c.—a.

[A.PPENDIX F

Medical Officers report further development in the adoption of the organized " sit-down " school lunch and the provision of hot cocoa. The rest and adequate time for eating lunch has resulted in the children enjoying better digestion and greater clearness of brain in the, afternoon session. Tooth-brush drill, although beset with some practical difficulties, has also been more widely adopted. Teachers who have once tried it say that they would never give it vp —great improvement in the atmosphere of classrooms being one only of the beneficial results. One, Medical Officer has reported a remarkable reduction in the amount of inflammation and congestion in the children's throats, which was apparently attributable to no other cause but the removal of septic matter as a result of tooth-brush drill. The relation between dental disease and inflammatory conditions of the throat is already well established. Medical Officers report the inadequate provision in schools for the education of backward children and those with defective speech and hearing. This matter is, I understand, engaging the attention of the Department. There are reported to bo too many mentally defective children in the public schools, for whom other provision should be made. The subject of the excessive employment of children outside school-hours has been fully reported upon by some officers. In dairying districts it is remarkable how tired and sleepy the children are during school hours owing to the amount of farm-work performed by them in the early hours of the day. It has been humorously suggested that in some sohools it would bo a kindness to provide dormitories rather than class-rooms. Certainly, in the interests not only of the education but of the health of these children, it is important that during the years of active growth some restriction of the amount of work performed by them, should be imposed. While further provision for treatment is the most immediately urgent, the most important need is for prevention. To provide the treatment for a defect is not to remove its cause. It may bo safely said that the causes of the commonest and at the same time the most serious defects found in children are known, and that their removal is practicable. Up to the present comparatively little has been done to educate the public on these matters. It cannot be too strongly emphasized that the general public is lamentably ignorant of the rudimentary principles of the healthy upbringing of children. As most of the defect and poor health in school-children is duo to causes operating in the pro-school period, no system which concerns itself only with children of school ago can effectively deal with the problems of child-health. An elaborate and costly scheme of dental treatment, for instance, is now being instituted by the Department, the work of which will bo endless unless fundamental causes are dealt with. The causes of dental disease, the most widespread and far-reaching of all defects, are dietetic, and operate mainly from birth onwards. Not to deal in a most thorough and comprehensive manner with the first six years of life, when the foundations of the future citizen's physique are being laid, is, even from the limited point of view of the Government's expenditure, and much more so from the standpoint of adult national efficiency, like maintaining the proverbial hospital at the foot of a precipice instead of erecting a fence at the top. In the building of a child's physique the first six years are of much greater importance than those of the school-going period. The effect of errors of nutrition in these early years can never in later life be wholly remedied. If satisfactory child-welfare, work is to bo accomplished it is imperative that an organized supervision of the pre-school period be instituted. In infancy and early childhood there is an appalling wastage of human life and health which the Government is vainly attempting to cope with at a later ago when the results of error and .malnutrition are more permanently established, and consequently more difficult to remedy or often completely irremediable. The pro-school period is for practical purposes, divided into two parts- infancy, or the first one and a half to two years, and the period from two to six years. In the infancy period irreproachable work is being done by the Plunket Society. This is in fact a unique organization, and is being quoted, in almost every country in the world as a modol in infant care. Its work, however, is not sufficiently widespread. The Plunket Society receives Government support in the form of a subsidy, but it will be necessary to effect a more complete linking-up and more active co-operation between its activities and those, of the school medical system. By an extension of the clinics and home-visiting work of the, Plunket nurses, by practical, mother-craft teaching to the older girls in school, and by more active general propaganda by Medical Officers specially suited for the work, the infancy period can, I think, be effectively dealt with. The intervening pre-school period can be approached by much the same methods, and through the increasing number of day and residential nurseries. These institutions would serve as media through which the children and consequently their parents could be reached. In general, much more prominence will require to be given to educative propaganda work —by articles in the Press, for instance, by the cinema, and by public lectures. A commencement has already been made through the Press, but further active propaganda by other methods is certainly needed. There is every indication of the hopefulness of such educational work. It is unquestionable that parents are interested in the health and well-being of their children, and that they are anxious for guidance in these matters. It has been unfortunate that up-to-date information on the subject has not been available to the public to the extent to which its importance warrants. As regards the children, 1 have given thirty or forty addresses to them in the schools, and have found them most receptive and eager to acquire information on the care of their health. I have no hesitation in saying that when taken in the right way there is no difficulty in inspiring the average school-child with enthusiasm for the cultivation of health and fitness. As regards the teaching of hygiene to school-children, this has been inadequate, mainly on account of. the teacher having insufficient guidance as to what to teach. There is no single book which contains the necessary up-to-date information It will bo necessary for the Department to issue a booklet on the health of children and its teaching in schools. In conclusion, I beg to emphasize that " the health of the people is a country's greatest asset," and that in childhood the most serious problems of national health arc to be solved. In New Zealand 60 per cent, of the adult male population recruited under the ballot system were not even in moderately fair health. The New Zealand birthrate is 24 per 1,000, the Japanese 34 per 1,000. In spite of the fact that New Zealand has the lowest infant mortality in the world, nearly eight hundred infants die here every year in their first year of life, and nearly eighteen hundred children die every year before they are five years old—that is, five every day ! This wastage of life is small as compared with the wastage of health and efficiency in those who grow up. The health of the people has become one of the most urgent and vital problems, and upon its successful solution depends not only our national prosperity, but even the future existence of our race. I have, &c, E. 11. Wilkins, The Director of Education, Wellington. Chief School Medical Officer.

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