Hadow (1933)

Notes on the text
Preliminary pages Membership, Analysis, Preface, Introduction
Chapter 1 History of the development of infant education
Chapter 2 Physical development of children up to 7
Chapter 3 Mental development of children up to 7
Chapter 4 Age limits and organisation of the infant stage
Chapter 5 Medical supervision, education and training of under 5s
Chapter 6 Training and teaching of children in infant and nursery schools
Chapter 7 Staffing of infant and nursery schools, training of teachers
Chapter 8 Premises and equipment of infant and nursery schools
Chapter 9 Summary of principal conclusions and recommendations
Appendix I List of witnesses
Appendix II Anatomical and physiological characteristics of 2-7 year olds (Harris)
Appendix III Emotional development of children up to seven plus (Burt and Isaacs)
Appendix IV Notes on typical nursery schools and classes
Appendix V Manchester's student nurse scheme for 'helpers'
Appendix VI Practice in Europe and US
Index

London: HM Stationery Office

Chapter 5 The medical supervision, education and training of children under the age of five
[pages 98 - 115]

THE PHYSICAL CARE AND UP-BRINGING OF THE PRE-SCHOOL CHILD AND THE MEANS THAT HAVE BEEN ADOPTED TO COPE WITH THIS PROBLEM

72. As we have shown in Chapter 1, public interest since the beginning of the present century has been much directed to the problem of the general welfare of children under the age of five. Since 1908 when the Consultative Committee first reported on this problem (1), the Chief Medical Officer of the Board of Education has repeatedly drawn attention to various aspects of it. In particular, he has stressed the serious consequences to the general health of young children that are due to the gap in medical supervision between the age when most mothers cease to take their babies regularly to the maternity and child welfare centres, and the age of five when most children enter the infant department of the public elementary school. Although by the terms of our present Reference we are restricted to considering the 'training and teaching of children attending nursery schools and infants' departments of public elementary schools', we nevertheless consider it essential, for a right understanding of the whole problem in its sociological perspective, to describe briefly the activities of the organisations working under the Ministry of Health and the Board of Education which affect children below the age of five.

The Maternity and Child Welfare Act 1918 vested health authorities with powers for attending to the health of young children from birth up to the age at which they attend school, by means of infant welfare centres, health visitors, day nurseries, etc. The general organisation of a maternity and child welfare scheme is based upon (a) home visiting and personal education through trained health visitors, and (b) medical supervision at centres, pre-natal, infant and pre-school. Facilities are also provided for certain institutional and ancillary services. For our present purpose it is only necessary to describe briefly the activities of the health visitors and infant welfare centres.

Health visitors. In 1932 there were 2,708 nurses engaged in health visiting work under local authorities in England; and in Wales, the equivalent of 183 whole time nurses; some in both countries did maternity and child welfare work only, while others were employed during part of their time as school and tuberculosis nurses. The equivalent of 2,083 whole time nurses was available for maternity and child welfare work in England and Wales, and in addition 2,327 visiting nurses, many of whom were district nurses who gave part-time services, were employed by voluntary agencies, working in association with health authorities. (2)

Infant welfare centres. In 1932 there were 2,034 infant welfare centres under local authorities in England, and in addition 749 were provided by voluntary associations; in Wales, the corresponding inclusive figure was 291. There was therefore in England and Wales a ratio of one welfare centre to about 13,000 of the population, or of approximately one to every 1,000 children under five years of age; (3) the distribution was very unequal; the welfare centre map contained many bare spaces. As a rule, the mothers do not bring their children much to the centres after the age of about one year. The 'toddlers' clinics', however, attract mothers who have no younger infants, while mothers with young babies sometimes bring their older children from time to time to the doctor at the infant consultations. Arrangements are also made for the systematic home visiting of pre-school children. The Chief Medical Officer of the Ministry of Health, in his Annual Report for 1930, emphasised the importance of this, whether or not separate sessions were held for the children at the clinic. 'Regular visits, special centres for inspection, say three or four times a year, and following up whenever required, would do much to detect these incipient ailments (discharging ears, enlarged tonsils, adenoids, squint, rickety deformities) and enable treatment to be obtained at the School Clinic or elsewhere.'

