Our growing children : with special reference to the physical education of the weakly

Preface

At a time when those who are responsible for the elementary education of the children of the people are waking up in England to the vast importance of a definite scheme of physical education (in this late realisation of their responsibilities being behind other nations), there is some danger that the special claims of the weakly children may be overlooked. I have attempted in these few pages to indicate the general principles which it is necessary to have in mind when arranging the physical education of children, but especially of the weakly.

I have ventured to deal with the serious matter of lateral curvature of the spine, and it is to be distinctly understood that in doing this I presume that every parent or guardian having charge of a child who is the subject of this deformity, will, when possible, place the child under the personal care of a surgeon practised in both orthopaedic surgery and the special gymnastic exercises adapted for each patient ; but such surgeons are at present very few in number, and it will often

VI.

Preface.

be necessary to rely upon unprofessional treatment. I trust that this little book may prove of use to those who have charge of such children, whether they be professed teachers of physical exercises, or parents.

No one “ system ” can be set up for the treatment of children with muscular faults and their resulting deformities ; a “ system ” presupposes that all the children under care are alike, and there is only one condition in which this can be the case — I mean when the children are normal and perfectly healthy ; under these conditions a defined system is a possibility, and that employed (though with less accuracy and care than could be wished) by our Board Schools is an excellent method. But the weak and faulty child, in a physical respect, needs to be studied apart.

During my experience in treating cases of spinal deviations and other faults in growing children, I have been so struck by the ignorance of parents and others in these matters, that I have undertaken the present work.

GERARD SMITH, M.R.C.S.

37, Gloucester Place ,

Portman Square , London. IV.

December, 1895.

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OUR GROWING CHILDREN.

WITH SPECIAL REFERENCE TO THE PHYSICAL EDUCATION OF THE WEAKLY.

CHAPTER I. Formation of Habits— General Effects of

Muscular Work — Postural Faults

School Hygiene — Seats and Desks— Eye- Strain in Schools.

Ihe possession of a well-developed and symmetrical boay may not be an absolute necessity for the due execution of intellectual work, and doubtless many men and women exist and have existed with undeniable intellectual powers, housed in weak and imperfect bodies ; but it is also certain that a boy or girl with a healthy, strong, elastic and symmetrically developed muscular system, a body which is well under the control of its inhabitant, has a decided advantage over the weakly child, since brain workexhausts the strong less than the weak ; and a good

i physical groundwork keeps at a distance much of that terrible over -sensitiveness which parents and others so proudly boast of as “ a highly strung nature” — the modern habit of purely intellectual people, which when fully fixed keeps them in a life-long state of suffering from exaggerated conceptions of both joys and troubles, favours and offences, realities and romances. Such persons live in alternations of impossible optimism and equally untenable pessimism, their want of physical groundwork preventing even their intellectual self-control.

The object, indeed, of all physical training is the attainment of symmetry of body conducing to health, and also the training of the muscles to obey accurately the will ; not only for the sake of securing in after life the free and graceful (because unlaboured) combined movements, but also as part of the education of the brain cells in the habit of obedience to the will.

The formation of habits is a real structural work, the brain cells are actually modified by the repeated direction of the will, intercommunicating nerve paths are marked out in the brain which did not exist in the untaught infant ; at every repetition of a movement or set of associated movements, the cells act more readily and with less effort of the will in directing them, for the nerve paths become more clearly marked out, and impressions tend to slide more readily along them, until in time the movements or combined actions become almost unconscious or automatic. They have become habits, bad or good ; they possess the body, which loses control of them. Transfer the picture to the intellectual sphere, and we see the same formation of mental habits as is found in the less mysterious muscular training. The easily repeated muscular movement has its analogue in the ready recalling of memories and words, things stored up in the brain cells.

But this is entering upon too serious ground. What really concerns us in this connection is, that the muscles may be trained to obey the will, as may every other voluntary faculty ; and, moreover, that in muscular exercise we have a means of modifying the activity of the wear and repair of the body. The muscles aie the lesponsible agents of all vital actions and reactions; they are the seat of those changes upon which depend the due temperature of the body, as upon their activity depends the removal of waste and injurious matters from the blood, muscular contractions enforcing the circulation of the blood, and through it of all other circulations in the body. Digestion, absorption, secretion and elimination are dependent upon muscular work for their perfect performance.

