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J. A. (Joel Asaph) Allen.

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M. Sternberg, U. S. A.; J. Rufus Tyron, U. S. N.; Walter Wyman,
U. S. M. H. S.; Drs. J. Ford Thompson, Charles Hagner, Louis
Mackall, J. Taber Johnson, T. Morris Murray, G. Byrd Harrison,
and Jos. II. Byran.

JEJntertainments. — Dr. G. Wythe Cook, Chairman ; Drs. G. N.
Acker and Thos. E. McArdle.

Registration. — Dr. Carl H. A. Kleinschmidt, Chairman ; Drs.
John S. McLain and Johnson Eliot.

Railroads. — Dr. H. L. E. Johnson, Chairman ; Drs. E. L.
Tompkins and J. Foster Scott.

Printing. — Dr. Llewellyn Eliot, Chairman ; Drs. Thomas N.
Vincent and F. B. Bishop.

Halls and Ejchibits. — Dr. H. H. Barker, Chairman ; Drs. J. T.
Winter and C. M. Buchanan.

Ways and Means. — Dr. C. W. Richardson, Chairman ; Drs.
John Van Rensselaer, Wm. Dillenback, Henry B. Deale and Wm,
Compton.

Information. — Dr. W. Sinclair Bowen, Chairman ; Drs. E.
Oliver Belt and F. S. Nash.

Hotels. — Dr. Geo. S. Ober, Chairman; Drs. Wm. E. Handy and
D. O. Leech.



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Buffalo Medical i' Surgical Journal

Vol. XXXIII. OCTOBER, 1893. No. 3.

©rlglriaP eKcJcJreAA.



SCHOOL-LIFE AND PHYSICAL DEVELOPMENT.^

By LOUIS A. VVEIGEL, M. D., Rochester, N. Y.
President of the Medical Association of Central New York.

It is quite the proper thing at the present day to indulge in physi-
cal culture. The merchant, the professional man, the clerk and
the artisan fd|ls it his duty to atone for sins against his personal-
ity by exercise.

Well-equipped gymnasia and facilities for athletic sports of
various kinds are at his command, which enable him to indulge in
physical culture according to his taste and fancy. Learned disser-
tations upon the necessity of exercise to overcome the direful
effects of our enervating mode of life exist in profusion ; and in
perusing them one is led to believe that in exercise alone is to be
found the universal remedy for the violations of the laws of Nature.
We have no desire to underestimate the good that may be accom-
plished by properly regulated exercise ; at the same time, it may
not be out of place to give a little consideration to natural physical
development in contradistinction to the artificial.

It goes without saying that the early years of life are preemi-
nently the ones in which the body may and should be developed in
a natural way. It is also the period during which proper physical
development is most easily interfered with. During the very early
periods of life, it may be assumed that Nature is usually allowed
to have her sway, and is unhampered in her efforts to gradually
bring about a nicely adjusted coordination of the functions of the
body. But as the child of Nature advances in years, the time for
artificial education arrives, which means that it must be subjected
to conditions entirely at variance with its former habits of life, and

1. President's address delivered before the 26th annual meeting of the Medical Asso-
ciation of Central New York, held at Rochenter, N. Y., June 16th.



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130 WEIGEL : SCHOOL-LIFE AND PHYSICAL DEVELOPMENT.

which may or may not exert a deleterious influence upon its physi-
cal development, according to circumstances.

In taking up the question of school-life and its effect upon
physical development, we are confronted with a difficult task, for
it is not an easy matter to determine to what extent premature or
close mental application is responsible for defective bodily vigor.
Investigations instituted with this object in view, must of neces-
sity be general in character, and cannot take into account the in-
dividual, however desirable this might be. Our schools are made
up of children in all stations of life, and thus represent the average
of a given community. It is by a study of this average that we
are enabled to arrive at some conclusion with reference to the per-
fection or imperfection of a system of education, in so far as it
affects the health of children.

