Popular Science Monthly/Volume 38/November 1890/School Life in Relation to Growth and Health
By Prof. AXEL KEY (of Stockholm).
ONE of our highest, and at the same time one of the pleasantest, objects in life is the instruction of our children. It is our duty to promote their physical and mental health by all the means in our power; and the success of our efforts to that end is one of our greatest joys. The doubt has gradually grown strong whether modern instruction at home and in school, as a whole, is so arranged and guided that the aim of a sound mind in a sound body, which should never be left out of sight, is reached. More and more sharply is the question of the influence of the present school system on the growing youth debated in every enlightened country of Europe. More and more distinctly is it declared, especially from the side of the doctors, that the school imposes too great demands upon the young organism in the critical period of its growth; that it, as well as all our education, seeks too one-sidedly to stimulate mental growth, and that the physical development is thereby so neglected that great dangers arise, perhaps fatal for the whole life, to the body as well as to the closely related mental health. Much as has been thought and written on the subject, and much as school hygiene has been advanced recently, thorough investigations of the condition of children's health in schools have not hitherto been made in other countries than Denmark and Sweden, and a practical basis for conclusions on the matter is therefore wanting. The first fundamental research was instituted by Dr. Hertel in Copenhagen in 1881, and its result was so significant that a special hygienic commission was appointed to examine the conditions of health in all the schools of the kingdom. At the same time a grand school commission was named by the Government of Sweden to inquire into the organization of the whole higher school life. This commission, of which I am a member, has examined nearly fifteen thousand boys from the middle schools or the preparatory schools for the university, and three thousand girls in the private girls' schools, in reference to their health, and has measured and weighed them. The results of these researches show that boys pass through three distinct periods of growth: a moderate increase in their seventh and eighth years; a weaker growth from their ninth to their thirteenth years, and a much more rapid increase in height and weight from their fourteenth to their sixteenth years, or during the period of puberty. 108 THE POPULAR SCIENCE MONTHLY.
The growth continues after the last period, but more slowly. The development of girls also presents distinct periods, but the changes occur a few years earlier than in boys. It may be men- tioned for comparison that American boys are taller and heavier than Swedish boys during the period of puberty, but that other- wise the Swedes excel all other boys and pass the Americans in their nineteenth year. Danish boys compare well with Swedish, and Hamburg boys, according to Kotelmann's researches, come very near to them. The smallest boys examined were those in Belgium and northern Italy. Swedish girls are decidedly taller and have greater weight than the girls examined in other coun- tries. Comparing the subjects by stations in life, the more rapid growth begins a year earlier in the children of the well-to-do classes than in those of the poorer classes. Scanty and hard con- ditions of life are restrictive and hindering to the growth of chil- dren. The slow growth of the poorer children previous to the period of puberty is prolonged at the cost of the latter ; it is as if something hindered these children from entering their period of more rapid development in the same year of their life as children living in better circumstances. The development of puberty is delayed in them, but as soon as it is begun it goes on with in- creased rapidity, and, in spite of the delay, is completed in the same year as it is in the better situated children. "We see here a striking example of the elasticity that resides in children and asserts itself in the processes of growth. A feather can be bent very forcibly or nearly doubled up, without losing the power of springing back to its former condition. But if the pressure is too strong or lasts too long, the power is lost the quill gives way or acquires a permanent set. So a child which has been held back in its growth by unfavorable circumstances has a marvelous power of winning back what it has lost, and of returning in growth to its development-curve. But if the disturbing influ- ences take too sharp a hold or persist too long, the child continues so far backward in its development that it is never able to make it normal again.
It is an interesting question, and especially important in rela- tion to education, whether the growth of children goes on evenly during the different seasons, in summer and winter. Some pene- trating researches in this matter have been made by Pastor Malling-Hansen, superintendent of an institute for the deaf and dumb in Copenhagen. According to them, children exhibit a relatively light growth from the end of November to the end of March. This period, which includes all the winter months, is followed by a second, from the end of March till July or August, during which the children grow rapidly in height, but their in- crease in weight is reduced to a minimum. After this follows a
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third period, continuing to the end of November, in which the increase in height is very small and the gain in weight very- large. The daily accession of weight is often three times as great as during the winter months ; and an earlier beginning of the summer vacation will be accompanied by a stronger growth in weight during the holiday time. These facts are of great moment in aiding to determine the best arrangement of vacations an im- portant question in school management.
