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The Pamphlet Collection of Sir Robert Stout: Volume 30

Education in Relation to Public Health

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Education in Relation to Public Health.

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Mr President, Ladies, and Gentlemen,—

The subject which I have chosen for my paper is one full of importance for us all, and one which I trust will commend itself to you for mature consideration in the future.

With you, gentlemen, lies, as you yourselves are quite aware, the moulding of the thoughts and the tendencies of the generations which follow us. I know many of you, possibly all, recognise this, and I have noticed constantly the struggle that you are making to perfect the profession in which you are engaged. It would be a difficult matter to single out the most noble professions in the world: Two are very prominent, and these two are the profession for the treatment and prevention of disease on the one hand; and the arousing of intelligence, the assertion of control, the direction of thought into proper channels, and the desire for knowledge based on good principles, on the other: this latter I would term education. And I am certain that the two go together, and depend much one upon the other, and that working one with the other much will be done. Nay, I am the more convinced that in the hereafter they will work together, and that, too, somewhat on the lines which I propose to indicate to you in my paper this afternoon. Unhappily, as Maudsley says, "We are not yet agreed as to what should be the true aim and character of education. Regarding the subject from a scientific point of view, the best education would seem to be that which was directed to teach man to understand himself, and to understand the nature which surrounds him, and of which he is a part and product. But if this be the true aim of education, how vast a revolution remains to be accomplished! How many things are men taught which they ought not to be taught, and how many things are they not taught which they ought to be taught."

"It will be admitted as regards a knowledge of their own nature and their relations to the law of external nature, man is yet in a position of ignorance very like that in which the savages are in regard to the laws of physical nature. Like them he feels their effects without understanding their nature; like them he cherishes superstitious belief instead of systematically setting to work to enlighten his understanding; like them he suffers from the stern and inexorable laws which he has not been taught to understand, and which he does not oven recognise when he suffers by them."

Looking at this in the same light Dr. Humphry, of Cambridge in an address at the Sanitary Congress at Glasgow, said "so close is the inter-dependence of the physical, the mental, and the moral in man that an improvement or a deterioration in one of them is certain to be a deerioration or improvement in the other two. Thus a good sound educa- page 2 tion and that mental training which gives strength to thought and judgment, and which can only he carried out in the heathful body, will react beneficially upon the body as well as upon the moral tone, and will add to that uprightness of honor and that vigorous bearing which makes the man. No sentimental fancies, of overdrawn apprehensions of interference with the liberties and rights and free actions of citizens should he allowed to hinder the enforcement of those principles and laws which are requisite for the prevention and mitigation of disease. Let the salus populi simply, sensibly, and scientifically be really and practically the suprema lex. Will the extension of our education system to the masses advance their sanitary and moral condition and therefore prove a great boon to them, or will it not? The answer must depend upon the quantity and quality of that education. Knowledge, conjoined with the power to wield it, brings all nature under her sway. It not only reveals to us the best paths to health and strength of mind and body, but also enables us to follow them. Sanitarians are therefore necessarily educationists, and it is for us to point out and strongly impress upon those who are engaged in education that that education, and that only, is good which stores the mind without injuring the body. "We cannot too often or too forcibly reiterate the statement that the mental and moral qualities are largely dependant upon the physical, and will rise or fall with it, and especially in these days when in the growing struggle for existance, teachers are being ranged against teachers and pupils against pupils in competition for certificates, prizes, and places."

In connection with this Sir T. Spencer Wells's remarks are highly interesting: "We have heard of late much about over pressure from work in schools. This is one of the novelties of our time. No doubt it exists, and I think it may be in part traced to some of our sanitary success. We have reduced the mortality of early infancy. Many children who would formerly have died off hand are now saved, and find their way into the schools. They are the survivals of the least fitted. They live but they are not strong; not so strong as the average. They have to submit to the same routine and to be forced up if possible to the same standard as the rest. But the effort is too much for them. Their frames are not hardy enough to resist the mental strain. They show all sorts of nerve symptoms; disappoint the teachers, and are the types brought forward as victims of the system.

"The vice of the system is that it is indiscriminate. There is no revision of the recruits, and the tasks are not apportioned to the feeble powers of sanitary survivors."