In general it would appear that, while much has been accomplished for infants up to the age of about one year or even later since the passing of the Maternity and Child Welfare Act, 1918, much remains to be done in many parts of the country to ensure a measure of continuous supervision of the physical health and welfare of children from this age up to the age of five.

On 31 March 1932 about 157,000 out of the 1,189,000 children between the ages of three and five in England and Wales, i.e. approximately 13 per cent of the whole, were attending public elementary schools; there were also at the same date 55 nursery schools recognised by the Board of Education which afforded accommodation for 4,520 children between the ages of two and five. (4) For these children medical inspection and treatment was provided through the agency of the infant and nursery schools. In 1932 there were also some 3,726 places available for children under five in day nurseries. (5) For the remainder, systematic observation by trained persons was limited to those instances in which the care of the pre-school child had been carried forward as an extension of the infant welfare movement. In some areas that side of child supervision which is undertaken by the health visitor, namely, home visiting, has been specially developed. It does not bring each child into direct contact with a doctor, but it does serve to remedy the ill health and subnormality in young children which is definitely connected with diet, sleep and home environment; and cases of physical defect also are by this means referred for treatment to the clinic or welfare centre, or brought to the notice of the parent for treatment by a doctor. Nevertheless, for the large majority of young children there is a hiatus in the national health service, in that there does not at present exist any general means of ascertaining whether the child's care and environment are conducive to healthy development, or of detecting at an early age signs of departure from the normal, and still less of ensuring that preventive or remedial measures are sufficiently available. With the parts to be played respectively by the clinic and the school, we are not here concerned; both should be pressed into the service of the child and its parent; but in country districts where medical inspection and treatment will not be secured for the children in any large measure through the agency of nursery schools and classes, the development of other means for ensuring medical supervision during the critical period between infancy and school age is specially necessary. That such a development would be practicable is already evident from the experience of some local authorities.

NURSERY SCHOOLS

73. We have already described briefly in section 22 of Chapter 1 the gradual development of nursery schools for children under the age of five from the free kindergartens, from the open air nursery school established by Miss Margaret McMillan and her sister at Deptford in 1911, and from various other voluntary nursery schools which were established before 1918, largely on the lines indicated in the Report of the Consultative Committee on The School Attendance of Children below the age of Five (1908).

Legislative power to supply or aid the supply of nursery schools was granted to local authorities for elementary education by the Education Act 1918. Section 19 of that Act was re-enacted as Sections 21 and 119 of the Education Act 1921, which run as follows: 'The powers of a local education authority for elementary education shall include power to make arrangements for (a) supplying or aiding the supply of nursery schools (which expression shall include nursery classes) for children over two and under five years of age, or such later age as may be approved by the Board of Education, whose attendance at such a school is necessary or desirable for their healthy, physical and mental development; and (b) attending to the health, nourishment, and physical welfare of children attending nursery schools'. (Section 21).

'Notwithstanding the provisions of any Act of Parliament the Board of Education may, out of moneys provided by Parliament, pay grants in aid of nursery schools, provided that such grants shall not be paid in respect of any such school unless it is open to inspection by the local education authority, and unless that authority are enabled to appoint representatives on the body of managers to the extent of at least one third of the total number of managers, and before recognising any nursery school the Board shall consult the local education authority.' (Section 119).

The existing legislative provisions regarding nursery schools impose no obligation on parents to send their children to them, and they do not rank as public elementary schools within the meaning of the Education Acts. It will be noted that Section 19(1)(a) of the Education Act 1918 (6) defines the type of children for whom provision may be made in nursery schools, 'which expression shall include nursery classes', as those 'whose attendance at such a school is necessary or desirable for their healthy, physical and mental development'. In practice nursery schools recognised for grant have hitherto been provided only in congested urban areas where the housing conditions are unsatisfactory.

