Lecture 4
From Cradle to Grave
Medicine at School
Topics
• Liberal Reforms
• School Meals
• School Medical Inspection
• Schools as Sites of Health
– Games and Sport
– Domestic Science
– Sex Education
Themes
• State – parents – children: who is responsible
for health?
• School as a new site of health interventions
• Visibility of school children and their health
problems
Liberal Reforms
• The Liberal welfare reforms (1906-14) were acts of social legislation
passed by the Liberal Party after the 1906 General Election. Argued that
this legislation marked the emergence of the modern welfare state in the
UK. Outlook shifted from laissez-faire system to more collectivist
approach.
• The Liberal welfare reforms took place after a Royal Commission on the
country's Poor Law provision. Two contrasting reports known as the
Majority Report and the Minority Report were published. As they differed
so greatly the Liberals were able to ignore both reports and implement
their own reforms. Implementing the reforms outside of the Poor Law,
meant that the stigma attached to claiming poor relief was removed.
• During the 1906 General Election campaign neither of the two major
parties made poverty an important election issue and no promises were
made to introduce welfare reforms. Despite this, when the Liberals led by
Henry Campbell-Bannermann and later Herbert Asquith won a landslide
victory they immediately began introducing wide ranging reforms.
Spurs for Reform
• Emergence of New Liberalism (e.g. David Lloyd
George)
• (Genuine) concern about poverty influenced by
social inquires e.g. Charles Booth and Seebohm
Rowntree
• Threat of Labour Party and trade unions
• Concerns about physical (and mental)
deterioration (Boer Wars)
• Example of public health – often on local scale –
idea this could be implemented nationally and
more broadly
Areas of reform
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•
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Birth
1907 the Notification of Births Act.
Children
1906 free school meals, 1907 medical inspection.
Elderly
In 1908, pensions were introduced for those over 70.
They were paid 5s a week (average wage of a labourer
being around 30s a week) to single men and women
and 7s 6d to married couples, on a sliding scale. The
pensions were means-tested (to receive the pension,
one had to earn less than £31.50 annually) and
intentionally low to encourage workers to make their
own provisions for the future.
National Insurance/Health Insurance
• 1911 National Insurance Act (Part 1) gave workers the right to
sick pay of 9s a week and free medical treatment in return for
a payment for 4d (the payments would last for 26 weeks of
sickness). Medical treatment was provided by panel doctors.
Doctors received a fee from the insurance fund for each panel
patient they treated. The National Insurance Act (Part II) gave
workers the right to unemployment pay of 7s 6d a week for 15
weeks in return for a payment of 2½d a week.
• Compulsory health insurance for workers earning less than
£160 per year. The scheme was contributed to by the worker
who paid 4d, the employer who paid 3d and the government
who contributed 2d. Scheme provided sickness benefit
entitlement of 9s, free medical treatment and maternity
benefit of 30s.
• c.13 million workers came to be compulsorily covered.
Children and Reform
• In 1906, children were provided with free school meals.
• Following an unfavourable report by the Board of Education's inspectors
on infant education in 1906, school provision for children under 5 was
restricted (previously, the normal age for the entry of working-class
children into full-time education had been 3).
• 1907 Medical inspections of schoolchildren introduced
• In 1907, the number of free scholarship places in secondary schools was
increased (paid for by the Local Education Authority (LEA)).
• The 1907 Probation Act established a probation service to provide
supervision within the community for young offenders as alternative to
prison.
• In 1908, the Children and Young Person's Act formed part of the Children’s
Charter which imposed punishments for those neglecting children. It
became illegal to sell children tobacco, alcohol and fireworks or to send
children begging. Juvenile courts and borstals were created.
Free school meals
• After 1870s (elementary education compulsory)
noticed increasingly that school children had too little
food and clothing to attend school.
• Plight of ‘half-timers’ – children who were still sent to
work part-time or how had to assist at home e.g. ‘little
mothers’
• Mid-1870s initiatives in some schools to provide meals
– provided soup for small payment.