Allow me to show you how much this, the latest branch of our medical profession—this hygiene or public health—has done for Great Britain. What attracted and aroused attention to the matter? Well it was due to the report of Dr Farr on the vital statistics. It is just 50 years ago, for it was in 1837 that the Registration Act first came into force, and Dr. Farr showed that the death rate was too high. Measures were taken to lessen mortality, with the result that we now know that there is a gain of 20 years in the average duration of life. Fifty years ago the average duration of life was calculated at 30 years, now the health life table puts it at 4 9 or 50. Again during this 50 years the population of the United Kingom, although losing vast numbers by emigration, yet has increased about eight millions.

How much of this is due to pure sanitation is difficult to say. Much is of course due to the progress made in medicine and surgery. The mortality from small pox has strikingly diminished, but all those are due in great measure to the attention aroused by Dr. Farr's statistics and page 3 sanitary legislation consequent to these. It has been calculated that each individual is worth L150 to the state. Now if we take it at a low figure and claim only two millions out of the eight millions of increase in the population, why then the country has gained clearly a sum of at least L300,000,000!

It cannot be denied that the efforts of sanitarians have done much for the country. They wish to do more, but have been thwarted over and over again by the want of knowledge of the ordinary principles of sanitation which pervades all classes from the lowest up to the legislature. Many beneficial measures have not been passed, others again have been repealed. Wisely did Lord Derby say that sanitary education must precede sanitary legislation. Thus it has been that efforts have been made and with astonishing success in introducing a system of instructing children at school in the elementary knowledge of public health.

Amongst others Mrs Catherine Buckton some 15 years ago, after being elected a member of the Leeds School Board urged the Education department to allow domestic economy to be taught to girls in the lower division of elementary schools by qualified teachers on scientific principles. This was acceded to, and the course included the nature of good and bad air, ventilation, and why we have fevers, cookery, food, especially the feeding of infants and preparing food for the sick. Much more important knowledge this than being able to give the locality, physical features and population, &c., of such places as "Kimberley" and "Penjdeh."

The Manchester and Sheffield School Boards instituted departments for teaching manual work to boys. On this the Royal Commissioner reported as follows:

"That after having had the opportunity of further considering the value of manual work as a part of primary instruction, and after having seen such work introduced into elementary schools of various grades in other countries besides France, are able to express even a stronger opinion in its favor than at the time of their first report."

Mrs Buckton goes on to say that a separate department for the manual instruction for girls should be adopted, to include sweeping, scrubbing, dusting, bed making, washing and ironing, cleaning of utensils, furniture, windows, kitchen flues, boilers, cisterns, and every sanitary apparatus to be found in a cottage dwelling

Two years ago the Lords of the Committee of Council on Education sanctioned the addition of hygiene to the list of sciences towards which aid is afforded by the science and art department. The following is the syllabus: Elementary stage. (1) Food, diet and cooking; (2) water and beverages; (3) air; (4) removal of waste and impurities; (5) shelter and warming; (6) local condition; (7) personal hygiene; (8) treatment of slight wounds and accidents. Advanced stage. (1) Food and adultertions; (2) water and beverages; (3) examination of air, water, chemical and microscopical; (4) removal of waste and impurities; (5) shelter and warming; (6) local condition; (7) personal hygiene; (8) prevention of disease. In addition to these, for honours, questions will be set on trades nuisances, vital statistics and sanitary law.

In Germany Dr. Scholtz of Bremen in an address before the German Teachers Association, follows in the same direction. he recognises that the Education of the body is of as great importance as that of the mind. He asks: "What is hygiene but the establishment of the condition under which man may reach the highest physical and psychical development, the restoration of nature so long opposed and crushed by a degenerate civilisation?" He quotes as a truth the witty aphorism of Baron page 4 Liebig that the actual stage of culture a people has, as a whole may be estimated by their consumption of soap, and he propounds four theses: Firstly, that hygiene should be obligatory in all primary schools. Fully recognising the justice of complaints of overwork in schools, he maintains that there are subjects taught of much less value which should be made to give way. Secondly, that hygiene should be taught as a part of natural science and that in a practical way. He remarks that botany as commonly taught is utterly useless. Thirdly, he insists that instruction on hygiene should be strictly limited to is bearing on health. Fourthly, he maintains that hygiene should be compulsory and an integral subject in the training schools—i.e. normal schools.

I see also that quite recently Professor Hutton in an address to the North Canterbury Educational Institute I as advocated reforms in science teaching. I quite agree with him as to the receipts that would accrue from the course he suggests. But I firmly believe that a course of teaching such as I have been indicating would be of much more national benefit than by teaching in our free schools Chemistry, Physics, Botany, Geology, and Zoology. These, useful subjects though they be, belong to a higher education; which, in my opinion, it is not the duty of the State to provide.

