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34 of
, 53, 6
|
5cbool jºlygiene
B ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
VOL. I., NO. I
HN A. BERGström, Ph.D., Professor of Education,
University of Indiana.
LMER. E. B.Rown, Ph.D., United States Commissioner
of Education.
ILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
- ogics, Clark University.
of N J. C.Ronin, M.D., Assistant Chief Medical Inspector,
Health Department, New York City.
BRAHAM Jacobi, M.D., LL.D., Professor of Diseases of
New York University.
BBERT W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
usetts State Board of Health.
º HARRING to N, A.B., M.D., Secretary of Massa-
Alvin N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
Heorge H. MARTIN, LL.D., Secretary of Massachusetts
| State Board of Education. -
...H. McColloM, M.D., Professor of Contagious Diseases,
* University.
|
Children, New York City. CHAMPE S. ANDREws, Esq., New York City.
* - I -
Homas M. BALLIEtt, Ph.D., Dean of School of Pedagogy,"
346 | PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
536
BOSTON, MASS. JUNE, 1908
ºbe (Wfficers amo Council of the Eig50ciation
º orary President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABot; Secretary and Treasurer, Dr. THOMAS A. STOREY.
J. H. McCURDy, M.D., Director. International Young
Men's Christian Association Training School.
CHARLEs A. MooRE, Chairman Welfare Department,
National Civic Federation.
Edward L. STEvens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. Storrow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
Nicholas MURRAy But LER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDER1ck ForcHHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON, E. FischEL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULick, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart:
§. of Physical Training and Athletics, University of
1SSouT1.
GeoRGE MEyLAN, A.M., M.D., Adjunct Professor of
Łºsical Education, Columbia University, New York
ity.
THOMAS A. Storey, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
* As a result of the several business meetings held, it was definitely decided that the
ºlicy of the Association during the coming year should lead to the formation of sev-
ral active committees which may cover such work as the compilation of a bibliog-
aphy on school hygiene; the formation of a conspectus of state and municipal laws
elative to school hygiene; the accumulation of further statistics concerning medical
*ction: and the publication of a monthly bulletin on school hygiene.
Jubscription price, 50 cents a year
3 EORGE S. C. BADGER, M. D., Editor
D. C. HEATH AND COMPANY., Publishers
- . 48 Hereford Street, Boston, Mass.
12o Boylston Street, Boston, Mass.
iſ communications concerning manuscripts and editorial matter should be addressed to the editor.
pmmunications concerning advertising, subscriptions, and business matters should be addressed to the publishers.









2 S C H O O L H Y G I E N E
TABLE OF CONTENTS
EDITORIAL
THE SCHOOL HyGIENE Association
‘‘ SCHOOL HyGIENE ''
ARTICLES
REPORT of CoMMITTEE of Oculists AND ELEc-
TRICIANs on ARTIFICIAL LIGHTING AND Color
SchEMEs of Boston School BUILDINGs . . . 3
School BATHS IN Sweden
THE PREVENTION OF TUBERCULos Is AMONG SCHOOL
CHILDREN . . . . . . . . . . . . . . . . 5
EYE STRAIN IN School CHILDREN . . . . . . . . 6
FROM THE BATH DEPARTMENT OF Boston . . . 6
THE ULTIMATE DEMANDs of ScHool, HyGIENE . . 7
AN OPEN LETTER FROM DR. JEssen, STRAssBURG,
GERMANY. . . . . . . . . . . . . . . . . 8
THE EYES OF PUBLIC SCHOOL PUPILS . . . . . . Q
DEPARTMENT of Hygiene UNDER BoARDs of EDU-
CATION . . . . . . . . . . . . . . . . . . 9
PLAY GROUND LEGISLATION . . . . . . . . . . . I I
THE EDUCATION OF THE PUBLIC IN SCIENTIFIC
MEDICINE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 2
HEALTH OF OUR HIGH-SCHoo L CHILDREN . . . . . . . . . 13
SCHOOL CLIN1cs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I4.
EDITORIAL
THE SCHOOL HYGIENE
ASSOCIATION.
THE American School Hygiene Associa-
tion was organized to bring into effective
Service the large amount of practical
knowledge concerning school hygiene that
has been developed by scientific men dur-
ing the last few years. At the same time
it aims to foster the increase of knowledge
On these topics. This data is largely tied
up in reports of scientific societies, in
Scientific volumes, etc. It is not generally
known or appreciated in educational cir-
cles. It is the aim of this association to
bring the scientific men who are conducting
Original investigations relating to the
welfare of school children into effective
relation to the men occupying administra-
tive positions with reference to education,
upon whom rests the necessity of deciding
upon policies and putting them into
Operation.
The present time is auspicious, for º
terest in the subject of school hygienir
extends over the whole civilized world, dot
was indicated by the attendance at thio.
Second International Congress on Schoºn
Hygiene held in London last August. .
The association owes its origin to
letter written by Sir Lauder Brunton ti
Dr. Arthur T. Cabot, asking if he woul,
not aid in securing delegates to the Inte;
national Congress on School Hygiene iſ
1907. After correspondence and discus
sion, it was decided that there was need d
a permanent organization to foster the
interests in America, and that the immd.
diate formation of such a body would bloé
the best mode of bringing about that cq
operation desired by Sir Lauder Brunto
“SCHOOL HYGIENE.”
THE journal called ScHool, HyGIEN
represents an effort to place before t
public a report of progress in the movde.
ment to secure improved school conditionnus
for children and to awaken public intereind
in the importance of the subject. Suthea
improved conditions are only to be olers
tained by widespread public sentimeſcril
acting upon the legislative bodies of state; w
cities, and towns; for the public makes thot
laws and the public provides the monelou
and progress cannot be made beyond thee
point to which the public is educatewit
The problem of securing improved schoen
conditions becomes, therefore, the probw
lem of the education of the public, anula
however enthusiastic a small body of ihe
terested persons may become, and houb.
ever thoroughly they may be convinced ºnly
the primary importance of this matteos
they must wait upon the action of the
1egislative bodies, which are in turn actee
upon by public sentiment. T
This Journ AL, therefore, stands for gen
attempt made to meet the conditions der:
described and to call the attention of f t
many persons as may be reached to thf t
existing school conditions in this countrat
to the methods of remedying these condary





















S C H O O L H Y G I E N E 3
inions by legislation and otherwise, to the
ºrogress already made in improving them,
ao the results obtained by improved condi-
hi. ins, and to methods and results obtained
º other communities than ours. The
ovement in behalf of school hygiene is
ot to be regarded as an original experi-
thent being conducted by the American
ileople, for most European countries are
ear ahead of us in the matter, and their
ixperience and results reaching over many
usears are of great importance to us, and
(ne object of the Journ AL will be to present
eshose methods and results.
nº. The establishment of this periodical
s not represent an effort to establish
oney-making enterprise, and it rests
pon no firm financial basis. The asso-
tion which is responsible for it has no
Nts members, a sum which is not even
cient to pay its running expenses, and
to establish its proceedings. The Journal
must, therefore, stand on its own feet,
end its future will be determined by the
ºne. Sure of support received from the
. to whom it is sent. If they sub-
eſcribe to it and secure other subscriptions,
e; will become a permanency; if they do
thot subscribe, its future is more than
eloubtful. The subscription price has
theen made very low in order to bring it
evithin the reach of every one, and it is in-
Oended to continue to publish it at this
bw price in order to secure as large a cir-
nulation as possible. The money to start
ihe publication has been raised by private
Aubscription, but the money has been given
ºnly for the first year, and it will not be
cossible to continue its publication without
eshe support of the persons to whom it is
teent. -
The periodical starts with an edition of
ten thousand copies, and is sent to those
bersons who would naturally be interested.
f they believe that such a publication is
tif use and should be continued they will
raturally subscribe the small sum neces-
dary; if they do not regard it as advisable
to attempt to inform the public on those
matters, they will naturally not subscribe,
and if those who do not subscribe are in
the majority, this publication will in time
fall to the ground. The future of this
Journ AL, therefore, rests largely in the
hands of those persons to whom it is sent,
for advertising and continued solicitation
cannot be attempted, and the information
contained in this editorial must be taken
at its face value and acted upon by those
persons who are in sympathy with its aims
and object.
The Jou RNAL OF SCHOOL Hyg|ENE may
vary from eight to sixteen pages in the
amount of reading in subsequent numbers,
depending on the material at hand. Con-
tributions to its columns are earnestly
desired.
REPORT OF COMMITTEE OF OCU–
LISTS AND ELECTRICIANS ON
ARTIFICIAL LIGHTING: AND
COLOR SCHEMES OF BOSTON
SCHOOL BUILDINGS.
A COMMITTEE of three oculists and two
electricians was appointed April 29, 1907,
by the Boston School Committee, “to
consider the artificial lighting of the public
Schools and their color schemes.” The
high standing of the members of this com-
mittee in their respective professions, and
the thoroughness of their investigations
make this report a most valuable docu-
ment. It is published by the Boston
School Committee as School Document,
No. 14, 1907.
The committee reports that the 1itera-
ture , while voluminous is lacking in
definite information; that there is an
extraordinary lack of information in regard
to the lighting systems of the present day.
Certain definite requirements exist:
I. Forty to sixty desks must receive
practically the same illumination.
2. In certain subjects taught, as draw-
ing, sloyd, Sewing, and writing, suitable
shadows are probably desirable for the
comfortable use of the eyes. These
Shadows must not interfere with desk
work. -
3. Brilliant points of illumination are
undesirable and may be dangerous if






4 S C H O O L H Y G I E N E
maintained in a constant position in re-
lation to the eye.
4. “The means of illumination should
neither contaminate the air, produce much
heat, nor be rich in the injurious rays of
the spectrum.”
5. The construction of the fixtures must
be such that they can easily be kept clean.
6. The color of the walls, window shades,
and wood-work must be very 1ight.
7. The lighting must be suitable for day
and evening sessions.
Illumination must be by direct or
indirect lighting, or by a combination of
the two. In direct lighting, the opaque
shades are placed directly above the lamps
to reflect all the light downward.
In indirect lighting all the light is re-
flected upward to the ceiling and walls
and thence to the lower portions of the
TOO111.
Direct lighting is the simplest and
cheapest method, but has the following
serious objections: 1. It is difficult to
shade the lamps in such a way as to avoid
Bright points of 1jght. 2. The shadows
are intense. 3. It is hard to distribute
the light evenly at each place.
Indirect illumination avoids these ob-
jections, but has certain other serious dis-
advantages inseparable from it, not the
1east of which is the greater expense.
The present lighting system in the more
modern Schools is by indirect lighting plus
a certain portion of direct. The lighting
arrangements in a standard schoolroom,
26 ft. x 30 ft. x 13 ft. high, containing fifty
desks, consist of six fixtures suspended
from the ceiling, each composed of two
eight and two sixteen candle-power in-
candescent lamps, contained in a shallow
bowl of opal glass and covered with a sheet
of plate glass. The larger part of the light
is reflected to the ceiling and thence down-
ward to the desk, while a smaller amount
is transmitted directly through the opal
glass shade. Over the teacher's desk is a
single light reflected downwards by an
opaque shade.
The one serious objection to this method
seems to be the difficulty of keeping it
clean. It was found that the accumula-
tion of dust diminished by .20 per cent the
amount of 11ght possible. These fixtures
require much time and care to keep clean
and in repair.
The committee in conjunction with the
electrical engineer of the Schoolhouse Com-
mission carried out very carefully planned
experiments to determine the best method
of illumination. A room 28 ft. x 28 ft. x 14
ft. was used in the expriment. The will
ows were boarded up to shut out aſ
daylight. The walls of the room were ligh
yellow, the ceiling white. The wiring wa
so arranged, with duplicate circuits, the
one experiment could be tried immediatel .
after another by merely throwing a switcºil
The direct method of lighting and thi.
combined direct and indirect, were aloº.
tried. The objections to the indired
method and its greater cost making it,
the committee's mind, unsuitable fū
school use. -
It was found that direct lighting w
unsatisfactory, as it was impossible
locate the lamps so as to bring them out
the vision of both pupils and teacher. r
The experiments were chiefly confinees
to schemes of illumination depending º
!
r
tially upon direct and partially on diffuse |
1ight. The lamps used were what
known as high efficiency or low waſ
incandescent lamps which have recents:
come on the market. The most sation
factory results were obtained from nit
thirty-six candle-power 40-watt Tungstºn
lamps, each equipped with the diffusin
prismatic reflector. These shades are º:
structed of prismatic glass coated on t ol
outer or inner surface with a Whi.
enamel. The lights were arranged in
three rows of three lamps, each runni",
parallel to the rows of desks. The ºf -
of light distribution is slightly to the le.
of the middle of the room when facing tº
teacher's desk. This was arranged .
order, as far as possible, to throw #.
dominant shadow from left to right on #.
pupil’s desk. Đà
About the same results were obtainii.
from 100 watt G. E. M. lamps with tº.
same style of shades. pil
The fixture is extremely simple, co.
sisting of a rod or chain, from which ba.
suspended a shade holder, shade, and lan.
socket. The shade is open at the base, i.
made of clear glass, with the inner or out.
surface enameled in a manner to give
appearance of frosting, and the out.
surface fluted in a manner similar to t.
ordinary prismatic shade. §:
In the mind of the committee there W
no question that the light furnished frºsci
the Tungsten 1amps, with the sha(h.
described above, was superior to them.
furnished by the standard clusters. ou.
The comparative current consumptaff
of a schoolroom lighted with nine 4o-Wa,
Tungsten lamps, nine Ioo-watt G. E. Co.
1amps, and the present standard lightſ of
with indirect clusters, is as follows:
a1
|






S C H O O L H Y G I E N E 5
–T
- T ungsten 40-watt lamps, 360 watts.
wiſ & E. M. Ioo-watt lamps, 9 oo , ,
#5 Indirect clusters (present
ºf standard two 8-candle power
Yº and two 16-candle power
tha each), 960 , ,
* The cost of the Tungsten lamps, and of
"wiring a building for these is less than for
that of the present standard clusters, and
ºne current consumption 62.5 percent less.
* The amount of light given to each desk
"s 2.5 candle feet as against 1.5 candle fº.
"rom the present standard clusters. The
simplicity of construction of the lighting
rtures makes easy the task of keeping
m free from dust and at their maximum
ciency.
This method of lighting is therefore
*ecommended by the committee.
-
C
use
SCHOOL BATHS IN SWEDEN.
Wat
C From “Education in Sweden.” The report of the
Titº'oyal Swedish Committee for the International Congress,
atuſ,ondon, 1907.
* IN several towns the pupils of both sexes
jºin the public elementary schools have,
s hrough the care of the school authorities,
‘been given the opportunity of obtaining
a sold baths free of charge and, in some
"places, in the same connection, instruction
1 in the art of swimming. - -
* The largest cities have made it feasible
ºr the elementary school children also to
r ºpptain free baths during the cold season
"of the year. For this purpose they have
tºartly provided special bathing accommo-
flation in several of the elementary school
"buildings, and partly defrayed the cost of
... baths for the elementary school children in
"the public bathing establishments. In
"Stockholm all public elementary school pu-
ils are able to obtain warm baths free of
St. Every child gets one or two warm
aths every month. On the whole their
ticipation in this is voluntary, but has
...become very general, in the same measure
w s the children and their parents have had
...time to become convinced of the advantage
"derived from the bath, as well as of the
groundlessness of fears for colds after
bathing, and similar objections.
" In the greatest number of the elementary
"schools of Stockholm, the “Finnish '' bath
*(hot air and steam) is the form of bath
"employed; the bather, having been thor-
..oughly washed in the sweating room first,
"afterwards obtains a shower bath and then
“a cooling off in the bathing tank. In a
couple of the Schools they use the system
tof bathing tubs or sitting baths (half
ºntº.
le
baths), with a subsequent shower bath.
During 1906 the number of warm baths
given to the public elementary school
children of Stockholm amounted to about
two hundred thousand. In several of the
newest elementary school buildings of
Gothenburg establishments for warm baths
have been arranged, and the city besides
defrays the cost of free warm baths for a
large number of elementary school children
in the Renström bathing establishment.
The experience obtained by the use of
School baths is that they have a remark-
ably excellent effect hygienically, and that
in other respects also they have proved
noteworthy advantages.
THE PREVENTION OF TUBERCU–
LOSIS AMONG THE SCHOOL
CHILI) REN.
HENRY BURTON JACOBS, M.D., BALTIMORE.
(From the Journal of the Outdoor Life.)
IN this article the important part the
children play in the fight against tuber-
culosis is emphasized. The cases of con-
Sumption which begin to be numerous after
the fifteenth year are probably contracted
during the years of School life, and as
consumption claims by far the largest
share of its victims between the ages of
fifteen and thirty, the importance of safe-
guarding the School years is manifest.
This statement is made more clear since
we know that, after infection takes place,
there is a long period of latency. In
Solving the problem of tuberculosis, it is
evident therefore that parents, guardians
of children, teachers, and other school
authorities must be important and active
factors.
Properly constructed school buildings,
thoroughly ventilated and cared for, with
good yards or playgrounds are most im-
portant. Good health as well as knowl-
edge should be acquired during the school
hours. Certainly, the school should give
hygienic surroundings superior to those
found in the crowded tenements of the
1arge cities. The advisability of erecting
School buildings adjacent to public parks
or Squares, where extensive playgrounds
and gardens can be secured, is suggested.
The importance of instruction in hygiene
is particularly emphasized. This instruc-
tion should continue through all the years
of School life and should begin with the
most elementary things pertaining to the


6 S C H O O L H Y G I E N E
child's habits of living. In the later years
special instruction should be given about
tuberculosis.
EYESTRAIN IN SCHOOL CHILDREN.
IN an article published in the New York
Medical Journal, June 1, 1907, Dr. Walter
S. Cornell gives some important facts con-
cerning eyestrain in school children. In
New York City 29.5 per cent of 79,069
children examined suffered from defective
vision. In Philadelphia 28 per cent of
I4o, ooo examined. In London 26 per cent
of 20, ooo children examined by eight
ophthalmologists had defective vision, and
of this number 12.5 per cent suffered from
vision of one half or 1ess. The author
examined personally I, 156 children and
found 34 per cent with defective vision,
and of this number 6 per cent with vision
One half or 1ess.
A small proportion only of this number
is fitted with classes. The rest suffer from
real eyestrain. The fault of this deplor-
able condition is divided among physi-
cians, school teachers, and parents. Ig-
norance of the existing facts, indifference,
and poverty are the real factors to be
dealt with.
The relationship of poor vision to
scholarship was studied in 219 children.
As will be noticed the difference in marks
loetween those with normal and those with
bad vision is greatest in arithmetic and
spelling, which studies require more ex-
tensive use of the blackboard.
PERCENTAGEs OBTAINED.
Arith- Geogra- Spell- Aver-
Children with metic. phy. ing. age.
Normal vision, 79 69 76 75–
Fair vision, 7O 7I 77 73 +
Bad vision, 66 7o 7 I 69
The children were again grouped accord-
ing to their scholarships, into three classes.
Good scholarship comprised a mark of 85
or more, fair scholarship 7o to 84, and poor
scholarship less than 70. The following
result was obtained: Of the bright chil-
dren, 22 had normal vision, 4 had fair
vision, and I had bad vision. Of the
fairly bright children Too were normal, 27
had fair vision, and 3 had bad vision. Of
the dull children 42 had normal vision, II
had fair vision, and 3 had bad vision. The
results on analysis, therefore, correspond
to the conclusions drawn from the first
grouping, namely, that the scholarship
and visual acuity vary directly and pro-
portionately.
FROM THE BATH DEPARTMENT O
BOSTON. -
“A CLEAN mouth is as important as
clean body.” This motto is printed o
the front page of a small pamphlet en
titled, “ Care and Use of the Teeth.” I
is prepared by “The Trustees of the Bat
Department of the City of Boston,” an
printed by the Industrial School fo
Crippled and Deformed Children, at twºc
dollars a thousand. It is being widelite
distributed in Boston, and it is hoped win
be of service in arousing a proper regard "
the teeth. The condition of the mouth
of a large percentage of school children º'
foul. It is due wholly to neglect. Thiº
pamphlet has the cordial endorsement o
all the best dental societies in Boston. I*
speaks for itself:— 111
What are the teeth for? Not merely forlo
ornament. Their chief use is to prepareci
food for the stomach; to grind the food in
and mix it with saliva. Food which is not of
thoroughly chewed causes indigestion and of
constipation.
How long should the teeth last? “fo the tr
end of 11fe. 11.
How do we lose them? By decay and sº
1oosening. 11.
What causes teeth to decay?
a1
- - - Bits of food º
and candy sticking to the teeth; also
poor physical condition. º
Where does the food lodge? All along thi
edge of the gums, between the teeth, an SC
in the crevices of the grinding surfaces.
Can decay be prevented? Yes, to a larg
extent.
How can decay be prevented? By scrub
bing the teeth thoroughly with a toot
brush, tooth powder, and water; and by
keeping up the general health.
How often should the teeth be cleaned? A
1east twice a day — after breakfast and a
loedtime. Better after each meal.
Should the gums be brushed? Yes. Mod
erate friction helps to keep them healthy,
How often should tooth powder be used
At least once a day — at bedtime.
Twice a year, at least, a dentist shoul
carefully examine the teeth.
A bad condition of the throat, the mos,
and the ears is made worse by decayed teel
They add to the chances of catching injectio
diseases. Well-cared-for teeth and a cled
mouth help to prevent tuberculosis.
Cleanliness is the best guard again
disease.
l














S C H O O L H Y G I E N E 7
OH THE ULTIMATE DEMANDS OF To overcome this difficulty, several of
SCHOOL HYGIENE.
BY GEORGE H. MARTIN,
Secretary of the State Board of Education.
|
I (FROM School Hygiene in Massachusetts.)
nd THE movement now in progress, which
Ohas reached different stages in different
yºcountries, seems to be shaping itself so as
ly to include as necessary features the follow-
Ol
illing elements:
º Physicians. – A sufficient number of
trained physicians to carry on the neces-
sary examinations and exercise the needed
"oversight of all the children in the public
i. and private schools; these physicians to act
under the direction of the local educational
authority, but in co-operation with the
Oſlocal health authorities. In the larger
recities the physicians should act under the
Odimmediate direction of a chief medical
0 officer, who should be a permanent member
ld of the educational staff.
2. Nurses. – A sufficient number of
he trained nurses to establish and maintain
mutually helpful relations between the
hiſ schools and the homes. The teachers, the
nurses, the school doctors, and the parents
are all needed for an effective system of
school hygiene. This is not now merely a
- theory, but has been demonstrated so
Widely under such different social con-
ditions as to have all the weight of a
"scientific fact.
3. Examinations. – Examinations of all
school children as to their physical condi-
tion in relation to school work at fixed
periods, the first and most important
h being at the time of admission to school.
| The results of this examination will
determine the amount and kind of over-
A sight which the child will need as he goes
on in his school work, and the sort of
régime to which he may safely be sub-
jected.
Just at what periods subsequent exami-
nations should be made is now a question
under discussion, and various experiments
are being made, but probably they will
not need to be annual, as now required by
the Massachusetts 1aw.
4. School Clinics. – The most serious
obstacle to the successful operation of a
system of medical inspection is the failure
of parents to provide the treatment which
School inspection has shown to be neces-
sary. This is due partly to indifference
and partly to poverty.
the Swiss cities have established school
clinics or centers where, without cost to the
parent, examinations may be made and
treatment provided. Some of these cen-
ters are for the treatment of the teeth only;
others are for any of the diseases or defects
from which the child is suffering.
It seems probable that in the near future
similar provision will need to be made in
all cities of considerable size. Already the
need of such provision has been demon-
strated in many cities and towns in Massa-
chusetts, and if such clinics were estab-
1ished in the large centers, they could be
used for the benefit of the smaller contigu-
ous places, which now offer no facilities
either for satisfactory examination or for
treatment.
5. Special Classes. – The results of medi-
cal examinations, wherever carried on in
a school system of any considerable size,
show that there are some children who
cannot safely be left to associate with well
children, and who need special classes
carried on under special conditions. Such
are the ringworm and favus Schools of
London and Paris.
There are other children whose constitu-
tion will not endure the confinement of the
ordinary class room, and the hours of the
ordinary class day, who need specially
planned buildings and special hours for
work. They must have more fresh air
than will suffice for most children.
There are still other children whose men-
tality is low, who need slower and more
patient treatment than the majority of
children. School classification will need to
take other elements into consideration than
age and scholastic attainments.
6. Sanitation of Buildings.-While great
improvements have been made in school-
house sanitation in recent years, there
remains much to be done. There are still
in Massachusetts schoolhouses in which
every hygienic principle is violated, and
the first step in the promotion of school
hygiene in many communities is to furnish
decent accommodations.
In 1ighting, heating, and ventilation, in
provisions for drinking and washing and
the sanitary conveniences there is still a
vast amount of work to be done.
Some recent experiments made in Chi-
cago seem to show that the differences in the
light received in schoolrooms at different
hours of the day and at different seasons
of the year and in different parts of the
room are great enough to call for a modi-
fication of the school work in the interest of

8 S C H O O L H Y G I E N E
the eyesight of the children. The results
of these experiments are given in the
Popular Science Monthly for October, 1907.
7. Physical Culture. — In order that
medical inspection in the future may find
in the schools fewer victims of disease, it is
seen to be necessary to take active meas-
ures to build up constitutions sound
enough to resist the attacks of disease and
to endure the strain of the long process
of school training.
Physical culture, including not only in-
school gymnastic exercises but out-of-
door training in formal exercises, in super-
vised games, and in athletic sports, is
fast making for itself a place among the
school activities of progressive communi-
ties, and will apparently in the future be
reckoned as an essential part of school
hygiene.
8. Playgrounds and Camps. – The cities
everywhere are waking up to the fact that
growing children need an abundance of air
and exercise, and that these are the very
things which city conditions do not afford.
Boston has taken a long step forward and
has set an example to all the cities in
placing its playgrounds under the care of
the school authorities thus recognizing play
as a legitimate and necessary feature in the
promotion of school hygiene. The way is
Opening to utilize the vacation seasons
for recuperation and for the storing up of
energy in camps by the shore and in the
country, and the promise is that this means
of education is to become more general in
the future.
9. The Training of Teachers. — The fact
has been made apparent by all the recent
experience the world over, that, in matters
of health as in the processes of instruction,
in the last analysis the teacher holds the
key to the situation.
The schoolhouses may be constructed
ever so perfectly, the physicians and
nurses may do their work in inspection and
diagnosis and treatment ever so skillfully;
the School program may make the most
elaborate provision for physical training,
but, unless the teacher knows the human
body and the conditions of health and how
to Secure them, and takes as much interest
in helping her children to be well and to
keep well as she does in helping them in
their scholastic work, unless she comes to
feel as much responsibiliy for one as for the
other, School hygiene will languish and
prove ineffective.
The normal schools and a11 other institu-
tions for training teachers will need to
place much more emphasis than they have
-
been doing upon this side of professional t
training. Whatever else they do or do not t
do, this cannot safely be neglected.
T
C
AN OPEN LETTER FROM DR. JESSEN
STRASSBURG, GERMANY. a
t
(Addressed to the Dental Hygiene Council, Boston Mass).
O'
A Foul mouth is the beginning of so
many local and constitutional disturbances s
that in the growing child the mouth should
be thoroughly healthy. Extensive in-
vestigations in many places have shown
that nearly ninety-six per cent of school
children have diseased teeth. That is an
appalling number, and we are compelled
to designate carious teeth (tooth-rot) as p
a people's disease. In Germany, in recent st
years and under uniform direction, 157,361 p
school children have had their teeth ex-te
amined. The statistics have been col- ti
lected by the Bureau of Dental Hygiene
in Dresden and they show conclusively c.
that: th
I. On account of bad teeth the physical g]
development of the child is seriously G
retarded. sh
2. The more the physical developmentiscº
disturbed the less in general is the mental sc
capacity of the child.
3. The worse the teeth, the worse, as a to
rule, is the school standing. U18.
These are conclusions which demand pt
serious attention from all the authorities dº
who are concerned with the hygiene of the sc
community. There is no doubt that the th
development of tuberculosis, which every hy
year in Germany kills 87,ooo persons at
mostly in the prime of life, is favored to a he
large extent by a bad condition of the p1
teeth. The checking of this widespread di
condition is generally recognized as of the W.
utmost necessity. The prevention of tu-T
berculosis is of quite as much importance as a
is its control. The tuberculosis question of
aside from influence of unfavorable social di
conditions, unhygienic dwellings, iº
cient supply of air and light, — is a ques-W.
tion of nutrition, and, therefore, a healthy cli
mouth is an essential first condition. te
Insufficient nutrition because of incom-te
plete digestion, plays quite as important a de
part in the most frequent constitutional 9
disease of adolescence, chlorosis or anemia, in
People do not sufficiently appreciate how ºn
much digestion is influenced by faultyś
chewing and insufficient mastication of the **
food. The numerous stomach and in-
testinal disturbances of chlorosis have as
1.
1.
S C H O O L H Y G I E N E 9
all their chief cause bad condition of the
9t teeth.
Universally, there is a culpable igno-
rance concerning these things and an in-
difference about the teeth which is almost
º belief. When children begin in
N. &hildhood to go to the dentist regularly,
and later as grown-ups continue this duty,
then an altogether different condition of
neral healthfulness will obtain. Several
hool dental clinics; they have been con-
Vinced of their scientific and practical
n-value. It is only a question of time when
every city will have such a clinic. The idea
º: establishing school dental clinics origi-
in nated with dentists. The first was created
in Strassburg in Alsace." It is at the dis-
as posal of all the children of the public
º free of charge; it is under munici-
51 pal control and employs regularly regis-
X-tered dentists who give all their skill and
jl- time to this work.
ne. Upon this plan, gradually, school dental
lyclinics have been established in thirty-
three cities and communities; and in a
all growing number of places, Charlottenburg,
ly Grünwald, Cologne, Mannheim, they are
shortly to be opened. Berlin has under
is consideration the question of introducing
al School dental hygiene privileges.
The treatment is particularly directed
a to the saving of the diseased teeth; the
use of tooth-forceps is gradually disap-
ld pearing. Dentists should save and not
es destroy. Already the experience with
he school dental clinics has demonstrated
he their necessity. In no branch of public
ry hygiene are such decisive results obtained,
is and with such relatively small cost. The
a health of the children is Substantially im-
e proved by dental treatment. The chil-
ld dren willingly come to the clinic except
he when the folly of the parents prevent.
1- The numerous absences from school on
as account of toothache and in consequence
n, of illness resulting from bad digestion
a diminish. The children are fresher and
fi. more alert in their lessons. In Strassburg
s: where there have been school dental
yclinics for five and a half years, the masters
testify that among the older children and
1-teachers there is a better appreciation of
º hygiene, that the working capacity
alof the pupils has increased, and that again
a.in the school attendances is recorded.
windirectly, the school dental clinics show
ty an educative influence upon the parents.
eThe teachers who in the beginning were
1--
S By Professor Dr. Jessen. — EDITor.
indifferent to the new undertaking are now
convinced of the importance of dental
hygiene and encourage the work with
enthusiasm. Compulsory visits to the
School dental clinic cannot be required,
yet a certain pressure can be used, as is
under consideration in Charlottenburg,
in that children with diseased teeth will
not be allowed the privileges of the forest-
Schools, vacation-colonies, and other rec-
reation grounds.
Thus the most universal of all diseases,
carious teeth, is most effectively con-
trolled. A well conducted school dental
clinic is the best and most effective insti-
tution for the prevention of tuberculosis.
THE EYES OF PUBLIC SCHOOL
PUPILS.
AT the 1ast meeting of the Board of
Education the Association of Women
Principals presented a series of recom-
mendations looking to the protection of
the eyes of the pupils in the New York
public Schools which had been determined
upon after consultation with a number of
prominent specialists, among whom were
Drs. J. E. Weeks, Alexander Duane, W. E.
Lambert, C. S. Bull, T. R. Pooley, and
D. S. Webster. These recommendations
were to the effect that hereafter no text-
book be used in the schools which is printed
on calendered paper, casting a glare;
that half-tone cuts shall not be allowed for
the illustration of books used; that only
frosted globes shall be employed for electric
lights; that all lights in night schools be
provided with green shades; that each
pupil when studying from a book shall be
required to hold it an angle of forty-five
degrees, and when studying or reading shall
be required to look up frequently from the
page; that the seats in all the schools shall
be of a size to suit that of the pupils using
them.
DEPARTMENT OF HYCIENE
UNDER BOARDS OF EDUCATION.
(Abstract.)
LUTHER H. GULICK, M.D.
THE returns from medical inspection
made in American schools up to the present
time indicate that the percentarge of
Ocular defects increases throughout the
School life of our 18, ooo, ooo children.
Beginning at somewhere about six per





IO S C H O O L H Y G I E N E
cent it advances to from thirty to sixty
per cent.
Upon good eyesight depends to a large
degree one's ability to conduct successfully
the affairs of 1ife. Notwithstanding this
great damage or degeneration that is
happening to American School children
with reference to vision, there is hardly a
school board in America that has in its
employ a technical expert to decide upon
questions relating to eyesight. School
books are being adopted without there
having been established standards based
upon adequate research as to the length
of lines for the various ages, size of type,
size and stroke of 1etter in connection with
the 1ines, the width of the margins, the use
of halftones as compared with outline
drawings, the use of dead finished as
compared with coated paper, and the like.
There are authorities upon many of these
matters, but we have no experts in the
employ of departments of education who
can speak authoritatively from the stand-
point of special study made of these
conditions as they obtain in American
schools.
This extraordinary condition with ref-
erence to vision does not stand alone.
Through the school we have changed the
life of the child from one of predominant
activity to one predominantly sedentary
in character. During five hours of the
school day for ten months in the year,
children are obliged to be seated for the
major portion of the time. So extensive
a readjustment of the 1:fe habits of the
young of a species has never before taken
place in the history of our kind. Its
effects upon digestion, circulation, nutri-
tion, and posture are as yet unknown.
Yet there is not employed by any board
of education in America one expert to
make a special study of this group of
problems centering about the changed
conditions of life as they exist under the
conduct of the modern school.
The returns from examinations made
by competent physicians in all parts of
America indicate that there are large
numbers of children whose progress
through school is hindered and whose
prospects in 1ífe are lessened by the fact
that these children have hypertrophied
tonsils and adenoids; and yet up to the
present time there is not employed by
any department of education in America
a technical expert to study the reasons for
the occurrence of such growths, particu-
1arly as related to school life, nor as to
how they may be prevented. The only
thing that is being done is to attempt to
get the tonsils and adenoids operated upon
after they have grown.
We know that growth is more funda-
mental than education; that when educa-
tion is too severe growth is interfered with:
yet there is not a school system in America
that systematically weighs and measures
its children to ascertain whether or not
they are growing normally, and then
adjusts the school tasks to fit this funda.
mental physiological condition.
We know that nervous diseases among
children are increasing. We believe tha
these disorders are related to the in
creased nervous tension upon children.
Many believe that this is due partly to th
tasks imposed by school life; and yet
there is not a board of education
America that is employing an expert t
ascertain the facts with reference to thes
problems. -
The fatigue of overwork, the fatigue
resulting from home study, - these we º -
recognize to be fundamental matters :
and yet our courses of study all over.
America are constructed without * :
guidance of experts whose authority is a
based upon investigation in these matters
These are some of the facts which lea
me to advocate the employment by de
partments of education of technical ex
perts who shall work upon these problems
experts who shall have power with refer
ence to these matters, just as other expert
now in the employ of departments 0
education have power with reference to
their special lines. School buildings are
not erected without the direction of expert
architects. The recognition of the techni
cal expert in medical lines is just as neces
sary as it is in architectural lines. It
not sufficient to secure the best availablº
authority on these subjects. No oculism
no group of oculists, at the present tim 11]
possesses the information needed to an gi
swer the questions that arise in connecticſ.
with the vision of school children º
school conditions. It is a specialty withi gº
a specialty. We do not need authority of
we need evidence. And then we net tº
power within departments of educatiº ri
to see to it that the fundamental conditiº
of successful human life, namely, healt aſ
is properly conserved. To this end the ch
should be organized under every board at
education a department of school hygiei in
having adequate financial support aſ sº
administrative power. St:




















S C H O O L H Y G I E N E I I
PLAY GROUND LEGISLATION.
JOSEPH LEE.
A LAW by itself will accomplish nothing.
- The same is true of an ax. But a man
- can cut down more trees in an afternoon
with an ax than he can chew down with
his teeth, and a public purpose will accom-
plish more with a law that fits it than
without. Getting a law through is also
an important means of creating public
opinion. It is wasting your best oppor-
tunity for effective agitation to get your
\g law passed without a fight. Permissive
at bills especially should be made the occasion
n of public education.
n. Public sentiment and methods of local
n government are so various that a model
et law for all jurisdictions is impossible, but
can agree on the general features.
t
I.
The effective radius for playgrounds for
children under ten is about a quarter of a
H
ſ
S
Such playgrounds for summer pur-
poses should be in parks, but there should
also be one such with every primary or
grammar school. The schools are where
the children can get to them. They have
also things that the playground wants:
water supply and sanitary arrangements,
a place to keep toys and apparatus, a place
to play when it rains or is too hot, and to
be used for quiet games in the vacation.
ls. The school building casts a shadow needed
ºr on the summer playground. The school
its must have the space around it in any case
of for the sake of light and air, for outdoor
to recess, and because the afternoon session
rein the primary schools will, with advancing
ert civilization, be held outdoors.
ni Riis's famous law of April 17, 1895, pro-
esviding that no schoolhouse shall be con-
| structed in the city of New York without
blº an open-air playground, contains the mini-
is mum requirement. Permissive laws are
m unnecessary, as a school without a play-
an ground is not a school.
iº But what is a playground? An ancient
de Massachusetts statute 1imits the school
| grounds to two acres; a Pennsylvania law,
|
TS
h
1
TS
d
t
X
t On the other hand, permits school commit-
tº tees to carry on “parks.” Probably the
it right minimum size is that adopted by the
in English Board of Education for London
t and elsewhere, of thirty square feet for each
e child. The same rule obtains in Germany
and has been partially adopted in Wash-
1 ington. It is not excessive. But perhaps
Some provision for “exceptional circum-
stances '' must be made as a concession to
the nerves of the taxpayer. For surface
fitting up and conduct of the ground you
must, I think, fall back on “suitable,”
that pale and common drudge 'twixt law-
yer and man. “Open-air '' is a good
adjective to apply. It admits ascension to
the roof, but excludes descent to the base-
1ment.
II.
For boys from ten to seventeen the law
should provide another class of play-
ground.
A bill passed both houses of the Legisla-
ture of Washington in 1906–07, but was,
unfortunately, vetoed by the governor,
providing that thereafter no material en-
largement to a city of over ten thousand
inhabitants should be permitted unless the
plan included the setting aside of one
tenth of the area, exclusive of streets, for
parks or commons. Representative Ralph
Davol, of Taunton, has this year intro-
duced into the legislature of Massachu-
setts a bill which in its present form
requires every municipality of over ten
thousand inhabitants to have a referendum
as to whether or not it will provide one
suitable playground and an additional one
for every twenty thousand inhabitants
above that number.
For boys of this age the playground
must, as the American boy is at present
constituted, include the possibility of base-
ball. To grown men this means about
two acres to the game; but my own re-
corded observations, including Boston
Common (on which the different games
Overlap in the most bewildering way, but
with a comparatively low resulting death-
rate), show a possible number to the acre
of some thirty-five boys or even more. At
thirty-five to the acre, and reckoning sixty
boys from ten to seventeen, per one thou-
Sand of population, and supposing every
boy plays about four times a week, we
have, counting the use of the playground,
six afternoons a week and Saturday morn-
ing, a baseball requirement of about one
acre per thousand. But all boys do not
play ball; and we must encourage other
things, such as the use of apparatus, the
Successful modifications of the game, in-
door ball, gymnasium ball, and long ball,
and also such other games as volley ball,
requiring much smaller space. On the
whole, for the sake of the bigger boys, I
think the minimum size of playgrounds of
this class should be two acres. Our laws
might, perhaps, require that minimum with
Some Saving clause for exceptional circum-
stances. As to the area per one thousand



I 2 S C H O O L H Y G I E N E
inhabitants, I do not think we are ready
as yet for any provision. The effective
radius of playgrounds for this age is about
half a mile. A good phrase is “ a system
of playgrounds,” occurring in Mayor
Quincy's Boston law of 1898; another is in
the words “centrally and conveniently
1ocated ” from Mr. Davol's bill. Permis-
sive laws on this subject are, perhaps, un-
necessary, but help in agitation.
I think these bigger playgrounds, like
the smaller ones, should be carried on by
the school committee, and that, on the
whole, the 1aw might so provide. The
purpose for which we have playgrounds is
chiefly educational. The moral and men-
tal effects are far more important than the
physical; and the physical effects them-
Selves are best secured when they are made
subordinate. The school committee must
in any case have charge of play and physi-
cal education within the schools and in the
School yards. It directs the work of the
School doctor and School nurse, or, at least,
is in immediate receipt of their reports,
and thus has knowledge which is often of
vital importance in the prescription and
regulation of play and exercises. The
School gardens, often on the playgrounds,
are a vital part of school work. And the
teaching force provides men and women
of the sort of character which is more im-
portant than any amount of athletic skill.
Not all teachers can be leaders of play, but
I think the teachers will include better
1eaders than can in sufficient numbers be
found elsewhere, though there must be
some specialists at the head. Playing
with the children will enable the teachers
to know them in the wild state and not
merely in the menagerie, and will greatly
improve the relation between the two.
Such an arrangement would also put up
to the school committee its real work, the
training of men and women, not the im-
parting of knowledge. Playgrounds, it is
true, are not merely for school children,
but for all the people; but so are Dr. Leip-
ziger's lectures and many other things that
schools are learning to provide. What-
ever body has charge of the playgrounds
should have power to “provide and carry
On play, recreation, sports, physical edu-
cation, and athletics.” It should have
police power and power to make and en-
force rules with a penalty attached. Ap-
propriations should be left to the regular
Body in charge of the municipal finances.
The school committee should provide
folk dances for the bigger girls and for all
the children in the schools; but that is not
a playground question. For men and
boys Over seventeen, there should be large
Suburban fields; and park departments
should be assigned by 1aw the duty of
providing them.
There should be provision for playing in
the streets, as under the Massachusetts'
law which permits cities and towns to
provide by ordinance for coasting. “And
the streets of the city shall be filled with
boys and girls playing in the streets
thereof.” -
NOTE. The following are the more im-
portant playground laws: The New Jersey
law of May 7, 1907, providing that the
mayor of any city may appoint “three fit
and suitable persons '’ who shall buy and {
carry on playgrounds; the Pennsylvania ;
law of June 26, 1895, providing that * .
school authorities may enlarge the school. 1
grounds to be “used for parks and recrea- )
tion purposes by the public ’’; the New 1
York law of May 15, 1888, authorizing the Y
incorporation of private playground socie- t
ties; the Massachusetts law of 1893
(Revised Laws, Chapter 28, Sections 19, 20, b
and 21), providing that park departments \
may buy and carry on playgrounds. The F
Massachusetts law permitting cities and 9
towns to make ordinances regulating P
coasting is Revised Laws, Chapter 52, 9
Section 6; one permitting cities and towns d
to construct and maintain bicycle paths
is Revised Laws, Chapter 48, Sections
86 and 87. 11
For an excellent summary of the laws on º
the subject see the article by Mrs. Samuel
A. Ammon in Charities, August 3, 1907, E
n
pages 516, 517. a.
C
THE EDUCATION OF THE PUBLIC .
IN SCIENTIFIC MEDICINE. f:
At the annual meeting of the American
Medical Association, held in Chicago June
2–5, 1908, the President of the Association,
Dr. Herbert L. Burrell, of Boston, de.
livered an address on “A New Duty of th: "
Medical Profession: The Education -
the Public in Scientific Medicine.” §
In the course of his remarks he says t]
“The medical profession now has at t]
cepted facts that bear on the welfare
the people; is it not our duty to mak
them known? of
“The various infectious diseases aſ th
obviously ones concerning which the pub ex
lic should be informed. The people shoul
be educated as to the necessity of pure aſ
pure water, and pure food; they shoul h

-. - S C H O O L H Y G I E N E I3
e know the hygienic value of bathing. They
is should know that hospitals are provided
yf not alone for the care of the sick poor, but
that knowledge of disease may be ad-
vanced. Take a familiar example in our
social life. When it is recognized and
brought home to the public that con-
tagious diseases in children are to a degree
unnecessary, that by proper sanitation
and medical school inspection they may be
in 1arge measure prevented, then people
... will demand that their little ones in public
schools shall be protected against disease,
which often leaves them invalided and
crippled for life. A child among the better
classes to-day, until it begins to go to
school, is usually free from contagious dis-
eases, but the moment it enters a school,
it is subjected to dangers from infection
which it rarely escapes. To be consistent
in our present method of life we might as
well expose our children deliberately, as
they did in country districts in former
times, when a child was sent to a neigh-
bor's to get the measles, as it was a con-
venient time for him to be sick. The
º and intellectual development of
dour children is in the public mind, but the
g possibility of preventing them, by ade-
3. uate precautions, from having infectious
iseases is not appreciated.”
Concerning the infectious diseases, the
º of pure air, both in schools and
in homes, of pure water and pure food, and
in sufficient sleep, and the hygienic value of
1. bathing, the school public, that is, the
fathers and mothers, ought to be informed.
By means of properly written newspaper
and magazine articles and of lectures, a
certain number may be reached, but only
C a few. The real education of the families
will for the most part, come from the
family physician. Dr. Burrell says:
in "There is a distinct reaction, I believe,
is against the obliteration of the family prac-
m, titioner. The well educated family prac-
e.titioner now has a new duty. He it is,
who should be the instructor of the family.”
. Among the poorer people of our large
cities, who is the family practitioner? in
the usually accepted meaning of the term,
there is none. The district physician,
the out-patient hospital physician, or the
nearest private physician, oftentinues un-
known to the family, cares for the sick
one. . The intimate relationship between
the family and the physician does not
exist, and, therefore, much of the good the
doctor could do and attempts to do, fails.
A new force has come into existence,
however, in the education of the school
1S
nS
1S
e
7
public, namely, the medical inspection of
schools. In many of our large cities there
are school physicians working in the
schools, and school nurses devoting much
of their time to the homes. The school
nurses have already proved of inestimable
value. They are the link, 1ong missing,
that brings the homes in touch with the
schools. To safeguard the physical wel-
fare of the pupils, the parents must be
educated. How often do parents at first
refuse to allow their child to be operated
on for removal of obstructing adenoids.
The nurse finally in triumph brings the
child to the operator, and tells how
patiently she has had to work in explain-
ing the condition, its only cure, and the
benefits to follow. Such experiences the
school nurses have in abundance. Is not
this an education of the public? Have
not the medical inspector of schools and
the nurse, among our poorer families,
assumed the place of the family prac-
titioner; that is, become the family
medical adviser?
Our public schools are growing in im-
portance. Their services to the public
cannot be limited to the mere instruction
of the pupils in book knowledge. While
this will remain their chief duty, other
duties are so closely bound to this that
they must be assumed by the school
authorities. The medical inspection of
Schools by physicians and nurses must be
perfected and carried on in every large
community.
It is through school inspection then,
properly carried on, that a large part of
the public will be informed of the facts
already in possession of the medical pro-
fession. The results may not be at once
apparent. It will be difficult to change
the habits of the parents; but the children
can be educated into acquiring habits that
will maintain a better standard of health
and living.
HEALTH OF OUR HIGH SCHOOL
CHILDREN.
(From the New York Medical Record,
April II, 1908.)
IN this article the author, Dr. Elizabeth
Jarrett, medical examiner to the Board
of Education, describes the physical con-
ditions found to exist among the candi-
dates for positions as teachers in the public
Schools of New York City. Most of these
candidates are graduates from New York
Schools, some from outside schools. The
majority are between eighteen and twenty-


I4 S C H O O L H Y G I E N E
five years of age. In addition to certain
written examinations, they must also pass
a physical examination, and the results
of these physical examinations are de-
scribed.
Between eight hundred and twelve
hundred applicants, men and women, are
examined every year. The physical ex-
amination aims to exclude those afflicted
with incurable organic disease. The re-
sults are startling. In the first year
seven per cent of all the applicants were
rejected as liable to become burdens on
the pay roll within a few years. Con-
ditions of anemia, albuminuria, and or-
ganic heart 1esions were especially common
among the younger candidates immedi-
ately following the final examinations of
the Schools.
The Board of Education then required
the physical examination to be made
loefore the school examinations, and as a
result, the physical conditions were de-
cidedly better. The conclusions reached
are: I. That a strain of even a few weeks
may produce in these young people a
temporary derangement. 2. That those
with organisms sufficiently strong react
immediately upon removal of the strain.
3. That a small percentage has had the
way paved for permanent injury to a vital
Organ.
The value of these examinations is
evident in many ways. They show the
physical conditions of a large number of
young men and women immediately
following the years spent in the public
schools. In a measure, therefore, they
show the effectiveness of medical school
inspection, as at present conducted, for
these candidates have presumably at-
tended schools where medical inspection
is carried on. The act as an incentive to
acquire and maintain a good physical
condition. Knowing that a rigid physical
examination must be passed, the candi-
dates realize that good health is as essen-
tial as book knowledge.
SCHOOL CI.INICS.
THE great need of school clinics in the
1arge cities has been strikingly evident to
those familiar with the physical condi-
tions of school children. The mere detec-
tion of physical ills, while important, is
only a first step toward the curing of them.
Carefully compiled statistics from many
cities in this country and abroad show that
a 1arge proportion of the pupils suffer from
remediable conditions that not only pre-
vent proper physical development but
the London County Council, Dr. A. H.
markedly hinder their progress in the
schools. In New York City, in 1907.
the physical records of 141,908 pupils
show that IoS,329 required medical treat.
ment. Of this large number the greate
part suffered from easily remediable con.
ditions. Adenoids, enlarged tonsils, de
fective vision and hearing, defective
teeth, and orthopedic deformities com.
prised over one half of all the cases re.
quiring treatment. -
How best can treatment be given? I
would seem that there are hospital facili.
ties sufficient to care for all, but such is not
the case. The regular hospital clinics, al.
ready overcrowded, cannot care for any
considerable proportion of these children.
The hospital clinics, too, are not conveni.
ently located for many of the schools. The
hospital physicians are oftentimes not fa
miliar with the school conditions, and can
not give the time to study the childre
properly. The school physician, aided º
the constant observation of the schoo
nurse and teacher, is better qualified
form an opinion as to the need of treat-
ment than the hospital physician who #.
the patient but for a few minutes. The
hospitals have done and are doing excel:
1ent work, caring for the school children, but
the large numbers presenting themselves
for treatment are swamping the clinics.
The establishment of school clinics
would solve this problem as to how treat-
ment can best be given. Already in many |
cities abroad and in a few in this country|
special school clinics have been started.
This is especially true in regard to dental
clinics. |
To satisfactorily complete the medical|
inspection of schools special clinics must ||
be established. In a paper read before ||
Hogarth lays great stress on the value
of these clinics. The principal conditions|
needing treatment, he says, are parasiti |
and contagious affections, – chronic eye,
ear, skin, and throat conditions. These ||
because of their great number, the hospitals |
cannot treat nor can the family physician ||
Dr. James Kerr in a report to the London |
County Council for the year ending March ||
31, 1907, says, “Without school clinics th: |
work of medical inspection will fail.”.
The expense of carrying on these clinić
ought not to be large. That they aſ:
needed is evident. If established in thiſ
1arge cities where school inspection by
physicians and nurses is already carried on
thé physical welfare of the children will
be thoroughly safeguarded.



















