Chapter Five Expanding Children’s Health

Still, as of 1906, much of the public health focus on children’s health remained on reduction of infant mortality. But concerns about children’s health did not end when the child turned one year old. Brunton argued that school-age children had to be part of the calculus of the expanding networks of public health. In fact, as children grew older and left home for school, typically at the age of five, they were often exposed to more ecological hazards stemming from the urban penalty than they were in a home laden with the detritus, dung, and dust that attracted flies. When they left home, children were subjected to the poor air quality and the lack of sunlight that Cantlie so vehemently feared.

At the same time, as children entered the public sphere while attending school, this also afforded public health authorities new opportunities to monitor the child for signs of neglect and malnourishment and to provide the child with a healthy course of physical education. While children were in schools, public health officials had greater access to children, which allowed them to observe and provide interventions without creating the perception of the state invading the privacy and intimacy of the home. Just as infants were monitored in their homes by regular health visits, in schools a young child’s diet could be monitored to ensure they received necessary nutrition, and public health authorities could measure a child’s physical development at regular intervals. Lastly, as James Kerr, the School Medical Officer for the London County Council, hoped, the classroom provided a space to teach children vital lessons on good hygiene, much like health visitors taught lessons to their mothers at home.3Mooney, Intrusive Interventions, 95. Thus, schools played an important, complementary role to home health visits in public health campaigns targeting English children. The growth of school medical programs, especially after the findings of the Report of the Inter-departmental Committee on Physical Deterioration and culminating in the establishment of the School Medical Service in 1907, demonstrates an ever-increasing attention paid to children’s health, while also inviting us to consider new ways in which public health campaigns were expanding in the early twentieth century.

Studying the history of public health in schools also engages with the third stage of my argument – about the shifting administrative center of public health. Although the original responsibility for implementing school-based public health programs was largely left to local authorities, these programs highlight the growing role of the state in promoting preventative public health. School-based public health campaigns engaged two separate branches of local government: the Medical Officers of Health, who reported to municipal governance and the Local Government Board and were responsible for domestic and municipal public health administration city-wide, and School Medical Officers, who were employed by the Board of Education and were responsible for managing in-school programs.

Officially, School Medical Officers were responsible for examining students on admission to school to determine their “fitness both for the mental work of the school and for the physical training required, to attend to any cases of illness that might arise, to arrange for the isolation of infectious diseases . . . and to report, from time to time, to the governors any [environmental] circumstances that may imperil the hygienic safety of the children.”4Mackenzie and Matthew, The Medical Inspection of School Children, 2. School Medical Officers often worked in tandem with the local Medical Officer of Health.5Sometimes these positions were combined and the responsibility to serve as a School Medical Officer was added to the work of the Medical Officers of Health, but more commonly these were separate positions held by two different people. A School Medical Officer investigated outbreaks of infectious disease in schools and notified the Medical Officer of Health about any diseased students, and the Medical Officer of Health then proceeded to investigate the sanitary conditions in their home. In turn, when a Medical Officer of Health received reports of an infectious disease in a household, they would notify the education authority, so that a School Medical Officer could ensure that the potentially infectious child was removed and excluded from school.6Reynolds and Wyatt, Seventh Annual Report of the Education Committee, 168–69. In Manchester, as an example, this reciprocal relationship worked especially well. While the administration of the school medical service was separated from the administration of the municipal public health, the full-time School Medical Officer, Dr. Brown Ritchie, reportedly worked “in perfect harmony” with the local Medical Officers of Health.7Report of the Inter-departmental Committee on Medical Inspection and Feeding of Children, 1:16. The need for this partnership in public health was obvious as both Medical Officers of Health and School Medical Officers sought to protect the health of English children from the ecological and economic dangers of the urban penalty during their critical developmental years. Yet, as we will see, occasional bureaucratic roadblocks did periodically complicate this important partnership.