History of Education Society

History of Education Society
The Medicalization of Education: A Historiographic Synthesis

Author(s): Stephen Petrina
Source: History of Education Quarterly, Vol. 46, No. 4 (Winter, 2006), pp. 503-531
Published by: History of Education Society
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The Medicalization ofEducation: A

Historiographic Synthesis
Petrina
Stephen
We believedwe had overwhelmingevidence thattoknow a childbetter is to
love itmore.
G. StanleyHall (192 3)1
Sol Cohen was rightandwrong. Education was medicalized but this

processoccurredmuch earlierandnot necessarilyin theway he explained
it. Today, psychotherapeuticknowledge is neverthelesscommonly
officesand classroomsof
acceptedas centralor naturalto administrative
North American schools.But thismedicalizationof classroompolicies,
practices,and schoolswas not a progressiveprocess of themedical
establishmentsecuring itshegemonyover the jurisdictionofmodern
education. Rather, themedicalization of education was much less
determinedand much more contingent thanmedicalization theses
Medical practiceswere constructedin schools throughcomplex
suggest.
among the likes of janitors,nurses,
and subtle interrelationships
pediatricians,pathologists, pharmacists,psychologists,psychiatrists,
socialworkers,and teachersduring the latenineteenthand firstthree
were reinforced
These interrelationships
century.
decadesof thetwentieth
by practicesof eugenics,hygiene,and public health. Inmaterial forms,
were manifestedwithin architecturalspaces,
these interrelationships
discourses, and practices in clinics, courts, hospitals, prisons, and
schools. Education is just one of a varietyof social practices that
values,andwhere a varietyof
embracedthepowerof psychotherapeutic
were administeredand politicized. There are
health interventions
countlessredundanciesacrossdiversesocialpracticesin the"psychiatric
of life,"orwhatCohen called
state,""medicalization
society,""therapeutic
the"triumphof the therapeutic.,,2
of British
studies at the University
is associate professor of curriculum
Stephen Petrina
1924-1984.
of education,
is at work on a book on the automation
He
Columbia.
392.
and
1G.StanleyHall, Life andConfessions

(NewYork:Appleton, 1923),
ofa Psychologist
2
Sol Cohen.
the School:
"The Mental
The
Hygiene Movement,
of American
Medicalization
of Personality
Development
Education."
History
of Education
The
Quarterly,23 (Summer 1983): 123-149; idem, "The Triumph of theTherapeutic:
Robert
30 (1990):
Review."
371-79;
Castell,
Quarterly,
History
of Education
Essay
The Psychiatric Society trans. Arthur Goldhammer
and Ann Lovell,
Fran?oise
Castell
The
Leifer.
"Introduction:
Press,
1982); Ronald
(New York: Columbia
University
Medical Model
Mind and
as the Ideology of theTherapeutic State." The Journal of
History
Quarterly Vol.46
ofEducation
No. 4
Winter2006

504
HistoryofEducationQuanterly
Medicalization refersto a processwhereby nonmedical problems

are definedand treatedasmedical problems.The medicalization thesis
derives from thework of sociologistsof the 1930s to 1950s, such as
KingsleyDavis, C.WrightMills, andTalcott Parsons,who linkedsocial
control to an increasingdominance ofmedicine over individualand
social problems. In the 1970s, sociologists referredto this increasing
dominance asmedicalization. IrvingZola, one of the firstto use the
term,definedmedicalization as a "processwherebymore andmore of
everyday life has come under medical dominion, influence and
When Ivan IllichpublishedMedical Nemesis in 1975 and
supervision."
itsexpanded edition,Limits to
Medicine in 1976, "themedicalization of
life"thesisemergedfromacademic topopular discourse.Critics reacted
to this"medical imperialism"
medicalization theorists
narrative,leaving
to refinetheirconceptualwork. This challenged historians,such as
Cohen, to specifytheways inwhich practicesweremedicalized. By the
early 1990s, sociologistssuch asPeterConrad limited
medicalization to
the process of "defininga problem inmedical terms,usingmedical
language to describe a problem, adopting a medical frameworkto
understanda problem,or usingmedical interventionto 'treat'it."The
uniqueness of education as a psychotherapeutic
practicedemandsmore
thana footnotetoCohen's medicalization thesis.3
For Cohen, themental hygienemovement in the192Oswas a form
ofmedicalization psychiatrists
and psychologistsentered theschools
and renderedstudentpersonalityand behavioraldisordersintomedical
problems.4AlthoughCohen noted thatthisprocessbegan in the 1890s,
11 (Autumn 1990): 247-258; Andrew J. Polsky, The Rise of the Therapeutic State
Press,
1991); Philip Reiff, The Triumph
NJ: Princeton
University
of the
& Row,
of
Shea, "The Ideology
(New York: Harper
1966); Christine Mary
Therapeutic
of the Therapeutic
and the Emergence
State." PhD
Mental
Health
Liberal
diss.,
of Illinois at Urbana-Champaign,
1980.
University
"
18
Annual Review of
"Medicalization
and Social Control.
3Peter Conrad.
Sociology
at Levels
Peter
Conrad
and
Schneider.
of
(April 1992): 209-232;
Joseph
"Looking
Social Science and Medicine
Medicalization."
Fox.
"The
(January 1980): 75-79; Renee
106 (January 1977):
Medicalization
and Demedicalization
of American
Society." Daedalus
Behavior,
(Princeton,
MedicalNemesis (London:Calder & Boyars, 1975), 31; Ivan Illich,Limits

9-22; Ivan Illich,
as an
"Medicine
Stewart,
1976); Irving K. Zola.
Review
20
P.M.
487-504;
(October
1972),
Sociological
of Medicine:
A Critical
the Profession
and
"Sociological
Imperialism
Strong.
of Medical
Examination
of the Thesis
Social Science and Medicine
13
Imperialism."
1979): 199-215;
Inquiries (Philadelphia:
(February
Irving K. Zola, Socio-Medical
Temple
Press, 1983), 295.
University
"The Mental
4On mental hygiene, see Cohen.
Idem, "The
Hygiene Movement";
of Personality: Changing
and the Development
Mental Hygiene Movement
Conceptions
"
2
of the American College
and University,
1920-1940.
History of
Higher Education Annual
in
Intellectual History,"
Idem, "the School and Personality Development:
(1982): 65-93;
Historical Inquiry inEducation ed. John H. Best (Washington, DC: American Educational
a Clinic:
A Historical
Research
Idem,
Association,
109-137;
1983),
"Every School
toMedicine
Institution
(London:
of Social
McClelland
&
Control."

TheMedicalization ofEducation
505
his cases dealwithmental hygienein the 1920sand themedicalization of

personality in schools and universities.This medicalization thesis
remainsproductiveand extremelyrelevantto understanding
modern
educationand lifeinschools.Other historianssupportthislinkbetween
medicalization and psychiatryormental hygieneaswell. For example,
French historical sociologist Robert Castell and his colleagues
concluded that"not onlywas psychiatryinvolvedin thegeneral trend
towardthemedicalization of childhood, itwas thedrivingforcein the
whole process." Cohen, Castell, and others generally date the be
ginnings of themedicalization of educationwith the arrivalof the
neurologistSigmund Freud toAmerica in 1909, the foundingof the
National Committee forMental Hygiene that same year, and the
foundingof theAmerican PsychoanalyticAssociation in 1910.Histo
rians document the confluence of mental hygiene, psychoanalysis,
and child guidance,which also had itspsychiatricbeginnings in 1909
with the foundingofWilliam Healy's JuvenilePsychopathic Institute
in Chicago. By the 1920s, permutations of psychoanalysis,via
mental hygiene and child guidance, were introduced intoNorth
American schools to attend to both normal and abnormal student
problems.5
I argue,however,thatthemedicalization of educationoccurred in
more complexand subtleways thanrecognizedbyCohen, Castell, and
otherhistoriansfollowingtheirleads.
Whereas Theresa Richardson and
Christine Shea documented the power of industrialphilanthropists,
suchas theRockefellers,tocontrolsocialwelfare throughpracticessuch
asmental hygiene,I argue that thispower responded to a politics of
medicine alreadyembedded in thedesigns and policies of theschools.
medicalization tomental hygieneor ableist
Contrary to thesesthatlimit
"special education," I argue that the "common" classroom provides
on Modem
in From the Campus: Perspectives on the School

Education,"
Reform
Sol Cohen
and Lewis C. Solmon
(New York: Praeger,
1989), 18-33;
N. Grob, Mental
Gerald
Illness and American
(Princeton,
NJ:
Society, 1875-1940
"In Defense
of Common
Princeton University
Press,
1983), 144-78; Fred Mathews,
as
Sense: Mental
in Twentieth-Century
America,"
Hygiene
Prospects 4 (Fall
Ideology
Perspective
Movement
eds.
1979): 459-516; Theresa Richardson, The Centuryof theChild: TheMental Hygiene
Movement
and Social Policy in theUnited States and Canada

ofNew
(Albany: State University
York Press, 1989); Shea, "The Ideology
ofMental
Health."
5Of course, in the 1920s and 1930s, at $10.00 per hour, or an average of $3,000 to
was
as a
for two years of treatment, psychoanalysis
$6,000
quite limited
therapeutic
a result,
rather than strict, technical forms of psychoanalysis,
permutations,
procedure. As
were
sectors such as education. On this, see
in
popularized
Stephen Petrina, "Luella Cole,
and Educational
1921-1931,"
Sidney Pressey
Psychoanalysis,
History
of Education
For fees and services, see Harold
T. Hyman.
524-53.
"The
Quarterly 44 (Fall 2004):
as a
Value
of Psychoanalysis
Procedure."
Therapeutic
Journal of theAmerican Medical
Association
107 (August 1936): 326-29.

506
HistoryofEducationQuarterly
clues to a formof medicalization typicallyoverlooked.6Disability

historians, such as Elizabeth and Philip Safford,documented the
interdependencies
betweenmedical intervention
and themanagement
of trainingand custodial care institutionsfor theblind and deaf, and
intellectuallyand physicallydisabled.7Although themedicalization of
disabilityand specialeducationhas itslogicalconclusion ineugenicsand
social Darwinism, the sciences of thewell-born fail to informthe
normalizing and regulating practices of common, modern
6Gerald Coles, The LearningMystique (New York: Ballantine, 1987); Barry

"Backwardness"
to "At-Risk"
(New York:
State University
of New
Franklin,
From
York
Behavior
"An Educational
1976); Jeroen Decker.
(London: Lexington,
Regime: Medical
in
of Retarded
and Deprived
Children
Schoolmasters,
Jurists and the Education
Press, 1994);PeterConrad, Identifying

HyperactiveChildren:TheMedicalization ofDeviant
Doctors,
theNetherlands around 1900."History ofEducation25 (July1996): 255-268; Gerald M.
and theMedicalization
Erchak, and Richard Rosenfeld,
"Learning Disabilities,
Dyslexia,
of the Classroom,"
in Images of Issues: Typifying Contemporary Social Problems ed. Joel Best
(NewYork:Aldine De Gryter, 1989), 79-97; SteveHarlow. "TheMedicalization of the
Classroom:
Constriction
The
of Difference
in Our
Schools."
Holistic
Education
Review
(Summer 1989): 12-17; BernardHarris, TheHealth oftheSchoolChild:A History ofthe