Now gentlemen, I have thought it a convenient occasion, and in connection with this address to go into questions of more personal association with ourselves. I have told you broadly something of Public Health and its effects upon the people. Let us see how we ourselves stand and our conditions, and in what regard our respect, or otherwise, for the laws of nature has done for us during the past few years.

Thirty or forty years ago this place wherein we dwell was unpolluted by the touch of civilisation. A few wandering Moriories in the past, followed on later by their masters the Maori, travelled occasionally through this place. They never stayed here for any length of time for this locality did not find them so easily in food as many other places. By this I mean that there was never any great collection of people continuously here leaving behind them sources of disease to affect their after comers. But for the white man there was great attraction. A genial and dry climate and a fertile land, consisting of a considerable depth of black soil with a rich yellow alluvium underlying it, and a substratum of shingle for drainage; a flat surface surrounded with hills to keep off the prevailing boisterous southerly winds and storms; an almost natural harbor with good sea communication; and in the early days at times very difficult access to any port whence they might get their necessaries of life and dispose of their products. What wonder, then, that such a place as this should on the advent of the white man be seized on, settled on, and developed until it has grown into the fair and beautiful looking town that it is. The white man invaded the hitherto sacred precints of nature; let us see how nature treated this invasion and the respect or disrespect of her own laws.

And now I must ask you to extend me a little latitude, and not be too hypercritical if I am not, perhaps, quite exact, or do not give you information upon any one subject that may possiblely strike anyone of you. The subject is an enormous one, and one which I could spend hours in detailing to you, and one in which I have spent a good many hours in working out data in order to give you merely salient points. To be exact, to avoid hypercriticism or the challenges of the would-be-wise, much more would require to be done. I therefore throw myself on your leniency, feeling sure that the interest, and I hope satisfaction, aroused in you will make up for any shortcomings.

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I have gone into the vital statistics of the registration district of Oamaru, which includes the county of Waitaki, with the exception of the ridings of Herbert, Hampden, and Moeraki. These are in separate registration districts, and time has not been at my disposal to examine these. It would be impossible to separate, Oamaru town from the district in this matter, as indeed it ought to be impossible in all other matters The close connection between town and country is not perhaps always and in all matters so recognised as it should be. It is merely a question of time when the distinction will not be so diverse. Really one thinks sometimes that the old story of the "belly and the members" had been told in vain.

My thanks are due to the Registrar (Mr Filleul) and his assistant (Mr Tait) for the kind manner in which they have afforded every assistance in the use of the books in the office.

My researches extend over a period of 11 years from 1876 to 1886 inclusive, and I have compared the result obtained with statistics furnished by authorities in various parts of the world. My estimates of the population are based on the census returns furnished in 1878, 1881, and 1880. The intervening years are estimated on an average taken between these years. And I find that the population has increased in 11 years from 8409 to 11,175. There has been a slight decrease in the population of the town during the last two or three years which has been more than made up for by the increase in the country, and this is as it should be. There are not the public works going on in the town now, which formerly attracted a floating and not altogether a desirable population. In connection with this increase, which amounts to some 3666 person, I find that during the 11 years there have been 4542 children born here, and there have been 1078 deaths among persons of all ages.

Now my principle object in working out this information was to ascertain upon what health footing we are as compared with other places. It is somewhat difficuty to do this fairly, because we are throughout the whole colony a young country and we have only a small proportion of deaths of old people—that is, persons of 60 years and upwards—and this because the colony is not old enough. This has also to be borne in mind when comparing the death rate of last year with the death rate of 11 years ago; on this ground the death rate should now be higher—on the contrary it is less.

Firstly, let us see what the death rate of ordinary places is: The mean annual death rate of nine principal countries in Europe for twenty-two years is 25.7 per 1000 of inhabitants. The death rate of New Zealand for the last 10 years is 11.27; the death rate of Oamaru and district for the last 11 years is 9.5, and this is a fact which ought to be highly satisfactory.'

It may be argued that this ought to be so. "Well, I suppose we stand in relation to the rest of New Zealand in very much the same position as Brighton, Hastings, Cliffton, and other health resorts stand to the big centres—let us see how we compare with them. From a report published in the Sanitary Record of August 1886 the death rate of 46 health resorts in Great Britian averaged 15-6 and was considered unusually small; but ours for an average of 11 years is only 9.5, and last year only 8.3. Thus you see we may claim to be living in a very healthy climate, and that our violation of the laws of nature has not done us so much harm as it does in other places.