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|_ B
34-6ſ
..s3%
‘...."- LIBRARY,
UNiv. or MARChá.
FEB 25 1909
school Hygiene
ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
OL. I, No. 2
BOSTON, MASS.
SEPTEMBER, 1908
hn A. BERGström, Ph.D., Professor of Education,
Leland Stanford Jr. University.
LMER. E. B.Rown, Ph.D., United States Commissioner
of Education. -
ILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
pHN J. Cronin, M.D., Assistant Chief Medical Inspector,
Health Department, New York City.
º: JAcoBI, M.D., LL.D., Professor of Diseases of
Children, New York City.
omas M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
New York University.
bseph LEE, A.B., A.M., LL.B., Boston.
HILIP KING BRow N, A.B., M.D., Medical Department,
University of California.
"obert W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
Thessy P. WALcott, A.B., M.D., Chairman of Massachu-
setts. State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded. *
HARLEs HARRINGto.N., A.B., M.D., Secretary of Massa-
\chusetts State Board of Health.
|
|ALv1N. N. KENDALL, A.M., Superintendent of Public
| Schools, Indianapolis, Ind.
ſº H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
. H. McCoilo M, M.D., Professor of Contagious Diseases,
Harvard University.
ºtbe CŞfficers amo Council of the Eig50ciation
ot y President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WAlcott; Vice-President, Dr. ARTHUR
- T. Cabot; Secretary and Treasurer, Dr. THoMAs A. STOREY.
H. McCURDy, M.D., Director. International Young
Men's Christian Association Training School.
CHARLEs A. MooRE, Chairman Welfare Department,
National Civic Federation. -
Edward L. STEvens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEETHoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
Nicholas MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDERick ForchHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGToN E. Fischel, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALsey GULick, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart:
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEyLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. StoREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM. H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
As a result of the several business meetings held, it was definitely decided that the
bolicy of the Association during the coming year should lead to the formation of sev-
ral active committees which may cover such work as the compilation of a bibliog-
aphy on school hygiene; the formation of a conspectus of state and municipal laws
elative to school hygiene; the accumulation of further statistics concerning medical
inspection: and the publication of a monthly bulletin on school hygiene.
:
Jubscription price, 50 cents a year
#eorge S. C. BADGER, M. D., Editor . -.
J. C. HEATH AND COMPANY, Publishers
- communications concerning manuscripts and editorial matter should be addressed to the editor.
Il c munications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
48 Hereford Street, Boston, Mass.
12o Boylston Street, Boston, Mass.






I 8 S C H O O L H Y G I E N E
TABLE OF CONTENTS
EDITORIAL
“School HyGIENE ". . . . . . . . . . . . . . I 8
ARTICLES
MEDICAL INSPECTION IN PUBLIC Schools As CoN-
TRIBUTING TO HEALTH AND EFFICIENCY . . . 19
REPORT ForM Issued BY THE DEPARTMENT of
HEALTH OF PENNsylvan IA . . . . . . . . . 22
PRovision for Exception AL CHILDREN IN THE
PUBLIC Schools . . . . . . . . . . . . . . 23
PRELIMINARY REPORT of the CoMMITTEE on
School Hygiene . . . . . . . . . . . . . . 27
MEDICAL INSPECTION of ScHools . . . . . . . 27
PLAYGROUND Association of CHICAGO . . . . . 28
THE PHYSICAL CoNDITION of our School CHIL-
DREN . . . . . . . . . . . . . . . . . . . 28
REPoRT of THE ExAMINATION OF THE EYES AND
EARs of THE School CHILDREN IN MINNEApo-
LIS . . . . . . . . . . . . . . . . . . . . 29
THE School AND ITS PART IN THE PREVENTion
of TUBERCULos Is . . . . . . . . . . . . . 29
THIRD INTERNATIONAL CoNGREss on School Hy-
GIENE, PARIs . . . . . . . . . . . . . . . 3o
EDITORIAL
“SCHOOL HYCIENE ''
THE first number of ScHool Hygien E,
Dublished in June, 1908, has met with a
most cordial reception. Letters com-
mending the purpose of the journal have
been received from widely scattered
sources. The subscription list has grown
steadily during the summer until now a
most encouraging number of subscribers
is on our cards. As was said editorially
in our first number, the success of this
journal must depend on the support given
it by subscribers. The first number, sent
out in the middle of June, reached its
readers, most of whom are engaged in edu-
cational work, at their busiest time of the
year. It was, perhaps, an unfavorable
time to issue a first number, but it seemed
best to do so, and apparently no mistake
was made.
The object of this journal is to sec.
improved school conditions for childr
point out to the school authorities throug
out the country the great need of sa
guarding the health of the pupils, and a
see that physical defects which hinder #
child's progress in school and preve
natural physical development are rend
died. To this end articles will be p
lished dealing with the various proble
of school hygiene as they present then
selves in the different cities and townso
the various states. t
There is need of such publications.
SCHOOL HyGIENE because surprisine
little has been done in this country for le
physical welfare of the public school cº
dren. Comparatively few cities and to h
have any medical inspection of the º
The children are compelled by law to in
tend school, they are compelled by ſi
school rules to be housed five hours a d;
five days of the week. They are crowd,
together in rooms and subdued to an u
wonted quiet for the purpose of menir
training, yet, in the majority of cases, lit.
or no intelligent effort is made to give ".
children the best possible conditions ro
this training. Not only is this true, ºh
having placed the children in the schº
in many cases no attention is paid to .
health of the children during the schol.
hours. The rule of the survival of }.
fittest prevails, which ought not to be * *
case with these young children. el.
An awakening public sentiment is brich
ing about a change for the better. Ingre
ligent leadership and the successful resiu
sure to follow will insure marked prog.
The columns of School, HyGIENE
show what ought to be and is being dºlo
and what the results of efficient sch'ar
inspection show. º
- et
The Jou RNAL OF SCHOOL HyGIENE ſºut
vary from eight to sixteen pages in bo:
amount of reading in subsequent numb%
depending on the material at hand. C#
tributions to its columns are earnesis
desired. 1a


















S C H O O L H Y G I E N E IQ
SCMEDICAL INSPECTION IN PUBLIC
dr SCHOOLS AS CONTRIBUTING TO
": HEALTH AND EFFICIENCY
(At stract of address delivered before Department of
intendence, National Education Association, Wash-
ºn, D. C., 1908. . §: .# in full will be
* + 1ish CHOOL HYGIENE.
t * Dy the publishers o )
*We THOMAS F. HARRINGTON, M.D.
empirector of Department of Hygiene, Public Schools,
Dú Boston, Mass.
* PRIOR to the introduction of medical
henspection into the public schools of Bos-
nson (1894), every state having upon its
tatute books a compulsory educational
aw was in the position of compelling by
*aw the children of its province to go di-
insectly into the midst of dangers to their
r lealth. Unfortunately, some states are
cºet in that same indefensible position.
That these dangers are real and a menace
"o the individual and to the community no
100ne denies to-day; that they can be almost
o intirely avoided or removed is beyond
Hispute.
Little was then known of the great possi-
"ilities in preventive medicine. Tubercu-
"bsis was an inherited disease, spinal
1 turvature was due to a “fall,” deaf chil-
enren were heedless or disobedient, measles
ind Scarlet fever were diseases which every
hild should have, diphtheria was
* quinsy,” unless it “turned into croup,”
S rom which “no one ever recovered.”
he child suffering from defective vision
ovas the dunce of the schoolroom until,
rowing too large for the grade, or driven
rom school by ridicule and shame, he
Found peace in the truant school or in the
hop and factory, where his defects became
menace to 11 fe and 11mb.
The idea that medical science had any
elationship to the problems of public-
"chool life was not entertained prior to the
mºreat awakening in preventive medicine
sluring the epoch 1880–90. During this
...emarkable period, Robert Koch discovered
"he bacillus of tuberculosis; Eberth, the
}rganism of typhoid fever; Klebs and
lºoeffler, the bacillus of diphtheria; Lava-
h'an, that malaria was transmitted by
mosquitoes; Fehleisen, the streptococcus
»f erysipelas; Kitasarto, the bacillus of
etanus, - all discoveries that transferred
*uberculosis from the class of diseases sup-
Josed to be inherited and placed it in the
»ategory of diseases preventable and cur-
ºble; that proved diphtheria to be a spe-
ific, communicable disease, and not a filth
*isease; that suggested that skin affections
may be contagious, that lockjaw may be
epidemic, and that night air is as healthful
and as free from disease as day air.
In such a renaissance it was but natural
that attention should center upon those
affections which for ages had been known
to be communicable and most prevalent
at the earlier periods of childhood. The
legal authority to carry out such an inves-
tigation was the board of health; the
most likely place to find the facts was in
the aggregation of children in School.
Thus originated the first scientific basis for
medical inspection of schools. In Boston,
Mass., in 1892, medical inspection of
schools was inaugurated.
Within recent years medical inspection
has widened its scope beyond the detection
and isolation of communicable diseases
among school children, and has come to
include all questions of physical defects
and mental backwardness of children.
There are many causes of ill-health and
mental dwarfing which are seldom, if ever,
acute and requiring immediate inspection.
On the contrary, they are detected by their
effects on the daily school life of the child,
and are not diseases dangerous to the
public health. The problem, then, is one
of pedagogy, pure and simple. The ad-
vantage and the necessity for data such
as this latter form of inspection alone can
furnish is beyond measure. Future prog-
ress in physical and mental growth depends
almost entirely upon these data.
Science to-day has proven conclusively
that the blunting of the moral sense has a
distinct anatomical or functional stigma
which in many cases is removable. Few
teachers in cities where attention to defec-
tive eyes, throats, and ears has been di-
rected have failed to witness the trans-
formation, mental, physical, and moral,
following the correction of refractive errors,
the removal of adenoids causing deafness
or Oxygen starvation and abnormal me-
tabolism.
Thus the problem in relation to physical
defects becomes one of prevention and
remedy. How can these be accomplished
best? The question is plainly whether the
inspection of school children is a part of the
duty of the board of health in its protec-
tion of the general public health, or
whether its object is to ascertain and de-
termine the fitness or unfitness of the child
for education at school, due regard being
given to the nature of the work imposed
as well as to the child's capacity and en-
Vironment. If the detection of infectious
diseases among school children is the object
and aim, as well as the limitation, of medi-



2O S C H O O L H YG I E N E
cal inspection, few will deny that the agent
of the board of health should have exclu-
sive right upon all premises, schools in-
cluded, and that it is the duty of these
agents to exercise preventive measures,
whether they relate to the child, the school,
the home, or the workshop. Any number
of foci of infection found and eliminated,
however small, justifies the existence of
the agencies employed in affording this
protection to the individuals; yet the
actual number of cases of communicable
diseases found among those pupils thought
to be ill is surprisingly small, less than fif-
teen per cent. The diseases classified as
communicable and coming within the legal
scope of the health department are detri-
mental to the health and efficiency of the
child only so far as they become compli-
cated by possible sequelae. Assuming that
teachers are not trained to detect these
sequelae, the presence or absence of such
complication should form a part of the
notification blank which permits the child
to return to school after exclusion. The
general law requires that the child be free
from contagion liable to affect the other
children before being permitted to return
to school. In some cities it contains the
additional statement that “the child has
recovered fully ” from the disease. If the
attending physician or the agent of the
looard of health would furnish to the
schools data of the child's physical condi-
tion after an attack of contagious or infec-
tious disease, the necessity for further
inspection would be greatly reduced, and
the child’s health and efficiency would be
promoted immeasurably. To-day these
defects form the basis of the great need of
medical inspection in schools. With such
information before her, the teacher would
imave a guide by which the school work of
the child could be regulated so as not to
aggravate nor cause physical defects.
It was my privilege to point out, in an
address before the Boston Medical Library
Association, in February, 1907, the antithe-
sis, “ Medical Supervision versus Medical
Inspection of Public Schools.” Since that
date the school committee of Boston has
established a department of school hy-
giene having for its basis such supervision
in its broadest sense, a plan which it is
loelieved will make for the greatest health
and efficiency in school children.
It is no new theory to assert that mental
development without a true physical
equivalent is unstable and undesirable;
that individuals differ as to capacity and
capability of mental acquirement; that
the standard of a nation's health depenir
directly upon the physical state of its chs
dren — its future citizens, men and womdr.
Physiology and psychology have for yeala
pointed out the correlation and intima
dependency of mental and physical growif
that race, heredity, age, sex, climate, na
trition, period of growth, season, enviro
ment, former diseases, etc., are all factoſh
often predominating factors, in dº
the fate of the individual. et
Medical inspection as carried on in Amy
ica has done little to solve the grin
problems in pedagogy suggested by thor
data. In the absence of a standing ariſh
with compulsory military service, wherebu
the physical status of the whole populatile
may be learned, it becomes necessary ało!
essential to study closely the advanciph
army of school children so as to gain thcl
information necessary for healthy devip
opment. Nothing can be taken ic
granted; every problem must be solvil
rationally; every factor of home life aſſo
school life must be weighed carefully ali;
each given its value properly. This 9e
quires the coöperation of pedagogue and
physician under a different relations).y
than that prevailing in existing-boardn
health systems of school inspection. Tºa
physician should be counselor and advio
to the teachers, school authorities, aitt
home authorities in adjusting the "
questions of mental and physical corrée]
tion in school curricula. He must bda
part of the school system to which to
parent and state intrust the child. Sº
should have supervision and control of S;
those questions having to do with 39.
physical welfare of the school child, Sh
the guidance of those means best calculaca
to accomplish greater health. In this alc
only can the curative and the preventº
as well as the constructive measures*
health be fostered and strengthened. .
foi
DEPARTMENT OF SCHOOL HYGIENE ho
The Department of School Hygieneda
tablished at Boston, Mass., the first in ,
country, if not in the world, has all tºbe
factors. The organization provides ſº
director of school hygiene, three assistãº
directors; as many special instructors: 5
physical training, special assistant instrº
ors in physical training, instructors Pº
athletics, and assistant instructors of dº
1etics, supervisors of playgrounds, º
ground teachers, heads of playgrou?:
helpers in playgrounds, and helpers in sº
gardens, as the board may from time”
S C H O O L H Y G I E N E
2 I
emime authorize; a supervising nurse and
chssistant nurses; an instructor of military
ill, and a medical inspector of special
º The director of school hygiene
all have general supervision and control
all matters affecting the physical wel-
, nare of pupils and teachers; of medical in-
iropection, except that under the control of
to he board of health; of School, nursing;
id:#f physical training, military drill, ath-
etics, sports, games, and play engaged in
my pupils or conducted in buildings, yards,
grand grounds under the control of the board,
thor in other buildings, yards, and grounds
irºhat it may have the right to use for such
reburposes. In the normal school, the
thealth of the pupil-teachers is under per-
aſonal supervision of the director, who 1S a
lcºhysician. Here, as well as in the high
thchools, a gymnasium is equipped and
evipecial teachers are provided for instruc-
ion and the physical examination of the
lvirls. Military drill is provided for the
aşoys. Both courses are compulsory. All
aligh-school pupils, boys and girls, are com-
spelled to take a setting-up drill of ten
aminutes' duration each day. This is given
sy room captains selected for the purpose.
rdin the elementary and primary Schools,
Talisthenics and drills in the classroom and
vigorridors are given by the teacher under
a;upervision of the assistant director.
na. From the kindergarten to the normal
reschool one principle is emphasized,
blamely, that proper breathing, proper
standing, and proper carriage are the three
issentials of all physical training. These
pfæssentials are taught and enforced in the
schoolrooms in every movement of the
child, and not left to gymnasium or
calisthenic periods or military drill periods
alone. Instructors in athletics have a
irating and a certification similar to regu-
lar teachers, and after written and practical
examination. Selected teachers in the
elementary schools act as play-teachers
for the children of these schools after
hours daily, and on Saturdays and holi-
a days, extra compensation being allowed.
School yards in crowded districts are
being equipped with suitable apparatus
for playgrounds for younger children. The
iseason is to run from May 1 to November
s25; matrons, janitors, and teachers are
furnished by this department. On large
splaygrounds, as well as at the public baths,
garrangements are made whereby instruc-
tion in athletics, Swimming, games, and
play may be carried on under school super-
ºvision, thus offering the best means to
emake these activities a source of better
health to all the children rather than a
spectacular exhibition by the few. A
specific appropriation amounting to more
than $50,000 annually, and which can be
used for no other purpose, is provided by
1egislative act.
The nursing division of the department
is under the direction of one supervising
nurse, who has at present thirty-four
assistants. The division is provided for
by an additional special appropriation of
$25,000 annually. Rooms are equipped
at Schools in each district, and each nurse
has an assignment of approximately
twenty-seven hundred pupils. Appoint-
ments are made from a certified 11st sim-
ilar to that of otheremployees in the service.
They are not permitted to visit homes
of contagious diseases. The great advan-
tage of having a nurse under the school
jurisdiction who may look after the minor
ailments in school life and who visits the
homes of children, giving advice and assist-
ance to mothers, and in harmonizing the
fixed customs and traditions of a great
alien population with our habits and
standards of living, is solving many vexa-
tious problems of the past, and forms a
1ink between the school and the home not
possible by any other means. It does not
Seem possible to conceive a more satisfac-
tory arrangement nor a more effective
piece of school machinery than nurses
under school supervision. With a corps
of medical inspectors under this same su-
pervision, who would conduct a daily clinic
in their respective school districts, there
are no problems connected with the health
and efficiency of school children which
could not be quietly, rationally, economi-
cally, and effectually solved. Until such
an organization is perfected in part or in
whole, little progress can result from the
efforts to promote the health and efficiency
of our school children.
MEDICAL inspection of school children
is conducted as a national movement in
France, England, Belgium, Sweden, Switz-
erland, Bulgaria, Japan, and the Argentine
Republic. In Germany and the United
States it is found in many of the cities.
In some of these countries its scope is very
Wide indeed. In some thirty cities of
Germany free dental work is included in
medical inspection. The new English na-
tional law provides for thorough work,
looking not only to the detection of
contagious disease, but including also a
complete physical examination at stated
intervals.



22 S C H O O L H Y G I E N E
THE following list of questions is issued by the Department of Health of PennspI
vania to its health officers to aid them in the performance of their duties:
[Form 51] COMMON WEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
Report of .
Health Officer Post-Office address District No. º
Inspections of Schools Date 190 O.
In Township County .
Principal or Teacher .
Secretary School Board P. O. Address Tilt
Structure (Wood, brick, stone, etc.) No. of rooms What are their dimensiº
No. of pupils in each room? Are rooms well ventilated P How? }
Are rooms well lighted? No. of windows in each room CO
How are rooms heated? .
Of what are floors constructed if other than wood? Are they warm or coſ.
Is the room clean? Have they cloak rooms? How many? *
Give dimensions Are they well lighted? By
Are they ventilated? HOW P Are cellars clean? .
Whitewashed? Are they used for storage? How lighted? EX
How are pupils supplied with water? What is its character? a11
What is its source? (Well, spring, public) If a well, is it dug” Artesian P º
If dug well, are walls cemented or loose masonry? #
Is it tightly covered to prevent dirt and water working into the well? sci
Is the waste carried away to prevent its seeping back into the well? º
Distance from privies cesspools piggeries or stables e11.
If from spring, is it covered? Is surface drainage excluded? i.
Distance from privies cesspools stables or pigpens Ca.1
Are the grounds neat and clean? Are there evidences of petty nuisances? º
Are there piles of rubbish about the grounds? .
No. of water-closets or privies Are they clean? Free from odorºtiv
Are vaults full? Any evidence of their overflowing? Offensive? º
Are privies and dividing fences in good repair? .
Are they painted or whitewashed? of
Distance from a stream or other body of water? What provision to prevent draini.
Does the drainage wash into any stream or other body of water? º
Give name of stream of which it is a tributary.


S C H O O L H Y G I E N E 23
CHILDREN IN THE PUBLIC
SCHOOLS
BY JAMES H. VAN SICKLE
Superintendent Baltimore Public Schools
(Read at Atlantic City Meeting.)
THE problem of educating extremely
backward and defective children in the
bublic schools is a comparatively new one.
Before compulsory attendance laws began
jo be strictly enforced, public School
authorities had no adequate idea of the
magnitude of the problem. Children who
failed to get along fairly well in the ordi-
nary classes, either by reason of their low
mentality or their refractory bearing, or
both, often ceased to attend, and were
onabsent or truant without the knowledge of
the authorities. In an article in The
Teacher, December, 1907, Dr. Witmer
Somments upon this fact in discussing the
svolution of special classes in the Philadel-
phia schools. Before attendance at school
was enforced by 1aw the superintendent
oliad eported that there were not enough
backward children in any neighborhood
in Philadelphia to form a special class.
By 190o there were reported 1,122 children
in the schools too backward for the usual
grade instruction.
The experience of Philadelphia is the
perience of Baltimore and doubtless of
1arge communities. Before the at-
hdance laws were effectively enforced
there were as many of these special cases in
the community as there are now; few of
them, however, remained long enough in
school to attract serious attention or to
hinder the instruction of the more tractable
and capable.
If it were not for the fact that the pres-
ence of mentally defective children in a
school room interfered with the proper
training of the capable children, their edu-
cation would appeal less powerfully to
boards of education and the tax-paying
public. It is manifestly more expensive to
maintain small classes for backward and
refractory children, who will profit rela-
|tively little by the instruction they receive,
than to maintain large classes for children
of normal powers. But the presence in a
class of one or two mentally or morally
defective children so absorbs the energies
of the teacher, and makes so imperative a
claim upon her attention, that she cannot
ºunder these circumstances properly in-
struct the number commonly enrolled in a
Class. School authorities must therefore
greatly reduce this number, employ many
more teachers, and build many more school
rooms to accommodate a given number of
pupils, or else they must withdraw into
small classes these unfortunates who im-
pede the regular progress of normal chil-
dren. The plan of segregation is now
fairly well established in 1arge cities, and
superintendents and teachers are working
on the problem of classification, so that
they may make the best of this imperfect
Imaterial. Whether or not school boards
really approve spending money upon the
education of mentally defective children,
the enforcement of the compulsory at-
tendance 1aws leaves no other course open.
We are committed to their education so
far as their capacity permits. The move-
ment for their education is supported on
other grounds by those who are not very
much, if at all, concerned with the financial
side and the need of protecting the rights
of the more capable children. The in-
vestigations of modern science, as well as
the philanthropic sentiments that actuate
people in every community, have rein-
forced the practical and economic argu-
ments which were the primary considera-
tions whenever public school authorities
had formed special classes.
The action this very year of the Balti-
more School Board in establishing special
classes for epileptics illustrates this fact.
Formerly a child who was subject to
Severe attacks was not allowed to attend
school after it was known that an attack
was liable to occur in the school room in
the presence of other children, some of
whom were sure to suffer nervously in con-
sequence. Even after the compulsory
attendance law went into operation we
excluded the worst cases; but we were
surprised to find, in the spring of 1907, on
taking a census of these children, that we
had 83 of them in school. Almost wholly
as a protective measure, and in the in-
terests of the normal children, it was
decided to try experimentally their separa-
tion from other children. Three special
classes were authorized by the board and
two were Organized early last fall. We
wish to study these two before proceeding
further.
At once it may be said, “Why make the
education of epileptics a public school
matter at all? Institutional care is needed
by these children.” This is true of a large
number of them certainly, but perhaps
not of all. Home and day-school care are
sufficient for the less serious cases. In-
stitutional care is, however, at present out
of the question. Maryland has an ex-






24 S C H O O L H Y G I E N E
cellent school for the feeble-minded at
Owing Mills, just outside of Baltimore, but
it is more than full, and it has a long wait-
ing list of applicants. Not until the state
realizes the magnitude of this very problem
and increases the capacity of the school can
the city send all or any appreciable number
of its epileptics of school age to this state
residential institution. Meanwhile they
must receive such instruction as will best
fit them for self-support or partial self-
support, and they must not be allowed to
remain in the regular school rooms. Be:
sides accomplishing a useful educational
purpose, the segregation of the mentally
defective children will call attention to the
need of enlarged facilities at the state in-
stitution, where undoubtedly many of these
children ought to be. ----
Not all parents are as yet willing to send
their afflicted children to the special class.
The very existence of the class, however,
enables us to relieve the regular class of
the presence of the epileptic child, for now,
when we exclude him from the regular
class, we are not depriving him of oppor-
tunity for such education as he is fitted to
receive. On the contrary, we are offering
him an opportunity superior in several
particulars to that which he had pre-
viously enjoyed. We give him a teacher
especially fitted in disposition and attain-
ments to look after his welfare. ... We fur-
nish him with car tickets if he lives at a
distance from the school, . He works in a
room especially equipped for his comfort
should he be ill in school hours. In it are
work benches and tools and materials of
various sorts, besides the ordinary equip-
ment of books. There is a garden in which
he may work. He is released from the
exactions of the ordinary school curricu-
1um. His teacher studies his capabilities
and gives him what he needs. -
We have not yet forced attendance in
these classes. The teachers visit the
homes of those children reported to them
for transfer to the special class, and in
most cases succeed in securing parentalcon-
sent and coöperation through tactful ex-
planation of the advantages offered:
One of the supervising principals, Dr.
C. A. A. J. Miller, physician as well as
teacher, is giving special attention to the
work in two classes. After three months'
experience he submitted the following
InoteS: -
“The epileptics in our care up to date
can be divided into three classes from the
standpoint of ability;
“r. The bright. 2. The mediocre.
“3. The weak-minded. -
“The first class, the bright, of whº
there are but few, take up all the sch,
work as readily as the ordinary healt
child. The second, , or mediocre, cli.
upon whose minds the disease has má 9
considerable inroads, are like children
arrested development; they gradual
though very slowly take to the vario
studies and manual work and pro
thereby. The third class are those wh
minds have possibly been permanent
weakened by the disease. Even these
educable. -
“We of course take the word educa
in the widest sense and claim that we
succeeding if through our efforts in sch
we are effectually teaching our pupils: wº
“ I. The common school branches. It
“ 2. Manual work of some kind. {rt
“3. Obedience, attention, manliness, a
fortitude, the acquisition of which is do;
away with needless petting and humori
“4. More correct habits pertaining
personal cleanliness, exercise, eating, dri
ing, sleeping, etc., the practice of whic
producing better physical condition as
greater cheerfulness and hopefulness.” le
Dr. Miller quotes from each of the t
teachers and then sums up as follows: 1
“The conclusion that we are compella
to draw from class room experience in nt
work with epileptic children is, that the
are educable; some are making maring
progress, in the common branches, all aſ
accomplishing something; all are dosa;
well in their manual work which is tend
toward a vocation that may be pursuedu
home, Sewing, basket-making. (Latery
we shall try cooking, housekeeping, willna.
basketry, chair-caning, broom-makºht
modern cobbling.) All are hopeful, chºla
ful, and growing in power of attention wi
concentration; some are establishing begio
personal habits and following to a limian
extent rules of hygiene. In fine, in
general progress is good.” gu.
It is open to question whether it is aimc
necessary to separate the epileptic feesec
minded from other feeble-minded or bam
ward children or even from the disciplinwh
cases. It is asserted that the refract.ht
boy is made more gentle and sympathêr
by being allowed to help the teacher c.
for an afflicted classmate. If this view)
correct, it simplifies the problem of speced
classes; for it is easy to find fifteen m
twenty children needing special treatmán.
within an area so small that the questſh;
of transportation need not arise. Wh
These were by no means our first specs





S C H O O L H Y G I E N E - 25
Ungraded classes, not differen-
:1asses. -
liated very much as to grades of defect in
ildren, whether mental or moral, Were
thorized under a rule adopted by the
ard of School Commissioners in the year
4902. This rule appears under the chapter
116aded “Discipline.” It provides that
ayupils who cannot work to advantage in any
ioegular class may be transferred to an un-
d class. As the rules prohibit cor-
punishment, the disciplinary function
nºf these classes in connection with re-
ractory pupils, forced into school under
he operation of the compulsory attend-
anceſaw, was at first more appreciated by
teachers than the help they would afford
ho mentally defective children. . The boy,
who by reason of persistent bad behavior
it his home school, is obliged to walk a
treater distance to attend an ungraded
alass, begins to see that since a record of
ofood conduct is a prerequisite to his re-
intering his former school, bad conduct.
gioes not pay, and in many instances, he
it hooses the path of less resistance – that
chof good conduct. In new surroundings he
as likely to be less of a leader than perhaps
was in his former school. He finds his
remacy disputed by other boys, earlier
in the ground, who resent his air of domi-
ellation, and who, though without definite
dintention to aid the teacher, nevertheless
thelp to coerce the newcomer into a more
rimodest bearing. A transfer to a more dis-
lant ungraded class is a resource in difficult
osases, but it is seldom necessary to use it.
d; We now have twenty ungraded classes,
d5ut they are not all of the disciplinary
Brype. A more or less successful attempt
lºnas been going on for some years to separate
&he disciplinary cases from those that are
plainly defective or positively backward
yithout marked disciplinary complica-
tions. Often one type so shades into
another that there is no very clearly de-
fined or conspicuous boundary line for our
guidance. In such instances, if we have
imore than one class in a given locality, we
secure the assistance of medical examiners
amployed by the Commissioner of Health,
rwho are most willing to coöperate with
the teaching force in making a proper
rouping.
c New York, Philadelphia, Milwaukee,
go, and some other cities have quite
tly set examples worthy of study and
tion in their recognition of differences
namong backward, defective, and refractory
it:hildren and their selection of means by
which each variety of defect may receive
acs nearly as possible the proper treatment.
Plans recently put into operation in St.
Louis are perhaps less well known than
others on account of their very recent
promulgation. In November, 1907, Su-
perintendent Soldan reported to the board
of education that there were at that time
in the various public schools of the city 181
children so mentally defective as to be
incapable of doing the regular school work
provided for normal children. These were
not merely slow or backward children.
They were unable to do either the amount
or kind of work which even a slow child
can do; yet these children were considered
capable of education with educational
facilities adjusted to their needs, and with
constant supervision of their physical con-
dition. Nine children cited by Superin-
tendent Soldan as typical of the entire 1ist
ranged from nine to fourteen and a half
years of age. They had attended school
from three to six years. Four had not ad-
vanced beyond the first grade, and only
two had advanced beyond the second.
“Nature,” says the report, “puts the
defective child in a class by himself and
Education should take Nature’s hint.”
It was recommended that twelve school
rooms be selected and equipped, not as
makeshifts, but in the best possible man-
ner, with a view to meeting a permanent
demand. As to location, the report dis-
cusses the advantages and disadvantages
of a central school, of vacant rooms in
existing schools, and of small houses to be
rented for the purpose; and recommends
that Ordinary two-story, six-room houses,
conveniently located with reference to the
homes of the children, be rented. Each
house is to accommodate two classes of
fifteen children each, and 1eave room
enough for work and free movement and
Some yard room for recreation. Trans-
portation is to be furnished to those
children whose homes are not within
walking distance. There are to be two
teachers in each center, and a woman
attendant who will live in the building
and take care of the heating and cleaning,
and at times assist in taking some of the
children to school. The instruction given
will not follow any fixed course, but will be
adapted to individual needs. The teachers
must be exceptionally capable and sym-
pathetic, and will be among the best-paid
teachers, in the service. Some strong
teacher is to give her whole time to the
supervision of these classes, and medical
attendance is to be furnished. Imbecile
or demented children are not to be ad-
mitted, nor are merely slow or backward
-












26 S C H O O L H Y G I E N E
children to be taken from Schools near
their homes and put into these classes.
Attendance is not to be made compulsory.
If the new institutions are made so ex-
cellent that it is a clear advantage to each
defective child to attend, it is argued that
no compulsion will be necessary. Should
a parent prefer to send his child to one of
the regular schools, no objection is to |be
made, provided the child does not disturb
the rest of the school by his presence.
To meet the present needs of the city of
St. Louis for the education of defective
children, the Board ordered that three
houses be provided, and they appropriated
$12,000 to cover the expense of the special
schools for the remainder of the present
school year. A later report shows that
three special centers of two classes each,
organized on the above-described plan, are
now in operation and that each center has
a waiting list of applicants for admission.
Great changes have taken place every-
where in courses of study and plans of
classification and promotion since the days
when exceptional children began to be
studied with some approach to the scien-
tific spirit. Careful classification requires
that children of about equal working power
be grouped together, so that none shall be
held back on account of slow-moving class-
mates, nor shall any be unduly hurried
through the course. Sometimes these
very great ameliorations of former rigid
and unwise school arrangements are OVer-
looked by those who discuss present-day
conditions. They also overlook some
liome conditions which are very important
factors in over-pressure. For instance, a
recent study made by the teachers of one
school of 560 pupils in a foreign section of
Baltimore shows that 76 children, ranging
in age from six to thirteen years, are
obliged by their parents to attend a de-
nominational school from one to two and a
half hours daily, in addition to the five
hours which they spend in the public
schools. Many of these boys sell papers
in the morning before school. Thus they
have no leisure, they scarcely know the
meaning of play, their parents have no
conception of the physiological limit to
mental activity. No wonder these chil-
dren appear anemic and show signs of
fatigue. Before this study was under-
taken, it was the opinion of the teachers
that the children were suffering from 1ack
of sufficient food, and they were agitating
the question of giving them daily a
nourishing meal at the city's expense.
They found by investigation, however,
with proper food. Unwise selection º
food rather than insufficient food we
characteristic. It is the home that m
be reached, and the child through
home. This school is only one of many
which such conditions obtain. àr
For such conditions the school curridº'
1um cannot be held responsible. Tº
school is meeting these conditions in pº
by introducing as much activity as
variety as possible into the daily pn
gram. It is also trying by means |
parents' meetings to reach the home ar.
influence it against such oppression a
children. r
A good city school of to-day can ro
well by all except about one or two ºr
cent of its pupils. These few must ha
special care. Among these even the dº
and the blind, once thought to be , .
stitutional cases, are in a few cities “.
ceived into the public schools with º
results. They mingle with other child:
in some of their work and recreation aſ
thus are better prepared for their later ||
among normal people. The day schol,
for the blind and deaf in Chicago and M
waukee are of this mixed type.
School attendance 1aws have for
upon our attention three classes of child
— the backward, the defective, and Ol
refractory. Many of these, with prol
training, will become self-supporting, ""
ful citizens and are where they bel. C
when in attendance at a public schjn:
Others should spend their lives in a star
institution which would protect them iſ C
the crushing competition of the capajº,
meanwhile, using the products of t.
directed labor for their entire or paſ".
support. Thus the state would at . C
same time protect itself by keeping or
manifestly subnormal from propaga’ſ
their kind. Until the state makes 1.
quate provision for a task, the magnitºl
of which has not been realized by legal.
tors, the town and the city must prºot
for defectives in special classes, for”
rights of normal children cannot be slas.
guarded when 50 per cent of the endhei
of the teacher is expended on 5 per cenº
the pupils in the class. du
In dealing with exceptional children%
coöperation of teachers and physicianº
absolutely essential. The teacher of N
special class needs to develop to some º
tent the insight characteristic of the sk M
ful diagnostician, and the school physic: (
needs to be a good deal of a psychologist"















S C H O O L H Y G I E N E 27
wirelliMINARY REPORT OF THE
lico MMITTEE ON SCHOOL HYGIENE
l
om the Transactions of the American School Hy-
ssociation, Atlantic City, N. J., 1908.
JOHN J. CRONIN
comMITTEE appointed by the Ameri-
chool Hygiene Association to obtain
ºnowledge of what some of the larger cities
ºere doing in the way of medical inspection
ºf school children, presents the following
reliminary report:
p ation sought from cities of the
s ted States. . . . . . . . . . ' ' ' '.' ', ' ' ' I48
arom cities in the Dominion of Can-
nada and Newfoundland ‘.
6
24
I95
eplies were received from cities of
the United States . . . . . . . . . . . . . . 48
!)ominion of Canada and Newfound-
di land....... . . . . . . . . . . . . . . . . . . . 4.
*[exico. . . . . . . . . . . . . . . . . . . . . . . . . . O
entral America. . . . . . . . . . . . . . . . . . O
º uth America. . . . . . . . . . . . . . . . . . . O
Apology may be made for the cities of
ſouth and Central America and Mexico
on that the time was too short for the com-
hunication to be received and answered.
| Cities conducting medical inspection:
h]nited States. . . . . . . . . . . . . . . . . . . . . 2O
Sanada and Newfoundland. . . . . . . . . . I
* Cities not providing medical inspection:
*Jnited States. . . . . . . . . . . . . . . . . . . . . 28
"...anada and Newfoundland. . . . . . . . . . 3
I
Of the cities conducting medical inspec-
ion, eighteen are under the control of the
a)epartment of Health.
. In fourteen cities the parents are noti-
lied by the school authorities of any physi-
ºal defects found. In two cities this
lotification is made by the Health Depart-
ment. No city or state as yet heard from
slas any laws compelling parents to get
dheir children in proper physical condition
nor school attendance. The compulsory
ducation and truancy laws are the only
a leans at present available to compel
narents to attend to the physical defects
: f their children.
, Nine cities employ school nurses.
s! Montreal is the only city in the Dominion
ict Canada having medical inspection of
st:hools.
MEDICAL INSPECTION OF SCHOOLS
J. E. LABERGE, M.D.
Medical Supervisor of Infectious Diseases, Montreal,
Canada
THIS is the subject of a paper read at
the annual meeting of the American School
Hygiene Association at Atlantic City in
1908. The paper is chiefly interesting as
confirming the results of medical school
inspection already determined in other
cities, both in the United States and
abroad. Medical inspection of public
schools in Montreal has existed since 1896,
and as direct results of it there has been
noted a change for the better in the physi-
cal condition of the pupil, in the condition
of the cleanliness, and in the number of
contagious diseases reported. The full
value of the work is not obtained in Mon-
treal because of the many school boards
directing the education of the children,
there being in all fifteen school boards.
There are fifty thousand school children
regularly inspected by fifty physicians.
Twice a year, at the opening of school in
September, and again in January after the
Christmas vacation, a careful examination
of every child is made and a report given
to the Health Department. In addition
to this, the school buildings are inspected
and a report of their condition filed with
the Health Department. A daily visit to
each School is also made during term time,
and those pupils examined who are con-
sidered by the teachers to need medical
attention.
Among the 50,000 children in school,
34, II4 were found suffering from illnesses
more or less serious and necessitating
treatment. The first complete inspection
revealed the following startling facts:
Defects of vision
* - - - - - - - - - - - - - - - - I,
Hypertrophied tonsils and ade- 333
noids . . . . . . . . . . . . . . . . . . . . . . . . 5,29 I
Decayed teeth. . . . . . . . . . . . . . . . . . I3,385
Pediculosis . . . . . . . . . . . . . . . . . . . . . 3,656
Itch. . . . . . . . . . . . . . . . . . . . . . . . . . . . I 25
It will be noticed that in Montreal, as in
every other larger city where the school
children have been physically examined,
the number of pupils suffering from reme:
dial physical defects that retard mental
development is astonishingly large. The
discovery of these defects is but the first
Step; the remedying of them the second
step, leading to the most important action
of all, the prevention of them so far as
human foresight is possible.







28 S C H O O L H YG I E N E.
PLAYGROUND ASSOCIATION OF
CHICAGO
THE following extracts from a leaflet
issued by the Chicago Playground Asso-
ciation are of interest:
The Playground Association of Chicago
is working:
To promote the play spirit through festi-
vals of play, sport, folk games, and national
dances.
To investigate city conditions with
reference to playground extension.
To secure more playgrounds and recrea-
tion centers.
To study and promote playground
efficiency.
To encourage outdoor life and apprecia-
tion of the natural beauty around Chicago.
In these activities the Playground Asso-
ciation unites the coöperation of public
toodies and individual citizens who are
earnestly working for playgrounds. The
need of such a voluntary organization has
been felt by the Park Boards and the
Special Park Commission. Representa-
tives from these commissions, as well as
from educational bodies, philanthropic
societies, social settlements, athletic or-
ganizations, and the various national
groups, join in the work of the Association.
Play spirit is quite as fundamental as
play space. In promoting play spirit the
Playground Association conducts each year
a great festival of play, sport, folk games
and national dances. All the splendid
equipment of the recreation centers, their
swimming pools, their outdoor and indoor
gymnasiums, their halls and club rooms, –
these facilities are but the framework and
opportunity for the spirit which brings the
real achievement in better and happier
community life, in sturdier citizenship, in
child 11fe freed from the conditions and
temptations which the great city unfairly
thrusts upon it, and in a young manhood
and womanhood given place and incentive
for wholesome recreation and social gather-
111g.
With the extension of recreation centers,
neighborhood play festivals are promoted
and advantage is taken of every oppor-
tunity to rally the spirit of neighborhood
good fellowship in play and sport and to
encourage and revive folk and national
festivals among the people of the city.
More playgrounds and recreation centers
are needed for the thousands of Chicago
children and young people to whom play
space and recreational facilities are in-
accessible. The crowded parts of the west
and north sides present an overwhelming
argument for many more small parks
the type which the south side is finding .
useful. Playgrounds for small child.
should be sprinkled a few blocks an º'
throughout the entire city. Every sch,
should have one. But these are ...
enough. The Juvenile Court statis”;
show that the critical period of childhºf
is at the age of fifteen and sixteen ye.
More children become delinquent at tyn
age than at any other. And this is ;
very time when the playgrounds for sm
children begin to lºse their hold. To sc
these boys and girls over into a manhº.
and womanhood of health and charaq
the city must have more small park recº.
tion centers.
Efficient supervision is recognized 13
playground leaders throughout the coul.
try as a prime essential. Almost better,
have a playground than one without ca.
ful direction. If this is true of the smür
playground, it is equally true of the recr"
tion centers. The Playground Associati;
is working to establish a high standard I
service in the supervision of the recreat
centers. It emphasizes the usefulness .
directors whose social experience à S
practical initiative will rally neighborh
F.
O
spirit and organizations and promote (
use of all the recreation center facilities ºf
play, recreation, and social gatherings. n.
- Be
THE PHYSICAL CONDITION OF Op .
SCHOOL CHILDREN f t
JOHN SPARGO Oa.
1
(From The Independent, June 18, 1908.) .
ALMOST three years ago the au)f
called the attention of the readers of uc]
Independent to the fact that “a large nxa.
ber of the children in our public schot
are underfed to a more or less serD11
degree, being therefore handicapped, hil
physically and mentally.” A statem-or
made by Mr. Robert Hunter that sevror
thousand children in the public schoobt:
Greater New York were underfed, ind
author found to be “terribly nearitic
truth.” In the United States he re
mates that “not less than two mi T
children of school age are the victimſ t
poverty, which denies them comot
necessities, particularly adequate nhei
ishment.” e11.
It is not claimed that these two mino
children are “famishing ” or “dyingr
starvation”; rather, that they are suy
ing from malnutrition in the patholog
sense, causing a wasting of tissue an I.
general physical deterioration. 11y



S C H O O L H Y G I E N E 29
* To remedy this evil the establishment
ºf some system of school meals is favored.
"ot “free meals,” but rather according
By the Parisian system, where those able
ay do pay, the number, absolutely
nable to pay being, in normal times, small.
hat this feeding of school children is
hºt a cure for the underlying ills that
°ºuse the poverty responsible for the
ºndition of the children
is admitted.
is but a makeshift to afford relief that
I urgent. Such relief is particularly
ssary during times of business depres-
when great armies of unemployed
and women workers throng the
"reets.
In Bradford, England, the school au-
orities are feeding daily more than eight
º dred children (the very poor), and the
º: indicate that children 1earn when
Cºley are fed who cannot learn when
*"ungry.
at EPORT OF THE EXAMINATION OF
ºrd THE EYES AND EARS OF THE
* School childrEN IN MINNE
*SS
SOTA; 1904-5
ch HENRY M. BRACKEN, M.D.
e (From the St. Paul Medical Journal, October, 1905.)
* THE Minnesota State Board of Health,
n October 13, 1903, appointed a commit-
£e of specialists to consider and advise as
05 the examination of the eyes and ears
f the school children of Minnesota. The
oard issued test charts and reporting
lanks to all villages and cities having a
opulation of one thousand and upwards.
u)f 122 municipalities asked to conduct
fuch an examination, 56 reported. The
ºxaminations were made by the teachers,
shot by physicians. The results are as
plows: There were examined 21,951
|hildren; of this number 3,166 suffered
Trom uncorrected defective vision, 51.3
Vrom defective hearing. No reports were
obtained from the larger cities of St. Paul
nd Minneapolis, yet it is in the larger
rities that defects in vision and hearing
re most numerous.
li. This first attempt at medical inspection
mf the school children must demonstrate
mp the school authorities of Minnesota that
nheir full duties, to their pupils are not
eing properly discharged if they, having
linowledge of the facts, neglect to provide
ngr the physical well-being of the children
uy efficient medical inspection.
O -
in IN The New England Medical Gazette of
ily, 1908, is an article by Dr. F. A. Fer-
|
guson, of Bath, Me., on “The Medical
Inspection of Schools.” In reply to a
circular letter sent to the Superintendents
of schools of all the 1arger cities of Maine,
it was found that in no city was there any
regular system of medical inspection of
schools.
THE SCHOOL AND ITS PART IN THE
PREVENTION OF TUBERCULOSIS
(From The Lancet, London, May 9, 1908.)
THIS is the title of an address by John
Hay, M.D., assistant physician to the
Royal Infirmary of Liverpool, in which
he shows the important part the public
schools play in the great problem of tuber-
culosis. The subject is discussed under
three heads: (1) A consideration of how
many school children are actually infected,
and the nature of the infection. (2) A
discussion of the steps to be taken to lessen
the risk of infection and to cure those
already diseased. (3) To determine what
can be done to make the school a more
potent factor for good, for the school is the
place where the public opinion of the
future is largely formed and where new
views of hygiene are to be inculcated.
An examination of 436 school children
in Liverpool was made, and of this number
6 showed definite evidence of tuberculosis,
3 with tuberculous glands of the neck, I
with a healed tubercular hip joint, and 2
with active pulmonary tuberculosis. The
latter two were, of course, sources of in-
fection to the other children. These fig-
ures closely agree with those of other
observers. Thus, 3 cases of pulmonary
tuberculosis were found among 806 chil-
dren in Liverpool; in London, among
I,67o children, 8 cases; in Blackburn, I
among 4oo children; in Dundee, none
among 517 children; in Dunfermline,
none among 1,371; in Aberdeen, 17
among I,200; in Edinburgh, 19 among
I,318.
These figures are interesting as showing
the number of children found suffering
from pulmonary tuberculosis in the schools.
A very small number surely, less than one
half of one per cent. An examination of
1,028 children absent from school because of
tllness showed that 69 were suffering from
pulmonary tuberculosis. When this num-
ber is compared with the relatively low
figures just quoted, the obvious inference
is that tuberculosis, when attacking chil-
dren, rapidly unfits them for school life.
For this very reason they cease to be a
Source of danger in school. Children with
pulmonary tuberculosis are rarely found







3O
S C H O O L H YG I E N E
in School; they are incapacitated and
remain at home.
What steps can be taken to lessen the
risk of infection? In the author's opinion,
carefully carried-out inspection of the
school children, teachers, and school build-
ings is of the first importance. Over-
crowding in school rooms must be avoided.
The children may be divided into three
classes: (1) Those who are healthy and
free from any taint of infection. (2) Those
who are suffering from active consumption,
about one half of one per cent. (3) Those
who are predisposed to consumption.
This latter class assumes an important
part in the prevention of consumption,
for in this class is included those children
coming from tuberculous homes. These
children should receive careful physical
examination from time to time, and their
health should be safeguarded in every way.
School hygiene and home hygiene must
be insisted on by the school authorities
and boards of health working in harmony.
Compulsory notification of tuberculosis,
hospitals for advanced cases, and super-
vision of the consumptive, if allowed to
remain at home, are essential. In Ger-
many, France, and in a few English cities,
schools have been established in the coun-
try for those children likely to become
tuberculous. They must not be over-
worked, they must have sufficient sleep,
and they must be well fed. A careful
record of their weight would be of value
as an indication of the effect of the stress
of school life and of the special treatment
which they receive.
The schools are important in the forma-
tion of public opinion. The children of
to-day are the citizens of to-morrow, and
the intelligent enthusiasm for good hy-
giene shown by teachers and conveyed to
the pupils must bear good fruit in the
years to come.
IN one of the Massachusetts rural news-
papers an advertisement of the annual
town meeting recently appeared contain-
ing the item, “To see if the town will
appropriate $25 for medical inspection.”
In Woonsocket, R. I., six medical inspect-
ors are paid $50 apiece per year. In Bos-
ton they receive $200; in Detroit, $2.5o;
in New York City, $100 per month; in
Newark, N. J., $1,400 per year; and in
Camden, N. J., $2,400 per year.
MINNEAPOLIs formerly had medical in-
spection of schools paid for by the city and
carried on by the board of health. This
year the city refused to pay for it, and so
did both the board of education and T
board of health. Accordingly, this y
medical inspection was given up in Min
apolis, but there is now strong local ag
tion looking toward reëstablishing it.
THIRD INTERNATIONAL CONGRE
ON SCHOOL HYGIENE, PARIS
MARCH 29 – APRIL 2, 1910
PRESIDENT'S ANNOUNCEMENT
THE first of the International Congres
on School Hygiene was held at Nurembe
in April, 1904; the second in London,
August, 1967; the third will be held
Paris during the Easter holidays, fr
Tuesday, March 29, to Saturday, Apri
I9 Io.
national Exhibition of Hygiene in Scho
and Education will be organized.
The various civilized nations have b
able to compare their respective resour
and methods. These meetings have
sulted not only in a most promising er
In connection with it an Int
1ation, but they have originated a mo
ment in public opinion towards promot
the necessary reforms, . and by carry
them into effect.
Shortly after the Congress held in L.
don, the organization of the medical
-
spection of school-children was offici. T
decided on by the English government.E
At a meeting held in London on Aug
8, 1907, the Permanent Committee of
ternational Congresses on School Hygi
passed the following resolution:
“The Permanent Committee of
International Congresses on School
giene accepts thankfully the proposal m
to them by the Ministry of Public Inst
tion and Fine Arts of France and by
“Ligue francaise d'Hygiène scolaire
organize the third of these Congre;
with the help of all French societies
terested in the hygiene of schools.
The Congress of 1910 will enjoy
helpful patronage as well as the d
collaboration of the French Ministr
Public Instruction and of the Soci
interested in the hygiene of childhood.
We ask all the friends of school hyg
to appoint, in their respective count
national and district committees, repre:
ing municipalities, schools, professi
educators, medical men, and parents. '
cial invitations will be forwarded in
time to the foreign governments.
Dr. ALBERT MATHIEl
37, rue des Mathurins, Pº
(President of the Permanent Committee of the I-
national Congresses on School Hygiene.)
S C H O O L H Y G I E N E
3 I
JOURNAL OF EDUCATION
EDITED BY A. E. WINSHIP
The only national educational weekly published in this country
Once a subscriber, always a Subscriber
An educational newspaper, published weekly, reporting
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Subscription, one year, $2.50
Send for Specimen copy. Mention School Hygiene and
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32 S C H O O L H Y G I E N E
º
Hygienic conditions in schools and in rooms of all public
buildings should be maintained with the most scrupulous
care, for a dust-laden atmosphere is a constant menace to health.
Continuous activity on the part of pupils stirs up the dust from the floor
and keeps it in circulation. Proper ventilation will assist materially in keeping
dust at a minimum, but the only solution of this problem is to eliminate the
dust entirely. This can be successfully accomplished by treating floors with
STANDARD
FLOOR DRESSING
Actual use has proved beyond question its effectiveness as a dust-exterminator—the
danger from disease contagion from dust being reduced almost one hundred per cent,
Standard Floor Dressing is also a remarkable preservative for floors. It not only keeps
the floors from splintering and cracking but actually lessens the labor in caring for them.
Dealers everywhere sell Standard Floor Dressing in barrels and cans. Apply three
or four times a year for best results.
WE WILL PROVE file remarkable efficiency of Sfandard Floor Dressing af our expense.
On request we will apply if fo the floor of one schoolroom or corridor free of all charge.
We are confident that a frial will result in the continued use of Standard Floor Dressing.
Every Board of Education, every School Superintendent, Principal and Teacher
should know how to guard the health of children under their care. Learn what eminent
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STANDARD OHL COMPANY (Incorporated)
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---
B
tit Lºſ
Ulva y - vir Rººkie
FER 95 1909
§chool Hygielle
4 of ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
33% PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
Vol. I, No. 3 BOSTON, MASS. OCTOBER, 1908
N. vibe ºfficers amb Council of the £1550ciation
ary President, Hon. THEoDoRE RooseVELT.; President, Dr. HENRY P. WALCOTT : Vice-President, Dr. ARTHUR
T. Cabot; Secretary and Treasurer, Dr. THOMAS A. STOREY.
John A. BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
ELM-ER E. B.Rown, Ph.D., United States Commissioner
of Education.
WILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
John J. CRoNIN, M.D., Assistant Chief Medical Inspector,
* Health Department, New York City.
AM Jacobi, M.D., LL.D., Professor of Diseases of
ldren, New York City.
oMAs M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
New York University.
LEE, A.B., A.M., LL.B., Boston.
... P. KING BRow N, A.B., M.D., Medical Department,
ersity of California.
Robert W. Lovett, A.B., M.D., Instructor in Orthopedic
A. Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
George H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
J. H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
J. H. McCURDy, M.D., Director. International Young
Men's Christian Association Training School.
CHARLEs A. MooRE, Chairman Welfare Department,
National Civic Federation.
Edward L. STEvens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. Storrow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
Nicholas MURRAY Butler, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDERick ForchHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WashingtoN E. FischEL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALsey GULick, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart-
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEyLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. Storey, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
- As a result of the several business meetings held, it was definitely decided that the
policy of the Association during the coming year should lead to the formation of sev-
eral active committees which may cover such work as the compilation of a bibliog-
raphy on school hygiene; the formation of a conspectus of state and municipal laws
relative to school hygiene; the accumulation of further statistics concerning medical
inspection; and the publication of a monthly bulletin on school hygiene.
Jubscription price, 50 cents a year
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
A11 cºmmunications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.























