HEALTH AND EDUCATION.*

By T. CLIFFORD ALLBUTT, M.A., M.D. Cantab., F.R.S. Senior Physician Leeds General Infirmary, &c., &c. (Continued from p. 365.)

WHEN in the next place I turn to the pupil teachers, I turn to a blot upon our system which I cannot show too dark. The pupil teacher is a mischief to his scholars, a mischief to his superiors, and a mischief to himself. He is a mischief to his scholars because his narrow and immature intelligence is incapable of the large and interesting way of putting things, which rather than the domination of book learning should enliven our schools. These poor puppets have no ascendency at best, and for the most part are querulous with fatigue; at best they lack that tact and sympathy which experience only can give, and for the most part they are opinionated and raw; at best they have but little formal stores of knowledge, which are paid out only as they went in, unenriched and untransformed by any of the vigorous or attractive personal quality which makes the success of the master, and awakens the interest of the disciple. This is the mischief to his scholars. The mischief to his master is that the master, in hours of leisure which he needs for relaxation or for his own culture, is pinned to the desk with these unlucky whelps, who have somehow to be licked into shape, whatever his weariness, whatever his hunger for mental relief. We speak to-day of the educated, but let me in passing say a word for the educators, masters and mistresses worn out before their prime. Some of these I do see and can speak of, those who do not yield to the common temptation to throw all teaching into the drudging hands of their pupil-teachers; and I attribute their failure, not to their school work, but to these outer labours. Thirdly, the pupil-teacher is a mischief to himself. The sufferers I see are not the scholars, but these pupil-teachers. Herein I have much sad experience.

At the age of consummation of the bodily frame and functions, an age of peculiar susceptibility both of mind and body, these striplings are exposed in their immaturity to the weary strain of day-long teaching and of night-long learning. Their seething brains do not rest even in sleep. Youths bear this better than girls; the phenomenal damage to many impulsive girls, and the more latent but broader mischief spreading through these as they develop into young women, are incalculable. From the few driven even to suicide to the many shaken and miserable, to the multitude weakened and stunted, we pass to consider the usefulness of these persons, and to point the opinion I have reserved for the present, namely, that I do not think the amount taught to our lesser children is too great, but I do think the way in which it is taught is ungenial and oppressive. And how can it be otherwise? The pupil-teacher system is an unmixed abomination. It is an abomination in that it diverts the brain at a receptive age to yield before it is grown, in that it feeds the little ones on lean and unripe food, and in that it spends the store of strength in the master which should animate and expand his own powers. There can be no compromise with these errors: the

whole thing must be swept away. Junior masters, like other young professional men, must be made at training schools, after their preliminary studies are complete, and must enter upon the life of teaching as the qualified subalterns of older and more experienced chiefs. Moreover, the medical examination before admission must be more searching; now it is too often a matter of form. With head masters inspirited, and healthy, genial, and cheery subalterns comparatively mature, the little ones would be so happily carried forward that rumours of overwork for them would gradually die away.

My next subject is the Middle-class Schools. By these I mean the many schools which on the one hand are not controlled by the ratepayer, nor inspected by Government, and on the other hand are not grammar or high schools. These schools are mostly private adventures, and vary as widely as the persons who keep them. Many of these are admirable schools. Established by men or women who love teaching, who can win the young and enforce discipline, their success may be great. On the other hand, too often they bear the faults of their proprietors, and lack that continuity of tradition which in permanent schools may partially compensate the shortcomings of individual masters. Such schools for boys nowadays are rarely set up by incompetent men; the competition with the permanent schools is too keen both in learning and in play to give much chance to inferior schools, and thus second-rate academies for young gentlemen have for the most part been improved off the earth. Their temptation is the other way; having no permanent fame to keep them open, they must rely on the better kind of advertisement-such advertisement as is given them by success in public class lists. Thus an unhealthy forcing may be carried on, and promising young people injured by a system of pressure and cram. Private schools for boys seem doomed to a gradual extinction, and this section of our subject need not detain us. The establishment of high schools for girls is acting in like manner upon their private schools, and a happy thing on the whole this is, worthy as many of them are. Not infrequently, however, private schools for girls have not been established by teachers of capacity because such is their calling, but by ladies whose means of livelihood have failed them; so that private girls' schools are too often the failures of failures. Not only is the education given in too many of them vapid and jejune, and the tone of them narrow and commonplace, but it is so given as not even to present the indirect benefits of idleness. If in them there is no rioting of animal spirits, there is on the contrary a tedious parcelling of time into fragments, and a like frittering of studies into dead and disjointed morsels, which trifle away the energies of the students and burden their dormant understandings. At such