• Mid-1880s Penny Dinners provided B’ham, Bristol and
London (often given free or cheaper in practice).
• 1888 45,000 children at 48 school boards in London
dependent on school meals.
• Voluntary sector heavily involved in local provision.
Free school meals
• 1906 Education (Provision of Meals) Act
• Caused debate and dissension. Many local councils ignored
this system, as it was not compulsory.
• Made compulsory in 1914, in which year 14 million meals per
school day were served (compared with 9 million per school
day in 1910), most of which were free. In 1912, half of all
councils in Britain were offering the scheme.
Opposition to school meals provision
• School meals recommended by 1904 Report on
Physical Deterioration but not free school meals!
• ‘The individual and the family, as well as for their own
good as for the common good, should provide
themselves with the necessaries of maintenance, by
their own exertions and out of their own resources. By
such action [introduction of free school meals] the
motive for a sound and well-ordered family life is
weakened… By a law of social development… the
individual and the family under normal conditions have
to maintain themselves…’
• B. Bosanquet, ‘Lectures on Charitable and Social Work’,
1901.
Elimination of malnutrition
• 1932 Board of Education claimed only 1% of
schoolchildren malnourished. Chief Medical Officer
claimed ‘the schoolchildren of this country are better
nourished than at any previous time of which we have
record’.
• School milk scheme introduced 1934.
• Yet great regional variation – many areas of high
unemployment struggled to provide them e.g. South
Wales.
• Social surveys continued to show evidence of
malnutrition e.g. John Boyd Orr claimed high incidence
of rickets, dental decay and anaemia in 1936, and
suggested 20% of children malnourished.
Provision of meals and milk
1938 268 LEAs provided
free school meals
635,000 receiving free
milk
176,000 children getting
free meals
Yet did little overall to
eliminate malnutrition or
child poverty (John Welshmam)
Medical inspection of school children
• Origins of interest in medical inspection of schoolchildren in
1880s – interest in ‘bodily infirmity’ in schools.
• After 1870s attendance compulsory and more children to
observe and survey/anthropometric studies
–
–
–
–
Over-pressure in school (Dr James Crichton-Browne)
1896 committee Mental and Physical Condition of Children
Attracted interest of doctors, psychologists and educationalists
Child Study Association/Childhood Society
• 1890 London School Board appointed first school medical
officer, Bradford 1893.
• 1907 medical inspection of school children introduced poor families, however, could not afford doctors’ fees.
• 1912 medical treatment was provided. However, education
authorities largely ignored the provision of free medical
treatment for school children.
Health of school children
• Poor to appalling – led to difficulties learning
• Bad teeth
• Defective eyesight
• Poor hearing
• Poor physical development
1909 in Stockport MOH inspected 4,000 children
59% had ‘various defects’
600 dirty heads
800 ‘mouth breathers’
300 heart disease and anaemia
65 ringworm and skin diseases
Impact of School Medical Service
• Inspections by doctors and nurses increased, school clinics
established (supporters believed offered cheap and effective
treatment to children, but GPs feared would rob them of fees).
• Gradually expanded – by 1930s almost every LEA offered treatment
for minor ailments, dental defects and defective vision. Most
offered treatment for adenoids and tonsils, over half orthopaedic
services and X-ray treatment for ringworm. Some offered artificial
light treatment for rickets and other bony defects.
• Meant many children could stay on at a normal school.
• Also new treatments introduced e.g. artificial light for treating
rickets, lupus and non-pulmonary TB.
• Yet failed to tackle prevention, deficiencies in service and varied
from locale to locale. Poorer areas with high unemployment spent
less on school medical services, though needs greater.
• See Bernard Harris, The Health of the Schoolchild (1995).
