doctors visiting schools, made this clear. Such men as Dr. Leslie Mackenzie, entering the big halls where the children were going through their drill-making a pretty spectacle, it is true, as they toed the line and made movements that revealed the subtle grace of young creatures-the doctors, looking at all this, saw behind all this. They saw mute suffering behind it, they saw disease; and even swift-coming Death cast its shadows on many of these young performers. And so their Reports made disagreeable reading. They show little appreciation of mere pretty spectacles.

Perhaps we might read them with impatience, but that we are obliged to remember that the most successful teachers-from Aristotle to Dr. Barnardo-were doctors. Some of them were school doctors, such for example as Séguin, Esquirol and Pinel. Such are Schuyter, Axel-Harten, and Kerr to-day.

The work of the school doctor is not that of the ordinary practitioner; otherwise there would be perhaps no reason for the former to come into existence at .all. The home doctor usually sees his little patient alone and in bed. The school doctor sees him in class. The home doctor diagnoses disease. The school doctor diagnoses children in good health. The home and hospital doctor has to know something of the mechanisms involved in eating and drinking, in swallowing and digestion; but the school doctor has to acquire a knowledge which is much more recent-which has been won for the most part within the last twenty years. He has to understand the mechanism involved in

It is certain that no child has benefited more from the labor of the elementary school doctor, than has the child of riches and luxury, educated at home or in seclusion because of his delicacy. Twenty years ago, such children were often educated at great expense, and in great darkness. Thus, for example, a

learning to read and to write, to sing and to draw, to think and to reason; and, over and above all this, he has to study the problems raised by an entirely new environment-the modern elementary school.

This new work was begun in a haphazard way. As long ago as 1804, there was a doctor taking notes on school children, and publishing them. But the school-doctor, proper, is a very recent person. The first was appointed in London in 1891; the second, Dr. Kerr (now the Medical Superintendent of the L.C.C.) was appointed as Medical Adviser of the Bradford Board in 1893; and, during the following years, he worked out results in detail of the effect of school-work on the eyes of the children in all the standards, in an interesting series of studies which are of permanent interest and value to investigators.

But, all the while, one sad fact was becoming clear and clearer, viz.: that the failure in eye-sight of many children was only a symptom. From the dark tenement rooms of grim streets, from slum and noisome alley, teemed the children of poverty. The mere improvement of school methods or teaching, the mere testing of vision or purchase of spectacles, would not do much to preserve the sight of such of these children as had eye-trouble or other ailments. Of what use to concentrate attention on methods of teaching, since, however harmful bad methods may be, they are nothing in comparison with the havoc wrought by uncleanness, by bad ventilation, and overcrowding? Dr. Kerr has bluntly stated the truth in his last report:

youth whose case would have been diagnosed successfully to-day almost at a glance, was allowed to pass from one school of standing to another, to undergo treatment, and engage in tasks, for which he was altogether unfitted. The end of all this was tragic.

"The majority of cases of injury to health," he writes, "may be traced originally to a want of cleanliness!"

Long before these words were written, the fact which they express was realized. Measures to promote cleanliness were taken by teachers, and also by Education Authorities, all over the country, with a consciousness on the part of those taking part in these preliminary efforts, of the difficulty and delicacy of the whole task. The effect of the efforts made, however, seemed to prove one thing clearly enough, viz.; that the instinct of the race is on the side of reform. Leaflets were printed, setting forth the need for protecting the clean, as well as the duty of saving the neglected children of the community. It was prophesied that these, though carefully worded, would give offence to many; but no murmur of displeasure followed their circulation. Parents who had fought the compulsory vaccination question with bitterness, welcomed this new departure in school work gladly-looking to a campaign for cleanliness and fair living as the real cure for the horrible epidemics of which we all live in dread.

Meantime, a Cleansing Committee was formed by the London Authority. The scope of the work which it has in hand can be imagined, perhaps, when one reads the following details from the Medical Report of 1905.

In one London school, which is, of course, typical of others, the doctors describe 11 per cent. of the children as "dirty and verminous," and 34 per cent. as "dirty in body and clothes"-that is to say, 45 per cent. of all the children are unfit to sit beside others. Eightyseven per cent. are in an unsatisfactory state. Only 12 per cent. can be described as clean-that is to say, clean above a low average.

The Education Authority began by assuming that the children have homes; and they engaged nurses to visit, not

only the schools, but these homes of children showing signs of gross neglect. To and fro went the new servants of the Education Authority, bringing counsel and tactful words, bringing help, too, where it was needed; and there is no doubt at all about the value of their work.

It was bold, however, to assume that all the children had homes. Many children live in one-roomed tenements! From these close-packed chambers where they sleep, the mother, as well as the children, departs, in many cases, in the morning. Of 110 boys, all very far below the average in physique, 44 had a mother at home-in the case of the other 66 the mother was dead, or at work all day. The nurse could not often find any one "at home" when she visited their sleeping-places.

