# Labour and Childhood/The School Doctor at Home

CHAPTER XI
THE SCHOOL DOCTOR AT HOME
THE British school doctor exists, but so small is the number of men appointed to this post (they hardly number as yet fifty), and so greatly do the amount and nature of their work vary, that at present the phrase "school doctor" has no very clear meaning to many. Moreover, a great many people think that even if school children are examined, there need be no school doctor—that a medical officer of health will do quite well for this kind of work. It is clear that the British school doctor is hardly even a new arrival. He is a person who is being quarrelled over on the doorstep!
Not but that he has been allowed to look in and even to make a hurried round. In London the school doctor enters a school, looks, listens, examines some children, even weighs and measures a few; but he does not return as the Wiesbaden doctor returns, in a fortnight. He fares forth over a great wilderness, disappears like a cloud, and is perhaps seen ​only after a year has passed, and when many ailing children have gone forth to enter on their life struggle in bad health. Occasionally to be sure a man may make a study of one group of schools or of a single neighbourhood; but the City is vast, the time of nearly all the school doctors is but a fragment (they are not all, as we saw, whole-timers—most of them are men in ordinary practice, giving a part of their time to this work), and all the schools have to receive a visit. No zeal or ability could make such work bear great practical results in so far as the children seen are concerned.
In provincial cities the position is a little different. Take Bradford for example. There the school doctor has to take a general oversight of forty thousand children! By dint of labour he can see every class in every school more than once a year. One cannot deny that something may be done by such medical inspection of forty thousand children. But can any one pretend that all these children are safeguarded? that all receive treatment? or that the condition of of each can be learned and taken account of?
Nevertheless, good work has been done in England. One may go further and say that work has been done here of a kind that is not yet even attempted in Germany. In reading the accounts of the German ​system we cannot but feel that the views on school doctor's work, though very definite, are wonderfully restricted. At first, and for a long time, as we saw, it was believed in Germany that this work had to do merely with school buildings. Then it was recognized that it should include the child—in so far as his state of health is concerned. Only to-day is a voice here and there heard crying that, beyond all this, the teaching itself and the training itself given in school has a physiological side; that elementary education at least, is always more or less of a physiological experiment, and that for this reason, in elementary schools, the teachers and doctor should come a little closer together. Why should either confine himself to looking for disease? Has the school doctor no interest in seeing and hearing a lesson given? For a long time the German teachers seem to have looked askance at the school doctor, more particularly if he seemed to interrupt or disturb a lesson. He was careful not to "interrupt." He turned his eyes away from all teaching at first. But this feeling of utter separation between the teacher's and doctor's work is breaking down a little. He is now required to sit through lessons.
In England, I think it never existed—or hardly ever existed—this feeling of estrangement. One of ​the first school doctors ever appointed in England seems to have begun at the point which the Germans are approaching, for he looked keenly at all the school work; he studied it from the distinctively physiological point of view, and others followed his example. There were various reasons why they should thus fly as if on wings to this kind of work. As a matter of fact, they could hardly attempt much of the preliminary work, important as it is! They might, of course, and did, look at buildings. They were keener on the subject of ventilation than the German. But from across the Channel came the axiom, "The school doctor must not attempt treatment in any case. That is not his work. He must simply inspect, notify, and give information." That axiom came from little towns for the most part—towns where the school doctor could have an intimate conversation with nearly every parent, and where he could keep up, by circular letters at least, a regular correspondence with many towns where teacher, doctor, and parent knew one another, and were kept in touch by frequent meetings! It was fairly easy in such places to see that every child had treatment who needed it!
​But English city life is another story. In the great industrial centres the school doctor's advice was very often flung away. We know now that more than half of all the children are in such a condition that advice should be given about them to their parents! But in the poorer schools only 3 per cent of the children needing spectacles get them. Of the 30 per cent of all the children who have adenoids, of the 8 per cent even who have this distressing ailment in a very acute form, the school doctor may have inspected a great number; but how many even of these have received treatment? And of these, how many are cured? It is well known that these cases are often tedious, and parents cannot spare the time to go often to hospital. A large number cannot, or do not even go once after being warned. "He will grow out of it," they say of the sufferer. So the case is neglected, and the patient becomes in many cases deaf for life. Well, the school doctor cannot at present do anything—it is his business to note the evil, and then to leave everything to take its course—and hurry on to the next school.
For sixteen years the few men engaged in this work have known the limits of their powers so well that, almost unconsciously perhaps, they began to think of other matters than treatment. They looked, ​as we say, at school buildings like their German confrères. But the thoughts of some happily took a much wider range. The hygiene of instruction is more advanced here than in Germany.