34 - S C H O O L H YG I E N E
TABLE OF CONTENTS
EDITORIAL
PAGE
THE TEACHING OF PHYSIOLOGY . . . . . . . . . - 34
PROGREss IN OHIO . . . . . . . . . . . . . . 35
ARTICLES
THE AMERICAN School Hygien E Association . 36
SPECIAL Schools for DEFECTIVE CHILDREN . . . 37
THE REQUIREMENTs of PRoPER SCHOOL FURNI-
TURE . . . . . . . . . . . . . . . . . . . 38
DENTAL INSPECTION . . . . . . . . . . . . . . 4 I
WHAT Do HISTORIES OF CASES OF INSANITY TEACH
Ls conce RNING PREVENTIVE MENTAL HyGIENE
DURING THE YEARs of ScHool LIFE * . . . . . 42
LEssons FROM A QUARTER CENTURY of LEGAL RE-
QUIREMENT OF THE TEACHING OF HYGIENE . , 45
THE School Room. As A FActor IN TUBERCULosis . 46
ExtRActs FROM THE CONSTITUTION OF THE AMERI-
CAN School Hygiene Association . . . . . . 46
EDITORIAL
THE TEACHING OF PHYSIOLOGY.
THE child entering school for the first
time, having lived a life of more or less
looisterous freedom, comes under changed
conditions. The physical activities are
being subdued, the intellectual awakened
to be trained. Good health which was so
easily maintained is now beset with a
multitude of enemies. Physical restraint;
crowded, usually overcrowded, school-
rooms; poor ventilation,-alas, often none
at all,— exposure to infectious conditions
from the bodies of other children, all con-
spire to injure the physical well-being of
the child.
The study of physiology in the public
schools has come to occupy a very impor-
tant place in the curriculum. Through it
the child gets his first knowledge of the
body, its structure and functions. The
simplest rules of personal hygiene must be
made the important part of this study.
The safeguarding of the health of bº
School child can be accomplished (te
when there is intelligent coöperation de
children, parents, and the school authth
ties. To obtain this coöperation thor
must be some knowledge of hygiene, to
this is possible only through the study si
physiology.
This is a required study in the pulm
schools of many states. Unfortunately at
is not a very interesting study to m
children, or at least, it is not made interta
ing. So much time and space have to st
given to the evil effects of alcohol at
tobacco that the child wonders what im
all about, and at the end has little mit
than a confused idea that physiolopſ
alcohol, and tobacco are in some w
closely allied. Yet physiology can
made interesting as well as valuable to
child. eS
A class of forty boys averaging w.
years of age was having a recitation onse
physiology of digestion. The use of bº
teeth, mouth, Saliva, and gastric iſ th
were considered and the answers gi in
showed the results of good teaching, in
when the exercise was over there was
the feeling of incompleteness. What le.
the boys gained that was useful? Sºp.
knowledge of the processes of digest re
But how were they to make use of ce
knowledge? So far it was a gence
knowledge only. Could any part of it
made personal? Why, yes, the part to
teeth play in the process of digestion m 16
be made personal. Questions were t at
asked concerning the value of the te: T.
What would happen if there were too cl
teeth or none at all? What caused alth
of teeth? What were the evil .."
rotten teeth? The boys were eageſ th
answer these questions, edged out pl
seats, waved hands frantically, scowleſ sp
wrong answers, and when called upon co
answer stood erect by the desk and prouca
gave what they considered correct answto
To the final question, “How many of of
boys have cleaned your teeth this ".
ing,” there was but one response. (gC


S C H O O L H Y G I E N E 35
boy in a class of forty had cleaned his
teeth that morning. The other boys sat
dejectedly in their seats, ashamed. Fur-
ther questioning showed that more than
one half of these boys made no use of the
toothbrush at all, the others only occa-
ysionally.
If the study of physiology were made
more personal in its application, if less
ly attention were given to the evils of alcohol
land tobacco, which children use not at all,
T and the time thus spent were given to the
o study of personal hygiene made simple and
: attractive, an interest in physical develop-
i ment and the care of the body for the joys
it would bring would take the place of the
(present apathy or fear of irrelevant evils.
PROGRESS IN OHIO.
W
|
' ' It is a great satisfaction to those inter-
ested in the welfare of Schoolchildren to
watch the growth of medical inspection of
lſ schools.
been adopted in many cities and towns of
the United States, and every year finds an
"increasing number of cities with medical
inspection.
We learn from The Ohio Sanitary Bul-
letin of 1908 that school inspection is
"possible in Ohio under the state law but is
restricted to the supervision of the sanitary
condition of the school buildings and to the
control of contagious diseases.
In Cleveland there is one school inspec-
tor in every ward, twenty-six in all. In
1907, they made 15,887 visits to the schools
and 2,825 to the homes of the children.
* They examined 32,584 children and ex-
cluded temporarily from school 1,967 of
them.
: In Toledo, however, a committee from
the Chamber of Commerce formulated a
plan whereby four schools might be in-
spected by well-qualified physicians. This
committee went before the board of edu-
cation and was unable to gain permission
to inspect the four schools without cost
on the following ground:
* We admit that there are children
going to the schools who ought not to go
Begun in Boston in 1894, it has
to school; we admit that there are cases
that should be kept from school; we admit
that there are many cases of contagious
disease, but if doctors go in there they
will find out more trouble than we are
looking for, and the people will ask that
investigators be appointed to go through
the schools. We haven’t the money to do
it now we are building school buildings.”
How is it possible to get such a thing past
the board of education which says, “ The
money is not there.” The committee said,
“This doesn't cost you any money,” and
are answered, “Oh, but it may take some-
thing after you get through.”
Medical inspection of schools in Toledo
is certain to come. The parents of the
School children will not weigh the health
of their children against the trifling cost
of looking after it and decide in favor of a
petty economy almost criminal in nature.
The Ohio Sanitary Bulletin has performed
a public service in publishing the reason for
the decision of the Toledo Board of Educa-
tion against school inspection. The reason
given, “We haven’t the money to do it now
we are building school buildings,” is inde-
fensible. Better no new school buildings
than a neglect of the health of the school
children in the many buildings now in use.
THE secretary of the State Board of
Health in Iowa recently published an ar-
ticle against medical inspection of schools.
In Fort Dodge, Ia., last December, there
was an epidemic of scarlet fever. The
board of health attempted to inaugurate
medical inspection, but was opposed and
ordered to stop by the superintendent of
schools. The board of health was vic-
torious in the resulting controversy.
CHICAGO has a hundred medical inspec
tors who work only for the detection of
contagious disease. The commissioner of
health wishes to employ this same force to
conduct regular physical examinations of
School children. This is opposed by some
of the school trustees, as they doubt the
legal right of the board to do this work.

36 S C H O O L H Y G I E N E
THE AMERICAN SCHOOL HYGIENE
ASSOCIATION.
THOMAS A. STOREY, M.D., Secretary.
THE American School Hygiene Associa-
tion was organized in Washington City on
May 6 and 7, 1907. The constitution
which was adopted at the first congress of
the association states that the organiza-
tion was accomplished in order to “stimu-
1ate research and to promote discussion of
the problems of school hygiene,” and “to
take an active part in movements wisely
aiming to improve the hygienic conditions
surrounding children during school life.”
The association has held two congresses,
in which a number of papers were pre-
sented. The titles and contents of these
papers indicate clearly the lines along
which the members of this association are
extending their influence, and show that
the association is working for the realiza-
tion of the objects set forth in its constitu-
tion. Briefly, these papers were titled as
follows: At the first congress, “Medical In-
spection in Massachusetts,” Hon. George
Martin, secretary Massachusetts State
Board of Education; “Medical Examina-
tion in New York City Public Schools,”
John J. Cronin, M.D., assistant chief medi-
cal inspector, Board of Health, New York
City, discussion by Dr. Thomas Darling-
ton, commissioner of health, New York
City; “Physiological Age and Its Influence
on School Progress,” C. Ward Crampton,
M.D., assistant director of physical educa-
tion, New York City Public Schools; “The
Requirements of Proper School Furni-
ture,” Robert W. Lovett, M.D., Harvard
Medical School.
At the second congress: “Preliminary
Report of Committee on Medical Inspec-
tion,” John J. Cronin, M.D., first assistant
chief medical inspector, New York City;
“A Brief for the Organization of Depart-
ments of School Hygiene within Boards of
Education,” Luther H. Gulick, M.D.,
director of physical education, public
schools of New York City; “The Medical
and Sanitary Inspection of Schools and
Their Relation to the Tuberculosis Pro
1em,” Samuel G. Dixon, M.D., Committ
of Health, Pennsylvania; “Medical I
spection of Schools and Boards of Health
J. E. Laberge, M.D., medical inspecto
Montreal, Canada; “Artificial Illumin
tion in Schools,” Myles Standish, M.I.
assistant professor of ophthalmology, Ha
vard University; “ Statutory Enactment
relating to the Medical and Sanitary I
spection of Schools,” A. C. Vandive
LL.B., counsel for the Medical Society
the County of New York; “Playgrour
Legislation,” Joseph Lee, LL.B., Bosto
“The Status of Hygiene in the Americ
College,” George L. Meylan, M.D., adjun
professor of physical education, Columb
University; “Medical Supervision in t
School of Education, University of Cl
cago,” Joseph E. Raycroft, M.D., Un
versity of Chicago; “Provision for Exce.
tional Children in Public Schools,” J.
Van Sickle, A.M., superintendent Balt
more public schools; “What do the Hi
tories of the Cases of Insanity teach
concerning Mental Hygiene of the Schd
Year?” Adolph Meyer, M.D., direct
Pathological Institute, State Commiss
in Lunacy, New York; “The Readju
ment of the Elementary and High Scho
upon the Basis of Physiological Age,”
Ward Crampton, M.D., assistant direct
of physical education, public schools, N:
York City; “Schoolhouse Construct
as Affecting the Health and Safety
Children,” R. C. Sturgis, B.A., chairma
Schoolhouse Commission, Boston; “Tº
Inspection of the Ventilating and Lightſ
of Cleveland Schoolrooms,” Marti
Friedrich, M.D., health officer, Clevelan
“Shall Medical Inspectors of the Pub
Schools be Appointed, and What Shall
Their Functions?”, Richard C. Newtº
M.D., editor American Health; “Medi.
Inspection and Educational Needs of tº
Foreign Born and Backward Children
Harlan Shoemaker, M.D., assistant me
cal inspector, Philadelphia.
During the summer of 1907 a numb
of the members of the association "|
|


S C H O O L H Y G I E N E 37
esent in London as delegates to the
Second International Congress on School
Hygiene which was held there at that time
inder the auspices of King Edward. Dr.
anry P. Walcott and Dr. Robert W.
vett, of Boston, and Dr. Luther H.
ick, of New York, were further dele-
ed by the Department of State at
ashington to represent the United States
at that congress. The report of these
elegates to President Roosevelt was sub-
itted soon after their return and will
imately appear as a governmental
blication.
In the beginning the plan was to publish
h year the proceedings of the associa-
n. That plan has been given up, for the
*sent at least, and the publication of a
bnthly journal has been substituted.
is journal will reproduce appropriate
apers and reports, or abstracts of the
me, that are presented at the various
eetings of the association. It will, in
idition, publish news relative to the
fairs of school hygiene over the world.
ppies of this journal, School Hygiene, are
w being very widely distributed locally
ld internationally.
Since its organization the association
has nearly doubled its membership. An
examination of the names enrolled indi-
tes that its members are scattered over
e United States and Canada, and that
ey represent some of the very best edu-
cational, scientific, medical, sanitary, and
hygienic interests in these two great
untries.
Within a year and a half, then, the
erican School Hygiene Association has
en organized; it has declared its policy;
held two congresses in which a number of
important papers were presented; repre-
ted the United States at a great and
gnified international congress; brought
into membership alliance with it a number
men of the highest educational, scien-
tific, medical, and public-spirited reputa-
tion; and has brought into active existence
a monthly publication for the broad dissem-
ination of information relative to its ideals.
It is hoped and confidently expected
that this association will continue to
receive this cordial support from its mem-
bers and that its influence will be produc-
tive of far-reaching and highly important
effects upon the health of school children,
and through them upon the health of
humanity.
SPECIAL SCHOOLS FOR DEFECTIVE
CHILDREN.
BY R. C. ELMSLIE,
Assistant Medical Officer of the London County Council
and Assistant Surgeon to the Metropolitan Hospital.
(From the Transactions of the International Congress of
School Hygiene, London, 1907.)
EIGHT years ago, in London, the first
invalid center was opened for the instruc-
tion of children unable to attend the 1arger
schools on account of infirmity. There are
now twenty-three such centers, with 1,802
children on the rolls, the schools being
situated all over London. Each holds
from forty to one hundred children, who
are sent for each day and fed at noon.
There is an examination for entrance to
such schools, and the children are obliged
to remain until they are sixteen years old.
Three classes must be provided for:
(A) Children with tuberculosis of the
bones and joints.
(B) Fixed deformities and paralysis
(C) Chronic heart and lung diseases.
The criticism made by the author is
that those in charge of these schools do not
see that efficient medical and surgical
treatment is carried out and that the
results are satisfactory. He estimates
that 20 per cent of these children will earn
their living at some trade 1ater in 1ife, 5o
per cent if specially adapted work can be
found, while 30 per cent will be unable to
support themselves.
HEALTH COMMISSIONER WENDE has
appointed five doctors as medical exam-
iners for the public schools in Buffalo.
The appointments were all from the
eligible list of the Civil Service Commission
and took effect August 16. Dr. Callanan
will have charge of the parochial schools.
Miss Rose O’Hara has been appointed
a school nurse and will look after pupils
discharged from school by the medical
examiners, and also will see that the phy-
sicians’ directions are carefully observed.
Miss O'Hara's name stood at the head of
the civil service eligible list.













































38 S C H O O L H YG I E N E
THE REQUIREMENTS OF PROPER
SCHOOL FURNITURE.
(Presented at the first congress of the American School
Hygiene Association, Washington, D. C., April 6, 1907.)
BY ROBERT W. LOVETT, M.D., BOSTON.
THE question of school furniture has
been before the public some sixty years,
having originated with Barnard in 1842,
and about one hundred and fifty models
have been advocated and upward of thirty
forms have received a practical trial.
At present, as far as can be learned from
the manufacturers of school furniture,
about sixty-five per cent of American chil-
dren sit on a sort of bench with a back
which is fastened to the front of the desk
behind it, thirty odd per cent are seated in
a chair much like the ordinary kitchen
chair, and a very small per cent have for
their use a carefully studied out chair de-
vised and used in a11 new schoolhouses in
Boston, and coming into a little use outside
of that city, chiefly in New England.
About ninety per cent of all desks and
chairs, wherever used, are adjustable for
height. This latter point is of importance
and is, of course, most essential, but such
adjustment does not make a badly de-
signed chair into a good one, and probably
serves to satisfy those not familiar with
the subject that the best modern school
furniture is in use when it can be called
adjustable. -
The seating problem concerns growing
children and not adults, and growing chil-
dren possess certain characteristics of
importance in this connection. The
period of growth is one of instability and
strain, the resistance to bodily and mental
fatigue is less than at other periods of life,
and muscular tone is impaired by rapid
growth. The period on the whole is one of
marked susceptibility to environment, the
influence of unfavorable conditions being
felt more than at most other times of 1ífe,
and the reaction to unfavorable conditions
being quicker and more extensive. We
have, then, in this matter, to deal with a
Special class of individuals requiring espe-
cial care, and precautions are not needed
So much for the average or very strong
child as for those below the average, who
have less than normal resistance.
There is one fundamental condition
underlying the whole problem which is not
always appreciated. The spinal column
s a structure inherited from the quadru-
peds and a structure which was meant to
bear weight and to carry out its function
in the horizontal position. When thi
structure was called upon to perform it.
function in the upright position, adapta 1
tions were made in it, but essentials wer. 1:
not changed, so that really it remains a
structure intended to serve as a horizonta A
support, but transformed into an uprigh n
weight-bearing column. In the quadru S
peds the vertebral column forms a lon, d
arch upward and is supported in front º t
behind by the anterior and posterior limbs f
The internal organs are suspended front
this bony ridgepole, which is curved i
such a way as to support them economi
cally. When the upright position is as t
sumed, the spine no longer supports weigh
in its line of greatest strength, but the vert
cal thrust that comes upon it comes in th F
1ine not of its greatest strength, but in it. Y
long axis, in which it is not so well adapte f
to resist distorting forces. The anterio
limb, instead of supporting part of th
weight of the column, hangs free, and it
weight is hung upon the column. Thiſ
thorax and the organs contained in th
chest and abdomen no longer hang down
ward from the column as a ridgepole, but
drag directly on it in the line of its length
The column is supported upon the pelvi
in a position of unstable equilibrium and
has not only to hold itself upright, but tº
carry weight as well.
The problem before us is, therefore, tº
keep a particularly susceptible class of
individuals free from the distortion of a
structure which is mechanically perform.
ing a function for which it was not origi. .
nally constructed. -
In regard to lateral curvature, there are
definite figures at hand. Wherever large
numbers of school children have been
examined, the percentage of lateral curva.
ture has been found to be from 25 to 50
per cent. This statement rests upon the
analyses of 9,485 children by observers in
different parts of Europe. The statistics
of the school children of Lausanne may be
considered as representative, having been
carefully taken by competent observers,
In 2,314 school children there were 571
cases of lateral curvature, 24.7 per cent.
In the different grades of schools the fig-
ures were as follows:
Grade I, there were 8.7%
x y 2, , , ,, 18.2%
-> 3, 1 * x * 19.8%
, , 4, , , ,, 27.2%
7-7 5, x - --> 28.3%
x * y x - --> 36.4%
,, 7, , , ,, 31.0%


S C H O O L H Y G I E N E 39
he steady increase of 1ateral curvature
through school life as shown by these fig-
ures is at least suggestive. In the few
solated figures that have been collected
as to the frequency of lateral curvature in
merican schools, the percentage has been
h higher. These figures suggest that
some unfavorable condition is at work
during school life. It is not proved that
his unfavorable condition 11es in school
iture, although it is generally believed
it this has much to do with it.
The reason why it is harmful for a child
habitually to sit or stand in distorted atti-
udes is the following one: Growing bone
is an adaptable structure and in its growth
follows the lines of 1east resistance: where
pressure is greatest it grows least, and
where pressure is least it grows most. The
foot of a female Chinese infant is distorted
by being kept bandaged during growth
until the heel and great toe joint in adult
| life practically are in contact. The flat-
| headed Indian child is made flat headed
by having a board pressing on his fore-
head during his early years. Permanent
curves of the spine, both backward and to
the side, accompanied by deformity of
the bones, were produced by Wullstein,
who held for three months in a distorted
ition Some growing dogs. The main-
ance of the distorted position in a child
Qugh long hours tends to repeat the
llstein experiment, demonstrating dis-
tion of the bones of the spine from the
intenance of improper positions.
his evidence would seem to point to
the advisability of supporting the backs
of growing children, during long hours of
sitting, in the position in which they were
least likely to become fatigued and to
uire deformity. It becomes necessary
t to inquire what this position should
and how it is to be favored by properly
apted furniture. As most of the school
iod is spent in sitting, the problem be-
es one practically concerning the chair
d desk. Before speaking specifically of
e form of chair and desk, one considera-
n must be mentioned. It has become
ident from what has been said that the
Vention of fatigue is one very import-
fit factor in the problem, and any con-
Sºleration of school furniture is incomplete
which does not call attention to the neces-
sity of an occasional change of position
and activity. All are familiar with the
comfort which comes from sitting for
& Periods in any position which does not
Tºmit a change, especially in a cramped
Sition. This applies with especial force
to children, who are naturally restless, and
whatever school furniture is used, an occa-
Sional change of position and activity is
essential for a proper routine; otherwise
distorted attitudes will be assumed for the
change and rest that they afford. In this
way even short but frequent gymnastic
periods, taken under unfavorable condi-
tions standing between the desks, have a
distinct value, and it is not possible to 1ay
too much stress on the need of this in
connection with any school furniture, how-
ever good it may be.
Again, muscular fatigue is less likely to
come on in properly fitted school furniture
than in badly fitted school furniture. It is
observed by careful teachers that bad
attitudes and restlessness prevail much
more during the latter part of the day
than in the morning. This restlessness
must be accepted as a symptom of mus-
cular fatigue.
Support with a fixed chair resolves itself
into the support of the average position,
and this average position is assumed to be
the erect sitting position.
The two deformities with which one has
to deal, and which are to be prevented, are
round shoulders and 1ateral curvature.
To prevent the backward bowing of the
spine, support is needed which shall press
forward on the back near its lower third,
that is to say, just above the hollow of
the back. It is easy to see that a chair
back which touches the back only at the
shoulders tends to produce the backward
bowing of the spine when one remembers
that the weak part of the spine for back-
ward bowing is above the waist line. The
most vicious attitude to be corrected in
the whole range of distortion is found in
the child who sits in an ill-fitting chair with
the hips well forward, the back bowed
to its utmost extent, and the shoulder
blades touching the edge of the back sup-
port. The more the small of the back is
supported, the less the muscular fatigue,
and the less tendency will there be for the
child to slide down or to twist to one side-
or the other to secure relief from his dis-
comfort.
Having thus stated the problem to be
met, and having defined in a general way
the existing conditions, one comes next
to the question of what practical points
desirable school furniture should embody.
It will probably be admitted that both
seats and desks should be adjustable verti-
cally. This represents the minimum re-
quirement and one generally accepted.
To go further into the question as to the






























4O :
S C H O O L H YG I E N E
style and relation of desks and seats, bow-
ing of the back is induced
I. By a desk too low or by a seat too
1ow in connection with a 10w desk.
2. By a desk too far forward.
3. By a support to the upper back and
none to the 10wer.
4. By too deep a seat or by too high a
seat in relation to the desk.
Twisting and bending the spine to the
side are in general induced by the discom-
fort of improperly fitting furniture rather
than by any specific lack of adjustment.
Too high a desk, however, necessitates
reaching up and consequently twisting,
and a desk too far away from the seat is
likely to induce a twist in the writing
position.
It is generally admitted that the follow-
ing requirements are necessary in any
reasonable school furniture:
I. The height of the seat from the floor
should be such that in the sitting position
the feet rest on the floor.
2. The height of the desk should be such
that the back edge allows the arm to rest
on it naturally, with the elbow at the side.
As a matter of practice, desks have to be
adjusted about one inch higher than they
should be, as the space necessary between
the bottom and the top of the desk, in
order to contain the books, makes a desk
so thick that to clear the knees it must be
up a little higher than is theoretically
desirable.
3. The seat should slope backward and
downward about three eighths of an inch,
the depth of the seat should be about two
thirds of the length of the thigh, the widths
of the seat should be that of the hips.
4. The back of the seat should have a
slope backward and upward of about one
in twelve from the vertical 11ne. The
slope of the desk has been advocated at
a11 angles, from zero to forty-five degrees.
Theoretically, the best slope for the eyes
is said to be about thirty degrees, but this
is so steep that the ink will not flow from
the pen and the books slide off, so that it
is not practicable. From ten to fifteen
degrees has been adopted as a usual inclina-
tion.
Although these theoretical requirements
had been practically agreed upon by those
who have studied the subject, there was
existing in 1903 no form of school furniture
in general use which embodied a11 of these
principles, the chief objection being that
practically all chair backs supported the
upper part of the back and gave no sup-
port to the lower.
The Boston Schoolhouse Commissionne
1903, took up the problem of devising an
simple and practical chair which shoca
fulfill as many of the theoretical requi
ments as were consistent with praction
utility, and the question was worked si
by Dr. F. J. Cotton at the lateral curth
ture clinic of the Children's Hospital, Bar
ton." The school chair resulting frte
these investigations is now in use in
newer Boston schools to the number of
twenty-two thousand, and the geneti.
report of the teachers is that in practice at
has worked on the whole better than tim
old furniture, and that the proportionw.
correct attitudes is larger than it forme: ht
was. The chair is reported here chie. If
for the reason that it represents an idi
vance and it costs no more than ordinapi
furniture. It is not patented and is tow.
bought in the open market, and althout to
it probably does not present the fire
achievement by any means, it seems dºvé
tinctly better, both theoretically aſſor
practically, than any form of school fur: A
ture in general use. fo
In the construction of the back reth
modeling wax and wood were used, beian
shaped to fit the backs of the childréal
and in the hospital clinic two separa
models, one for the older and one for tº:
younger children, were worked out ind:
pendently, and the curves of the two weſt
found to be practically identical. A thiſ
model for adolescent girls was founi
necessary later on account of the large hips
and had flattened lower corners. The
description of the back rest for the middl:
group is as follows:
“The model finally settled on consists
of a curved support of wood 9% inches
wide and 5 inches high, with a concavity
of one inch in depth from side to side, with
a convexity of one inch in profile, th:
whole very slightly tilted backward. The
maximum convexity lies one third the way
up, and, when properly adjusted, comé
about opposite, or a little above, the fourth
lumbar vertebra. This support is carried
on a light casting running in the grooved
a single cast-iron upright attached to the
back of the seat. A set-screw fixes the
height after adjustment.
“Seats have been manufactured from
these models in two sizes, and are used
with the adjustable desk and seat casting;
that provide for height adjustment. As
the matter stands, the new furniture prº-
vides a seat adjustable for height, with the
* Reports of Boston Schoolhouse Commission, 1901.”
I9 os.


S C H o O L H y G 1 EN E 4 I
nnew back rest also adjustable for height,
and a desk likewise provided with a verti-
Scal adjustment.”
li is chair back is so arranged that not
i º does it support the back in the erect
(sitting position, but in the writing position
the lower edge of the chair back touches
3 º steadies the upper part of the pelvis,
"tending to prevent twisting in this position.
It was found in arranging the relation
of the desk to the chair that certain prac-
considerations were of more import-
than theoretical ones as to plus,
us, and zero “distance.” If the chair
was too far away from the desk the child
had to sit with a bowed back in writing.
If the seat was too near the desk there was
º in getting up, and the abdomen
pressed against the edge of the desk in
# writing. The practical solution seemed
to be in having the seat and desk in such a
º that the back edge of the desk was
ºvertically over the front edge of the chair
for varied but little from this position.
: Adjustable desk tops and chairs movable
forward and back are open to the objection
Sthat they are noisy and get out of order,
and school furniture of this type will prob-
tably never come into general use.
- r. Cotton has devised a scale by which
º adjustment of the furniture to the in-
dividual child is easily made by the janitor
ºunder the supervision of the teacher.
| One must not, however, consider im-
i proper school furniture as the sole cause
; of spinal deformity in children, for home
º and habits, overwork, poor
* food, and similar conditions all have their
influence in making it difficult to hold
sconstantly the correct upright attitude.
sIt does seem, however, that ill-fitting
school furniture is a competent cause of
ious attitudes, and the experience of the
ustrial world shows that such furniture
uces fatigue. It is evident that lateral
ature exists in one quarter of the
ool children where statistics are avail-
e, and that it increases steadily in
ool life. In the face of these facts,
since all are practically agreed as to the
essential requirements of proper furniture,
it would seem worth while to make an
effort to bring about its more general
THE regents of the University of Utah
Ve decreed that no teacher, student, or
ployé infected with tuberculosis will be
admitted hereafter to the buildings of the
university.
F. J. Cotton: American Physical Educational Review,
ember, 1904.
DENTAL INSPECTION.
(Extract from a paper read before the American
Academy of Dental Science, October 2, 1907.)
LAWRENCE W. BAKER, D.M.D., BOSTON.
“EMERSON has taught us,” says Presi-
dent Eliot, “that if we hope to reform
mankind, we must begin not with adults,
but with children; we must begin in the
schools.” The study of oral hygiene
should, therefore, be introduced into the
public schools; toothbrush drill is just as
important to the health of the child as the
prescribed physical exercises.
Several attempts have been made in this
country at teaching and practicing in the
schools this branch of hygiene. One in-
stance in particular is worthy of note. The
results of treatment in a children's home
were, according to the superintendent’s
report, a marked decrease in contagion,
with a consequent financial saving to the
institution. Dental inspection has been
introduced into the public schools of
Brookline, and Prof. William H. Potter, of
the Harvard Dental School, reported on
the results of this work in the Boston Medi-
cal and Surgical Journal (December 13,
1906). The teachers of the Dental De-
partment of Harvard University are urging
the public school officials of Boston to in-
troduce dental inspection and the study of
oral hygiene into the school system.
The united testimony of high authorities
on this subject is strong. Dr. George V. I.
Brown says: “If the mouths of the children
in our public schools could be systemati-
cally examined, . . . the death-rate of this
country would be very materially lessened,
the percentage of illness much reduced,
and a stronger and more vigorous race
result.”
According to the London Lancet (Octo-
ber 21, 1902), Professor Osler's words are:
“If I were asked to say whether more
physical deterioration was produced by
alcohol or by defective teeth, I should un-
hesitatingly say defective teeth.”
The city of Strassburg, in Germany,
affords a striking example of systematic
compulsory education in the care of the
mouth and teeth. The third annual re-
port of the work declares: “Since the in-
troduction of the treatment there is a
marked improvement in the general health
of the public school children, and there are
1ess headache, earache, and stomach
troubles.” It is almost unnecessary to add
that pain from dental origin has been
practically controlled.








42
S C H O O L H YG I E N E
WHAT DO HISTORIES OF.CASES OF
INSANITY TEACH US CONCERN-
ING PREVENTIVE MENTAL HY-
GIENE DURING THE YEARS OF
SCHOOL LIFE 2
DR. ADOLPH MAYER,
Director of the Pathological Institute of the New York State
Hospitals, and Professor of Psychopathology, Cornell
University Medical School.
(Abstract from The Psychological Clinic, Vol. II, 4.)
MENTAL hygiene has made decided
strides in our schools during the last dec-
ade. To be sure, the work so far accom-
plished has had little bearing on the
psychological problem of adult mental
efficiency. It has very properly occupied
itself first with those impediments which
Imust be removed to make teaching itself
possible, i. e., the correction of disorders
of vision and hearing, the avoidance of
Over-fatigue and other causes of wear and
distraction, the regulation of sedentary
work and play, the maintenance of general
health and nutrition, not to mention the
problem of faulty ventilation which so
often spoils the clearheadedness of a pupil.
In the main, chief attention has been paid
to the physical machine, while no adequate
provision has been made for its proper
direction and control. As a result many
will stumble and perhaps fall at the critical
period of individual development, when
most of the concrete difficulties of mental
life arise, such as the direction and balanc-
ing of instincts, the shaping of convictions,
and the adaptation of one's capacity to the
many possibilities and impossibilities pre-
senting themselves in real life. Here is
evidently another problem of which we are
forced to take cognizance, the attainment
of mental balance. The study of those
pronounced mental disorders of adoles-
cence and adult life, which appear to be
the magnified results of fate and poor hy-
giene, should teach us much that will
incidentally add to the efficiency and
happiness of those who are not so seriously
involved or threatened.
To what extent these more remote issues
of mental hygiene can become a matter of
concern in the school years is a question
worth consideration. It seems to me that
a knowledge of modes of miscarriage is best
fitted to show us the weak spots of our
mental mechanisms. None of our organs
are perfect. We can only ask that they
be fairly efficient. And in this respect our
mental organ is no exception. It is the
finest product and the very climax of our
evolution, but much attention and path,
culture are needed to enable it to cope
the difficulties of ordinary existence. nº
mention those realms in which original
aggressive and productive activity,"."
conflicting passions and instincts are w t1.
to play an important rôle. It jº
every workman to discover the weakne.
and 1ímitations of the tools on which
must rely, and the first step towar
mental hygiene is an adequate knowle.
of the weaknesses and limitations of
individual mind, and of the places at wi
we do well to provide for braces and
ancing material. .
To understand the significance of .
appeal for mental hygiene from the psyc
logical side, it must be borne in mind ti
psychopathology is beginning to assig.
definite rôle, not only to the growth, nut.
tion and possibly extraneous diseases
the brain, but also to those brain coſ;
tions which we know and use only
mental states and mental activities in
sense of a dynamic psychology. We
beginning to consider as legitimate mateſ
of science what common sense has taug.
us and the teacher has long used in prº
tice. We want to know the effect of Cº
tain activities and reactions on subsequt
life, and also whether by modifying ment
attitudes and habits we may not be able
avert trouble in the future.
The most serious affections which fill O.
hospitals for the insane are due to thº
difficulties of instinctive and emotioſ
adaptation which form both theoretica.
and numerically the most important typic
of psycho-biological problems. We mafi
admit that approximately 1o per cent ºf
the admissions to hospitals for the insaſ I
suffer from general paralysis or pares'.
and about 20 per cent from alcol
psychosis, that is to say, from disordºſe.
with a plainly bacterial or toxic noſ i
mental factor as the exciting link – to ºn
sure also based primarily upon a deviatiº
of instincts, but rather upon an excessºr:
what is considered sane enough to tº
tolerated as a mere social evil, name}
alcoholism and irresponsible sexual relº
tions entailing risk of venereal infection
But at least 30 per cent of the admission;
seem to make up a group of disorders'
the more personal instinctive adjus:
ments involving a miscarriage of instinct
through lack of balance, — dementia pſ.
cox." This type of mental disorder §
peculiarly 1iable to lead to permaneſ'
* A precocious or early dementia in contradistinction"
the dementia of senility.


















S C H O O L H Y G I E N E 43
e, and is one in which the so-called
genic factors are especially promi-
To be sure, even this group of psy-
is referred by many to auto-intoxi-
s and to other hypothetical assump-
while the simple laws of disturbance
the proper activity and anabolism and
itabbiism of the nervous system would
ºve dequate explanation. Certainly the
r of those is increasing who agree
e that the bulk of the manifesta-
subsumed under the caption of de-
a precox may be most practically
sed as the inevitable and natural de-
ment from a deterioration of habits,
due to developmental defects of the
1 endowment, but in part at least to
shing of instincts and to progressively
modes of meeting difficulties, and
sability of a proper balance of anab-
and catabolism which they entail:
king over the records of sufficiently
judied cases, I find that the children who
ter developed abnormal reactions of the
of dementia precox were peculiar
than defective in the sense which
ve in mind when speaking of those
re backward or retarded. Further-
I find that as a rule we are concerned
with aggressive mischief (which is
apt to lead to the truant school and
cial delinquency) than with repres-
and with what is at times charac-
d as “depth of thought.” The
en affected are the very ones whom a
r generation might have looked upon
; model children.
On looking over the number of records
“find the following remarks about several
Atients during their years at School:
L.M. was giddy and backward in School,
ºcessively timid and bashful.
N. B. was very quiet, sleepy; of ineffi-
ent mentality; seclusive, shy, retiring.
| M. O’N, was bright; later was discon-
ned and shiftless.
L.L. said, “I seemed awfully stupid and
reamy.” Although diligent, she failed
ºf promotion.
S. learned slowly and was seclusive.
other very frequent type is the one
Irnished by the so-called “nervous child,”
#Sily startled and subject to bad dreams.
... I wish to be clearly understood here.
... Yery sane human instinct forbids
orrowing trouble. We realize that there
many children who show the traits
ioned, and possibly we know that
of our friends manifested traits like
*Clºsiveness, occasional day-dreaming,
discrepancies between thought and
|S
lſ
action. It must be admitted that these
traits alone are not sufficient indications
of inevitable failure. On the other hand,
we insist that those who can take and heed
a warning will be saved from danger by a
timely recognition of what risks there are.
A knowledge of the mode of development
of Some of the graver mental disorders
must help us to discriminate those traits
of character that should serve as warnings
to be heeded. We can then understand
that a pedagogy with a knowledge of the
principles may achieve what the ordinary
pedagogy has failed to accomplish as yet.
This achievement will come less as the
result of attempts at eradication than
through the more rational method of
furnishing such timely protection and
balancing material as will make dangerous
tendencies harmless.
A consideration of carefully studied cases
of dementia precox convinces me that in
reality we have to do with a perfectly
natural though perhaps unusually persis-
tent development of tendencies difficult to
balance. Evolution's method of trial and
rejection will lead some children into a
reading craze, others into mere day-dream-
ing of an apparently indifferent, though
often fantastic kind, and still others into
sexual imagination. All these tendencies
are common traits of adolescence, usually
offset in one way or another by the more
matural and sociable children. The cor-
rection comes from more powerful attrac-
tions exercised in an opposing direction by
better instincts; or the consequences of
the failure to meet the requirements of
actual life may call for a halt. Here the
very habits of the patient, the loss of sense
for the real, and the abnormal satisfaction
in mere dreaming and good resolutions,
encourage a mere dodging of the conse-
quences rather than the giving up of the
harmful instincts. There develops an
insidious tendency to substitute for an
efficient way of meeting the difficulties a
superficial moralizing and self-deception,
and an uncanny tendency to drift into so
many varieties of shallow mysticism and
metaphysical ponderings, or into fantastic
ideas which cannot possibly be put to the
test of action. All this is at the expense
of really fruitful activity, which tends to
appear as insignificant to the patient in
comparison with what he regards as far
1oftier achievements. Thus there is de-
veloped an ever-widening cleavage between
mere thought-life and the life of actual
application such as would bring with it
the corrections found in concrete experi-















44
S C H O O L H Y G I E N E
ence. Then, under some strain which a
normal person would be prepared for, a
sufficiently weakened and sensitive indi-
vidual will react with manifestations which
constitute the mental disorders constitut-
ing the “deterioration process '' or demen-
tia precox. Unfinished or chronically
sub-efficient action, a life lived apart from
the wholesome influence of companionship
and concrete test, and finally a progressive
incongruity in meeting the inevitably
complex demands of the higher instincts, –
this is practically the formula of the deteri-
oration process.
It is interesting to watch nature's way
of coping with these incongruities of de-
velopment. Very often the traits which
we are analyzing appear in pupils of
relatively good endowment. The result
is then, often enough, merely a so-called
nervous prostration, a temporary break-
down, or a mere slump in which the
patient goes through a period of relative
inactivity during which he gets a chance
to find himself and to emerge gradually
from the ill-adjustment, but unfortunately
too often with broken ambitions, a disap-
pointment to himself, his friends, and his
teachers. These cases show us nature's
plan: she uses a period of invalidism which
furnishes temporary protection against the
harsher demands that would have to be
met in an environment of normally healthy
persons, and affords opportunities for a
gentle acquisition of balancing material.
It is our duty toward those of less fortunate
assets to provide a more timely and more
rational reduction of the demands made
upon them, and to supply them with the
balancing material which will rescue at
1east a certain number of them who would
otherwise completely fail.
To those who think that it is scarcely
worth while to trouble ourselves over the
few who would fall by the wayside anyhow,
I can address no stronger plea than to
urge that what often leads to complete
breakdown in some will partly spoil the
life of others, or at 1east seriously interfere
with their success. What appears as
though seen through a magnifying glass
in the serious deteriorations is met with
on a smaller scale as frequent impediments.
Consequently, any increase in our knowl-
edge is bound to help us to formulate the
best possible hygiene of conduct even for
the normal. It will make us realize that
the ordinary principles of work and rest,
of exercise and its influence upon our
readiness to meet the ordinary demands of
1ife, must also be applied to the more
personal issues of our life, where w
concerned with the training of charm
and with the storing up of energy nd
which to meet the inevitable conflif
both the individual and the sociator
stincts of a more complex nature. -
this sense that I have lately spoken q C.
solidarity of mental hygiene and eſot
conceptions. 1 &
I cannot expect to do more than in 9t
very briefly some of the methods of
ing the type of conditions herein re: -
to. S
The problem is first presented in taºit
form where we follow the developmeq
habits, the mutual reinforcing of inhil
influences upon one another, and
compatibility and incompatibility.
there feel the need of principles W.
would guide us in measuring the caſ:
of a child to acquire and balance:
habits. The study of defectives and
ures brings home to us more forciº
fundamental fact of economics,
certain persons are adequately end
for small demands, but are bound tº
under an excessive demand. There w
be far more happiness and real succes
mental hygiene if more people would
ize that at every step every person can
something well, and take a satisfacticſ
doing it, and that this satisfaction
something done is to be valued as tent
greater than the satisfaction taken in m
thought or imagination, however lofty,
Most failures in life are persons w
withdraw from straightforward and wiſ
some activity into seclusion, into flights
imagination, or so-called “deep-though
all of which tends to make ordinary
crete activity appear as shabby and
ferior. To find pleasure in mere activi
however humble, is a safer ideal and (
stitutes to my mind the basis of what
sometimes called the Anglo-Saxon
periority. It must be remembered t
thought at its best is only a link in a ch:
of events leading up to some final achiº
ment. Its real and lasting fulfillment
found only in action.
The study of imbecility teaches ust
if the defective only finds his level theſ t
no danger of further complication, h
where nature is not kind enough to tá
away the temptations and ambitions
well as the capability for a succes
adjustment, we find often enough t
imbecility is superseded by demeſ
precox. Here we must apply natuſ
principle of protection. We must
the proper level for the child, and ſo




































S C H O O L H Y G I E N E 45
at 1east withdraw it from unhappy
timely comparison, from the strain
sappointment, from inactivity and
poorly balanced flights of imagina-
B of my most urgent suggestions
be to take seriously every falling off
ciency of the pupil, and to consider
ly the nutrition and the condition
b eyes and the possible existence of
jids, but also the more intimate needs
—direction. It would be well to sub-
o the school physicians many of the
sts that are made for relief from
es. Headaches are an excellent ba-
ter of practical mental hygiene;
ven where physical causes are found and
emoved, headaches in children are almost
lways an evidence of blundering by the
hild, by the parents, or by the school.
| To sum up, I would urge that we spread
mong teachers and pupils a realization
e fact that, knowledge must be a
ledge ready for doing things. Even
ltivating the instincts of play and
sure we must aim to make as attractive
i possible those games and diversions
high require decision and action and
ry with them a prompt demand for
Ection of mistakes and reward for
£vement: actual play with others and
5thers, and not the play of mere ru-
ation. We further must aim to find
ls of activity with moderate demands
well within the limitations of even the
brilliant or less vigorous children, and
giving full enough satisfaction to re-
main attractive and truly stimulating.
It is lamentable to hear youngsters,
ºncºuraged by their elders, refuse to do
ertain things because they already know
to do them. When doing things
mes less attractive than knowing
§S, an avenue for disappointment if
for failure has been opened before the
il. It is evidently the plain duty of
hose who have to map out curricula and
hºse who have to advise as to the life of
hildren who are in danger, to see that the
loing 9f things is made infinitely more
*tractive than is usually the case. I do
10t. See why. the success of efforts directed
QYards this object should not appear
more glorious than, or at least as glorious
is the devising of some new plan of cram-
ºg the pupil with the subjects of a con-
entional curriculum. Thus it is that
ugh training in wholesome action as
1 as in physical culture a real hygiene is
ing its Way into the schools.
It would probably be wrong, and cer-
tainly Utopian, to expect that Schools
should create special classes for every
special emergency. I rather look forward
to the establishment of school hospitals, or
hospital schools, which will undertake at
the proper time the investigation of special
difficulties presented by certain cases, and
provide for the training of the child and
the parents. At the same time a more
careful study of 1evels of capacity and of
ways of making the easier1evels sufficiently
attractive and full of meaning, may well
become a matter of serious coöperation
between the pedagogue and the psycho-
pathologist.
LESSONS FROM A QUARTER CEN-
TURY OF LEGAL REQUIREMENT
OF THE TEACHING OF HYGIENE.
HELEN C. PUTNAM, PROVIDENCE.
Bulletin of the American Academy of Medicine,
une, 1908.
MEDICAL inspection of schools instructs
indirectly but forcefully by drawing atten-
tion of pupils, parents, and the public to
care of the person, general health, and de-
velopment; to school furnishings, lighting,
ventilation, and playgrounds; but instructs
most efficiently when school nurses are
employed. It means much in two of Our
largest cities, where from fifty to eighty
thoroughly trained nurses not only attend
to minor ailments at the schools, but daily
radiate therefrom into homes, showing
mothers details of cleaning, feeding, cloth-
ing children and of caring for the premises.
The immediate result observed is that
pupils sent from school by the physician
return sooner and in better condition, and
that many otherwise unknown wrongs to
childhood are reported to proper authori-
ties for correction.
MOTHERS’ OR PARENTs’ CLUBS.
A valuable supplement to medical in-
spection, sometimes instituted by citizens
coöperating with teachers, is mothers’
clubs (or “parents” including fathers).
Social devices invite attendance, and the
opportunity is seized to discuss under dis-
creet leadership various parental problems:
clothing, food, amount of sleep, care of
teeth; recreations, children’s reading, and
instruction concerning sex and morality;
temperance and cigarettes, communicable
diseases. School physicians or others occa-
sionally give talks to children or illustrated
evening lectures at the schoolhouses to the
general public.




