Now 1st us go a little further and enquire how long this has been so whether we are improving or falling back. And in dealing with this page 6 phase we have to consider whether during the last eleven years any material thing has occurred to increase or lessen our mortality to produce or hinder those diseases generally called Zymotic, which are the penalty laid down by nature for the infringement of her laws. And the answer comes back sharp. Yes there has been something done—something of vital importance; something expensive, but which the bare faced logic of facts and figures show, has done something to mitigate the penalty ordered by the Resident Magistrate of Nature's Court. And I seem to hear the sanitary Counsel for the defence urging the plea of an increased and wholesome water supply. Let us see what he has to plead:—

"Prior to the year 1880, your worship, my clients, the inhabitants of this town, had to content themselves with such water for drinking and washing and for providing their beasts of burden with drink, as your worship's Mistress Dame Nature, chose to provide in the way of rain, they also had in times of drought to full back on the water supplied by a small stream which ran through their dwellings. In times of scarcity they used to send carts down to a hole in this stream and then fill barrels with the water obtained from this hole, and paid many pounds for water obtained in this way. My clients also, were unable to comply with your regulations and keep their streets clean, and were in the habit of digging holes to put their filth in, and also dug other holes close beside the first holes and called the latter wells and drunk the water. The filth from many of these holes also flowed into the stream whence they bought their water, and they were punished accordingly. For sickness and disease came amongst them. And then they set to work and brought in fresh water; and they did not die, not so many of them &c."

As a matter of fact the mortality for four years previous to the bringing in of the water supply into Oamaru was at the rate of 10.4 per 1000 as compared with 8.9 the rate for seven years after. The infant mortality was also much higher with an exception in 1883 when the mortality was exceptionally high; but this was due to the great mortality amongst children from an epidemic of whooping cough prevalent that year and the dregs of scarlatina introduced the proceeding year from outside sources. I may point out as a most striking fact that in the four years prior to the introduction of the water works there were no less than 14 deaths from typhoid fever, and that for the six years succeeding them there have been only six. The mortality also amongst children from diarrhoea—which is a sure index of the health of the people—has much lessened of late; being only an average of 8 per annum as against 14 before the introduction of the water.

It may appear to you that this is a terrible fuss to make over a difference of one or two deaths in a place. But it is not the deaths only but the corresponding amount of sickness and its cost. Take the mortality amongst typhoid said by some to be one in eleven, by others, one in twenty—but take it as one in fifteen that would give 210 cases of typhoid in four years as against 96 in the succeeding six years.

Typhoid again is at least a three weeks illness and requirs four to six weeks more to recover strength. Now this gives us for four years 630 weeks of acute illness with all the attendant expense of doctors, medicines, etc., loss of work; and 1050 weeks more of convalescence during which work cannot be done and money cannot be earned, or a total of 1680 weeks or 32½ years; as against six years, with 200 weeks of acute illness and 400 convalescence or a total of 12¾ years.

Now what has this cost including everything, the actual cost, doctor's attendance, physic and nursing, and loss of work or salary during all that page 7 time? It cannot be put down at less than £4 a week, (it has been estimated at £9 7s). Reckoning it very roughly at this rate (£4), and in this crude way there has been a saving to the community of over £4000 on typhoid fever alone during the last six years.

In this connection I may point out that the decrease of mortality can not in any way be attributed to more rain, for from the information kindly supplied by Mr T. W. Parker, I find that the rainfall for the last six years has been slightly less than it was for the four years prior to the introduction of the water supply.

Roughly in this way have I tried to show you the benefits of Hygiene, and practically how much may be done to increase the wealth as well as the health of nations by its means. Sanitary science as compared with other sciences is a baby in arms, but it is a sturdy chicken and growing very quickly, and showing daily the increased necessity for its wellfare.

But now there is another matter bearing upon the subject at issue, upon which I would that I had more time to dilate. It is a sort of corollary of my paper and it is the "effect of teaching on health," and I much fear there is a huge stumbling block in the road. The path of sanitary education is stopped—stopped by the fear of teaching the children how dangerous the present scheme of education is.

Quis custodiet custodes ipsos?

How shall we teach public health when the primary laws are set aside by the heads of department? What folly to teach children that they require 400 cubic feet of air and then only give them less than half!

