind. It is impossible that the opening years of this new campaign should be cheerful. The facts that come to light seem to be most depressing just in those lands where the battle is keenest and most determined. Thus in Germany, though some causes of disease have been removed of late, yet the consciousness of the real scope of the evil is growing. It seems greater now than it did ten or even five years ago. The workers stand like people going through a home that has been ravaged by fire. They note again and again ​how things that were forgotten, or believed to be safe, have really been lost or damaged. But this survey is not the herald of evil to come. It takes account of a past tragedy. To-morrow the house shall be re-built—on a safer and wider foundation. This is certainly not a day of rejoicing. But it is a day of hope.
* ↑ There is now in Wiesbaden and many other cities a preliminary inspection by the doctors to find out which children are ready for school life, and which had better remain at home for a while. A certain number of little ones are sent back to home-life for a while. Those who are allowed to begin school life are not examined for some weeks, so that they may get used to their surroundings. (Before the doctor's visit they rehearse, with the teachers, part of the proceedings, more especially if he is going to test ears and eyes—though, in many places, this testing of the higher sense-organs is done a little later in the school life.)
* ↑ This is very well illustrated in Dr. Arkell's figures. It is seen in the health sheets and records kept by school doctors in all lands—and is quite as noticeable, according to the reports, in Japan as in England.
* ↑ It seems that in one of these—Kallstadt—a village of from 1100 to 1200 inhabitants and with from 150 to 160 school children, a school doctor is engaged to visit the school every three months, and to note those who are ill and give information to the parents. For these services he receives twenty-five marks a year, and for every child examined a fee of four pfennige!
* ↑ All this is very practical. For, as many writers have shown, the face of the land and the shapes of the mountains change as the result of earthquakes and eruptions. Now and then there is a tremendous upheaval. One of these destroyed 14,000 little houses.