places the weary round begins with red noses and chill fingers before breakfast, and ends with the foretaste of next day's lessons at night; and after years of this, young ladies go home with no education whatever in the real sense of the word. Unable and even unwilling to think for themselves, full of scraps of knowledge, but empty of all larger conceptions

and principles, their minds treated not as organs but as shallow vessels, they find themselves pushed into the world, not only helpless and unprepared in faculties, but not even with healthy bodies. Half an hour's walk before dinner, all in a row, and drilled into propriety by a governess, is all the exercise and fresh air many of them get. Do we wonder that four-fifths of them may grow up dolls, and the other fifth what Howell calls "sciolous zelotists," and the whole of them flimsy and unhealthy? Happily the high schools are changing much of this. Mental development is preferred to cram, and bodily development is seen to be the condition of a sound and powerful intelligence, and physical education is carried on side by side with mental. All transitions bring harm with them for the time, and it is right to say that the new discovery of the feminine mind, which is the America of the nineteenth century, has blinded us too much to this fundamental need of growth in bone and blood. For a time a certain precocity, as I said before, is attained, but nature will surely return upon us and take a grievous revenge. Personal remarks are odious, but the odium of them may be attenuated by numbers when I venture to say that large bodies of young women of the middle and upper classes in the new colleges present in one aspect a painful sight. Seen all together they impress one with a vision of lamps without oil; mobile features but pale cheeks, soft speaking eyes glaring through glasses, lean and angular bodies, thin restless hands; the blood gone to feed the brain, an overgrown flower on a withering stalk. This may succeed for a time, but for a time only. These women will never be the mothers of heroes, and even now, if they have a fault, it is the lack of that steadfastness, balance, and sanity which give force and permanent value to the qualities of the mind. Still, in the girl-graduate there is much that is very beautiful and very hopeful.

The public school education of boys is excellent, and I would dwell on one feature of it only-that is, the examination system, which has penetrated even into them. I cannot conclude better than by asking you to think how we are to withstand this monstrous growth of examinations, and what we are to discover in its place. Much that is harmful in teaching and I have dwelt on much of it-is not inherent therein, and seems indeed in course of elimination; but the examination system is growing and invading us more and more every year, and threatens to become the upas-tree of modern education. If something cannot be found to replace it and so limit its encroachments, my second-sight of the education of the future is a ghastly one. From cradle to grave, poor humanity is incessantly examined. In elementary schools, as I have said, the class of persons from whom the examiners are taken, and their great superiority in general culture both to teachers and taught, ensure as a rule some considerable breadth of handling. Nor are these Government examinations competitive, and it is the competitive element which is baneful. Too frequently young Britons are filtered through smaller and smaller sieves until their poor brains are attenuated into threads. Examinations, as we have them, find out and force certain kinds of pupils

those of quick and receptive minds. But they positively discourage the more original and the less bookish boys and girls, who certainly may ultimately be at least as useful citizens, and in the services probably more useful than the rest. Even on those who are selected the influence is very harmful. While securing a height of attainments and favouring in the pupil the quick selection of materials, it forms on the other hand a mechanical uniformity of mental mould, and it positively forbids the self-feeding of the mind. The mind is not to be fattened like an ox: it is to thrive like a colt, and to gain activity, endurance, and size by the search for food as well as by the ingestion of it. The mind must forage for itself as well as receive; must search, and not be be crammed. Now, wherever a boy may turn, examinations face him, not mere class tests, which are useful enough, perhaps even desirable as methods of teaching, but competitive examinations, which seem to have every evil in them and no goodness except the incidental merit of displacing jobbery and nepotism. Surely we should find some other substitute than this, for are we not the only European people who submit to this tyranny, even our learned neighbours in Germany knowing little of it?