Beginning in the infant school, they studied the little ones. They watched them drilling, drawing, and learning their letters. They brought their knowledge of a child brain and nervous system into the infant room, and by-and-by new light was thrown on old "occupations." Things that Froebel did not know were made clear to the infant-school mistress. She began to see what a baby eye, a baby brain, and baby muscles are. But all the while she was not simply a learner; she also had something to teach the doctor, new as he was to one half of his whole task.
Into the class rooms of older children too he, the school doctor, passed, listened to the singing, looked at the singers, and began to speak of things which are not mentioned in song books, and to speak of matters that are not dwelt on by many singing masters, even among those who have degrees for music and get splendid reports. And he threw new light on the teaching of drawing, of languages, of ​the three R's. He noted nerve symptoms and spoke of these, gave lectures to the teachers of defective children (which were eagerly attended by some who were teaching the normal children), and made maps of the human brain in the presence of astonished and awakened teachers. The question of fatigue began under him to assume a new interest, and its signs were perceived at last and understood; and the meaning of child character and behaviour, the processes and order of growth, the order of development of human faculty—all began to become clearer, like the outline of things taking shape in the rising light of dawn. But still, in all this, the teacher was no passive recipient. He was giving and teaching—all the time. Perhaps it will never be really known what part each played in the new conquest of knowledge. The school was a strange place at first to the doctor. His knowledge of child-life was at first, I think, somewhat small. And the teacher's experience and training had a value that was perhaps never realized till it was ​brought into touch with this new order of observer. However that may be, the progress made in a few years was extraordinary. It revolutionized in many ways the whole idea and method of teaching—in the small areas where doctor and teacher were working together. And the influence spread far beyond. It did not always reach the people in the next village. But it reached sometimes people who were far away! It reached Germany. All this could not have happened at first in Germany—where the teachers held aloof from the new "official." But it happened in England and indeed very little else was allowed, during these early years, to happen.
So now in either land we see the result of the past work. In Germany, where the people have done everything, and the State (with the exception of Hesse and Meiningen) nothing, there is a popular movement to bring the whole child population under the care of the school doctor, and to use the State and its power to insure the gains that have been won. All this is due, of course, to the way in which the work was approached. When the sick were made whole, and the stammering were made to speak, the parents saw very well the uses of the school doctor. And now, ​assured of their position, some of these doctors are looking further ahead and turning their thoughts to education itself as a physiological process. They were bound, of course, to come to this. No one, who deals with living things, can be thinking always of disease. The wild flowers are healthy enough. They fade quickly. The cultivated flower, the cultivated brain, has greater resources. It has its secrets to-day, its secret risks, its secret evils, its secret store of wealth. It is very interesting. Even the school doctor of Germany, moving about in schools every day, must have become conscious of all this. He too has become conscious of great events taking place as a result of the teaching given in the schools. The lesson, at which at first he was an intruder, must have begun, sooner or later, to have some interest for him. He was preparing all the while to see things that were dark to Froebel. He divined, too, that in upper schools there were secrets of life into whose heart he might glance as the varied appeal and labour of school life awakened new powers of response. And now he is at the gate of the fields into which his English confrères have broken like children who, not being allowed to go into the garden, have consoled themselves by getting into the orchard.
​Meantime, though the work of gathering statistics goes on in our country, our schools are not centres of healing. "Examination" has a dismal sound in the ears of many. It seems to indicate a test, not an open door to health and new life. And very slowly though public opinion is changing, the great public come to see that they want this new kind of doctor. But it is said, if he must come, then why should we not engage the services of the medical men we employ already? We are a conservative people—why not engage a medical officer, or his assistant? That is briefly what many think.
There is, of course, the ever-present question of expense. It would cost a great deal of money to engage a vast army of medical men for these new posts. That, it is allowed, might spell economy if it stemmed the great flood of disease bearing social wreckage for ever into our hospitals. But of course it would mean a great initial expense. For you cannot get first-rate advice on a large scale without paying accordingly. First-rate advice, the service of highly trained and accomplished school doctors, is bound to be costly. This is what John Bull thinks, and his thoughts appear to be reasonable.
They are reasonable—only they do not take account of all the facts. The only persons who ​could answer John Bull in an altogether illuminating way are the ablest of our own school doctors. And it is unlikely, for various reasons, that they will undertake this task. This is why the mere looker-on has to attempt it.
It is of course necessary to have trained medical men to undertake the work of giving advice in (and treatment later probably through) the schools. This is so clear that it hardly needs to be emphasized at all. No trained nurse, no devoted mother, no clever teacher, no person in authority, can take the place of, or do the specific work of, a trained medical man or woman. And this special training is of course expensive, and those who receive it and give their services afterwards have, of course, a right to be paid at a reasonable rate.