School
Medical ServiceinEngland andWales (Philadelphia:Open UniversityPress, 1995);
A History
B.T.
theMainstream:
Outside
(London:
John S. Hurt,
of Special Education
in Special
of Special
"The Origins
Lazerson,
Education,"
Batsford,
1988); Marvin
and Finance
eds. Jay Chambers
Policies: Their History, Implementation
Education
and
William T. Hartman (Philadelphia: Open University Press, 1983), 15-47; David
Education
and the Influence
of the
Elementary
27 (February
59-83;
1998):
of Education
History
to
of Special Education
Perspective: The Delivery
10 (November
Remedial and Special Education
Disabled
and At-Risk
Students."
Mildly
Focus on Historical
Radical Analysis
Scott Sigmond,
7-11;
1989):
of Special Education:
and Learning Disabilities
(New York: Routledge,
1987); Gerald Thompson.
Development
'"A Convenient
Parker,
Dispensary':
School Medical
Service,
1907-39,"
"An Historical
C. Reynolds.
Maynard
inVancouver
"A Fondness
for Charts
and Children:
Scientific Progressivism
Schools,
12 (Spring/Fall,
in Education
1920-50."
Historical
Studies
111-128; Margaret
2000):
DC:
The History of Special Education: From Isolation to Integration (Washington,
Winzer,
and Anne Digby,
Galludet
Press,
eds. From Idiocy to
1994); David Wright
University
on
Mental
(New York:
People With Learning Disabilities
Deficiency: Historical Perspectives
see Peter Conrad.
"Medicalization
1996). On the sociology ofmedicalization,
Routledge,
and Social Control." Annual Review ofSociology18 (Spring 1992): 209-232; Renee Fox.
"The Medicalization
and Demedicalization
of American
Society." Daedalus
106 (January
Medical Nemesis (London: Calder & Boyars, 1975); Ivan Illich,

1977): 9-22; Ivan Illich,
Limits to
Medicine (London:McClelland & Stewart, 1976).
and
7Elizabeth
Problems,
Perspectives
"Writing Disability
History:
Bredberg,
and
Sources," Disability & Society 14 (June 1999): 189-201; James G. Carrier, "Sociology
inMass
American Journal
Differentiation
and Allocation
Education,"
Special Education:
of Education 94 (May 1986): 281-312; Aude de Saint-Loup, "A History of

Misunderstandings:A History of theDeaf," Diogenes 44 (Summer 1996): 1-25; Philip
A HistoryofChildhoodandDisability(NewYork:Teachers
L. SaffordandElizabeth Safford,
T. Scholl, Ed, Foundations
Press,
1996); G?raldine
College
ofEducation for Blind and
Children
and Youth: Theory and Practice
(New York: American
Visually Handicapped
Foundation
Garland
Bodies:
for the Blind,
Thomson,
1986); Rosemarie
Extraordinary
inAmerican Culture and Literature
(New York: Columbia
Prefiguring Physical Disability
and Ann Digby, From Idiocy to
Mental
ibid; David Wright
Press, 1997); Winzer,
University
on
People with Learning Disabilities
Deficiency: Historical Perspectives
1996).

507
TheMedicalization
ofEducation
Brown offereda historyand theoryof therhetorical

classrooms.8Joanne
powerbehindmedical languageand stopped there,butwe have to start
with medicine as an idiom in science and followpsychologists into
clinics and hospitals to attend to their trainingand socialization in
Historians such asMargo Horn, KathleenJones, and
medical practice.9
Anthony Platt documented the gradual medicalization of child
guidance, but I suggest that compulsory vaccination clinics and
dispensarieswere more obvious formsofmedicalization and predated
child guidance clinics of the 1910s by two decades.10And where
historiansdocumented theprocess ofmedicalizing education through
medical inspectionsduring the 1900s and 191Os, I argue thatthereare
numerous sites thatsupportedamore subtle formofmedicalization at
thattime."1
Although historiansplace theoriginsof psychotropicdrug
8Ian R. Dowbiggin,
1880-1940
and Canada,
"Medicine,
Eugenics
KeepingAmerica
(Ithaca: Cornell
and
the Supreme
Sane: Psychiatry and Eugenics

Press,
1997);
University
Court:
From
Coercive
in theUnited States
Paul Lombardo.
to
Sterilization
Health Law andPolicy 13 (Fall 1996):

Reproductive Freedom." Journal ofContemporary
1-25; Roy A. Lowe.
Doctors
"Eugenicists,
and the Quest
for National
Efficiency:
An
Educational Crusade, 1900-1939."HistoryofEducation8 (April 1979): 293-306; Philp R.
in the United States

of Involuntary Sterilization
Reilly, The Surgical Solution: A History
Press); Steven Seiden, Inheriting Shame: Eugenics
(Baltimore: Johns Hopkins
University
and Race inAmerica
Press, 1999).
(New York: Teachers
College
a
9JoAnne Brown, The Definition of Profession (Princeton, NJ: Princeton University
Press, 1992).
in theUnited States,
It's Too Late: The Child Guidance Movement
10Margo Horn, Before
1922-1945 (Philadelphia:Temple UniversityPress, 1989);KathleenW.Jones, Tamingthe
Troublesome Child: American Families, Child Guidance, and theLimits ofPsychiatric Authority
Harvard
Press,
1999; Anthony
Platt, The Child Savers: The
University
(Cambridge:
of Chicago
Invention
Press,
1969); Theresa
University
(Chicago:
of Delinquency
of
of Childhood
the Medicalization
and the Colonization
Richardson,
"Revisiting
Review
and Psychiatrists,
of Kathleen W.
Children's
Jones'
by Psychologists
Policy
Reviews in theHumanities
& Social Sciences (February
Taming theTroublesome Child" H-Net
The
Love and theAmerican Delinquent:
Steven Schlossman,
2000): http://www.h-net.org;
of
University
(Chicago:
Theory and Practice of Progressive Juvenile Justice, 1825-1920
Press, 1977). See also Jane Addams, The Child, theClinic and theCourt (New York:
Chicago
New Republic,
(Boston: Little, Brown
1925); William
Healy, The Individual Delinquent
and Company,
1922).
of theMedical
Hidden
"Robert Morant's
nN.D.
Agenda?: The Origins
Daglish.
Treatment of Schoolchildren."History ofEducation 19 (February 1990): 139-148; John

Vaccination:
Duffy.
"School
Class
and Health:
The
Precursor
to School Medical
Inspection."
Journal
of 'the
Allied Sciences33 (July1978): 344-355;Mona Gleason. "Race,

Medicine and the
Historyof
School
Medical
Inspection
and
"Healthy
Children"
in British
Medical History 19 (January2002): 95

Columbia, 1890 to 1930." Canadian Bulletin of
The Emergence,
and the Limits of Corporeal
112; David Kirk. "Foucault
Regulation:
in
and Physical Training
and Decline
of School Medical
Consolidation
Inspection
International Journal of 'theHistory of 'Sport 13 (August 1996): 114
1909-1930."
Australia,
Bodies:
Australian
Kirk
and Karen
131; David
Eugenics,
"Regulating
Twigg.
in Victoria,
1900-1940."
and School Medical
History
Inspection
of
Anthropometries
Patricia
Potts.
and
Education Review 23 (February
"Medicine, Morals,
19-37;
1994):
to
of Special
the Development
The
Contribution
of Doctors
Mental
Deficiency:
Education inEngland." OxfordReview ofEducation9 (April 1983): 181-196; StephenT.

508
control of hyperactivechildren in the 1930s, this blatant formof

medicalization is located in the discoveryof thenervous child in the
late 1800sand early 1900sand itstreatmentthroughdispensaries,patent
medicines, and vivisectiontechniques.12
In summary,thepracticesdocumentedby historiansare accurate
but, individually,inadequate to account for themedicalization of
education. To comprehend the scope of this process, one has to
integratehistoriesof deviantstudents(e.g.,Conrad, Horn and Jones),
hyperactivechildren(e.g.,Conrad),medical inspections(e.g.,Gleason),
mental hygiene(e.g.,Cohen andRichardson),disability(e.g.,Safford&
Safford,Saint-Loup), and specialeducation (e.g.,Erchak andRosenfeld,
Franklin,andHarlow). Even ifone undertook thistask,thefullscope of
themedicalization processwould not be appreciated. In thisarticle,I
synthesize this historiographyby describing themedicalization of
education as a diversification
of educationalhygieneduring the 1890s
and early 1900s.
Within eightunique sites intelligencetests,
medical
inspections,physical education and instructionin hygiene, school
lunches,hygieneof instruction,school sanitation,clinical psychology,
etiologyof nervous children,and vivisection in the 1890s and early
1900s developed a well-articulated modern, psychotherapeutic
discourse and practiceof schooling.These sites constituted,in 1915,
what educator Louis Rapeer called "educational hygiene." He
divided this into intellectualdisability training,
medical supervision
or mental hygiene,school sanitation or schoolhygiene,physical dis
ability training, physical education, instruction in hygiene or
physical hygiene,and the hygiene of instructionor what I call
neoscholastic
hygiene.
These sitessuggesta thoroughpracticeofmedical
interventionand an aggressivesubjugationof education to allopathic
medicine.Alreadyby 1917,LifeMagazine depicted thepublic school as a
clinic,monitored bymedical inspections,sanitizedand chargedwith the
mandate of "medicalmoralization" (Figure 1).Medicine provided
powerful discourses, procedures, and strategies for educators and
interventionistsin schools. Education came under the influenceof
allopathicphysicians in the 1890s and, increasinglythroughthe early
1910s, under the influence of psychiatrists,psychologists, and
psychiatricsocial workers. Schooling was reconstructedas medicine
was reoriented toward scientificlaboratoryand clinical practices or
A Study of the Rise and Fall

and Concession:
Woolworth,
"Conflict, Collaboration
in the Seattle Public
Medical
1892-1922."
PhD
Schools,
diss., University
Authority
2002.
Washington,
1
on theMedicalization
Peter Conrad.
"The Discovery
of Hyperkinesis:
Notes
Deviant
Behavior."
Social Problems 23 (October
1975): 12-21; Idem, Identifying.