The first effects of active movements are the obvious quickening of the respiration and pulse, on account of the more rapid using up of the tissues this more rapid combustion causing a demand for an increased supply of oxygen, just as with a furnace more air is drawn in to complete combustion. This oxygen must be supplied by the lungs, hence the breathing becomes more rapid, and with this the circulation of blood through the lungs becomes more free (the blood being the carrier of oxygen to the tissues, taking up, as it does, the oxygen in the lungs) the heart meets the demand by increased action.

A man lying down, having a pulse of about 66, will, on sitting up, increase the pulse to about 70, and on standing up to about 75 or 80, simply because each position is one in which more muscular action takes place than in the former one. And this increase of respiration and circulation are reciprocal, or should be, in a state of health, neither being hurried beyond the demands of the other. In the well trained athlete this reciprocal action is properly educated, though even in him, the first rapid effort of running, for example, leads to some increase of the rate of breathing before the heart rises to meet the demand. As he goes on, however, sooner or later he gets what is called his “ second wind,” which means that he is no longer out of breath, as the heart and lungs have struck a just balance of action, and he can now go on until his strength is exhausted if need be — and increased supply of oxygen means more rapid waste of tissues, and therefore more rapid formation of waste products, chiefly of carbonic acid gas, which must be removed by the lungs, or it collects in the blood, blocking the free interchange of oxygen in the lungs.

This means carbonic acid poisoning, the chief symptoms of which are the retarding of the blood in the right or respiratory side of the heart, and the blockage of the breathing evidenced by laboured breathing and a blueish colour of the surface. The distressed state of a person undertaking violent exercise when not in fit condition, is not, therefore, one to be lightly regarded, and the occasional death of an elderly person during unusual exertion is proof of this danger. Elderly people may safely take even violent exercise, if from childhood upwards they have never given it up for any length of time, but it is seldom in this working age that such is the case. Few men or women are able to keep the due reciprocal action of heart and lungs equable for violent exercise after their young days.

It will be evident also that other organs besides the lungs will have a more free supply of blood during exercise, and thus many excretory organs, such as the kidneys and skin, perhaps loaded with waste products waiting for removal, will be enabled to throw off their burdens. We are always at work poisoning ourselves, unless by exercise we clear the excretory organs, and if we duly perform this duty our bodies are ready for taking in fresh supplies of fuel, appetite keeps up, and health results.

Sensations of weakness are not always the result of over-exertion ; many people feel continually out of tone, and come to the doctor for that refuge of the drug worshipper, a “ tonic ” ; they get the idea that more food is required, they take this at extra times, and perhaps add the most burdensome substance of all carbons — alcohol — to their food, in order to gain strength, thus piling on the blockage of the blood still more. It must be recognised that the feeling of languor and weakness is one of the results of the accumulation in the blood of our self-poisons, and that exercise removes these and gives refreshment and vigour.

Our brains, the organ of mind, partakes in these results. Blockage in the brain cell is not always only the result of absorbing cranky and exhausting ideas, but is often simply due to want of muscular exercise. The mind will not keep clear, and our life and expressions will not be the reflex of our true selves if we allow this blockage; regular, free and boylike exercise is the means of attaining to a real self-control, mental and physical.

The increased blood supply to a moving muscle is felt at the commencement of exercise as an aching or stiffness, the muscle swells up with blood. This is felt in healthy muscles, but passes off, as they get their “second wind” and the blockage passes away; the muscles then work on until fatigue from want of fresh food supply comes on. A weak muscle, however, will tire without this preliminary stage of swelling up with blood and consequent aching ; the weaker muscles may be equal to a slight and short effort with less aching than is felt by the strong ones, any slight aching in the muscles early in an exercise is, therefore, rather a sign of healthy circulation than the reverse, and those who feel no such swelling of the muscles are often persons who soon get exhausted.

The first steps in the education of the infant consist of learning to direct the movements of the limbs at the bidding of what can at first be scarcely termed its will, since the efforts are little more than mere reflex actions ; when the eyes have learned to rest upon an object, or to follow a bright light the hands instinctively try to grasp what the eyes have recognised. At first the movements are not accurate, but are apparently aimless, and this wandering and jerky movement is only slowly replaced by direct and successfully aimed movement. The brain cells concerned in the various actions have to be educated and to be connected by nerve paths or threads which this education forms, from cell to cell. When this stage is attained the mere reflex movements, such as the closing of the hand when the palm is touched, or the movement of the eyes in following a light become will-directed and attain their aim. This process of path making among the brain cells is the habit forming before mentioned.