If by the present paper I could deal two hard knocks, one at the pupil-teacher system, and one at competitive examinations, I should indeed feel I had been of some good in the world, for hitherto I have asserted only that such examinations are injurious to the mind and character. I have yet to say how terribly mischievous they are to the body. That high wranglers at Cambridge are rarely heard of again is a commonplace, and is true so far as this, that only those of great physique and endurance recover the premature exhaustion of the tripos. I believe there is no single agency comparable to competitive examination for straining and exhausting the brain and nervous system, and I regard the individual competition of the Cambridge schools and public services to be most mischievous. At Oxford the mischief is less, partly because the men are not classed individually, partly because the whole strength is not thrown into the final effort. If examinations are to continue, the classes ought to be very large, say one honour class and pass class, and no more. Many good men are now suffering injustice, and the community suffering loss, because the want of high nominal success bars their promotion; their tutors and friends being meanwhile conscious of their superior endowments. It is said that many of the ablest and largest-minded tutors at the universities are beginning actually to encourage those of their best pupils, who have money or other assured means of livelihood, to throw up all competitive work and follow the bent of their own genius. From my personal knowledge of many of them, I can say that a very strong feeling is growing in the minds of these leaders against the competitive system, as being wasteful both of work and health, and anxious thought is being taken how otherwise the promising students may be recognised and the results of their more liberal labours appreciated. A man's reputation in his year often appears even now to be a surer sign of his real value than his place in the tripos, and

some extension of the Thesis system might be devised as a measure of results. Perhaps no one of my hearers will fail to call to mind some poor victim-boy or girl-who was done for by the mocking triumph or desperate rebuff of a public competitive examination. Tremendous efforts are made with no adequate increase in mental growth, but with ill consequences to life and nervous vigour which are conspicuous enough in a large minority, and which are no less baneful to the majority because they are more latent and diffused. The great increase of nervous affections in children is, I believe, due in part to the effect of the examinations their fathers underwent in their youth; and when, as is now coming about, both parents are to go though the fire the results may be frightful. It would be better almost to return to a state of barbarism, for barbarism has a future before it, an exhausted people has none.

NOTES ON INDIGESTION.*

BY DR. BRYAN, F.R.C.S. ENG.

I WAS in hopes that sufficient papers would be given by gentlemen to render it unnecessary that I should prepare one; under some little pressure, how ever, I have done so, but fear that it may be thought on a subject well known to most. I made several attempts to write it, but had so many interruptions that I thought I should give it up. However, imperfect as it is, I now present it to you.

Causes. Indigestible food; quick eating, and too much; constipation; hurrying up from meals; irregular times; drinking too much fluid; a medley; probably immoderate smoking. It proceeds-1st, from impaired organic power of the stomach; 2nd, a deficient or disordered state of the gastric juice; 3rd, impaired absorbing power of the stomach.

Dyspepsia, or indigestion, occurs most commonly between the ages of 20 and 45, and is either primary or secondary, idiopathic or symptomatic, simple or complicated; when complicated, it may have been either the primary or secondary affection.

The first thing to be done in commencing the treatment of dyspepsia, particularly with constipation, is to ascertain if the liver properly performs its functions, and to seek the origin of the dyspeptic symptoms. See that the teeth are in order; that the patient masticates well; ample time for eating; regular hours for meals; food wholesome, plain, and digestible; the condition of the stomach; whether the dyspepsia is primary, or secondary to some other affection. If the stomach is distended, five drops of hydrochloric acid in a tablespoonful of water, after eating, when the stomach feels burdened. To maintain for some time a lax condition of the bowels is absolutely necessary, that not even a temporary block should be allowed to exist in the lower regions. Laxative mineral waters (Carlsbad) are very

* A Paper read at the Autumnal Meeting of the South Midland Branch of the British Medical Association at Wellingboro', 4th October, 1883.

useful, also Cascara cordial (U.S.), confection of senna (Apothecaries' Hall), etc.