46 S C H O O L H Y G I E N E
THE SCHOOLROOM AS A FACTOR IN
TUBERCULOSIS.
BY PROF. W.M. OLD RIGHT,
Professor of Hygiene in the University of Toronto.
(From the Transactions of the International Congress
of School Hygiene, London, 1907.)
TUBERCULOSIS is undoubtedly prevalent
among School-teachers. In Canada, in
I881 and 1883, an analysis of the returns
showed that teaching was one of the occu-
pations most frequently attacked. Late
figures from the United States census are
significant.
The ratio of deaths from consumption
in I, ooo deaths:
Of all males engaged in all occupa-
tions was . . . . . . . . . . . . . . . . . . . . . . I54
Of all male teachers. . . . . . . . . . . . . . I84
Of all females engaged in all occupa-
tions . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 5
Of all female teachers. . . . . . . . . . . . . 256
The causes are to be found in foul air and
possibly chalk dust. The remedy is
obvious.
THE AMERICAN SCHOOL HYGIENE
ASSOCIATION.
(A) EXTRACTS FROM THE CONSTITUTION.
ARTICLE II.
The Objects of this association shall be:
(a) To stimulate research and to pro-
mote discussion of the problems of school
hygiene.
(b) To take an active part in movements
wisely aiming to improve the hygienic con-
ditions surrounding children during school
1ife.
ARTICLE X.
The council shall be empowered to
publish its proceedings in a volume or
journal, together with special reports,
bibliographies, and articles that may aid
in the objects of this association.
ARTICLE XIV.
Any person may become an active mem-
ber of this association upon recommenda-
tion of two members, election by the coun-
cil, and the payment of one year's dues.
ARTICLE XVI.
The association shall hold an annual
meeting and . . .
ARTICLE XIX.
Funds shall be raised by annual dil
three dollars from each active mel
and in such manner as shall be approv
the council. -
RESOLUTIONS ADOPTED AT THE FI
MEETING.
Whereas, The maintenance and devi
ment of the health and vigor of s
children is a matter of paramount in
tance, and
Whereas, Experience in all great
has shown the importance of health in
tion; be it .
Resolved, That in every city and
adequate provision should be made
for sanitary inspection of schools and
medical inspection, the latter to in
not only inspection for contagious distă
but also of eyes, ears, teeth, throat,
nose, and of general physical condi
Whereas, The improvement in the hº
and of the hygienic conditions surround
schoolchildren depends largely upon
intelligent coöperation, the competeſ
the interest, and the faithfulness
teachers and principals in matters of
gienic importance; therefore, be it
Resolved, That all schools haſ
courses for the training of teachers sh
give instruction in
(a) Personal and school hygiene,
(b) The principles and practice of phy
cal training, and that each of these subj
should be given as much time as the má
subjects in the course. -
Resolved, That examinations for licem:
to teach should include questions uſ
these subjects, and that the answers'
such questions should be given eſſ
weight with the answers to the questſ
upon any other subject.
(B) PUBLICATION.
A monthly journal called Sch
Hygiene is issued ten months in each yeº
This journal is free to members of t
association. Subscription price to other
one year, to begin with June, 1908,
cents a year. Dr. George S. C. Badg
Editor, 48 Hereford Street, Boston, Ma
THOS. A. STOREY, M.D., Secretary,
College of the City of New York.
New York City

















S C H O O L H Y G I E N E
47
OURNAL OF EDUCATION
EDITED BY A. E. WINSHIP
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The Danger of Dust in Schoolroon
How It Can be Reduced Nearly One Hundred Per Cent
UST Danger is a real — not a theoret-
ical — menace. Scientific research
has proved that dust is the greatest
D
carrier and distributer of disease germs
known.
It is ever present and ever active
—it threatens mankind everywhere — in
offices, stores, schools, corridors, and in
nearly every public building.
The Dust problem in schoolrooms is
one that should have the serious considera-
tion of every Board of Education, every
Superintendent of Schools, every Principal,
every Teacher. The elimination of dust is
a duty that must appeal with peculiar force
to those charged with the responsibility of
caring for the health of pupils.
HOW DUST SPREADS DISEASE
Disease germs multiply with exceeding
rapidity. A single germ falling on fertile
soil will, in an incredibly short space of
time, generate millions upon millions of its
kind. These micro-organisms are found
by the million in dust, so that every current
of air causes the dust to be set in circula-
tion, and with it the countless myriads of
living germs that are such a menace to
health.
The remedy for the elimination of dust
is not sweeping and dusting, for such ex-
pedients merely start the germs afresh on
their aerial errand of warfare against
mankind.
THE TRUE REMEDY
The most effective method of dust pre-
vention is that of treating all wooden floors
with a suitable dressing.
Standard Floor Dressing is the
remedy for the elimination of dust .
has been tested by Physicians and Ei
tional Boards with the most grati
results, and reports show that it red
the percentage of floating dust near,
/...undred per cent. It is being used
remarkable success in thousands of pº
for counteracting the dust evil. H. J.
year the number of permanent uses E.
creases, and in all cases results are
tremely satisfying. The action is nº "
mechanical. The application of a J.
coat is sufficient to keep the floor at ,
the right degree of moisture to catch:
hold all dust and dirt. T
Standard Floor Dressing should be J.
plied to floors about three or four ti "
a year to get the best results; meanwi. R.
the floors should be thoroughly cared
so that with each sweeping the surfac
left perfectly clean. W
Floors treated with Standard F. C.
Dressing present a splendid appearai 6.
The dressing acts as a preservative
prevents the boards from splintering "
cracking. The dressing does not eV. J.
orate, and by reducing the labor of cai -
for the floors saves its cost many times OV
Standard Foor /Yessing is not intell
for /iouse/ho/d use.
We are making a remarkable of
applying to schools, public building
stores and offices. Our offer is this
we will, free of a// cost, treat one sch.
room or corridor floor, or part of a
floor with Standard Floor Dressing,
to prove our claims. -
Upon request full par-
ticulars may be had regard-
ing such demonstrations,
and complete information,
testimonials and opinions
of the medical fraternity on
Standard Floor Dressing
will be supplied gratis.
Our little book, “Dust and
its Dangers,” explains the
subject fully. Any one
may have a copy by merely asking for
STANDARD OIL COMPANY
(Incorporated)
H.
|




tº Hal Lººſ,
Uſº (ºf Rºck's
B ,25 1909
5cboot illwgiene
ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
BOSTON, MASS.
NOVEMBER, 1908
A. BERGströM, Ph.D., Professor of Education,
eland Stanford Jr. University.
ER E. B.Rown, Ph.D., United States Commissioner
bf Education.
WILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gºgics, Clark University.
John J. C.Ronin, M.D., Assistant Chief Medical Inspector
- ealth Department, New York City.
| ABRAHAM Jacobi, M.D., LL.D., Professor of Diseases of
| Children, New York City.
}MAs M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
ew York University.
; : Joseph LEE, A.B., A.M., LL.B., Boston.
in PHILIP KING BRow N, A.B., M.D., Medical Department,
Iniversity of California.
BERT W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
- etts School for Feeble-Minded.
| CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
George H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
J. H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
H. McCURDy, M.D.. Director International Young
Men's Christian Association Training School.
(Ibe (Wfficers amo Council of the Big50ciation
orary President, Hon. Theodore Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. C.A.Bot; Secretary and Treasurer, Dr. THOMAS A. StoREY.
CHARLEs A. MooRE, Chairman Welfare Department,
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. Storrow, Chairman of Boston School Board.
EDw ARD LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE. S. ANDREws, Esq., New York City.
NICHOLAS MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABOT, M.D., Fellow of Harvard University.
FREDERICK FORCHHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. FischEL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULIck, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart-
ment of Physical Training and Athletics, University of
Missouri.
GEORGE MEYLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. StoREY, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
EORGE S. C. BADGER, M. D., Editor .
. C. HEATH AND CoMPANY, Publishers
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
| communications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIAL
ROCEEDINGS OF THE SECOND
INTERNATIONAL CONGRESS OF
SCHOOL HYGIENE.
THE three bulky volumes which contain
full the proceedings of the London Con-
| ºfess of 1907 have just been distributed,
d are being scanned with interest by
American subscribers. This interest is
nºt due to the American contributions,
fºr of the 1,008 pages of proceedings, the
Pºpers by American writers Occupy Only 30.
This report presents the most complete
conspectus available of the existing theory
and practice in the wide field which it
covers, and it will serve as a waymark in
all future discussions.
The impression received at the meeting
is confirmed by the reading that the gen-
eral addresses by the presiding officers,
both of the Congress and of the Sections,
served to give éclat to the meeting because
of the distinction of the speakers, rather
than for any valuable contribution to the
discussions.
A considerable number of papers only




























5O S C H O O L H Y G I E N E
record the personal opinions of the writers
and are of value only in proportion to the
experience back of them.
Several classes of papers have perma-
nent value:
I. Those which furnish the results of
investigations of health conditions in
schools or in neighborhoods. They serve
as a stimulus to smaller investigations
elsewhere, and offer standards of com-
parison.
2. Those which describe curative work
on special classes of defectives, as cripples
and blind and deaf children.
3. Those which describe general methods
in municipal oversight and control.
4. Those which treat of special diseases,
as diphtheria, Scarlet fever, measles, and
tuberculosis. Some of them are especially
illuminating.
5. Those which tell of the study of back-
ward children and the relation of physical
defects to the mental and moral character
of the subjects. The facts revealed by
these papers probably represent universal
conditions and ought to be widely repub-
1ished in this country.
Papers dealing with psychology, with
physical education, and with school build-
ings contain little that is new for American
School people. In the department of out-
Of-School hygiene, however, we have
much to 1earn, and it would do American
teachers and School authorities good to
read all the papers presented at the meet-
ing of this section.
The “Proceedings ’’ ought to be in the
libraries of all normal schools, medical
Societies, and boards of health.
MEDICAL INSPECTION
CAN CITIES.
(From “Medical Inspection of Schools,” by Dr. Luth
H. Gulick and Leonard P. Ayres, now in pº" 11t her
So far as diligent inquiry has been able
to ascertain, the first regular system of
medical inspection in the United States
seems to have been in Boston in 1894.
Before this, however, in New York City, in
1892, Dr. Cyrus Edson, then Sanitary
superintendent, appointed Dr. Moreau
Morse medical inspector of schools. Dr.
IN AMERI-
visions.
Morse was probably the first public m
cal school officer appointed in this count of
Since its first inception in Boston t
movement for medical inspection has 1. M
idly spread in the United States, and
many states has developed from m
inspection for the detection of contagº
diseases to systems embracing most tº
ough physical examinations.
Four state 1aws have been passed.
1899 the legislature of Connecticut pass
a law providing for the testing of eyes;
in all the public schools of the state. Uni
this 1aw the State Board of Education B
required to furnish test-cards and blank B.
and instructions for their use, to the scº C.
authorities. The superintendent, print C.
pal, or teacher in every school is requit C
to test the eyesight of all the pupils duri C.
the fall term, and notify in writing tº D
parent or guardian of every pupil whol. D
any defect of vision, with a brief statemſ D
of each defect. D
New Jersey has a statute which wºn E
into effect in 1903. It authorizes boat E
of education to employ competent phys E.
cians as medical inspectors of schools. F.
also defines the duties of the medical in Fl
spector. The law is permissive and nº G
mandatory in its provisions.
Vermont followed, in 1904, with a la H
requiring the examination of the eye. H
ears, and throats of school children ann
ally.
In 1906 the legislature of Massachuset. H
passed a law providing for a system
medical inspection throughout the stall
According to its provisions, every towl.
and city must establish and maintain ||
system of medical inspection, with comp
tent physicians, for the detection of CO
tagious diseases. Examinations are coſ
ducted annually by the physicians for th
detection of non-contagious physical di
fects, and eyesight and hearing tests aſ
made each year by the teachers. The law
is mandatory, not permissive, in its pro
Without authoritative and specif
enactment, the state boards of health 0.
New York, Utah, and California have con
ducted examinations of the eyesight an
hearing of school children. -
At the present time, 1908, there are iſ
Operation, so far as can be ascertained
Systems of medical inspection in some form
in the following seventy-one cities outsid:
of Massachusetts. (As in this state medi
cal inspection is obligatory under the Statº
law, systems exist in practically ever,
city.)







S C H O O L H Y G I E N E 5 I
The work in Massachusetts includes 32 begun the work in 22 cities and 47 towns,
it cities and 321 towns. At the beginning of and boards of education in 19 cities. No
he present year it was reported from reports were received from the remaining
Massachusetts that boards of health had towns.
m. CITIES OF THE UNITED STATEs, OUTSIDE OF MAss ACHUSETTS, HAVING SOME FORM OF
- MEDICAL INSPECTION OF SCHOOLS, JUNE, 1908.
State. Controlling Authority.
Albany. . . . . . . . . . . . . New York. . . . . . . . . . . . Albany County Medical Society
Sº Ann Arbor. . . . . . . . . Michigan. . . . . . . . . . . . . Board of Education
| Asbury Park. . . . . . . . New Jersey. . . . . . . . . . Board of Education
Atlantic City. . . . . . . New Jersey. . . . . . . . . . Board of Education
º timore . . . . . . . . . . Maryland. . . . . . . . . . . . Board of Health
nk Buffalo. . . . . . . . . . . . . New York. . . . . . . . . . . Board of Health
Camden. . . . . . . . . . . . New Jersey. . . . . . . . . . Board of Education
| Chicago. . . . . . . . . . . . Illinois. . . . . . . . . . . . . . Board of Health
in Cincinnati. . . . . . . . . . Ohio. . . . . . . . . . . . . . . . Board of Health
iſ Cleveland . . . . . . . . . . Ohio. . . . . . . . . . . . . . . . Board of Health
tº Dallas. . . . . . . . . . . . . Texas. . . . . . . . . . . . . . . Board of Education
h: Dayton . . . . . . . . . . . . Ohio. . . . . . . . . . . . . . . . Montgomery County Medical Society
Detroit. . . . . . . . . . . . . Michigan. . . . . . . . . . . . . Board of Health
Des Moines. . . . . . . . . Iowa. . . . . . . . . . . . . . . . Polk County Medical Association
tº Elgin. . . . . . . . . . . . . . Illinois. . . . . . . . . . . . . . Board of Health
r Englewood. . . . . . . . . New Jersey. . . . . . . . . . Board of Education
* Evansville. . . . . . . . . . Indiana. . . . . . . . . . . . . . Board of Education
rt Dodge . . . . . . . . . Iowa. . . . . ... . . . . . . . . . . Board of Health
|Fort Worth . . . . . . . . . Texas. . . . . . . . . . . . . . .
| Galveston. . . . . . . . . . Texas. . . . . . . . . . . . . . . Board of School Trustees
and Rapids. . . . . . . Michigan. . . . . . . . . . . . . Board of Education (nurses only)
at Hackensack. . . . . . . . New Jersey. . . . . . . . . . Board of Health
Harrisburg. . . . . . . . . Pennsylvania. . . . . . . . . Dr. C. S. Rebuck and Visiting Nurse Asso-
ciation
rtford. . . . . . . . . . . Connecticut. . . . . . . . . . Board of Health
azleton . . . . . . . . . . . Pennsylvania. . . . . . . . . Board of Education
Ouston . . . . . . . . . . . Texas. . . . . . . . . . . . . . . Houston Association of Optics and Aurists
rsey City. . . . . . . . . New Jersey. . . . . . . . . . Board of Education (nurses only)
nsing. . . . . . . . . . . . Michigan. . . . . . . . . . . . . Volunteer work
| Lincoln . . . . . . . . . . . . . Nebraska. . . . . . . . . . . .
Long Beach . . . . . . . . California. . . . . . . . . . . .
s Angeles. . . . . . . . California. . . . . . . . . . . . Boards of Education and Health
ilwaukee. . . . . . . . . . Wisconsin . . . . . . . . . . . . Milwaukee Medical Society
inneapolis. . . . . . . . . Minnesota. . . . . . . . . . . . Associated Charities and Women's Club
ontclair. . . . . . . . . . . New Jersey. . . . . . . . . . Board of Health
ount Holly. . . . . . . . New Jersey. . . . . . . . . .
ewark. . . . . . . . . . . . New Jersey. . . . . . . . . . Boards of Health and Education
ew Haven. . . . . . . . . Connecticut. . . . . . . . . . Board of Health
eWDOrt. . . . . . . . . . . Rhode Island. . . . . . . . . Board of Health
ew Orleans. . . . . . . . Louisiana. . . . . . . . . . . . Board of Education
ew York. . . . . . . . . . New York. . . . . . . . . . . Board of Health
Norristown. . . . . . . . . Pennsylvania. . . . . . . . .
golen. . . . . . . . . ‘. . . . Utah. . . . . . . . . . . . . . . .
ºrange. . . . . . . . . . . . . New Jersey. . . . . . . . . . Board of Education
Hasadena. . . . . . . . . . . California. . . . . . . . . . . . Board of Education
Passaic. . . . . . . . . . . . . New Jersey. . . . . . . . . . Board of Education
Paterson. . . . . . . . . . . New Jersey. . . . . . . . . . Board of Education
hiladelphia. . . . . . . . Pennsylvania. . . . . . . . . Board of Health
lainfield. . . . . . . . . . . New Jersey. . . . . . . . . . Board of Health
Ort Chester. . . . . . . . New York. . . . . . . . . . .
Ortland. . . . . . . . . . . Oregon. . . . . . . . . . . . . .
rovidence. . . . . . . . . Rhode Island. . . . . . . . . Board of Health



52 S C H O O L H Y G I E N E
City. State. Controlling Authority. .
Reading. . . . . . . . . . . . Pennsylvania. . . . . . . . . Volunteer work la
Rochester. . . . . . . . . . New York. . . . . . . . . . . Board of Health CC
Salt Lake City. . . . . . Utah . . . . . . . . . . . . . . . Board of Health ri
San Antonio. . . . . . . . Texas. . . . . . . . . . . . . . . Board of Education 11(
Schenectady. . . . . . . . New York. . . . . . . . - -
Seattle. . . . . . . . . . . . . Washington. . . . . . . . . . Board of Health re
Sioux City. . . . . . . . . . Iowa. . . . . . . . . . . . . . . . Volunteer work el
St. Joseph. . . . . . . . . . Missouri. . . . . . . . . . . . . at
St. Louis. . . . . . . . . . . Missouri. . . . . . . . . . . . . ch
Superior. . . . . . . . . . . . Wisconsin . . . . . . . . . . . . ci
Syracuse. . . . . . . . . . . New York. . . . . . . . . . . Board of Health D1
Union Hill. . . . . . . . . . New Jersey. . . . . . . . . . Board of Education th
Utica. . . . . . . . . . . . . . New York. . . . . . . . . . . Boards of Health and Education a1
Washington . . . . . . . . District of Columbia. . Board of Health
Waterbury. . . . . . . . . Connecticut. . . . . . . . . . Board of Health
Waverly . . . . . . . . . . . Rhode Island. . . . . . . . .
Westchester. . . . . . . . Pennsylvania. . . . . . . . .
White Plains. . . . . . . . New York. . . . . . . . . . . Board of Health
Wilmington. . . . . . . . . Delaware. . . . . . . . . . . . Board of Education
Woonsocket. . . . . . . . Rhode Island. . . . . . . . . Board of Education CC
- - 111
(From the British Medical journal, September 26, 1908.)
MR. Wy ATT, director of education for
Manchester, England, claims his city is
doing more for school children than any
other city in the United Kingdom.
There is a residential school for crippled
children, a sanatorium where instruction,
besides care and nursing, are brought to
the child in bed. There is a residential
school for epileptic children; a country
school at Mobberley, classes for stammer-
ing children, and for the blind and deaf.
The Education Committee spends $1 o, ooo
a year in providing free meals, and from
$15,000 to $20,000 per year in the provi-
sion of premises where the food can be
properly cooked.
Alluding to medical inspection, he
thought that its success depended to a
great degree upon the teachers, who would
have to coöperate with the doctors as
well as possible.
THE NEW SCHOOL HYGIENE.
GEO. W. VANDERGRIFT, NEW YORK.
(From the Medical Record, June 13, 1908.)
As a member of the New York Com-
mittee on the Physical Welfare of School
Children, the author has had exceptional
opportunities to study the various con-
ditions of school life as they affect the
physical well being of the children. He
says, “The conditions that tend to cause or
to aggravate physical defects fall naturally
into two groups – unhygienic conditions
at school and unhygienic conditions out of
school, particularly at home. To previº
as well as to cure physical defects, we mus
study these errors of school and H
environment and correct them.” t
The home conditions of 1,400 º
school children of New York City wº
investigated by the Committee on thin
Physical Welfare of School Children. Thb:
cases were taken from schools both w.
crowded tenement districts and in spaciosi
well-to-do localities. It was found this:
low incomes and congested districts do nin
monopolize physical defects. Only 8. S.
per cent of the cases reported belong a
families having an income of less thao
$1o per week; 59 per cent have more thap.
$15; 43 per cent have over $20; and a
per cent over $30 per week. D.
Of the 1,400 children, only 145 aſ a
reported for malnutrition. Though 5 st
per cent go without milk, cereal, meat, Ut.
eggs for breakfast, only 2.8 per cent repoſif
no meat or eggs during the day and Onlic
o.7 per cent claim to have nothing ſo
breakfast. a.
The housing conditions, especially amoſ: m
those of low incomes, were found to b \
highly unsanitary. While the hours fºr E
sleep were adequate, the sleeping room; g.
were hygienically impossible, compelliºt
the sleepers to breath a vitiated air. Th: \
following two facts were noted: tha o
children receive inadequate medical and s
dental care; while 74.9 per cent of thº
1,400 children examined had defectivº
teeth, only 27 per cent had ever consulteº
a dentist.
Conditions at school that cause ºſt
S C H O O L H Y G I E N E 53
aggravate physical defects are poor venti-
lation, crowded schoolrooms, too long
confinement, lack of playgrounds, a cur-
riculum directed to the chronological age,
not adapted to the physiological age.
ome and school conditions are being
remedied. The new school hygiene must
eliminate all unhygienic conditions, both
at home and in the schools. Parents,
children, school authorities, and physi-
s themselves — in other words, the
lic — must be educated to demand
the correction of all conditions unsanitary
and evil.
LETTER FROM MINNEAPOLIS.
N reply to a request for information
concerning medical inspection of schools
in Minneapolis, Mr. Eugene T. Lies,
eral secretary of the Associated Chari-
, writes as follows:
‘As to what Minneapolis is doing, I
ght say this: For two years or more
there has been agitation, largely on the part
tº of the Minneapolis Improvement League
tº and on the part of the Woman's Club, for
º improved methods of cleaning, abolition of
ter for school children. After con-
erable back talk on the part of the
hool Board, and considerable discussion
ſlin public meetings and in newspapers, the
#School Board, some six months ago, issued
a new code of rules governing cleaning
ldſ operations which are declared to be almost
fect. Another result of the general
itation was the closing up at least of a
tion of the basement schoolrooms and
arrangement with a local department
re for free water from its private ar-
ian well, the delivery being contracted
between the board and a teaming con-
ºn. All this led to the adoption, three
four months ago, by the School Board, of
a resolution calling for a commission of
iºdical men from the Hennepin County
* Medical Society to advise with the School
"Bºard about all questions of school hy-
*ślene. This commision was appointed by
* the Medical Society and has at its head, Dr.
W. A. Jones, one of the leading physicians
Minneapolis, and one of its public-
irited men, fearless and able. The
mmission is now preparing a compre-
insive report covering all phases of the
ject, the same to be presented to the
ard as early as possible. It is expected
at it will remain as a permanent body,
Il
sement schoolrooms, and pure drinking.
to be ready at all times to advise with the
School Board.
“For some time groups of people inter-
ested in school questions have been eager
to see established in Minneapolis a system
of medical inspection in the schools. In
Order to make a beginning, it seemed wise
to carry out an experiment, under private
auspices, in two of the schools. The
Associated Charities and the Woman’s
Club together carried on this work last
winter and spring. A corps of four
physicians of the best standing, three men
and one woman, did the work free of
charge. In all, 1,411 children were ex-
amined and accurate records were made
out. A visiting nurse was detailed on the
work in each school, being loaned ' by
the Associated Charities and paid by the
Woman's Club. The nurses aided the
doctors during the work of examination,
and then followed up defective children
into the homes, attempting to induce
parents to secure treatment for children
wherever necessary. In cases of financial
inability to provide their own physician,
the nurse arranged for treatment at the
University Dispensary.
“The figures are now being tabulated
and a report will soon be issued covering
all phases of the work. From what
already appears, it would seem that a
system of medical inspection is needed in
Minneapolis as well as in New York, Bos-
ton, Philadelphia, and other eastern cities,
where this work has been carried on for
some time.
“Just at the present time conferences
are being held between the City Health
Commissioner, Dr. P. M. Hall, and a com-
mittee consisting of Dr. W. A. Jones,
representing Hennepin County Medical
Society; Mrs. J. E. Bell, representing the
Woman's Club; and Mr. E. T. Lies, repre-
senting the Associated Charities, with a
view to formulating a plan for securing a
considerable appropriation of money for
medical inspection work in the schools
during the coming year, the same to be
carried on under city auspices. Out of
all the discussion, and as a result of the
experiment, Minneapolis will doubtless
have, before long, a complete system of
medical inspection and physical examina-
tion of school children. In many ways
our city is taking advanced steps along the
lines of preventive social efforts, and this
matter of medical inspection, while but
one, is a conspicuous example, represent-
ing as wide influence and as great power
for public welfare as any other.”














54 S C H O O L H YG I E N E
COOPERATION OF PARENTS AND
TEACHERS.
MRS. M. C. WILCOX.
(From Life and Health, October, 1908.)
It is a difficult task for a teacher to take
a poorly fed, poorly nourished child
through any grade of school in the same
time that a stong, well-nourished child
goes through, the standing of each being
equal at the beginning, and yet that is
just what is expected of teachers by many
unenlightened parents.
If parents expect teachers to crowd their
children on through the grades when their
physical and mental capacity is lessened
by their own careless habits regarding the
1aws of hygiene, they should be informed
that it will be at their own expense, or
rather at the expense of their child's health.
The 1atest methods of teaching make
heavy drafts upon the child's powers of
observation. The spirit of competition
also enters largely into every child,
whether fostered by the teacher or by
others. This also makes drafts upon his
strength, especially if he is an ambitious,
nervous child. It is of the highest impor-
tance, therefore, that the child shall enter
school in a normal state of health and that
this condition shall be maintained by
carefully observing all the laws of health
in the schoolroom and at home. This can
be accomplished only by coöperation of
parents and teachers.
(Extract from the fifth annual report of the Board of
Health of the Province of Quebec.)
How EVER regular the ventilation of the
class rooms may be, it does not obviate the
necessity of their thorough airing when the
pupils have been dismissed. The ventila-
tion which is effected during the presence
of the pupils amounts, in fact, only to a
constant dilution of the vitiated air, while
airing by the opening of the windows on
the two opposite sides of the room com-
pletely changes the air of the room.
In default of ventilation, the 1east that
can be done to 1essen to some slight extent
the evils of the present situation would
be to adopt the rule 1aid down for the
Schools of Dresden, Germany. At the end
of each hour of Occupation the class rooms
are emptied for some minutes (five to ten)
and during this time the windows are
thrown wide open. Class is then resumed
with a completely renewed atmosphere.
The teachers in the Dresden schools bear
testimony to the good results of this prac-
tice. The pupils do more work and atti tº
close of the day display much less lassitui h.
than formerly. D:
to
ExAMINATION OF ONE HUNDRI,
EYE CASES IN THE DED HAM fo
PUBLIC SCHOOLS.
RALPH WALDO PLACE, M.D., in
Former Senior Surgeon, Eye Department, Boston Dispento
sary, Boston. II]
(From the Boston Medical and Surgical Journal, Augu by
13, 1908.) A.
MANY parents refusing to have theia.
children's eyes, examined and glass.
properly fitted when necessary, the Scho
Committee of Dedham, Mass., decided t
take the matter in hand. N
Notwithstanding the fact that thº
teachers had tested the vision in thes
cases, as required by law, and found it ſay
from normal, that several were cross-eyed
and that notices had been sent to thº
parents, nothing had been done for them
although many were from eight to twelv
years of age.
Some parents were unable to buy glasses
Others seemed indifferent whether thei
children had them or not, one even tellin
her little girl she could go blind before sh
would get them for her. The childrei
were examined in each schoolhouse, .
darkened room being found in the base
ment. Homatropine was used in all hy
permetropic cases, and an examinatioſ
with the retinoscope and ophthalmoscop
given to all. Careful notes were made icº
each case. Only those having considerſe
able refractive error were fitted to glasses aſ
Many of these had large amounts of simplish
and compound hypermetropic astigmaq
tism. Eyes of this kind should havi
glasses for constant use as early as p0SA
sible, so they may not become hopelessly
amblyopic. A few had high myopia whics:
needed correction to stop its progress, in
Three far-sighted children had beed
fitted to near-sighted glasses by optician.
Of course these only aggravated the E
trouble. et
One cannot help being impressed by th
valuable work teachers are doing in testinct
the acuity of vision. In the 1arge majoritwº
of instances they are able to detect SubG.
normal sight, but some must be tested bot
an oculist in Order to discover 1atent errorisy
Young children with two, three, and eve
four diopters of far-sight can sometime ch
read the usual amount at a distance, anºsa
these must be watched for inability to reaſin







S C H O O L H Y GI E N E - 55
ir books for any length of time without
ing the vision blur or eyes ache. These
ients especially have nervous symp-
is greatly relieved by wearing glasses.
he School Committee made an appro-
priation for the oculist. Measurements
for the frames were taken at the time of
testing and the glasses delivered through
the headmaster in each school, he collect-
in the money for them. Those unable
to pay were given glasses and the com-
mittee paid, the money being contributed
by charitably disposed Dedham people.
As a large number of glasses were furnished
iat one time, they were obtained at a
‘special rate.
º SUMMARY.
Number examined, II 3
|Number wearing properly fitted
s glasses, 2 I
|Number wearing glasses which failed
| to correct defects, I 6
|Number recommended to wear
n glasses, 47
|Number not needing glasses, 29
| FOREIGN PLAYGROUNDS.
Eou IPMENT IN LEADING AMERICAN CITIES
BEST IN THE WORLD, BUT GERMANY
AHEAD IN OTHER RESPECTs.
om the Boston Saturday Evening Transcript, October
Io, 1908.) -
FREDERICK GREELEY, president of the
hicago Playground Association, has just
mpleted his investigation of the muni-
|cipal playgrounds of London, and will, in a
few days, leave for Paris. The Chicago-
jah's visit to London is part of a special mis-
n which he has undertaken, at the re-
test of Mayor Busse, for the purpose of
scovering what Europe has to teach
merica in the way of play centers.
"No matter where I go,” Mr. Greeley
id in London, “I found a lively interest
in What we had done and what we hope to
º in the future.
"In one respect we are far ahead of our
|ºtropean fellow laborers in the field. The
ºuipment, not only in Chicago, of which
|ºnow the most, but of the other leading
ºries, like New York, is the best in the
Wºrld. But there our superiority ends.
ºrmany is ahead of us in almost every
er respect. Their organization and
- stem are wonderful.
|. For instance, the daily play time of the
ºildren, which is compulsory just the
ºne as attendance at school, is scheduled
ſºm start to finish. The children are
|
divided into classes of twenty or thirty,
and over each is placed two or three in-
structors. These instructors are experts
and devote their spare time from their
regular pursuits to the instruction of the
children, receiving, perhaps, fifty cents an
hour. Under their experienced super-
vision there is no overdoing of any par-
ticular feature of the various items.
“Frequently the exercises in the play
centers are varied by walking tours in the
country, sometimes extending over several
days. The children are led by one of
their older members, called a pioneer, and
he carries a map of the roads and plans the
entire tour. They carry their own rations
with them and prepare them by the way-
side whenever possible. One far-reaching
result of this training of the children is
that when the boys leave school they are
ready to step right into the army ranks,
proficient in everything but the technic
of war.
“One of the most interesting experiences
of my whole trip was an excursion up the
Elbe from Dresden with about twelve
hundred school children. I had an ex-
cellent chance of seeing the effect of the
German system upon the physical side of
the child, and it proved an eye-opener for
me. Among those thousand and more
children I was able to find only two who
wore glasses, and the great majority of
them were fine, healthy-looking yougsters,
large and strong beyond their years.
“England is progressive in its provisions
for children, but it still is behind the
United States. For instance, at Battersea
and Hampstead I found some fine play-
grounds, but in the congested parts of the
city, where such open spaces are a matter
almost of life and death to the 1ittle chil-
dren, they are conspicuous by their ab-
sence. The result was that I found the
London children undersized and sickly
and immeasurably inferior to the German.
“One feature of English municipal ac-
tivity is the public swimming baths which
are to be found everywhere in London.
Another is the public laundries, where
the poor may take their week's clothes,
and have the use of hot water, tubs, and
mangling boards.
“ In Paris I discovered that, although
they had many fine Open spaces and parks,
there was practically no organized attempt
to provide play centers for the children or
to attract the little ones to the parks.
“My trip has taught me that what we
need in the United States is a better organi-
zation and more system.”











Abate the Dust Evil
It has been proven beyond a shadow of doubt that many diseases of
school children can be traced directly to the dusty condition of schoolroom
floors. Dust carries the germs of disease. The constant changes of classes and
the ever moving feet of the pupils cause the dust to rise from the floor and cir-
culate through the air. Proper ventilation aids materially in getting rid of dust,
but so long as the floors remain dry and untreated the danger will still exist.
Hygienic conditions and dustless schoolroom floors can be had at small
cost. By treating floors three or four times a year with
STANDARD
FLOOR DRESSING
dust can be practically eliminated. Experience proves that Standard Floor
Dressing reduces dust over eleven- twelfths; so that with dust abated and the
atmosphere cleansed the chances for contracting disease are reduced propor-
tionately.
Standard Floor Dressing not only makes sanitary schoolrooms, but also
preserves the floors. Prevents them from cracking and splintering and at the
same time lessens the cost and labor of caretaking.
Standard Floor Dressing is sold everywhere in barrels, half-barrels, and
in one gallon and five gallon cans.
Not intended for household use.
A FREE DEMONSTRATION
We want to prove the efficiency of Standard Floor Dressing af our
own expense. We will freaf free of charge one schoolroom or corridor
floor or part of one floor in any store or public building, just to show
how Standard Floor Dressing eliminates dust. Ask for particulars.
Boards of Education, School Superintendents, Principals
and Teachers should write for information, testimonials and
our free book, “Dust and Its Dangers.” The health of your
pupils may depend on your action.
STANDARD OHL COMPANY
(Incorporated)
-


§chool Hygiene
3 461 ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
S3% PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
WOL. I., NO. 5 BOSTON, MASS. DECEMBER, 1908
t (ſpe (Wfficers amo Council of the Eiggociation
º BERGströM, Ph.D., Professor of Education,
eland Stanford Jr. University.
LMER. E. B.Row N, Ph.D., United States Commissioner
ºf Education.
ILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
of N J. CRoNIN, M.D., Assistant Chief Medical Inspector
ealth Department, New York City.
AHAM JAcoBI, M.D., LL.D., Professor of Diseases of
hildren, New York City.
MAs M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
ew York University.
ošEPH LEE, A.B., A.M., LL.B., Boston.
PHILIP KING BRow N, A.B., M.D., Medical Department,
niversity of California.
opert W. Lovett, A.B., M.D., Instructor in Orthopedic
Fº Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
tts School for Feeble-Minded.
Alvin N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
ºpRGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
. McCURDy, M.D., Director International Young
en's Christian Association Training School.
|
|
t
#ary President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABot; Secretary and Treasurer, Dr. THoMAs A. Storey.
CHARLEs A. MooRE, Chairman Welfare Department,
National Civic Federation.
Edward L. STEvens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
NICHOLAS MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDERIck ForchHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. Fisch EL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULIck, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGton, Ph.D., Director of Depart-
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEYLAN, A.M., M.D., Adjunct Professor of
Łºsical Education, Columbia University, New York
ity.
THoMAs A. StoREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
ORGE S. C. BADGER, M.D., Editor
C. HEATH AND CoMPANY, Publishers
EDITORIAL
A PAMPHLET has just been issued by the
º Sachusetts Board of Education en-
ed “Suggestions to Teachers Regarding
ºberculosis and Its Prevention.” This
in response to an act of the legislature
1908 providing that tuberculosis and its
ºvention shall be taught in all grades of
public schools of this state in which
truction is given in the subjects of
'siology and hygiene. “The pamphlet
ot intended as a textbook for teachers
this subject, but is merely to suggest
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
communications concerning manuscripts and editorial matter should be addressed to the editor.
communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
certain points of instruction and to empha-
size certain points to be dwelt on with
particular emphasis.” An outline of the
subjects to be considered is given, followed
by a brief and excellent description. The
outline is as follows:
I. What tuberculosis is. What con-
sumption is. What the tubercle bacillus
is. When discovered, and by whom.
Methods of growth. Things favorable to its
growth. Things unfavorable to its growth.
II. Outline of history of tuberculosis:
(1) Ancient times; (2) dark ages; (3)
present. -






58 S C H O O L H Y G I E N E
-
III. What tuberculosis does: (a) In the
world; (b) in this country; (c) age at
which it kills; (d) compared with other
great disasters — yellow fever, Slocum
disaster, San Francisco fire, Civil War.
IV. How tuberculosis is spread. Spu-
tum; milk; anti-spitting 1aws.
V. Tuberculosis is preventable; it is
curable; it is not hereditary. How pre-
vented: (a) By 1iving so as to keep health,
— fresh air, exercise, food, etc.; (b) non-
spitting. -
VI. How cured: Sanatoria; home treat-
ment; methods of getting fresh air. A
tendency and not the disease is inherited.
VII. Early signs and symptoms of con-
sumption. Importance of other things
besides a cough — pallor, anemia, 1oss of
weight, weakness, listlessness, uncleanli-
mess, glands, etc.
VIII. The campaign against consump-
tion in Massachusetts. Every one must
do his share. Tuberculosis exhibits, socie-
ties, hospitals, etc.
IX. Reference to standard works on the
subject.
The advisability of giving instruction to
school children in tuberculosis has been
questioned. The reasons for it seem to
outweigh those against it. Tuberculosis
is responsible for about one seventh of all
deaths, and most of the deaths due to it
are among those under forty. It is a
curable disease, but more than this, it is
preventable, since infection takes place
very largely from the sputum of consump-
tives. The safe disposal of this sputum
would very greatly diminish the spread of
the disease. School children can be taught
how dangerous sputum may be and how
best to dispose of it. They are certain to
carry this instruction to their parents, and
in this way good is certain to follow. The
people most needing instruction are the
ones least likely to receive it through lec-
tures or written matter. They certainly
will receive it from their children or
brothers and sisters taught in the public
schools.
Tuberculosis is a curable disease. The
-
best means at our disposal for curing it w
through good personal hygiene. Gold
hygiene puts the individual, whether tube
cular or not, in the best possible physic.
condition. The tubercular individu be
must win his own battle. Every cell ann:
tissue of his body fights the invading germ
Poor hygienic methods of living place ce.
and tissues at a disadvantage; good hth
gienic methods of living give them the ty
highest degree of efficiency.
The same is true of individuals not tub
cular, but who are exposed to tubercul
infection. Good physical condition is
powerful safeguard against infection, a
not only from tubercular, but from “any
infection.
The pamphlet issued by the Massach
setts Board of Education, and a simil
one entitled “Simple Lessons on Tube
culosis or Consumption for School Childr
of the Seventh and Eighth Grades,” issu
by the Committee for Prevention of Co
sumption of the Associated Chariti
Washington, D. C., teach the gospel
fresh air day and night, sunlight, clea
ness, bathing, plenty of plain, nourishi
food, and care of the teeth and bowe
At the recent International Congress
Tuberculosis held in Washington, the
was nothing of value added to the tre
ment of tuberculosis beyond what is co
prised in good hygiene.
If school children can be taught t
hygiene, so simple, yet apparently so lit
appreciated, a great advance in SOC
progress will be evident. The study
tuberculosis in the schools ought to res
in benefits to the whole community, fil
in reducing the prevalence and mortal
of the disease, and secondly in teaching
better hygienic standard of living. |
THE PREVALENCE OF DENT
DECAY IN SCHOOL CHILDREN.
WALTER S. CORNELL, M.D., PHILADELPH.
SystEMATIC examination of the tet
of school children has recently been mº
in European and American cities, and
revealed conditions of decay and neg




















S C H O O L H Y G I E N E 59
which are startling in their prevalence and
degree. This is particularly true in the
"case of small children, whose temporary
ºth are allowed to decay without parental
cern, and often with the ignorant
lief that their shedding is accomplished
turally by this process. The writer
one occasion, in the Todd School,
iladelphia, issued ten official parents’
tices on account of decayed teeth after
systematic routine examination of
tº twenty children.
Doctor Kerr, in the London Report for
go7, mentions the deplorable condition
"revealed by an examination of 7oo very
| yºung children. Among these were found
e child with II decaying stumps,
other with 14, and another with 17.
e girl had but two teeth. One boy
}ssessed not a single sound tooth.
The medical inspection of school chil-
en has demonstrated the fact that one
ird to one half of them stand in need of
ntal attention. The hopelessness of
jing much under the present limitations
medical inspection results in the issu-
ice of parents' notices in the worst cases
ily. This, at least, is true of Phila-
ºlphia, where, in 1905, but 2, or 7 notices
are issued after the inspection of 141,303
hildren.
A number of municipal and personal
ports on the prevalence of these condi-
bns, recently issued, are valuable be-
use of the exact statements contained
erein. A few of them are quoted below:
City of New York. (New York Health
eport, Special Bulletin, 1996.) An ex-
mination of 79,065 school children showed
º 386 possessed one or more decayed
eth.
New York Children. (Report of Dr.
aven Emerson on physical condition
poor children admitted to the summer
nitarium at Sea Breeze, Long Island.)
s.An examination of 1,478 poor children
19ne to fifteen years of age showed 278
|(18.8 per cent) with no apparent dental
decay and 1,200 (81.2 per cent) with
gdºntal decay existing. The latter ex-
bited a total of 5,996 decayed teeth, thus
eraging 4.7 carious teeth each. A
lbsequent report by the same author
|ournal of the American Medical Associa-
|º, November 16, 1907), on boys and
girls Over five years of age, states that
1974 children out of a total of 1,343 ex-
lººd showed decay in one or more
City of London. (Report of the London
ounty Council, 1907.) The examination
of 7oo young children of poor Social
station revealed the fact that 680 (97 per
cent) possessed decayed teeth. Of these
68o children, 2 os possessed 2 decayed
teeth, 152 children possessed 3 to 5 de-
cayed teeth, and 323 children possessed 6
or more decayed teeth.
Another study was made, designed to
show the condition existing in older School
children. An examination of I 32 boys
showed 62 per cent with two or more
carious teeth. An examination of a
1arge number of girls revealed decayed
teeth in 37 per cent of them. In another
series of boys and girls, 43 per cent of all
children possessed one or more decayed
teeth.
City of Edinburgh. (Quoted from Mc-
Kenzie’s “Medical Inspection of School
Children.”). A careful examination of 591
children showed that not more than 25 per
cent cleaned their teeth, and that Only
5 per cent used the toothbrush daily. Of
the whole 591 children the teeth were regu-
lar in 67 per cent, and very irregular in 5.5
per cent, the remainder being fairly regu-
lar. Six per cent of the whole number of
children possessed badly decayed teeth.
Decayed first teeth were found in 57 I
children (96 per cent of all), and decayed
permanent teeth in IIo children (19.4 per
cent of all). Many children, of course,
were counted in both groups of cases.
The children with decayed first teeth
averaged 4.95 decayed teeth each, and
those with decayed permanent teeth
averaged 2.5 decayed teeth per child.
City of Aberdeen. (Quoted from McKen-
zie’s “Medical Inspection of School Chil-
dren.”) The examination of Aberdeen chil-
dren was made purposely along the same
lines as in Edinburgh, and the results
are, therefore, comparable. Six hundred
children were examined. Of these I 2
per cent used a toothbrush daily. Three
per cent presented markedly irregular
teeth, and the teeth of 5 per cent were
much decayed. In the recording of decay
no distinction was made between tempo-
rary and permanent teeth, but separate
records were made for the younger and
for the older children. Thus, in the
youngest children, 33 per cent exhibited
decayed teeth. In the children over
nine years of age, 8o per cent possessed
decayed teeth. As to the number of
teeth diseased, the average was two
carious teeth for each (defective) child
under nine years of age, and three and
one-half decayed teeth for each child
twelve to fifteen years of age.


