of
of
of
509
t /
~~~ ~
40~~~~~~~
s~~~~~~~~Y
A~~~~~~~~
-W,
G-1~
'
! k
al,t

EA
S !~~~~~~~~~~~
510
HistogyofEducationQuarterly
methods also common to changes in business, corrections,jurispru

dence, and health.13
In 1908,Clark UniversityPresidentG. StanleyHall outlined the
progress throughwhich scientific
medicine and psychologycame to
regulate each day of development in childhood and adolescence.
Speaking at a gathering to celebrate the centennial of theMedical
School at theUniversityofMaryland,Hall noted a numberof thehigh
He acknowledged the
points inwhat he called "social therapeutics."
doctors'unprecedentedprogressfromtheearlydaysof childstudyin the
late 1880s to currentpsychotherapeuticpractices inmental, physical,
and schoolhygiene,and thehygieneof school subjects."The doctornow
followsthechild into theschool" he exclaimed,opening "a tinyhealth
book" foreach of theyoung scholars. In addition to layingdown the
rulesof lifeineach tinyhealthbook, he continued,physiciansadopted a
"pastoralfunctiontoyouth" tokeep thempure and liberatethemfrom
"the quacks thatplay upon" adolescence and young adulthood.These
functions
marked a battle against the evilsof ignoranceand quackery,
and somethingthatknowledge in thename of libertycould cure.Hall
practiced psychology for thirtyyears and saw an inseparable
interrelationbetween the psychic and the somatic.The boundaries
betweenmedicine and psychology in his own lifewere blurred,as he
served as medical superintendentof theBay View Hospital for the
Insane while practicing the "new psychology" at Johns Hopkins
University in the 1880s.He heldweekly clinics forhis studentsin the
and science.At
hospital,providingtraininginbothmedical therapeutics
Clark, he practicedand lecturedat theWorcester StateHospital until
themid 1890s.With theauthorityofhisMD grantedatJohnsHopkins,
Hall never reducedhimselfto a "merepsychologist"as his peer did a
For
decade earlierwhile bowing in thepresenceofmedical practitioners.
Hall, medicine and psychologywere equallypowerfulin theirguidance
over education.By the timehe hostedFreud's visit to theU.S. in 1909,
themedicalization of educationwas extensiveand diversified.14
13Louis Rapeer, Essentials ofEducational Hygiene

(New York: Scribners,
1915), 130?
2
also William
"Outlines
of School Hygiene,"
Burnham,
Seminary
Pedagogical
in American Medicine
1892): 9-71; Lester King, Transformations
(Baltimore:
(February
The Structure
Press,
Rosen,
Johns Hopkins
1991), 218-225;
University
George
of
American Medical
of Pennsylvania
Practice, 1815-1941
Press,
(Philadelphia:
University
1983), 13-36; Paul Starr, The Social Transformation ofAmerican Medicine
(New York: Basic
1. See
Books 1982), 180-196.
and psychology
the reason
^his
integration of medicine
partially underwrote
went out of his way to host Freud
visit in 1909. G.
why Hall
during his first American
"The Medical
and Children."
Profession
Stanley Hall.
Pedagogical Seminary 15 (February
and Principles
of Psychology."
209, 215; Boris Sidis. "The Nature
1908): 207-218,
AmericanJournalofInsanity56 (July1899):41-52,41. On Hall andMedicine, seeDorothy

Ross,
G. Stanley Hall:
The Psychologist as Prophet
(Chicago:
University
of Chicago

Press,
511
Intelligence Tests andMedical Inspections

At the225-year-oldrenownedSalpetriereHospital inParis during1881,
JeanMartin Charcot established an outpatient clinic a consultation
externe
or Policlinique.In his clinicalpractice in thehospital, thefamous
neuropathologistand chefde cliniqueCharcot attendedto the"neuroses
and psychoses"ofwomen confined to thehospital.He demonstrated
daily in frontof studentsand each Friday to the public within the
teachingtheaterbuilt in theearly 1880s.The outpatientclinic,orwhat
was called thePoliclinique,extendedCharcot's reach intoParis andwas
opened fortherapeutically
treating
working-classmen andwomen fora
varietyofmild mental disorders.Scientificlaboratories,social services,
and the teaching theater tied to the Policlinique formed a huge
psychotherapeuticcomplex. By the early 1890s, the Policliniquewas
attracting5,000 patientsperyear andwas themain sourceofCharcot's
clinicalpracticeuntilhis death in 1893. In 1889,PierreJanet,Charcot's
studentand Parisian psychiatrist,
was appointedhead of thepsychologie
clinique,
anotherarmofwhat came tobe knownas thenotoriousClinique
Charcot.15Another of Charcot's students,Alfred Binet, left the
Salpetrierein 1890 afterstudyingforsevenyears,and similartoJanet,
moved fromneuropathological studies to a more psychotherapeutic
approach to treatingindividual
mental "abnormalities."In 1892,Binet
accepted a post as associate directorof the Sorbonne Laboratoriede
but continued to spend a fewdaysperweek at
Psychologie
Physiologique,
theSalpetriereclinic.
In theSorbonne clinic,Binet andVictor Henri, a clinician and
psychopathologist,began a seriesof psychophysicalexaminationson
youngboys fromthelocal schools,using a rangeof apparatusborrowed
fromtheSalpetriereor contrivedtodetectdifferencesinattentionspan,
character,
memory, judgment,and self-confidence.
Binet's andHenri's
access to school childrenwas carefully
monitored, and headmasters
refused to allow examinationsof youngwomen, as theyrecollected
Charcot's dramaticdemonstrationsat theSalpetriere.By 1895 and 1896,
afterexaminingabout 400 boys,Binet and Henri outlined an entire
discourse on psychologie
individuelle-an individualpsychologywhere
1972),
393-97; William
H.
Burnham,
Great Teachers andMental
Educational
Hygienists(NewYork:Appleton, 1926), 189-247.
15Christopher
Goetz,
Michel
Bonduelle
and Toby
Health:
Gelfand,
A Study
Seven
of
Charcot:
Constructing
Neurology(NewYork:OxfordUniversityPress, 1995);JanGoldstein, ConsoleandClassify:

The French PsychiatricProfessionin theNineteenthCentury (Cambridge: Cambridge
in A History
Press,
1987); Pierre Janet, "Pierre Janet,"
of Psychology in
ed. Carl Murchison
Clark University
(Worcester, MA:
Press,
1930),
Autobiography
in the
S. Micale.
"The
of Charcot."
123-133; Mark
Salpetriere
Age
Journal
of
S. Micale.
and its
1985): 703-731; Mark
Contemporary History 20 (October
"Hysteria
Future
The
33-124.
Historiography:
Perspective."
History ofPsychiatry, (March 1990):
University

512
the objectivewas comparisonsofmentally "abnormal"withmentally

"normal" individuals.Four years later,Binet and Theodore Simon, a
medical studentand buddingpsychologist,refined
psychologie
individuelle
with youngboys confinedtoPerray-Vauclue,an institution
formentally
"abnormal" adolescents. They described their psychophysical
procedures for"diagnostic
du niveau intellectuel
desabnormaux"in 1905
as away of detectingdegreesof differenceinabnormalityand normality
foreventualmedical, pedagogical, or psychological treatmentof indi
viduals. In 1908,Henry Goddard, directorof theVineland Training
School fortheFeeble-minded in theU.S, translated
Binet and Simon's
apparatusand procedures toEnglish, and proceeded to administerthe
"intelligenceexaminations"to his youngTraining School charges and
about 2,000 childrenin localNewJersey schools in 1909 and 1910.16
Signifyingan increasingconfidence in allopathicmethods and
marking the twenty-year
anniversaryof theAssociation ofMedical
American
Institutions
Officers of
for Idiotic and Feeble-minded, the
sthenics
was established in 1896. "Psycho-Asthenics"
JournalofPsycho-A
was coined at thistimeto referto theetiology,diagnosis,and treatment
of "idiocy or feeble-mindedness"and epilepsy while the journal
communicated theprogressof institutionalpractice and the arts and
sciencesofmedicalizing theabnormalor pathologicalmind. Trials to
diagnosemental abnormalitieswith psychophysicalperformancetest
apparatus (i.e., reactiontime)were conducted inFrance,Germany,and
theU.S. throughoutthelate 1800s, but physiciansand psychiatrists
had
more routinely relied on medical inspections and observations to
mental abnormalityin individuals.17
identify
In Boston, fifty
"medicalvisitors"were appointed in 1894 tovisit
thecityschools to examine"all childrenthoughtby theirteacherstobe
ailing." Chairman of theBoard ofHealth and physicianSamuel H.
Durgin assigned eachmedical visitor,or doctor, to an urban district.
Acting on a recentepidemicof diphtheria,Durgin ordered each of his
physicianstovisitschools eachmorning tomake routineinspectionsof
the school children and enforce necessary sanitary precautions.
16Stella E.
Sharp.
"Individual
Psychology:
Study
in Psychological
Method."
AmericanJournal ofPsychology,
(April 1899): 329-391; Th?ta H. Wolf, Alfred Binet
(Chicago:
University
Minds: Henry Herbert
of Chicago
Goddardand
Press,
143-89; Leila Zenderland,
1973),
Measuring
the Origins ofAmerican
Intelligence Testing (Cambridge:
For
of intelligence
1998), 71-120.
testing,
historiography
a Purchase
on 'The School
and Its
of the Future'
Press,
University
Cambridge
see
Petrina.
Stephen
"Getting
Constituent
Commodities:
Histories
and Historiographies
of Technologies."
History of
on 86-91;
75-111,
idem, "'The Never-To-Be
Quarterly 42 (Spring 2002):
Luella W. Cole,
in
and Mental
Investigation':
Forgotten
Sidney L. Pressey
Surveying
Indiana,
History ofPsychology 4 (August 2001): 245-271.
1 1918-1921,"
Editors,
"Announcement,"
1896): 34-35.
Journalof Tsycho-Asthenics 1 (September
Education

513
Authorityoverwho to examinewas renegotiatedand as the superin

tendentof schools noted, "the doctors inspectnot only the pupils
selectedby the teachers,but alsomany others."He also noted thatthey
did much "more than inspect" in that they treated, taught, and
introducedan allopathicpoint of view tohealth.Through establishing
were able to implement
with theboys and girls,"they
"pleasantrelations
hygienicand sanitarypractices thatprovided continuityfromvisit to
visit.They also used theirauthorityto send studentshome fromschool
and follow-upwith visits to thechildren'shome.A largenumberof the
inspectorswere agents of the Board of Health and had "double
authority";hence, theycould order the parent(s) to keep the child
was approved.Approximately5,000
isolatedin thehome until recovery
childrenwere inspectedover fourmonths,uncoveringfifty-eight
cases
ofdiphtheriaand a numberof other illnesses.Eventually,thephysicians
accepted as theircharge thediagnosisof normalitybased on a physical
examination-the "mental and the physical are mutually inter
dependent" commented one proponent in 1903. "The medical
inspector should always be psychologist as well as physician,"he
continued, so "that he may assist the teacher in determininghow
much mental exertion should be requiredof each age or period of
development, that evilmay not result fromoverexertionat critical
periods.He should assist the teacher in classifyingthe pupils" and
regulatingbody,mind, and soul.Chicago followedsuitwith inspectors
appointed in 1895, and in 1898 in a seven-monthperiod, 115,000
were examinedat a costof $13 ,000,or abouthalfofwhat itcost
students
New YorkCity forthesame practice.18
Physical Education, Dietetics, and School Hygiene
About thetimeDurgin was appointingmedical inspectorsto theschools
ofBoston, a physicianfromtheBoston General Hospital was declaring
in Public
Schools: Discussion."
18Edwin Seaver. "Medical
Inspection
Journal
of
and Addresses of theNational Education Association 40 Quly 1901): 238-39,
239;
"Discussion."
Zirkle.
Journal
of Proceedings and Addresses
of the National
Proceedings
Homer W
EducationAssociation42 (July1903): 784-85, 784; Edwin P. Seaver. "The Medical
Visitors."
Management
Hygiene,"
Boston
76-79,
(1895):
Superintendent's
Report,
Stratton D.
of
Division;
Brooks,
"Report
Boston
102-48,
(1908):
Superintendent's
Report
Management Division; John Duffy. "The Early Days

Movement."
Conspectus
ofHistory
1 (October
1981):
43-54;
Archives
the Director
Archives
and
Records
of
and
School
Records
of the School Health
George
Rosen,
A History
of
PublicHealth, expanded edition (Baltimore:JohnHopkins UniversityPress, 1993), 340

Medical Inspection
41; LutherH. Gulick andLeonard Ayres,
ofSchools(NewYork:Russell
in
"Medical
1908). See also John C. Burnham.
Sage Foundation,
Inspection of Prostitutes
in theNineteenth
America
Medicine
45 (January 1971):
Century." Bulletin of theHistory of