The infant is constantly on the move ; it quivers with little muscular thrills and jerks, undirected or misdirected nerve discharges, and during the whole of child life this fidgetiness is the natural state. A healthy child cannot keep still for more than a very few moments. Such an effort is a task for a child it is work, to be learned by degrees, and if too much stillness be demanded of a child, exhaustion and irritability is the result. Those who have to teach children should remember that movement is a child’s rest, and enough of it should be scattered amongst the lessons.

The matter of what is called “over-pressure” in school work is not in my present scheme, but I may remark that I think the danger is not in the actual amount and number of the tasks set, as it is in the cast iron system of grading on the competitive lines which keeps anxious and conscientious children in a life-long state of worry, and fear of coming failure and catastrophe. Dull and stupid children, who have been told almost from their birth that they are the best and most faultless darlings the world has ever seen, and no children can ever equal them, will not suffer thus ; but the clever, sharp, and therefore nervous child, who at the same time has not been praised too much, will not have a happy school life. There are also those most unhappy ones who have talents only in some special direction, and who are not capable of learning in other lines, who have to suffer very greatly because nobody ever discovers what their brains are fit for. The mental sufferings of such children are severe and pitiful.

Over pressure at school is inevitable in our day, and will continue to be so for all classes of children who will have to work for their living ; the choice has to be made by the majority of parents between the mental health for the child and its progress amongst its fellows. One or the other is likely to suffer, except in the case of the children of the wealthy, whose education may take as much time as is convenient, and may proceed in the natural and gradual way, since there is no hurry for them to be thrown out on the world to get their living.

We have it in our power, however, to do much towards minimising this evil, by insisting upon a fair alternation of physical and mental occupation in school. After school hours, at all ages up to fully io years, lessons should cease, no home work being taken away to worry over up to bed time ; there should be plenty of time allowed before bed time for all trace of lesson worry to evaporate from the brain. Before, after, and during lesson hours, there should, at all ages before 15 years, be sprinkled shorter or longer intervals of physical exercise, which should be compulsory — especially with girls, who are more apt than boys to resent active exercise ; indeed, girls suffer more from over brain work than boys for many reasons ; a healthy boy, no matter what he may be doing, at the instant the bell rings to close school, will shut up his book and his brain at the same moment and rush off to his play, but the girl will soberly walk home, pondering upon her chances in some coming examination, or of getting the better of another girl, or of other worries connected with her lessons ; she is both more ambitious and more conscientious than the average boy, and has more of the competitive spirit in matters intellectual.

Below 7 years of age, all work should be play ; from 7 till 12, brisk play should be put in short periods between the head work, and up to 15, there should always be at least half-an-hour given up to active exercise, in the course of the five hours which should constitute a day’s brain work.

This is not a treatise upon school hygiene, so I will pass over the matters of diet and clothing, &c. I suppose that I ought to apologise for having so rashly entered upon the realm of intellectual work in children, but we do still worship those sad cases of pathological intellects ; there is only one sight more sad than that of a precociously learned childf and that is the preternaturally religious infant — both are diseased products.

There are certain faults of school-life, on the physical side entirely, to which we must direct attention ; the first in importance are those faults of posture seen so often in children. Every position taken in school should be part of muscular education, for every position of the human body is produced by muscular action, and this should be symmetrical and balanced by the due action of opposing muscles or sets of muscles.

The most fertile source of faulty postures in school are seats and desks constructed upon wrong principles ; a child may be absolutely forced into bad positions by bad seats and desks, positions which lead to permanent deformity of the spine, if they are such as unequally exercise the muscles attached to that part.

We do not need luxurious seats for school children, which would encourage lazy habits of sitting ; seats with backs fitting into every curve of the back up to the neck, take away the responsibility of the muscles to retain a healthy sitting position, but the angle of the seat with the back, and the shape and slope of the back of the seat must be such that the child has a constant hint of what is the correct position, the base of the spine, the pelvis, must be held upright upon the two natural points of bone on which we sit — the tuberosities of the ischium as they are called — and the angle which the back of the seat makes with the seat itself is responsible for this matter ; the seat itself must so slope that the child naturally slides back against the back support. I am strongly in favour of a seat with a low back support which is inclined backwards only slightly, and is so shaped that the natural hollow of the last section of the spine is filled up when the child sits upright.