THE GENERAL AIM AND FUNCTION OF THE NURSERY SCHOOL

74. Our witnesses generally agreed that there were two principal reasons for the establishment of nursery schools: they ensured the adequate medical supervision of children before admission to the public elementary school, and they provided satisfactory conditions for 'nurture' and education for little children between the ages of two and five.

The objects of the nursery school are set out by Miss Grace Owen in her pamphlet entitled Education and Nursery Schools (1930), as follows:

'(i) To provide healthy external conditions for the children - light, sunshine, space and fresh air.
(ii) To organise a healthy, happy, regular life for the children, as well as continuous medical supervision.
(iii) To assist each child to form for himself wholesome personal habits.
(iv) To give opportunity for the exercise of the imagination and the development of many interests, as well as skill of various kinds.
(v) To give experience of community life on a small scale, where children of similar as well as varying ages work and play with one another day by day.
(vi) To achieve a real unity with the home-life.

"Education by life" is the only true description of nursery school education, for formal instruction has no place in it.'

(a) The medical or hygienic aspect which is primarily concerned with the physical well-being of the children;
(b) the educational aspect; and
(c) the social aspect.

(a) The medical or hygienic aspect

The nursery school is distinguished from the ordinary school by the emphasis placed on physical well-being. This is stressed in the section of the Education Act which we have quoted in Section 73. It is primarily through hygienic requirements in their widest sense that opportunity is afforded for the training of the child. The social and educational aspects of school life are not neglected, but these aspects are first approached through attention to personal cleanliness and suitable diet, and through abundant opportunities for bodily activities of different kinds.

The great majority of nursery schools provide a midday meal (7) and keep the children at school during the greater part of the day. Baths are provided for those children who require them; but the need should decline, as the standard of cleanliness is raised through the example of the school, and parents are led to do their part so far as home conditions permit. Each child has its own towel, toothbrush, and comb.

There are certain aspects of physical care which are common to all nursery schools; of these the principal are inspections by the school doctor not less than once a term and sometimes once a month; frequent visits by the school nurse; the systematic measuring and weighing of the children; the exercise of great care in the detection and isolation of cases of infectious illness; and the keeping of a medical record for each child. The children sleep on beds during the early part of the afternoon. One of the great advantages of the nursery school is the opportunity which it affords for the early detection and treatment of defects of the respiratory tract, of the sense organs, and of skin diseases. Moreover, a considerable proportion of the children entering nursery schools suffer from rickets, for which appropriate treatment by means of suitable diet, massage and artificial sunlight can often be provided. The pressing need for preventive and remedial treatment for children below the age of five is well stated in the following passage from the Report of the School Medical Officer of the London County Council (1926):

'The School Medical Service is a receiver of damaged goods and spends most of its time and energies in patching them up. What is now required is an intensification of social effort directed to the care of the infant in arms and the toddler before school age, so that children shall come to school in the beginning with constitutions unimpaired and with bodies attuned to receive the mental, moral and physical education which it is the primary function of the school organisation to impart.'

The daily programme of the school comprises a succession of happy and joyous pursuits and activities in which the distinction between work and play disappears. The children work when they think they are playing, and play when they think they are working. The educational influences in nursery schools derive largely from Froebel, Madame Montessori and Margaret McMillan. Where the Froebelian influence is strong much importance is attached to play, story telling, singing, dancing, nature study and handwork, in all of which the teacher plays a prominent part. Where Montessorian influence prevails the emphasis is laid rather on individual effort, sense training, and the use of didactic apparatus; the teacher observes and guides, and the children are allowed within a prepared environment and within certain limits to follow their own pursuits. In the best nursery schools the method is eclectic, and combines features drawn from various sources. The pursuits include rhythmic movements, speech training and handwork, and the children usually take great pleasure in all forms of dancing, singing and reciting. The manual activities are of a simple character, e.g. digging in sand pits, building with large wooden blocks, drawing with crayons on brown paper. The activities and pursuits of each day are designed mainly to develop the senses, to guide the imagination and to form right habits. Children rapidly learn not to interfere with other children, not to waste time and not to destroy the equipment provided. By degrees self-control takes the place of external control and the foundations of genuine interest in various kinds of work are laid.

