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apt to lay the foundation of a constant craving for something which is
only too likely to take the form of alcoholic craving in later years.
It is impossible for the stomach to perform its duty satisfactorily if
it is never allowed rest, and the introduction of stray morsels of
food at irregular times prevents this, and introduces confusion into
the digestive work, because there will be in the stomach at the same
time food in various stages of digestion.

Warmth. - Warmth is one of the influences essential to health and to
sound development, and although artificial warmth is more urgently
required by little children and by old people than it is by young
adults, still, if their bodies are to come to their utmost possible
perfection, they require suitable conditions of temperature. This is
provided in the winter partly by artificial heating of houses and
partly by the wearing of suitable clothing. Ideal clothing is loose of
texture and woven of wool, although a fairly good substitute can be
obtained in materials that are made from cotton treated specially.

This is not the time or place in which to insist on the very grave
dangers that accompany the use of ordinary flannelette, but a caution
must be addressed in passing to those who provide clothing for others.
In providing clothes it is necessary to remember the two reasons for
their existence: (1) to cover the body, and (2) as far as possible to
protect a large area of its surface against undue damp and cold.

Adolescents, as a rule, begin early to take a great interest in their
clothes. From the time that the appreciation of the opposite sex
commences, the child who has hitherto been indifferent or even
slovenly in the matter of clothing takes a very living interest in it;
indeed the adornment of person and the minute care devoted to details
of the toilet by young people of both sexes remind one irresistibly of
the preening of the feathers, the strutting and other antics of birds
before their mates.

Girls especially are apt to forget the primary object of clothing, and
to think of it too much as a means of adornment. This leads to
excesses and follies such as tight waists, high-heeled shoes, to the
ungainly crinoline or to indecent scantiness of skirts. Direct
interference in these matters is badly tolerated, but much may be
accomplished both by example and by cultivating a refined and artistic
taste in sumptuary matters.

Sleep. - Amongst the most important of the factors that conduce to
well-being both of body and mind must be reckoned an adequate amount
of sleep. This has been made the subject of careful inquiry by Dr.
Dukes of Rugby and Miss Alice Ravenhill. Both these trained and
careful observers agree that the majority of young people get far too
little rest and sleep. We have to remember that although fully-grown
adults will take rest when they can get it in the daytime, young
people are too active, and sometimes too restless, to give any repose
to brain or muscle except during sleep. In the early years of
adolescence ten hours sleep is none too much; even an adult in full
work ought to have eight hours, and still more is necessary for the
rapidly-growing, continually-developing, and never-resting adolescent.
It is unfortunately a fact that even in the boarding schools of the
well-to-do the provision of sleep is too limited, and for the children
of the poor, whose homes are far from comfortable and who are
accustomed to doing pretty nearly as their elders do, the night seldom
begins before eleven or even twelve o'clock. It is one of the saddest
sights of London to see small children dancing on the pavement in
front of the public-houses up to a very late hour, while groups of
loafing boys and hoydenish girls stand about at the street corners
half the night. There is little wonder that the morning finds them
heavy and unrefreshed, and that schoolwork suffers severely from want
of the alert and vigorous attention that might be secured by a proper
night's sleep.

Great harm is done by allowing children to take work home with them
from school; if possible, the day's work should finish with school
hours, and the scanty leisure should be spent in healthy exercise or
in sleep.

Overcrowding. - In considering the question of adequate sleep it
would be well to think of the conditions of healthy sleep.

For sleep to be refreshing and health-giving, the sleeper ought to
have a comfortable bed and an abundant supply of fresh air.
Unfortunately the great majority of our people both in town and
country do not enjoy these advantages. In both town and country there
is a great deficiency of suitable dwellings at rents that can be paid
with the usual rate of wages. In consequence families are crowded into
one, two, or three rooms, and even in the case of people far above the
status of day labourers and artisans it is the exception and not the
rule for each individual to have a separate bed. The question of
ventilation is certainly better understood than it was a few years
ago, but still leaves much to be desired, and there is still an urgent
necessity for preaching the gospel of the open window.

Exercise. - In considering the question of the exercise of
adolescents, one's thoughts immediately turn to athletics, games, and
dancing. As a nation the English have always been fond of athletics,
and have attributed to the influence of such team games as cricket and
football not only their success in various competitions but also their
success in the sterner warfare of life. This success has been obtained
on the tented field and in the work of exploring, mountaineering, and
other pursuits that make great demand not only on nerve and muscle but
also on strength of character and powers of endurance.

