HEALTH AND PHYSICAL TRAINING IN

PREPARATORY SCHOOLS.

THE aim of this article must be twofold. (a.) To discuss some of the problems presented to the headmaster of a preparatory school in connection with the general conditions of health in his school and the physical training of his pupils. (b.) To mention some of the methods employed by the writer or known. by him to be employed in schools similar to his own.

There is no need so much as to mention the use of specific remedies for specific diseases. These are the province of the medical adviser, not of the headmaster The latter can only be held responsible for the general conditions which go to make up the healthy life of the school. I shall allude to what I consider the right relation of the doctor to the school. It is the doctor's business to show interest, and to give advice in all matters connected with the health of the school, sometimes even to veto or insist upon some detail, but it is the master who is responsible for the general conditions, and we may venture to claim that he is better qualified to organise and control these than any doctor who has not been the head of a nursery of small boys varying in number from twenty-five to sixty and upwards.

Perhaps to a greater degree than any other kind of professional life, that of the school-master is liable to sudden anxiety on the score of health. By its nature it is so, and if he would reduce the frequency of these occasions to a minimum he must needs think much and deeply of them. It is not an easy thing to do this and not let the rest of the work suffer in consequence. The man must be strong in nerve and self-control and sympathy and tact, and above all strong in foresight. He will not meet with much sympathy, indeed he does not wish his thoughts to be apparent. They must permeate not pervade every department, or they will spoil the whole. Until he has himself seen the consequences of some apparently trivial omission, has known what might have been saved by a little more care, a man, especially a young, strong, athletic man, is naturally inclined to look upon details of care as coddling and softening. It is right enough and a wholesome corrective that he should think so as a private individual, but as a head master he will not think so. He knows that the Spartan treatment upon which Jones will thrive means pleurisy or bronchitis to Brown, and since he has to arrange for two dozen Jones's and two dozen Brown's, it is difficult to persist in as hardy a treatment as he would like. Consequently health occupies and must occupy as much of his mental horizon as other parts of his work. Is there not even a subtle danger lest in some schools, especially in small schools, or schools in well-known health resorts, the care for health should occupy more of the horizon than the care for character.

To proceed to details. It is obvious that the first care should be to exclude epidemic diseases. It may be said "No," the

first care should be positive not negative, to secure good general conditions, not to be on the look out for diseases. The order is immaterial. Let us take the negative and exclusive side first, for I submit that in doing the one you will not leave the other undone. No precaution which can be backed by reasonable medical authority can be thought superfluous. The saving clause should be noticed; the doctor must be at the master's back, else fads and fuss are inevitable. The doctor may have fads, the doctor may appear fussy, let him! The master may not. The one knows, or is expected to know, what he is about. The other may have “nerves.' Drainage, water supply and sanitary conditions must be not only perfect, but regularly inspected. A terrible burden is this perfection sometimes, but a necessary one, and recognised as such by all. It is vexatious to be always liable to the information that such and such a "trap," or ventilator, or shaft, which was recommended by the highest authority a year or two ago, is now found to be inadequate, or ineffective. The circumstances have changed; the school has grown, sanitary science has progressed. What is to be done? must we be always changing? always tinkering? It looks like it sometimes; but I believe the only common-sense attitude is, first to get an expert who can be trusted, trusted, that is, not only to know what is best, but also to seek his employer's interest as well as his own, and refrain from unnecessary patchwork and expenditure, and then to carry out his instructions. There is no middle course; workmanship and system, whatever it may be, must be of the best. Makeshifts and laisser aller will bring their own punishment, and, alas, not to the schoolmaster alone, but to those whom he has deceived. In this context I may perhaps mention what I believe to be a want. There are many excellent and reliable sanitary engineers, and many ways-good, bad, indifferentof inspection, from the local M.O.H. to the diplomaed and titled professor of public health, but what a diversity in their recommendations, and in their charges! If public authority is to touch private venture schools at all, can it not begin with this: To give us some sanitary court of appeal, to do for us what the Local Government Board does for public works and offices, or at least, if not to compel us to submit to inspection, to allow it to us, an inspection to which we could turn confidently, knowing that it would give us an honest and unbiassed opinion. Nay, I believe it would be best if it could compel us to conform to its regulations. We should then know what we are doing. Public inspectors and engineers are of course not infallible, any more than private experts, but we should at least be delivered from the uncertainty as to whose advice to follow; from the haunting fear which overtakes the most guiltless at times that in the hands of expert and contractor he is but a defenceless prey.