(c) The social influence of the nursery school

The social function of the nursery school has two sides; it trains the child in right personal and social behaviour and so fits him later to be a useful member of the community, and it also exerts through the child an influence for good on the standards and ideals of the home. The nursery school not only provides suitable environment for the child but also gives him companions of his own age and skill, and sympathetic adults who are able to train him in good habits. Our witnesses stated that in the best nursery schools the capacity that the children show in helping others and the pleasure they take in doing work for the school are always in evidence. They wash and dress themselves, serve and carry food, wash dishes, put away their possessions and look after their pets with care and a sense of responsibility. They learn to give and take, and to carry on their own activities without interfering with others. Through the children the influence of the school reaches the parents. In nearly all the schools mothers' clubs or guilds have been organised. Directly or indirectly the mothers gain through these organisations fuller knowledge of their children's needs and possibilities. In some schools 'open days' are held and the parents are interested spectators of the daily round of school activities. The gratitude of the parents is displayed in many ways, for instance mothers help in washing school linen and overalls, and fathers construct toys and attend to the garden. The sense of parental responsibility is increased rather than diminished by the attendance of young children at the nursery school. (9)

TYPES OF NURSERY SCHOOL

75. There are several ways in which the nursery schools which have been recognised up to the present by the Board of Education may be classified. From the administrative point of view the most important distinction is between nursery schools provided by the local education authority and nursery schools provided by voluntary bodies: out of the fifty-five nursery schools which up to 31 March 1932 had been recognised by the Board of Education, 30 had been provided by local education authorities and 25 by voluntary bodies. The character of the building, playground or garden affords yet another basis of classification: the earlier nursery schools were usually conducted in adapted houses or cottages; in one instance the buildings consist of a series of army huts. Another basis of classification is that of the facilities which are provided for 'open-air' activities. The best known example of the completely open-air nursery school is the Rachel McMillan Nursery School at Deptford, in which the garden is the essential feature and the buildings consist of open shelters. (10) On the other hand, in some of the older nursery schools there is little open space available, and most of the school activities take place within the building. We regard the provision of open shelters, with a liberal space for a garden playground, as an essential feature in the design of all newly-provided nursery schools. (11)

A distinct type of nursery school has been recently developed in Bradford where the education committee have established joint nursery and infant schools in which the ages of the children range from two to six plus or seven plus. There are at present six schools organised in this way. (12) The types of building vary considerably; some date from 1920 and some were built as late as 1930. In some, the nursery is separate from the main block; in others, classrooms have been adapted under the same roof. In the newer buildings there is a central quadrangle with the nursery rooms on one side and the infant rooms on the other. In all these schools, whatever the character of the building, the amenities usually associated with the modern type of separate nursery school are provided so far as possible. The general supervision of both departments is in the charge of one head teacher, who is qualified both in infant and nursery school work.

These arrangements are at present experimental, and it is too early yet to draw conclusions from them. It is claimed, however, that the children pass from the nursery department into the infant department without any break such as may occur in their transfer from a separate nursery school to the lowest class of an infant school. Particular attention is being given to the problem of the transition class.

SIZE OF NURSERY SCHOOLS

76. When nursery schools were first recognised for grant in 1919, the general opinion was that they should be small, partly in order that they might be homelike, but chiefly that there might be less risk of infectious illness. The Board of Education, in the Prefatory Memorandum to their Regulations for Nursery Schools (March, 1919), stated that the ideal number for a school was probably about 40 children, though it might sometimes be necessary to provide for more than that number if the needs of the district were to be at all adequately met. 'The Board will, therefore, not refuse to consider proposals for a nursery school providing for as many as 80 to 100 children; but in no case should the number exceed 100.' Experience, however, showed that, under careful supervision, the risk of infectious illness was less than had been anticipated, particularly when the children were grouped in separate open-air shelters. The Rachel McMillan Nursery School at Deptford now affords accommodation for 260 children, for whom provision is made in separate shelters, (13) each containing a group of 35-40 children; but the majority of nursery schools remain comparatively small, providing accommodation for 25 to 100 pupils. It is evident that small schools are more expensive to provide and maintain, and though on purely educational grounds we are disposed to regard a nursery school for 60 to 80 children as of ideal size, we would recommend on economic grounds that, wherever necessary, nursery schools should be planned to accommodate 160 to 180, provided that the children are grouped in units not exceeding 35 to 40. It is clearly essential that the nursery school should be placed within easy distance of the homes which it is intended to serve, and this consideration in practice imposes a limit on the possible size of the school. On the other hand, it is clearly desirable that the accommodation should not greatly exceed the numbers we have recommended, on account of the difficulties of superintendence which are peculiar to a school containing very young children.