Strange enough are the circumstancesof these English children. In other communities it is a misfortune for a child to be fatherless. But here the widow's son is to be envied. He has more to eat than the child with two parents, since fathers sometimes eat more than they earn; and even then are obliged to go hungry. And what kind of washing appliances are there in these tenement rooms-where the very walls are infested with vermin, where water is a luxury, and heat is bought by the penny at a gas jet? "There is often no accommodation in the houses," says Dr. Kerr; "and one cannot say this child must be cleansed or turned out of school, as it is not reasonable, with the means at the disposal of most of these people, to expect them to disinfect clothing." Still less is it reasonable to ask them to wash frequently. Cleansing Acts should, we are told, be compulsory, not permissive. This is true, doubtless; but force is no remedy. The submerged may hate water to-day as the famishing loathe food. But it is water, not force, that is wanted.

Meantime Nature sets about the work of cleansing in her own terrible way. Not only does she sweep large numbers out of existence; she sets up conditions of body which are called disease, but which are often mere protests of cleansing agents. Take, for example, the case of adenoids. These are so common among our school children, that you will hardly see any elementary class that does not include four or five sufferers. It is a distressing condition, inducing deafness, nervousness, and-stupidity.

But adenoids repre

sent at first, in many cases, though not in all, an effort on the part of Nature to get rid of impurity.

What becomes of the mouth-breather to-day? The nurse who visits the school does not deal with cases of adenoids. She is looking for signs of gross neglect that can be quickly removed by washing, disinfecting, etc. Even the visiting doctor does not take any steps. He cannot operate; and, besides, he is usually there only to take notes on eyes, weight, etc., or to look for signs of outbreak of contagious disease. The teacher may, and sometimes does, note the child's distress, and try to urge the parent to move in the matter. But, as a rule, the ordinary teacher merely wonders a little why the sufferer is still so behindhand in his school-work. And, meanwhile, the child may get better; but the probability is that he grows daily worse. haps, growing much worse, he is sent to a hospital. But, even in hospital, the adenoids are neglected. They do not appear to be so serious as the things that follow in their wake. Their treatment, too, (where the condition has been long neglected) is apt to be very tedious indeed. "The importance of

Per

2 Not only is blindness caused by neglect. Eye-disease of almost every kind is caused by, or aggravated by dirt. Mr. Bishop Harman has written a book on "The Conjunctive in Health and Disease." In it he shows that the condition of the eyes in cases of eye-disease

treating children for adenoids," says Dr. Kerr, "may be strangely overlooked. Children suffering in this way are often passed unnoticed even in the hospitals; and a child has been seen who had spent nine months of the last three or four years in a general hospital, but has been a mouth-breather probably all the time, and, within the last three months, has lost hearing through double otitis, the sequel of neglected adenoids."

So much for one method Nature outraged employs for cleansing purposes. There are many others which are as little benign-which spell, indeed, not deliverance, but retribution; but it is not necessary to allude to them here.

The drifting downward of the neglected normal child may or may not be sudden and rapid. It is usually in very early life that disease or neglect has the most fatal effect. Thus, for example, forty to fifty per cent. of the blind become blind simply from neglect of sanitary measures in the first weeks of life. Strangely enough, this early period is the one chosen for vaccination. And all kinds of experiments in feeding are made on infants under nine months. The harvest is a sad crop of ruined lives. But the stage of permanent disablement is reached, sometimes quickly, sometimes slowly. When the blow has fallen in full force, and the child is blind, deaf, or defective in intellect, then education, if it is to be really effective, must be highly specialized, and expensive-so expensive that (despite the opening of "special classes") we have not yet fairly made up our minds to undertake the expert teaching of those in whom brain or sense-organ is damaged.

But, happily, in the majority of cases such as "blight" varies with the state of the hair. There is no need to say any more. The very aspect of such children seems to suggest that the noblest sense-organ cannot survive the degradations to which it is subjected in them.

the final blow of complete blindness, or more or less complete deafness, or mental defect, does not always fall. There is a large class of children in every city and civilized country who were born normal (some even gifted perhaps), but who have ceased to be normal through sickness coupled with unfavorable conditions of life. For these, life's sky is always becoming overcast. One zymotic disease succeeds another; and, in the pauses of these, they attend school and limp along as best they may, though in the rear of their comrades. A certain number enter the Cripples' School at last; some fall ready victims to consumption. Some are merely dull and backward-doomed as failures. The beginning of all this misery was measles and whooping cough in many cases. The rally from these diseases was never complete. Good conditions, such as sunshine, pure air, frequent washing, and good feeding, would have brought many through their first convalescence in triumph. But these things were not forthcoming; and now behold them fallen behind already in the race of life, a hindrance to their class-mates and a puzzle to the teacher.