It is said that " our modern system of education imposes too
great demands upon the young organism in the critical period of
its growth ; that it seeks too one-sidedly to stiqyulate mental
growth, and that the physical development is thereby so neglected
that great dangers arise to the body, as well as to the closely
related mental health." Let us briefly examine these cfiarges
against our school system.

It is obvious that statistics with reference to the health and
physical development of school children, to be of any value, must
include a large number. Investigations of this character have
been made in several foreign countries and the results published.
Thus, in 1881, a fundamental research was instituted in Copen-
hagen, and its result was so significant that a special hygienic com-
mission was appointed to examine the conditions of health in all
the schools of the country. This commission has examined nearly
15,000 boys from the middle or preparatory schools, and
3,000 girls in private schools, in reference to their health,
and has measured and weighed them. The results of these re-
searches show that boys pass through three different periods of
growth : First, a moderate increase in their seventh and eighth
years ; second, a weaker growth from the ninth to the thirteenth
years, and a much more rapid increase in height and weight from
their fourteenth to sixteenth years, or during the period of puberty.
The growth continues after the last period, but more slowly.

The development of girls, also, presents distinct periods, but
the changes occur a few years younger than in boys. Comparing
the subject by stations in life, it was found that the more rapid



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W£I6£L : SCHOOL-LIFE AND PHYSICAL DEVELOPMENT. 131

growth begins a year earlier in the children of well-to-do classes
than in those of the poorer classes. Scanty and hard conditions of
life are restrictive and hindering to the growth of children. The
growth of the poorer children previous to puberty is prolonged at
the cost of the latter. It is as if something hindered these chil-
dren from entering their period of more rapid development in the
same year of life as the children living in better circumstances.
The development of puberty is delayed in them, but as soon as it
is begun it goes on with increased rapid ity» and in spite of the de-
lay, is completed in the same year as it is in better situated chil-
dren.

It is an interesting question, and especially important in rela-
tion to education, whether the growth of children goes on evenly
during the different seasons in summer and winter. Researches
show that children exhibit a relatively light growth from the end
of November to the end of March. This period, which includes all
the winter months, is followed by a second, from the end of March
until July or August, during which children grow rapidly in
height, but their increase in weight is reduced to a minimum.
After this follows a third period continuing to the end of Novem-
ber, in which the increase in height is very small, but the gain in
weight very large ; the daily accession of weight is often three
times as great as during the winter months.

Investigations by this same commission among school boys as
to the percentage of illness, demonstrated the fact that during the
period of weak growth, which precedes the coming on of puberty,
and during which pupils are passing through the preparatory or
low classes of the schools, the power of resistance of the youthful
organisms against external influence is diminished.

During the period of development of puberty, on the other
hand, when the youthful life is approaching maturity with all its
swelling force, the capacity for resistance rises from year to year,
the liability to illness falls, reaching its minimum in the last year
of that period. Immediately afterwards sets in another period of
diminished capacity for resistance, which usually includes the last
years of school-life ; the very time when the greatest demands are
made upon the pupil.

The percentage of illness among girls is even greater than
among boys, as it was found that sixty-one per cent, of the whole,
all belonging to the well-to-do classes, were ill or affected with
serious chronic disorders. Such a condition of affairs, growing



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132 WEIGEL : SCHOOL-LIFE AND PHYSICAL DEVELOPMENT.

worse in the years preceding paberty and daring its beginning,
while it is not materially improved in the last years of the period,
certainly deserves careful attention.

Professor Key, of Stockholm, in commenting upon this, says :
^ The amount of work, sitting still, etc., exacted of the girl, is not
consistent with her health during her growing time. Without go-
ing into particulars as to the influences injurious to the health of
growing children, which proceed from their homes, or may be
brought out in connection with the school and school- work, it is
still manifest that the burden of work that children have to bear
under the present school regulations far exceeds what is permis-
sible, and is, to a large extent, responsible for the liability of
school children to illness."

It may be objected that statistics regarding the condition of
children in some foreign countries do not apply to American boys
and girls ; that in this country the social surroundings and general
mode of life are better. We are said to be better fed and better
housed. Be this as it may, it cannot be denied that the nervous
strain to which children are subjected in this country, both in and
out of school, more than counterbalances our boasted advantages
in other directions.