THE RELATION BETWEEN THE SEPARATE NURSERY SCHOOL AND THE INFANT SCHOOL OR DEPARTMENT

77. We hope that the valuable ideas embodied in the nursery school will increasingly be realised within the existing infant school system. Meanwhile it seems highly desirable that the nursery school should be developed separately, and be left free to perfect its methods, and to fulfil its special purpose. The infant school has admittedly suffered in the past from bookish and academic traditions. The nursery school is one means of counteracting these influences, by extending upwards its own special tradition of health, of reasonable freedom, and of joyous spontaneous pursuits. It is true that this new spirit which is found in the best nursery schools is also to be found in its genuine form in very many infant schools. Nevertheless, at the present stage in the development of infant education, the nursery school has a value of its own as an educational instrument. Its position as a social institution, we discuss on a later page.

BABY CLASSES AND NURSERY CLASSES IN INFANT SCHOOLS

78. It has long been considered necessary in many districts, on account of home conditions and the wishes of parents, to admit children under five. Baby classes may be found in a large number of infant schools throughout England and Wales, and the majority of children below the age of five who are at present attending public elementary schools are accommodated in such classes. Though such children have been admitted in considerable numbers to public elementary schools since the early [eighteen] seventies, the school boards, and since 1902 the local education authorities, have been mainly concerned in making adequate provision to meet the needs of children above the age of compulsory attendance. (14)

The provision made for the baby class (15) has often been unsatisfactory. Fixed desks are still to be found instead of small movable chairs and tables. The office and lavatory accommodation is often unsuitable. The floor space and the lighting and ventilation are frequently insufficient. The class is often too large, and in some small rural schools the children may have to sit with the older children in a single room. Furthermore, the staffing arrangements have often left much to be desired.

While some or all of these defects may still be found in many baby classes throughout England and Wales, the evidence which we have received from a large number of head teachers of infant schools in different parts of the country indicates that many local education authorities and managers are taking steps gradually to improve the provision for children below the age of five. (16)

In the newer buildings and in old buildings that have been remodelled, it is now customary for the young children to have direct access to their room through a cloakroom devoted exclusively to their use. (17) The baby room has been furnished with light tables and chairs and stretcher beds. Cupboards have been lowered, made more capacious, and so constructed that the tops may be used for the exhibition of beautiful or interesting objects. Sometimes the teacher's cupboard has been supplemented by further cupboards composed of small sections. These 'pigeon holes' for the school belongings of the children serve to give them a sense of ownership, with an accompanying measure of personal responsibility. Pictures have received more enlightened attention in recent years; they are changed from time to time and are hung where they can be easily seen by the children. Flowers, growing things, and the like, are more frequently found in baby rooms than formerly. Other school equipment is undergoing change, the nature of which depends largely on the knowledge and convictions of the teacher. In schools where these improvements have been carried out, their general purpose and practical effect have been towards changing the baby class into a nursery class.

