THE ALIMENTARY EDUCATION OF CHILDREN.1

By MARCEL LABBÉ.

Professor of the College of Medicine of Paris, Physician at the Charity Hospital.

A good diet is the first consideration in obtaining good health. Besides providing, one should know how to nourish oneself.

This can be taught. I am not of the opinion of J. J. Rousseau, who states that man left to himself will naturally live right and will never have indigestion. No more do I believe with H. Spencer that a child's appetite is a judicious guide for it. Though hereditary instinct is sufficient for animals, it does not seem that it would be a suitable guide for man, who is, from the point of view of hygiene, the least rational of the animals. An alimentary education is, then, indispensable.

It should be commenced early. It is, in fact, during the growing period that benefit or harm from the diet reacts most strongly on the health. It is during the first years of life that habits are formed, that reflexes are created, which later direct the entire organic life of the individual. It is easy to act on the plastic nervous system of the child in order to instil into it good habits just as it would be difficult to uproot vices to which the adult has become accustomed.

Alimentary education should, then, be addressed above all to children. This idea is not new; the Persians of the heroic ages had already felt the truth of it. We read in Montaigne that the education of the eldest son of the king was entrusted to four teachers, one of whom was the most temperate man of the kingdom.

The Americans of to-day think, in the same way, that in order to accomplish the hygienic education of the people, it is necessary to commence by training the children, who are the men and women of to-morrow, and it is on them that is brought to bear the principal effort in the prevention of tuberculosis and in instruction in alimentary hygiene. For these reasons I will discuss this vital question: The alimentary education of children.

The methods of instruction have been much discussed. Each has extolled his own. With Henri Labbé, I am of the opinion that we

1 Lecture given at the Sorbonne. Translated by permission from the Revue Scientifique, Sept. 10, 1921. (Translator's Note.-This article, of course, presents the subject chiefly as it relates to France, though it also has a general application of interest everywhere.) 101257-22-36 549

must not be exclusive and that each system has its advantages. In a report presented to the National Committee on Social Hygiene in 1919, we showed that there is a place for using all the vaunted plans of education, simultaneously or successively, by adapting them to the social station and to the age of individuals. It is evident that we would not use the same methods in dealing with a baby, a young child, and an adult.

In the case of the infant, the nurslings, the bottle fed, or those already weaned, it is the mother who gives them their alimentary education and who teaches them hygienic habits. It is therefore to the mother and to the nurse that the doctor's advice is addressed. This is the affair of the specialist in pediatrics, whether obstetrician, pediatrist, or hygienist, whether infirmary attendants, nurses, or specialized nursemaids. The education is given in the family, at the dispensary, at the infant asylum, or at the day nursery. For the nursling, much has already been done. Establishments such as the Institut de Porchefontaine and the new Institut de Puériculture, organized by the State, render great service by spreading, through precept and practice, correct principles of infant alimentation.

Once past this first period of life, the alimentation of the child is left somewhat to chance. And yet it is not less important. During the first years, whether the child is brought up at home or goes to the kindergarten, its education should be begun. It is either direct or indirect. Direct, if it is addressed to the child itself through practice, through example, through games, through little alimentary lessons, through "health chores"; indirect, if the instruction is addressed to the parents, by means of lectures, sample dietaries, posters, and pamphlets.

Later, during childhood and adolescence, the education of boys and girls should be given in the schools by means of theoretical and practical lessons. It is the girls especially who should be addressed, since they are destined to become the nurses and the housekeepers; besides the rules of alimentation, it is desirable to teach them cooking, domestic economy, and the conduct of the household.

It is important in giving this alimentary instruction not to fall into pedantry and not to try to put the question of nourishment into sterile formulas, intelligible only to scientists. It is above all by practice and by example that we should proceed; theoretical instruction should be only an explanation of the facts.

During the first six or seven years of its life, the child is usually kept in the home with its parents. In ordinary families, it is preferable that the child should not appear at the family table and that it be raised apart, in the nursery. If it sits at the table with the parents, they assume responsibility for its alimentary education—a

heavy responsibility, for it is often upon the habits, good or bad, contracted at this time, that depends the future health.