In this country no extensive researches have been made to
show the relation of school-life to growth and health. Most of the
investigations I am familiar with were made with the object of
obtaining data for special purposes.

I should suggest that physicians, particularly in the larger com-
munities, institute inquiries in a systematic and thorough manner,
so that, eventually, we may be able to determine in what manner
physical development and growth during the critical periods of
childhood and youth are influenced by school-life. Similar re-
searches in rural districts would be valuable for a comparative
study of the influence of city and country life upon children dur-
ing the years they attend school.

It would also be of interest to extend our inquiries to children
in reformatories and other institutions, where the daily routine of
life is, perhaps, painfully regular. In reformatories we would find
a class of children who grow up under less restraint, and in whom
the natural propensities and impulses have been to a larger extent
unchecked. We would probably find that good physical develop-
ment is the rule.

In collecting data, the special points to be considered are age,



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WSIGBL: SCHOOItLIFE and physical D£y£LOPMBNT. 133

sex, weighty rate of growth as between boys and girls of the same
age, rate of growth at different periods of school-life, the percent-
age of illness, and its nature, whether functional or organic, etc.,
etc. By collecting observations bearing upon these points, we
will eventually be able to pass judgment upon the merits and value
of certain systems of education, and to determine to what extent
the health of children is affected by them.

As Professor Key says : << It is incumbent on us to see with
all possible care that the growth of youth during their years of
puberty, which is so full of importance, is not disturbed or dis-
torted by any influence adverse to Nature. But as instruction is
now arranged, at school and at home, we should first of all direct
attention to the phase of a child's age immediately preceding the
period of puberty, when the growth is at its lowest, the child's
capacity for resistance is weak, and his liability to illness increases
from year to year. We must learn how to obviate this liability to
illness, and it is for science to forge the weapons with which to
doit."

It is not within the scope of this paper to dilate upon the
various diseases and malformation for which the exactions of the
school-room are responsible ; you are all familiar with them. It
may not be out of place, however, to say a few words upon the
subject of prophylaxis. As already stated, there exists a popular
notion that physical exercise is a universal remedy, applicable to
the child as well as to the adult. Our educators seem to realize
that the health of children is affected by long-continued mental
application, and attempt to provide relaxation by the introduction
of physical exercise, in the shape of calisthenics, or some other
gymnastics. But such exercises, as usually practised, fall far short
of what is actually required, and may be mildly termed a farce.
Is it not true that the very children who need physical exercise the
most, take the least interest in what is intended for their physical
betterment ? This is, perhaps, due to the fact that the methods
adopted are not sufficiently recreative in character, or are too
difficult of execution. As Lagrange well says : << It is obvious
that difficult exercises cannot be recreative. This is still a great
reproach to our gymnastics, when we undertake to apply it to
children subjected to school-work, and who have so great need of
amusement and distraction in the intervals between their studies.
It is not a relaxation that the brain of a child can find in these
methodical exercises, but, rather, one lesson more added to so



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184 WEIGEL : SCHOOL-LIFE AND PHYSICAL DEVELOPMENT.

many others. Among the movements of our gymnastics, those
which are not hard enough to discourage the child by long
apprenticeship, are so destitute of interest that they repel by their
monotony. Such, for example, are the * floor' exercises. Forty
children, ranged in three lines, wait, with erect body and fixed
eye, the command of the master. Then, all together, at his order,
turn the head first to the right, then to the left ; they count aloud,
one, two, three ; and, while counting, extend their arms, bend
them, raise them, drop them ; then the legs have their turn, and,
finally, the trunk and loins. All these motions are very hygienic,
but where is there a place for transport and joy in that cold
discipline, that fixes the features and effaces the smile, in those
insipid gestures, of which the slightest distraction would destroy
the grouping. Yet, to the pupil, pleasure is not only a moral
satisfaction ; it is a hygienic element, indispensable to his health.
To impose on a child exercises in which he will find no pleasure,
is more than a want of solicitude — it is an offense against
hygiene." Furthermore, he says : " Our artificial methods of
gymnastics are not favorable to the physical education of children,
because they are athletic, and not hygienic, methods. They look
especially for strong subjects to make champions of them, when a
good hygiene should look for weak subjects to make strong ones
of them." We must not forget that the weak form a large
majority of the children of the present generation. Our children,
so precocious now in their mental development, are far behind in
their bodily growth. They need methods of education adapted
to their weak physical aptitudes. This is the capital fault of
artificial and difficult methods. They do not bring exercise within
the reach of children. They are, properly speaking, methods of
" selection." They subject children to a sort of trial, taking the
strongest to make athletes of them, but leaving the weakest, or the
great majority, delivered to all the physical and moral woes that
re derived from want of exercise.