The term 'nursery class' is frequently employed by teachers and others in a somewhat vague sense to describe a class for children below the age of five in which certain amenities commonly found in nursery schools have been provided. In Manchester, Leicester and several other urban areas in which the local education authorities have taken systematic steps to improve the conditions for children below the age of five, the term 'nursery class' has acquired a more definite connotation, and means a class consisting, as a rule, of about 30 children under the charge of a qualified teacher who is assisted in most cases by a girl who is called a 'student nurse', 'probationer' or 'helper'. (18)

For such classes new premises have been built, or old premises suitably adapted. There is a playground reserved for children below the age of five during part of the day, and special sanitary accommodation within the school buildings or accessible by a covered way. There is also washing accommodation which may include baths, and always includes a supply of hot water. The furniture consists of light chairs and tables, and special cupboards. Beds for rest and sleep during part of the afternoon session are provided for all the children. Milk with rusks or biscuits is supplied during the morning, but usually there is no midday meal, such as is given in nursery schools. As we have said, in many classes for children below the age of five in infant schools, some of the amenities described above are found. We think, however, that the term 'nursery class' should be restricted to classes like those at Manchester and Leicester, which are fully organised on the lines described above. (19)

The principal differences between the separate nursery school and the nursery class appear to be: (i) nursery schools may admit children at the age of two, whereas in nursery classes, the age of admission is usually three; (ii) a nursery school is usually a separate educational unit under its own superintendent, whereas a nursery class forms an integral part of an infant school; (iii) the provision of midday dinner is almost universal in the existing nursery schools, whereas in nursery classes it is the practice as a rule to provide milk with a rusk or biscuit during the morning; (iv) the nursery school as a rule remains open for longer hours than the nursery class; (v) medical inspection and treatment of the children is carried out more frequently in the nursery school than in the nursery class; (vi) children passing from a separate nursery school into the infant department of a public elementary school experience a break in treatment and methods of teaching - this can be reduced if they pass direct from a nursery class into the lowest class of the infant department within the same school building; (vii) the cost of the provision and maintenance of a nursery school has up to the present been higher than the cost of providing and maintaining a nursery class.

There is, moreover, the important administrative difference that the nursery school is not, from the legal point of view, a public elementary school and is subject to a separate set of official regulations. (20)

THE PROBLEM OF CHILDREN BELOW THE AGE OF FIVE IN RURAL AREAS

79. Most of our witnesses were definitely of opinion that it would be impracticable to establish separate nursery schools in rural areas. On the other hand, a number of classes on nursery lines have been organised in village schools; though it was repeatedly pointed out by witnesses who had a first-hand knowledge of rural conditions that the provision even of a nursery class was generally impossible owing to the small number of young children in the village. It was commonly stated that children under five years of age can only profit from attendance at school if there is a sufficient number of them to form a group, i.e. to justify the setting apart of a room and a teacher for their special training. We agree with this point of view.

Our witnesses from rural areas were insistent that increased facilities for attending to the health of the young children in the country were required. To this we have already referred in some detail, and our general conclusion is given in Section 81.

THE SOCIAL NEED FOR NURSERY SCHOOLS AND CLASSES

80. The physiological and psychological evidence which we have received shows the importance throughout the whole of life of correct treatment from the earliest years of childhood. We believe that, where home conditions are good, the best place for the child below the age of five is at home with his mother. But during these decisive years some expert advice appears to be essential; and for the majority of parents this has to be obtained mainly through the public medical service or through the agency of the schools; the advantage of the school being that the mother is enabled both to obtain advice, and to share her responsibilities with a teacher who is skilled in the care of young children.

Any provision made by the state should be designed to supplement the home and to strengthen the ties between parents and their children. Apart from the educational aspects of nursery schools and classes, they are a remedial agency affording partial compensation for unfavourable home environment, and they should therefore be provided first in districts where home conditions are bad.

One of the chief arguments advanced in support of the view that nursery schools and classes should form a normal part of the state system of education was the importance of securing adequate medical supervision of children between babyhood and school age. The serious consequences of the hiatus in medical inspection and treatment during this critical period could not, however, be remedied through the agency of nursery schools and classes alone, so long as the attendance of the children remains voluntary, and none of our witnesses expressed the view that attendance should be made compulsory. In this respect therefore, nursery schools and classes can only be complementary to that extension of the 'child welfare' service which we have elsewhere advocated. On the other hand, the achievements of both nursery schools and classes in the nurture and training of young children are remarkable, and there can be no doubt of the high value of the work they are doing for the children whose attendance at such a school is necessary or desirable for their healthy, physical, and mental development. (21) In these cases the provision is essential to remedy the deficiencies of home training, but not equally essential or even desirable in all circumstances.