Elizabeth Yew. "Medical
203-211;
Inspection of Immigrants at Ellis Island, 1891-1924."
Bulletinofthe
New YorkAcademyof
Medicine 56 (June1980): 488-503.

History ofEducationQuarterly
514
the benefitsof a full regimenof exercise and physical education for

students. Speaking in front of the Boston Society forMedical
Improvement,WM. Conant outlined two inseparable goals for
physicaleducation.Hygienically,regulatedprogramsof fitnessoffered
procedures whereby students corrected deformitiesof the body,
prevented the onset of certain physical ailments, and maintained a
healthy physiology and moral outlook. Educationally, physical
education offered procedures for developing agility, discipline,
endurance, expression, judgment,posture, strength,and powers of
self-control.Physicallyandmorally fityoung bodies were, according
to Conant, prepared to carry the load of business, labor,marriage,
professions,
war, or otherdemandingcallings.Conant summarizedthe
declarationof theprofessionalizationof physicaleducation thatNew
York physicianLuther Halsey Gulick crafted in 1890. At the time,
Gulick was foundingpresident of the Playground Association of
America,which stood for the lessonsof self-governancenurturedby
unstructuredplay.As directorof theYoungMen's ChristianAssociation
Gymnasium inJackson,
Michigan, Gulick was a devotee of "muscular
Christianity,"where physical educationwas an instrumentformoral
lessons thatwould dissipate evils rooted in criminal intentions.
Convinced of links between physiology, emotional control, and
morality, he agitated for the widespread adoption of medical
inspectionsof all school children in themid to late 1890s and for the
National Education Association's institutionof a PhysicalEducation
Department in 1895.19Fitness inyoungbody,mind, and soulmade fora
capillary,responsivediscipline and prompt obedience, which eased
teachers'"mass controlof largebodies of children" in classrooms.20
andMelinda
Soloman.
the Body: The
19Laura Azzarito, Poetra Munro
"Unsettling
at the Turn
of Physical Activity
of the 20th Century."
Institutionalization
Quest 56
Muscles
and Morals:
Dominick
377-396;
2004):
Cavallo,
(November
Organized
and Urban Reform, 1880-1920
of Pennsylvania
(Philadelphia:
University
Playgrounds
"The Educational
of College
Conant,
Press,
Athletics,"
1981), 32-38; W.M.
Aspects
Boston
Medical and SurgicalJournal 18 (February 1894): 20; LutherH. Gulick. "Physical
Education:
A New
Profession."
Proceedings
of theAmerican
Association for theAdvancement
ofPhysicalEducation5 (July1890): 59-66;Harvey Green, Fit ForAmerica:Health, Fitness
and Sport
in American
181-215;
James Hughes.
1986),
Society (New York: Pantheon,
as a Factor in Character
and Addresses
"Physical Training
Building."Journal
ofProceedings
Education Association 40 (July 1896): 911-18;
Roberta
Park.
"Science,
of theNational
of Physical
and the Professionalization
1885-1905."
Research
Service
Education,
in Exercise and Sport 57 (Spring
Park. "Physiologists,
1987): 7-20; Roberta
Quarterly
Nineteenth
and Exercise,
Century
Biology
14 (Spring
1987): 28-60; Martha
Journal
of Sport History
and the Science of Sex
the Body: Women's
Physical Education
"Recreating
Verbrugge.
inAmerica,
Bulletin of theHistory of
Medicine
Differences
1900-1940."
71 (1997): 273-3 04.
in Public Schools." Journal of
20N.D. Kimberlin.
"Physical Training
'Proceedings and
on 297.
Addresses of theNational Education Association 39 (July 1895): 296-97,
Physicians,
'Hygienic
and Physical
and Educative'."
Educators:

515
Physical exercisesupplementedinstructioninhygiene,whichwas
made partof thepublic school curriculumduring the 1880s and 1890s
primarilydue toagitationby the
Women's ChristianTemperanceUnion
(WCTU). By the early 1890s,nearly everystate in theUnited States
of hygienein some shapeor
passed legislationrequiringtheinstruction
endorsedphysicianEli Brown's YoungTemperance
form.The WCTU
Manual (1888) and other popular textbookssuch as physicianAlbert
Blaisdell's The Child'sBookofHealth (1894),which offeredstudentsclear
lessonson hygiene,nutrition,and the evilsof alcohol, narcotics,and
tobacco.The didactics of anatomy and physiologygave way to the
formationof healthhabits.Hygiene and healthprimers,textbooks,and
similarpublications,includingBernarr
Macfadden'smonthlyperiodical
Physical
Culture(ca., 1899), linkedolder discoursesofmoral temperance
care of thebody and dietetics.Now, the
with newer ideasabout virility,
on avoiding thedisabled body.21
abled bodywas instructed
In 1894, theNew England Kitchen petitioned theBoston School
Committee to provide lunches for students in the city'snine high
schools. As the firstschool lunch program, it became a model for
other cities across the country.The New England Kitchen, under
directionof chemist-cum-domesticscientistEllen Richards, opened
itsdoors forpatronsin1890 todemonstrate
modern notionsofnutrition
value of food.There was a
alongwith theprophylacticand therapeutic
connection, theKitchen's advocates argued, between diet, hygiene,
mental performance,and moral temperance."Good thinking,like
good rowing,"said Richards, "requires proper feeding."The lunch
program effectivelylinkedscientificnutritionwith medical dietetics,
mouths formedicine's entryintothepublic schools.
opening children's
the phrase "health
formed in 1918, coined
21The Child Health
Organization,
education"
in 1919 to distinguish new practices from the older instruction in hygiene.
toTeach Them
Charles Woodward
The Laws ofHealth
and How
and Pauline Williamson,
see Howard
the history of health education,
1925). On
(New York: Charles E. Merril,
Conrad.
"Historical
ofHealth
Education."
Mind
and Body 42
Steps in the Development
in the United States
A History ofHealth Education
(May 1935): 81-82; Richard K. Means,
onSchool
Health (Auburn:
(Philadelphia:Lea & Febiger, 1962); Idem,HistoricalPerspectives
"A History
of the Formation,
Press,
1975);
John Taylor,
University
at Southern
of Health
and Growth
of the Department
Education
Development,
to 1993."
at Carbondale,
1921
PhD
Illinois University
Illinois
diss., Southern
at Carbondale,
1996. On
the history of the body and physical culture, see
University
Discursive
and Critical Theories:
Jeanette Rhedding-Jones.
"History
Play and Body
Auburn
CultureandSociety8 (2000): 249-261;William Joyce,ed.The Illustrated

Work." Pedagogy,
Culture
Bodies:School
(London:Alan Radley, 2001);David Kirk,Schooling
HistoryofPhysical
Practice and Public Discourse, 1880-1950
Press, 1998); John
(London: Leicester University
Massey, American Adonis: Tony Sansone, theFirst Male Physique Icon (New York: Universe,
on
Park. "History of Research
Selected
2004); Roberta
Physical Activity and Health:
from 1867 to the 1950s." Quest 41 (August 1995): 274-287;
of the
Idem, "ADecade
Topics
andWriting
About theHistory ofHealth,
and Sport,
Fitness, Exercise
Body: Researching
1983-1993. "JournalofSportHistory21 (Spring 1994): 59-82.

516
The Boston school lunchprogramwas initiatedin1894 underprotestof

who were entrepreneurialin selling snacks (cocoa,
theschool janitors,
milk) or home-bakedgoodies (cakes,cookies) to thestudentsin
crackers,
basementcorners.Protectingtheirinterests,thejanitorscomplained to
the school committee and generated resistanceoutside the schools.
Local push-cartowners felttheirsmallbusinesseswere threatened,and
dime storemerchants placed signs inwindows stating: "Don't Let
Anyone Tell You What You Should Eat!" Parents inquiredwhether
The Boston
theirchildrenwere guinea pigs fordietetic experiments.
and proceeded to supervisethesellingof
School Committee intervened,
all food in schools.Persuaded byRichards' notions thatgood behavior
and thoughtwere linked to good food, the committeeapproved and
demanded that the city'snine high schools be served.About 2,500
studentsopted forluncheseach day.For fivecents,theyreceiveda lunch
of breadwith butter,crackers,and soup.Richards calculated thecaloric
value of the new lunches,and monitored the carbohydrate,fat,and
proteincontentof the food.She also tied thevalue of teachingproper
tablemanners and thehygienichandlingof food to thenutritionalvalue
Within a fewyears,similarlunchprogramswere initiated
of thelunches.
inNew York and other largecities.The program inBoston continued
until 1907,when itwas turnedover to theWomen's Educational and
IndustrialUnion. Local physiciansapproved,and as one specialistof
dieteticsput it in 1893:Doctors will soon prescribewhat foodsstudents
should eat. "Physicians,"he said, "are tobe the teachersand authorities
on foods."22
in
in the United
Nutrition
"Science Gendered:
22Rima Apple,
States, 1840-1940,"
and Andrew Cunningham
eds. Harmke
The Science and Culture ofNutrition
Kamminga
Barnett, "Every Man His Own Physician: Dietetic
(Atlanta, 1995), 129-154; L. Margaret
& Andrew
in Science and Culture ofNutrition
eds. Harmke Kamminga
1890-1914,"
Fads,
Cunningham (Atlanta:Roclopi, 1995), 155-178; Robert Clarke, Ellen Swallow: The
Woman who Founded Ecology (Chicago: Follett,

1973), 123-140; Ephraim Cutter. "Address
on Dietetics?Medical
and to Come."
Food Ethics Now
Journal of 'theAmerican Medical
Association20 (March 1893): 238-244, on 242; Caroline Hunt, The DailyMeals ofSchool
Children,
U.S.
Bureau
of Education
Bulletin
No.
3 (Washington,
DC:
Government
PrintingOffice, 1909);Caroline Hunt, The Life ofEllenH. Richards(Boston:Whitcomb
on School Children,"
"The Nutrition
Charles G. Kerley,
and Barrows,
1912), 215-229;
Revolution at the Table:
Teachers College Record 6 (March
1905): 85-89; Harry Levenstein,
The Transformation
Press, 1988), 44
of theAmerican Diet (New York: Oxford University
in Feeding
School Children."
"Problems
59; Horace Makechnie.
Journal of theAmerican
of
Association
30 (January 1898): 56-57; A.E. Miller.
Medical
"Hygienic Management
Association
31 (December
Children."
1556-58;
1898):
Journal
of the American Medical
2 (April
"Boston High
School Lunches."
Journal
ofHome Economics
Mary H. Moran.
and Julia Pulsifer, Boston s Public School Lunches (Boston:
1910): 181-84; Mary H. Moran
The Care of the
and Industrial Union,
Women's
Educational
1908); Nathan
Oppenheim,
Child inHealth (NewYork:Macmillan, 1900);Ellen H. Richards, "The Food of School
Children
and Young
Students,"
inPlain Words About Food: The RumfordKitchen
Leaflets ed.
Ellen Richards (Boston:Home SciencePublishingCompany, 1893/1899),89-103 ;Idem,

TheMedicalization
ofEducation
517
In themidwesternUnited States in1896, theIndianaStateBoard of

Health passed nine rules addressinga far-reaching
hygieneof public
school practice.Written under the insistenceof JohnHurty, the
secretaryof the Board of Health in Indianapolis, the rules were
immediatelydubbed the"Magna Carta" of school hygiene in Indiana.
Rule number one empowered school officialsto refuseadmittanceof
childrenfromhouseholds thatwere infected
with contagiousdiseasesor
children suspectedof infectionuntil an examinationwas made by a
certifiedphysicianand approved by a stateHealth Officer.Explicitly
linkingmorality,sanitation,and the science of germ theory,thenext
seven rules spelled out in no uncertain terms the governance and
maintenance of classroom apparatus, furniture,and physical plants.
School and townshiptrusteesand janitors
were requiredtoput physical
componentssuch as desks,floors,pencils,tablets,andwater fountainsin
"sanitarycondition" before opening theirschools.As his friendand
biographer put it,Hurty stood for better hygiene through"better
sanitation,betterpreparationof teachers,school health examinations,
bettertextbooksand bettereverything."
"Bettereverything"
meant that
architectureand interioreffects
were governed by codes of hygiene.
School hygiene transformed
thework of theeducational architectand
interiordesignerand generouslyelevated thepower and statusof the
school janitor.As school hygiene leaderFletcherDressler concluded,
"the janitorof themodern school building is, next to the principal,
perhaps themost importantofficerin theschool."Now, thejanitorset
housekeeping standards,safeguardedvaluable property,exertedmoral
authorityover students, regulated the conditions for safety,and
governedtheentirehealthenvironment