But what does the phrase "a fully qualified school doctor" mean? Where are these "fully qualified" men to be found? The ablest and oldest school doctors know very well that they are not qualified—that they are only apprentices. They also know ​that they have to make the school perhaps where their successors will learn. For them there is no college. A little while ago, when they began work, they certainly did not even know that the new learning—the kingdom of knowledge that is now widening out before their gaze—existed. They began, as we saw, by looking at the buildings. They then began to look at a great many children, and they saw that more than half of these children were not quite well, and that a great army of them were ill, and likely to be soon very much worse. And only last of all did they begin to see that learning, like eating, brings certain parts of the body into activity, and that one may learn something about the organ of thought as well as about the organs of digestion. Yet as years went by and new helpers were found in the school, the new learning began to be gained. It is won, as other kinds of knowledge are won, with effort and in doubt, and often only after many fruitless attempts and much labour. And now, though much has been fairly earned, it is still the day of small things—all the more because, after all, very few great scientists will go into an elementary school class room and think they have much to do with, or much to learn from, child or teachers.
But when the school doctor hears that any kind of ​medical man—a medical officer, for example—will do for this work, he naturally feels that while he, himself, is a beginner, the majority of doctors have not even begun fairly to consider the needs of the schools. He feels that though there is no college for school doctors, no chair, no Minister of Public Education, even, yet there is a new science of education. This is his discovery; or rather it is the discovery of the many doctors who have taken part for forty years or more in the study of the brain and the study of school children.
If the expert medical officer begins this work, he certainly cannot begin it as an expert. He may learn rapidly, but still he is a beginner. This will mean that he makes a sacrifice.
One does not begin, as one of the youngest apprentices, by receiving a large salary.
​The popular way of looking for the good school doctor is to offer him a large salary. And yet it does not work out very well. "If there is one thing I hate," said a certain medico the other day, "it is this school hygiene, and all this child-study that people are going in for now. It's all nonsense. All the same, it is a good opening. If they offer a decent salary, say £500 a year, I don't see why one shouldn't go in for it." And, indeed, there is no doubt that if a large number of very good salaries were offered tomorrow, a large number of fully qualified medical practitioners would apply; but it is not at all so certain that these, if engaged, would advance the cause of education. It is much more likely that they would, for some time to come, set it back—perhaps set it back indefinitely. Obviously, this is not the way to find the right men. Where are they? And is there a supply of living enthusiasts always on hand?
Strange to say, there is. And it is opportunity, not a bait, that is wanted to bring them into the field. Opportunity would be found for all, if, all over the land, education committees engaged medical men and women to take up it might be only a very small part of the whole duties of a school doctor. They might be engaged for example to visit a school twice or three times a year, and to report on the new scholars ​or on the sickly or abnormal children. They might, or might not, according to the desire of parents, be permitted to give treatment. They might take steps to prevent the spread of infection, and there is no child ailment which they might not, if they willed, specialize on, in so far as observation is concerned. The door would thus be opened to many, and that, at first, is all that is wanted. Many would enter, and every one would reveal himself, more or less. Their work might cost as much or as little as the parents willed. It might cost the merest trifle, as in many German villages. It should be open to them, as ratepayers, to extend it or to restrict it. But since parents are obliged to send their children to school, and since they have to take risks in doing so, the schools should be made, in so far as is possible, safe places. Therefore it is right that some degree of medical inspection of all elementary schools should be compulsory.
If once this was admitted, and if all schools had some kind and degree of medical inspection, then from every part of the country Medical Reports of some kind or another would begin to pour in at the head office of the Board of Education. Perhaps some of these Reports would come from men who, from the first, aspired to be genuine inspectors of ​educational method, and not mere statisticians or recorders of disease. Almost certainly a fair number would be genuine enthusiasts, attracted, not by the pay (since the payment at first could not be a very tempting bait), but by real love of the work. Their reports would then need consideration—the consideration of trained medicos, not of brilliant litterateurs, or of politicians, or men of every and any order of experience and education except that kind of knowledge that would make them able to judge of the value of this new information. And so we should have to follow the example of Japan—and the example of Germany. A central medical board would be wanted, not to frame cast-iron rules, or to interfere with the new growth, but to preserve it and keep for it a place where it may grow, if the living impulse in it is strong enough.
