Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870–1930 by Richard A. Meckel (review)

Richard Meckel’s Classrooms and Clinics: Urban Schools and the Protection and Promotion of Child Health, 1870–1930 is the first comprehensive account of late nineteenth- and early twentieth-century school hygiene reform. Written at the intersection of education and public health history, Classrooms and Clinics describes the evolution of the complex and multifaceted reform movement to use schools to protect and improve children’s health and thereby extend the state’s responsibility over the physical and mental well-being of children. Meckel details not only how “the health of schoolchildren was discursively constructed as a sociomedical problem in need of being addressed” (p. 4), but also how the different and sometimes competing reform agendas between and among school and health officials, parents and professionals, public and private arms of the medical profession, and social welfare, religious, antimedical, and philanthropic interests shaped the direction and character of school hygiene programs. In doing so, Classrooms and Clinics fills a long-standing void in the history of schooling and public health.

Meckel’s book is organized around the four principal phases in the development of school hygiene discourse beginning in the 1870s when public health officials first targeted schools as part of the larger urban sanitary reform agenda. Concerned about the ability of school leaders to protect child health amid poorly constructed and ventilated school buildings and empowered by both miasmatic and bacteriological theories of disease, public health reformers exerted their authority over school buildings and then the process of schooling itself as “the late-nineteenth century construction of school diseases served to medicalize both education and educational reform” (p. 36). During the second phase, which started in the 1880s and continued into the 1910s, the medical gaze of reformers extended beyond the physical conditions of schools to the children themselves as health reformers policed school inclusion and exclusion through vaccination policies and the implementation of school medical inspection systems.

Beginning in the 1900s and extending into the 1930s, the third stage in the development of school hygiene discourse emerged as fears of epidemics were replaced by concerns that physical defects and diseases were the causes of academic failure. Because medical inspections provided physicians access to the often startling physical condition of poor and working-class children in urban schools, it was not long before they linked physical deficiencies with slow progress in school. Inspection reports therefore provided further justification for the encroachment of medical expertise into schools, which soon played host to a number of institutional innovations and short-lived interventions to address these problems including medical and dental clinics, school lunch programs, and open-air schools to combat the spread of tuberculosis.

Not all of these reforms delivered on their stated goals, however, and by the early 1920s the move away from the detection and correction of medical problems to the prevention and promotion of health was under way. This final stage was shaped both by the resistance of the private practice wing of the medical profession to socialize health care through schooling and by the reform leanings of the national Child Health Organization. Reform energy ultimately settled in the 1930s around a more educational mission for school hygiene efforts—one marked by a clear delineation between the role and responsibility of schools versus that of parents in protecting and improving child health.

Classrooms and Clinics covers a lot of ground, but therein also lies one of the unsatisfying aspects of the account. For in charting the general trajectory of school health policies and practices, some related narratives seem inadequately explored and appreciated. The intense politics of school vaccination policies, for example, are given sort shrift, as are the spirited turf wars that erupted between local school and health officials over everything from school sanitation to the administrative control of...