of theschool and itspremises.23
"The Prophylactic
and Therapeutic
Value
of Food,"
in Plain Words About Food: The
Richards
Science
(Boston: Home
Rumford Kitchen Leaflets ed. Ellen H.
Publishing
to School
in Relation
"Public
Kitchens
104-114;
Idem,
1893/1899),
Company,
and to Restaurants,"
Lunches
Plain Words About Food: The Rumford Kitchen
Leaflets ed.
Ellen H. Richards (Boston:Home Science PublishingCompany, 1893/1899), 161-65;

Idem, "Luncheons forSchool Children."New EnglandKitchen
Magazine 3 (May 1895):
51-54.
23ThurmanB. Rice, The HoosierHealth Officer:A BiographyofJohnN. Hurty
State Board
of Health,
Indiana
B. Morrison,
134-35; Gilbert
1946),
(Indianapolis:
"School Architecture
and Hygiene,"
inAmerican Education ed. Nicholas
Butler
Murray
in John A. Garber,
"The
(New York: L.B. Lyon Company,
1900), 430; Dressier
quoted
School Janitor," U.S. Bureau ofEducation Bulletin 24 (1922): 3;May Ayres, JesseWilliams
andThomas Wood, HealthfulSchools(New York:Houghton Mifflin, 1918); Severance
and Henry T. Baily, School Sanitation and Decoration

(New York: D.C. Heath,
Burrage
Construction
"The Hygienic
of Schoolhouses
from an Architect's
Kilham,
1899); W
on School
Fourth
International
II (1914):
Vol.
Transactions,
Standpoint,"
Congress
Hygiene
35-38. On
the history of school sanitation, see John Duffy, The Sanitarians: A History of
American Public Health
of Illinois Press,
(Urbana: University
175-220;
1990),
Idem,
"School
and the Health
of American
School Children
in the Nineteenth
Buildings
in
and History ed. Charles
(New York: Dawson,
1979), 161
Century,"
Healing
Rosenberg

518
Hygiene of Instruction,Clinical Psychology,and theNervous Child

Elsewhere on theAtlantic coast and about the timedoctors enteredthe
Boston schools, a pediatricianfrom
New York broughtclinical science
to bear on thewhole of classroompractice. In theearly 1890s, Joseph
Mayer Rice made headlines in thepopular and academic presses forhis
surveyof elementaryschools in thirty-seven
cityschool districtson the
east coast and in themidwesternUnited States.Rice summarizedthe
healthof theschools inThe Forum in 1892 and 1893:most of theclasses
he observed,and generallytheschoolshe surveyed,
were sick;evilswere
medicine to take.
evident,and therewas some tough scientific
While
"roots
criticized
for
the
of
all
aggressively
educational evils" in
locating
an old regimeofpedagogyand corruptgovernance,hiswork came tobe
representedas thefirstlarge-scalepracticeof thenew social scienceof
schooling.Rice returnedto some of these schools again in 1895 and
1896 and examinednearly100,000 studentstoattend toknowledgeand
practice inarithmetic,
English composition,penmanship,and spelling.
More interestedinconditionsunderwhich studentslearnedthaninhow
well individualsadded or spelled, he contrivedhis testapparatus to
examine the students' "mental labor." Rice argued that therewere
hygienicprinciplesto thedesignof schoolroomsand texts,and tohow
andwhat shouldbe taught,and atwhat age and speed itcould be learned.
For Rice, the new pedagogy was governed by knowledge of these
hygienic principles and a psychotherapeuticdetection of errors in
practices like adding and spelling.Without this psychotherapeutic
knowledge and the skills to diagnose errors, teacherswere "fullyas
liable toprosecutionfor
malpractice as thephysicianwho has bungled in
setting a bone." He proposed a practice where teachers clinically
examined students to provide an idea of theirattainmentof school
knowledge and forwarded standardized test results to central
laboratoriesforanalysis.Time and time again, Rice was recognized
forexercisingclinical science inhis hygieneof instruction.24
178: Suellen Hoy, Chasing Dirt: The American Pursuit
(Oxford: Oxford
of Cleanliness
Press, 1995), 87-149; Petrina, "Getting a Purchase";
University
Nancy Tomes,
Gospel of
Germs: Men, Women
and American Life (Cambridge:
Harvard
Press,
1998);
University
and
Idem, "The Private Side of Public Health:
Hygiene,
Sanitary Science, Domestic
Germ Theory, 1870-1900,"Bulletinofthe

Medicine 64 (Winter 1990): 509-539.
Historyof
in two volumes. J.M. Rice, The Public
24Rice's work through the 1890s was published
School System of the United States (New York: Century,
1893), 9; J.M. Rice, Scientific
Management inEducation(New York:Hinds, Noble & Eldridge, 1914), 55, 27, 136.On
see Lawrence
The Transformation of the School: Progressivism in American
Rice,
Cremin,
"The Academic
1876-1957
Levine,
Education,
(New York: Knopf,
1961), 3-8; Murray
and Social Functions," American Psychologist 31
Test: Its Historical
Context
Achievement
Science 37
"Educational
See also, Edward L. Thorndike.
(June 1976): 228-238.
Diagnosis."
seeWilliam
E Foster. "Educational Malpractice:
(January 1913): 13 3-142. On malpractice,
or
11 (March 1986): 122-29.
Educate
Litigate." Canadian Journal ofEducation

519
In Philadelphia, Lightner Witmer modeled educational

common tomedicine
and psychologicalpracticesafterinstitutions
the clinic and dispensary.If other practitioners,such as Rice, shifted
but respectedboundaries among education,medicine, and psycho
logy,Witmer removed any boundaries that impeded psycho
therapeuticpractice in education. In what became a manifesto for
Witmer made a pitch at the fourthannual
"clinical psychology,"
meeting of theAmerican PsychologicalAssociation forpedagogical
and psychological practices that were clinical in outlook and
scope. The followingyear, 1897, he opened a "psychologicalclinic"
at the University of Pennsylvania. Attending to "abnormal"
and "normal" children from the local Philadelphia public
schools, Haddonfield Training School, Miss Marvin's Home
School, and the PennsylvaniaTraining School, he set out to treat
whatever ailed his young subjects. A "medical and psychological
examination" led to a "diagnosis of the child's mental and
physical condition and the recommendationof appropriatemedical
Witmer often referred to his first
and pedagogical treatment."
was treatedwith a pair
case where an ailment of reading difficulty
of eyeglasses.He routinelyprefaced this case by remarkingthathis
work was for abnormal and normal children alike.The young boy
was broughttohis officeby a local school teacher,asWitmer described
themeeting: "She was imbuedwith the idea that a psychologist
should be able, throughexamination, to ascertain the causes of a
deficiency in spelling and recommend the appropriatepedagogical
treatmentfor itsameliorationor cure."And so itwould be in clinical
psychology. "As the physician examines his patient and proposes
with a definitepurpose in view,namely thepatient'scure,"
treatment
he explained,"so theclinicalpsychologistexaminesa childwith a single
definiteobject inview thenext step in thechild'smental and physical
development." Admitting that while "clinical psychology" and
"psychologicalclinic"were odd juxtapositionsof concepts, theywere
nonethelessthebest choices to indicatethe"characterof themethod" he
used. Clinic referredtomedical, or hygienicand therapeutic,
method
rather thanmedical space. Like Hall, Witmer traineda number of
studentsin psychotherapeuticpractice he called his "psychological
training school" the "hospital school." Indeed, the renowned
psychoclinicistJ.E. Wallace Wallin asserted in 1920 that "schools
must be organizedmore or less on theplan of themodern hospital.
That is, thepupils should firstbe carefullyexamined and diagnosed
the instruction... inorder
beforeany attemptismade to differentiate
that remediable defectsmay be discovered and corrected when
possible." AsMaud Merrill noted upon writing a historyof theclinic,
"the trainingprogram for 'psychoclinicists'
was to fitthemto become

520
examiners in psychological clinicswhich functionedas 'educational

dispensaries. 5
In Boston, again during themid-i 890s, physicianPhilip Knapp
isolated150 "nervouschildren"fromthecityschools to investigatethe
etiologyofwhat appeared tobe an increasingnumberof cases.Although
his colleague argued,"muchofour school systemseemsalmostexpressly
designed for themanufactureof nervous invalids,"Knapp found that
schoolworkaccounted foronly a smallpartof nervousnessinchildren.
"Ifunder any school regimeonly a partof thescholarsbreakdown,"he
reasoned,"theremust be some reasonother thanschoolworkwhy they
succumbwhile theircomrades are unaffected."If schoolwork"rarely
occasions nervousdisease,"Knapp concluded, thentheetiologyismore
likelypathological and attributedto functionsof the centralnervous
system.Arriving at a similar conclusion on nervous or precocious
childrena fewyears earlier,anotherphysiciansuggested thenew term
aprosexiato referto "the inabilityto fixtheattentionon anymore or less
of function"now named and
abstract subject."With "hyperactivity
isolated as a pathological, neurophysiological symptom,physicians
focusedon cure and prevention.By the 1900s, physicianswere more
confidentof theetiologyof thenervous child thanearlierphysicians.
Punton, forexample,unequivocallydeclared,"precocityisa suresignof
"The belief that the child will outgrow its
biological inferiority."
nervousnessand consequentlythereisno cause foralarmwhen a child
suffersfrom the various formsof nervousweakness ... is not only
misleading,but absolutelyfalse,and contraryto allmedical knowledge
and experience."He continued:"the sooner thisfactiswell understood
bybothparentand teacher,thebetter,foritmay savemany a boyor a girl
frombecoming a confirmedneuroasthenic, hystericor epileptic."
Nervous childrenwere "more curable thanany other time,butwhen
neglected," developed "serious permanent disabilities." Some
physicians recommended a "prescription for themother," such as
Carter'sLittleNerve Pills, linkingthepharmaceuticalindustryto the
25Lightner
Witmer.
"The
in
of Practical Work
Organization
Psychology."
The
French.
"On
Review 4 (January 1897): 116-17; Idem, "Clinical Psychology," The

Psychological
1 (March
1907):
Psychological Clinic
the Conception,
Birth, and Early
1-9, 4,
1, 8. For Witmer
of School
Development
see
Joseph
Psychology."
American
Witmer:His Life
39 (September 1984): 976-987; PaulMcReynalds, Lightner
Psychologist
American
DC:
Association,
1997);
John
Psychological
(Washington,
of Lightner Witmer."
"The Clinical
Journal of theHistory of the
Psychology
and the
Sciences 15 (Winter
1979): 3-17; Barry Richards.
"Lightner Witmer
Sciences 1 (Winter 1988): 201-219;
History of theHuman
Project of Psychotechnology."
4
American Journal
Children."
Wallin.
J.E.Wallace
of School Hygiene
"Handicapped
in Clinical
and Progress
"Oscillation
1920): 29-48, on 44; Maud Merrill.
(September
and
Times
O'Donnell.
Behavioral
15 (July1951): 281-89, on 284.

Psychology
Psychology."Journal ofConsulting

521
with nervous
public school system.Eventually,in the193Os,drug trials
school childrenemergedas legitimateand sociallyacceptable.26
The vivisectionof school childrenwas sporadic throughoutthe
By the
century.
common in thetwentieth
1800sbut became increasingly
late nineteenth century,vivisection referred to any experimental,
invasive
manipulation of animal and human subjects.InBoston during
1896, ArthurWentworth performed lumbar punctures on thirty
childrenunder his care in theChildren'sHospital, primarilyto test
the diagnostic value of withdrawing spinal fluid.Labeled human
vivisection,Wentworth's work inspired similar experiments on
children in orphanages and institutionsfor the "feebleminded"and
waywardyouth during theearly 1900s.27The firstclinical drug trials
with childrenwho demonstrated"educationaldisabilities"were direct
ed by Charles Bradley in themid- to late 1930s.The thirtychildren
were confined
(twenty-one
boys,nine girls)used in theBenzedrine trials
to theEmma PendletonBradleyHome inProvidence,Rhode Island.Of
the270 studentscared for,thegroupchosen forthetrialsdemonstrateda
rangeof behavioralproblems and nervousdisorders.Bradley claimed
"striking changes" and "spectacular improvement in school
performancein half of the children,"and proceeded to sponsor and
inspiresimilarstudiesthroughthe195Os.Ciba PharmaceuticalProducts
Inc. patentedmethylphenidatehydrochloride in 1950, trialed and
marketed it as Ritalin in themid-1950s, and in 1970 finallyran up