Later there might be prizes, even many prizes, to offer in this profession, as in others. But they would be won by service and self-devotion, not by influence or through the ignorance of the public and at its expense. There are many victories—every man in an army is a victor—towards the end of a battle, but not at the beginning. Workhouses, prisons, refuges—great sums are spent in providing all these, and in making deep channels as it were for the dark, swift ​river of human misery that is flowing ever into the night of forgetfulness. Yet, need this river be so deep—so wide? "No," say the school doctors standing at its source. "No," thunders even the merest tyro, perceiving how slight, how curable in the earlier stages are the fierce maladies that mow down at last the sons and daughters of poverty.
The day will come doubtless when the task of those who prevent illness will be thought more highly of. The day is nigh, perhaps, when the elementary school will have quite openly as its first great aim the conquest of health and sanity for its children.
Into the hands of the working people the guidance and control of education is bound to fall in an ever-growing degree as the years pass. They will be drawn into this work through their own children attending school, and sharing the life of the school. And they will be drawn into it also because they are bound to play a more and more important part in the counsel of the nation, and to become more conscious of the causes of its successes and its failures.
This growing power of the people is a thing in which every class of worker must rejoice at last and find his safety. For it cannot be well for a nation to fall under the power of any one class or profession, ​be it the priest, the doctor, the teacher, or any other It cannot be in the interest of science or progress that any one of these should usurp power, for then the mere love of this power, and the tyrannical use of it, would take the place (as has been seen before) of the higher hunger after knowledge, and the desire for the conquest of disease. So the old phrase, " We must educate our master," may be amended so as to run, "We must all, for our own safety and freedom, allow the people to educate themselves in the only new way in which they can be educated—that is, by accepting responsibility."
"But are they, the people, fit for it?" some voice may cry; and the thought may occur to thousands of plain and humble folks, "Are we indeed fit for it? Do we know anything at all of education? " This book serves no purpose at all, if it does not serve to show that work, the rough labour of tillers of the ground, ​builders, sailors, carpenters, weavers, miners, foresters, iron-smelters, engineers, IS education. A strange sleep, an absence of mind comes to even the brightest looking people who have never at any period of their lives engaged in it. Their intellectual life is strangely barren. And no wonder! For in common work humanity was evolved, and purely as the result of such work the human brain was developed, and furnished with new chambers! How then can we say that those who still engage in it are the uneducated. Ignorant some of them may be, and degraded even by the later forms of toil; but they are still near the source of education, since they have never ceased to work for the necessaries of life.
The schools, then, are not alien places to them—that is to say if the education given there is worth anything. For in its earlier stages education should recall earlier forms of work. But when the stage of later forms is reached the children should not be withdrawn hastily as they are withdrawn to-day. They should be allowed fearlessly and eagerly to follow the path of human progress. That is to say, they should be allowed to grow up. They must become masters of the new tools, or be mastered by them. There is no other alternative.
Until this is done there can be no lasting social ​peace. In vain the masses will ask for possession of the means of production. The power of producing is the factor in the problem of economic life which decides the fate of individuals and of classes. But the new education would offer the highest order of producing power to all who were able to win it. And in doing this it would not condemn all to one order of employment, but rather give life and meaning to all kinds of labour, and art, and learning. It would make clear how all these were made possible, and the need for them created in the first place, by work; how every kind of learning has its origin and source in the expanding life of a human being struggling for food, for clothing, and shelter, but struggling in such wise that at last he must unlock all the secrets of Nature, use her terrible forces for his own ends, and enter into close relations with all his fellows. All this will become plain to the masses when they cease to halt, as they halt to-day, in so far as their children are concerned, at the threshold of the modern world—hurrying their children of thirteen or fourteen into mills and into casual labour as if they feared to let them fairly escape out of the shadow of the Dark Ages.
Meantime they have to face the fact that their children are in many cases ill, and if not ailing ​themselves, are exposed every day to the risk of contact with disease and impurity. The new education discounts the results, however favourable on paper, of a system that ignores this. It recognizes that the creative power is within that gave us all we possess—that it reveals itself in the healthy, the growing, the vigorous, in whom the upward movement of life is not checked. In short, the new education is physiological.
The school doctor is free to take a limited view of his own functions. Even then they must appear to him to have a great social significance. Even if he does no more than condemn insanitary buildings, and insist on the prompt treatment of simple ailments, he must feel that this is something—that it is a great thing.
But among the ranks of members of the new profession there must be some whose thoughts will take a wider range.