Fig. 2 gives an idea of the faulty position of the spine due to too low a seat.

Fig- 1 is Liebrich s scat and desk, with adjustable foot-rest, the chair raised or lowered on movable boards. This seat and desk is the best which I know of.

The position of the feet is secured by a foot board at a natural slope, and children should be made to use this when at work ; the desk must be at such a height that the arms rest upon it naturally when sitting upright, and the edge of the desk must come near enough to the child to enable him to read easily from the book when sitting upright ; this necessitates a slope for the desk, which would be too sharp for writing purposes ; some means of raising the lid, or a separate support on the lid, must therefore be made. It is obvious that as children vary in height and in proportions, these various parts must be adjustable, as also must the distance between the desk and the seat ; there are many good forms of such desks and seats on the market, amongst which the best as regards price, &c., can be chosen.

I am speaking of healthy children, and therefore hesitate less in advising the low back support ; if a weakly child needs a high support, it should be such as may be used or not, at will ; the seat may be as I have just described, with the addition of a slightly sloping continuation of the back.

Fig. 2.

In writing, the child cannot see the work well it sitting upright, since the paper must rest on the desk ; the child therefore leans straight forward, but only slightly and straight from the hips, not bending the spine much. I fear that I am on delicate ground

H when I speak of the position which the paper should occupy, because the old-established conventional position is very dear to many teachers : the paper straight before the pupil in the middle line, its edge parallel with that of the desk, the elbow close to the side, the hand pointing straight forwards ; but I believe that this position is an extremely constrained and faulty one, obliging the child to so twist the spine that it takes a serious faulty posture ; or, if the child does not do this, he places the paper more to hie right, thus securing a possible position for the writing hand, but being forced to crane the neck sideways, and overwork his eyesight.

The natural position of the arm, when the pen is held easily and placed upon the desk, is slightly away from the side, with the hand slanting slightly across the chest, and this is the proper position for the hand in writing ; the paper must be made to follow this, and be sloped accordingly, the bottom left hand corner slightly approaching the body ; this gives an easy position, the paper easily seen, the hand in a natural position, and the writing a legible and neat slope. Or the paper may be sloped the opposite way, the bottom right hand corner downwards, and the child and seat turned to the right, the paper being to the right hand of the writer.

As to this position in writing, I am rash in entering the arena; my own handwriting is the worst possible, due to the fact that much of my leisure school time was occupied in writing reams of impositions, the value of which as correctives of my various evil tendencies was computed, not from what they taught me, but from the number of lines accomplished, a most absurd and inefficient method of punishment. Whilst testing for the best form of seat and desk, and position in sitting, for the school child, a very important matter will arise — it is the question of the eyesight in children at school ; it is a fact, that all the influences which go to form the myopic or short-sighted eye, may exist in school ; comparatively few persons become short-sighted in mature years (excepting, of course, in old age), many cases of the defect of short sight no doubt come on during school life, as the result simply of weak health. With perhaps, in the case of the poor, insufficient food, and other debilitating causes, thete remain, however, a large proportion of cases which might have been prevented by attention to the position of the child, and the lighting of the schoolroom.

Too long hours at work, of course, can be passed over as too obvious causes; size and clearness of print is anothei matter to be attended to, especially in the case of the German language; the making of maps upon too small and detailed a scale is another fault too often found ; the object of maps should only be to teach the broader characteristics of coast outline, &c. ; small handwriting, with (in the case of girls) fine needlework, come also under consideration.

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All these things lead to eyestrain, and before the sight gives in, there will very often be found headache ; eye-strain being the most common cause of headache in school children, a child may be, quite unconsciously to itself, over working its eyes and the headache may be the only symptom of the fact ; but the young eye has a great power of working at short range, and children will get a habit of holding the eyes too close to their work if not corrected by being kept in proper sitting position, for eyes can be trained in a very short time to work at 7/«natural range. In lighting school rooms, the windows must be placed at both the back and sides of all rooms which are too deep for one set of windows to light the furthest end ; the windows should reach to near the ceiling, and should be square at the top, not tapering off to a point, whilst outside there should be no ornamental overhanging eaves or other obstructions to the entrance of light from the sky. If it be necessary to modify the light (and the room should admit direct sunlight for at least some part of the day) the blinds should be of a semi-translucent material, and not of any of the primary colours, a neutral tint being the best — brilliant primary colours tire the eyes by the one set of vivid impressions.