The different forms of indigestion will depend upon different states of the stomach, and of its associated viscera as the liver, pancreas, duodenum, or other remote organs; yet seldom manifested by symptoms enabling a close observer to determine which the one actually present :—1st, simple diminution of the functions of the stomach from impaired secretion, weakened contractibility and languid circulation, or asthenia of the organ; 2nd, vascular irritation, not amounting to inflammation.

The more acute and sudden attacks of indigestion are generally consequent on some manifest cause, particularly an overloaded state of the stomach, and when from this source the symptoms soon follow a full meal; there are various uneasy or even painful sensations, as oppression and weight at the epigastrium and heartburn, tongue dry and clammy. When the fit of indigestion occurs during the night, there are frightful dreams or the nightmare, severe pains in the stomach and bowels, and various sympathetic affections, as headache, impaired or indistinct vision, musco volitantes, noises in the ears, and dulness of hearing, palpitations. These attacks are liable to pass into the more confirmed or chronic stages of the complaint. It may proceed in delicate females from other causes, as mental impressions, long fasting, or deprivation of wonted stimuli, in which cases various symptoms occur, viz., debility, mental functions more or less active, sleep disturbed, unrefreshing, heavy, or prolonged, appetite capricious, savoury articles chiefly relished, a full meal accompanied by heaviness, yawnings, disposition to sleep, sensation of fulness, weight, flatulence, eructations, bowels costive or irregular, biliary secretions disordered, palpitation of the heart, pyrosis, glairy matter thrown up, the urine deposits a reddish substance (lithic acid), and if irritative or inflammatory condition of the stomach be present, the fluid is scanty and high coloured; pain and tenderness at epigastrum is a common symptom, connected with fulness; the pulsevariable. There is a sympathetic affection of various organs, as the heart, lungs, liver, etc. Dyspepsia may terminate in restoration to a healthy state of digestion, or pass into severe functional and structural disease of the stomach, as ulceration, morbid disease, cancer, etc. I have had three cases lately of long standing which ended fatally. But the restoration does not occur unless the predisposing and exciting causes are removed, as many of these depend upon habits, desires, and passions, which are controlled with the greatest difficulty. Hence the frequent serious consequences of severe or neglected dyspepsia are to be found, as violent gastrodynia or gastralgia, pyrosis or a glairy fluid, vomiting of a severe prolonged character. But the irritative states of dyspepsia are more common in the male than the female, and are by no means uncommon in this country in hot seasons, and even in very cold weather, and affect chiefly sanguine and bilious temperaments; they are more commonly occasioned by the use of stimulants, highly seasoned food, by stimulating medicine, by hot spices, pickles, Cayenne pepper, etc. (Copland).

The first stage of indigestion is characterised chiefly by a sense of distension of the stomach, by acrid or acid eructations, and flatulence soon after a meal; loss of appetite, and nausea (but they vary with the nature and quantity of the food), bowels costive, sometimes irregular.

With regard to food and drink, tea, coffee, cocoa, and all hot and sweet beverages, must be entirely banished from the dietary, and sherry also placed under the ban. Sound claret and water, or milk mixed with some alkaline effervescing water, are the safest beverages. Much fluid is hurtful. Animal food should be restricted to roast or boiled mutton, the lighter kinds of fish, and a little broiled fat bacon; little butter, Allen and Hanbury's malt farinaceous food, etc. Cathartics are of service in emergencies, in the smallest doses, on an empty stomach, either before dinner in the form of a slowly acting pill, or early in the morning in the form of a more rapidly acting liquid. (Dr. Wm. Brunton.) The principal meal should be taken early in the day, before the nervous system has been exhausted by nervous or bodily exertion. Strychnia is of value it should never be given in the form of pill. (Dr. Arthur Leared.) For loss of appetite: 5 grains of Carb. of ammonia, 15 grs. of bicarbonate of potash, 3iss. of infusion of chiretta, three times a day. For rotten egg eructations, charcoal biscuits and creosote pills, or carbolic acid, are useful.

In all cases of chronic dyspepsia, hygienic treatment, moderate exercise, regular hours, ventilated rooms, and change of air and scene, are of extreme importance. The use of narcotics, and alcoholics in excess, must be abandoned. Only a small quantity of food should be taken at a time, and drinking large quantities of water must be abolished, particularly at dinner.