Team games appear to be the especial property of adolescents, for
young children are more or less individualistic and solitary in many
of their games, but boys and girls alike prefer team games from the
pre-adolescent age up to adult life. It is certain that no form of
exercise is superior to these games: they call into play every muscle
of the body, they make great demands on accuracy of eye and
coordination, they also stimulate and develop habits of command,
obedience, loyalty, and _esprit de corps_. In the great public schools
of England, and in the private schools which look up to them as their
models, team games are played, as one might say, in a religious
spirit. The boy or girl who attempts to take an unfair advantage, or
who habitually plays for his or her own hand, is quickly made to feel
a pariah and an outcast. Among the greatest blessings that are
conveyed to the children of the poorer classes is the instruction not
only in the technique of team games but also in the inoculation of the
spirit in which they ought to be played. It is absolutely necessary
that the highest ideals connected with games should be handed down,
for thus the children who perhaps do not always have the highest
ideals before them in real life may learn through this mimic warfare
how the battle of life must be fought and what are the characters of
mind and body that deserve and ensure success. It has been well said
that those who make the songs of a nation help largely to make its
character, and equally surely those who teach and control the games of
the adolescents are making or marring a national destiny.

Among the means of physical and moral advancement may be claimed
gymnastics. And here, alas, this nation can by no means claim to be
_facile princeps_. Not only have we been relatively slow in adopting
properly systematised exercises, but even to the present day the
majority of elementary schools are without properly fitted gymnasia
and duly qualified teachers. The small and relatively poor
Scandinavian nations have admirably fitted gymnasia in connection with
their _Folkschule_, which correspond to our elementary schools. The
exercises are based on those systematised by Ling; each series is
varied, and is therefore the more interesting, and each lesson
commences with simple, easily performed movements, leading on to those
that are more elaborate and fatiguing, and finally passing through a
descending series to the condition of repose.

The gymnasia where such exercises are taught in England are relatively
few and far between, and it is lamentable to find that many excellent
and well-appointed schools for children, whose parents pay large sums
of money for their education, have no properly equipped gymnasia nor
adequately trained teachers. When the question is put, "How often do
you have gymnastics at your school?" the answer is frequently, "We
have none," or, "Half an hour once a week." Exercises such as Ling's
not only exercise every muscle in the body in a scientific and
well-regulated fashion, but being performed by a number of pupils at
once in obedience to words of command, discipline, co-operation,
obedience to teachers, and loyalty to comrades, are taught at the same
time. The deepest interest attaches to many of the more complex
exercises, while some of them make large demands on the courage and
endurance of the young people.

In Scandinavia the State provides knickerbockers, tunics, and
gymnasium shoes for those children whose parents are too poor to
provide them; and again, in Scandinavia there is very frequently the
provision of bathrooms in which the pupils can have a shower bath and
rub-down after the exercises. These bathrooms in connection with the
gymnasia need not necessarily be costly; indeed many of them in
Stockholm and Denmark merely consist of troughs in the cement floor,
on the edge of which the children sit in a row while they receive a
shower bath over their heads and bodies. The feet get well washed in
the trough, and the smart douche of water on head and shoulders acts
as an admirable tonic.

Another exercise which ought to be specially dear to a nation of
islanders is swimming, and this, again, is a relatively cheap luxury
too much neglected amongst us. Certainly there are public baths, but
there are not enough to permit of all the elementary school children
bathing even once a week, and still less have they the opportunity of
learning to swim. There is much to be done yet before we can be justly
proud of our national system of education. We must not lose sight of
the ideal with which we started - viz. that we should endeavour to do
the best that is possible for our young people in body, soul, and
spirit. The three parts of our nature are intertwined, and a duty
performed to one part has an effect on the whole.




CHAPTER III.

CARE OF THE ADOLESCENT GIRL IN SICKNESS.


If measured by the death-rate the period of adolescence should cause
us little anxiety, but a careful examination into the state of health
of children of school age shows us that it is a time in which
disorders of health abound, and that although these disorders are not
necessarily, nor even generally, fatal, they are frequent, they spoil
the child's health, and inevitably bear fruit in the shape of an
injurious effect on health in after life.

That the health of adolescents should be unstable is what we ought to
expect from the general instability of the organism due to the
rapidity of growth and the remarkable developmental changes that are
crowded into these few years. Rapidity of growth and increase of
weight are very generally recognised, although their effects upon
health are apt to be overlooked. On the other hand, the still more
remarkable development that occurs in adolescence is very generally
ignored.

As a general rule the infectious fevers, the so-called childish
diseases - such as measles, chicken-pox, and whooping-cough - are less
common in adolescence than they are in childhood, while the special
diseases of internal organs due to their overwork, or to their natural
tendency to degeneration, is yet far in the future. The chief troubles
of adolescents appear to be due to overstress which accompanies rapid
development, to the difficulty of the whole organism in adapting
itself to new functions and altered conditions, and no doubt in some
measure to the unwisdom both of the young people and of their
advisers.

This is not the place for a general treatise on the diseases of
adolescents, but a few of the commonest and most obvious troubles
should be noted.