Bad housing, bad home environment, and economic hardship may be palliated and even ameliorated through nursery schools and classes; but their remedy calls for other action by the state and the local authorities. The provision of schools, whatever be the scale on which it is made, so long as these conditions survive, leaves untouched the problem of the child's early environment.

Nursery schools and classes do not form an integral part of the system of education which is obligatory upon education authorities. We regard the provision of them not as a general but as a particular responsibility. Each authority should consider the needs of their area, regard being had to home conditions and the wishes of the parents, and, after consultation with the Board of Education, should take such steps as seem to them desirable to supply or aid the supply of this form of education.

GENERAL CONCLUSIONS REGARDING EDUCATIONAL PROVISION FOR CHILDREN UNDER THE AGE OF FIVE

81. The problem of the physical and mental welfare of children below the age of compulsory school attendance is essentially sociological. Any fundamental attempt to solve it must eventually take account of the provision of better housing conditions for large sections of the population, and the consequent improvement in the child's early environment. The systematic efforts which are now being made in the schools to give the older girls some instruction in housecraft and infant care are helping towards a solution of this problem, and in course of time will do much more to help. Among other remedial agencies, it is impossible to leave out of account the invaluable work which is being done by the maternity and child welfare centres, the day nurseries, and similar organisations. In Section 72 of this chapter we have attempted to give a brief summary of the activities of these health services. The available statistics show that only about 13 per cent of the total number of children between the ages of three and five in England and Wales are attending infant departments of public elementary schools or separate nursery schools. It is not possible to say how many of the remaining 87 per cent are dealt with in any way by the public health authorities. It is, however, certain that the majority do not attend infant welfare centres after babyhood, even when this service has been extended to children below the age of five. It is thus evident that neither the maternity and infant welfare centres, the day nurseries, nor the nursery schools and the classes for children under five in public elementary schools are at present dealing with more than a small percentage of the total number of children below that age.

We have received many suggestions for 'closing the gap' in medical inspection and treatment during the years which intervene between attendance at the infant welfare centre and admission to school. We do not summarise them here because this problem is outside the scope of our reference. Nevertheless, we desire to take this opportunity of recording our opinion that sufficient supervision of the health of children below the age of five is a pressing need, and we think that the possibility of extending existing services should be explored with a view to providing more adequate facilities for the medical inspection and treatment of such children.

In general we think that, where the home conditions are good, the best and most natural place for a child below the age of five is at home, particularly if the mother takes advantage of the facilities for regular medical supervision of such children which are available, or may be made available in the future. We fully recognise, however, that the home surroundings of large numbers of children are not satisfactory and we think that children below the age of five from such homes might with great benefit to themselves, to their parents, and to the state, attend either separate nursery schools or nursery classes within public elementary schools. (22)

We are of opinion that the nursery school is a desirable adjunct to the national system of education; and that in districts where the housing and general economic conditions are seriously below the average, a nursery school should, if possible, be provided. The nursery school should be designed primarily for those children who, by reason of unsuitable environment, require careful attention to their physical welfare, and need to spend longer hours at school and to be provided with meals.

We consider further that, even in districts where the social and economic conditions are more favourable, the establishment of a nursery school may be expected to have a beneficial influence upon other schools, and to provide also a centre in which problems connected with the general development and 'nurture' of children may be investigated. We think therefore that, apart from purely social and economic considerations, model nursery schools for children from the age of two onwards are educationally desirable, and that they should be made accessible to teachers from other schools.

Our witnesses were in general of opinion that separate nursery schools met a legitimate need, particularly in congested urban areas where social conditions rendered special provision necessary. We agree with this view. On the other hand, there are areas in which nursery classes within infant schools or departments will satisfy the existing need. Where children below the age of five are admitted to infant schools or departments, nursery classes should eventually be the normal type of provision.