º
*.
6o S C HO O L H YG I E N E
City of Baltimore. (Quoted from the
Journal of the American Medical Associa-
tion, November 23, 1907.) Of the 9,295
public school children examined in Oc-
tober, 1907, I, 17 o (or 12.6 per cent)
showed decayed teeth.
These revelations point most clearly to
the necessity of instruction of both school
teachers and children in the care of the
teeth, and in the evil effects of decay. A
monthly inspection of the children’s
teeth by the teacher, and an annual in-
spection by the school medical inspector,
are the measures required to bring home
to each child and parent a realization of
the importance of the subject.
The need of the present time is the es-
tablishment of dental dispensaries in
our cities for poor school children, the
maintenance of such dispensories for the
primary purpose of saving teeth rather
than extracting them, and the proper
financial compensation for those dental
surgeons doing this work. Not less im-
portant is the education of all parents
to the relation between sound teeth and
good health.
(From the Pedagogical Seminary, June, 1908.)
WILLIAM H. BURNHAM, in an article en-
titled, “The Hygiene of the Nose,” dis-
cussing adenoids in school children, says:
Special symptoms to be observed are
the following:
First. Disturbances of breathing.
Breathing through the nose is difficult,
so the mouth is kept open.
Second. Disturbances of speech. The
voice has a nasal sound, since the stopping
of the nose hinders clear speech.
Third. Disturbances of hearing on
account of the swelling of the Eustachian
tubes. In this way buzzing in the ears,
deafness, etc., may occur.
Fourth. Disturbances in the functions
of the brain resulting in inattention, so-
called aprosexia nasalis, and the 1ike.
Investigation has shown that this is a
common disorder among school children.
In Boston, from 5 to 6 per cent suffer from
adenoids; in Germany, about 1o per cent.
In Leipzig investigation made by the
School physicians showed out of 9,031
children, 23.2 per cent afflicted with
adenoids. It was found that there were
Imore cases among the children of the so-
called district schools where the poorer
classes attended. This was thought to
be connected with the scrofulous tendency
and the fact that the children were weaker
and not as well cared for. In the burger-
with adenoids; while in the district schools
bezirksschulen, 25.5 per cent had adenoids
In Stockholm specialists are attacher
to the elementary schools to examin
every child. In 1905, among 3,495 chi
dren, they found 13.8 per cent with e
larged upper tonsils. In 1906, amon
3,907, 12 per cent were found.
Adenoids seem to occur more frequentl.
among the mentally deficient. Amon
I 14 feeble minded, Halsted found 20.1 pe.
cent with adenoids. In one school i
New York, where there was a special clas
for defectives, a physical examinatio
showed that 137 had adenoids, or e
1arged tonsils, or both.
Perhaps until further studies have bee
made it is not best to attempt to establish
other correlations, but several are sug;
gested. It seems to be a defect of civiliza
tion. No extended investigations, so fall
as I am aware, have been made amon
primitive people, but among the Sout:
American Indians apparently adenoid
seldom occur. Catlin reports that, ac
cording to his observation, North Amer
can Indians always sleep with the
mouths closed.
Teachers have an excellent opportunit
for detecting the presence of adenoids i
their pupils.
If they make the preliminary observa
tions, a blank like the following can b
used:
always
I. Does the pupil sit with Q sometim
Open mouth P. . . . . . . . . . . 11O
always
2. Does the pupil complain of } sometim
headache?... . . . . . . . . . . 11O
very º
3. Is the pupil attentive? . . . . | somewhat tº
11O
very
4. Is the pupil backward º
learning?... . . . . . . . . . . . ( no
always :
5. Does the pupil's voice have | sometime t
a nasal sound? . . . . . . . . . In O
always
6. Does the pupil stutter?... | sometime
1]. O
always
7. Is the pupil hard of º
ing?... . . . . . . . . . . . . . . . . 11O
- often
8. Does the pupil complain of sometim:
11O


























S C H O O L H Y G I E N E 6 I
OUTDOOR PLAY SESSIONS.
LILIAN V. ROBINSON.
THREE years ago the Boston School
oard appointed a special committee of
e physicians to look into the conditions
ffecting the physical welfare of children
the first three grades of the public
hools, and to suggest possible means for
ettering their school life. It was the in-
eresting and valuable report of this com-
ittee that suggested the “outdoor play
essions º' carried on by the Hawthorne
lub and South End Neighborhood House.
The children of the Way Street school-
ouses of primary grades come from as con-
ested and dreary a quarter as the city
ontains. Way Street itself lies parallel to
he Boston & Albany tracks, and the At-
antic Avenue Elevated crosses it close to
he schoolhouse, so that the noise from each
* is an almost constant irritation to the ears
f children, teachers, and occasional visitors.
A slaughter house, with its unpleasant
ights and odors, was opened a few doors
rom the school two years ago, but this the
awthorne Club, with the aid of the head
master, teachers, and representatives of
ther settlement houses, succeeded in
losing last spring, after an agitation cover-
g a year or more.
The Schoolhouse Commission, in answer
o the Hawthorne Club's appeal some five
fears ago, made many improvements in
he school building itself, but after all has
)een said, the situation is as bad as can
ell be imagined, and the building a sorry
ºplace for the school life of 11ttle children
O whom the school ought to mean beauty,
leanliness, order, an uplifting influence
"in the midst of sordid surroundings. It
as the situation and condition of the Way
Street School which perhaps weighed most
ith the school committee in 1eading them
O grant permission for the play sessions.
The children leave the school an hour
before the close of the afternoon session,
marching with a teacher to lead and one as
rear guard, through the short streets
|Which divide the school and the Haw-
horne Club playground. Their shining,
|Happy faces as they approach the door
º into the playground are a pleasant
$19.ht.
|. The playground, a vacant lot running
he length and half the breadth of a city
block – a reclaimed dumping ground
Qaned by its owners to the Hawthorne
lub – was cleaned and put in good condi-
10n by the street department. Shrubs
ind vines were planted about its edges by
the park department; swings, tilts, swing-
ing ladders, drinking fountains, sandbox,
and basket-ball equipment were supplied
by private subscription.
Once in the playground the children
divide themselves among swings, tilts, etc.,
and the littlest ones, in less time than one
can tell, are building houses or digging
ditches in the sand box. A young woman
gymnast from Dr. Sargent's Training
School is in charge, with the two public
school teachers. During the first year of
the play session the children were allowed
to play as they pleased. Good discipline
was maintained and there was little quar-
relling, although seventy-four children
from one schoolroom occupied the play-
ground at one time. The teachers say
that on play-Session day absence from
school is seldom known, and that the chil-
dren look forward to it eagerly through the
week.
The children are most careful not to
injure shrubs and vines, and though they
look longingly at blossoms of syringa or
althea in the spring, only once was one
picked. Now and then flowers are dis-
tributed among the children on leaving,
and the Hawthorne Club members, chil-
dren a little older than those of the Way
Street School, have given the products of
their roof garden to the school this autumn,
filling eight or ten boxes with geraniums,
wandering Jew, wax plants, etc., which
they have “raised.” One of the older
club children, a girl of fourteen, who has
just entered the high school, comes each
play session as a volunteer assistant to
help the children in their play, and has
proved a very useful assistant.
It seems impossible that a play hour
once a week can really mean a physical
gain for the children, but their dull little
faces have grown bright and animated, and
the cleanliness which is insisted on for the
playground has brought rosy cheeks and
an appearance of better health at least.
The play session is but a part of a scheme
of work connected with the school. A
“school secretary '' or “school visitor,”
under the direction of the teachers and
the Hawthorne Club, goes into the homes
of the children, looking up cases of tardi-
ness or absence, finding out conditions
under which the children live, making
friends with the parents, – in short, doing
what the overworked but devoted teachers
would like to do had they time and
strength.
Last year the school secretary did little
but make friendly visits, gaining the con-

























62 S C H O O L H Y G I E N E
fidence and liking of the mothers and
smoothing out difficulties among tardy
children, coöperating to some extent with
the school nurse, such as taking children
to the dispensary or hospital. This year
a more definite plan is being worked out
by the school secretary and her committee
— an attempt to do something towards
solving the housing problem, perhaps the
greatest problem of the congested quar-
ters.
The committee aims to coöperate with
the good landlord and good tenant and to
combat the careless or bad landlord and
tenant. The posting of the owner's name
and address at the entrance of every tene-
ment house is one thing for which the
committee is striving. The school secre-
tary, a person with special training in
hygiene and sanitation, as she makes her
visits, notes conditions in the home, not
only those that can be bettered by the
tenants, but those due to the careless
1andlord or to other tenants in the house
who are objectionable. The school secre-
tary then reports to her committee, they
in turn calling other organizations to their
aid and appealing to the city authorities
as may seem wise.
With the coming of the warmer days
1ast spring the Hawthorne Club endeav-
ored to attack the dust nuisance, another
great problem of the district, perhaps the
greatest menace to the health of the
people. A petition representing many
prominent organizations was presented
Mayor Hibbard asking that the streets of
the congested quarters might be flushed
through the summer months daily. The
mayor responded at once, and as a result
streets of the congested districts paved
with brick, asphalt, or granite blocks in
the South, North, and West Ends were
flushed by the fire department between 6
and Io P.M. daily, to the great relief and
pleasure of the people. It is hoped that
another year the plan may be more fully
worked out, and as a matter of fact an
investigation of flushing machines used in
other cities is now being made by the super-
intendent of streets, with the thought of
perfecting plans in Boston another
St11111116.1".
For the children this year — and it is
through the children that we can hope to
accomplish most – a delightful game has
teen invented called “ play hygiene.”
The rules of good hygiene are being
taught by means of this game in the play-
ground, and later, when cold weather com-
pels the gymnast to carry on the play
SCHOOL HyGIENE AT THE STAT
Sessions in the school room, the game wi
still serve its purpose.
. An account of the game “play hygiene
will be given in a later issue of this paper.
NORMAL SCHOOL, CEDAR FALL;
IOWA.
HOMER H. SEEREY.
THE ENVIRONMENT OF THE STUDENT
THIS School has a campus of forty acr
of land, all of which is kept as a lawn or :
a garden, so that the sanitation as well
the appearance may be the best possibl
It has cement walks and paved bric
drives, so that it is practically impossib
for the students to bring any soil or oth
dirt on their shoes into any building
the School. The playgrounds are cared fi
by the school and are on high ground, we
drained. These playgrounds consist of
quarter-mile cinder track, a football fiel
baseball field, basket ball courts, hock.
field, a large number of dirt tennis cour
and a golf field, all of which are kept
condition and repair by the regular e
ployees, who know how to do best th
work assigned. The site of the groun
is at the border of the city of Cedar Fal;
and is elevated so that the view of all th
Surrounding country is obtainable fro
two to fourteen miles. The drainage
the land is so fine that all the creeks a
brooks that run into the Cedar River co
tain water only after rains or during
freshet. The water supply of the cit
consists of potable spring water obtaint
from a large number of springs locate
above the ordinary level of the river. T
spring water is so pure and abundant th
it is used for all purposes that the scho
needs. -
THE GYMNASIUM AND PHYSICAL TRAININ
The board of trustees has erected a n
table gymnasium on the edge of the Sp
cious and well-planned playgrounds.
gymnasium has a length of two hundr
and twenty-four feet and a breadth
sixty-seven and one-half feet. It is ſo
stories high, as the basement is in reali
the first story, and it has such a capaci
that more than two thousand studen
can be handled each day. There are fo
exercise rooms, sixty by ninety feet, eaſ
of which can give opportunity for Q.
hundred students each class hour. T
bathing facilities grant free shower bat
i





























S C H O O L H Y G I E N E 63
every student, the heating of bath water
eing four thousand gallons of hot water
n hour, while a fifty-thousand gallon na-
atorium grants swimming privileges to
11 who desire it four days of the week.
he lockers are free and are all ventilated
dividually by an automatic system, with
ntrance and exit fans producing sufficient
urrent of air passing through the lockers
o clean and dry the clothing used during
he exercise hours. Every room, whether
ffice, dressing room, bathroom, or exer-
ise room, is mechanically ventilated and
hermostatted so the air is always sweet,
ure, and equable. There are no odors in
hese rooms such as are common in many
odern gymnasiums. Both outdoor and
ndoor work is maintained every term,
here being four physical directors of the
est professional training in regular em-
jloyment, assisted by a large number of
dvanced students who are preparing to
e professional physical directors. Every
tudent is required to have two years'
work, three hours a week the first year
nd two hours the second year, and may
ave two more years of work if desirous
f continuing such training. The outdoor
ork may be football, baseball, basket
all, tennis, cross country, track, hockey,
golf, and all other sports that are ex-
isting among young men and women.
|
CLEANLINESS.
Special attention is given to cleanliness
f floors, walls, and furniture. There is
O dust permitted about the buildings,
and since there are now eight of these,
covering a floor space of nearly eight acres,
it is no small undertaking. Every janitor
is a specialist and works under close super-
ision. Every man is a competent work-
man in his business and is required to keep
the rooms in good condition. Water and
Work are all the materials used. No soap
or other cleaning preparation is necessary.
Brushes are used instead of brooms, and
the wiping of every floor with clean water
is done once or twice a week, as may be
necessary. Each man who succeeds satis-
factorily in keeping his rooms and halls
up to standard is granted, as a recognition
of his service, half a month's time each
year for vacation without 1osing his
monthly full salary. In addition, every
Schoolroom where class or laboratory work
is done, is furnished fresh air by mechani-
cal appliances every day in the school
year, and the opening of windows for ven-
tilation is entirely unnecessary. Since
every room is also thermostatted, the
students remove their Overcoats and sur-
plus clothing, so that they are as comfort-
able as in a well-managed home, and being
furnished lockers for this clothing, they
are not exposed to any risk of loss. The
recitation buildings are in a quadrangle
and are so connected by corridors and
tunnels that students are not required to
go out of doors in making changes of hours,
and hence there is no exposure to contend
against. The result of such a physical
environment is manifest in that there is
practically no coughing in any of the school
rooms at any time in the year; there is no
possibility of the spreading of any con-
tagious disease more than would be out of
doors; there is no crowding of 1arge num-
bers into any class beyond the hygienic
capacity of the room, and health and
physical vigor are a constant quantity,
nothing special causing absence except
such as is regularly occurring in every
student's 11ſe.
INSTRUCTION.
There are several courses given to the
students in class work. These are called
physiology and hygiene – principally hy-
giene, sanitation, physiology of exer-
cise, advanced hygiene, including first aid
to the injured, and personal and domestic
hygiene. Certain of these courses are
required of all students. In addition,
personal lectures are given on problems
that are connected with health and dis-
ease, food and raiment, recreation and
rest, psychology and happiness, in order to
familiarize the students with the 1atest and
best modern thought on these important
questions. In the library is found a spe-
cial collection of books on these matters
and all the periodicals that are now pub-
lished in English that are specially intended
to be advisory and educational in sanitary
and in personal science are in the reading
room. By means of all these undertak-
ings, agencies, and endeavors, it is hoped
to spread the knowledge of sanitary sci-
ence among the people and give the state,
through the work of the school teachers,
a more reasonable condition of prosperity
and happiness.
IN concluding an article “On the Ne-
cessity of the Medical Inspection of Edu-
cational Institutions,” read at the Mon-
treal Medical Congress, June, 1904, Dr.
C. N. Valin says:
“The influence a methodical, scientific
inspection of schools will have upon the






















64 S C H O O L H Y G I E N E
education of the public is very great.
Actually the great obstacle to the ap-
plication of sanitary measures comes
from the ignorance of the masses. To
enlighten these masses, we have the School.
Prophylaxis started in school is carried to
the home; what the child learns at school
he conveys to his family. Then youth is
the incoming generation and, with it,
we shall have a generation perfectly dis-
ciplined and ready to submit to sanitary
ordinances.”
THE SCHOOLROOM IN ITS RELA—
TION TO THE DURATION OF
LESSONS, THE SEQUENCE OF SUB—
JECTS, AND THE SEASONS OF THE
YEAR.
BY WILLIAM H. BURNHAM, M.D., PH.D.,
Professor of Pedagogy, Clark University, Worcester, Mass.
(From the Transactions of the International Congress
of School Hygiene, London, 1907.)
THE recitation period should not exceed
fifteen to twenty minutes for children
from six to nine, twenty-five to thirty
minutes for children of nine to twelve,
thirty-five to forty minutes for older chil-
dren, with recesses of five to fifteen minutes
following. The evidence shows the wis-
dom of putting mathematics and 1anguages
in the morning and gymnastics and
drawing in the afternoon.
Hygiene justifies a long vacation in the
summer and a short one in the spring.
DR. E. C. PoHL, of the Portland, Ore.,
Board of Health, writes as follows:
A system of School inspection was
inaugurated in the city of Portland one
year ago, the work being performed by
volunteer inspectors, with the hope of
demonstrating the benefits to be derived
therefrom. An appropriation has been
Secured this year for paid inspectors, of
which we have two, and a school nurse.
The greatest objection to school inspection
has come from people, particularly the
newspaper people, of Christian Science
persuasion. These objections, of course,
merit no serious consideration, and the
work has, up to the present time, more
than justified itself.
Very truly yours,
ESTHER C. PoHL,
Health Officer.
THE HEALTH OF SCHOOL
CHILDREN.
(From the Medical Senting, §ptember 1908, Portland
te.
AN effort has been made to secure i
Portland the appointment of school inspec
tors, who shall be licensed physicians, tog
through the public schools at certain times
examine the children, and make recom
mendations as to treatment that they
should have. Many children, especiall
those of the poor, suffer from sligh
troubles which, if treated at once, would b
speedily removed. These affections inter
fere a great deal with the health of th
children and with their capacity for study
There has been some opposition on th
part of some Portland newspapers to any
examination of children by physicians i
the public schools on the theory that th
public authorities were thus usurping th
functions of parents at the expense of th
taxpayers; but, after all, this will only be
a slight shifting of work which cost
money from the shoulders of the poor t
the shoulders of those who are best able t
pay. The appropriation recommende
for this purpose is only $900 per year,
very small sum.
y
HERBERT F. TRUE, M.D.
(From the Southern caſiº Practitioner, September
1908.
IN the examination of 5,321 school chil
dren of Los Angeles, 2,241, or 61 per cent
were found defective in eyesight; 1,170
or 22 per cent, defective in hearing; 1,835
or 31 per cent, had adenoids; 1,390, 0
25 per cent, had enlarged tonsils.
Besides the above, many diseased con
ditions of these important organs wer
discovered.
In the examination of 5o bright pupil
and 5o dull pupils, selected by 6 teacher
on account of their marked brightness 0
dullness, 8 bright ones were found defec
tive in some condition of the eye, ear, nose,
or throat, and 43 of the dull ones had som
easily-detected and marked defect of thes
organs. This proportion speaks for itself
The dull ones are the defective ones, and the
defective ones are the dull ones. As thes
1ittle ones were lined up, the practiced
eye of the physician could see at a glance
that this one or that one had some physica
defect, and in most cases the diagnosis
could be reached without a detailed ex-
amination. Upon the tests being applied
additional defects were discovered.
|




















S C H O O L H Y G I E N E 65
DEATH IN SCHOOL DRINKING CUPS.
PROF. ALVIN DAVISON, LAFAYETTE
- COLLEGE.
(From the Technical World Magazine, August, Chicago.)
“THE evidence condemning the use of
the common drinking-vessels upon any
occasion, whether at school, church, or
home, is derived from three sources: (1)
The frequent presence of disease-producing
bacteria in the mouth; (2) the detection
of pathogenic germs on the public cups,
and (3) the discovery that where a number
of persons drank from a cup previously
used by the sick some of them became ill.
“During the past six months I have
investigated, by means of direct micro-
scopic examination, by cultures, and by
guinea-pig injections, the deposits present
on various public drinking-vessels. Cup
No. 1, which had been in use nine days in
a school, was a clear thin glass. It was
broken into a number of pieces and prop-
erly stained for examination with a micro-
scope magnifying 1,000 diameters. The
human cells scraped from the lips of the
drinkers were so numerous on the upper
third of the glass that the head of a pin
could not be placed anywhere without
touching several of these bits of skin. The
saliva, by running down on the inside of
the glass had carried cells and bacteria to
the bottom. Here, however, they were
less than one third as abundant as at the
brim.
“By counting the cells present on fifty
different areas on the glass as seen under
the microscope, it was estimated that the
cup contained over twenty thousand
human cells or bits of dead skin. As
many as 150 germs were seen clinging to a
Single cell, and very few cells showed less
than ten germs. Between the cells were
thousands of germs left there by the smears
of Saliva deposited by the drinkers. Not
less than a hundred thousand bacteria were
present on every square inch of the glass.
Most of these were of the harmless kind,
abundant in the mouth, but some were ap-
parently the germs of decay feeding upon
the bits of the human body adhering to the
Cup. In order to determine how much
material each drinker is likely to leave on
the cup, I requested ten boys to apply the
upper lip to pieces of clean flat glass in the
same way as they touched the cup in
drinking. These glass slips thus soiled were
Properly stained for microscopic examina-
tion, which showed an average of about one
hundred cells and seventy-five thousand
bacteria to each slip.
‘‘ More than ten thousand churches
have now adopted the individual com-
munion cups, and many schools either
provide a sanitary drinking-fountain or
require the pupils to use individual cups.
In many places in Germany pasteboard
cups are furnished which, after being once
used, are destroyed, Wherever hygienic
measures have been adopted in a com-
munity, sickness and death have decreased.
By 1iving more in accordance with the
rules of hygiene New York City reduced
her death-rate from 25 per thousand to 18
per thousand during the period from 1890
to 1905. Within the same years, Chicago
has reduced her death-rate from 19 to 14
per thousand.”
METHOD OF EXAMINATION IN THE
LOWEST CLASS OF PUBLIC
SCHOOLS IN LEIPZIG.
BY DR. THIERSCH.
(From the Transactions of the International Congress
of School Hygiene, London, 1907.)
I. There is an examination by the
teachers of sight and hearing at the begin-
ning of the second half year.
2. The doctor’s examination takes in
one class at a time. The parents are in-
vited to be present by a printed circular
explaining the object of the examination.
When they assemble at the selected time,
the medical inspector gives a half-hour's
talk on hygiene, choosing one of the follow-
ing subjects:
(a) Cleanliness of body and baths.
(b) Cleanliness of the mouth and care of
the teeth.
(c) Proper nourishment.
(d) Properly aired sleeping rooms.
(e) Proper clothing, including corsets.
(j) Games and sports.
(g) The alcohol question.
Much interest has been taken in these
talks by the parents. Each child, with
1oosened upper clothes, is then taken sepa-
rately to the physician in a small room,
who examines the child in the presence of
the mother and teacher, the former giving
information about the child. The exami-
nation includes throat, teeth, hair, lungs
if necessary, spine, and skin. These, with
data as to eyes and ears and general bodily
characteristics (height and weight) and
the facts of value learned from the parents
are put on a card. This card goes with
the child from class to class as he pro-

66 S C H O O L H Y G I E N E
-
-
gresses through the school for the infor-
mation of the teacher. If conditions are
found requiring medical treatment, the
parents are advised to take the child to
their physician.
It takes for forty children from one and
one-half to two hours. The method of
further examinations is to be formulated,
especially for children who are not found in
satisfactory condition at the first exami-
nation.
MISCELLANY.
(journal of the American Medical Association,
October 31, 1908.)
IN view of the fact that investigation
showed that sixty per cent of children
examined in the Philadelphia schools had
eyestrain or defective vision, the city in
1907 established an ophthalmologic divi-
sion of the bureau of health. The city
council appropriated $300 for glasses for
children unable to pay for them, and with
this money 354 children were fitted with
glasses. These children, without glasses,
could not read from the blackboard and
could not see the print in their books; in
many instances they were thought back-
ward and often mentally deficient. The
correction of these defects by the fitting of
proper glasses was followed by remark-
able improvement in the work and conduct
of the pupils. Children in special schools
were enabled to return to the regular
schools.
PHYSICAL EXAMINATION OF
SCHOOL CHILDREN.
(From the Brooklyn Eagle, New York, October 7, 1908.)
THIS was the subject of a paper read by
Doctor Darlington, health commissioner
of New York City, before the joint School
and Medical Congress at Washington.
In the public schools of New York City
there failed of promotion in their grades
1ast year over two hundred and fifty
thousand pupils. Doctor Maxwell, super-
intendent of the New York schools, claims
that the root of the trouble is the physical
unfitness of the children, owing to 1ack of
nutrition and physical defects, to do
reasonably good school work.
To correct these physical defects there
are now 200 doctors and 200 nurses, and
a 1arge Supervisory force, engaged in the
work of examining the children and seeing
that they are properly cared for. Not all
of the pupils have yet been examined
but last year, out of 142, ooo children
examined, IoS, ooo, or 76 per cent, were
found to be suffering from non-contagious
physical defects.
Doctor Darlington says that the medical
inspection will reduce the number which
fail of promotion so greatly as to save
from the school funds much more than
the cost of inspection, and make the
schools much more efficient.
HOLIDAY CAMPS.
BY FR. THOMASSEN, OF COPENHAGEN.
(From the . Transactions of the International Congress
of School Hygiene, London, 1907.)
BRION, of Zurich, in 1876, took a large
number of poor children from Zurich to
the country. In 1878 the movement of
vacation camps was taken up by Frank-
furt, and now “there is hardly any large
city in Austria or Germany that does not
every summer send its poor and sickly
School children out camping for about
three or four weeks.”
In France they are working for vacation
camps and have a special newspaper for
the purpose. Since 1881, thirty-four to
thirty-eight per cent of the children in the
public schools of Copenhagen have been
sent to the country for vacations. This
comes about in one of three ways: (1)
Country folks invite their relatives; (2)
farmers open their doors to city children;
(3) in the last year a number of vacation
camps were opened by the agitation of the
teachers' associations. To one of these
teachers' associations the government has
granted a twenty-five years' lease of a
public forest for the purpose. Railroad
corporations (government and private)
and steamship companies give free trans-
portation in all cases both ways. In 1906
I7,4oo children were furnished such free
transportation under the direction of the
city schools.
HYGIENE IN THE COLLEGE OF THE
CITY OF NEW YORK.
THOMAS A. STOREY, M.D., PH.D.
THE Department of Physical Instruction
in the College of the City of New York is
govering hygiene, medical examination and
inspection, and the various phases of physi-















S C H O O L H Y G I E N E 67
cal exercise in courses which are required
in the last year of the academic depart-
ment and in the first and second years in
the collegiate department. There are now
about fourteen hundred students taking
this required work. A thorough medical
examination is planned for each student
entering the academic department and for
each student entering the collegiate de-
partment. Medical inspection is planned
for each student once each term during
each year up to and including the Sopho-
more year, that is, during the three years
he spends in the academic department and
also in his freshman and Sophomore colle-
giate years. Medical consultation is open
to all students at any time. The depart-
ment attempts no treatment save that
necessary in emergencies.
A class hour in this department is di-
wided into the following periods. (The
| students are assembled in the exercising
hall uniformed in white and ready for
exercise.)
(a) Floor talk on health.
(b) Mass drill.
(c) Apparatus work.
The “floor talks '' are on the following
lines: First term, “Ways and Means of
Securing and Conserving Health ''; second
term, “The Influence of Certain Abnormal
Conditions and Habits on Health ''; third
term, “Some of the Common Causes of
Disease ’’; fourth term, “The Carriers of
Disease ’’; fifth term, “Our Defenses
against Disease ’’; sixth term, “The
Nature of Some of Our Common Diseases.”
The mass drills are carefully graded
throughout the six terms, so that there is
a progression from the first term to the
last. Emphasis is placed on drills that
Secure desirable physiological reactions,
develop obedience and ready response to
command, strength, and endurance.
The apparatus work is arranged for the
students in the two collegiate years. It
also is carefully graded. The exercises are
Selected with special reference to the de-
velopment of form and coördination.
The swimming pool is listed as a part of
the required apparatus work. Each stu-
dent must learn to swim and is taught to
dive and is given instruction in the care
of the partially drowned.
A practical application of the laws of
health is maintained in all these phases
of physical exercise. Bathing, cleanliness
of body and uniforms, care of the swim-
ming pool, exercising ball, locker rooms,
and corridors are parts of the work for
which the students are held responsible.
(From the Washington, D. C., Herald, October 5, 1908.)
, WILLIAM H. ALLEN, secretary of the
Bureau of Municipal Research, in the July
number of the North American Review,
enumerates ten steps for the protection and
physical welfare of school children, which
constitutes a program that is immediately
practicable in all states. They are as
follows:
I. A thorough physical examination of
all children of all schools, public, parochial,
and private.
2. Notification of parents and family
physicians as to children's needs. That
tens of thousands of records of defects
piled up at health headquarters do not
help children has been conclusively proved
in New York.
3. “ Follow up ’’ notices with visits to
inform and persuade parents to correct
defects and to remove their causes.
4. Enforcement of existing 1aws and
securing proper authority; where this is
now lacking, to compel obstinate parents
to take necessary steps.
5. Periodic re-examination of school
children during school life.
6. Physical examination of children
when applying for work certificates.
7. Use of information gained regarding
physical effects of bad living conditions to
secure enforcement of health and tenement
1aws, restriction of hours of 1abor, control
of dangerous trades, prevention of child
1abor.
8. School buildings and school curricu-
1um should be so constructed and so man-
aged that they cannot themselves either
produce or aggravate physical defects.
9. The effect of school environment and
school requirements upon the child should
be constantly studied. Teachers should
loe examined and re-examined for their
vitality, which exercises an important
influence upon that of the pupil.
Io. Hygiene should be so taught that
children will learn their health rights and
How to maintain them.
2
NOTES ON THE STATISTICS OF
MEDICAL INSPECTION.
LEONARD P. AYRES.
THE man who will come forward with a
simple, rational, and practicable system
of statistics for medical inspection will
confer on the movement a boon of so great
importance that he will merit the lasting
gratitude of all who are interested in the
work. At present, definite information in

68 S C H O O L H Y G I E N E
quantitative terms is meager in quantity
and dubious as to quality. To cite a very
simple instance: It is almost impossible to
get any reliable statistics as to the cases of
contagious diseases found in different 10-
calities. Diligent examination of all the
printed reports obtainable from cities hav-
ing systems of medical inspection yields
very meager results. In most cases the
doctor's report shows how many cases of
contagious disease were found, but not
how many children were examined in find-
ing the cases. Again, when the number of
children examined is stated, it is almost
always found on investigation that the
number given represents not the number of
children examined, but the number of ex-
aminations of children.
Again, passing from a consideration of
examinations for the detection of conta-
gious diseases to examinations for the
discovery of physical defects, an even
greater paucity of available information is
discovered.
It is, of course, of the utmost importance
that the physical defects disclosed by the
examination of the school physician be
given attention by the parents of the child,
and through them brought before a physi-
cian and remedied if possible. It is of very
slight practical utility to discover that a
child has enlarged tonsils or defective
vision if the discovery results merely in the
addition of one to the statistical table of
the defects discovered. Unless the cases
are followed up, and unless parents can be
persuaded or coerced into having their
children given the necessary medical atten-
tion, it is obvious that a large proportion
of the work of the school physician in
making the examinations will be of scant
utility. Nevertheless, despite the obvious
importance of ascertaining whether physi-
cal examinations result in any good, at-
tempts made to discover and report the
number of cases where glasses have been
supplied or medical attention given are few
in number and ineffective in method.
A careful examination of the reports of
the superintendents of schools of the one
inundred largest cities of the country, of
the reports of the superintendents of
schools of such other cities as are known
to have systems of medical inspection, and
of a 1arge number of magazine and news-
paper articles by recognized authorities
fails to bring to 11ght a single official report
giving the three essential factors, that is,
total number of children examined, total
number having physical defects, and total
number of cases where the parents have
-
taken steps to have remedied the defects
discovered. Such information as is dis.
covered is scant and indefinite.
Nor is information as to the financial
status of the movement easier of access.
It is very difficult to obtain reliable data
as to the expense of medical inspection
outside of the matter of salaries in Ameri-
can cities. Apparently, in most cases no
careful account has been kept. The ex-
penses for printing, incidentals, etc., in
connection with the medical inspection
have simply been included in the general
expenses of the board of health or the
board of education. A recent careful
examination of over one hundred reports
of boards of health and education from the
largest cities discloses only two cases
in which any itemized account of such
expenditures was given.
But, as has been stated above, the gen-
eral meagerness of available information
is not the only obstacle which confronts
the student of this subject. The element
of reliability is a no less important factor.
As a specific instance it may be profitable
to note briefly some features of the printed
reports of the most extensive and expen-
sive system of medical inspection in
America — that of New York City.
In the City Record, bearing the date of
Saturday, November 30, 1907, there is a
report by the Board of Health on “Medi-
cal Inspection and Examination of School
Children.” On page 12304 is found the
information as to the work of the medical
inspectors of schools in all boroughs for
the years 1903–6. The data are as follows:
.
Visits to Children
Year. Schools. Examined.
I903 . . . . . . . . . . . IO3,3OI II,301,691 M
I904 . . . . . . . . . . . IoI,566 I 2,236,050
I905 . . . . . . . . . . . 68,964 6,285,435
I906. . . . . . . . . . . 88,813 5, oo 7,244 l
As the average attendance in all the
public schools of New York City in 1903
was only 466, ooo, and in 1906 only 523,000,
it is, of course, evident that these figures,
under the caption of “Children Examined"
in reality refer to “Examinations of Chil-
dren.”
Now, if 150 medical inspectors were con-
tinuously employed during these four
years, and if each one worked two hours
per day for 200 school days each per year,
the aggregate annual number of working
hours for the force would be 150 x 200 x 2,
or 60,000. Using this figure as a divisor,
we may ascertain how many schools were
visited per hour by the inspectors, and

S C H O O L H Y G I E N E 69
flow many children were examined. We
have the following table:
Schools Visited Children Ex-
Year. per Hour. amined per Hour.
I903. . . . . . . . . I.7 I88
I904 . . . . . . . . . I.7 2O4
I905 . . . . . . . . . I.5 IO 5
1906. . . . . . . . . I.5 83
It is worthy of note that during the year
1904 each medical inspector must have
visited nearly two schools per hour every
day in the year, and that during every day
in the year every inspector employed
examined over 200 children every hour.
WORK OF NURSES.
In the copy of the City Record published
Friday, February 21, 1908, is found a re-
port of the Division of Contagious Diseases
for the third quarter, 1906–7.
On page 2150 of this report the number
of nurses assigned to sehool duty in the
borough of Manhattan is given as 27. In
the report of the commissioner of health
published as Appendix R of the report of
the superintendent of schools for the year
ending July 31, 1906, there is a statement
of the work performed by the nurses in the
borough of Manhattan during the year
1906.
From these two sources we are able to
gather the following information:
Number of nurses. . . . . . . . . . . . . 27
Number of visits to schools. . . . Io,2O7
Number of examinations . . . . . . 2,961,370
Number of instructions in
School for pediculosis and
trachoma . . . . . . . . . . . . . . . . . 565,427
Number of treatments in
School for miscellaneous ail-
ments. . . . . . . . . . . . . . . . . . . . . 96, oog
Number of visits to tenements, 27,572
. If the 27 nurses worked 2 oo days a year
in the schools, each one of them must have
done the following work every day in the
year:
Visits to schools. . . . . . . . . . . . . . . . .
I.
Examinations in schools. . . . . . . . . . sº
Instruction for pediculosis and tra-
choma. . . . . . . . . . . . . . . . . . . . . . . . IO4.7
Number of treatments for miscella-
neous ailments. . . . . . . . . . . . . . . . . I8
Number of visits to tenements . . . . 5. I
If we again suppose that each nurse
Worked five hours every day, we find that
*Very nurse during every hour of the day,
*Very day of the week, and every week in
the year, made on the average IIo exami-
nations in school, gave 2 o instructions for
pediculosis and trachoma, nearly four
treatments for miscellaneous ailments, and
visited a tenement.
This means that they all worked at the
steady rate of two examinations per min-
ute, an instruction for pediculosis or
trachoma every three minutes, and a treat-
ment for miscellaneous ailments every
fifteen minutes. During their spare time
they also gave 4,959 treatments in the
districts for scarlet fever, measles, or
diphtheria, and made 9 Io miscellaneous
visits.
These figures have been extracted from
the report with considerable labor. They
are mostly taken from sub-totals. The
grand totals in the board of health statis-
tics, while impressive in size, are difficult
of comprehension, as they are made up from
divers elements. For instance, in the
report of the commissioner, published as
Appendix R of the superintendent’s re-
port, in the summary of the work per-
formed by the nurses there appears the
grand total of 666,395. This is made by
adding together the number of instructions
in school for pediculosis and trachoma, the
number of treatments in school for mis-
cellaneous ailments, and the number of
treatments in the district for scarlet fever,
measles, and diphtheria. To the layman
there would seem to be slight reason for
including in one total the number of in-
structions given in schools for the preven-
tion of 11ce and the number of treatments
for diphtheria given in the district.
MEDICAL INSPECTION OF SCHOOLS
IN PHILADELPHIA.
THE following plan was adopted by the
Department of Public Health and Charities,
Bureau of Health, in 1904:
The duties of the medical inspectors in
connection with the public schools shall
comprehend:
I. Sanitary inspection of the building.
2. Systematic examination of the pu-
pils of public schools.
SANITARY INSPECTION OF THE
BTILDING.
(a) As to Overcrowding.
(b) Methods of Heating and Ventilation
(c) Illumination.
(d) As to Cleanliness.
(e) Drinking Water.
(j) Toilets.






7o
S C H O O L H Y G | E N E
(g) Coat Rooms.
(h) Cellars.
(i) Playgrounds.
Give size and general conditions of
the playgrounds (including the con-
dition of sand pile).
Are they adapted to the needs of
the pupils?
(f) Note the character, quality, and quan-
tity of cakes, candies, fruits, etc.,
sold about the school to the pupils.
(k ) Summarize briefly the result of this
inspection and note the conditions
which require betterment in the
order of their importance.
(l) A monthly report shall be sent to the
chief medical inspector as to whether
suggestions for sanitary improve-
Iments have or have not been acted
upon.
(m) A weekly report shall be sent to the
chief medical inspector of all the
defects requiring immediate atten-
tion.
DUTIES OF THE MEDICAL INSPECTOR IN
CONNECTION WITH THE INSPECTION
OF SCHOOL CHILDREN.
The inspector is to make arrangements
with the principal for the use of a room in
which to examine all children set aside as
suspicious. -
The medical inspector is to use every
opportunity to instruct the teachers in
the recognition of gross signs of sickness,
and is to request the teachers to set aside
in a particular room, if such be available,
all pupils that in his or her opinion are
carriers of contagion or require immediate
medical aid. -
The inspector will adopt the following
routine in his medical examination of the
school children:
(a) He shall visit each school in his dis-
trict daily, beginning at 9 o'clock, at as
early an hour as is practicable, and ex-
amine all children set aside by the prin-
cipal as suspicious.
(b) On his daily visit to the last school
on his list he shall, in addition to the im-
mediate examination mentioned in para-
graph “a,” begin a systematic inspection
of each child in the school and preserve
a card record of the same, be the child sick
or well. He will continue this inspection
with each school in turn of his district
until a record of every child allotted to
him has been made. -
The inspector is to exclude from school
every child suffering from:
(a) Acute disease, contagious or not.
(b) Any form of disease that may be a
menace to other children with whom it
comes in contact.
(c) Any disease of sufficient gravity to
seriously impede its work at School.
The inspector is to exclude from school
all children who do not present evidence
of successful vaccination.
The official exclusion cards, properly
filled out, are to be sent to the parents of
every child excluded. These cards give
the reason for exclusion and state the con-
ditions on which the child may return.
In the case of children suffering from
physical defects that are not of sufficient
gravity to warrant exclusion from school,
but which may materially impede their
educational progress, the inspector is to
notify the parents of the children in writ-
ing and recommend that the children be
given medical attention by either the
family physician, the district physician, at
a dispensary, or in a hospital.
In case of the systematic examination
of all children in the schools, the inspector
is to report in writing to the chief medical
inspector the actual number (and the per-
centage) of children suffering from any
defects whatever, namely:
Defects of vision or hearing, deformities,
ophthalmic diseases, throat and nose dis-
eases, cutaneous diseases, diseases of
thorax, diseases of malnutrition, and para-
sitic diseases of scalp and elsewhere.
When a child has been excluded from .
school because of one of the reportable
diseases, the inspector is to call at the
house of the child on the second or third
day following exclusion and inquire if it
is receiving medical care. If not, he is
to report the case to the chief medical
inspector. If it is, he is to get the name
and address of the attending physician
and send them, with those of the child,
to the chief medical inspector.
In the examination of all children suſ-
fering from sore throats, the inspector
shall adopt as a routine procedure the
making of cultures for the isolation of
bacillus diphtheriae if it be present. These
cultures, with a full record, are to be for-
warded at once to the laboratory of the
looard of health for examination.
The medical inspector shall scrupu-
lously respect the rights of the family
physician, and shall forward to the chief
medical inspector reports of his advice
in connection with all cases. -
The inspector is to make a daily report.
of his work to the chief medical inspector.

S C H O O L H Y G I E N E 7 I
New Apparatus for
Visual Instruction
VERY teacher should know of the
Reflectoscope and just what this in-
strument accomplishes. It projects
on the screen, before an entire class, illus-
trations from books and magazines, draw-
ings, maps and post cards, all in their
natural colors and without any
expense for preparation.
The Reflectoscopes are in successful
use in about 1,100 School and College
lecture rooms.
Send for Illustrated Catalogue C
A. T. Thompson & Co.
Sole Manufacturers
15 Tremont Place, Boston
1 Madison Ave., New York
|| || Brattle Street
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The purifold
Paper Drinking Cup is the cup that protects.
The public cup is the cup that kills. . One drink
from a public cup may bring disease or death.
Washing it is no protection. The dirt may be
removed, but the germs are not.
The PURI FOLD folds flat, costs little, and
lasts long. Every school child should use one.
Write for our special prices to schools.
BURNITOL Mi FC. CO.
Cambridge, Mass.
Reliable
Chemicals
at
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T. METCALF COMPANY
39 TREMONT STREET a
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Merck
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BOSTON







Why Contagious
Diseases Are SO
Quickly Transmitted in Schoolrooms.
A SURE METHOD
HIE time is not far distant when action
will be taken by the Boards of Health in
every city, town and village of this
country, to compel the elimination of
dust in schoolrooms by proper care of
the floors.
Educators are rapidly coming to a realization
of the fact that “dust" is the principal cause
of disease transmission among school children.
The floors in schoolrooms are bare, and when
large numbers of pupils are assembled the con-
stant motion of feet produces a continuous cir-
culation of dust. These dust particles are com-
posed of vegetable, animal and mineral material
finely pulverize d.
From tests made with
dust collected from
school room s and
other places of public
assembly, it has been
found that With the
dust were uncount-
able myriads of dis-
ease germs—bacilli of
Tuberculosis, Ty-
phoid Fever, Diph-
theria, Pneumonia
and other dangerous
diseases. These ex-
periments afford irre-
futable proof of the
dangers arising from dust and explain why con-
tagious diseases are so quickly transmitted in
schoolrooms.
To do away with this menace — to avoid the
dangers of dust-poisoning, it is not only neces-
sary to provide a system of ample ventilation,
but also to treat the wood floors in such a way
that dust and germs cannot pollute the atmos-
phere.
Standard Floor Dressing has proved itself a
perfectly satisfactory dust-preventive. By
keeping the floors at a proper degree of moist-
ure the dressing catches and holds every parti-
cle of dust and every germ coming in contact
with it. Tests have been conducted to deter-
mine the quantity of dust and number of organ-
isms which would settle on a given surface.
Results prove that the dust from
floors treated with Standard Floor
Dressing is twelve times greater in S
weight than that collected from un-
treated floors. The inference is obvious
— the balance of disease-laden dust
in the rooms with untreated floors
was circulating through the air, be-
cause even after settling on the
floor every current of air would
disturb it and start it afloat again.
Another test proved that dust once
settled upon a floor treated with
Standard Floor Dressing remained
there, and a bacteriological examina-
OF PREVENTION.
tion demonstrated that 97%% of all the dis-
ease germs caught with the dust were
destroyed outright.
Such tangible proofs should convince any.
one that Standard Floor Dressing is invaluable
for use in schools as a preventive of disease.
In addition to its germicidal properties,
Standard Floor Dressing does splendid work
in keeping the floors themselves in a state of
excellent preservation. It prevents the wood
from splintering and cracking and renders
sweeping and caretaking a comparatively
easy task.
While Standard Floor Dressing is not in-
tended for use in the
home, it is intended
for use in schools,
hospitals, sanitari-
ums, stores and pub-
lic buildings of every
description.
It is sold in con-
venient form by deal-
ers in every locality,
and may be had in
full barrels, half-
barrels, one gallon
and five gallon cans,
Three or four treat-
ments a year give
best results, and when
spread with the patent Standard Oiler may be
used very economically. The Oiler distributes
just the right amount to every part of the
floor, and as the dressing does not evaporate,
one application will last for several months.
Standard Floor Dressing is now being used
with remarkable success in thousands of
schools, colleges, stores and public buildings,
and we have yet to hear of an instance where
the dressing has failed to reduce the circula-
ting dust and kill the floating disease germs.
All we ask is an opportunity to prove the
merits of Standard Floor Dressing.
In order to convince those who may be
skeptical, and those who are really interested,
we are making an extraordinary offer. Select
one room or corridor in any public building
under your supervision and we will
dress the floor with Standard Floor
Dressing AT OUR OWN EXPENSE—
the test will not cost you one cent.
We make the offer because we are S0
sure of our ground and have such faith
in the efficiency of our dressing.
Correspondence is desired with those
responsible for the care of schools and
public buildings. Those wishing fur-
ther information should write for Our
book “Dust and Its Dangers” and for
testimonials and reports. Sent to any
address on request.
STANDARD OIL COMPANY
(INCORPORATED)
A
S.
AI
S
*Eſ
Q
-
,
H
L
M
*
M



346 |
.53%
5cbool ſilva
ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
- tº Iº.
UNav. 9a fluºe
F; 25 1999
ICIl C
BOSTON, MASS.
JANUARY, 1909
HN A, BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
LMER. E. B.Rown, Ph.D., United States Commissioner
of Education.
ILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University. -
HN J. C.Ronin, M.D., Assistant Chief Medical Inspector
Health Department, New York City.
BRAHAM JAcoBI, M.D., LL.D., Professor of Diseases of
Children, New York City.
Homas M. BALLIETT, Ph.D., Dean of School of Pedagogy,
New York University.
SEPH LEE, A.B., A.M., LL.B., Boston.
HILIP KING BRow N, A.B., M.D., Medical Department,
University of California.
obert W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
ENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
ALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
ALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
EORGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
, H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
, H. McCURDy, M.D., Director International Young
Men's Christian Association Training School.
(Ibe (Wfficers alto Council of the Eiggociation
onorary President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABot; Secretary and Treasurer, Dr. THoMAs A. Storey.
CHARLEs A. MooRE, Chairman Welfare Department
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
NIcHolas MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDERIck Forchheim ER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. Fisch EL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULICK, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart-
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEYLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. StoREY, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
EORGE S. C. BADGER, M.D., Editor .
. C. HEATH AND CoMPANY, Publishers
- . 48 Hereford Street, Boston, Mass.
- 120 Boylston Street, Boston, Mass.
ll communications concerning manuscripts and editorial matter should be addressed to the editor.
ll communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIAL
A CHANCE FOR THE AVERAGE
- PUPIL.
THERE has been a great awakening of
nterest in the physical welfare of school
hildren in recent years. As a growth
Tom the medical inspection of children by
hysicians to detect ills already existing,
ave come the nurses whose province it is
O See that the treatment for these ills is
arried out. In a few cities a further and
lost natural step has been taken, to pre-
serve the physical welfare of the well and
by training to increase it. As the physi-
cally unfit are by proper treatment
enabled to join the ranks of the physically
fit, they at once enter upon the training
which will lessen the chances of further
illnesses. This is as it should be.
Is it possible to arouse an interest in this
training among the children? The best
results are possible only when this interest
is aroused. The element of jun is most
important. Physical exercises and even
the supervised play can be made mere
tasks to be performed without any particu-





























74 S C H O O L H Y G I E N E
1ar reason for them evident to the children.
If carried on in this manner there is no fun
in them. The enthusiasm of the teacher,
the element of fun in her, and her physical
appearance, are of greater importance than
many seem to realize. Among older
children in the grammar and high schools
it seems possible to establish a ranking
system that shall include progress in both
mental and physical development.
In most pupils there is a distinct pride
in their school work. It is called forth by
a system of ranking, perhaps, or by the
words of praise on their monthly reports,
or by prizes for excellence in general or
particular studies. Why might not a
similar pride in physical development be
fostered? To only a very few are positions
On the athletic teams possible. Could not
the winning of high rank in the classroom,
or of special praise, or of prizes be made
dependent upon progress both in studies
and physical development? Would not
Such a system, if at all feasible, awaken in
pupils a pride in both achievements?
At a recent meeting in Lewiston of the
Maine Academy of Medicine and Science,
a most interesting and suggestive ex-
perience was given by one of the members.
In a certain school prizes were offered for
the best progress made in both mental and
physical development over a definite
period of time. Educational and physical
tests were made at the beginning and end
of the session. The pupils making the
greatest progress received the prizes. The
method of procedure was somewhat as
follows: At the beginning of the session
“A ’’ was marked 90 per cent on his
studies and 80 per cent on his physical
development; “B,” 7o per cent on his
studies and 70 per cent on his physical
development; “C,” 60 per cent and 6o
per cent respectively. “A ’’ started with
a combined mark of 17o, “B” with 14o,
and “C” with I 20. At the close of the
session, “A ’’ received on his studies 95
per cent, on his physical development 9o
per cent, a total of 185. “B” received 85
per cent and 85 per cent respectively, a
total of 17o, and “C,” 85 per cent and 8
per cent, a total of 165. “A” showed
progress of 15 points, “B” of 30 points anio
“C” of 45 points. “C” won the prize b
cause showing the most progress.
To the many, continued high rank
impossible from the lack of endowmen
with the necessary mental qualities. Thºt
same is true of physical developmen:
To the many, then, the sentiment is e
pressed by “What's the use?” The sug
gestion outlined above gives to the man
the chance of recognition for progres
made. It handicaps only the superlā
tively endowed and these do not nee
prizes for excellence of attainments ofte
made without hard work. his
ARTIFICIAL ILLUMINATION
SCHOOLROOMS.
MYLES STANDISH, M.D., BOSTON.
OFs
[Read before the annual Congress of School Hygient
Atlantic City, 1908.]
THAT many schoolrooms are impro
erly illuminated is brought to the attentioſ
of every ophthalmologist by the number
of young men who appear in his consultin
room every year upon their return from
boarding schools complaining of trouble iſ
the use of the eyes, which they attribut
almost universally to insufficient illumina
tion in the room in which they are obligeſ
to study, or to annoyance from points 0
brilliant illumination which are withiſ
their fields of vision. The same story i
repeated by others who attend evening
schools, and who nearly always allege tha
the light is insufficient.
A properly arranged 11ght for the pur
pose of study upon a single desk is no
difficult. It is evident that there should
be sufficient light, that it must come from
the left side in order that the shadow of the
pen shall not fall upon the words as they
are written, that the 1ight shall be so place
as not to be directly reflected from th:
paper into the eyes of the student, and
that the general illumination of the room
shall be nearly as great as that upon the
paper or book in order to prevent too great
a contrast; in other words, that the cen:
tral point in the field of vision shall not bº
much more brilliantly illuminated than
the periphery of the field. It is well that































S C H O O L H Y G I E N E 75
he light on the book should be slightly
ominant over that of the general illumina-
ion, but that the contrast, should not be
bo great. The greater in , excess the
‘mount of illumination upon the book, the
reater will be the discomfort. But in the
choolroom the problem is much more
omplicated. Here we desire to have the
umination the same as in the case of the
ingle desk, but there are from forty to
ixty desks that have to derive their illu-
ination from fixtures which can in no
|ay be arranged for the proper illumina-
ion of a single desk. The first requisite
or successful illumination in the School-
loom, as elsewhere, is that the general
“lumination shall be good. This neces-
sarily depends upon the decoration of the
foom. If the walls, desks, and other fur-
lishings are so dark that practically they
eflect no light, then any method of ar-
|anging the lighting apparatus will always
be unsuccessful. This phase of the matter
s one that is of great importance at the
present time, when it is the fashion to give
ill libraries, and even many schoolrooms,
in exceedingly dark tone. The tables and
|iesks are made of dark oak or cherry, walls
ire decorated in dark reds and greens, the
bookcases are often of Flemish oak to give
he same general effect, with the result that
sufficient light can never be reflected from
he walls to diminish the striking contrast
between the illuminating page and sur-
Ifounding objects. The attempt is often
ade to remedy this defect by increasing
the amount of illumination. This always
ails to produce the desired comfort on
Account of the intense contrast established.
As many schoolrooms are used by day as
well as by night, and the decoration of the
|Walls must be such that they will not reflect
too much daylight, as would be the case if
he walls were left white, nevertheless,
- hey must reflect sufficient light at night to
give a good general illumination. Perhaps
he best color for this purpose is an exceed-
ngly pale yellow-green, very nearly white,
ºr if the room is too dark by day, a pale
puff serves the purpose by day and night
| better than any other color. The window
6 Shades should be given consideration. In
| modern schoolroom the areas of the
indows are usually one fifth of the floor
Jace, and if shades are installed which
ransmit light too freely, the illuminated
ăreas of the windows may be annoying in
he daytime. If, on the other hand, the
| Shades are absolutely opaque, they dimin-
sh to too great an extent the amount of
ighton the opposite side of the room. The
|
|
best shade with which I am acquainted is
a “hand-painted ” gray-green. This will
exclude the direct rays of the sun suffi-
ciently, yet transmit enough 1íght to en-
able the whole area of the window to be a
source of illumination. It is fortunate
that this shade is also a proper color for
use at night. As has been stated above,
the comfortable use of the eyes depends
on proper diffusion and reflection of 11ght
from the walls, and if one side of the room
having an area equal to one fifth of the
floor space is left without shades at night,
showing from within an absolutely black
space, there is a great loss in the amount
of illumination, but if “ hand-painted ”
shades of this color are used, and are drawn
at night, they afford a sufficiently good re-
flecting surface to give an even illumina-
tion in the room. Next in importance is
the material of the desks and other furni-
ture. If the desks are dark, they will
reproduce the common fault of a brilliantly
white page in the center of the field and
1ess illumination in the periphery. There-
fore it is necessary that the desks and other
furniture should be of some light-colored
wood, and it is of importance also that the
surface of the desks should not be polished.
A great stumbling block in the way of
proper decoration of schoolrooms, from an
illuminating as well as a decorative point
of view, is the blackboard. This generally
extends around two sides of the room and
consists of a broad black area nearly on a
1evel with the eyes of the children in the
seats, and if it always remained black it
would be more harmful than it is. As a
matter of fact, the surface when in use is
generally covered with a fine layer of
chalk, giving a grayish tint which does
reflect a considerable amount of light. In
my opinion the blackboard is an anach-
ronism in the modern schoolroom, and
some substitute should be devised which
will reflect more light and tone in better
with the general decoration.
Whatever means of illumination we
adopt in a modern schoolroom, the follow-
ing factors should be considered: The
amount of contamination of the air pro-
duced by the effects of combustion, the
amount of heat given off, the steadiness of
the light, the harm which comes from hav-
ing bright points of intrinsic brilliancy
within the fields of vision of the teacher
and pupils, whether the spectrum contains
a large proportion of injurious rays, the
cost of supplying the light, the cost of fix-
tures, the ease with which they can be kept
in order and clean, and last, but not least,

