The Teeth. - It is quite surprising to learn what a very large
percentage of young soldiers are refused enlistment in the army on
account of decayed or defective teeth, and anyone who has examined the
young women candidates for the Civil Service and for Missionary
Societies must have recognised that their teeth are in no way better
than those of the young men. In addition to several vacancies in the
dental series, it is by no means unusual to find that a candidate has
three or even five teeth severely decayed. The extraordinary thing is
that not only the young people and their parents very generally fail
to recognise the gravity of this condition, but that even their
medical advisers have frequently acquiesced in a state of things that
is not only disagreeable but dangerous. A considerable proportion of
people with decayed teeth have also suppuration about the margins of
the gums and around the roots of the teeth. This pyorrhoea
alveolaris, as it is called, constitutes a very great danger to the
patient's health, the purulent discharge teems with poisonous
micro-organisms, which being constantly swallowed are apt to give rise
to septic disease in various organs. It is quite probable that some
cases of gastric ulcer are due to this condition, so too are some
cases of appendicitis, it has been known to cause a peculiarly fatal
form of heart disease, and it is also responsible for the painful
swelling of the joints of the fingers, with wasting of the muscles and
general weakness which goes by the name of rheumatoid arthritis. In
addition to this there are many local affections, such as swollen
glands in the neck, that may be due to this poisonous discharge. One
would think that the mere knowledge that decayed teeth can cause all
this havoc would lead to a grand rush to the dentist, but so far from
being the case, doctors find it extremely difficult to induce their
patients to part with this unsightly, evil-smelling, and dangerous
decayed tooth.

The Throat. - Some throat affections, such as diphtheria and quinsy,
are well known and justly dreaded; and although many a child's life
has been sacrificed to the slowness of its guardians to procure
medical advice and the health-restoring antitoxin, yet on the whole
the public conscience is awake to this duty. Far otherwise is it with
chronic diseases of the tonsils: they may be riddled with small cysts,
they may be constantly in a condition of subacute inflammation
dependent on a septic condition, but no notice is taken except when
chill, constipation, or a general run-down state of health aggravates
the chronic into a temporary acute trouble. And yet it is perhaps not
going too far to say that for one young girl who is killed or
invalided rapidly by diphtheria there are hundreds who are condemned
to a quasi-invalid life owing to this persistent supply of poison to
the system.

Another condition of the throat which causes much ill-health is well
known to the public under the name of adenoids. Unfortunately,
however, many people have an erroneous idea that children will "grow
out of adenoids." Even if this were true it is extremely unwise to
wait for so desirable an event. Adenoids may continue to grow, and
during the years that they are present they work great mischief. Owing
to the blocking of the air-passages the mouth is kept constantly open,
greatly to the detriment of the throat and lungs. Owing to the
interference with the circulation at the back of the nose and throat,
a considerable amount both of apparent and real stupidity is produced,
the brain works less well than it ought, and the child's appearance is
ruined by the flat, broad bridge of the nose and the gaping mouth. The
tale of troubles due to adenoids is not even yet exhausted; a
considerable amount of discharge collects about them which it is not
easy to clear away, it undergoes very undesirable changes, and is then
swallowed to the great detriment of the stomach and the digestion. The
removal of septic tonsils and of adenoids is most urgently necessary,
and usually involves little distress or danger. The change in the
child's health and appearance that can thus be secured is truly
wonderful, especially if it be taught, as it should be, to keep its
mouth shut and to breathe through the nose. In the course of a few
months the complexion will have cleared, the expression will have
regained its natural intelligence, digestion will be well performed,
and the child's whole condition will be that of alert vigour instead
of one of listless and sullen indifference.

Errors of Digestion. - From the consideration of certain states of
the nose, mouth, and throat, it is easy to turn to what is so often
their consequence. Many forms of indigestion are due to the septic
materials swallowed. It would not, however, be fair to say that all
indigestion is thus caused; not infrequently indigestion is due to
errors of diet, and here the blame must be divided between the poverty
and ignorance of many parents and the self-will of adolescents. The
foods that are best for young people - such as bread, milk, butter,
sugar, and eggs - are too frequently scarce in their dietaries owing to
their cost; and again, in the case of many girls whose parents are
able and willing to provide them with a thoroughly satisfactory
diet-sheet, dyspepsia is caused by their refusal to take what is good
for them, and by their preference for unsuitable and indigestible
viands.

A further cause of indigestion must be sought in the haste with which
food is too often eaten. The failure to rise at the appointed time
leads to a hasty breakfast, and this must eventually cause
indigestion. The food imperfectly masticated and not sufficiently
mixed with saliva enters the stomach ill-prepared, and the hasty rush
to morning school or morning work effectually prevents the stomach
from dealing satisfactorily with the mass so hastily thrust into it.