againstmass protestand accusations thatstudentswere "drugged into
conformityin theclassroom."28
in School
in the Production
of
"The Influence of Overwork
26Philip C. Knapp.
in Childhood."
Boston Medical
and Surgical Journal 85 (July 1896): 37
Nervous
Diseases
in School Children."
PractitionerAl
"On Aprosexia
and Headache
39, on 37, 38; D. Guye.
on 198; John Punton.
"Nervous Disorders
of Children:
198-201,
1891):
(September
to School Life andWork."
American Medicine
13 (February
Their Relation
1907): 79-86,
on 84; William
B. Pritchard.
"The Hygiene
and Management
of Nervous
Children."
on 503. See also Archibald
Archive
27 (July 1910): 499-505,
Church,
of Pediatrics
"Nervous
Editor.
Children."
Precocious
23 (September
700-705;
1906): 678-681,
of Pediatrics
Archive ofPediatrics 14 (February
1897): 116-18.
see Diana
"Vivisection
and
B?lais.
Animal
of children,
Archives
Children."
the vivisection
Susan Lederer.
49 (July 1910): 267-273;
"Hideyo Noguchi's
Cosmopolitan
Isis 16 (March
Luetin Experiment
and the Antivivisectionists."
Idem,
1985): 31-48;
as Guinea
and Medical
1890-1930,"
Experimenters,
"Orphans
Pigs: American Children
7On
Human."
inIn the
Name oftheChild:Health andWelfare, 1810-1940 ed.Roger Cooter (NewYork:
inAmerica
Idem, Subjected to Science: Human
1992), 96-123;
Experimentation
Routledge:
Press, 1995), 40-46,
(Baltimore: Johns Hopkins
University
Before the Second World War
Overview:
"Historical
P?diatrie
Susan
Lederer
and Michael
Grodin,
79-85;
in Children as Research Subjects eds. Michael
and Leonard H.
Grodin
Experimentation,"
in the
"Murder
Glantz
Searle,
Press,
1994), 3-28; G.M.
(Oxford: Oxford University
Name
of Science," Catholic World 70 Quly 1903): 493-504.
for Neurologic
and Behavior
"A Children's
28Charles
Hospital
Bradley.
Disorders."
Journal
of the American
Medical
Association
107
(August
1936):

650-653;
522
Neoscholastic Hygiene
Beginning in the early 1890s, therewas fierceresistance to thepro
cesses of medicalization, most aggressivelydemonstrated by anti
vaccinationists,antivivisectionists,
alternativehealers, and proponents
of "medical freedom."Opposition groups andmany of the laypublic
believed that education was medicalized through the hegemony of
allopathic practices.As Woolworth documented, parents combined
with Christian Scientists to contain allopathic practices in cities such
as Seattle during theearly1920s.29The directorof hygieneforBoston
schools reported in 1908 that he and his officers encountered
"opposition from teacherswho feared that pedagogy was to be
medicalized, from parents who resented any usurpation of home
authority,fromphysicianswho fearedtheirprivatepracticemight be
invaded,and fromcertainmembers of the public at largewho saw
dangersofpaternalismin themovement." Initial"fears,"he emphasized,
paled in lightof the inroadsofmedicine into schooling.By 1910, 337
citiesacross theUnited Statesemployed1,194doctorsand 371 nurses to
administermedical practices. In 1912, seven stateshad compulsory
medical inspection laws likeMassachusetts and another twelvestates
Benzedrine."
American Journal ofPsychiatry
Idem,. "The Behavior of Children Receiving
on 578, 584; Idem, Charles
94 (November
and M.
Bowen.
1937): 577-585,
Bradley
of Children's
Behavior
Disorders."
American
(Benzedrine)
"Amphetamine
Therapy
and Dexedrine
Idem, "Benzedrine
Journal ofOrthopsychiatry 11 (January 1941): 92-103;
in the Treatment
of Children's
Behavior Disorders."
Pediatrics 5 (January 1950): 24?37;
Lester Grinspoon
and Susan B. Singer. "Amphetamines
in theTreatment
ofHyperkinetic
Children."
Harvard
Education Review 43 (November
Molitch
1973): 515-555; Mathew
and John Sullivan.
"The Effect of Benzedrine
Sulfate on Children
taking the New
Stanford Achievement
Test." American Journal
1937): 519
ofOrthopsychiatry 7 (October
and Leandro
Products
522; Max Hartmann
Panizzon,
assignors to Ciba Pharmaceutical
and Piperdine
and Process
ofMaking
Inc., "Pyridine
Same," U.S. Patent
Compounds
Desk Reference,11th
2,507,631 (May 1950): 1-3; "Ritalin (methylphenidate),"
Physician's
ed. (Oradell, NJ: Medical

On the history of Ritalin and the
Economics,
1956), 441-42.
treatment of Attention-Deficit
see Conrad,
"The Discovery
of
Disorder,
Hyperactivity
Children:
theMedicalization
Idem, Identifying Hyperactive
Hyperkinesis";
of Deviant
Behavior
C. Leger,
and Marie
"A Very
(Toronto: D.C.
Heath,
1976); Toby Miller
ChildishMoral Panic: Ritalin,"Journal of

Medical Humanities 24 (Summer2003): 9-33.
For Ritalin
controversy, Harlan
Vinnedge,
"Drugs
for Children:
PracticeMedicine," New Republic164 (March 1971): 13-15.
Politicians
Who
Would
see Lederer,
On
278-298;
29Woolworth,
"Conflict,"
antivivisection,
"Hideyo
see Nadav
For
and Anti
anti-vaccination,
Davidovich,
Noguchi."
"Homeopathy
at the Turn
Vaccinationism
of the Twentieth
in
The Politics of
ed.
Century,"
Healing
Robert D. Johnston
Kaufman.
"The
11-28; Martin
2004),
American Anti-Vaccinationists
and Their Arguments."
Bulletin of theHistory
Medicine
of
41 (September
Porter
and Roy Porter.
"The Politics
of
1967): 463-478;
Dorothy
Prevention:
Anti-Vaccinationism
and Public Health
in
Nineteenth-Century
England."
Medical History 32 (July1988): 231-252. On Medical Freedom and allopathichegemony,

see
Stephen
Petrina, Medicalizing
Liberty in the Kingdom
Foucault
(unpublished manuscript).
ofEvils:
Education, Medicine,
Psychotherapeutics,

52 3
had somewhatmore permissivelaws.At theFiftiethAnnual National

Education Association (NEA) Meeting inChicago in 1912, Charles
Reed, a physicianfromCincinnati,announced thatdespite twodecades
of medical progress in the schools, opposition was collective and
systematic.
The United States now had the"peculiarand questionable
distinction,"Reed announced,of a "nation-widemovement to defeat,
efforts
not only themedical inspectionof schools,but allotherstatutory
topreventdisease ... thruobservanceofhygieniclaw.""These people in
theirorganizedcapacity,"hewarned theNEA crowd,"havingraisedthe
shibbolethof "Medical Freedom," are engaged inan activepropaganda
upon thepeople." "They
of theirselfishinterests
to impose the tyranny
have raised thecry thatthemeaning of all thishealth legislationis to
deprivetheindividualhis righttoemploythephysicianofhis choice,and
on thisfalsehood,theyhave solicitedand receivedcontributionsto their
corruption fund." Reed spoke for the medical profession and
representedthe resistanceto allopathicmedicine as dangerouslynaive
became evident,"explainedReed, that"thehealth
and selfish."It finally
of therisinggenerationinvolvesan intimatetechnicaland professional
knowledgeof anatomy,physiology,hygiene,thecauses and prevention
of disease, and the art to determine and define the physiological
limitationof each individualpupil."30
By 1910, therewere at least eight differentsites and trajectories
throughwhich education was medicalized. The medicalization of
educationwas popularized throughthe trainingof new practitioners
in these sites.G. StanleyHall heldweekly clinics forstudentsat Bay
View Hospital for the Insanewhile at JohnsHopkins in Baltimore.
were tightlytied to
LightnerWitmer's effortsin trainingpractitioners
Freedom."
of Children
and Medical
"The Medical
30Charles A. Reed.
Inspection
50 (1912): 273-78;
Journal ofProceedings and Addresses of theNational Education Association
The
of Boston, Mass."
School Hygiene
"News and Comment:
Department
Psychological
in schools, see Julia Graham
251. On the progress of medicine
Clinic 2 (1908): 251-52,
and Future."
Services
Health:
and Adolescent
Lear.
"School
Based
Past, Present
A. Averill.
Status
"The Present
Adolescent Medicine
7 (June 1996):
163-180; Lawrence
States." American Journal
in the 100 Largest Cities of theUnited
of School Health Work
ofSchoolHygiene 1 (February 1917): 30-38, 53-62; Idem,EducationalHygiene (Boston

HoughtonMifrhn, 1926);JosephineBaker,ChildHygiene (NewYork:Harper & Brothers,
1925); Gulick
and Ayers, Medical
Inspection,
167-180;
Ernest
B. Hoag
and Lewis
M.
Terman,Health Work in theSchools(Boston:Houghton Mifflin, 1914);Philip van Ingen,

"HistoryofChildWelfare in theUnited States," inA Half CenturyofPublicHealth ed.
P. Ravenel
(New York: Public
Mazyk
M.
Essentials-, Marie
Ready,
"Hygiene
Health
Association,
1921), 290-334;
Rapeer,
Biennial
and Physical
Education,"
Survey of
Education,1928-1930, US. OfficeofEducationBulletinNo. 20 (1931): 353-380; JamesE

Rogers, SchoolHealth Activitiesin 1930, US. OfficeofEducationPamphletNo. 21 (May
in the
in Biennial Survey ofEducation
in City Schools,"
Services
1931); Idem, "Health
DC: U.S. Government
United States, 1938-40
1942), 1
Printing Office,
(Washington,
Small, Educational Hygiene, Bureau ofEducation Bulletin No. 33 (1923).
50;Willard

524
themedical department at theUniversity of Pennsylvania.Henry

Goddard, at the Vineland Training School in New Jersey,was
persistent in offeringinternshipsin psychotherapeutictrainingand
care forthedisabled during the 191Os.Opportunities forinterningand
investigative
work in hospitalswere typicalof changes occurring in
scientificpsychologyin theU.S. during the 1900s and 1910s.Among
changes thattookplace inmedical trainingduring the late 1880s and
early 1900s was the decrease in apprenticeshipswith general
practitioners and an increase in clinic and hospital internships.
Abraham Flexner's report on medical education published in 1910
helped increase the rate of this change. Flexner, a young physician
trainedat JohnsHopkins, argued thatin clinics and hospitals,medical
studentsshould be placed in positions of both observerand clinician.
Clinics and hospitals provided settings for close personal contacts
between internsand patients,and a settingforobserving a range of
medical practices.Appointmentsand internshipsinclinicsand hospitals
helped psychologists repudiate philosophical psychology, or
introspectionism, and materialize scientific psychology. The
generation of psychologists that includedWalter Dearborn and
Robert Yerkes atHarvard andArnold Gesell atYale opened thedoors
tomedical institutions
with theirnewfound interestsin clinical and
abnormalpsychology.
Yerkes spearheadedpsychologicalinternshipsfor
his Harvard students in Boston's hospitals and clinics.Luella Cole,
Norman Fenton, Florence Goodenough, Sidney Pressey,Leta Stetter
Hollingworth, and David Shakow were among thosewhose rite of
passage intoeducationalor school psychologywas throughhospitals in
the 1910s and early1920s.31
ReflectingFlexner'srecommendations,therewas a sharp increase
in thenumberof "teachinghospitals" in theUnited States during the
191Os.The Boston PsychopathicHospital, forexample,was a relatively
31
For Cole
psychological
and Pressey's
and
internships
training,
training,
see Petrina,
"Luella Cole,
Sidney Pressey." On
see
"A Plea for the
of
Loyal Crane.
Training
Psychologists." Journal ofAbnormal Psychology20 (July 1955): 228-233; Samuel
"The Training
of Mental
Fernberger.
Hygienists."
Psychological Clinic
Morrow.
"The Development
of Psychological
137-142; William
1930):
14
(October
Internship
Training." Journal ofConsultingPsychology10 Quly 1946): 165-183; JohnO'Donnell,

The
American
of Behaviorism:
(New
Origins
Psychology, 1810-1920
"An
Shakow.
Press,
195-97; David
1985),
University
Internship
York:
for
New
York
Psychologists
2 (April 1938):
(withSpecial Reference toHospitals)." Journal ofConsultingPsychology
73-76;
Lewis
Terman.
"Professional
Training
for Mental
Hygiene."
Monthly 80 (March 1912): 289-297; Robert I. Watson.

American Journal
Psychologists."
of Orthopsychiatry
I.Watson.
"A Brief History
of Clinical
Psychology."
22 (Spring
Popular
Science
"Training of Clinical
1952): 140-152; Robert

Psychological Bulletin 50 (September
Clinic 1 (July
1953): 321-346; LightnerWitmer. "The Hospital School." Psychological
1907):
138-146;
Pennsylvania."
in
Idem, "Courses
Psychology
Psychological Clinic 4 (November
at the Summer School

1911): 245-273.
of theUniversity

of
525
small,four-story,
brickbuildingbuilt to functionas a researchlaboratory
care and outpatientfacility.
and temporary
This "charitable"institution
opened itsdoors inJune 1912 andwas modeled afterKraepelin's dem