76 S C H O O L H Y G I E N E
whether a uniform amount of illumination
can be maintained upon all the desks.
In Germany and elsewhere an attempt
has been made to secure as many of these
desiderata as possible by indirect illumina-
tion, i. e., by having the source of 1ight
screened entirely from below and reflected
upon the ceiling and the upper third of the
walls, whence it is diffused throughout the
room. Such a method of illumination,
when properly arranged, gives an impres-
sion much akin to daylight, but it 1acks
one important factor of daylight, namely,
shadows, and as we are so accustomed to
depend upon shadows for our judgment
of solidity, size, and perspective, the ab-
sence of shadows produces a peculiar
psychological effect upon those who remain
long in such a room, due, perhaps, to an
effort of the eye to recognize objects with-
out this long-accustomed aid to vision.
Most individuals will demand under such
circumstances a much more brilliant il-
lumination than they require with direct
illumination. If indirect illumination is
attempted with incandescent lights, it
requires a maximum of expense to produce
a comfortable sensation of sufficient illu-
mination. If, as has been done in Ger-
many, the electric arc 1amp is used instead
of incandescent 1amps, it is not so satis-
factory, for proper trimming and care of
such lamps is necessary to prevent a
considerable amount of flickering. This
requires an amount of skill which is not
generally obtained at the hands of the
average janitor of a schoolhouse. A
widely extended experience has shown
that while indirect illumination may be
fairly satisfactory in 1arge halls and 1ecture
rooms, it is, as a rule, a source of great
complaint in rooms in which studying,
writing, drawing, or sloyd is done.
On the 29th of April, 1907, the School
Committee of the city of Boston appointed
a committee, of which I had the honor to
be chairman, consisting of three oculists
and two electricians, to consider the sub-
ject of illuminating Schoolrooms in the
city of Boston."
This committee rejected, after careful
consideration, indirect illumination for the
reasons given above. It also did not con-
sider that gas illumination by incandes-
cent mantles was desirable, owing to the
heat and products thrown off into the air
by this method of illumination. They
therefore determined to make a series of
* The members of this committee were James E. Cole;
George S. Derby, M.D.; Robert H. Hallowell: F. I. Proc.
ter, M.D.; Myles Standish, M.D.
experiments with incandescent electri
lamps for the purpose of deciding, if pos
sible, upon some practical and not to
expensive method of arriving at :
satisfactory illumination of schoolrooms
They were aided in their labors by thi
Schoolhouse Commission, a board which
constructs the schoolhouses of Boston
This commission placed at our disposal :
room in an abandoned schoolhouse. Th:
size of this room was 28 by 28 feet, and th:
adopted in Boston. The walls wer
painted a light yellow and the ceiling
white, and the room was wired with dupli
cate circuits, so that one experiment coul
be tried immediately after another by a
simply throwing a switch. They als
gave us the services of their electrica
engineer, Mr. B. B. Hatch, to whose intelli
gence, skill, and ingenuity the success o
our experiments was largely due.
It was found that in most methods of
direct illumination it was necessary ti
have at least nine stations; that it was
difficult not to have too great illuminatio Ho
on the desks directly beneath the fixture les
and on the other desks too little, and tº:
avoid conflicting shadows arising from th: :
multiple sources of light; that often no
only would there be several shadows of
the pen falling in undesirable positions
|but also several shadows of the head of th:
pupil would fall upon his work. Experi
ments were made by arranging all th:
1ights on the left side of the room and als
by making two lines of 1ight, one at th:
1eft side of the room and the other at th:
center of the room, all placed at an angl; haſ
with various forms of reflectors. It wa
found that while most of the desks wer: Bo
fairly evenly illuminated by such aſ
arrangement, and while the shadows fe
at the right of the work, it was impossible
SO to place the lamps as not to have the
bare filaments within the field of vision
most of the time. In fact, no arrange.
ment could be made in which the baré
1amps were used where this undesirable fles
factor was not present. Having deter.
mined that the distribution of 11ghting
stations was desirable and that bare fila:
ments should not be permitted, the questle
tion of shades was of next consideration
We found that most of the shades in the
market confined the illumination to a
comparatively small area directly beneath
the fixture, beyond which there was an
abrupt fall in the amount of the light, and
that it was absolutely desirable to find a


































S C H O O L H Y G I E N E
77
|ight as evenly as possible. There are cer-
ain shades in the market through which
ight is transmitted and dispersed widely,
ut they were found undesirable on ac-
ount of the facets which became multiple
sources of brilliant illumination. Finally
he committee, after consultation with
Major E. A. Zilensky, U. S. A., retired,
made experiments with the shade invented
It was found that this shade was
he inner or outer surface with white
namel, and that sufficient light passed
through to properly illuminate the ceiling
ind upper portion of the walls of the room,
but that the greater proportion of the light
|Was reflected downward at such an angle
that the area of illumination was sur-
prisingly wide. Within these reflectors
; Fere placed incandescent lamps; the
Ower third or 1ess of the bulb was frosted,
O that it was impossible for the filament
to be seen, yet the greater part of the light
passed through the clear portion of the
bulb and was reflected by the prisms
iownward and outward with great even-
less of distribution. Such lights produce
hadows which give to the room in general
| satisfactory illumination, but the prob-
em arose as to how to arrange the stations
to that these shadows would never fall
'pon the pupil's work. The final arrange-
ment, as worked out by Mr. Hatch, is
†hown in the accompanying plan, from
# which it will be seen that the center of the
ight distribution is to the left of the middle
ºf the room when facing the teacher's
lesk, and slightly nearer the front than the
back of the room. The exact position in
the standard schoolroom in the city of
|Boston is indicated on the diagram. With
he lamps so placed and ten feet six inches
Above the floor within a Zilensky prismatic
liffusing reflector, it was found that in no
ase the shadow of the pen fell upon the
ork of the pupil who was writing; that
he dominant shadow either fell directly
Oward the pupil or to his right; that at no
desk was the shadow of the head cast upon
he work, and that, with proper lamps,
he candle-foot illumination on the top of
he desks was approximately 2.5 at every
desk, a comparatively even distribution.
he supporting fixture is simple, consisting
erely of a rod and chain from which is
suspended the shade and 1amp socket.
he simplicity reduces the expense of
he fixture and the cost of keeping it
lean. Indeed, if dust accumulates up-
On it, it does not materially reduce
the illumination upon the desks in the
TOO111.
Experiments were made with various
forms of lamps. The ordinary incan-
descent lamp was quickly rejected. Ex-
periments were principally made with what
is known as the high-efficiency or low-watt
incandescent lamps which have been put
upon the market in the 1ast year or two.
The most satisfactory results obtained
were from 36 candle-power 40-watt tung-
sten lamps. The tungsten lamp is similar
in appearance to a slightly elongated
standard incandescent 1amp with the 1ower
portion frosted. The filament is more
brittle than the ordinary filament, and as
a result the 1amp can only be used when
hanging in a vertical position. The 1ife of
the lamp is about a thousand hours, con-
siderably longer than the ordinary carbon
filament, and it gives practically an even
light throughout its entire life. Its spec-
trum is very satisfactory. About the
same results were obtained from Ioo-watt
G. E. M. 1amps.
The committee found that the compara-
tive current consumption of a schoolroom
lighted with nine 4o-watt tungsten lamps,
nine Ioo-watt G. E. M. 1amps, and the
present standard lighting with indirect
clusters, as used in the Boston schools,
was as follows:
360 watts
90o x -
9 tungsten 40-watt lamps . . . .
9 G. E. M. Ioo-watt lamps. . . .
6 indirect clusters (present
standard two 8 candle-power
and two 16 candle-power
each,
96o ,,
As will be seen, the saving in current by
the substitution of 9 G. E. M. Ioo-watt
lamps was not great, but the increase in
illumination was considerable, as the aver-
age candle-foot for the present standard
when clean is about 1.3, whereas the ar-
rangement that has been described above
gave 2.5 candle-feet at the level of the tops
of the desks.
The saving in the substitution of tung-
sten lamps is 62.5 per cent in current con-
sumption, but from this should be de-
ducted the cost of lamp renewals, after
which the saving is about 45 per cent. The
first cost of wiring a school building which
is to be lighted with the tungsten lamp is
smaller than with the standard incandes-
cent 1amp, owing to the fact that there is
1ess current and it is carried on consider-
ably smaller wires. The committee of
which I have spoken estimated that the
first cost of installation in a building of


































78
S C H O O L H Y G I E N E
twenty-eight classrooms would be approxi-
mately $850 less than the expense of the
present system. This saving was effected
after allowing for the first cost of the
tungsten lamps. The cost of the fixtures
above described, including the tungsten
1amp, is approximately $5. Since this
report was written the price of tungsten
lamps has been reduced nearly twenty per
cent, which would make a still greater sav-
ing, both in the cost of maintenance and
installation. Even with the 10w cost of
current with the tungsten lamp, it is pos-
sible that in some cities the price of gas
may be sufficiently low to cause the mu-
nicipality to use gas in the schoolroom.
It would seem to the writer that the only
practical method of illuminating school-
rooms with gas necessitates the use of in-
candescent mantles, and that the products :
of combustion given off when in use, espe-
cially if the lamps are not well adjusted,
is a very undesirable factor. Nevertheless,
I would like to draw attention to a report
of Mr. Bishop Harmon to the Education
Committee of the London County Council
giving the results of his researches as to
the best method of illuminating school-
rooms by this means. I was much inter-
ested to note that, working independently,
he had arrived at a very similar distribu-
tion of the lighting stations to that rec-
ommended by the Boston committee, and
also that the distribution of 1íght depended
upon the question of the reflecting shades.
He found that in most of the shades in use
in London public schools much of the light
was dispersed into the upper part of the
room, that the bare mantle was often ex-
posed, and that the brass work of the
lourner cast a black shadow beneath the
1ight. After considerable experimenta-
tion he found that efficient reflection
only be obtained from a Welsbach burner
when the opal sides of the shade subtended
an angle of about 90°. The spread of the
shade is about II inches. He says in his
report that with a properly devised fixture
the 1ights can be placed where most
wanted. “For such a pendant there is the
usual ceiling plate, ball and socket joint,
and a variable length of tubing to suit the
height of the room. The fixture is tri-
angular in shape. One side carries the
gas, the other side is merely a support to
balance the shade. On the gas side is the
stop-cork which is on the bend and quite
clear of the bottom tube. The burner
screws on to the bottom without any
wasted room filled in with needless brass.
Work.” -
The benefits obtained from this arrange
ment were that the reflections from the
inner side of the shade gave a very wid:
distribution of light, that the teacher'
eyes were screened from the dazzling of th:
naked mantle by the depth of the shade
and that no shadow could be detected
directly below the lamp, even when th:
screen was held but a few inches below th:
lourner. -
Summary. — That the essential factor
in the proper illumination of schoolroom
are: (1) The walls should be painted aver
light color, preferably an exceedingly pal:
green or buff. (2) The wooden finish of th:
room and the desks should be light ir
color. (3) The window shades should b:
able to exclude direct rays of the sun
diffuse daylight freely, and also in th:
evening reflect a generous proportion of th:
1ight which falls upon them. (4) Direc
illumination is desirable. (5) The lighting
stations should be so arranged that nº
annoying shadows shall fall upon th:
pupil’s desk. (6) The newer forms of in
candescent 1amps and Zilensky shades
when properly arranged, can give a candle
foot illumination of 2.5 on each and ever
desk in the ordinary schoolroom. Finally
that in most cities the expense of electricit
used in the manner described in this articl:
is not so much greater than the cost of ga:
as to be prohibitive.
THE SCHOOL CLINIC IN BRAD–
FORD, ENGLAND.
(From the British Medical Journal, October 24, 1908.)
Hospital so luxuriously furnished as to b:
an actual attraction, a greatly diminisheſ
lbirth-rate and a death-rate that has beeſ
reduced so that it is one of the lowest iſ
England, the physicians are barely able tſ
make a decent living. The recentl
established school clinic is about the 1as
Straw.
(Indianapolis News, October 24, 1908.)
A comMITTEE representing the Board C.
Health and the Board of School Com
missioners is to discuss methods and
estimate the cost of a permanent system
of medical inspection in the schools.
t

































S C H O O L H Y G I E N E
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A PLAN TO SHOW THE POSITION OF LIGHTS IN THE STANDARD SCHOOLROOM OF THE



8o - S C H O O L H YG I E N E
MASSACHUSETTS STATE CONFER–
ENCE ON ORAL AND DENTAL
HYGIENE.
THE Dental Hygiene Council of . Mass-
achusetts cordially invites you to take an
active part in a conference on Oral and
dental hygiene during the week of January
18, 1909. This conference is to be held at
the Twentieth Century Club, and Ford and
Huntington Halls, Boston. The South End
House, the Twentieth Century Club, and
the Monday Evening Club join with the
Dental Hygiene Council in this invitation
to the meetings.
The purposes of the conference are to
bring the importance of this vital subject
fully and frankly to parents, educators,
social workers, and philanthropists, to
invite the public to an open discussion on
dental hygiene; to determine how best to
further the popular movement for better
care of the mouth and teeth.
Dental hygiene is an important factor in
vital economics. Neglect of the mouth
and teeth in the early years of life fre-
quently is the first cause of physical,
mental, and moral defects. In the whole
range of hygiene there is nothing more
important than the care of the mouth.
SCHOOL HOUSES IN NEW YORK.
(New York Tribune, October 29, 1908.)
A DELEGATION from the New York City
Federation of Women's Clubs at a public
hearing presented an urgent appeal to the
Board of Estimates and Apportionment
that no diminution should be made in the
appropriation for school nurses, believing
that it should be increased rather than
diminished.
(From the Bulletin of the American Academy of Medicine,
December, 1908.)
DR. PHILIP ZENNER, of Cincinnati, in
discussing the report of the delegate to the
Second International Congress on School
Hygiene, said:
“I do not know that what I am about to
say properly fits in here. But the doctor
referred to the teaching of sexual physi-
ology and hygiene in the school, and what
I have to say pertains to that. I wish to
report an experiment which took place in
Cincinnati during the past winter. At the
beginning of the school year one of the
teachers in a poor district of the city, a
district in which 1íved black and white and
in which were saloons and factories with
home environment of the worst character
asked the superintendent if he would no.
have a lady physician speak to her girls
for whom she had much concern, on the
subject of sexual physiology and hygiene
The superintendent spoke to me upon th
Subject and I managed to interest Dr. Nor
Crotty of our city, who was not only a
able physician, but who had been a schoo
teacher before studying medicine. She
gave a series of fifteen talks on such sub.
jects as cleanliness, character, the menses
the anatomy of the pelvic organs, repro.
duction in plant and animal life, infectious
diseases, womanhood, motherhood, and
the like. The children she addressed were
in the two grades below the high school
their ages varying from twelve to sixteen.
Though I at first declined to do so, fearing
that a class talk to boys of that age might
do more harm than good, I was led to give
the class several general talks and finally
gave the boys a mild “sex talk.”
“A word as to the result. The teachers
say that the character of their pupils so far
as they can see is altogether different. There
is a very different moral tone in the school
The girls show a respect for themselves
they never showed before. Both boys and
girls have entered into new and confiden.
tial relations with their teachers. Before
impure literature was circulated very freely
around the class. Now, that has ceased
for their children. One man came also
saying that his wife had died, that he had
been very much concerned about his girl,
that a11 efforts of his and of his friends had
been futile, but that since the institution
of these talks she had become a very differ.
ent girl. He went to the trouble to go to
the school to thank the teacher personally
for what had been done. Such acts show
how much good the teaching did in this
particular instance.”
FEEDING OF POOR SCHOOL
CHILDREN.
(From the Journal of the American Medical Association,
November 28, 1908.)
By a resolution of the Berlin Council it
is directed that in the coming winter 8,000
poor school children shall receive warm
dinners in the soup kitchens. The same
privilege is to be extended to children not
of school age on the recommendation of
charitable Societies.





























S C H O O L H Y G I E N E 8I
DEFECTIVE SCHOOL CHILDREN
SEGREGATED.
(From the Journal of the American Medical Association,
December 12, 1908.
ONE hundred and fifty children of the
public schools of Cincinnati, who are four
years or more behind on their studies have
been segregated in one School and are to
be examined by corps of specialists who
have volunteered their services. The
environment of the children outside of
school hours will also be investigated.
FROM AN ADDRESS BEFORE THE
MASSACHUSETTS TEACHERS’ AS-
SOCIATION, BY PRESIDENT
CHARLES W. ELIOT.
(From the Transcript, November 28, 1908.)
HEALTH of our children is another
quarter where we need to advance. For
four or five hours a day we herd our chil-
dren in the schools and give them a vitiated
atmosphere. Personally I enjoy the open
window and sleeping practically out-of-
doors. I have been in schoolrooms here
when I thought every additional five
minutes in that bad air was a drag. I
haven’t thrown up the window because
the still somewhat unenlightened condition
of the teaching profession made me doubt
whether such an act would be welcome.
Cold air doesn't necessarily mean colds.
I am told by explorers that they never
have colds at the North Pole. Health is
the problem, and I don’t know that much
progress has been made in the medical
knowledge of the teaching profession.
HUNGRY SCHOOL CHILDREN
IN CHICAGO.
CoNFLICTING reports were made early in
October regarding the number of ill-fed
children in the Chicago schools. One
report to the Board of Education contained
a detailed statement showing that in
twelve schools I, 123 cases of poorly nour-
ished children were found.
Inspectors reported to the Health Com-
missioner that in 24 school buildings they
found only 77 cases of ill-fed children.
The Chicago Tribune of October Io, 1908,
finds in these reports striking evidence
that doctors disagree.
The Chicago Examiner of October 25,
1908, reports that the school nurses in
their last weekly report to the Health
Department record not a single case of
hungry children.
A CORRECTION.
IN the article published in the November
number of ScHool, HyGIENE entitled,
“Medical Inspection in American Cities,”
by Drs. Gulick and Ayres, was given a list
of the cities having some form of medical
inspection of schools. To the list as pub-
1ished are to be added the cities of Eliza-
beth, N. J., and Eveleth, Minn.
In 1901 the Board of Education of Eliza-
beth appointed a medical inspector at a
salary of $300. In August, 1908, two
medical inspectors and a dental inspector
were appointed at salaries of $350. The
Jou RNAL desires to hear from other cities
conducting medical inspection not already
mentioned.
CARE OF SCHOOLROOMS.
THE Journal is asked from time to time
for detailed information relative to the
care of schoolrooms; what the best
treatment is for floors, walls, and desks.
Below is given the regulations governing
the work of the janitors of the Boston
schools. The Journal will gladly publish
the regulations of other school communi-
ties if they will be sent to the editor.
In the Boston schools the floors are of
rift hard pine, in some instances of maple.
Materials used for cleaning are washing
powders, soda, ammonia, Sulpho-Nap-
thol, formaldehyde, Oxalic acid crystals.
The brushes, Russian bristle. The brooms,
best corn. Hard and soft soap. In a few
schools oil has been used on the floors, to
the satisfaction of teachers and pupils.
Muriatic acid is used for cleaning toilets,
urinals.
RULE 9. In Sweeping, janitors shall
use sawdust dampened with water and a
suitable disinfectant, and once every two
weeks shall cover all floors with sawdust,
wet with a solution of formaldehyde, which
shall be swept up before it becomes dry.
Basements shall be swept once each
week, or as often as may be necessary to
keep them in good condition.
Staircases, corridors, and rooms occupied
by kindergartens, manual training, or
evening classes or for lectures, shall be
swept daily; other rooms, including closets
and dressing rooms and assembly halls,
twice each week, once by Wednesday night
and again on Saturday.
Floors paved with marble, slate or
terrazzo shall be washed as frequently as
may be necessary to keep them clean.


82 S C H O O L H YG I E N E
RULE Io. Wainscoting, dadoes, win-
dow sills, window shades, moldings, hand
rails, furniture, and radiators shall be
dusted every morning before the opening
of School.
Pictures, casts, shelves, walls, and ceil-
ings shall be dusted as often as may be
necessary to keep them in good Order.
Cloths shall be used for dusting in prefer-
ence to feather dusters.
RULE 13. Yards, walks, and Outhouses
shall be examined daily and kept clean and
in good order.
RULE I:6. Chairs and desks shall be
washed once a year, and those occupied by
pupils who have contracted a contagious
disease shall be thoroughly washed with a
solution of formaldehyde.
RULE 17. Door knobs and hand rails
shall be washed with a solution of formal-
dehyde at least twice each month. -
RULE 18. All painted and varnished
woodwork, oil-painted walls, dadoes, and
wainscoting shall be thoroughly washed
each year.
RULE 1.9. Windows shall be cleaned
twice each year, viz.: During the April
vacation and again during the last week of
the summer vacation. Additional com-
pensation, to be determined by the Board,
will be allowed for cleaning windows at
other times during the year, which cleaning
must be done only by direct authority of
the Schoolhouse Custodian.
RULE 2 o. Sanitaries shall be flushed
with water at 1east once each day and kept
thoroughly clean and disinfected. Urinals
shall be washed with soda, potash, or
diluted muriatic acid.
POPULAR AND JUVENILE SPORTS.
(From the Journal of the American Medical Association,
December 12, 1908.)
Follow ING the praiseworthy example
of America and England, sports have been
fostered to a greater extent in Germany
during the 1ast few years, especially
among the youth in schools. In this way
for some time the introduction of popular
and juvenile games has been favored and
there are a number of successful results to
show in this field. In a 1arge number of
communities playgrounds for the schools
have been established, partly by the com-
munal authorities and partly by societies.
In a 1arge number of cases the drill grounds
have been placed at the disposal of the
schools for this purpose by the military
authorities. In about five hundred grade
and high Schools a playtime obligatory on
all pupils has been introduced in addition
to the ordinary hours for gymnastics. In
a large number of other schools such a
regular playtime is optional. Also in a
number of schools a regular system of
outdoor sports is organized for the vaca-
tions. In a smaller way instruction in
swimming and sport on the ice is favored
in the schools. From all these measures
it may be hoped that the growing youth
will no longer, as has often formerly been
the case, restrict its ambitions exclusively
to mental training, but will also seek in
addition a sufficient physical development
so that the old proverb, “Mens sana in
corpore sano,” may attain a higher signifi-
cance for the youth of Germany.
SCHOOL NURSES.
LEONARD P. AYRES.
DR. S. W. NEWMAYER, of Philadelphia,
terms the school nurse “the most im-
portant adjunct to medical inspection.”
Dr. John J. Cronin, of New York City, in
writing of the work of the school nurse in
that city, says: “Instead of opposition to
this work at school, it is most highly en-
dorsed by teachers, principals, educators,
parents, and children. Since this innova-
tion, many cities throughout the world
have copied our nursing system as far as
possible up to the standard set by this
city.” Dr. Ernest J. Lederle, formerly
Commissioner of Health of New York City,
says: “ The school nurse has been voted
a success from the day she began work.”
Dr. Walter S. Cornell says of the school
nurses in Philadelphia: “As a rule, in the
foreign, poverty-striken sections they are
invaluable.” Dr. Thomas F. Harrington,
Director of the Department of School
Hygiene of Boston, writes: “It does not
seem possible to conceive a more satis-
factory arrangement or a more effective
piece of school machinery than the school
nurse under school supervision.”
Citations from the best authorities on
the subject, similar in tone to those quoted,
might be indefinitely multiplied. It may
be said, indeed, that there is no division of
opinion on the subject. The leading
authorities without exception advise and
recommend school nurses in connection
with the work of medical inspection. -
Although this feature of the work is
recognized as being so important, its
development in America has been com-
paratively recent. The first regular em-
ployment of trained nurses in connection

S C H O O L H Y G I E N E 83
with the work of medical inspection seems
to have been in December, 1902, in New
York City, when a corps of nurses was
established at a salary of $75 each per
month. Previous to this the experiment had
been tried in a small way but with great
success in London. The success of the ex-
periment was immediate and the movement
has spread rapidly. New York still main-
tains the corps of trained nurses. Philadel-
phia and Boston have them. Baltimore,
Los Angeles, Grand Rapids, New Haven,
Orange, N. J., and Syracuse and Yonkers,
N. Y., are among the other cities employing
School nurses.
Indeed, experience has proved, espe-
cially in the largest cities, where systems
of medical inspection have been in opera-
tion some time, that the employment of
competent school nurses is almost a
necessity. This comes to light first in
dealing with the cases of children who have
been excluded for minor contagious dis-
eases. A child who has been sent home,
say, for pediculosis, receives no attention
from his parents. After a few days' ab-
sence he returns to school in the same con-
dition in which he left. This process may
be repeated several times before the child
is finally put into fit condition for resuming
his school work. The result is that when
he does return he is behind in his studies
and while he has been absent the city has
been paying for his instruction and no in-
struction has been received. Such cases
as this are typical and numerous. Again,
there are many simple cases of minor ail-
ments which, properly treated by the
nurse in school, will not prevent the
regular attendance of the child. Where
such treatment is not possible, they compel
his temporary exclusion. In many other
cases the school nurse, by visiting the
home and conferring with the parents,
secures treatment of some ailment by the
family physician which in the absence of
such home visiting would be neglected.
A good idea of what may be accom-
plished by the trained nurse in the public
School is given by Dr. Newmayer in a
paper read at a meeting of the Medical
Society of Pennsylvania, September 11–13,
I906. He describes the work of one nurse,
Miss Annie L. Stanley, who was loaned to
the city of Philadelphia by the Visiting
Nurse Society to show the great value of
the trained nurse in the medical inspection
of schools.
In April, 1904, the schools of the Fourth
Section, five in number, were assigned to
the nurse. A well-organized system was
worked out and closely followed. The
nurse visited the schools daily, three in the
morning session and two in the afternoon.
The medical inspector diagnosed and ex-
cluded from the school cases of contagion
and recommended for treatment children
suffering from various ailments. Written
instructions as to the disposal of each case,
treatment recommended, and whether the
case was to be visited by the nurse at its
home were left at the office of the principal.
The nurse each day obtained from this
office the instructions. She followed up
each case and saw that the instructions
and recommendations of the physician
were brought to a speedy and successful
termination. In each school a small room
was set aside for the work of the nurse.
Here she had a drug closet and all requisite
supplies. When necessary, she visited the
homes of the children to give treatment
and instructions, and obtained the co-
operation of parents, thereby assuring
success and more permanent results.
Sometimes circumstances made it neces-
sary for the nurse to personally take a
child to the dispensary for treatment.
These home and dispensary visits were
made after school hours and on Satur-
days. There were various problems to be
solved in each case, and the nurse in-
variably found the remedy. The duties of
the school nurse assured success to the
work of the medical inspector in improving
the health of the school children. She
1essened the number of exclusions from the
classroom for minor contagious diseases.
She saw that all excluded cases were
placed under treatment as soon as possible,
so that there should be the least possible
1oss of time from school and education.
She treated those cases which would for
various reasons receive no attention at
their homes. The medical inspector recog-
nized and excluded from the school cases
of contagion, and recommended for treat-
ment children suffering from defects hin-
dering them in their studies. These cases
might or might not receive the necessary
attention, but with the nurse all uncer-
tainty was dispelled.
It was also found feasible to use the
nurse during the summer months when
there was no school in the lessening of the
great mortality rate among infants from
summer diarrhea, due mainly to improper
care and feeding. Again, she aided ma-
terially in the campaign to lessen the
Inumber of cases and spread of consump-
tion.
Wherever they are employed, the home

84
S C H O O L H Y G I E N E
visiting by the school nurses is recognized
as one of the most important, if not the
most important, feature of the whole
system. Dr. H. W. Buckler, one of the
medical inspectors of Baltimore, says that
this feature of the work is the most effica-
cious in its direct results and the most far-
reaching in its indirect influences. In the
home the nurse has opportunities of de-
tecting and correcting the causes that
produce the trouble for which treatment
was advised. Often entire families are
found to be suffering from the same disease
for which the child was excluded, showing
how utterly useless the work in the school
would be in such cases without the nurse
to attack the root of the evil in the home.
The nurse on her first visit explains why
the child has been excluded and what has
to be done, often giving a practical demon-
stration of the treatment needed. If the
condition is one which calls for a physi-
cian's services, she urges upon the family
the necessity of calling their regular doc-
tor, or, in the case of very poor families, she
often takes the child to the proper dis-
pensary and sees that it gets the treatment
required. The nurse's opportunities for
advising the family are manifold, as are
also her chances of noting unsanitary
conditions and non-observance of the 1aw
and reporting the same to the proper
authorities.
In Boston the nurses are under the
Department of School Hygiene, which is
an integral branch of the educational
system.
The nursing division of the department
is under the direction of one supervising
nurse, who has at present 34 assistants.
The division is provided for by an ad-
ditional special appropriation of $25,000
annually. Rooms are equipped at schools
in each district and each nurse has an
assignment of approximately 2,700 pupils.
These nurses are appointed from a certified
list similar to that of other employees in
the service.
New York pays its nurses $75 per month
and employs them for twelve months in
the year. Boston pays the supervising
nurse $924 for the first year, which is in-
creased by an annual increment of $48
to a maximum of $1,116. The assistant
nurses receive $648 per year and an annual
increase of $48 until the maximum of $840
is reached. New Haven pays its nurse
$600 per year.
To sum up the case for the school nurse,
she is the teacher of the parents, the pupils,
the teachers, and the family in applied
practical hygiene. Her work prevents
loss of time on the part of the pupils and
vastly reduces the number of exclusions
for contagious diseases. She cures minor
ailments in the school and furnishes effi-
cient aid in emergencies. She gives prac-
tical demonstrations in the home of re-
quired treatments, often discovering there
the source of the trouble, which, if un-
discovered, would render useless the work
of the medical inspector in the school.
The school nurse is the most efficient
possible link between the school and the
home. Her work is immensely important
in its direct results and very far-reaching
in its indirect influences. Among foreign
populations she is a very potent force for
Americanization.
HEALTH AND RECREATION
RESORTS FOR CHILDREN.
(From the Journal of the American Medical Association,
November 28, 1908.)
Accord ING to a report of the director of
the public charities in Hamburg, there
existed in Germany in 1906 the following
institutions for children: 41 sanatoria in
salt-water bathing resorts, with 4,472 beds;
22 Seashore Sanatoria, with 2,164 beds; 28
Sanatoria in health resorts, with 1,304
beds; 6 Sanatoria for pulmonary patients,
exclusively children, and Io sanatoria for
pulmonary patients in which children are
also received, which together provide 283
beds. In addition there were the so-called
vacation colonies, in which children need-
ing recuperation are cared for during the
Summer vacation; 19 forest recreation
stations, etc. All together, 66,299 children
were cared for in 1906 in all these sanatoria
and convalescent stations.
(From the Detroit Medical Journal, November, 1908.)
DR. G. L. KIEFER, health officer of
Detroit, has established a free dental clinic
for school children. Fifty dentists have
volunteered to devote one hour per week to
this work.
(From the Transactions of the International Congress of
School Hygiene, London, 1907.)
PROF. T. D. WooD, professor of Physical
Education in Columbia University, makes
a plea for the instruction of teachers in
hygiene and sanitation. One tenth to one
eighth of the time should be devoted to
this subject for two years, where teachers
are trained, and an adequate preparation
should be required from all teachers.

S C H O O L H Y G I E N E 85
HYGIENE OF THE EYE IN SCHOOL
CHILDREN.
W. M. CARHART, NEW YORK.
(From the American Journal of Obstetrics, July, 1908.)
I. THE increase during 1ate years in the
number of children wearing glasses is due
not to an increase in the number of weak
or diseased eyes so much as to the greater
strain on the function of vision necessi-
tated by our more extended use of the eyes
for close work in the complex civilization
of the present day.
2. The normal child is born hyper-
metropic and without astigmatism. The
myopic child is either defective from birth
or has acquired myopia from the stress of
eyestrain through the “turnstile of astig-
matism.” Astigmatism is not congenital
but is practically always acquired in the
normal child during the early years of life
by excessive strain on the muscles of
accommodation. .
3. Kindergarten and primary work
should be so arranged as to avoid strain
on the muscles of accommodation of the
eye in the plastic years of childhood.
Hence, sewing and all weaving exercises
should be limited in amount, if not abso-
lutely eliminated.
4. Systematic study should be begun
only when the delicate and soft tissues of
the child's eyes have attained sufficient
formation to resist distortion on moderate
use of the accommodation. This means
that prolonged, close work should not be
allowed until the age of ten or over. A
child beginning systematic study at that
age will, with suitable care, be able at six-
teen or eighteen to acquire all the knowl-
edge possible to its more precocious com-
panion, and will have the inestimable
advantages of normal eyes and healthy
physique.
5. No young child should be encouraged
to compete with its companions for prizes.
Mental and ocular overstrain are the in-
evitable results of such educational mon-
Strosities. In the primary schools, es-
pecially, there should be no grading of the
children.
6. A child incapable of the prolonged
use of the eyes at the proper age should
not be classed as culpably lazy. In the
majority of cases there will be found un-
COrrected refractive error.
7. Inability to concentrate the mental
attention, and deficient powers of observa-
tion are often caused by bad visual-mem-
Ory resulting from eyestrain.
8. The symptoms and physical signs of
eyestrain in children can be easily recog-
nized, and there is no more brilliant success
in medicine than that which follows the
correction in children of refractive Over-
strain.
ADENOID VEGETATIONS AND IM-
PAIRMENT OF HEARING.
COHN.
(Zeitschrift f. Ohrenheilkunde, Vol. LII, p. 246.)
As an argument for the establishment
of exact examination of the nose, throat,
and ears in school children, the author
gives the result of his investigations in
I,573 cases. Of this number 31.5, or about
18 per cent, were found to have a sufficient
degree of impairment of hearing to make
a professional examination advisable, al-
though in the majority of them the im-
pairment had not been noticed, either by
the patients themselves or by the teachers.
In 153 cases the impairment of hearing
was directly referable to the presence of
adenoids, and in I2 additional cases it was
referable to the consecutive changes in-
duced by adenoids which had spontane-
ously resolved. The number of cases in
which adenoid vegetations could be re-
garded as the causative factor in the im-
pairment of hearing in all the cases
considered amounted, therefore, to about
52 per cent, and the author lays stress
upon the importance of a preliminary
examination of all school children, both
objectively and by hearing tests, at their
entrance upon school life, as well as at
1ater stated intervals, and gives the Bezold
estimate of 2 meters, for the whispered
voice, as the lowest acceptable standard.
(From the British Medical journal, September 26, 1908.)
UNDER the title, “Defective Children in
Glamorgan, Wales,” Dr. Williams, the
chief medical inspector, reports as follows:
Of 4,021 children examined in II 7 schools,
1,360, or 33.8 per cent, were found with
defects capable of interfering to a perma-
nent degree with educational progress.
The chief objects of medical inspection
ine summarizes as follows:
I. Classification of children for educa-
tional purposes.
2. Introduction into schools of a high
standard of personal cleanliness.
3. Diffusion and the teaching of hygiene.
4. Prevention and cure of disease.
86 S C H O O L H Y G I E N E
THE PLACE AND LIMITATIONS OF
FOLK DANCING AS AN AGENCY IN
PHYSICAL TRAINING.
DR. L. H. GULICK,
Director of Physical Training in the Public Schools, New
York City.
(From the Transactions of the International Congress of
School Hygiene, London, 1907.)
THE adequacy of athletics as ordinarily
organized is well enough for boys, as they
are able to carry on something of the sort
in 1ater life. For girls, however, they are
inadequate and provide no future line
for activity. Selected folk dances are
gymnastic in effect, present the emotions
and feelings of races who formulated them,
and they, therefore, rest on a racial basis.
They are developmental medically, they
improve coördination, and give grace,
balance, and sense of beauty.
CAUSES FOR LATERAL CURVATURE
OF THE SPINE.
(Arch. für Kinderheilkunde, Stuttgart; reprinted from
the Journal of the American Medical Association,
January 2, 1909.)
MUSKAT thinks that the influence of the
school has been overestimated, and that
the tendency to curvature is implanted in
earlier life. Carrying an infant always on
the same arm is one of the factors in its
development. Another is the way in
which older persons lead children by the
hand in the street, drawing up one side of
the child’s body and twisting it out of
shape. The older person's hand cannot
reach the upstretched hand of a little child,
and the gap is bridged by dragging up the
child’s hand above its natural level. The
1eft shoulder is pulled up in the air, the
other shoulder depressed, with the result
that a tendency to left scoliosis is im-
planted in the child’s spine. Too long
sitting without change in school and the
carrying of school books are liable to
aggravate existing scoliosis or develop it.
The school-produced scoliosis is a left,
convex, high dorsal scoliosis, while ex-
perience shows that this is comparatively
rare. Left 1ateral scoliosis is far more
common, and this is traceable to the period
before the school age is reached.
THE Secretary of the State Board of
Health of Indiana is authority for the
statement that no city in that state has
Imedical inspection, and yet Indiana has
otherwise one of the most efficient public
school systems in the country.
(From the Transactions of the International Congress
of School Hygiene, London, 1907.)
PROF. JoHN EDGAR, of St. Andrew's
University, writing concerning the instruc-
tion of teachers in hygiene and sanitation,
said that the Joint Committee of Univer-
sity Training Centers in Scotland provides
that “the course of professional training
shall include attendance at an approved
course in personal and school hygiene to
extend over a period of two terms of at
least ten weeks each and to include thirty
to fifty hours' instruction.” This in-
cludes not only lectures, but visits to
schools and study of their equipment from
a hygienic point of view, physical observa-
tion of children, and practice in tests of
sight and hearing. A course in physiology
is also required.
SUICIDE OF SCHOOL CHILDREN.
(From the Journal of the American Medical Association,
anuary 2, 1909. “Berlin Letter.”)
THE suicides of school children, in-
creasing year by year, constitute an
especially sad phenomenon in the hygiene
of education. In the higher schools of
Prussia, from 1880 to 1903, an average of
fourteen pupils took their own lives
annually; in 1907 the statistics show
twenty, and in 1908, so far, twenty-three
suicides among these pupils. Removal of
the causes leading to some of these suicides
among the older school children justifies
the employment of school physicians even
in the upper schools. So far, school physi-
cians have been officially installed only in
the lower graded schools. Our neighbor-
ing community, Charlottenburg, has made
a satisfactory beginning in this line by the
appointment of medical inspectors for the
high schools also. We may hope that this
example will soon be followed by other
C1t1es.
SANATORIUM AND EDUCATIONAL |
INSTITUTION FOR CRIPPLES IN ||
BERLIN–BRANDENBURG.
(From the Journal of the American Medical Association,
January 2, 1909. “Berlin Letter.”)
THE association for the treatment and
care of cripples for the province of Berlin!
opened an institution on December 1, 2}
combination of clinic and school. Thº
medical department is provided with all
modern means of aid. It has at command
an aseptic operating room, a room for
medical mechanics, apparatus for massage
and electrical treatment, an orthopedic



S C H O O L
H YG I E N E 87
Journal of Education
Edited by A. E. Winship
The only national educational weekly
published in this country.
Reports every progressive educational movement,
with editorial comment. Keeps you posted. Gives
you a clearer view of the purpose of education.
Specimen Copy on Application
. . . $2.5 O
Subscription, one year
To New Subscribers
With each new annual subscription to the “Journal
of Education” we will give one year's subscription
to “School Hygiene,” which is the only paper
published in the interests of the health of school
children.
New England Publishing Co.
29 A Beacon Street Boston
| Il Brattle Street
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ºftwaliºn ſhººtº *O
Trac-
FIRR][]]
ºn art-
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The Purifold
Paper Drinking Cup is the cup that protects.
The public cup is the cup that kills. One drink
from a public cup may bring disease or death.
Washing it is no protection. The dirt may be
removed, but the germs are not.
The PURI FOLD folds flat, costs little, and
lasts long. Every school child should use one.
Write for our special prices to schools.
BURNITOL MFC. CO.
Cambridge, Mass.
workroom, a department for hydrotherapy,
etc. The pedagogic department is under
the charge of an inspector of education and
comprises three school classes and a sub-
sidiary class, a class for the so-called
Froebel's games, and three workrooms for
Shoemaking and tailoring.
who cannot be placed in the school de-
partment, receive instruction in the sick
Ward itself. The industrial training of
the boys comprises shoemaking, tailoring,
office work, and orthopedics; that of the
girls tailoring, art embroidery, housework,
and office work. The institute has at its
disposal 358 beds, but is far from being
adequate to the need, as, in the district in
which the association is active, there have
been enumerated 6,617 cripples, 3,857 of
whom require institutional care.
HEALTH LECTURES.
(Journal of the American Medical Association, December
19, 1908.)
THE New York Board of Education is
presenting a course of health lectures at
the different public schools. These lec-
tures treat of subjects such as the care of
the teeth and skin, and suggestions in
regard to the prevention of tuberculosis.
Those children
HYGIENE IN ITS BEARING ON
SCHOOL LIFE.
(From the Journal of the Royal Sanitary Institute, London.)
THE short course of lectures on “Hy-
giene in Its Bearing on School Life,” which
was instituted in 1906, was repeated during
1907. The course is arranged to assist
teachers and others interested in the train-
ing of children and the structural condi-
tions of the school, who purpose entering
for the examination in ‘s Hygiene in Its
Bearing on School Life.” It consisted of
lectures and practical demonstrations
relating to personal hygiene, and to schools,
buildings, and equipment. A nominal fee
was charged for these lectures; and for the
spring course seven students entered their
names and six students attended the au-
tumn course.
SINCE 188o the average height, weight,
and strength of Harvard students have
increased respectively an inch, four to
eight pounds, and thirty per cent, which
Dr. Sargent, director of the gymnasium,
attributes to the increased attention paid
to the body.









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Hygienic Schoolroom Floors
Hygienic conditions in schools and in rooms of all public
buildings should be maintained with the most scrupulous
care, for a dust-laden atmosphere is a constant menace to health.
Continuous activity on the part of pupils stirs up the dust from the floor
and keeps it in circulation. Proper ventilation will assist materially in keeping
dust at a minimum, but the only solution of this problem is to eliminate the
dust entirely. This can be successfully accomplished by treating floors with
STANDARD
FLOOR DRESSING
Actual use has proved beyond question its effectiveness as a dust-exterminator—the
º danger from disease contagion from dust being reduced almost one hundred per cent.
Standard Floor Dressing is also a remarkable preservative for floors. It not only keeps
the floors from splintering and cracking but actually lessens the labor in caring for them.
Dealers everywhere sell Standard Floor Dressing in barrels and cans. Apply three
or four times a year for best results.
WE WILL PROVE the remarkable efficiency of Standard Floor Dressing at our expense.
On request we will apply if fo the floor of one schoolroom or corridor free of all charge.
- We are confident that a frial will result in the continued use of Standard Floor Dressing.
Every Board of Education, every School Superintendent, Principal and Teacher
should know how to guard the health of children under their care. Learn what eminent
º medical authorities have to say on the subject. You will find interesting reading in our
º free booklet “Dust and Its Dangers.” Write for a copy.
- STANDARD OML COMPANY (Incorporated)
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§chool Hygiene
340/Issued BY THE AMERICAN school. HYGIENE Association
, S30
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
WOL. I, No. 7
BOSTON, MASS.
FEBRUARY, 1909
John A, BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
ELMER. E. B.Rown, Ph.D., United States Commissioner
of Education.
WILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
John J. C.Ronin, M.D., Assistant Chief Medical Inspector
Health Department, New York City.
ABRAHAM JAcoBI, M.D., LL.D., Professor of Diseases of
Children, New York City.
THOMAs M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
New York University.
Joseph LEE, A.B., A.M., LL.B., Boston.
PHILIP KING BRowN, A.B., M.D., Medical Department,
University of California.
Robert W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
GEORGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
J. H. McColloM M.D., Professor of Contagious Diseases,
Harvard University.
J. H. McCURDY, M.D., Director International Young
Men's Christian Association Training School.
Cbe Qfficers amo Council of the Eissociation
| rary President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABot; Secretary and Treasurer, Dr. THoMAs A. STOREY.
CHARLEs A. MooRE, Chairman Welfare Department
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
NICHOLAS MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABOT, M.D., Fellow of Harvard University.
FREDERIck ForcHHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. FischEL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALsey GULick, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart:
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEYLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. STOREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
GeoRGE S. C. BADGER, M.D., Editor .
D. C. HEATH AND CoMPANY, Publishers
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
All communications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIAL.
-
THE PHYSICAL CONDITION OF
SCHOOL CHILDREN.
THE physical condition of school chil-
dren is a matter of great importance.
From all over the civilized world, from
Crowded cities and from widely extending
towns, come the reports of the poor physi-
cal condition of the school children. So
Similar are the reports that they are con-
Vincing. Defective vision, impaired hear-
ing, decaying teeth, poor nutrition, un-
der-development, enlarged glands repre-
senting nature's effort to ward off some
infection from more vital parts, adenoids
obstructing the necessary flow of oxygen
to the lungs, – these defects and many
others are reported as being widely prev-
alent among school children everywhere.
To remedy these defects where they
already exist and to prevent their develop-
ment in others, the coöperation of parents,
teachers, nurses, and physicians is essen-
tial. But before remedial or preventive
work can be done, parents, teachers, and
even physicians, must be informed. Insist-






Qo - S C H O O L H YG I E N E
ent demands for the necessary remedies will
follow and cannot be denied as the parents
are the taxpayers. The Journ AL aims to
be a decided factor in this educative pro-
CeSS.
Judging from 1etters and periodical ex-
changes received from many sections of
our own country and from Canada,
Mexico, and South America, the JOURNAL
is a welcomed periodical, instructive and
suggestive. We hope it will prove a
decided help in the establishment of effi-
cient inspection in those communities at
present without it.
THE JOURNAL.
THERE have been issued now six num-
bers of ScHool, HyGIENE, and it seems
wise at this time to consider again the
reasons for publishing the Journal, and
to urge upon those interested in the
physical welfare of school children the
need of supporting it by subscription and
by sending material for publication.
The Journ AL, issued by the American
School Hygiene Association, is the result
of a desire to secure improved school con-
ditions for children, to awaken public
interest in their physical welfare so that
needed improvements can be obtained, and
to report progress in this movement.
From those now receiving the Journal
we urge a subscription. A splendid oppor-
tunity to do good is, to order the Journal
sent to some group of teachers for a year.
One subscriber has given twenty-five dol-
1ars ($25) to cover subscriptions for the
school teachers of Georgia. We must have
paid subscriptions if it is to be continued.
Doubtless many have failed to respond
from forgetfulness; others possibly do not
realize the necessity of giving their support
loy subscribing.
The arrangements whereby the Journal
is at present published terminate with the
June number. Its continuance after that
time will depend on the support it receives.
BOOK REVIEWS.
American Play Grounds. By F. B. MERC
Selling agents, The Dale Associatio
Boston. Price, $1.5o net.
The playground movement in Americ.
has taken on wonderful activity in th:
past few years. The value of directed
play is being more and more recognized and
assumes no small part in the educatio
of the child. The book Mr. Mero has
written is as interesting as it is instructive
The reader is convinced of the value o
properly conducted playgrounds over thos:
without supervision. It will be surprising
if many cities and towns at present without
playgrounds do not set about to procur:
them as a direct result of this book.
The details of starting and equipping
playgrounds, of supervision, of the games
best adapted to certain ages, of estab:
1ishing proper discipline, and of the cost
are clearly set forth.
Medical Inspection of Schools. By GULICR.
and AYREs. Published by Charitics
and The Commons, New York City|
Price, $1.o.o. N
The appearance of this volume, at a
time when the medical inspection o
schools is being so widely adopted, is very.
timely. The first two chapters will prove
of special interest to parents and teachers
everywhere because of the excellent dis-
cussion of the reasons for medical inspec-
tion.
The establishment of an efficient system
of school inspection is a difficult matter,
Many questions arise the correct answering
of which is most important. The part the
teacher should have in the work, the
value of the school nurse, the control of
the physicians, – whether by the board of
health or by the board of education, — the
extent of the inspection of pupils, —
whether for the detection of contagious
diseases only or for all physical defects, -
and the matters of expense, are all given
careful and eminently fair consideration.
The book ought to be in a11 school and
looard of health 11braries.
PLAY HYGIENE.
LILIAN V. ROBINSON,
Hawthorne Club, Boston.
.
It was a desire to “sugar coat '' the
subject of hygiene, to make it sufficiently
alluring for a Boston vacation playground
and “play sessions '' (described in the
December number of ScHool, HyGIENE),
































S C H O O L H Y G 1 E N E 9 I
hat led Hawthorne Club workers to invent
he game of “play hygiene.”
| A group of older Hawthorne Club mem-
ers (girls from eleven to fourteen) volun-
bered to help the workers “plan out the
ame '' for younger children in the Way
treet School, who come to the playground
ºr play sessions during the school months.
A very attractive doll with a complete
utfit of hygienic clothing (this the older
hildren helped make), a toy bed with the
roper bed clothing, mattress, etc., are
Sed for illustrating the lessons, the dol1
epresenting a child of the age of those
or whom the 1essons are planned (seven
r eight years). The doll's clothes and
he bedclothes are useful object lessons.
he following scheme of lessons in “play
ygiene '' was worked out with the older
hildren during the long summer days
hich they spent in the playground, two
rained nurses, a physician, the assistant
uperintendent of the Boston schools, and
trained gymnast collaborating or ad-
ising. The mere outline of the 1essons is
iven; each subject was considered at
One length, of course.
l'irst lesson. General scheme. We
ill consider the day of a child from her
irst awakening in the morning until she
etires at night, from the standpoint of
ealth. Tell why health is important: I.
2. That ill health makes us do poor
ork in school and later in any business or
ther calling we pursue.
A doll is used as “the child '' and is
hown first in miniature bed, with proper
edding, etc., and proper clothing for
'child.”
Throughout the 1essons the doll, toy
urniture (bath tub, toilet articles, etc.),
Te used, the doll's skin, hair, teeth, etc.,
eing considered in the separate lessons.
| Second lesson. Child in bed. Show
roper way of making bed and leaving it
Or ventilation, care of bedroom, the kind
ibedclothes to be used, etc.
Third lesson. Child rises, bathes, says
Tayers (whether Jewish, Catholic, or
rotestant). A proper and devout atti-
ide of mind helps one to keep well.
any wise people think fretting and worry-
Hg and losing one’s temper affect health.
Fourth lesson. Care of skin.
Fifth lesson. Care of hair.
Sixth lesson. Care of teeth.
Seventh lesson. Care of nails, eyes, ears,
0Se (or these can be separate lessons).
ſ
Eighth lesson. Ventilation; care of ex-
cretions; habits to avoid, such as spitting,
putting pencils in mouth, eating cheap or
dirty candy, eating between meals, etc.;
the importance of learning to cook as soon
as an opportunity comes.
Ninth lesson. Clothing, its cleanliness.
Personal neatness as a valuable business
aSSet, etc.
Tenth lesson. What to do in case of a
burn, or when touched with frost, or a cut,
if a good physician or the dispensary
cannot be reached at once.
Eleventh lesson. Review and reading of
prize paper.
At the end of the summer, children who
wished (for this was all volunteer work)
wrote papers on the general subject,
“ hygiene,” or on any part of it taken up
in the “game.” A small prize was offered
for the best paper. As a matter of fact, it
was difficult to choose the “best,” as they
were all about equally good. Two of the
children's papers (given below) are perhaps
the best proof of the success of the “game.”
It may be interesting to add that the 1ittle
Italian girl, Mary T., whose paper follows,
now has a room like the one she describes,
having earned its furnishings herself by
doing cleaning in one of the Hawthorne
Club houses after school hours.
Mary T., just fifteen years (Italian):
CARE of A BEDRoomſ.
THE subject on hygiene most interest-
ing to me is, “The care of a bedroom,”
which I think every young girl ought to
know how to take proper care of.
The bedroom that is arranged with
simple furniture and is looking very neat
is always attractive to everybody.
If I were to have the selection of a bed-
room, I'd select one just as I am going to
describe.
The room should have a nice hard
wooden floor, no carpet, to avoid the
collecting of so much dust. Then, a
simple wooden bed, which is as good as an
iron bed and can be painted when worn
of its first paint. Some furniture but
plain, and as little as possible, as, for in-
stance, besides a bed, a bureau, chair, a
1ittle table, a wash stand, and a 1ittle rock-
ing chair. Light and pretty wall paper,
which makes a room look very bright, and
1ittle white 1awn or muslin curtains on
windows, if more than one. A few pretty
pictures hanging on the wall frame, but
not too many. I think this is plenty for a
lbedroom.

























