Experimental Open-air Class, Regent’s Park

This is Dr Halliday Sutherland’s Report on Working of Experimental Open-Air Class in Regent’s Park. It appeared in the first annual report of the St Marylebone Dispensary for the Prevention of Consumption.

The Open-Air Class in Regent’s Park opened on January 19th, 1911 and continued for two months, being discontinued owing to the difficulty of finding a suitable teacher and of providing a salary from parents’ contributions of 6d. per week. Thanks to Miss Broadbent and the Charity Organisation Society, the class re-opened on June 12th, under more satisfactory conditions, Mrs. Fitzgerald a teacher of fourteen years experience being appointed, and the salary guaranteed for a period of seventeen weeks. Camp-chairs, foot-warmers, rugs and a table have been presented by Miss Broadbent, Sir Eric Barrington, Dr. J. Edward Squire and by Miss Mortlock Brown respectively. Through the kindness of Mr. Debenham, the Mayor, the class were able to share in the summer outing for children attending special schools. Mr. Debenham also presented rugs to the entire class at Christmas.

A considerable portion of our patients are children of school age. They include those suffering from active disease, and also that larger group presenting the signs of definitely determinable infection, these last being “tuberculous seedlings.” It was found, especially in the first group, that improvement was slow, or absent so long as they attended the ordinary schools.

The parents provide the mid-day dinner, and the surroundings at home being unchanged, any improvement may be attributed to the conditions under which the class is held. The Class now meets in the Bandstand, Regent’s park. The dinners are kept hot in special aluminium tins provided by Miss McGaw. The Dispensary lends clogs to the children for use in the Park.

The experimental seventeen weeks elapsed and the improvement in the children was very marked even during so short a period. It was apparent both in the Consulting room and in their homes. Perhaps the first thing noticed by the parents is the improved appetite, and as the food is the same, this can only be attributed to the substitution of in which ventilation is unsatisfactory.

Mrs. Fitzgerald reports a very marked improvement in attention, alertness, intelligence and cleanliness. There is an excellent esprit de corps among the children, and though their education is being carried out under primitive conditions, their work, which may be seen at the Dispensary, is distinctly creditable.

The great point is that, although the children are exempted from attending the ordinary schools by medical certificate, their education is being carried on the school officials of the L.C.C. have.given us the most valuable assistance. The attendance officer to whom a list of all absent children is sent every week sees that the children when exempted from the ordinary school, attend the Open-air Class regularly.

The arrangement of school work and hours is as follows:

Dinner is at 12:45, the children resting for three quarters of an hour before and after. The temperatures are taken at the Dispensary by the Nurse, morning and evening. Any child with a temperature of over 99 Fah. is put in absolute rest all day, and any with temperatures of 100 Fah. are sent home to bed in the morning. Practically all the children on coming to school for the first time show a degree of fever, which soon settles with graduated rest and exercise.

For half-an-hour on Tuesday and Friday mornings the patients have Swedish and medical gymnastics, under the supervision of Miss Bergheim, who has generously placed her services at the disposal of the Dispensary. These exercises strengthen the system generally, the respiratory and cardiac systems particularly, and are also used for the correction of any deformities of chest and spine, so frequent in these patients.

If the results of treatment in the Open-air Class were to be judged solely by the gain in weight, it could justly be urged that such increase is usual in growing children, and might therefore have no direct relation to the factor of pure air. To meet this objection the change in weight during the period of attendance at the Open-air Class is compared to the loss or gain during the period the children were under treatment at the Dispensary before being placed in the Class.

Further, these weights are compared with those of another group of children, likewise under treatment at the Dispensary but not attending the Open-air Class. From a clinical standpoint, there are two factors which might influence these results – the stage of the disease and the medical treatment adopted. To make this clear, the tables include the diagnosis and a statement whether or not the patient is on tuberculin treatment. The general and medicinal treatment is a constant factor.

It will be seen that the majority of these children are far below that which is regarded as normal weight. The weight in childhood varies greatly, according to age, height, girth and development, but there are  two methods whereby a rough standard has been stated. Where large numbers of children at different ages have been weighed, as in the Report of the British Association Anthropometric Committee and in the Report of the State Board of Health of Massachusetts, it is possible to give approximately the average weight at each age.

By making extensive observations of the height and girth to weight, various formulas evolved to estimate the weight frorn the height  and girth. Of these, Vierordt’s is H.G./7=W., H.=height in inches, G=girth in inches,W=weight in pounds.

As all these methods at best give but an average, a certain variation above and below is compatible with health. In the following tables the British Association and American statistics are taken as the normal, and. in the first twelve cases the variation from Vierordt’s standard is also worked out.

On the results of a course of Swedish Medical Gymnastics, Miss Bergheim reports :—
“A class of 39 children has attended a course of Swedish Medical Exercises twice a week for some 10 weeks. Twenty-one of these children, whose measurements I give in the following table, put in a fair number of attendances.

On the whole the children show distinct improvement in their method of breathing and their chest measurement. Expansion has increased in almost every case.

Out of 21 children, 13 have Lateral Curvature though in many cases slight. Nearly all have Winged Scapulae (projecting shoulder blades). It will be noted that while all the boys show some improvement, there are several girls who have apparently derived no benefit. Faulty clothing appears to me to be the chief explanation of this. The boys wear far less clothing than the girls, but what they do wear is looser and allows freer movement.

I trust to be able to remedy this by instituting a drill costume of, jerseys in place of overcoats; these being provided through the generosity of friends, one of whom now kindly takes a practice class which is held once a week between the two regular days. When one remembers that the children are mostly ill-nourished, have little power of concentration and until taught, do their exercises mostly in a perfunctory manner, the improvement gained is most encouraging.

On the grounds stated in this report, the Executive Committee considered it advisable to continue the class by a grant of £1 a week from the Dispensary funds, and this is regarded as the precursor  of a larger scheme ; this being that a house with a large garden be rented and converted into a modern open-air school capable of accommodating 50 to 100 children with a sufficiency of teachers. In support of this one would urge the hearty co-operation we have had from many of the parents, in what at first sight must have appeared to them as a startling innovation. In some cases they provided dinners then their children were previously fed at the ordinary schools. Further, the cases are at our doors. The value of such a school socially, educationally and medically, is unquestionable. A sum of £500 or £600 a year would probably be required.

There are it is estimated at least 500 tuberculous children of school age in the Borough of St. Marylebone.