Heartburn is best treated by rhubarb and magnesia and carbonate of ammonia, blue pill, alkaline solutions in bitter infusions or in lime water, charcoal, and, when attended with rancid eructations, by aromatic mineral, sulphuric acid, or nitro-hydrochloric, in suitable tonic infusions.

I have for some time prescribed lactopeptine, also mistura bismuthi co., which is a combination of liq. bismuthi, nuc. vomic., acid. hydrocyanic. dil., with morphia gr. doses; also a combination (at time of pain and flatulence) of carbonate of soda 5 grs., aromatic spirits of ammonia, 3 i., syrup ginger, 3 i., ess. peppermint 5 minims, hydrocyanic acid (Scheele's) 3 minims, water 3i.-which two remedies seldom fail to give relief.

Abernethy used always to commence with four or five grains of blue pill, h. s., and black draught, mane, as did also my old and valued preceptor, Dr. Robertson, formerly principal physician to Northampton Infirmary.

There is no doubt that the very frequent causes of Indigestion are in having eaten and drunk too much; and although a good deal is to be done by attending to the quality of the food, much more depends upon the quantity. Mixtures of different kinds of food are injurious to digestion.

Then as to the times of eating. In general, five or

six hours should elapse between one meal and another, and the meals regulated according to the necessary occupations and habits of the individual. (Copland.) As a general rule, breakfast about half an hour after rising; and from five to six hours afterwards, dinner; and the most suitable time is about two o'clock for the latter. When dinner is late, tea or coffee should be taken merely as a diluent.

Water is the safest drink, according to thirst; fermented wines, liquors, etc., require restriction; of all drinks, spirituous liquors are the most injurious, and Dr. B. Richardson recommends none to be taken without food. In my own opinion and experience, weak brandy-and-water may be allowed, 3 ss., three times a day.

Of diet and regimen (with reference to different states of dyspepsia) Dr. A. Todd observed that during the asthenic form, the quantity of food should be reduced to the power of disposing of it: a spare diet of animal food, and restricted use of fluids; a bulky meal should always be avoided, and eating discontinued before the appetite is allayed. Take tea or coffee at breakfast, with very little milk and sugar; let very little butter be used; and an egg lightly boiled. Dinner should consist of lean animal food, particularly mutton (game and venison), which ought to be roasted or boiled; rice mixed with the gravy of the meat. Young cabbage or greens, Brussels sprouts, cauliflowers, or French beans may be allowed. The wines best suited for indigestion are old dry sherry and the finer kinds of claret diluted with water.

I will now draw to a close, for fear of cloying you with too much matter, and hope I may have given a few hints to some of you, my medical brethren, as after a period of over half a century I may be supposed to have picked up some facts and wrinkles.

HURRY, WORRY, AND MONEY.*

BY T. PRIDGIN TEALE, M.A., F.R.C.S., &c., &c.
(Continued.)

ANOTHER point in which there is apparent ground for justification of the Department are the facts stated by Mr. Mundella, that "the school life of English children is the shortest in Europe, and the requirements of the English educational code are the lightest." This defence is open to a double reply. First, the fact that on the Continent educational codes prevail of greater severity than the English code is no proof whatever that the English is not injurious in its effect upon the health of teachers and pupils in this country. Second, if it be proved that the foreign codes are more severe than the English, and it can be further proved that they produce no harm to health, then the conclusion is not unreasonable that on the Continent the science by which educational requirements are brought into harmony with growth, development, and health has

An Address delivered at the Social Science Congress, Huddersfield, October, 1883.

attained a point of perfection from which the English educational system is separated by a long interval.

On the other hand, what evidence have we that in this respect of national health something is wrong in the educational machinery?