onstrationclinic inMunich and somewhataftertheClinique Charcot at
theSalpetriereinParis.Arrangements
with localuniversities,suchas the
Boston School ofSocialWork, Harvard, SmithCollege andTufts,made
theBoston PsychopathicHospital a convenientinstitution
forstudents
needing short-term
apprenticeshipsand residences.Cole and Pressey's
trainingat the PsychopathicHospital in 1917 and 1918 prepared
these two educational psychologists to specialize inmental hygiene
and the hygiene of instruction.They readily integrated the lab
oratory technijues of behaviorismwith the clinical procedures of
psychoanalysis.2 They popularized psychotherapeuticknowledge
and products in universitycourses and workshops for teachers.
Like medical practitioners, they adopted dispositions toward
treatmentand assumed the authority to manage and control in
dividual cases through the hygiene of instructionor "neoscholastic
hygiene. ,"33
The hygieneof instructionreaffirmed

theauthorityof disciplinary
content(i.e.,neoscholasticism)common to theschool curriculum(i.e.,
art,English, history,
math, science, etc.) and itsmaintenance through
standardized tests.Neoscholastic hygiene regulatedhow and what to
thinkabout subjectssuch as artor science andwas, in effect,away of
regulatingnormalityfromearlyages.Educational psychologistssuch as
Cole and Pressey recognized that theminutiae of everydayschooling
governed the students'mental health as well as mobility. They
called their "diagnostic or teach-test procedure" "Educational
Psychoanalysis,"or "the problem of findingout why pupilsmake the
errors theydo." "What makes a child begin common nouns with
capitals?Why does a given pupil put commas where they are not
to administer
make
32Who is qualified
and prescribe
examinations,
diagnoses,
treatments? Of course, the relations between medicine
and psychology were not without
and the Progressive
disputes. See for example John C. Burnham.
"Psychiatry, Psychology
Movement." American Quarterly 12 (October 1960): 457-465; Idem, "The Struggle

Between
Physicians
and Paramedical
Personnel
in American
Psychiatry,
1917?41."
Journal of theHistory ofMedicine 29 (January1974): 93-106; William J. Goode.

and the Emerging
Profession:
"Encroachment,
Charlatanism,
"American Sociological Review 25 (October
and Medicine.
1960):
Sociology,
Psychology,
David
Shakow.
902-914;
and Psychiatry: A Dialogue."
American Journal ofOrthopsychiatry 19 (March
"Psychology
on the
"Historical
381-396; Robert I.Watson.
1949): 191-210,
Perspectives
relationship
toMedical
of Psychologists
6 (January 1960): 51-59.
Research."
Neuropsychiatry
a
is
of
derivative
the
instruction
of
and refers to
3Neoscholastic
hygiene
hygiene
to reaffirm the
the use of clinical methods
content of school
authority of disciplinary
A. Averill, The Hygiene
Mifflin,
subjects. Lawrence
of Instruction (New York: Houghton
1928); Harry N. Rivkin, Educating for Adjustment: The Classroom Applications
ofMental
(New York: D. Appleton-Century,
1936).
Hygiene

526
needed?How do childrenarriveat theirqueer conclusions in regardto

causal relationships in history?"The "hygiene of instruction"or
educational psychoanalysismeant that the factsand figuresentering
young minds were controlled and monitored for potential adverse
effects.Art, science, and social studies books, for example, paid
homage to the past and patriotism. Regulations and publisher
agreementsbasically ensured thatonly "healthy"content and images
enteredtheminds ofyoung scholars.Educational psychologistsfurther
rationalizedthecurriculumthroughclinicalmethods.34
For educators, theclinicalmethod underwrotewhat psychologist
Giles Ruch called the"complete act of instruction":
1 Initialpresentationofmaterials tobemastered.This phase
consistsof settingproblems tobe solved,textbookreadings
and discussion, teachers'commentson persistentdifficul
ties in learning,etc.
2 Drill to support the temporary
mastery gained under the
first
phase of instruction.
This may be drillproperor itmay
mean applicationsand reviews.
3 Diagnosticmeasurementat theperiodwhen phases one and
twoare thoughtto be complete.
4 Reteaching or remedialinstruction
upon anyweakness re
vealed under the thirdphase.
5 Final measurement and evaluationof amore general and
lessdetailed characterthan thatof phase three.This con
stitutesthefinalsurveyof achievementand leads to a judg
ment as to whether the individualor class is ready to
proceed tonewwork.
see Petrina, "Luella Cole,

34On educational
psychoanalysis,
Sidney Pressey"; Leo
Brueckner.
Procedures."
"Diagnostic
Analysis of Classroom
Elementary School Journal 27
and Remedial
and ErnestMelby,
(January 1926): 25-40; Leo Brueckner
Diagnostic
Teaching
(New York: Houghton Mifflin, 1931); Luella Cole,
"The Use
of Quantitative
in Educational
in
and in Evaluating
Remedial
Instruction,"
Diagnosis
in Instruction in
ed. Stuart Courtis
Quantitative Measurement
(Chicago:
Higher Education
of Chicago
Carter Good.
in Secondary
"Research
Press,
1930), 164-177;
University
Research 22 (January 1930): 9-30; Arthur A.
School Methods."
Journal
of Educational
Measurement
and Remedial
School Executives Magazine
49
"Diagnostic
Testing
Teaching."
Monroe.
and Remedial
in
Procedures
358-360; Marion
1930):
"Diagnostic
Educational
Record 19 (February
105-113; Emanuel
Paulu, Diagnostic
1938):
Reading."
Heath
and Company,
(New York, D.C.
1924); Bertha
Testing and Remedial Teaching
and Teresa Baker. "A Diagnostic
and Remedial Activity in Supervision."
Rogers
Journal of
Research 5 (January 1922): 21-26; Eugene
Educational
Smith. "The Use
of Tests
and
in the Three
R's: A Symposium."
5 (March
Measurements
1928):
Progressive Education
see
On
"Educational
textbook histories,
136-152;
Thorndike,
Stephen
Diagnosis."
a Purchase
on
Petrina.
and Its Constituent
'The School
of Tomorrow'
"Getting
Histories
of Technologies."
and Historiographies
Commodities:
of Education
History
Metcalf.
(June
Quarterly42 (April2002): 75-111.

527
In 1939,CharlotteEasbyGrave, Principalof the

Woods Schools in
Roslyn, Pennsylvania, summarized this progressivepedagogy: "the
learningpillwas sugarcoated,whichmade it a littleeasier to swallow,
but itwas stillmedicine. No longer did the teacher say, 'Take this
because I toldyou so.' She said, 'Youwant to be well and strong,don't
you?'-then take thismedicine, it'sgood foryou." The school had
become an educational dispensary or "therapeuticmilieu" and
instructionwas no exception. The clinical, "diagnostic-remedial
approach [to instruction],"one analyst concluded in 1969, "is the
most frequently
used in schools today."35
Althoughmedical intervention
was what, in 1913, a neurologist
recognized as a "veritablemedicosociological problem," up until the
1930s the relationbetweenmedicine and sociologywas limited to
clinical sociology and psychiatric social work. In the 1930s,
sociologistsbegan to study systematicallythe "medico-authoritarian
mantle" associated with clinical and associated allopathic,medical
practices.36These studies and others through the 1960s were the
inspirationbehind themedicalization thesis. In the late 1960s and
1970s, sociologists of medicine and medicalization described
allopathicpracticesfroma perspectiveof "mentalities."To understand
medical practice in theschools, it isworth attendingto sociological as
well as historicaldescriptions.Eliot Freidson observed, forexample,
thatclinicalpractitionerssharea commonethosormindset conditioned
throughwork with patientsor students.He described the allopathic
ethos as a "clinicalmentality,"characterizedby commitmentsto action
as opposed to inaction,individualism,faithin procedure,perception
trained to illness as opposed to health, pragmatism and firsthand
experience, subjectivismin that the use of senses are importantto
35On clinicalmethods, see Robert I.Watson, Readings in theClinicalMethod in

Psychology
(New York:Harper & Brothers, 1949); Idem,The ClinicalMethod inPsychology
(New York:Harper & Brothers,1951). On thecomplete act of instruction,seeGiles M.
Ruch, The ObjectiveorNew-TypeExamination (Chicago: University of Chicago Press,
1929), 9; Charlotte E. Grave, "Twenty-Five
Years ofProgress at the
Woods Schools," in
Twenty-Five
YearsofProgressinEducationeds. (Langhorne,PA: Child Research Clinic of
theWoods Schools, 1939), 12;Bruno Bettelheim and Emmy Sylvester."ATherapeutic
Milieu." Americanjournal ofOrthopsychiatry
18 (April1948): 191-200; Thomas Oakland,
"DiagnosticHelp 5?: Examiner Is In," Psychology
in theSchools6 (1969): 359-367, on 360.
36MarySutton. "Medical Sociology in the Public Schools." New YorkMedical
Jrournal108 (December 1913): 1164-66, on 1164. On earlymedical sociology, see
Kingsley Davis. "Mental Hygiene and the Class Structure." Psychiatry1 (anuary
1938): 55-65, on 65; Harold D. Laswell, Psychopathology
and Politics(New York:Viking,
1930); C. Wright Mills. "The Professional Ideology of Social Pathologists."American
jtournalof Sociology
49 (1943): 165-180; Talcott Parsons. "Illness and theRole of the
Physician:A Sociological Perspective."AmericanJournalofOrthopsychiatry
21 (October
1951): 452-460; Louis Wirth. "Clinical Sociology." AmericanJournal of Sociology27
(January1931): 49-66.

528
HistoryofEducationQuanterly
practice,and an emphasison indeterminacy

or uncertainty.
The term
clinical literallyrefers to "bedside" or personal, practical psycho
therapeuticattentionto patients medical practice in thepresence of
patients, or practice at the "sick-bed." Eventually, the connotation
encompassed diagnosis and treatmentwith the patient present,
whether bedridden or not. Freidson suggested: "Clearly, neither
medicine nor the physicianmay be characterized as passive ...
medicine is committed to treatingrather thanmerely definingand
studying ... It has amission of active intervention
guided bywhat, in
whatever time and place it exists, it believes to be ill in theworld.
Furthermore,it isactive inseekingout illness ...And insofaras illnessis
definedas somethingbad [aweakness] to be eradicatedor contained
medicine plays the role of what Becker called the 'moral
entrepreneur."'37
If teachers share thismoral entrepreneurialismand clinical

mentality with medical practitioners, then students identifywith
patients.Talcott Parsons noted that theNorth American "patternfor
illness is focusedon thecapacity forachievementfor the individual."
Therapeutic recoveryfor a patient is defined as a 'job to be done in
cooperationwith thosewho are technicallyqualified tohelp.The focus
thenoperates topolarize thecomponentsof the 'problem'insuch away
whichmust be
that theprimarythreatto[thepatients']achievement
capacity
overcomeis dependency."
These accounts are insightfulbut, for some
historiansand sociologists,fail to account adequately forscience and
technology.An "objective" bedside attention paid by medical
practitionersto theirpatients,and a new precision in diagnosis and
treatmentthroughlaboratory
medical sciencemarked clinicalpractices
more and more throughout the nineteenth century.According to
historian John Harley Warner, new laboratory-based, clinical
knowledgewas a productof "privilegedepistemology."38
3
Eliot Freidson,Profession
Medicine:A StudyoftheSociologyofAppliedKnowledge
of
(NewYork:Dodd, Mead andCompany, 1971), 172, 252. See also,AndrewAbbott,The
Medical
SystemofProfessions
(Chicago:UniversityofChicago Press, 1988);Paul Atkinson,
Talk andMedical Work: The LiturgyoftheClinic (London: Sage, 1995);Caroline Cox and
Adrienne
Medical
Practice (London:
eds, A Sociology of
Collier-Macmillan,
1975);
The Semi-Professions
and Their Organization:
Social
Teachers, Nurses,
Workers
(New York: Free Press,
1969); Eliot Freidson,
Doctoring Together: A Study of
in America:
1975); Idem, Medical Work
Professional Social Control (New York: Elsevier,
onHealth Care (New Haven,
CT: Yale University
and
Press, 1989); Eliot Freidson
Essays
and Their Work
eds. Medical Men
Aldine,
Judith Lorber,
1972); Robert K.
(Chicago:
MertorK
Ambivalence
and Other Essays (New York: Free Press, 1976).
3 Sociological
"Definitions
of Health
and Illness in Light of American Values
Talcott Parsons,
inPatients, Physicians and Illness ed. E. Gartlyjaco