Local authorities providing medical treatment
Year
Provision
Clinics
Hospital
Spectacles
1908 55
7
8
24
1914 266
179
75
165
1917 279
231
95
223
1920 309
288
168
282
Number of LEAs between 328 and 317
Light therapy
• ‘agreement is almost unanimous as to the tonic effect of ultraviolet radiation on debilitated children, [as] shown by their
improved appetite, activity and nervous stability’.
(George Newman, Board of Education, 1928)
Just poor children….?
• E.B. Rheumatic. Heart weak. Gymnastics good for
her, but she needs to be carefully watched.
• L.B. Slight and delicate. R. lung not quite sound.
Gymnastics very useful but care to be taken.
• E.P. A nervous excitable child subject to
headaches. Weak trunk muscles and chest
habitually contracted...
• 1880s, school girls aged 11-14: crooked spines,
poor eyesight, anaemia, defective heart and
lungs, poor physical development, varicose veins,
stooped posture, rheumatic disease and TB.
North London Collegiate School for Girls
• 1880s introduced medical inspections and directed
gymnastics for girls/pioneered sport in school under
headmistress Frances Buss and medical inspector
Frances Hoggan
Schools as sites of sport, exercise and remedial
medicine
• Attempts to introduce exercise to schools of all kinds
• For boys from mid-19th, and girls towards end of 19th
century – in schools for middle- and upper-class wide
range of sports
• For poor ‘drill’ more common
• Martina Bergman Ősterberg, Superintendent of
Physical Education London School Board in 1880s
recommended Swedish system or Ling gymnastics her work frustrated by poor physical state of pupils
• By 1909 London School Board included marching,
dancing, skipping and gymnastic games
• Physical education – connected to interests of state
and citizenship (John Welshman)
Sport, manliness and Empire
Girls, Empire, sport and motherhood
• Warnings of over-exertion
• Dr Mary Scharlieb –
excessive athletics could
produce a ‘neuter’ type
of girl
• Sara Burstall,
headmistress Manchester
Girls School ‘They have
only a certain amount of
available energy’.
Margaret Macmillan
• Camp School at Deptford
in London around 1910.
• Remedial gymnastics and
provision of meals in
garden setting to
intensely deprived local
children.
• Also offered minor
treatment such as
removal of adenoids,
dental and minor surgical
treatment.
Domestic science
• Complex relationship between girls and education – teaching
domestic skills and broader education
• Girls as future home makers/mothers (national efficiency)
• 1878 teaching of domestic economy compulsory for girls;
grants for teaching cookery 1882, laundry 1890
• Teaching of domestic science increased in importance in
elementary schools 1880s and 1890s
• Concerns about industrial employment for poorer girls and for
better off women new opportunities in professions –
deskilling for both!
• Effort to make domestic skills more scientific – emphasis on
nutrition, public health, hygiene, scientific practice of
housework - contributing to home, community, nation
• 1896 Association of Teachers of Domestic Science established
(archives in Modern Records Centre at Warwick)
Domestic science
Health education/Sex education
• Increasingly schools seen as appropriate places for
dissemination of health education and sex education.
• Again debate about who was responsible for such
interventions. Role of parents, school or state.
• Controversy in 1940s about introduction of sex
education in schools
• Many pupils reported ‘Oh no, nothing, we didn’t learn
anything’ – sex education often incidental rather than
part of curriculum and emphasis on VD.
• Reticence amongst teachers about providing sex
education – and amongst children. Often taught
indirectly as part of biology or botany.
Maggie Thatcher Milk Snatcher
Conclusions
• Thatcher’s actions reignited debate about who is
responsible for health of school child as well as who should
pay for provisions.
• Late 19th century for multiple reasons saw creation of set of
interventions for school children by state – debate about
who should pay, how extensive interventions should be.
• Poorest areas where need greatest often had weakest
provision.
• Also underlines shift from child as worker to child to school
child and the emotional value of children, as well as their
future worth to the state.
• Schools came to provide a wide range of health and
medical provisions: medical inspection, milk and meals,
exercise and sport, domestic science teaching, sex and
health education and special interventions, notably
vaccination.