It is the practice in almost all schools to demand a certificate of health from the parents at the beginning of each term. Some use forms drawn up by themselves; others such as may be found in Dr. Clement Dukes' "Health at Schools"; others again, those issued by the Medical Officers of Health Schools Association. It

would be perhaps best if the same form was adopted by all, but the difference is one in detail merely. The point of chief importance, and I may say of the greatest difficulty, is to secure that the questions upon such certificates shall be conscientiously answered, and any quarantine regulations that may ensue therefrom shall be properly carried out. A certificate that a boy has not been, to the knowledge of anyone connected with him, exposed to infection during a prescribed period is of course no absolute guarantee; but it at least secures that the question shall be considered before he returns to school, and emphasises the importance of the question in the interests of the school. In my experience it is certainly the exception, not the rule, to find any want of sympathy with anxiety on this point, but it is not always so easy to secure the parent's co-operation when his own boy is concerned. It is no doubt very annoying to have to quarantine a boy at home who seems perfectly well, to feel that he is wasting his time, and that after all the chance of his having caught measles or whooping cough or mumps is very slight. It cannot be helped. If any parent who feels this could know what a school term is like with half the boys out of school, with work spoilt, with games disorganised, with all the interest of the school destroyed, he would be willing to fall in with our most rigid regulations rather than risk being responsible for such a state of things, to say nothing of being responsible also for the permanent injury which may be caused to the health of boys more delicate than his own, and for the injury caused to the reputation of a

school.

As to the form of such regulations, and the necessary periods of quarantine, and the steps to be taken for proper disinfection of the persons and clothes of boys who have been exposed to infection, we owe a great debt of gratitude to the Medical Officers of Health Schools Association. With their new code in his hands the headmaster is unassailable. He is entrenched, not behind the opinion of his own school doctor-which after all can only count for one as against that of the doctor at home-but behind the opinion of a body of experts to which the home doctor, however he may differ from it, is compelled to bow.

I

As a provision against sickness when it comes, in every school suppose there are special sickrooms set apart, and used only for this purpose. In most schools these rooms are in the schoolhouse, either in a separate wing, or on the top story, and easily isolated, and in very many there is also a cottage at some little distance from the school for infectious cases.

From answers to queries on this subject I find a curious divergence of opinion. In most cases it would seem that all ordinary non-infectious illnesses are nursed in the sickroom, while infectious cases alone are sent to the sanatorium. By some headmasters it is thought that it is easier both to nurse illness and to check epidemic outbreaks in the sanatorium, while others assert that it is more difficult to carry out the nursing efficiently in a sanatorium and that, since the first stage of many epidemic illnesses is the most infectious, it is almost impossible to stop

them from spreading when once they are introduced, and that therefore a sanatorium is an unnecessary and complicated luxury. My own experience has led me to the conclusion that where both sickroom and sanatorium are in use there is much to be said for the latter opinion. It too often happens that a boy sickens unexpectedly; he is put to bed in the sickroom; there are no very definite symptoms, and perhaps he is not removed to the sanatorium until the infectious nature of the illness has declared itself after an interval of two or three days. In the meanwhile he has been attended by the school matron, has been visited perhaps by the master's wife, no special disinfectants have been used, and the mischief is done. Or, again, the sanatorium from perhaps long disuse is not fully equipped with all the appliances for nursing and feeding of invalids. The person in charge of it, often an old servant, is quite able to nurse an ordinary illness, but ought not to be in charge of a serious case. The introduction of

a hospital nurse is troublesome and costly. The invalid's food has to be sent over from the schoolhouse; all sorts of complications arise, and it cannot be wondered at if, after enduring them for a while, the authorities decide that the sanatorium is a nuisance, and saves you nothing in the long run. One cannot but sympathise with the decision, but I would suggest that there is a better way--viz. to abolish the sickroom in the house altogether, and to send all cases that require nursing, whether infectious or not, to the sanatorium. There must of course be some room in the house in which a boy with a headache can lie down for an hour or two, or to which a boy taken ill in the night may be removed till the morning; but if he has to go to bed, let him go to the sanatorium. If it prove some trifling ailment requiring only a day or two's rest, he gets the rest and returns to school when he has had it; at any rate no harm is done. Should it prove infectious he has been caught in the first stages, and the risk of its spreading has been reduced as much as possible. Moreover the sanatorium is always ready. The necessary cooking is done in the sanatorium; the utensils are kept separately for the purpose. The caretaker must of necessity be an experienced nurse, and if a hospital nurse be required, her presence is far less noticeable than it would be if she were quartered in the schoolhouse; and lastly an immense saving is effected in the time and worry of the school matrons, who as a rule have very little of either the one or the other to give away. In small schools such an arrangement is often difficult to provide, but the need for it is less. In schools of 30 or 40 boys and upwards, I believe it would be of the utmost value. At any rate I have found it so, and would not give it up for anything. Of course, when an epidemic has once taken hold in spite of all precautions, either sanatorium or sickroom very soon overflows, and the school dormitories must be requisitioned as sick wards. There is nothing for it but to make the best of things, and to disinfect afterwards, but I believe that this necessity for converting the schoolhouse into a hospital would arise much less often if the sanatorium system for all who have to go to bed were more generally adopted.