From this discussion of the different phases in their growth I pass to the diseases of our school children. First, according to my examinations of fifteen thousand boys in the middle schools, more than one third are ill or are afflicted with chronic maladies. Short-sightedness, which is demonstrably for the most part in- duced by the overtaxing of the eyes in school-work, and well merits the name of school -sickness, rises rapidly in height of prevalence from class to class. Thirteen and a half per cent of the boys suffer from habitual headache, and nearly thirteen per cent are pallid ; and other diseases arise in the lower classes and then decline to rise again in the upper classes. Diseases of the lungs are most frequent among organic disorders. Diseases of the heart and intestinal disorders show a considerable tendency to increase in the higher classes. As to the average of illness in the different classes, it appears that in Stockholm seventeen per cent of the children in the first class were ill at the end of the first school year. In the second school year the illness-curve rose to thirty-seven per cent, and in the fourth class to forty per cent. This remarkable increase of illness during the first school year is not casual, but is exhibited in all the schools ; and corresponding conditions were brought to light in the examinations of Danish pupils. A sigkness ratio of 34*4 per cent was found as early as in the lowest classes of the middle schools. The illness-curve rose in the first classes, reached its first maximum in the third class, then sunk and rose again in the upper classes. These wavering conditions can not be founded in the organization of the school. The burden of work on the pupil rises incessantly from class to class, and the boys live continuously under the same hygienic con- ditions in the same places, and in the same school and parental houses. There must be a deeper underlying cause. A look at the growth-periods of the boys shows that the remarkable rise of the sickness-curve in the preparatory schools and the lower classes of the middle schools occurs exactly during the period from seven or eight years to thirteen years, the very time that has been shown to be one of weaker growth in boys. But as soon as the stronger growth of puberty sets in, and especially during the last years of that period, when the gain in weight is most rapid, the curve sinks from class to class, from year to year, till the year in which the
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important change is completed. Immediately after this point is reached, when the yearly increase in weight and height "begins to diminish rapidly, the sickness-curve again rises very fast. The most healthy of all the years of youth is with boys the seven- teenth, which is also one of the two years of most active growth. The eighteenth, on the contrary, which follows immediately upon the attainment of puberty, appears to be a very unhealthy year.
All this indicates undoubtedly that during the period of weak growth which precedes the coming on of puberty, and during which our pupils are passing through the preparatory or lowest classes of the middle schools, the power of resistance of the youth- ful organism against external influences is diminished. During the period of development of puberty, on the other hand, when the youthful life is approaching maturity with all its swelling force, the capacity for resistance rises from year to year, and the liability to illness falls, reaching its minimum in the last year of that period. Immediately afterward sets in another period of diminished capacity for resistance, which usually includes the last years of school life.
Among the school girls, the future mothers of generations to come, investigations instituted in thirty-five schools with three thousand and seventy-two pupils brought out a fearful amount of illness. Sixty-one per cent of the whole, all belonging to the well-to-do classes, were ill or afflicted with serious chronic dis- orders ; thirty-six per cent were suffering from chlorosis, and as many from habitual headache ; at least ten per cent had spinal disorder, etc. Such a condition of health in Swedish girls, grow- ing worse in the years preceding puberty and during its begin- ning, while it is not notably improved in the last, years of the period, certainly deserves careful attention. The explanation of it is easily found in the method of instruction for girls as a whole, and in the organization of girls' schools after the pattern of boys' schools. The amount of work, sitting still, etc., exacted of the girl is not consistent with her health during her growing time. Without going into particulars as to the influences injurious to the health of growing children which proceed from their homes or may be brought out in connection with the school and school- work, it is still manifest that the burden of work which children have to bear under present school regulations far exceeds what is permissible, and is to a large extent responsible for the liability of school children to illness.
The average time daily demanded by the school for work in class and at home is, according to the gymnasial schedules, seven hours in the lowest classes ; and it rises rapidly and constantly, till in the upper classes eleven or twelve hours are required. As
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tlie time here given is the average, and private instruction and optional study hours are not included, it is easy to conceive that there must be a considerable number of boys who have to take more time for school- work.