Artificial and difficult exercises are to natural exercises what,
in mental education, the higher instruction is to primary and
secondary instruction. Physical education has its " grades," as
well as mental education, and we commit an error when we
reverse them.

We do not, perhaps, sufficiently appreciate the true relation
between the muscular and nervous systems. Long ago, Dubois-
Reymond reminded us of the fact that all bodily exercises are



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W£igel: school-life and physical development. 136

really exercises of the central nervous system, the brain and spinal
cord. It is true, a certain amount of muscular power is necessary
for exercise, but this is not all. A man may have the muscles of
a Hercules, and still be unable to stand or walk, to say nothing
of executing more complicated movements. For instance, simple
intoxication is sufficient to deprive him of the power to codrdinate
his movements properly. Every action of our bodies, as a
locomotive apparatus, depends more upon a correct coordination
of the muscles than upon the strength of their contraction. The
real mechanism must be located in the central nervous system ;
consequently, exercise of muscles is essentially an exeicise of the
nervous system. A harmonious development of these two systems
is necessary, for, as Maudsley says : " He who is incapable of
guiding his muscles is incapable of concentrating his mind."

Recognizing 4.he applicability of artificial gymnastics, especially
the machine variety, to children, it may be a question whether it
is desirable or wise for our boards of education to add gymna-
siums, with their elaborate appliances, as a part of a school outfit,
or to engage teachers of gymnastics, who are an expensive and
unnecessary luxury. It would be no great loss to dispense even
with the aesthetic Delsarte system. We are already provided with
a perfect gymnasium. We have plenty of lawns, shady streets,
public parks, etc., where children may indulge in gymnastics best
suited to them, that is, natural, unrestrained movement. You
will, no doubt, agree with me that a half-hour's unrestrained
exercise in the open air accomplishes more good than any amount
of artificial work.

In all natural movements we use a large number of muscles at
once, and we sometimes bring into action those which are very
remote from the point where the work appears to be localized.
Active games constantly tend to the division of the work among
a large number of muscles. This is the consequence of the very
character of natural exercise. Being copied from instinctive acts,
of which they are simply the methodical regulation, they will
present the same character of causing the human machine to
execute much work without demanding much effort from it. The
hygienic quality of exercise is not effort, but rather work. The
more work we do, the more we stimulate the great vital functions,
notably, respiration, and the circulation of the blood.

There is one more point to which I call your attention. In
order to indulge in physical exercise, either in the shape of



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136 \V£IGBL : SCHOOL-I/IFE AND PHYSICAL DEVELOPMENT.

gymnastics or games, a certain amount of mascnlar power is
necessary. Now, occasionally we find a child so exhausted, both
physically and mentally, that it is utterly impossible for it to
make any muscular effort. Its nervous system has been subjected
to such a degree of tension, that any form of exercise would
simply throw an additional burden upon it, and add fuel to the
fire. Such children are never at rest, not even during sleep ; they
toss about the whole night, and arise in the morning exhausted,
instead of refreshed. They have indulged in involuntary muscular
exercise at a time when Nature intended them to be at rest. In
such cases, a mode of life which would place the child, to a certain
extent, in a passive condition, would be far more beneficial than
enforced activity.

Our American method of living is one of ceaseless activity,
and the time may come when we will be forced to acquire the
ability to rest, which we certainly do not have now.