In the first place, within the last few weeks of the Session the subject has been three times discussed in Parliament, and the Education Department has been three times placed in an attitude of defence. Such questions would hardly have been raised by our responsible legislators were there not a very strong under-current of dissatisfaction, and a presumption that there were grounds for this dissatisfaction. In the second place, facts are being collected, one-sided facts perhaps, by persons not themselves engaged in tuition, and are being published in pamphlets which reflect a widespread feeling of unrest: notably I may mention the pamphlet by the Rev. R. A. Armstrong, of Nottingham, on "Over-pressure in Education; and a second by Lieut.-Col. J. A. Digby, of Dorchester, on "Hothouse Education." The first of these gives a vivid picture, supported by numerous statements, of the strain that is put upon elementary teachers, and forcibly shows how the primum movens of the whole educational system is a refined mechanical distribution of the Government grant. "Payment by results," or, in the paraphrase of its first great advocate, "once place a man's ear within the ring of pounds, shillings, and pence, and his conduct can be counted upon with the greatest nicety."

The second pamphlet deals rather with higher education.

A third current of public thought finds vent in the daily journals, in leading articles, and in correspondence. I rarely take up a journal, medical or otherwise, without finding some contribution to this discussion. In the correspondence a letter now and then in defence of the system appears, but the bulk of the evidence, much of it from experienced and competent persons, is condemnatory of "results." Of the articles written in the journals it is rare indeed to find a sentence in palliation of the present system. Let me in the fourth place speak of a stream of thought which cannot easily be measured, as it does not often present itself through the press-I mean the conviction in the minds of members of the medical profession, a consensus of skilled opinion, that the educational machinery of the country is at present moving on wrong lines, on lines tending not unfrequently towards injury of health. There has been no polling of medical opinion on this point, but there has been plain speaking by members of my profession whose opinion on such matters must carry weight. For my own part, for some time past, long before I was aware that I might be called upon to give this address, I had been observing, collecting opinions and observations of others, and, whenever an opportunity presented itself, had been conversing with members of the medical profession on the bearing of education upon health. As a result of this I may declare the almost unanimous opinion of all those with whom I have conversed to be that education, so called or miscalled, at the present day, from the highest to the lowest, is doing injury to the

health and nervous system of very many of the rising generation.

As to elementary education, my own observations have chiefly been made upon female pupil-teachers who, from failure of health, strength, or eyesight, have sought my advice, and on inquiring into the work they have to do, and the series of examinations they have to pass, I was simply horrified at the refinement of human slavery and torture that had been invented and was being carried out in this civilised country.

*

The nation can hardly realise what is the life of these pupil-teachers. Apprenticed to their calling at the age of thirteen or fourteen, they spend five and a half hours a day in the fatiguing work of drilling little children in their lessons, and in trying to maintain their attention. They then have to spend the rest of a day, commencing at eight o'clock in the morning, until eight, nine, ten, and before examinations, even eleven o'clock at night, "ay, and even twelve, many a one," as said a schoolmaster, with scanty time for meals, and almost none for recreation, grinding away at their miserable treadmill, in order, not to improve their minds, not to develop their faculties, but to meet the demands of an inexorable examination. This, bad as it may be in the case of boys, is more acutely wrong in the case of girls, coinciding with that critical. period of their physical development which intervenes between girlhood and womanhood, when the physique is most sensitive to conditions affecting health and growth, and when the foundation of a healthy or a weakly womanhood is laid. Verily the present scheme for female pupil-teachers must have been invented by men, not by women, and certainly without the sanction of the medical profession. I am aware that the enormous and sudden demands resulting from the rapid extension of primary education have rendered the pupil-teacher a necessity; that the evils of the system are now being recognised; and that Mr. Mundella, in his speech on the Education Estimates, rejoiced in the rapid diminution of the numbers of pupil-teachers. Yet this is but an extreme instance of what in its degree is going on as to overwork of teachers and overpressure of the children in many elementary schools. A system which can formulate and tolerate the one is hardly likely to lend a sympathetic ear to the complaints of overwork by the others.

Enough has been advanced surely to convince a reasonable mind that the time has arrived when the nation should review its position in reference to primary education in order to retain and increase, if possible, the mighty advantages it has secured through the Education Act, and to eliminate what has become or tends to become injurious, and to weaken the educational progress of the country.

It is clear that the working of the Education Acts, in relation to their effect on the nervous system of children and the younger teachers, has to be inquired into; and it appears to me that some such questions as the following should be widely put by judicious

* Now changed to fourteen. † Now reduced to five hours.