and Social Structure,"
(London Collier
"The Fall and Rise of Professional Mystery,"
Macmillan,
1973), 140-41 John H. Warner,
in The
inMedicine
eds. Andrew Cunningham
and Perry Williams
Laboratory Revolution
Amatai
Mead,
Etzioni,
(Cambridge:
Cambridge
University
Press),
141.

529
'Whatemerged fromclinical practice, saysMichel Foucault, was

"medicalperception."For Foucault, thepatient's"bed" became "a field
of scientific investigationand discourse." "This new structure is
indicated but not of course exhausted-by theminute but decisive
change,whereby thequestion: 'What is thematterwith you?'... was
replaced by thatother question: 'Where does it hurt?', inwhich we
recognize theclinic and theprincipleof itsentirediscourse."Clinical
practice involves a mode of saying and seeing a productive,
pedagogical gaze. In education, a unique arrangement of
was practiced at the "deskside."Teaching was not
psychotherapeutics
somuch a dialogue as a "deskside" practice.This clinical "deskside"
practicewas, according toprogressivepractitioner
ArthurMetcalf, the
keynoteof progressiveeducation: "find theweakness of the child and
apply the teachingeffortat thepoint ofweakness."At the "deskside,"
onemetaphoricallyasks thischild,"where isyourweakness?" revealing
asFoucault suggested,amodern discourseof clinicalpractice.The first
taskof thispractice,said Foucault, "is therefore
political: thestruggle
a
againstdisease" is struggle"againstbad government."Frommedicine
came knowledgeof illness,but also knowledgeof "healthy
man, thatis,a
man and a definitionof themodelman" or student.39
studyof non-sick
Medicating Kids
I described eight, distinct practices throughwhich schools were
medicalized during the lastdecade of thenineteenthcenturyand the
firstthreedecades of the twentiethcentury.The medicalization of
education was summarized in expanding definitionsof educational
hygiene, encompassingmental, neoscholastic, physical, and school
hygiene by themid-191Os. Mental hygiene, as noted by Cohen,
attended to themaintenance of normalityaswell as thediagnosis and
of abnormalityand disabilityinpersonalityand intelligence.
treatment
The hygieneof instructionor neoscholastic hygiene expanded from
concernswith fatigueinducedfromacademic studiesto thedetectionof
of
pathologies behind adding or spelling and thepsychotherapeutics
reaffirming
theauthorityof school subjects.The medical practicesof
physicalhygiene,such asmedical inspections,physicaleducation,and
instructionin hygiene,were primarilyconcernedwith interrelations
among abilityand body,mind, and soul. Through the sanitationof
building and fixturedesign andmaintenance, schoolswere physically
Sheridan Smith (New York:
The Birth of the Clinic trans. A.M.
Foucault,
360; Foucault
xii, xv, xviii, 33-34; Metcalf,
1973/1994),
"Diagnostic
Testing,"
in Colin Gordon,
1980), 166.
ed., Power/Knowledge
(Brighton: Harvester,
39Michel
Vintage,
quoted

530
modeled on theclinic and hospital in thename of school hygiene.The

hygienicpracticesand textsof dietetics,health education,and physical
cultureresponded tonew alignmentsamong anatomy,anthropometry,
chemistry,
eugenics,medicine, physiology,and psychology.
I argued thatin theaggregate,our historiesof themedicalization of
education account somewhat for the diversificationof educational
hygienebut individuallyare incompletein thattheyfailto account for
thearticulationof itspractices.40I offereda synthesisand demonstrated
that themedicalization of educationwas material inasmuchas itwas
ideological. By providing a detailed narrativeof interdependencies
between allopathic medicine and education, I suggested that the
medicalization of educationwas basically a historicalaccomplishment
establishedon contingencies.During the late 1800s,clinical,scientific
medicine provided a "privilegedepistemology"forallopaths interested
in extendingtheirauthorityinto the fullrangeofmodern life.Besides
traditionalsystemsof church-sponsored
benevolence,new
interventionists dieticians, clinical nurses, physicians,psychiatrists,

psychologists, psychiatric social workers helped popularize a
seeminglysecular systemof expertisefor treatingeverydayproblems.
Of course,philanthropy,policy,and the legal systemshoredup long
term allopathic interventionin the schools. Indeed, themodern
classroomwas constructedthrough
models of theclinic and dispensary
institutionstowardwhich educators and psychologists turned to
enforce the rudiments of liberal, progressive practice even as
administratorsran theirofficesand hallwaysonmodels of theefficient
business establishment.
Why does itmatterwhetherwe recognizehow,when, andwhy
educationwas medicalized? Ifwe fail to recognize thatmerit and the
regulationofmobility only partiallyaccount for thepersistenceand
power of examinationand remediationindustriesinNorth American
education,we cannot understand the increasinglycomplex role that
medicine plays in the livesof students.41
We willmerelywonder at the
Steps
40On diversification
in the Development
of educational
of the Modern
Health 29 (July1959): 262-69.

41
hygiene,
School
see Kenneth
Health
E. Veselak.
Program."
"Historical
Journal
of School
of psycho therapeutic knowledge

for education,
650
Signifying the marketability
are
in Canada
Centers
and the United
States and competing
Sylvan Learning
operating
to provide
with
the Educational
Service
(ETS)
Testing
computerized
testing and
services to place students on the road to good academic
remedial
health. Companies
are
such as Sylvan and the ETS's Princeton Review
their services with public
coordinating
schools to exploit the $2.5 billion test preparation market. Denise Hawkins.
"Multiple
11 (February
Black Issues in Higher Education
Choice Mushroom."
12;
1995): 8-10,
Catherine
Horn
and Miguel
Ramos.
"The
Clark,
Madaus,
Marguerite
George
2 (April 2001):
for Educational
Statements
M.
1-10; Walter
Marketplace
Testing."
F. Madaus
and Robert
The Fractured Marketplace
Haney,
George
Lyons,
for

5 31
fact thatbetween 5 and 10 percent ofNorth American school-age

students are diagnosed with ADHD and about threemillion are
prescribed Ritalin and generic derivatives of methylphenidate.
Historians and educators ought to understand that a process of
medicating kids for school is completely interdependentwith a
complex of psychotherapeuticpractices and historicalcontingencies.
This historiographicsynthesisshould leavelittledoubt thatthispractice
has a deep and complexhistorythatdemandssustainedattention.
Larger
historicalandmoral problems are how andwhy allopathicphysicians
won school privileges and rights over a variety of alternative
practitionerscontesting access to the body, minds, and souls of
students.42
Standardized
the Cost of
1993); Richard P. Phelps.
Testing (Boston: Kluwer,
"Estimating
in the United
States." Journal of Educational
Student Testing
Finance 24
Peter Saks, Standardized Minds
343-380;
Perseus,
2000):
1999),
(Cambridge:
Standardized
(Winter
221-230.
42The U.S. Congress

passed The Child Medication
Safety Act of 2003 "to protect
a controlled
children and their parents from being coerced
into administering
substance
in order to attend, and for other purposes."
On
trends in methylphenidate
uses, see
William
Catherine
andWayne
Fuchs, Patrick Arbogast
Cooper, Gerald Hickson,
Ray.
"New Users
of Antipsychotic
Medications
Children
Enrolled
in TennCare."
Among
Archives ofPediatrics& Adolescent

Medicine 158 (August 2004): 753-59; Lawrence H.
on Ritalin (New York: Bantam,
1998); Idem, "Lessons from Three Year
Running
and Behavioral Pediatrics 23 (February 2002):
Svetlana
S10-S12;
Developmental
to Control Kids'
"Use of Ritalin
Kolchik,
Behavior," Honolulu Advisor
(13 November
Anton
2002),
http://the.honoluluadvertiser.eom/article/2002/Nov/l3/hf/hf01a.html;
Diller,
Olds,"
Miller,
Lalonde,
Christopher
of Methylphenidate
"Prescription
M.
Kimberlyn
to Children
McGrail
and Youth,
and
Robert
1990-1996."
Armstrong.
Canadian
Medical Association
Journal 165 (November 2001): 1489-494;Miller andLeger, "AVery
Moral
Linda M. Robison,
David
Panic";
Sclar, Tracy L. Sclar
in the Prevalence
of Attention-Deficit/Hyperactivity
"National Trends
the Prescribing
of Methylphenidate
Children:
Among
School-Age
Childish
and Richard
Galin.
Disorder
1990-1995."
and
ClinicalPediatrics38 (April 1999): 209-217; JulieM. Zito, Daniel Safer,Susan dosReis,

James
Gardner,
Myde
Medications
Psychotropic
and Frances
Boles
to Preschoolers."
283 (February2000): 1025-030.
Lynch.
Journal
in the Prescribing
"Trends
of
Association
of theAmerican Medical


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History of Education Society

The Medicalization of Education: A Historiographic Synthesis

This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

The Medicalization ofEducation: A

Sol Cohen was rightandwrong. Education was medicalized but this

1G.StanleyHall, Life andConfessions

Quarterly,23 (Summer 1983): 123-149; idem, "The Triumph of theTherapeutic:

This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

Medicalization refersto a processwhereby nonmedical problems

MedicalNemesis (London:Calder & Boyars, 1975), 31; Ivan Illich,Limits

This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

his cases dealwithmental hygienein the 1920sand themedicalization of

in From the Campus: Perspectives on the School

1979): 459-516; Theresa Richardson, The Centuryof theChild: TheMental Hygiene

and Social Policy in theUnited States and Canada

This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

clues to a formof medicalization typicallyoverlooked.6Disability

6Gerald Coles, The LearningMystique (New York: Ballantine, 1987); Barry

Press, 1994);PeterConrad, Identifying

theNetherlands around 1900."History ofEducation25 (July1996): 255-268; Gerald M.

(NewYork:Aldine De Gryter, 1989), 79-97; SteveHarlow. "TheMedicalization of the

(Summer 1989): 12-17; BernardHarris, TheHealth oftheSchoolChild:A History ofthe

William T. Hartman (Philadelphia: Open University Press, 1983), 15-47; David

Medical Nemesis (London: Calder & Boyars, 1975); Ivan Illich,

of Education 94 (May 1986): 281-312; Aude de Saint-Loup, "A History of

This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

Brown offereda historyand theoryof therhetorical

Sane: Psychiatry and Eugenics

Health Law andPolicy 13 (Fall 1996):

and the Quest

Educational Crusade, 1900-1939."HistoryofEducation8 (April 1979): 293-306; Philp R.

in the United States

1922-1945 (Philadelphia:Temple UniversityPress, 1989);KathleenW.Jones, Tamingthe

Treatment of Schoolchildren."History ofEducation 19 (February 1990): 139-148; John

Allied Sciences33 (July1978): 344-355;Mona Gleason. "Race,

Medical History 19 (January2002): 95

Education inEngland." OxfordReview ofEducation9 (April 1983): 181-196; StephenT.

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control of hyperactivechildren in the 1930s, this blatant formof

A Study of the Rise and Fall

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This content downloaded from 193.104.110.28 on Mon, 23 Jun 2014 04:45:53 AM

methods also common to changes in business, corrections,jurispru

13Louis Rapeer, Essentials ofEducational Hygiene

Books 1982), 180-196.

AmericanJournalofInsanity56 (July1899):41-52,41. On Hall andMedicine, seeDorothy

The Psychologist as Prophet

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Intelligence Tests andMedical Inspections

Great Teachers andMental

Neurology(NewYork:OxfordUniversityPress, 1995);JanGoldstein, ConsoleandClassify:

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the objectivewas comparisonsofmentally "abnormal"withmentally

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Authorityoverwho to examinewas renegotiatedand as the superin

EducationAssociation42 (July1903): 784-85, 784; Edwin P. Seaver. "The Medical

Management Division; John Duffy. "The Early Days

of the School Health

PublicHealth, expanded edition (Baltimore:JohnHopkins UniversityPress, 1993), 340

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the benefitsof a full regimenof exercise and physical education for

Association for theAdvancement