92 S C H O O L H YG I E N E -
Now, I will consider that a child, or
young girl, is in bed. In the morning she
awakes, gets out of bed, if Catholic says
her prayers. With windows open takes
a few exercises, dresses and makes her
morning toilet. Then, when all ready,
makes her bed by airing all the bedclothes,
takes a chair, places at foot of bed, turns all
the clothes over on chair, and has them
air an hour or more if possible. After
everything is perfectly aired, she turns
mattress down and remakes her bed very
neatly as follows: Mattress well laid
down on spring, spreads on the first sheet
and tucks in all the way around. Spreads
on upper sheet and lets it hang all around
except at foot of bed. Then spreads the
blanket over that and tucks in at foot and
turns the upper sheet down at the head
over blanket. Pillows well puffed and
aired and placed at head over all. After
she has made her bed looking neatly, she
should set her room to order by sweeping
it and dusting all around. The floor
should be washed as often as necessary
but swept every morning. Window sills
dusted and windows should be cleaned as
often as once a week at least. The cur-
tains should always be looking nice and
fresh. Then the bureau must be set in
order. Clean out the drawers if necessary.
Comb and brush cleaned as soon as used.
Excretions must be carried away the first
thing in the morning and then sprinkle
disinfectant.
After all this has been done the room is
1eft looking just as neat as it can possibly
1ook.
This is the way I think a bedroom ought
to be kept.
Minnie D., fourteen years (Jewish):
PERSONAL HyGIENE.
REASONS FOR KEEPING CLEAN.
I. Induces perfect health for the person
1Himself.
2. Uncleanlinesss causes the spread of
disease, which endangers the friends around
11S.
3. By keeping neat and tidy we make
other people happy besides ourselves.
4. If a person has a neat appearance it
expresses his character.
5. If we have a neat appearance others
will follow our example.
6. Work. We can work much better at
our school and home if we are clean.
7. If we are clean we can live longer and
better 11ves.
clean.
8. In applying for a business positio
the one who appears the neatest will hav
a much better chance than the untidy one
REQUIREMENTS FOR HEALTH.
I. If we expect to be strong and health
we must keep good courage.
2. Bad thoughts are injurious to o
health.
3. Bathing is very important. O
daily bath with vigorous rubbing helps t
keep the pores of the skin open and in thi
way we keep our health.
change our clothing regularly.
time we wear more woolen clothes tha
linen or cotton ones, because we want t
keep our bodies warm. It is not health
to wear too warm clothing in the winter-
as it shuts out the air from the body
Wear it sufficiently warm for comfort. . -
5. Care of the mouth and teeth. W
should take special care of our mouth
Wash it every morning so it will have
clean odor. Our teeth should be brusho
every morning. We should go to th
dentist twice a year and have them ex
amined. Dental floss is a very good thing
for the teeth. It makes the cracks very
6. Care of the eyes. We must be very
careful not to strain our eyes. Reading i
the cars or trains while they are in motio
is very bad. Artificial and poor light i
very bad for them. Reading when yo
are lying down is very hurtful to the eyes.
7. Care of the ears. The ears should b
washed each morning. There is some wax
in our ears which must be removed. Thi
can easily be done by twisting the corne
of a towel moistened with water and wiping
out the wax.
8. Care of the finger nails. The finge
nails should always be clean and neatly
trimmed. This can be done by usin
an orange-stick, file, or scissors.
9. Care of the hair. One of the most
important things to do in the morning is
to comb the hair. A girl should wear her
hair parted and braided back neatly. If
the hair is untidy it makes the person look
very careless. It should be washed once
a month. A shampoo makes the scalp
clean and makes the hair grow.
Io. Care of the feet. We must buy our
shoes so that the feet will have plenty of
room. In school we must be very careful
that our seats are low enough for our feet
to touch the floor. In winter we must




















S C H O O L H Y G. I. E. N. E.
93
wear rubbers to protect the feet from
getting wet. A very important thing is to
keep the feet dry.
II. Ventilation. Our bedrooms should
always be well ventilated. In summer all
the doors and windows should be open as
much as possible. In winter we must have
warm air but at the same time we must
have fresh air without causing a draught.
12. Religion. Religion is important for
health. If we say our prayers regularly
and keep our religion as we should we feel
much more comfortable and happy.
13. Rules for health.
Keep your house clean and well aired.
Go to the toilet regularly.
Keep good company.
Keep away from disease.
Assume good position in school.
Keep yourself neat and tidy.
Eat simple and only nourishing foods.
A BUREAU OF CHILD HYGIENE.
(By the Department of Health of the City of New York
and The Bureau of Municipal Research.)
THE establishment of the division of
child hygiene (by resolution of the Board
of Health, August 19, 1908) followed upon
a series of coöperative studies and ex-
periments by the Department of Health
and the Bureau of Municipal Research. A
study, conducted in the spring of 1908, of
the prevailing methods and results in the
examination of school children for non-
contagious defects, demonstrated clearly
that the accuracy of the examinations was
open to serious questions, and that no ade-
quate methods had been worked out for
Securing the treatment of children discovered
to be defective. Inspectors examining in
the same schools rendered reports differing
as widely as by Too per cent in the number
of children found defective; while of the
parents notified that their children re-
quired medical attention, only 8 per cent
reported any action. It was thus made
evident that more effective methods of
Supervision and of follow-up must be
devised.
To determine to what extent action on
the part of parents could be obtained by
personal interview and explanation, an
experiment in three schools was tried
covering the 1ast six weeks of the school
year 1907–1908. The parents who did not
respond promptly to the department's
customary postal notification that their
children needed treatment were inter-
viewed either at school or at home, with
the result that over ninty-five per cent either
took action or requested the department's
nurses to act for them. In three fourths of
the cases only one interview was necessary,
while the cost in nurse’s service per pupil
treated was only about sixty cents. Even
this figure could be considerably 1owered in
well-established work.
TREATMENT.
The main object of the experiment was
to discover how far treatment could be
secured through the method of personal per-
Suasion of parents. It had been asserted
that a large number of parents would
resent interference and would refuse either
to provide treatment or to allow it to be
provided. This view was not shared by
those directing the experiment; they
believed that the principal obstacles to be
overcome were ignorance or indifference,
and that through patient, tactful ex-
planation the great majority of parents
could be made to see the reasonableness of
treatment.
The general methods pursued were the
following: The inspector continued to
mail to parents the postal-card notifica-
tions as previously, at the same time giving
to the nurse the record of the physical
examination, indicating what defects re-
quired treatment. Within a few days
she either visited the home or requested
the parent to come to the school to consult
with her. At this interview, having the
child’s record before her, she explained the
Inature of the defects from which the child
was suffering and the necessity for having
them treated. She then urged the parent
to consult the family physician; where
there was none, and the family claimed to
be unable to pay a physician's fee, a dis-
pensary was suggested. Where, owing to
their occupation, the parents were
unable even to take their children to a
dispensary, the nurse obtained from the
parent a written request to take the
children herself.
The belief in the effectiveness of this
method was justified by the result. Only
4.2 per cent of the total number of parents
refused to act, while 81 per cent of the total
number of children needing treatment were
actually treated for one or more defects.
CONCLUSIONS.
The conclusion of the study and ex-
periment described may be summed up in
a few words: .
I. The examination of about fifteen
hundred unselected children, of whom
from 88 per cent to 98 per cent were
-
94 S C H O O L H Y G I E N E
declared in need of treatment, argues that
the necessity for medical supervision of
school children is more serious than has been
Supposed.
2. The obstacles to removing physical
defects are not primarily those of unwilling-
mess of parents. Personal interviews and
explanation by School nurses obtained
action or permission from 95 per cent.
3. The cost of such a system is not pro-
hibitive. Three fourths of the children
whose treatment was secured required but
one interview; the cost in nurses’ salary
was sixty cents per child treated, and this
can be reduced.
4. The most difficult problems are those
relating to adequacy of facilities for treat-
ment. The treatment of children involves
much work of a routine nature which has
no particular interest for the average clinic
physician. Whether working arrange-
ments can be made with dispensaries and
clinics for special attention to children
remains to be seen. The dental care of
school children has as yet received little
attention in this country. With a single
exception the existing clinics provide
for extraction but for 11ttle or no
filling.
THIRD CONGRESS OF THE AMERICAN SCHOOL
HYGIENE ASSOCIATION.
MEETING WITH THE DIVISION OF SCHOOL SUPERINTENDENTS OF THE N. E. A.,
CHICAGO, IL.L., FEBRUARY 22, 23, 24, AND 25, 1909.
PRELIMINARY ANNOUNCEMENT.
REGULAR PROGRAM.
FEBRUARY 22.
8.oo P.M. Meeting of the Executive Committee.
9.oo P.M. Meeting of Council.
(These committee and council meetings are open to members only.)
FEBRUARY 23.
9.30 A.M.
Address of the President.
HENRY P. WALCOTT, M.D., LL.D., Chairman Massachusetts State Board of Health.
Report of Committee on “The Status of Instruction in Hygiene in the Schools and
Colleges of America.”
LUTHER H. GULICK M.D., New York City.
H. H. SEERLEY, LL.D., President Iowa State Normal School.
“The Problems of Hygiene and the Province of the Normal School.”
MISS EVELINE GOLDSMITH, President of the New York Association of the Teachers
of Crippled Children. -
“The Place of the Crippled Child in the Public School System.”
2. OO P.M.
A. E. BENNETT, Ph.D., Dean Department of Pedagogy, Upper Iowa University.
“School Hygiene and Efficiency.”
WILLARD S. SMALL, Ph.D., Principal, Eastern High School, Washington, D. C.
“The Health of Teachers.”
J. H. KELLOGG, M.D., Superintendent Battle Creek Sanitarium.
“Suggestions toward Checking the Race Degeneracy due to the Conditions of School Life.”
JESSIE BENTON MonTGOMERY, Principal Grammar Department, State Normal
School, Indiana. -
“School Hygiene and Community Health.”
9.oo P.M. Smoker.


S C H O O L H Y G I E N E 95
FEBRUARY 24.
9.30 A.M.
1. E. L. STEVENs, L.H.D., Associate City Superintendent of Schools, New York City.
“Prophylaxis in the Practice of the School Superintendent.”
2. LEONARD AYREs, New York City.
“Relation of Physical Defects to Retardation.”
3. S. H. WooDBRIDGE, Associate Professor of Mathematics, Massachusetts Institute
of Technology.
“Air and the School-house.”
4. C. WARD CRAMPTON, M.D., Director of Physical Education, Public Schools of New
York City.
“A Demonstration Method of Teaching Hygiene in the High Schools and Its
Correlation with Biology and Physical Training.”
2.OO P.M.
1. LUTHER H. GULICK, M.D.
(Subject not announced.) - -
2. GEORGE H. MARTIN, LL.D., Secretary Massachusetts Board of Education.
“A Lesson from Medical Inspection.”
3. E. O. JoRDAN, Ph.D., Professor of Bacteriology, University of Chicago.
(Subject not announced.)
WILLIAM E. CHANCELLOR, A.M., Superintendent of Public Instruction, Washington,
“School-house Accommodations.”
JOINT PROGRAM WITH THE DIVISION OF SCHOOL SUPERINTENDENTS.
FEBRUARY 24.
8.15 P.M.
WILLIAM H. MAxwell, LL.D., Superintendent of Schools, New York City.
“The Necessity for Departments of Hygiene within Boards of Education.”
GEORGE E. JoHNson, Superintendent of Playground Association, Pittsburg, Pa.
“Hygiene of the Public Playground.”
WooDs HUTCHINson, M.D., New York City.
“The Evil Influences of School Conditions upon the Health of School Children.”
FRANK ALLPORT, M.D., Professor of Clinical Ophthalmology and Otology, Northwestern
Medical School.
“A Plea for the Systematic Annual and Universal Examination of School Children's
Eyes, Noses, and Throats.”
FEBRUARY 25.
Regular program continued.
9.30 A.M.
John J. CRONIN, M.D., First Assistant Chief Medical Inspector, Board of Health,
New York City; Chairman of Committee on the Status of Medical Inspection
in America.
“Status of Medical Inspection throughout the United States.”
2. J. H. HURTY, M.D., Secretary State Board of Health, Indiana.
“The Status of School Hygiene in Indiana.”
3. DAVID SNEDDEN, Ph.D., Adjunct Professor of Educational Administration, Teachers
College, New York City.
“Education in the Newer Aspects of Hygiene Requires Specialized Instructors in
the School System.”
I
-
4. Business Meeting.
Abate the Dust Evil
It has been proven beyond a shadow of doubt that many diseases of
school children can be traced directly to the dusty condition of schoolroom
floors. Dust carries the germs of disease. The constant changes of classes and
the ever moving feet of the pupils cause the dust to rise from the floor and cir-
culate through the air. Proper ventilation aids materially in getting rid of dust,
but so long as the floors remain dry and untreated the danger will still exist.
Hygienic conditions and dustless schoolroom floors can be had at small
cost. By treating floors three or four times a year with
STANDARD
FLOOR DRESSING
dust can be practically eliminated. Experience proves that Standard Floor
Dressing reduces dust over eleven- twelfths; so that with dust abated and the
atmosphere cleansed the chances for contracting disease are reduced propor-
tionately.
Standard Floor Dressing not only makes sanitary schoolrooms, but also
preserves the floors. Prevents them from cracking and splintering and at the
same time lessens the cost and labor of caretaking.
Standard Floor Dressing is sold everywhere in barrels, half-barrels, and
in one gallon and five gallon cans.
Not intended for household use.
A FREE DEMONSTRATION
We want to prove the efficiency of Standard Floor Dressing at our
own expense. We will treat free of charge one schoolroom or corridor
floor or part of one floor in any store or public building, just to show
how Standard Floor Dressing eliminates dust. To ſocalities far removed
ºłº from our agencies, we wiſ/ send free sample with fu// directions for
ºAº applying.
- Boards of Education, School Superintendents, Principals and Teach-
ers should write for information, testimonials and our free book, “Dust
and its Dangers.” The health of your pupils may depend on your action.
STANDARD OIL COMPANY
(Incorporated)


chool Hygiene
lf? ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
3 PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
,536 -
BOSTON, MASS. MARCH, 1909
Vol. I, No. 8
(Ibe (Wfficers amo Council of the Eł93Ociation
Honorary President, Hon. THEoDoRE Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABOT;
John A BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
ELMER. E. B.Row N, Ph.D., United States Commissioner
of Education.
WILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
John J. CRoNIN, M.D., Assistant Chief Medical Inspector
Health Department, New York City.
ABRAHAM Jacobi, M.D., LL.D., Professor of Diseases of
Children, New York City.
THOMAS M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
New York University.
Joseph LEE, A.B., A.M., LL.B., Boston.
PHILIP KING BRow N, A.B., M.D., Medical Department,
University of California.
Rob ERT W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
GEORGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
J. H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
J. H. McCURDY, M.D., Director International Young
Men's Christian Association Training School.
Secretary and Treasurer, Dr. THoMAs A. StoREY.
CHARLEs A. MooRE, Chairman Welfare Department
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
Nicholas MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABOT, M.D., Fellow of Harvard University.
FREDERIck ForchHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON.E. FischEL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULick, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W HETHERINGTON, Ph.D., Director of Depart;
ment of Physical Training and Athletics, University of
Missouri.
GEORGE MEyLAN, A.M., M.D., Adjunct. Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. StoREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
GEORGE S. C. BADGER, M.D., Editor .
D. C. HEATH AND CoMPANY, Publishers
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
All communications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIAL.
TUBERCULOSIS AND SCHOOL
CHILDREN.
THIS number of the Jour NAL is devoted
to a consideration of tuberculosis and
School children. In previous numbers
there have been articles dealing with this
subject, and in the December number it
was considered editorially. The great
campaign which has been waged during
the past few years against tuberculosis is
already showing good results in a lessened
death-rate, and in the intelligent efforts
being made to detect and properly care
for those in the earliest stages of the
disease. The open-air schools already
firmly established in England and in
Europe, and now being established in our
own country, are the direct result of this
universal campaign against the disease.
The public schools are not breeding
places of tuberculosis. It is doubtful if
any child contracts the disease in school.
The startling statement made that tuber-
culosis is a menace to the health of school
children is likely to be misunderstood.


98 S C H O O L H Y GI E N E
=
School life confines young children in
crowded and too often badly ventilated
rooms. Many of these children sleep eight
or ten hours in unventilated and often
crowded bedrooms. The few remaining
hours of the twenty-four are all that are
1eft for out-of-door 1ffe. Some of these
children are of tuberculous families and
have already been seriously exposed to
infection; some, as a result of more or less
severe illnesses, especially measles, whoop-
ing cough, and influenza, are 10w in physical
strength and in resistance to disease.
These are the children most likely to
loreak down under the strain of schºol life.
This breakdown is often due to a 1atent
infection becoming active.
Modern methods of diagnosis have made
it possible to detect these so-called pre-
tubercular and early cases. Modern
methods of treatment have made it possi-
lole for these children to be “cured ”
while continuing their education.
Whether children are really tubercular
or not, if physically unfit, or “run down ''
from any cause, it is a first and imperative
duty to get them well. The open-air
school and the “open windows '’ school-
room will greatly aid this effort, and with-
out 1oss of school time.
THE FRESH-AIR SCHOOL.
MISS ISABEL F. HYAMS.
“Let common need — the kinship of an unknown
destiny —
The unsolved mystery round about us, make
A man more F. than the gold of Ophir,
Sacred, inviolate, unto whom all things should
Iminister.”
— Whittier.
THE trend of medicine for some time has
been distinctly hygienic, basing its meth-
Ods more and more upon the time-honored
“ounce of prevention,” and certainly
there is, for many reasons, no more inter-
esting or important application of this
method than the School of Outdoor Life
for Tuberculous Children as conducted
during the summer months by the Boston
Association for the Relief and Control of
Tuberculosis, and continued since Septem-
ber in coöperation with the Boston School
Board by reason of the satisfactory results
obtained.
So much has been written lately about
this special disease that the public is
familiar with the fact that the number so
afflicted is appalling. Happily it can be
controlled, and, indeed, cured, provided its
presence is detected in the earlier stages,
the treatment being entirely hygienic in
its nature, and depending first of all upon
an unlimited supply of fresh air, and, next,
the necessary amount of nutritious food.
To secure these requirements for the
children to be treated, the first step was
the establishment of an outdoor school, -
for school it really is, - one demand being
that children withdrawn from the public
schools shall be kept up to grade and in
readiness to step back into the ranks when
improved health makes that feasible.
One hopeful feature of this work is its
feasibility, for in summer any pleasant
spot will do, preferably out of town; and
this is the best time to start the school, as
it gives an opportunity for the pupils to
accustom themselves to outdoor life before
the advent of cold weather.
When it is not possible to secure an open
space, the same end may be attained in a
measure by utilizing a room in any school
building and keeping the windows open, or,
better still, making use of the roof.
For at least six months of the year the
only equipment needed is a “lean-to " for
a kitchen, rooms for bathing and toilet
purposes, and a tent for use as a dining
room and shelter during rain storms.
This is the equipment which has been
in use at the Outdoor School on Parker Hill
since July 1 up to the present time.
A partial sketch of a day's work may
perhaps be of interest:
Arriving at eight o'clock in the morning,
the children were given their first lesson
in personal hygiene, having been taught
to wash hands and face and to brush teeth
at proper time, and were given a nutritious
breakfast.
The first part of the morning was de-
voted to housework and the care of flowers
and vegetables in the garden.
Little invalids as they are, it is necessary
to guard them from harmful fatigue, and to
this end an hour of physical rest later in
the forenoon was made fruitful by a talk
and study of the forms of life about them.
The child who has had his eyes open
lby contact with nature and her various
phenomena will never forget the enrich-
1ment.
Just before dinner, an abundant meal,
S C H O O L H Y G I E N E 99
an hour of play, also subject to supervision,
lest increasing vitality lead them beyond
their strength. An afternoon of rest and
play with an opportunity to use the shower
bath was brought to a close with a good
Supper.
At the end of two months the improve-
ment in health and strength and spirits
was very marked. The children had
gained from two to ten pounds in weight
and had changed from weak and lifeless
little invalids to cheerful and lively chil-
dren with ambitions to climb trees and do
“stunts.”
Of the thirty-two admitted, all well-
defined but incipient cases, from families
where it was known there was tuberculosis,
nine were dischared by the examining
physician as “arrested ” and in a suit-
able condition to return to the public
school. -
Our sympathies are, of course, at Once
enlisted for any suffering child, but on the
grounds of economy and for selfish reasons
it would certainly be a wise thing to have
more of these schools established as part
of the regular school system. Not only is
the presence of a tuberculous child in a
crowded school room objectionable on
hygienic grounds, but the standard of work
is lowered. No teacher can get the best
results from a sick child, and his presence is
an added burden upon her time and
strength.
We have already provided special
schools or departments for the mentally
or morally weak child; why not for the One
physically below parf
For the sick child who regains his health
all things are possible. If he is not helped
to regain his health he will grow up, if he
survives at all, into a handicapped adult
and the burden his shoulders are too weak
to bear will fall upon the community at
large. -
With the arrival of severe weather steps
must be taken to guard the outdoor child
from discomfort. He must have warm
clothing, blankets, bags for feet and legs,
mittens, overshoes, and cap.
A building containing kitchen, dining
room, class rooms, rest room, etc., all of
which can be heated, must be provided.
To meet these requirements a change was
made necessary from Parker Hill, and the
school has been established in suitable
quarters provided by the city at the Re-
fectory in Franklin Park.
In winter the program is modified to
meet new conditions, the study periods
are reduced to twenty minutes each, and
frequent changes are made to give neces-
sary exercise.
Not more than twenty children can be
successfully instructed by one teacher and
an assistant, for the ages range from seven
to fourteen years, and it is almost indi-
vidual work that is required.
As in summer, the children arrive at
the school, wash hands and face and break-
fast from 8.45 to 9.
9 to 9.15. Work in class room by
one section while the
other is doing work in
in kitchen and dining
TOO111.
9.15 to 9.30. Opening exercises.
9.30 to 9.35. Physical exercises.
9.35 to Io.o.o. Number work.
Io.oo to Io.o.5. Breathing exercises.
Io.o.5 to Io. 20. Spelling.
Io. 2 o to Io.4o. Number work.
Io.4o to II.oo. Recess.
II.oo to II. I 5. Reading, C.
II. 15 to II.30. Reading, D.
I 1.30 to II.35. Rest period, relaxation.
I 1.35 to II.5o. Reading, B.
II.5o to 12.oo. History.
12.oo to 12.15. Play and work in dining
TOO111.
I 2.15 to 12.30. Washing.
I 2.30 to I. oo. Dinner.
Brushing teeth, kitchen,
and dining room work.
Preparatory work in class
TOOIn.
I.oo to I. I 5.
I. I 5 to I. 30.
1.30 to 1.45. Music and voice drill.
1.45 to 2.15. Divisions C and D, rest.
B and A, language or
geography.
2.15 to 2.45. B and A, rest.
2.45 to 2.55. Physical exercise.
2.55 to 3.30. Drawing, which may be:
Sketching.
Cutting.
Painting.
Manual work.
3.30 to 3.45. Play games in groups;
prepare tables for sup-
per.
3.45 to 4.oo. Washing.
4.oo to 4.30. Supper.
4.30 to 5.o.o. Home.
The establishment of these schools would
undoubtedly do an immense amount of.
good by educating teachers and the
general public to an appreciation of the
value and necessity of fresh air.
Much of the friction arising between
teachers and pupils vanishes when the

IOO
S C H O O L H Y G T E N E
atmosphere is not laden with that which
provokes ennui, nervousness, and even
nischief.
The restless, troublesome child will be
sent to a schoolroom situated on the roof
where he can have a few weeks in which
to recover his balance.
Our homes and Our Schools are over-
heated and underventilated; and, Strange
as it may seem, those situated in the
country are often the worst examples.
That education in this line is possible
is demonstrated by the attitude of the
fresh air children. They do not want to
be discharged and return to the old “ hot
and stuffy '' schoolroom. They affirm
that they can think better and quicker
where they are.
That the work may not be neut...alized
by unsanitary home conditions, and that
the good results obtained may be made
permanent, the coöperation of the mothers
must be obtained by means of mothers’
meetings and visits to the homes of the
children.
Many mothers are not wise, but most of
them are loving and will be anxious to
1earn how to care for the children more
rationally when once they see the improve-
ment is actually effected by the simple
means employed.
The stress placed upon right living must
exert a wide influence in the home, for the
parents have a living example in the rosy-
cheeked happy boys and girls who return
to them at night, full of the experiences
of a day in the open.
It is to be hoped that there are not many
lmones in Boston where fresh air is not
obtainable and clean water and safe sani-
tation do not obtain. Where there are
such, these children will help us to find
them, and when the mothers are aroused
they will select and demand hygienic
living places.
Those who have read Jacob Riis's
Heartstirring story of the work done to
help the children of the poor in New York
City to a better mental, moral, and physical
condition will remember that first, 1ast,
and all the time the weapon was fresh air.
SCHOOL HYGIENE.
PAWTUCKET, R. I. Favorable action
has been taken by the Board of Education
for Opening a fresh-air school for tubercu-
1ar children. The city physician certified
to the fact that there are a sufficient num-
ber of incipient cases of tuberculosis to
warrant the opening of a class.
TUBERCULOSIS AND SCHOOL
CHILDREN.
JOHN B. HAWES, 2D, M.D.
A FEW years ago Dr. Grancher, of Paris,
made an examination of some 4, ooo school
children attending the Paris public schools
in regard to the prevalence of tuberculosis.
His results demonstrated that some 18
per cent of these children showed evidences
of this disease. The examinations made
by him and his colleagues were of a most
thorough and painstaking kind, and his
figures may be taken as correct.
The results of a similar investigation
carried on in Boston during the past two
or three years by the physicians of the
Boston Consumptives’ Hospital Dispensary
show practically similar results. It must
be clearly understood that this figure does
not mean that 18 to 20 per cent of the
School children in our public schools are
suffering from pulmonary tuberculosis.
Only a very small percentage, indeed, show
signs of active disease in the lungs, but
they do show evidence clear and
unmistakable that somewhere in their
bodies is lurking the germ of tuberculosis,
which is bound to break forth into con-
sumption or some other form of the disease
1ater on in 1ífe.
In this stage the disease manifests itself
by signs and symptoms which are evident
to the physician and school nurse, and
which should be plain to the parents and
to the teachers who have charge of the
children. Pallor, 1oss of weight, enlarged
glands in the neck, listlessness, constant
fatigue, and the other signs of debility
constitute part of the evidence which
should be a warning to every one; the
finer points of diagnosis, fever and high
pulse rate, and certain signs in the lungs
and elsewhere are unmistakable proof to
the physician and nurse that somewhere
in the body a tuberculosis focus is active.
These children are very rightly called
“candidates for consumption,” and very
good candidates indeed; unless they and
their parents are taught some of the simple
1aws of health and hygiene it will be from
their number that the consumptives of the
next generation are taken.
In few cases is it necessary for these
children to go away or to give up school,
Or to make any very radical changes in
their method of living. The majority of
such children will soon become strong and
healthy if they are taught, and particularly
if their mothers are taught, the need of
fresh air day and night, the need of more
S C H O O L H Y G I E N E
Io I
food of the proper kind, and the avoidance
of tea, coffee, and similar articles of diet,
the value of bathing and of personal
cleanliness. In a good many instances it
is best to take children in this condition
from school for a few months and to teach
them and their parents in their homes or
at the dispensary, which the children
should attend once a week, that which is
infinitely more important than reading,
writing, and arithmetic,+the rules of right
|living. In my own clinic at the Carney
|Hospital in Boston I spend far more time
|in talking to the mothers and to the chil-
dren of this class, who attend the clinic in
large numbers, and in trying to teach them
how to live, than I do in examining the
patients or in prescribing medicine. Little
effective work can be done in this way,
however, unless there is a nurse or a social
worker, or a volunteer visitor, who can
follow up the children in their own homes,
See the actual conditions under which they
are living, teach the children and the
mothers some of the fundamental rules of
right living, show them how to ventilate
their bedrooms properly, what sort of food
to eat and how to prepare it, and other
rules as regards bathing, dressing, etc.
No system of school inspection will be
complete or at all adequate unless the
school nurse and the school physician go
further than merely seeing the children
in the school building. It is essential to
know and understand home conditions and
to become acquainted with the children
and their parents in their homes in Order
to obtain their coöperation and to get good
results. The value of work of this kind
done in this way cannot be overestimated.
In my own tuberculosis classes it has
always been our custom, whenever we find
a child with tuberculosis, to examine the
other members of the family and especially
the other children. In this way we have
found many early cases of consumption,
and many of these so-called “ candidates
for consumption,” and have been able to
institute treatment at a time when treat-
ment will bring the best results.
The opinion is rapidly gaining ground
among physicians that in most cases
tuberculosis finds its way into the human
body during the early years of life, through
the lungs or through the intestinal tract,
and there lies dormant until early child-
hood, when it may appear as tuberculous
glands, hip or spine disease, or perhaps
not show itself until 1ater, when under
improper conditions of working and living
pulmonary tuberculosis sets in.
This is an era of preventive medicine.
Although few of us who are working along
these lines to-day will see actual results,
the results will show in the increased health
and efficiency and the decreasing mortality
from tuberculosis and other diseases in the
generations which are to follow.
The tendency among physicians to delay
making a positive diagnosis of tuberculosis,
or of this disposition toward tuberculosis,
until the signs and symptoms are far too
plain and evident, is much to be deplored.
The ignorance of the parents of the simple
1aws of health and hygiene, their ignorance
of the fact that a young child who is pale,
losing weight, and generally run down is
in a serious condition, is still more un-
fortunate. It is only by education of the
parents and of the children by every means
in Our power that the disease can be eradi-
cated. In my opinion the school nurse
and the dispensary nurse, who see the
children in their own homes and who are
thus enabled to teach them how to 1ive
and to correct their faults of 1íving, are
very important factors in this anti-tuber-
culosis campaign.
[From the Report of the Providence School Committee,
1907–8.
THE FRESH-AIR SCHOOL.
ABOUT one year ago the School Com-
mittee, at the suggestion of the League for
the Suppression of Tuberculosis, established
a fresh-air school for the physically de-
ficient, thus blazing the way, as we believe,
for this kind of work in this country. In
their fight against the Great White Plague,
the Society for the Suppression of Tuber-
culosis in this city has established summer
camps for children who are in a tubercu-
1ous condition. These children who in-
dividually give indications of tuberculosis,
or are exposed in tuberculous families,
Or are in the so-called pre-tuberculous
condition, would be likely to lose all
that they had gained by returning to
school and being deprived of fresh air.
The School Committee, therefore, opened
a fresh-air school in the abandoned Meeting
Street schoolhouse. One side of the
schoolroom was partially removed, and
windows, extending from near the floor to
the ceiling, were so arranged as to swing
upward toward the ceiling. The children
were selected by the physicians on the
Committee on the Fresh-Air School from
the League, which committee includes in




IO 2
S C H O O L H Y G I E N E
its membership the superintendent of
health, the medical inspectors of the
schools, the superintendent of public
schools, and the chairman of the School
Committee. Not to exceed twenty-five
children can be accommodated in this
building, and the usual number is about
twenty. These children range in age from
seven to fourteen, and are generally chil-
dren who are in an anemic condition and
have signs of tuberculosis, but are not so
far advanced as to give off tuberculous
germs. Usually they are members of poor
families who, in the nature of things, could
not have proper treatment at home and
who would probably fall early victims to
this scourge of the human race.
The results have been excellent so far as
so brief a trial can indicate. The windows
were kept open all of last winter, even in
the coldest days. The average tempera-
ture of the room is only about Io° higher
than the temperature out of doors. While
at first blush it would seem that this was
rather rigorous treatment for small and
delicate children, yet there have been no
bad effects attributable to the exposure,
and there have been no colds and no con-
tagious diseases in the school. The chil-
dren are provided with heavy, padded,
woolen bags, in which they sit during the
coldest weather. They are, of course,
allowed to wear their outer garments when
necessary, and heated soapstones rein-
force the heat from the bags and the gar-
ments. Milk is served to the children at
lunch time, and during the cold weather
nutritious soups are freely provided. At
one end of the room there is a large stove
furnishing heat, at which the children are
allowed to dry themselves when it is
stormy, and to warm themselves when
necessary, although it is little used for this
latter purpose. The children seem to
thrive on this open-air treatment. There
have been numerous cases where they have
been improved sufficiently to be able to
return to the regular schools, and have at
Once taken high standing in their classes in
such schools. There are four of the chil-
dren in the school this year who were in
the school last winter, and they seem to
have no dread of the coming winter and
the exposure to which they will be sub-
jected. The school is naturally ungraded,
but the children are able to prepare and
recite their lessons efficiently, and thus are
being carried along in their regular grade
work, while, at the same time, they are
unquestionably receiving improvement in
their physical condition.
TUBERCULOSIS AND SCHOOL
CHILDREN.
DR. JAMES J. MINOT.
It is found in autopsies on children tha
the frequency of tubercular lesions in
creases with the age. Statistics made by
combining all statistics available show i
children two years old 44 per cent and an
increasing per cent up to fifteen years |
when 67 per cent are found to be tuber. .
culous. A very large number of children ||
recover from their tuberculous process, so
that the real number affected is greater ||
than that indicated by the figures above.
Tuberculosis in children is much harder to ||
diagnose than in the adult. The use of
modern methods of diagnosis has shown
many children to be tuberculous who were
not supposed to be so. In the first thou-
sand children examined at the Boston
Consumptives’ Hospital Out-Patient De-
partment, 67 per cent were tuberculous,
36 per cent showing definite lung affection.
These were 1argely the children of families
where one or more members were suffering
with tuberculosis. Tuberculosis is prob-
ably the cause in very many sickly,
poorly developed, and backward children.
Tuberculosis may be roughly divided into
two classes, the closed and the open. By
“ closed tuberculosis '' is meant those
cases in which the tubercle bacilli are not
thrown off from the body, and these cases
are not to be considered as dangerous to
others in the sense of being infecting foci.
In this group are most of the bone, glandu-
lar, meningeal, spinal, and intestinal tuber-
culosis, hip disease, scrofula, and many
cases where the 1ung is involved, but the
process is not active or not advanced
enough to give rise to expectoration.
“Open tuberculosis '' includes all cases
of consumption where the tubercle bacilli
are thrown off in the expectoration and
such cases of tuberculosis elsewhere as give
off bacilli in the discharged matter. These
open cases are sources of danger to others.
Many of these early cases advance to the
1ater stages, infect others and die, and all
are in such poor health that they do not
derive proper benefit in school from the
money expended on them. This economic
1oss to the community is in itself a strong
reason why some means should be adopted
whereby these children may be cured and
make it possible and probable that they
grow up well and strong, and so eventually
be an economic asset and not a loss to the
community. In Illinois it has been shown
that yearly $1,187,ooo are spent in edu-






































S C H O O L H Y G I E N E
IO3
fing children who die of tuberculosis before
the twentieth year. (Thomas.)
The treatment of children with tuber-
culosis is the same as that of adults, – out-
ºf-door life day and night, abundant food,
avoidance of overwork. Children respond
more rapidly than adults to such curative
treatment. It is vastly cheaper to cure
the child than to permit him to drag along
at School and eventually to die or grow up
an invalid and become a public charge.
The Boston Association for the Relief and
Control of Tuberculosis opened last July
a day camp for tuberculous children. In
September the camp was converted into
an outdoor school in conjunction with the
Boston School Committee. The number
at any one time was limited to twenty. Of
the 31 children, all of whom showed signs
in their lungs, who have been at the school
and camp a month or more, 16 have been
sent back to the public-schools with their
disease arrested, 6 have been discharged
as non-residents, etc., the remaining 9 are
progressing favorably towards health. In
view of the frequency of tuberculosis in
children, and the far-reaching results of it,
it would seem desirable that energetic
methods be adopted to arrest it in early
life. The first step towards this is to find
every tuberculous child, making a syste-
matic examination of all school children if
necessary, certainly of all those from tuber-
culous families or who seem in any way
sick. “Every doubtful case is to be
considered as tuberculosis until proved
otherwise.” However slight the evidence
of tubercular disease, the child should be
treated. Those cases that are already far
advanced do not belong in the schools at
all but in hospitals. In the less advanced,
both open and closed, it is believed that an
outdoor school can restore the child to
health while he gains some education at
the same time. The outdoor School
means a life in the open air, and the feeding
and clothing of such children introduces a
Serious problem for school authorities.
This part of the outdoor school work can,
however, be undertaken by the health
authorities or a hospital which can properly
and without criticism provide for them
as for any other patient. In connection
with the school there must be a most
careful and constant supervision of the
children's home by specially trained
nurses to see and insist that the child 1eads
a proper hygienic life while at home.
There will necessarily probably still remain
a large number of children with a less
definite tubercular process, the “sickly ”
child, the “scrofulous ” child, etc., who
cannot be accommodated in the outdoor
school. These cases can be cared for by
having in every school building one room
where the windows are wide open all the
time and where health is given as much or
more attention than that given to learning.
And in all parts of the school building
more consideration should be given to
securing an abundant supply of fresh air
and at not too high a temperature. A
child spends a large part of his life in
school. Strong and healthy children are
those who spend the most time in the open
air. Life in the open is the best invest-
ment one who is not strong can make.
The nearer the schoolroom can be made to
approximate to out-of-doors, the larger
will be the return to the community on its
investment in schools. Open-air schools
have been used in Germany and England
for some years with most gratifying
results. Providence had the first one in
this country last year. Now there are
several. The Boston School Committee
has under consideration the organizing of
outdoor schools on a much larger scale
for next year.
TUBERCULOSIS AND THE PUBLIC
SCHOOLS OF RICHMOND, VA.
THE Richmond Board of Health has
issued a pamphlet for the use of the upper
and middle grades of the public schools
entitled “Tuberculosis, Its Causes, Pre-
vention, and Cure.” Besides being used
in the schools, it is given to the pupils for
distribution among the other members
of the family. It is also issued to private
schools. It is a well-written, interesting,
and instructive pamphlet.
SUBNORMAL CHILDREN TO BE
SEGREGATED.
(Journal of the American Medical Association,
ecember 19, 1908.)
PLANs announced by the President of
the Board of Education of Chicago are to
the effect that tubercular and subnormal
children in the public schools of Chicago
are to be segregated and provided with a
special mental and physical training in-
stitute to be founded on a 240-acre tract
of 1and in Riverside. Arrangements are
also being made to provide a substitute for
the present John Worthy School for delin-
quent children on the same tract of 1and.

The Danger of Dust in Schoolrooms
How It Can be Reduced Nearly One Hundred Per Cent.
UST Danger is a real—not a theo-
retical — menace. Scientific re-
search has proved that dust is the
greatest carrier and distributer of
disease germs known. It is ever present
and ever active—it threatens mankind every-
where—in offices, stores, schools, corridors
and in nearly every public building
The Dust problem in schoolrooms is
one that should have the serious considera-
tion of every Board of Education, every
Superintendent of Schools, every Principal,
every Teacher. The elimination of dust is
a duty that must appeal with peculiar force
to those charged with the responsibility of
caring for the health of pupils.
HOW DUST SPREADS DISEASE
Disease germs multiply with exceeding
rapidity. A single germ falling on fertile
soil will, in an incredibly short space of
time, generate millions upon millions of its
kind. These micro-organisms are found
by the million in dust, so that every current
of air causes the dust to be set in circula-
tion, and with it the countless myriads of
living germs that are such a menace to
health. -
The remedy for the elimination of dust
is not sweeping and dusting, for such ex-
pedients merely start the germs afresh on
their aerial errand of warfare against
mankind.
THE TRUE REMEDY
The most effective method of dust pre-
vention is that of treating all wooden floors
with a suitable dressing.
º
\
-
-
Standard Floor Dressing is the tru
remedy for the elimination of dust.
has been tested by Physicians and Educ
tional Boards with the most gratifyin
results, and reports show that it reduces
the percentage of floating dust near/y on
hundred per cent. It is being used with
remarkable success in thousands of places
for counteracting the dust evil. Every
year the number of permanent users in:
creases, and in all cases results are exi
tremely satisfying. The action is º
mechanical. The application of a thi
coat is sufficient to keep the floor at just
the right degree of moisture to catch and
hold all dust and dirt.
Standard Floor Dressing should be
applied to floors about three or four times
a year to get the best results; meanwhile,
the floors should be thoroughly cared for,
so that with each sweeping the surface is
left perfectly clean.
Floors treated with Standard Floor
Dressing present a splendid appearance.
The dressing acts as a preservative and
prevents the boards from splintering o
cracking. The dressing does not evapo
rate, and by reducing the labor of caring
for the floors saves its cost many times over.
Sfandard /º/oor /), essing is not intended
for house/ho/a/ use.
We are making a remarkable offer
applying to schools, public buildings,
stores and offices. Our offer is this –
we will, free of a// cos/, treat one school
room or corridor floor, or part of any
floor, with Standard Floor Dressing, just
to prove our claims.
To localities far re-
moved from our agencies,
we will send free sample
with full directions for
applying.
Our little book, “Dust
and Its Dangers,” con-
tains opinions of the med-
ical profession and ex-
plains the subject fully.
Any one may have a copy
by merely asking for it.
STANDARD OIL COMPANY
(Incorporated)






-
º
|
|
5chool Hygiene
3 4d ( ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
6.2%
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
Vol. I, No. 9
BOSTON, MASS.
APRIL, I909
T. CABot;
John A BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
ELMER. E. B.Rown, Ph.D., United States Commissioner
of Education.
WILLIAM HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
JoHN J. CRoNIN, M.D., Assistant Chief Medical Inspector
Health Department, New York City.
ABRAHAM JAcoBI, M.D., LL.D., Professor of Diseases of
Children, New York City.
THQMAs M. BALLIEtt, Ph.D., Dean of School of Pedagogy,
New York University.
Joseph LEE, A.B., A.M., LL.B., Boston.
PHILIP KING BRow N, A.B., M.D., Medical Department,
University of California.
Rob ERT W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
GEORGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education.
J. H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
J. H. McCURDY, M.D., Director International Young
Men's Christian Association Training School.
| (Ibe (Wfficers amo Council of the Et33Ociation
Honorary President, Hon. THEoDoRe Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
Secretary and Treasurer, Dr. THoMAs A. StoREY.
CHARLEs A. MooRE, Chairman Welfare Department
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
Nicholas MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABot, M.D., Fellow of Harvard University.
FREDERIck Forch HEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. Fisch EL, M.D., Professor of Clinical
Medicine, Washington University.
LuTHER HALSEY GULIck, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart:
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEyLAN, A.M., M.D., Adjunct Professor of
§sical Education, Columbia University, New York
ity.
THoMAs A. StoREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. Welch, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
GEORGE S. C. BADGER, M.D., Editor .
D. C. HEATH AND COMPANY, Publishers
- . 48 Hereford Street, Boston, Mass.
- 12o Boylston Street, Boston, Mass.
All communications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIAL.
THE third meeting of the American
School Hygiene Association was held in
Chicago on February 22–25. Five sessions
Were held, one of them being a joint
meeting with the Department of School
Superintendence. The meetings would
have been more largely attended, if they
had been held in the Auditorium Building,
Where the superintendents had their
headquarters.
The program was attractive and the
papers interesting. The school people
who attended did not hesitate to say that
they got more help than from the regular
meetings of the Department.
It was apparent from the discussions
that medical inspection of school children
is making considerable progress, and that
many forces are working for more fa-
vorable health conditions in schools. The
work done at the State Normal School
at Cedar Falls, Ia., seems to have reached
the high-water mark in the training of
teachers.
The proposed 1aw regulating school-
Io 6
S C H O O L H YG I E N E
house construction and care, and pro-
viding for medical inspection of schools
in Indiana, as described by Dr. J. H.
Hurty, secretary of the Indiana State
Board of Health, is so thorough-going
and drastic in its penalizing provisions
as to astonish the more conservative peo-
ple of the East. If the schoolhouses are
not models and the school children are
not sound in body, it will not be the
fault of the Indiana Board of Health.
The Association will miss the genial
presence of Dr. Henry P. Walcott, who
declined to serve longer as president,
because expecting to be absent froſ., the
country next year.
THE HEALTH OF TEACHERS.
W. S. SMALL, PH.D.,
Principal, Eastern High School, Washington.
NOT the least important factor in a
wholesome school environment for chil-
dren is the health of the teacher. In at
least seven cases out of ten the disorderly
and spiritually unwholesome school is
taught by a physically unfit teacher. It
is, therefore, a subject of radical importance
in the practical science of school hygiene.
There is an ancient and still prevalent
belief that teachers as a class are below
par in the matter of health.
In spite of the practical importance of
the subject, it still remains 1argely in the
realm of opinion. It is almost virgin soil
for investigation. Recognition of it as an
important phase of school hygiene hardly
goes back a decade.
In this paper I attempt only to sum-
marize information obtained from avail-
able literature, and to urge the importance
of systematic and thorough investigation
of the matter in its various aspects. Van
Tussenbroek states these as follows:
I. What is the relative mortality of
teachers?
2. What is the relative morbidity of
teachers?
3. What dangers to life and health is the
teacher especially exposed to in virtue of
the vocation itself?
4. Are these dangers such as to lead to
(a) real diseases of occupation; (b) pre-
mature exhaustion of vitality?
To these I should add: Are the inimical
conditions necessary or only accidental and
remediable; and, Is the health of teachers
improving or the reverse?
Mortality. So far as mortality statistics
tell the story, teaching is not unfavorable
to health. Dr. Ogle's mortality tables
(English) for the years 1880–1882 inclusive
give teachers a death-rate of 719 as against
I, of 3 for 1aw and commercial clerks.
(This is the class whose conditions of life
most closely resemble those of teachers, in
Dr. Ogle's judgment.) Other classes, with
conditions slightly less similar, have death-
rates as follows: Lawyers, 842; clergymen,
556; physicians, 1,126. Tables based
upon the United States census for 1890,
compiled by the same method as the above,
give the death-rates of the same classes as
follows: Teachers, 578; lawyers, 838;
clergymen, 574; physicians, 87 o. Law
and commercial clerks are not given as a
separate class in these tables.
There is no classification according to
age groups, sex, or grade of instruction.
The only item of importance that emerges
is that men teachers as a class show a low
rate of mortality. Dr. van Tussenbroek's
careful compilations point in the same
direction.
From official statistics she found for the
years 1891–1895 inclusive, teachers in
Holland between the ages of eighteen and
fifty inclusive had a death-rate consider-
ably below the average, and 10wer, also,
than clergymen, civil officials, and physi-
cians (the three classes most similar to
teachers, in her judgment). Divided into
age groups of eighteen to twenty-five,
twenty-six to thirty-five, and thirty-six to
fifty, the same classes show slight varia-
tions: the death-rate of teachers in the
middle group exceeds slightly that of
clergymen and civil officials but remains
distinctly below in the other two age
groups.
Classification according to disease caus-
ing death is also favorable to teachers with
two exceptions. In case of the rubric
“brain diseases and apoplexy,” the death-
rate of teachers is slightly above the
average; and in case of “tuberculosis,”
though the death-rate of teachers is below
the average, it exceeds that of clergymen,
civil officials, and even physicians, and
between the ages of twenty-five and
thirty-five it exceeds the average.
Van Tussenbroek compares these figures
for Holland with similar data for England,
Paris, Switzerland, and Germany. Direct
comparison is possible only in case of
England. In the other cases named,
variations in classification make the com-


































school H y G 1 EN E
Io7
\
parison either indirect or otherwise im-
perfect. They present, however, the same
general features: a relatively low death-
rate for teachers as compared with the
average and as compared with the voca-
tions classed by Van Tussenbroek as
similar, but with respect to tuberculosis a
decidedly less favorable condition.
Again, there is no differentiation accord-
ing to grade of instruction, and the figures
concern men exclusively.
Morbidity. Morbidity statistics are
almost entirely 1acking. Dr. Arlidge (Op.
cit.) quotes Ratcliffe's statistical analysis
of the sickness allowances of the English
benefit societies, in which he groups teach-
ers and clerks, and finds “among this class
less aggregate sickness and a less general
expectation than in any class in his ex-
perience.” Arlidge observes pertinently
that teachers who are really sick frequently
go on teaching; that comparatively few
teachers join benefit societies and those
who do are a selected type; and that
only men are concerned in these statistics.
Arlidge holds strongly that teaching is
unfavorable to health. Perhaps valuable
data might be extracted from the records
of our health insurance companies.
Dr. Seigel, in 1895, examined 1,157 teach-
ers of the public schools of Leipzig. He
found 42.8 per cent suffering from definite
diseases: nervousness, chronic laryngeal
catarrh, lung affections, and other “pro-
fessional diseases.”
In reply to Dr. Balliet's question: How
long can a woman of fairly good health
teach in our public schools, under present
conditions, without injury to her health?
one hundred and thirty-four teachers out
of 157 answering, 84 per cent said, “From
five to ten years”; 50 per cent said, “From
five to seven years.” Only 12 out of 157
said more than ten years, and only 8 said
more than twenty years.
Whether or not the general morbidity
of teachers is high, there seems to be some-
thing like general agreement that teachers
are especially liable to certain diseases, chief
among them being affections of the re-
Spiratory organs, including pulmonary tu-
berculosis, and nervous disorders.
Milligan and Yonge and Oliver, in case
of English pupil teachers (both sexes)
show direct relation between teaching
and specific throat diseases (“teachers'
nodes ''). Dr. Burger, a throat specialist,
interrogated by Van Tussenbroek, says this
affection is very common with teachers,
Singers, and children who shout and sing
too much. Zwaardemaker, quoted by
Van Tussenbroek, says that chronic laryn-
geal catarrh is prevalent among teachers.
He attributes these two throat affections
chiefly to improper use af the voice in
articulation. The evil effects of dust,
especially chalk dust, are adduced by
Oliver, Kuehner, and others as contribu-
tory causes.
Neither of these causes is inherent or
irremovable. Proper vocal instruction and
control of dust are all that is necessary to
remove these occasions of offense.
The mortality statistics cited above
indicate that pulmonary tuberculosis is
relatively common with teachers. The
figures of Karup and Gollmer, based upon
analysis of the mortality statistics of the
Lebensversicherungsbank of Gotha, show a
large death-rate from tuberculosis among
elementary teachers, but not among
secondary teachers.
With respect to the frequency of nervous
disorders among teachers, there is general
agreement. There is, however, 1ittle at-
tempt to analyze and classify the 1iability
of teachers. Van Tussenbroek makes a
partial classification, purely for conven-
ience in handling such facts as she could
muster. As teaching is an “intellectual
vocation,” its ill-effects must be due, pre-
eminently, to mental overstrain, which
would show themselves in definite diseases
of the central nervous system, in suicide,
in mental alienation, and in neurasthenia
(psychasthenia not differentiated). Facts
are few in this connection.
It is under the rubric “reurasthenia ''
that the largest percentage of the teacher's
ill-health is to be found. There are no
statistics. Even the indefatigable Van
Tussenbroek was unable to dig up any.
She has to content herself with the unani-
mous verdict of the large number of
specialists she personally interrogated that
neurasthenia is very common among
teachers. It is this, of course, that Page
meant by the 1ay expression of “ compli-
cated forms of disease and 10ss of spirits.”
Arlidge emphasizes it and attributes its
prevalence in elementary school teachers
to the constant strain they are under to
“satisfy managers and inspectors and to
accomplish results whereon their income
in some measure depends '' ; and to the
monotony of their work, which is of “ con-
stantly recurring sameness, preventing
them from ever attaining a point at which
their work can afford them real interest,
and reducing them to educational machine-
wheels rotating on their own axes and
never advancing.” (Parenthetically, this is