There is an old saying that "Those whom the gods will destroy they
first make mad," and in many instances young people who fall victims
to the demon of dyspepsia owe their sorrows, if not to madness, at any
rate to ignorance and want of consideration. The defective teeth,
septic tonsils, discharging adenoids, poverty of their parents and
their own laziness, all conspire to cause digestive troubles which
bear a fruitful crop of further evils, for thus are caused such
illnesses as anæmia and gastric ulcer.

Constipation claims a few words to itself. And here again we ought
to consider certain septic processes. The refuse of the food should
travel along the bowels at a certain rate, but if owing to
sluggishness of their movements or to defects in the quality and
amount of their secretion, the refuse is too long retained the masses
become unduly dry, and, constantly shrinking in volume, are no longer
capable of being urged along the tube at the proper rate. In
consequence of this the natural micro-organisms of the intestine cease
to be innocent and become troublesome; they lead in the long run to a
peculiar form of blood-poisoning, and to so many diseased conditions
that it is impossible to deal with them at the present moment. The
existence of constipation is too often a signal for the administration
of many doses of medicine. The wiser, the less harmful, and the more
effectual method of dealing with it would be to endeavour to secure
the natural action of the bowels by a change in the diet, which should
contain more vegetable and less animal constituents. The patient
should also be instructed to drink plenty of water, either hot or
cold, a large glassful on going to bed and one on first awaking, and
also if necessary an hour before each meal. Steady exercise is also of
very great service, and instead of starting so late as to have no time
for walking to school or work, a certain portion of the daily journey
should be done on foot. Further, in all cases where it is possible,
team games, gymnastics, and dancing should be called in to supplement
the walk.

Headache. - Headache may be due to so many different causes that it
would be impossible in this little book to adequately consider them,
but it would not be fair to omit to mention that in many cases the
headache of young people is due to their want of spectacles. The idea
that spectacles are only required by people advanced in life is by
this time much shaken, but even now not only many parents object to
their children enjoying this most necessary assistance to imperfect
vision, but also employers may be found so foolish and selfish as to
refuse to employ those persons who need to wear glasses. The folly as
well as selfishness of this objection is demonstrated by the far
better work done by a person whose vision has been corrected, and the
absolute danger incurred by all who have to deal with machinery if
vision is imperfect. Among other causes for headache are the defects
of mouth, throat, stomach, and bowels already described, because in
all of them there is a supply of septic material to the blood which
naturally causes headache and other serious symptoms.

Abnormalities of Menstruation. - The normal period should occur at
regular intervals about once a month. Its duration and amount vary
within wide limits, but in each girl it should remain true to her
individual type, and it ought not to be accompanied by pain or
distress. As a rule the period starts quite normally, and it is not
until the girl's health has been spoiled by over-exertion of body or
mind, by unwise exertion during the period, or by continued exposure
to damp or cold, that it becomes painful and abnormal in time or in
amount.

One of the earliest signs of approaching illness - such as consumption,
anæmia, and mental disorder - is to be found in the more or less sudden
cessation of the period. This should always be taken as a
danger-signal, and as indicating the need of special medical advice.

Another point that should enter into intimate talk with girls is to
make them understand the co-relation of their own functions to the
great destiny that is in store. A girl is apt to be both shocked and
humiliated when she first hears of menstruation and its phenomena.
Should this function commence before she is told about it, she will
necessarily look upon it with disgust and perhaps with fear. It is
indeed a most alarming incident in the case of a girl who knows
nothing about it, but if, before the advent of menstruation, it be
explained to her that it is a sign of changes within her body that
will gradually, after the lapse of some years, fit her also to take
her place amongst the mothers of the land, her shame and fear will be
converted into modest gladness, and she will readily understand why
she is under certain restrictions, and has at times to give up work or
pleasure in order that her development may be without pain, healthy,
and complete.




CHAPTER IV.

MENTAL AND MORAL TRAINING.


The years of adolescence, during which rapid growth and development
inevitably cause so much stress and frequently give rise to danger,
are the very years in which the weight of school education necessarily
falls most heavily. The children of the poor leave school at fourteen
years of age, just the time when the children of the wealthier classes
are beginning to understand the necessity of education and to work
with a clearer realisation of the value and aim of lessons. The whole
system of education has altered of late years, and school work is now
conducted far more intelligently and with a greater appreciation of
the needs and capacities of the pupils than it was some fifty years
ago. Work is made more interesting, the relation of different studies
to each other is more adequately put in evidence, and the influence
that school studies have on success in after life is more fully
realised by all concerned. The system of training is, however, far
from perfect. In the case of girls, more particularly, great care has
to be exercised not to attempt to teach too much, and to give careful
consideration to the physiological peculiarities of the pupils. It is
impossible for girls who are undergoing such rapid physiological and
psychical changes to be always equally able and fit for strenuous
work. There are days in every girl's life when she is not capable of


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