Our system is too young and the system of registration is too inexact, to in the meantime, permit proper data—and it is too much the custom in this Country on all subjects to think that we are special people—that what applies to other places does not apply to a new Country. We forget that older countries were once new countries; that the laws they have adopted are forced upon them, mainly by force of circumstances, and we do not realise that we are developing at such a rate that the force of circumstances acts upon us with a greater power in proportion to the rapidity of our development.

It has taken many years to develop short sight as a national curse to Germany, but if I may judge from the number of young people" in Otago—particularly in the south who wear spectacles, it has only taken a few years to develop short sight in our young Country. In the Franco-Prussian War, the German soldiers were ordered to fire from the hip instead of the shoulder, and the reason given out was defective ammunition which might burst at the breech and thereby of course be apt to injure their eyesight; but as a matter of fact it would not matter much whether they fired from the shoulder or hip, for the majority cannot see to take aim at more than 300 or 400 yards. How different "this is to the shooting of the Boers, brought up in the fields of nature! History tells us, alas, of the fatal effects of their good eyesight.

And this short sight is only a symptom of depreciation in other respects Time is too short to go fully into this, but I must, quote to you the result of researches made into this subject on the continent of Europe, and this statement is based on the reports published by English, American, German, Russian and French doctors, and is reported in the Sanitary Record of June 1835. Firstly, it is that upwards of 56 per cent—more than one half—of scholars generally are short sighted; that these also suffer from bad health. They go on to say that in country schools this short sight is only 1 per cent and increases in porportion to the education from 10 to 25, from 20 to 40, from 30 to 55, and from 64 to 80 page 8 and even up to 100 per cent. The young Volunteers (i.e. young men of upper classes, and highly educated, who servo one year as Soldiers instead of five) are so imperfectly developed physically, that they are sent back for a year, in twice the proportion of other conscripts. Others show that in consequence of bad seats numbers of children have one shoulder higher than the other, and they point out that owing to the deviation of the spinal column and consequently by pressure of the ribs indigestion and mal-nutrition are the results. Others show that toothache and congestion of the brain and faulty digestion, are observed amongst hard working pupils. They also point out that the pupils of the upper schools are pale, languid, thin, and show anæmic symptoms often the first indices of consumption, and two observers have stated that tuberculosis or consumption attacks especially the hard working pupils, those who fit themselves to be teachers and professors. Verbum Sapientibus. Is not all this, however to be more attributed to overcrowding than to over teaching?

Another malady attributed to over education is insanity. And it is really refreshing to learn the opinion of an expert in this subject and one who does not put it down so much to the effect of over education as to the effect of over educating an unfitted class of persons. Dr Savage has had many years experience amongst the insane and as a physician to the Bethlem Royal Hospital—commonly called Bedlam—his opinions are entitled to a certain amount of respect.

He says "Does Education produce insanity? Is the present age of School Boards one in which insanity is manufactured by over work? In my opinion true education—that is, the true development of mind and body—is the best preventative of insanity. Don't develop one side at the expense of the other. The Education which I have seen do much harm is that which may be called education out of harmony with the surroundings of the individual. I have constant examples in Bethlem of young men who having left the plough for the desk have found after years of struggle that their path was barred. Disappointment, worry, and solitude have produced insanity of an incurable type. A strong healthy girl of a nervous family is encouraged to read for examination and having distinguished herself is perhaps sent to a forcing house, where useless book learning is crammed into her. She is exposed, like Strasburg geese to stuffing of mental food in over heated rooms, and disorder of her functions results!

"Education leads men to over estimate their mental acquirements as compared with their bodily action, and with its increase are produced over ambition, feverish pursuit of gain and pleasure, aggregation in towns, celibacy, with vice of one kind and another, and development of religious indifference and general unbelief, associated with the neglect of general hygienic conditions."

These remarks of Dr. Savage are perhaps open to criticism, but they are on the whole true. At least, my object in bringing these as well as other opinions before you is to awaken thought and reflection. I would advocate teaching our children as they grow up the ordinary principles of the sustenance of their healthy lives. They will then be in a position when they grow up to be able to legislate with wisdom for their children, our grand children.

"Know thyself" was the wise man's saying two thousand years ago, and still we must repeat "Know thyself, thy body, its construction and functions—the conditions of its life; not merely to keep the body in health, but to preserve it as a temple fit for the soul."

Printed at North Otago Times Office, Thames-St., Oamaru.