We accordingly recommend that each local education authority should survey the needs of their area, with regard to home conditions and the wishes of the parents; and, after consultation with the Board of Education, should take such steps as may seem to them desirable to provide in schools nurture and training for children below the age of five.

Footnotes

(1) Report of the Consultative Committee on School Attendance of Children below the age of Five (1908).

(2) 4,088,100 visits were paid by health visitors to children between the ages of one and five during 1932, as compared with 3,814,437 visits during the previous year.

(3) The number of children between the ages of one and five who attended infant welfare centres was 109,053 in 1932, as compared with 107,770 in 1931.

(4) During the period 31 March 1932 to 31 July 1933, three additional nursery schools have been recognised by the Board of Education. The total accommodation in nursery schools on 31 July 1933 was 4,705.

(5) In 1932 there were 102 day nurseries; 19 of these were provided by local authorities, and the remaining 83 by voluntary associations. These day nurseries, which were set up primarily for the children of mothers who go out to work, were originally established by voluntary effort, but in 1914 the Board of Education initiated a system of grants in aid towards their maintenance. The supervision of day nurseries was transferred to the Ministry of Health in 1919 and amalgamated with the maternity and child welfare work. The existing day nurseries vary considerably in size, some taking as few as 17 children, and others as many as 65. Children are admitted from the age of one month to five years, and as a rule remain for the whole day in the day nursery every week day. Three meals daily are usually provided, for which a varying charge, or sometimes no charge at all, is made. The children are bathed, put to bed for a rest, kept occupied, and otherwise cared for. The day nursery is in charge of a matron, who may be a hospital nurse or creche-trained and she is assisted by one or more nurses and probationers. A visiting teacher is sometimes employed for the older children, but she is not necessarily a certificated teacher. Every day nursery is regularly visited by a doctor.

(6) Re-enacted in Section 21(a) of the Education Act 1921.

(7) A notable exception is Ardwick Nursery School, Manchester, established by voluntary effort in 1915, which does not provide midday dinner, on the ground of the close proximity of the children's homes and the intimate knowledge possessed by the superintendent of the nutrition received by the children in each home. The hours of attendance at Ardwick Nursery School are accordingly from 9 am till 12 noon and from 1.25 pm to 3.30 pm. It should however be pointed out that one disadvantage of a midday interval, unless the children's homes are very close at hand, is the difficulty of dealing with wet feet in inclement weather.

(8) See also Chapter 6, Sections 84-87.

(9) See Chapter 4, Section 70.

(10) See appendix IV.

(11) See also Chapter 8, Section 118.

(12) A nursery school of this type, Princeville Nursery School, Bradford, is described in appendix IV to this Report.

(13) See Chapter 8 footnote 8, and Appendix IV.

(14) See Chapter 1, Section 16.

(15) In 1932 there were 157,551 children between the ages of three and five in elementary schools in England and Wales, but we have not been able to obtain statistical data regarding the total number of baby classes.

(16) A number of local education authorities have utilised for classes for children under five some of the additional accommodation that is now becoming available in many infant schools (especially in urban areas) owing to the falling birth rate and other causes - see also Chapter 8, Section 113.

(17) This and like matters are discussed in detail in Chapter 8.

(18) In Manchester considerable progress has been made in the provision of nursery classes; there are now some sixty nursery classes within infant schools in that area each containing from 25 to 30 children. In the county borough of Leicester there are now twenty-four nursery classes in infant schools. Several other urban authorities, e.g. Chesterfield, Leeds, Sheffield, Stoke-on-Trent, Willesden, have established nursery classes of a similar character. Bradford has developed a distinctive type of nursery school. (See Section 75 above).

(19) Short descriptions of nursery classes organised on these lines are given in Appendix IV.

(20) Board of Education (Special Services) Regulations, 1925, Chapter VIII.

(21) Education Act 1921, Section 21(a).

(22) Many rehousing schemes in large towns will necessitate the erection of flats and tenements. We think that in such circumstances nursery schools or classes with garden playgrounds should be provided for the young children.