These may think, perhaps, of the children of the rich as well as of the children of the poor. To-day the papers are filled with details of the family history and physique of a millionaire homicide. A learned counsel has read nearly every book on the physiology of the nerves, and, armed with it, ​now carries on a public tournament with insanity experts in the court. This display of knowledge dazzles the public, and the persons who are the subjects of his psychological dissection suffer none the less because they are placed high in the social world. They are glad to pay for "dissection" because this may save the life of an erring son and brother? But would not the experts have done better work had they been engaged as co-operators with teachers and parents twenty years ago, and long before any crime was committed? Truly the rich, as well as the poor, have some reason to desire the advent of the school doctor.
"But they can engage him," some may cry, "to work in a very exclusive way in the exclusive school!" No, that is impossible. There is, as we have said already, no training college here, or even in Germany, for school doctors! They have to learn by observation, and the few and comparatively small schools of the richer class do not offer a wide enough field. Not through these could they develop an entirely new branch of applied physiology—that is to say, the science of the higher brain centres and their activity and development in childhood. No; this work must go on where it has begun—in the people's schools. Therefore the ​classes, as well as the masses, have an interest in the new education.
And in the people's schools it must now go on as fast as the people will allow. Here the old garments of medievalism will be rent, its austere method exposed, its codes of punishment and torture scattered to the winds.
The new education will have none of these. It is, indeed, more personal; but it is more reverent and more gentle than the old. At every step it cautions us. We hear its voice even in the stiff German circulars. Rudeness will wreck all. The human body is not vile. It is the instrument of instruments. The first condition of success is not that the doctor has many degrees, it is that he should not offend one of these little ones. The behaviour of children—that is not a thing to judge in the first place. It is a thing to understand in the first place. To judge is easy—it has been done for ages—to understand is the new task, begun very late. To ​classify according to health is comparatively easy—it may be done by the three-card system. To classify ability and weakness is not so easy. Each child presents his own problem. In short, the class room of to-day is not the class room of yesterday. It is full of new light—and of new shadows. As time goes on, some will make strange discoveries. And some, for the sake of comfort, may pull down the blinds.
But the brave will not pull down the blinds. They will go on fearlessly to note conditions—to unearth the causes of defect, disease, suffering, and failure, to set these open to the sunshine of an enlightened public opinion, and to lay the foundations of a happier order of social life, and a new era of human progress.
* ↑ Not, of course, that we can pretend that all our schools, or even the majority of them, are well ventilated.
* ↑ It was the school doctor who showed, for example, the real meaning of bi-manual drawing, who showed how as crawling, on all fours, precedes walking on two feet the infant nervous system finds in the large inclusive movement the path to a finer one. It was he who showed why skeleton lines are an evasion of eye training, and who threw light on the various methods of teaching reading and spelling. It was he who interpreted symptoms and movements, who "explained" the sensory child and his reserve—and so on ad infinitum.
* ↑ An apprentice may, of course, be a great worker, a pioneer. The point is, not that his work is either great or small—the point is that at first it does not command money. He creates, among other things, its money value. Kohn examined the eyes of 10,000 children. His work is so valuable that no one can fully estimate it. But he got no money for it. He never got any. Dr. Kerr's work at Bradford was very valuable. His salary was extremely small.
* ↑ The medical faculty in Hungary have a special college for school doctors. Special courses and lectures for young school doctors are given in various cities, but such methods would be scouted for any other order of thorough professional training. One cannot learn this new work through attending lectures. Not but that some of the courses do of course afford a means of real training in certain departments of the work, as, for example, the class on the eyesight of schoolchildren held lately by Köhn at Breslau. But as a matter of fact work in the schools, and the experience gained thus by doctors who have taken the ordinary diplomas, and whose attention is turned to scholastic problems, is the only means of getting an all-round training in England to-day. It is perhaps the best method. It certainly is the only one, and it gets rid of the question of fees.
* ↑ "For some years before the invention of electric telegraphy," writes Sir James Paget, M.D., "Professor Cummings of Cambridge, when describing to his class the then recent discovery by Dersted of the power of an electric current to deflect a magnet used to say, 'Here are the elements which would excellently serve for a system of telegraphy.' Our successors will wonder at us," says Sir James Paget, but perhaps they will not wonder, perhaps they will understand why the brain loses power, and becomes active only in a very limited degree when the stimulus of real work is withdrawn. It is possible that all this lack of readiness and resource will be clear to them as noonday, and that some kinds of cleverness will go out of fashion.
* ↑ That the German school authorities strive to get the parents to study character and temperament with the doctor and teacher is shown very clearly in some of the question-papers sent to them. For example, Dresden doctors send the following list: "Has the child had serious illnesses? Operation? Does he sleep well and quietly? Does he sleep with open mouth? Is he gay? Reserved? Truthful? Is he shy? Curious?" These questions suggest to parents the fact that faults are often symptoms—that behaviour itself is the result of physical conditions.