Consequently, the parents should watch themselves carefully and correct their own faults. They must avoid having meals at irregular hours, eating too long or too rapidly, hasty mastication, too abundant drinking, the abuse of wine, an excess of salt or pepper with which the dishes are seasoned; they must be careful at the table, materially as well as morally.

The child, indeed, sees every motion; it retains them and imitates them. If later on it has bad eating habits, it is most often the parents who are to blame. How many people by their unconscious example, sometimes even by conscious persuasion, teach their children at this time to be large eaters, heavy drinkers, food bolters, and by doing so, make of them later obese people, alcoholics, or dyspeptics. Certain diseases such as obesity are less often due to an inevitable heredity than to a vicious, pathogenic education given by the parents.

For children who go to the kindergarten or to the public school, there is no better means of alimentary education than the school lunch room, provided that it is organized according to the principles laid down by the school physicians.

It was in 1881 that the first school lunch rooms were established. Since then, they have multiplied in the kindergartens and the primary schools of Paris and of the Provinces. Their aim is to provide a warm meal, composed of two or three dishes, which the child eats with the bread, the dessert, and the beverage which it has brought from home.

All the children do not participate, but only those whose parents desire it. The meal is free for those without means, and paid for by those who are able to give the 50 centimes which it costs. The expenses of the school lunch rooms are defrayed in part by the price of the paid-for meals, in part by a grant from the Municipal Council.

This is an excellent undertaking but one whose organization is still imperfect. The medical inspectors of the schools have at different times voiced their criticisms; the lunchrooms exist in only a small number of schools; they function only during the three winter months; the menus are sometimes badly devised, ham, pork, and sausages too often in certain schools replacing fresh meats; finally the lack of space makes it necessary in many schools to serve the meals in the school yard, where the children are exposed to cold and to dust, or, indeed, in the schoolroom itself, where the air is not sufficiently renewed.

It is very important that school lunchrooms be more generally adopted; that there be planned and installed a suitable space for

them, comprising a kitchen, a well aired and well heated dining hall and a wash room. The dining hall should be provided with the necessary equipment so that each child may have his own plate, drinking glass, spoon, knife and fork, and napkin, and so that he may sit comfortably at a table. Absolute cleanliness should reign in the kitchen and the dining hall.

The menus should be suitably chosen with regard to the age of the children and to the tastes prevalent in the country. The Americans, in their school "lunches," have special menus for schools attended by Jews and by Italians. The question of meat in the diet of children has aroused numerous controversies. The partisans of vegetarianism are arrayed opposite those who believe in the usefulness of meat. The conclusion resulting from the discussion among school physicians has been that meat should be given in small quantity two or three times a week in the kindergartens, and every day in amounts of 40 to 60 grams to the pupils of primary schools. Meat might be replaced by eggs. Milk, vegetables, and in a general sense, fresh, natural foods, containing vitamins and substances indispensable for the building up of tissues, should be made a part of the diet. Finally, the children should be allowed sufficient time for eating; they should have half an hour for the noon meal.

Well organized, the school lunch room will have not only a hygienic value but it will fill an educational function-through the choice of foods, through the surveillance of mastication and of drinking, through the washing of the hands before the meal and the habit of eating in a cleanly way, the meal at school will provide instruction in the fundamentals of alimentary hygiene.

It is the school nurse, with which every modern school should be provided, who would be entrusted with the duty of supervision. She would order the menus, look after the cooking of the dishes, distribute them to the children, and preside at the meal; she would also forbid the use of wine or coffee in too great quantity and suppress the brandy which in certain Provinces the parents put in the child's basket.

The medical inspectors of the schools should supervise and criticize the menus, which would be presented to them. In their consultations they would prescribe special menus for weak or sick children (extra diet, supplemental meat, vegetable, or milk diets, etc.).

Thus organized, the school lunch room would be not only a type of economical restaurant but it would become a means of treatment, an example of hygiene, a place of instruction in dietetics. The menus would be an indication which would show the parents what should compose the child's diet.

The school nurse could do even more by giving, in family conferences or in private talks, advice to parents. If her investigation