IoS
S C H O O L H Y G I E N E
a revolting conception of the life of the
elementary teacher. If it were a true
statement of the essential and necessary
character of her work, it would be sufficient
argument for the abolition of Schools. As
a statement it is true in far too many
instances.)
Dr. Balliet found his casual observa-
tion of the frequency of nervous break-
down among teachers confirmed by the
questionary mentioned above. But he
attributes this frequency to exactly oppo-
site conditions from those alleged by
Arlidge. “The abolition in the public
schools of routine teaching, which made
but slight demands upon the teacher,
either in regard to scholarship or in regard
to skill in teaching, the broadening or the
school curriculum, and the introduction of
rational methods of instruction, have in-
creased the amount of work on the part
of teachers and the tax upon their strength
to an extent not appreciated by the public
generally.” -
One other item of importance with
respect to nervous disorders is that they
occur with greatest frequency in the first
few years of teaching. Oliver speaks of
the pupil-teacher stage as especially vul-
nerable. Wichmann found that 47 per
cent of the cases of neurasthenia with
teachers appeared in the first five years of
actual teaching, and One half of these in
the first year.
Apparently the strain is greater at this
initial stage, though Van Tussenbroek
thinks it is a matter of survival. These
are probation years in a fundamental
sense, during which the physically unfit
are eliminated. For conclusions, com-
parison with other occupations is neces-
Sary.
To summarize: The health of the teach-
ing body is an important aspect of school
hygiene and demands adequate investiga-
tion; there are at present very few satis-
factory data bearing upon any of the
essential aspects of the problem. From
the mortality statistics, it appears that
teaching kills few, but from the morbidity
statistics and the expert opinions of physi-
cians it appears to maim many. Nervous
disorders are its special liability. Con-
clusions as to whether or not the condi-
tions that make for the ill-health of
teachers are inherent in the vocation or are
accidental and remediable are not war-
ranted by available facts, but in some
instances the liability may be greatly re-
duced by proper prophylaxis.
In conclusion, I urge upon Superinten-
dents, university professors of pedagogy,
and others who may be in position to do
So, to add to our stock of scientific fact
relative to this subject. Let them not rest
content with the Emmanuelistic sentiment
expressed by one of their number: “The
trouble is not in the ventilation, in the
stupid pupils, in the domineering principal,
in the meddlesome parent, in the gossipy
teacher. It is in yourself. Change your
mental attitude. Replace evil, disturbing,
and unkind thoughts by thoughts of love,
patience, and trust, courage and confi-
dence. Let these good thoughts find ex-
pression in your body. Be calm when the
pupils are noisy, be patient when they are
stupid, be courageous when you know you
are right, and before long your body will
respond to the quickening mentalattitude.”
THE PROMOTION OF IMMUNITY
THROUGH PHYSICAL EDUCATION.3,
THOMAS A. STOREY, PH.D., M.D.,
Associate Professor and Director of Physical Instruction,
College of the City of New York.
THE production of active immunity is
a function of some of the fixed and circu-
lating cells of the body. When patho-
genic organisms within certain limits of
virulence gain access to the tissues they
are destroyed or rendered innocuous by one
or more of several processes. They may
be devoured by phagocytes; they may be
killed and dissolved by agents in solution
in the tissue juices; they may be im-
prisoned and walled off locally from the
rest of the tissues; and their toxic pro-
ducts may be neutralized or destroyed by
soluble antibodies in the tissue fluids.
These several defensive activities are
carried on directly by the tissue cells or
indirectly by the products of the vital
activities of those cells. On the cells of the
body depend the exhibition of the phe-
nomena of immunity.
The degree of immunity produced is re-
lated directly to the health of the cell. An
impoverished, poorly nourished, unhealthy
cell will not react to the same extent and
with the same success as will the normal,
healthy, well-nourished cell. -
The health, and, therefore, the immunity
producing power of the cell, depends upol
its nourishment, including food, water, and
Oxygen; upon its relief from the influence
of its own waste-products; upon its exer
cise; upon its opportunities for rest an
* Delivered before Section V, International Congress
on Tuberculosis, Washington, D. C., 1908.











































S C H O O L H Y G I E N E
ToQ
repair; and upon a reasonable freedom
from the direct and indirect influences of
pathogenic organisms. These facts have
everywhere been forced upon the attention
of men who are experimenting with the
immunity reactions of the blood. They
find healthy blood is necessary for good
reactions. Bactericidal phenomena, pha-
gocytosis, bacteriolysis, agglutination, the
production of antitoxins, and the other
phenomena of immunity are all more
marked in blood taken from healthy ani-
mals. It has been found in 1aboratories
everywhere that a reduction in mortality
and a more successful experimentation
with the vital phenomena of cellular struc-
tures in experimental animals accompanies
the provision of good and sufficient food,
exercise, and careful sanitation.
We have so far been dealing with the
tells of the body. We may now proceed
to the statement that the health, and, there-
fore, the immunity of the whole body
depends upon the health of all its consti-
tuent parts — on the health of its cells.
If the cells are all well nourished, active,
and protected from extremes of patho-
genic influences, their summated health
will be the health of the individual whose
body they in combination make. That
such a healthy individual is possessed of a
tertain degree of immunity has been
proven empirically and experimentally,
and it is equally well established that the
possession and conservation of the healthy
body depends upon the observance of
everal simple hygienic procedures. These
hygienic procedures are the same as those
which I have already stated were essential
ſo the health of the body cells. Further-
more, these procedures must be the funda-
mental procedures in any wise and well-
Idered policy of personal health control.
Physical education is concerned primar-
ly with human health. It employs the
ame hygienic procedures for its purposes
that are essential for the development of
talth and consequent immunity-pro-
Icing powers in the cells of the body. Its
inciples are based upon the fundamental
- It employs recognized
ygienic precepts in the procedures which
tlays down for health. The well-planned
theme of physical education of to-day
taches men to eat properly, to drink
ºperly, to breathe properly, to take the
ºper care of their excretions and wastes,
exercise wisely, to rest wisely, and to
tºp reasonably clean with reference to
sease-breeding organisms. Such govern-
g principles lead to and conserve human
health. Failure to respect any of these
principles will jeopardize the success of the
others. No rational scheme of physical
education nowadays relies upon exercise
alone for health nor upon any other pro-
cedure or habit. One must observe a11 of
these several requisites in order to work
under a wise policy of physical education —
of personal health control. The man who
regulates his habits of eating and takes no
exercise cannot expect health. The man
who exercises properly and eats wisely will
fail to secure health if his habits of sleep
are bad. On the other hand, a reasonable
observance of these several simple hygienic
laws on which physical education is based
cannot fail to secure and conserve health
for the average individual.
Such an individual will be possessed of
millions of active, healthy cellular struc-
tures working for his protection, construct-
ing for him a defensive armamentarium,
and ready on demand to respond with
supreme reaction against invasion of dis-
ea.Se.
STATUS OF MEDICAL INSPECTION
OF SCHOOL CHILDREN IN THE
UNITED STATES.
To the Officers and Members of the Ameri-
can School Hygiene Society, - As chairman
of the Committee on the Status of Medical
Inspection of School Children throughout
the United States, I have the honor to sub-
mit the following report and considerations.
An investigation reveals the following:
A total of 123 towns or cities claim some
kind of operation in the schools to look
after the health of children.
The supervision of the schools is under
the control of the health department in
70 per cent of the cities reported on,
under private control in One instance.
The frequency of visits varies from no
specified time to daily visits; many places
say weekly, monthly, and even yearly.
The number of children under the control
of one inspector varies from five hundred
to twenty-eight thousand, the smaller
number usually being 10oked after by vol-
untary service.
Many places claiming medical inspection
have no physicians; the service is per-
formed by nurses or teachers.
Remuneration varies from gratis service,
$5 per year, $20 per month, to $1 oo per
month.
The school authorities are almost unani-













I IO
S C H O O L H Y G 1 E N E
mous in stating that they consider the
work of value. Vote, 40 Yes to I No.
The above facts, which probably repre-
sent the truth, show the woeful absence of
any proper concept of the purpose of
school inspection.
There is no uniformity in the plant and
scope of the work; no uniform system of
report; no standard to determine what
constitutes a real defect that may now
interfere with the health and school
progress; no uniform idea of treatments
that should be required; no law to compel
treatment of neglected children.
Dependent upon the examiner there is
a high per cent of nasal obstructive ab-
normalities; another, defects of vision;
another, metabolic disorders.
The specialty of the examiner is ex-
pressed in the kind of defect he reports.
The great question that presents itself
is, Is it feasible for this Association to
adopt rules and regulations governing this
work which may be accepted as authorita-
tive by all places engaged in the work?
From a purely medical point of view
there is no evidence to show that the de-
fects found or not found represent the
facts of the case; on the contrary, there is
much evidence to show that a great deal
of our best English written to describe this
work is contradictory in terms from a
medical standpoint.
There is one thing at least to which this
society may justly lay claim: the transac-
tion of its meetings has exerted no little in-
fluence on the position assumed by our
leading schools of medicine. Within a
few years we may hope to find unity es-
tablished among physicians in the concept
and report of the physical defects.
Many of the universities are now about to
establish a course in sanitary science, and
the most important function of this course
will be to standardize the methods of diag-
nosis of defects in school children.
If it has taken as long as it has to teach
authorities medical and municipal of the
economics resulting from a proper super-
vision of children in school, when might we
hope to educate them to the value of having
a school hygienist to 10ok after the environ-
ment and apparatus used by the child in
the pursuit of knowledge and character
building?
This will come much sooner now that the
teaching institutions have taken up the
matter; young men must now graduate
with a full knowledge of the importance of
the subject; this knowledge will overcome
the financial obstacles that now prevail
only because the subject is not understood
properly by its advocates and, therefore,
not properly presented to the municipal
authorities for consideration.
Respectfully submitted by the commit-
tee,
LUTHER H. GULICK, M.D.,
Secretary.
John J. CRONIN, M.D., -
Chairman.
THE FEEDING OF PUBLIC SCHOOL-
PUPILS. -
(From the Journal of the American Medical Association,
ebruary 13, 1909.)
BERLIN.
THE feeding of poor school children is a
form of the social helpfulness that is exer-
cised at the present day in most civilize
countries, but especially in Germany. It
Dresden as early as 1884 a charitable asso
ciation (Verein gegen Armen not) started
“soup kitchen '' for poor school children
There has also been in Dresden since 1896
a special association for feeding poor school
children with substantial meals. At the
present time the public school children are
cared for in this way in many Germa
cities, partly by private associations and
partly by the city authorities. In Berlin
as I have already told you, 70,000 marks |
were lately appropriated for this purpose;
in Munich there is a municipal soup kitchen
which supplies annually 47.o,ooo meals |
with a total outlay of 64, ooo marks
($15,360); one in Strassburg supplies
Io8, ooo meals at an expense of 13, oo,
marks ($3,120). In Strassburg the poor
authorities have themselves undertaken the
entire business of furnishing food to the
poor. There is a central kitchen, wit
kettles holding each 35o liters, which ca
prepare 2,800 pint bowls of soup. For t
distribution of the soup to the local schools,
the city and suburbs are divided into dis
tricts, and the soup is sent in portab
kettles in so-called cooking boxes. The
distribution is made partly by voluntegr
waiters. Augsburg, Charlottenburg, N
remburg, etc., furnish free milk breakfast
The selection of the children to be fed is
made in most cities by the poor office ºn
the recommendation of the teacher, while
in some cities, for instance, in Mannheim,
a limit of wages of the head of the fami
is established. Supplying free meals
children is not regarded as coming under
the head of public charity (Armenuniºr
Stützung). -
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S C H O O L H Y G I E N E
III
PHYSICAL EXERCISE FOR SCHOOL
CHILDREN.
|Journal of the American Medical Association, February
13, 1909.)
º VIENNA.
THE new regulations for elementary
Schools give special attention to physical
exercise for the children under the super-
vision of the teachers. Thus on at least
|. days of each week one hour a day
must be devoted to gymnastic exercises,
| the open air, if possible, not in the turn-
|halle or gymnasium. The English system
of outdoor games and sports is preferred
to the German system of gymnastics. In
suitable weather the children are to take
short or long walks; on certain days when
School is not in session the class is to make
Excursions to the beautiful places in the
|Environs of the city. Walking is greatly
encouraged, and the older pupils are ad-
vised to take walking tours during the
lummer and Christmas vacations, going
|en to fifteen miles a day, and doing a mod-
ºrate amount of mountain climbing. The
Expenses of the needy pupils are to be
lefrayed by the schools. Of the gym-
lastic exercises, especially for the younger
|hildren, such as tend to strengthen the
|tings are chiefly favored. To be excused
||rom these exercises, a child must produce
a medical certificate stating what injury
|might result to him from taking them.
These recommendations are the result of a
|eries of investigations into the physical
Ondition of the school children, instituted
ly the board of health, and conducted
luring the 1ast year by a committee of
medical men and teachers.
THE TEACHING OF HYGIENE.
RICHARD C. CABOT, M.D.,
190 Marlborough Street, Boston.
1: THE teaching of hygiene has suffered
the past from the fact that much that is
aught rests upon no secure empirical
asis. It is probably less scientific than
mything now taught in the name of science.
he vague appreciation of this by the
upils and by the teachers themselves
akes the whole effort often abortive.
2. A good deal that is taught as hygiene
likely to do more harm to the mind than
001 to the body. This is partly because
the unwarrantably wide distinction
tween mind and body, suggested by the
ſms in which hygiene is taught.
3, Hygiene should be taught as science,
not as morals. We should give the chil-
dren true facts and 1eave them to draw the
inference for themselves.
4. In all that is taught proper allowance
should be made for the factors of indi-
viduality, for the difference between one
person and another, which are almost as
important in the field of hygiene as in that
of taste.
MEDICAL INSPECTION OF SCHOOLS.
ST. LOUIS.
(From the Journal of the American Medical Association,
February 20, 1909.
THE board of education is perfecting
plans for the establishment of a system of
medical inspection of school children.
PLAYGIROUND PRESIDENT COM-
PLIMENTS MASSACHUSETTS.
MAJORITY VOTE FOR PUBLIC PLAYGROUNDS
INCREASED BY LATE RETURNS.
Boston, March II.
THE remarkable general endorsement of
the playground movement and what it in-
volves by the voters of Massachusetts is
attracting attention nationally. Dr.
Luther H. Gulick, president of the Play-
ground Association of America and chair-
man of the Playground Extension Com-
mittee of the Russell Sage Foundation,
makes this statement of interest:
“The general sentiment of the voters of
a state has been tested for the first time in
America with reference to their estimation
of playgrounds. It is fortunate that this
test occurred in Massachusetts, because
Massachusetts has had a 10nger play-
ground experience that any other state in
America. The overwhelming vote in favor
of playgrounds is an additional evidence
that the American people propose, first of
a11, to take care of their children.”
By supplementary returns from elections
held in towns and cities of Massachusetts
this week, the majority vote in favor of
public playgrounds is considerably in-
creased. The towns of Peabody, West-
field, and Plymouth have accepted the
act (Chapter 513, Acts of 1908). The
city of Cambridge, voting Tuesday, adopted
it, 5,431 to 849. The total approximate
vote of all the 37 towns and cities that
have taken favorable action on this matter
is: Yes, 145, ooo; No, 32, ooo.
SILVER CITY, NEW MEXICO.
MEDICAL inspection of schools was be-
gun in August, 1908.


































-
-|
Why Contagious Diseases Are So
Quickly Transmitted in Schoolrooms.
A SURE METHOD
|HE time is not far distant when action
will be taken by the boards of health in
every city, town, and village of this coun-
try to compel the elimination of dust in
schoolrooms by proper care of the floors.
Educators are rapidly coming to a reali-
zation of the fact that “dust” is the principal cause
of disease transmission among school children.
The floors in schoolrooms are bare, and when large
numbers of pupils are assembled the constant mo-
tion of feet produces a continuous circulation of
dust. These dust particles are composed of vege-
table, animal, and mineral material finely pulverized.
From tests made with dust collected from school-
rooms and other places
of public assembly, it has
been found that with the
dust were uncountable
myriads of disease
germs—bacilli of Tuber-
culosis, Typhoid Fever,
Diphtheria, Pneumonia,
and other dangerous
diseases. These experi-
ments afford irrefutable
proof of the dangers
arising from dust and
explain why contagious
diseases are so quickly
transmitted in school-
IOOmS.
To do away with this menace — to avoid the
dangers of dust poisoning, it is not only necessary
to provide a system of ample ventilation, but also
to treat the wood ſloors in such a way that dust and
germs cannot pollute the atmosphere.
Standard Floor Dressing has proved itself a per-
fectly satisfactory dust preventive. By keeping
the floors at a proper degree of moisture the dress-
ing catches and holds every particle of dust and
every germ coming in contact with it. Tests have
been conducted to determine the quantity of dustand
number of organisms which would settle on a given
surface. Results prove that the dust from
floors treated with Standard Floor Dress-
ing is twelve times greater in weight than
that collected from untreated floors. The
inference is obvious—the balance of dis-
ease-laden dust in the rooms with nºntreated
floors was circulating through the air,
because even after settling on the floor
every current of air would disturb it and
start it afloat again. Another test proved
that dust once settled upon a floor treated
with Standard Floor Dressing remained
there, and a bacteriological examination
demonstrated that 97%% of all the dis-
OF PREVENTION.
ease germs caught with the dust were destroyed
outright.
Such tangible proofs should convince any one
that Standard Floor Dressing is invaluable for use
in schools as a preventive of disease.
In addition to its germicidal properties, Standard
Floor Dressing does splendid work in keeping the
floors themselves in a state of excellent preserva
tion. It prevents the wood from splintering and
cracking and renders sweeping and caretaking
comparatively easy task.
While Standard Floor Dressing is not intended
for use in the home, it is intended for use in schools
hospitals, sanitariums, stores, and public building
of every description.
every locality, and ma
be had in full barrels
half-barrels, one-gallol
and five-gallon cans.
Three or four treat
ments a year give bes
results, and when sprea
with the patent Stan
ard Oiler may be use
very economically. Th
Oiler distributes jus
the right a mount t
every part of the floo
and as the dressing doe
not evaporate, one application will last for sever
months.
Standard Floor Dressing is now being used wit
remarkable success in thousands of schools, co
leges, stores, and public buildings, and we have y
to hear of an instance where the dressing has faile
to reduce the circulating dust and kill the floati
disease germs. All we ask is an opportunity
Żrove the merits of Standard Floor Dressing. .
In order to convince those who may be skeptic
and those who are really interested, we are making
an extraordinary offer. Select one room or corrid
in any public building under your sup
vision and we will dress the floor wi
Standard Floor Dressing AT OUR OW
EXPENSE – the test will not cost y
One cent.
To localities far removed from -
agencies, we will send free sample w
full directions for applying.
Correspondence is desired with th
responsible for the care of schools a
public buildings. Our book, “Dust
Its Dangers,” with testimonials and repo
is sent free on request.
STANDARD OIL COMPANY
(Incorporated)




























..s 36-
5chool Hygien
240 ISSUED BY THE AMERICAN SCHOOL HYGIENE ASSOCIATION
Lºlly. OF MIC.
º
- UM º 1909
C
PUBLISHED MONTHLY EXCEPT IN JULY AND AUGUST
Wol. I, No. Io
BOSTON, MASS.
MAY, 1909
(II)e (Wfficers amo Council of the Et350ciation
Honorary President, Hon. Theodore Roosevelt; President, Dr. HENRY P. WALcott; Vice-President, Dr. ARTHUR
T. CABot;
º oh N. A. BERGströM, Ph.D., Professor of Education,
Leland Stanford Jr. University.
£LMER. E. B.Rown, Ph.D., United States Commissioner
of Education.
|Wººſ HENRY BURNHAM, Ph.D., Professor of Peda-
gogics, Clark University.
John J. C.Ronin, M.D., Assistant Chief Medical Inspector,
Health Department, New York City.
ABRAHAM Jacobi, M.D., LL.D., Professor of Diseases of
Children, New York City.
THoMAs M. BALLIETT, Ph.D., Dean of School of Pedagogy,
New York University.
Joseph LEE, A.B., A.M., LL.B., Boston.
PHILIP KING BRowN, A.B., M.D., Medical Department,
University of California.
Robert W. Lovett, A.B., M.D., Instructor in Orthopedic
Surgery, Harvard University.
HENRY P. WALcott, A.B., M.D., Chairman of Massachu-
setts State Board of Health.
WALTER E. FERNALD, M.D., Superintendent of Massachu-
setts School for Feeble-Minded.
CALVIN N. KENDALL, A.M., Superintendent of Public
Schools, Indianapolis, Ind.
GEORGE H. MARTIN, LL.D., Secretary of Massachusetts
State Board of Education. -
J. H. McColloM, M.D., Professor of Contagious Diseases,
Harvard University.
J. H. McCURDy, M.D., Director International Young
Men's Christian Association Training School.
Secretary and Treasurer, Dr. THoMAs A. StoREY.
CHARLEs A. MooRE, Chairman Welfare Department
National Civic Federation.
Edward L. Stevens, L.H.D., Associate City Superin-
tendent of Schools, New York City.
J. J. StoRRow, Chairman of Boston School Board.
Edward LEE THoRNDIKE, Ph.D., Professor of Psychology,
Teachers' College, New York City.
CHAMPE S. ANDREws, Esq., New York City.
Nicholas MURRAY BUTLER, A.M., LL.D., Litt.D.,
President of Columbia University, New York City.
ARTHUR T. CABOT, M.D., Fellow of Harvard University.
FREDERICK FoRCHHEIMER, M.D., Professor of Theory and
Practice of Medicine, etc., Medical College of Ohio.
WASHINGTON E. Fisch EL, M.D., Professor of Clinical
Medicine, Washington University.
LUTHER HALSEY GULIck, M.D., M.P.E., Director of
Physical Training, New York City Public Schools.
CLARK W. HETHERINGTON, Ph.D., Director of Depart:
ment of Physical Training and Athletics, University of
Missouri.
GeoRGE MEYLAN, A.M., M.D., Adjunct Professor of
§ical Education, Columbia University, New York
ity.
THQMAs A. StoREy, M.D., Ph.D., Associate Professor and
Director of Physical Instruction, College of the City of
New York.
WILLIAM H. WELCH, M.D., LL.D., Professor of Pathol-
ogy, Johns Hopkins University.
Jubscription price, 50 cents a year
GEORGE S. C. BADGER, M.D., Editor .
D. C. HEATH AND CoMPANY., Publishers
- . 48 Hereford Street, Boston, Mass.
- 120 Boylston Street, Boston, Mass.
All communications concerning manuscripts and editorial matter should be addressed to the editor.
All communications concerning advertising, subscriptions, and business matters should be addressed to the publishers.
EDITORIALS.
THE arrangements by which School
HyGIENE has been published during the
past year terrninate with this number.
It is impossible to continue its publica-
tion as an independent journal, without
financial assistance. The money re-
(eived from advertisements and sub-
Scriptions does not cover the cost of
publication and mailing. It seems wise,
therefore, to join forces with some other
publication devoted to matters of school
hygiene. The journal, “ Hygiene and
Physical Education,” issued by The F. A.
Bassette Company, of Springfield, Mass.,
is the one chosen to represent the Ameri-
can School Hygiene Association. Space
in this journal will be reserved for School
HYGIENE, and all matter appearing in
this space will have been passed upon by
the Association.
It is hoped that the subscribers to
SCHOOL HyGIENE will transfer their
subscriptions to the journal, “Hygiene
and Physical Education.”
The importance of this publication is


II.4
-
S C H O O L H Y G I E N E
great. It is the only means of collecting
information on matters of school hygiene,
and presenting it to those throughout
the country interested in educational
matters. Everywhere interest is being
manifested in school hygiene. Plans for
new school buildings are being carefully
studied as never before, that the many
mistakes of the past be not repeated.
Lighting, ventilating, toilets, wash-room
conveniences, are not left to the decision
of architects alone. Play-grounds and
the use of them are insisted upon. Medi-
cal inspection and supervision of school
children, open-air and vacation schools,
a11 are the expression of the new school
hygiene.
It is essential, therefore, that the pub-
1ication of SCHOOL HyGIENE be continued,
and this has been made possible by unit-
ing with the journal, “ Hygiene and
Physical Education.”
THERE are some schoolroom punish-
ments in very common use incompati-
ble with the best physical interests of
the pupils. The maintenance of disci-
pline is, of course, essential to progress
and to mental tranquillity. In some
schools, however, “ discipline '' is wor-
shiped, and for its maintenance some
harmful punishments are inflicted. Nor
is the offending culprit the only one to
suffer. Not infrequently the whole class
is punished for the misdeeds of a few.
A very common form of punishment
is the keeping in at recess time. This is
wrong. It Ought not to be permitted.
The recess hour is for the children; it is
the recreation hour and surely the younger
children can ill afford to 10se it.
Another punishment, simple and in-
offensive in itself, becomes harmful from
too long infliction. The placing of the
head on the desk and keeping it there
until told to sit up seems a mild sort of
thing. But when the unnatural position
is kept for half an hour or longer, perhaps
because the teacher has forgotten the
child, it becomes a really severe and
harmful practice. This form of punish-
ment is limited to the younger classes arid
these are the very ones most harmed by it.
The possibility of harm should be
eliminated from all punishments admi-
istered to school children.
THE PLACE OF THE CRIPPLED
CHILD IN THE PUBLIC SCHOO
SYSTEM.
EVELYN M. GOLDSMITH, NEW YORK CITY,
President, “ The Association of Public School Teach
of Crippled Children in the City of New York.”
THE place of the crippled child in the
public school system is one of the great
educational problems which has lately
become prominent.
It is impossible in the time assigned
this subject this morning to deal in
comprehensive way with the several
phases which suggest themselves. I have
chosen to speak of the place which has
already been given the crippled child,
the splendid way in which he has taken
the place given him, the progress which
Ine has made, and the reasonableness
of a still greater effort on his behalf.
You will permit me, then, to speak ||
to you first of the interest taken in this
problem in the city with whose condi-
tions I am most familiar.
In New York City the question is
most pressing one, because of the larg
number of afflicted children found in t
lower East Side and other parts of our cit
where the population is congested. It
has been stated there are 7,ooo crippled
children in New York City to-day. -
In other great cities, for example, i
Chicago, Boston, Philadelphia, there aſ
found great numbers of these little me
and women who, though mentally norma
are physically wanting. Strangely enoug
although special classes have been orga
ized for mentally deficient chlidren, at
well-equipped state schools have be
established for the blind, the deaf aſ
dumb, the crippled or deformed chi
has been entirely neglected as far
public provision is concerned until t
last few years.
Private charities became aware
this need of the cripple about eight yea
ago, but philanthropy recognized on
the physical needs. They established ho
|


















S C H O O L H Y G I E N E
II 5
-
itals; 1ater guilds planned to provide
utings, entertainment for these unfortu-
lates, who had the power to enjoy but
ot the opportunity.
| Soon there came the realization that
hysical well-being is not the only impor-
hint factor, but that man's happiness
epends upon the mental and spiritual
ement as well as the physical.
When the demand for satisfactory
ducational training could no longer be
isregarded, different philanthropies es-
blished schools by private contribution,
nd a system of transportation which-
lade it possible for children to attend
hese schools.
Hospitals, finding that the detention
the crippled children while under
eatment was of long duration, opened
hools within the institution. The physi-
ans, 1ooking to the future, say in their
ports, “We believe the school work is
bsolutely essential and should be largely
eveloped along industrial lines ''; but
hey add, “Our income is less than
ur expenses, yet the school is so essential
hat it is important that this expense
ould be borne.” Another report says:
“The school is of great importance;
ºr efforts in the past must be as nothing
l, what we will do in the future. It is
expense which we feel absolutely justi-
|ed in incurring, but that is at times
ery difficult to meet.”
| One of the first steps toward the solving
|f the problem of the education of these
hildren by the public schools of New
ork was made in 1906, when the Board
| Education joined forces with two
rivate guilds. The guilds had paved
he way, and it was for the Board of Edu-
|tion to recognize the system and at-
|mpt some advance.
|The school equipment and teachers
ere supplied by the Board of Educa-
on ; the buildings, transportation, nour-
|hment, and general public care were
|oked after by the guilds.
|This attempt was found successful and
further advance was made a year later,
1907, when classes for crippled children
ere added to the regular public schools
herever rooms were available.
|At present there are sixteen classes
|r crippled children in the public school
stem of the city of New York, and more
ill be added as children are found.
hildren from five to fifteen are now in at-
indance, coming at nine, bringing a
on-day lunch, and returning at two.
he expense of the state for the trans-
portation of these children is borne by the
Board of Education.
The regularity of attendance, often Too
per cent, and the general progress
made both mentally and physically,
justify beyond doubt the existence of the
schools.
No other city that I know of has taken
over the education of crippled children
in a public way — outside of New York
City — with the exception of Chicago,
and here much progress has been made;
in fact, Chicago in some ways is leading
New York.
In comparing the progress made by
these children in the regular public-
school work, we find they have often
covered not only the outlines planned
for the regular course, but have been
able to carry on advanced work, espe-
cially along manual training lines, when
frequently three of the lessons usually
given are grasped in One, showing eager-
ness and ability for this work. For, as
when nature deprives the body of one
sense she seems to supply to another
increased powers, so, for example, when
the legs are weak and useless the arms
and hands become more efficient and
seem capable of doing more advanced
work.
It is apparent that the present plan
of work has developed in a somewhat
experimental way. The work of the
future school must be planned still more
carefully to meet the special needs of
this class of children. There should be
separate buildings reasonably near the
homes of the pupils, with cheerful rooms,
many windows, no stairs, and provided
with all necessary equipment to add
comfort and health to the disabled. The
course of study should be such as to
arouse their ambition and quicken their
energy. It must appeal to their minds
and yet afford to their hands and bodies
rational exercise, develop skill in the
use of tools, giving special trade in-
structions for those capable of trades,
art, music, etc., or what goes to make
most of the crippled child. Such must
be the schools of years to come when
the public makes full provision for its
needs.
The work for crippled children in our
own country is still in its infancy. In
Europe the problem has been before the
educationists for some years, and in no
department has greater progress been
made during the last twenty-five years.
The greatest advance in the education




















116
S C H O O L H Y G I E N E
of the deformed in connection with the
regular system of public schools is to be
seen in Great Britain, especially in
London, Liverpool, Glasgow, and Edin-
burgh, where many public Schools, of a
special character have been established.
In Norway, Sweden, and Denmark
trade schools have been established for
adults, where crippled men and women
are taught to earn their own living and
thus become independent. Here work-
shops have been established for over
forty years, and within most recent times
have been greatly enlarged and extended.
They are supported by grants from
the government and private donations,
but while doing most effective work are
often handicapped by need of funds.
Here many trades are well developed,
the aim of which is to fit pupils to go
out into the world to take positions and
to become self-supporting. I have re-
cently seen many wonderful examples
of their self-dependence. For instance,
three months ago in Christiania, Norway,
I saw a man without fingers mak-
ing beautiful furniture sets carved
with most intricate designs. Another
most wonderful case was that of a women
with no arms, who, by means of her teeth,
threw bobbins from side to side, making
the most elaborate and exquisite lace.
In Stockholm, Sweden, many similar
cases were seen. One child 1ess than
five, born without arms, was trained in
the kindergarten to sew and paint with her
toes.
In Copenhagen, Denmark, many pupils
had graduated and were instructors in
the school. These examples illustrate
the possibility of training the crippled
child to grow up self-reliant, a useful
member of society, and not a burden
to himself or to the community.
In Great Britain the schools for crip-
pled children are a recognized part of
the system of public instruction. These
schools, it is important to note, are in
buildings of their own (as here in Chicago);
they are equipped with furniture and
appliances especially adapted to the
needs of the crippled child. Each school
has an ambulance or two, constructed
especially to admit children on stretchers
and invalid chairs, for even the child
who cannot be taken from his stretcher
is not considered too disabled for instruction.
All children are conveyed to and from
their homes, and a nurse accompanies
each ambulance. Her salary and the
cost of the medicines she gives, such as
“ cod 1iver oil,” — with an addition of
“ milk and crackers ” at recess, ar
paid by the Board of Education.
In Liverpool and Edinburgh an especially
noticeable feature is the emphasis place
upon the surroundings of the school
The playgrounds and gardens are beau
tifully arranged. The children have thei
Own garden plots and care for thei
flowers and vegetables.
This out-of-door work is considere
very essential for crippled children.
In London—the work started by a
“Aid Society'' with Mrs. Humphr
Ward as 1eader—this venture was foun
successful, and in February, 1899, te
years ago, the London School Boar
took up the work. Since then twenty
three centers, with 1,900 children, hav
been enrolled.
Mrs. Humphry Ward, in making he
experiment, saw that no school coul
be successfully carried on without a ho
midday meal for the pupils. She or
ganized a “Crippled Children's Dinne
Society.”
A good hot dinner of meat, vegetable:
bread, and pudding is provided for fou
cents; sometimes this is varied by potat
pie or vegetable soup, and at all time
is good, wholesome food.
The Board of Education furnishes th
kitchen, firing, and cook (as they do
Chicago). The cook is responsible to th
head teacher for the proper performanc
of her duties. These dinners are unde
the direction of the “Crippled Children'
Dinner Society”; the managers are fro
each school and meet monthly to discus
plans. Free dinners are given only unde
exceptional circumstances, and 1ast yea
only 4 per cent of free dinners was giveſ
a small per cent when we find these chi
dren come from the 10west and poore:
slums of London.
To these centers are also sent childre
suffering from heart disease, paralysi
overtaxed brains and nerves, who cannº
stand the bustle of a large school. The
schools have medical inspection an
this work is practically indispensable.
The after-training of these childre
that is, after the children leave schoo
is under the care of the same societ
As a child nears sixteen (which is ti
age he is supposed to leave school), h
achievements are carefully noted, brought
before the committee, and work suite
as far as possible, to the requiremen
of that particular child is found.
In conclusion, it must be admitted th





































S C H O-O L H Y G I E N E
II 7
expense of maintaining schools for cripples
is heavy, but the care of the disabled
child is eminently worth while. The
modern discoveries in surgery keep alive
phildren who could hardly have survived
the first decade a generation ago. It
would certainly be better in many cases,
if science could let some of the unfortu-
hates go, but they are here and must
be cared for until they are in a position
to care for themselves. The advanced
ºniº of the medical profession in-
volve antagonism to the natural law of the
‘ survival of the fittest,” and the phrase
“incurable disease ’’ has almost passed
out of use.
The great majority of the afflicted
belong to the wage-earning class, with
small means to secure protection and
relief. Fresh air and sunlight, the greatest
preventives and curatives, are unknown
to them. Those elements, at least, are
surely to be had in a well-ordered school-
room. If the state is not going to provide
an education for these children, it is
nurturing a whole army of prospective
paupers. Is it worth while to care for
the individual during the comparatively
short period of childhood rather than
during the longer period of adult life?
If they are given the proper kind of
instruction it has been shown over and
Over again that these children, when they
grow older, are able to provide a liveli-
hood for themselves.
| The state has no option but to provide
for the crippled child and to give him,
at any rate, a chance of leading an inde-
pendent life.
METHODS IN THE MEDICAL EX—
AMINATION OF SCHOOL CHIL–
DREN.
ERNEST B. HOAG, M.D.,
Director of Hygiene and Medical Examinations in Throop
Polytechnic Institute and in the Pasadena City Schools.
(Read at the annual meeting of the American School
Hygiene Association, Chicago, 1909.)
ARGUMENT is no longer necessary to
support the idea of medical work in
chools. The necessity for such health
upervision is now pretty firmly estab-
ished in the minds of nearly all progres-
ive school people. We may, therefore,
(oncentrate our attention upon methods
or the organization of the school health
department.
In studying that most admirable book
of Gulick and Ayres, “ Medical Inspection
of Schools,” one is struck with the very
general lack of uniformity in health or-
ganization, not only in the schools of
this country, but to a less degree in those
of Europe as well.
Medical inspection, or, as I much prefer
to call it, health supervision of schools,
is provided for by methods which vary
all the way from desultory voluntary
Services to the complete, well-paid, and
methodical plan of New York City.
In general it may be safely stated that
schools get just about what they pay for.
One does not usually expect satisfactory
service from a voluntary or poorly paid
superintendent or teacher. Whatever sort
of public service is worth having is usu-
ally worth paying for. Health officers
in schools should, therefore, be regarded
in the same light as any other employees
of the school system. We frequently
hear of a school medical officer inspecting
several thousand children in a year, or
even less time, while giving to this work
only a portion (and usually a small one)
of his time, and receiving for such work
a pittance of $200 or $300 or less. Now
such a piece of work as this is sometimes
worth just about what is paid for it,
but more often its value is much less.
No inspector can possibly cover several
thousand cases yearly in a few hours per
week and do valuable work for the schools.
He is just what his name implies, an
“ inspector,” and he places himself on
about a plane with our RAT Inspectors in
San Francisco or Los Angeles. He in-
spects, it is quite true, but he never studies
nor adjusts. -
Health work in our schools, to be useful,
requires training, aptitude, time, and
respectable recompense. Except where
the health department of a city is organ-
ized on a large and complete plan, with
its various departments in charge of
well-qualified directors, the medical super-
vision of schools ought to be under the
direct control of the Board of Education.
This is true because medical work in
Schools naturally forms an essential part
of our general educational system. It is
a great mistake to think of it as first
of all medical, for it is first of all edu-
cational. It must aid the boy and girl
in healthy growth and development;
it must help the school to adapt its work
to individual physical and mental con-
ditions; it must aid in the correction of
existing physical defects and in the
prevention of others; it must teach the

II 8 S C H O O L
H Y G I E N E
fundamental elements of preventive medi
cine; it should superintend the teach-
ing of physiology and hygiene, and help
to raise these subjects out of the depths
of their present state of alcoholic and
anatomic perversion to a rational basis
intelligible to the child; lastly, it should
coöperate with, or direct, the work of
physical training, until the School physi-
cian is regarded as something more
than an “inspector.” But when, as is
already the case in some cities, and
among them. New York, Boston, Phila-
delphia, Chicago, Los Angeles, and even
1ittle Pasadena, the medical work in
Schools is correlated with the entire school
system and receives the hearty sup-
port of superintendent, principals, and
teachers, then we may hope for, and
confidently expect, results which in the
end will give the pupils a square deal
while in school, a better preparation for
1ife's work on leaving school, and results
which will place the parents of the future
generation in a position to more intel-
1igently aid their children in growth,
development, and character formation.
This is the work of the physician
in the schools; and, to my mind, any
school health organization which does
not recognize the essential points in the
plan here outlined is little better than
none at a11.
THE INFLUENCE OF NASAL OB–
STRUCTION UPON THE MENTAL
DEVELOPMENT OF SCHOOL CHIL–
DREN.
WALTER S. CORNELL, M.D.,
Bureau of Health, Philadelphia.
THE association of retarded mental
development with nasal obstruction may
be demonstrated either by (1) a study
of the physical condition of the dullards
among the School population, or by (2) a
study of the mental condition of those
children suffering from nasal obstruction.
It may be remarked in this connection
that in childhood nasal obstruction is
almost always due to adenoids, and in a
statistical study the two terms may be
regarded as synonymous. Also that the
writer's understanding of “mentally de-
fective children '' includes the dull chil-
dren as well as those suffering from the
more serious degrees of mental defect.
The prevalence of nasal obstruction
among the dullards of the school popula-
tion is evident from four studies in differ-
ent Schools at different times by the
writer, three of which have already
been published. They are here briefly
recorded.
An exhaustive investigation of 44 school
children of very low mentality, living
in the poor foreign section of Philadel-
phia, showed 31 to be suffering from
nasal obstruction. It should also be
stated, however, that physical defects
were numerous and diverse, since 12
cases of defective vision, 9 cases of dis-
charging ears, 27 cases of poor nutrition,
and 16 cases of nerve asthenia were also
found, and the summary showed that
but 3 of the children were free of
some one or more of these 5 defects.
Home visitation by the school nurses
also showed that the environment in 9
cases was absolutely improper, and the
family or personal medical history of
I 3 was sufficient to reasonably account
for the mental defect existing.
Another investigation in the Clag-
horn Grammar School of Philadelphia
consisted in a comparison of the physical
condition of the two brightest classes
and the two dullest classes of the sixth
and seventh grades. These classes had
been purposely so made up by the prin-
cipal, Mr. Dudley, for the sake of better
teaching. In the two classes of bright
children I2 per cent and Io.2 per cent,
respectively, of the children suffered
from nose and throat defects. In the
two classes of dull children 28.1 per cent
and 31 per cent, respectively, of the
pupils suffered from these defects. It so
happened in these classes that the eye-
sight standard averaged exactly the same
in each class, so that this factor was
fortunately eliminated.
Another investigation * of 174 dull chil-
dren in four classes in the William McKin-
1ey Primary School (each class contained
the lowest 25 per cent of the children of
its scholastic grade in the school, while
twelve other classes contained the brighter
children) showed that nasal obstruction
existed in 4o cases. There were also
68 eyestrain cases and 8o miscellaneous
cases receiving parents' notices.
An investigation” was made of a special
class for very defective children organ-
ized in the Wharton School, Philadel-
phia, which showed that of the 22 mem-
bers of the class, 14 suffered from nasal
obstruction. It may be noted that 5 of
* “Backward Children in the Public Schools,” F. A.
Davis Company, Philadelphia.
* “ Mentally Defective Children in the Public Schools,”
The Psychological Clinic, Vol. II, No. 3.



























S C H O O L H Y G I E N E
II 9
-
the latter were complicated by discharging
ears. There were also II cases of defec-
tive vision, 7 cases of poor nutrition,
numerous miscellaneous physical defects,
and almost all the children 1ived with
Poor foreign and almost illiterate parents.
The mentality of school children suff-
jering from nasal obstruction may be es-
timated by their scholarship, expressed
By “ age per grade,” or by the scholastic
improvement ensuing subsequent to the
removal of the nasal obstruction. So
far as the writer is aware, these investi-
gations heretofore have not been made
and they are presented in this connection
with the thought that they may be of
considerable interest.
One hundred children whose adenoids
had been removed by actual surgical opera-
ſion after diagnosis by the writer and by
Other Philadelphia medical inspectors
were investigated in March, 1909. The
facts ascertained were, (I) the age and
grade at the time of operation, (2) the
date of operation, (3) the mental im-
provement after operation, according to
the opinion of the teacher, and (4) the
mental improvement after operation as
shown by grade promotion.
The series was reduced to 7o because of
inability to trace many of the children.
The average age for each grade is as
follows:
Grade I 2 3 4.
7.6 yrs. 9.7 yrs. I 2.2 yrs. I2.7 yrs.
These “age-per-grade '' figures may
now be compared to the age-per-grade
figures of the whole city of Philadelphia,
taken from a report of the Superintendent
of Schools, and also to the same figures
for the foreign district of Philadelphia
from which these cases were drawn. The
Mount Vernon School, with a population
of twelve hundred children of foreign pa-
rentage, is used for this latter comparison:
| AGE PER GRADE (MONTH OF MARCH).
Age (average for the city of Philadelphia):
Grade I 2
3 4 5
7y. 71m. 9 y. Ioy.3m. IIy.21m. I2y. Im.
Age (average for the foreign district):
Grade 1 2 3 4. 5
7y.8m. 9 y. Im. Ioy. Ioy. I Im. I2y. 31m.
Age (adenoid cases in the foreign district):
Grade I 5
2 3 4
7.6 yrs. 9.7 yrs. I 2.2 yrs. I 2.7 yrs.
The retardation of the nasal obstruc-
|tion cases is evident. -
Mental improvement after operation. —
|This was ascertained by two methods:
first, by an inquiry among the teachers,
and, second, by an investigation of the
promotion records. The reader will note
that, owing to the impossibility of tracing
a11 the children the Series studied below
is further reduced to 63 cases.
The opinions of the teachers were con-
scientiously given, and since there were
scarcely any instances in which more
than one case existed in any one class
room, the general opinion expressed is
free of the charge of individual prejudice.
According to the teachers the degree of
improvement may be thus stated:
Much improved after operation. . . . . . . I9
Improved after operation . . . . . . . . . . . . 2
Mental condition unchanged. . . . . . . . . I6
Deteriorated after operation. . . . . . . . . I
Much deteriorated after operation . . . . 2
Total number investigated . . . . . . . . . 63
This constitutes an encouraging report.
In many instances, however, the “im-
provement ’’ noted by the teachers must
have been slight for the record of promo-
tions subsequent to operations is dis-
tinctly less optimistic. It is here given:
CASES HAVING TWO OPPORTUNITIES FOR
PROMOTION SINCE OPERATION (OPER-
ATIONS JANUARY TO JUNE, I 908).
Promoted twice. . . . . . . . . . . . . . . . . . . . 4.
Promoted once and failed once . . . . . . . . 2 I
Failed twice. . . . . . . . . . . . . . . . . . . . . . . IO
CASES HAVING ONE OPPORTUNITY FOR PRO-
MOTION SINCE OPERATION (OPERATIONS
SEPTEMBER TO DECEMBER, 1908).
Promoted . . . . . . . . . . . . . . ----------- 7
Failed . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2O
Total number investigated. . . . . . . . . . 63
Such a record totalling 32 promotions
and 52 failures after removal of the
nasal obstruction certainly explodes the
theory that the removal of adenoids
is the panacea for all juvenile delin-
quencies. That it causes great improve-
ment in some cases as well as a notice-
able average improvement is the con-
census of the teachers’ opinions. It
is well to bear in mind, also, that the
frequently existing association of de-
fective mentality and nasal obstruction
does not signify in every case that the
One is directly caused by the other, since
Inasal obstruction is found most fre-
quently where poverty, poor nutrition,
and poor ventilation exist, conditions
which suffice in themselves to 10wer the
mental standard of the child.




Hygienic Importance of Dustless Conditions
in School Buildings
The problem of preserving hygienic conditions in school build-
ings is one that deserves the serious attention of those responsible
for the health of pupils under their care.
Ample ventilation and scrupulous cleanliness are vital, but
unless the floors receive proper attention and treatment the dust
that accumulates will be a constant menace, for dust is recognized -
as the greatest carrier and distributer of disease-germs known.
A simple yet effective treatment of floors is found in
STANDARD
FLOOR DRESSING |
-a preparation that accomplishes its purpose by catching and
holding all dust particles and killing millions of disease-bacilli
coming in contact with it. Then, again, Standard Floor Dressing
preserves the floors by preventing them from cracking and
splintering. It makes the wood last longer and reduces the
labor and cost of caretaking.
Three or four treatments a year are all that are necessary.
Not intended fºr household use.
A TRIAL FREE OF ALL COST
We will gladly prove the efficiency of Standard Floor Dressing
as a dust preventive, by treating floor of one room or corridor
in any school or public building AT OUR OWN EXPENSE.
To localities far removed from our agencies, we will send
free sample with full directions for applying.
Sold in barrels, half-barrels, and in one and five gallon
º, Cans Write for testimonials, reports and book
“Dust and Its Dangers.”
STANDARD OTL COMPANY 24
(Incorporated) º
º
º































THE UNIVERSITY OF MICHIGAN
UNDERGRADUATE LIBRARY OVERDUEFINES:
$0.25 per day for rººf. AL CIRCULATION
$2.00 per day for RECALLED ITEMS
DATE DUE
DEC 05 (996
was 2 1997,

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