In briefly presenting these points, I intended them to be
suggestive in character. You all realize that the subject is a
prolific one, and one upon which there is, perhaps, a great deal of
misconception. By making investigations, as indicated, we may
be better able to fit the demands of the child's organization to its
strength and capacity of resistance during the different periods of
his growth; better able, than we are now, to devise means to
promote his health and physical development. One hundred
years ago, the author of school hygiene introduced his warning
against a too early and too sudden strain upon the physical
powers of the mind and body, with these words : ** Yet, spare
their fibers, spare their minds' strength ; waste not upon the child
the vigor of the man that is to be."

43 Mortimer Street.



Migraine. — Migraine may be relieved, Lucking says, with a pill,
twice daily for some time, consisting of Indian hemp one-sixth
grain, phosphate of zinc one-tenth grain, and arsenic one-thirtieth
grain. The severity of the attack may be effectually diminished
with liquor trinitrine, in minim doses, two or three times daily. —
N'. Y. Med. Hecord,



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COTT : INTUBATION. 137

©rigiriaP (sommumcatioriA.



INTUBATION.*

By GEORGE F. COTT, M. D.,
Instructor in Laryngology, University Dispensary, Buffalo, N.Y.

The object of this paper is not to produce something new,
bat principally to call your attention to some important feat-
ures of intubation, together with the experience of different
operators.

I must necessarily confine my remarks to acute affections of
the larynx in children requiring intubation, and will incidentally
allude to its practicability in laryngeal stenosis of the adult.

I will not take up your valuable time with an historical sketch
of intubation, since every practitioner is more or less familiar
with it ; it is sufficient to state that the O'Dwyer tubes are the
only practicable ones for general use at present, giving by far the
most satisfactory results, and bidding fair to hold first place in-
definitely. In the following remarks, therefore, I will consider
their use only.

The question, whether a child would not do as well if left
alone, is pertinent and deserves some notice. I do not always con-
sider the operation one of necessity as regards the saving of life,
but principally to relieve obstructive breathing. No doubt, many
children in whose larynx a tube had been inserted, would recover
without it, but the agony caused by the want of air, before the
child becomes delirious, must be fearful. I have been called upon
to intubate when the previously attending physicians said <' The
patient may die or may recover. I have seen some do one and
some the other ;" but did not advise intubation to relieve the
most urgent symptom, obstructive breathing. Since jotting down
these notes, I have been talking with other medical men, and
have learned that many consider relieving stenosis to be entirely a
secondary matter and has no bearing whatever upon the final
result. In my opinion this is a grave mistake. Any operator can
trace recoveries directly to this mechanical intervention. Even
though the child dies, the parents are very much relieved when
they know the little patient has not suffocated. If you take into
consideration the suffering a child endures, no rest, no sleep for



1. Read before the Roswell Park Medical Club.



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138 COTT : INTUBATION.

two or three days, what a relief it was to find in every instance the
little patient fast asleep before you have cleaned the instruments and
left the house. I, therefore, maintain that in all cases of laryngeal
stenosis, pseudo membrane or no pseudo membrane, if life is
threatened, insert a tube, and if the child dies, it will certainly die
happy. Then again, the tube serves another purpose. In diphtheria^
for instance — for in that disease principally we are called upon to
intubate — when the membrane does not extend to the bronchi, the
pressure exerted upon the surface surrounding the tube causes
maceration of the pseudo membrane and itis consequent expulsion
by coughing, thereby preventing its active absorption. The argu-
ment advanced by those not inclined to interfere, that dyspnea is
often observed after as well as before operating because the mem-
brane rapidly extends into the trachea and bronchi, holds good in
a limited number of cases only. Dr. O'Dwyer has examined a
large number of cases po8^mortem, in which stenosis was marked,
even though the tube was still in the larynx; he found great swelling
of mucous and submucous tissue, the false membrane playing an
unimportant part in the obstruction.

A peculiar relaxation of tissue occasionally occurs after a tube



Online LibraryJ. A. (Joel Asaph) AllenBuffalo medical journal → online text (page 14 of 78)