It is an absolutely essential rule that no child should face the light when reading or writing, and black boards should be placed so that the light does not o-et reflected from them to the eye, or any shading of

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1 7 the eyes from stray light be needed ; the surface of such boards should be dead black, and not glossy. It should be distinctly understood that the eye is capable of being altered in shape by efforts to focus objects at short or long range, and that this effort, if long continued, brings about a permanent alteration in the form of the globe of the eye, and establishes the long or short sight.

Of course, many cases of long sight from short eyes, or short sight from long eyes, are the result of hereditary faults, but they may also be made out of naturally normal eyes by such errors as I have enumerated. Astigmatism, or inequality of curve of the front of the eye (the cornea), is an affair of heredity and will be identified by the oculist.

It is obvious that the occasional performance of systematic muscular exercises at intervals during school time, will be the best relief to the eyes possible.

I cannot enter upon the large subject of the ventilation and warming of the room, my object being only to deal with matters affecting posture and muscular movements in children.

The faulty posture taken by the child who has acquired short sight by the habit of working the eyes at short lange, or by any other cause, is one which will often pioduce squinting, the eyes converging towards the work ; this is another reason why we must ensure a good relative position of the eyes and the

work so that the eyes may be approximately parallel in working.

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CHAPTER II. General Arrangement of the Chief Muscles

A TEACHER of remedial exercises must have at least an elementary knowledge of the points of attachment and action of the muscles which may be at fault and need educating, and in the slight outline which follows, it must be understood that I am writing only for the uninitiated, and that this has no pretence to be anything but a mere enumeration of the muscles, with their positions and actions.

The names of the muscles are fixed by very old anatomical customs, and we cannot well attempt to translate them into plain English, which is apt to be very much longer in expressing these things than is the Latin ; I shall keep mostly to the old names here, but the names of the muscles are of no importance, so long as the teacher carries in the mind a picture of their positions and uses.

The minute microscopical characteristics of muscular fibre, and the phenomena of contractility upon which depend the action of muscles, would be out of place here, all those matters can be learned from books on physiology. I will content myself by saying that the action of a muscle consists in shortening, so that the two ends of the muscle move nearer to each other when a stimulus is sent down the motor nerve supplying the muscle, whether that stimulus be at the command of the will, or the reflex effect of any other external influence. If both ends of a muscle be movable, obviously both the parts to which it is attached will move when it contracts, but as a rule, one end is fixed by the action of other muscles, when the special action of any muscle is called out, so that only one end is free to move. The arm, for instance, may move when the shoulder is fixed. Again, many muscles are fixed to the body at one end, and to a limb at the other; or in other parts they may be fixed to a heavier part at one end than at the other, the lighter weight will then be moved. The fixed end of a muscle is called its origin, the movable one its insertion, and these two are interchangeable at will ; for example, the muscles in front of the chest called the pectorals, when pulling the arms towards the chest, as in rowing, have the fixed point or origin at the chest, the arms being the moving end ; but if the hands grasp a bar over-head, and these muscles pull they raise the body from the ground, the movable’ point being then the body.

The state of rest in muscle is not one of absolute relaxation, that is, when we are in the waking condition ; during sleep it is probable that the voluntary muscles are absolutely at rest and quite relaxed, but when awake, even when a man is perfectly still, the muscles are in a state of slight and constant contraction, a condition of what is well called “tone,” and a state from which as a starting point, the condition of shortening and actual work can be immediately called forth by the will ; it is evident that, unless this state of readiness existed, the first part of the contraction would be wasted in bringing the muscle to the necessary position of tone. It is probable that when a man is weak and wants “ tone ” his muscles really are in the condition of sleep, and his feeling of slackness depends upon a true state of this kind ; more effort is required in such a state in order to do muscular work. The absence, or exaggeration of this tone is indeed a very valuable index to the physician or surgeon, of certain states of the nervous system ; the position of the patient in this respect being tested by galvanism.