The School Authority of Mannheim has opened "Förder-schüle" for such children. The Förder-schüle are schools which are practically healthcentres. They are furnished with cheap baths; provision is made for remedial drill, good feeding, and free play in sunny rooms or out-of-doors. The curriculum lays stress on eye-andhand training, while the classes are smaller than are those of the ordinary school. As might be expected, a great number of children recover in these new surroundings, and, ceasing to be sub-normal, go back to the ordinary school; whereas from the schools for the defective or feeble-minded, hardly any children pass upward.

The story of how the fatally injured -the blind, the deaf, the defective in

intellect, have become, in a sense, the real saviors of the normal and giftedof how the study of the unfortunate has been the means of letting in a flood of life on the mental processes of the more favored children-all this makes perhaps the most interesting page in the whole history of Pedagogic Science.

Before touching on it, however, we may cast a brief glance at the work of another nation struggling with the problems of School Hygiene, but struggling with them under conditions that are a great deal more difficult than

our own.

Six years ago, New York began to listen to her school-doctors, who were saying, practically, what the British school doctors are saying now; namely, that uncleanness is the bane of the elementary school. But the situation in New York was even more grave than it is here; and, having once fairly realized this, the Education Authority entered the arena boldly, and set about its scavenging work in good earnest. In 1901, the Finance Committee appointed 150 Inspectors to go round schools and take a note of children believed by the teacher to be ill with contagious disease. The schools were connected by telephone with the Central Office of the Department of Health. When the Inspector was in doubt over a case, he sent for a physician; and if the physician reported the child ill, the teacher was warned to exclude, and the Inspector visited the child's home to see that the case was isolated. If, in spite of this, the parents took no care to observe directions, a member of a corps of policemen known as the "Health Squad" arrived, and threatened removal. In the course of nine months, 9,000 children were thus excluded and isolated.

The defect of the system was soon found to be in the fact that it left the

child is now inspected weekly. Of course inspection does not mean examination; and the Inspector does not touch any child. He stands and lets the children file past him, while they, themselves, pull down their eyelids and open their mouths for his inspection. As the result of this measure, 25,260 cases of contagious eye-disease were excluded in six months, many of them, of course, quite preventible-the result of neglect. In one day 1886 children were sent away for pediculosis; that is to say, for the horrible condition of the hair, skin, and clothes.

Where were these children to go? Many of them had no homes. The Inspector might visit the last place where their parents had alighted; but in New York, as here, there is a point where visitation breaks down entirely. It was now that the Nurses' Settlement came to the help of the Department of Health; and, by its efforts, a cleansing crusade began. In the course of a short time, more than a quarter of a million children had been treated for diseases which disappear with washing!

The battle with death is waged; not at one point, but at many. Teachers, policemen, inspectors, nurses, physicians, bacteriologists, all bear a hand. The enemy is even stronger than that which we have to face in London. Thus trachoma (a disease of the eyelids) is rare in London. It is common

It appears that children may suffer from very slight attacks of diphtheria that do not prevent them from attending school. Indeed, such things as chronic diphtheria and chronic scarlet fever are possible. The chronic cases, and slight cases, are of course the most fatal carriers; so that it is better, as well as cheaper, to have means for bacteriological examination than to open many isolated hospitals. The L.C.C. opened one small bacteriological labo

in New York. Favus is almost unknown in the provinces in England; and there are only about 120 known cases in London. No less than 10,438 children were treated for favus between 1902-4 in New York. Into New York-the great vestibule of the West -a stream of aliens is pouring, bringing with it the diseases, as well as the sorrows, of many nations. At the door of the New World, the school's emissaries meet the foreign child, and battle at once with his foreign disease. They give him the key to the new language, absorb him into the new citizenship with all its disciplines and all its rights, and send the bright-glancing waters of its new Republican life rolling over all the wrongs, the heart-burnings, the diseases, and the pollution of the past.

All elementary education is physical education. For what part of education is not physical? And what part of elementary education does not bring the physical side openly into view? The use of the muscles is as much a factor in the learning to read and to reason, as in the learning to walk or to lift weights. To be sure, the rapid development of the healthy child seems to hide this from observation, as the day hides the stars. It is only when great obstruction exists in the growing body that the physical side of thought comes clearly into evidence. The afflicted and defective child has done an immense service to the race, in making clear the fact that there is an order even of limb movement that leads towards right thinking, and that, not in one lesson, but in all lessons, moveratory in 1903. The School Inspectors of New York have splendid laboratories at their service. On one day, Jan. 10, 1903, when there was a sudden outbreak of sore-throat, 10,000 swabbings were taken and sent to the laboratory: 757 carrier cases were discovered out of these, and the disease checked. Such prompt action against a deadly foe could not be taken in any borongh in England.