How do children thus situated find time for meals, for rest, for exercise in the open air, for recreation, and, above all, for sleep ? Must not their mental force be worn out and benumbed by such a burden, their physical growth and health suffer, and their ca- pacity to resist unwholesome influences of every kind be dimin- ished ? There is no doubt about the answer. The mention of sleep raises a question of great importance to the rational teach- ing of children. "We all know how much greater is the need of children for sleep than of grown persons, and how necessary for their good it is to be able fully to satisfy this need ; but how great it is generally at any particular age of the child is very hard to define exactly. The amount varies under different climatic con- ditions. In Sweden, we consider a sleep of eleven or twelve hours necessary for the younger school children, and of at least eight or nine hours for the older ones. Yet the investigations have shown that this requirement lacks much of being met in all the classes, through the whole school. Boys in the higher classes get but little more than seven hours in bed ; and as that is the average, it is easy to perceive that many of them must content themselves with still less sleep. It is also evident from the investigations that the sleeping time is diminished with the increase of the working hours from class to class, so that pupils of the same age enjoy less according as they are higher in their classes. It thus appears constantly that in schools of relatively longer hours of work, the sleeping time of the pupils is correspondingly shorter. In short, the prolongation of the working hours takes place for the most part at the cost of the time for sleep. If, then, the load of work of a school youth is too much for his stage of growth, and too little time is left for recuperation and sleep, the momentous question arises, whether it has been statistically proved that the length of the working time exercises a definite influence on the health of the children. It has. The average time of work of each class was computed, and the pupils were divided into two groups, consisting of those who studied more and those who studied less than the mean. It was found that the amount of illness of those who worked longer than the average was 5*3 per cent higher than that of those who worked less ; a result which must be regarded as of very great importance when we consider how many other unhealthy influences there are to make themselves felt. The result was still more significant in the two lowest classes. The liability to illness there, in connection with the longer hours of work, was from 8*6 to seven per cent higher. We may also ob-
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serve in this condition a new evidence of the depreciation of the caiDacity of the yonnger pnpils of these classes to resist unhealthy influences.
It is incumbent on us to see with all possible care that the growth of youth during their years of puberty, which is so full of importance, is not disturbed or distorted by any influences" ad- verse to nature. But as instruction is now arranged, at school and at home, we should first of all direct attention to the phase of the child's age immediately preceding the period of puberty, when the growth is at its lowest, the child's capacity for resistance is least, and his liability to illness increases from year to year. We must learn how to obviate this liability to illness, and it is for sci- ence to forge the weapons with which to do it.
The deeper we go into these researches, the more we appreciate the great truth that lies in the conception expressed by Rousseau in the last century. When, he thought, we have brought a boy to the age of puberty with a body sound, healthy, and well devel- oped in all respects, then his understanding also will unfold rap- idly and attain full maturity under continuous natural direction and instruction ; all the more vigorous will his physical develop- ment be afterward in the bloom of youth. Rousseau, we know, would not recognize a compulsory lesson in a book before the twelfth year as a means of instruction. We can not follow hiin so far, but we certainly shall have to learn, better than we know now, how to fit our demands on the child's organization to his strength and capacity of resistance during the different periods of his growth ; better than we know now, how to promote his health and his vigorous physical development. The father of school hygiene, Johann Peter Frank, introduced his warning a hundred years ago against a too early and too strong tension of the youth- ful powers of mind and body with the words : " Yet spare their fibers spare their mind's strength ; waste not upon the child the vigor of the man that is to be."
��It is shown by M. Camena <T Almeida, from a comparison of mountain-heights as giver) in Berghause's table, that the altitude of the highest masses increases in going from the polar to the equatorial regions ; yet the greatest elevations are not found at the equator, but near the tropics in 27 59' and 35 28' north in Asia, and 15 52' and 19 47' south in South America. These points are also near the isothermal lines of the highest summer temperatures. The heights of the mountains seem, too, to bear a relation to the height of the line of perpetual snow, they seldom rising more than from six thousand to ten thousand feet above it. From these facts the author deduces a relation between the height of mountains and climate ; assuming that there is a limit above the snow -line above which, if a mountain passes it, it is so ground down by frost and the wear of the elements as speedily to be reduced to a proper level.
- Address before the International Medical Congress in Berlin. Translated for the Popular Science Monthly from the Internationale klinische Rundschau.