DR. WINSLOW ANDERSON: This subject is of paramount importance, it seems to me, not only from the point that has been raised, namely, contagion, but also from another, and, perhaps, an equally important one, namely, the comfort, the health, nay, the life of the patient. It was my misfortune two years ago to be very ill in bed for eight weeks. I then recognized, as I do now, that had I had a hospital at home, or a room particularly adapted to sickness, I certainly should have been much better off. Nothing can be more important than to have a sunny room, properly constructed and properly ventilated, where a member of a family may be taken care of as thoroughly as in any hospital. It prevents the great danger attendant upon the removal of the patient. It gives one at home all the necessaries of the sick-room. And the importance of this original suggestion, which I had never seen before Dr. Potter called my attention to it last year, I believe is of more value than we, at first thought, would give it. In nearly every household, at one time or another, there is an acouchement, and all of us know how sadly deficient the lying-in chamber is from a sanitary standpoint. The carpets on the floor may be dirty; have been there perhaps for years. Sepsis, puerperal fever, and the death of the patient may follow from the unsanitary surroundings of the room, because it is well recognized that carpets, hangings, cushions, etc., cannot be aseptic. For this reason, alone, I would strongly urge the fact upon the members of the Sanitary Convention, that a hospital at home is an essential. Few households have escaped without some contagious disease-diphtheria, scarlet fever, measles, whooping-cough, etc. How much better all these could be treated in a hospital at home. I think the suggestions of Dr. Potter are of great value.

DR. POTTER: Mr. President, if there are no further remarks, in closing the matter I would like to make another suggestion, and that is that we have in this country a great many boarding-houses, rooming-houses, hotels-in fact, one might say the majority of the population live in such. Now, when sickness comes on in one of these places the effort on the part of the proprietor is to get that case out of the house just as quickly as he can. You all know how it is. He consults the doctor, and tries to get the patient out as quickly as he can, so that he can again rent the place. Suppose the law should compel that boardinghouse keeper to provide such a suite of rooms as I suggest, arranged for that purpose, and made it an obligation on the part of the proprietor of the establishment to keep it in order, as it would be to keep his fire apparatus or his plumbing in order. The terror of the sickness would be banished. The sick ones could be kept in the hospital of the boarding-house or hotel, and that would be all in regard to it. I maintain that the public has an interest in this subject. The sanitarians are interested in this thing, and if it has never before been advanced by any one, it is time, I think, that the profession in these Western States took hold and advocated it. Where so many new establishments are going up it would be so easy to get it commenced, and once you have begun a thing like this it goes nowadays all over the world.

DR. J. R. LAINE: I believe there is a good deal in the idea of having hospitals at home, but it must be seen that in the houses of the rich it will be considered in the light of a luxury. It is not among the rich that we as sanitarians have to deal with disease. I believe that if the idea of a hospital-room is to become established it will have more to do

with the boarding-house and with the hotel than it will have with the private home, unless it be as a luxury. It is out of the question to make a hospital-room in a house of from seven to eight or ten rooms, with an average family of perhaps four to seven persons. Very few will perhaps do so, but nevertheless the conception of the idea is valuable.

Now, I have very little respect for the adult man of ordinary intelligence who will permit himself to get varioloid or smallpox. It should be considered a shameful thing for a man to do; as much so as to get an obscene disease under the lights of present knowledge. It is such a simple matter for an individual to become protected from smallpox, and yet it is suggested that we should urge the rich man, under this plea, to build a hospital-room so that in case he or his family should get smallpox, they would not be dragged out to the pesthouse. It is indecent for him to let himself get into a condition that would compel people to drag him to the pesthouse. But it is not so with diphtheria; it is not so with scarlatina, and it is not so with tuberculosis. These may overtake the children, or may overtake the adult residents of the house, and it is proper that they should have, if they can afford it, a place to care for the sick; but I must emphasize what Dr. Potter has said with reference to the necessity of such a room or rooms in large boarding-houses and in hotels. I have seen frequent instances where it has appeared to me to be a positive injury to patients to take them out of their hotels to hospitals outside. Even in an ordinary case of pneumonia, it is regarded by the hotel-keeper as something that he desires to get rid of as expeditiously as possible. The patient should be taken care of in the house where he lives, but we all know that the chambers in our private residences are quite good enough for the ordinary disease. They should not be used by people who have tuberculosis, or who suffer from consumption. They should not be used for the treatment of scarlatina, and yet we all know that we have frequently to temporize with patients, for delicate persons are often frightened very badly, and made much worse if moved from the place where they are accustomed to sleep. So it must be considered in the light of a necessity with reference to hotels and boarding-houses; in the light of a luxury with reference to the residences of the rich, and an expedient, if possible, in the houses of the poor.

NOTES ON THE HYGIENIC CONSTRUCTION OF SCHOOLS,

With Some Practical Hints on the Management of School
Children.

By WILLIAM A. EDWARDS, M.D., of San Diego, California, Fellow of College of Physicians of Philadelphia; and LELAND E. COFER, M.D., United States Marine Hospital Service, San Diego, California.

School hygiene, besides being a study of preventive medicine, is, or rather should be, a study of common sense. Unfortunately medical men are very seldom consulted as to the proper arrangement of schoolrooms, and still less so as to the care of the school children while they are indoors; therefore, if we can approach the lay authorities, who generally have charge of the construction and management of schools, through a general paper, and that relieved of seeming monotony by

the absence of statistics and technicalities, we may perhaps demonstrate the necessity of medical surveillance both in the construction and management of schools, and thereby raise the health standard above what it is at present.

CONSTRUCTION OF SCHOOL-HOUSES.

In the construction of school-houses, the same hygienic principles. are applicable as in other houses, only they should be doubled, if such a thing is possible. The site for a school building should be selected with as much, or even more, care than that of a dwelling. Proximity to marshes, ponds, and high buildings should be avoided, and if there be only one hill in the town where a school-house is to be built, that hill, or a portion of it, should be secured, if possible, for the site. It is not necessary to call attention to the advantages in the way of fresh air and drainage which either the summit or the slope of the hill affords. School-houses, like hospitals, should be built on the pavilion plan, and the ground covered with asphalt before the buildings are put up. If the buildings are constructed of wood, as they should be, the greater extent of surface required, and the consequent increase of the cost of the land, would be obviated by the saving on strong stairways, and second and third-story floors, and heating and ventilating flues, all of which have to be constructed, in the average three-story school-house, with the best of material, and in the most perfect manner, and with expense in keeping with the work. The floor of the building, which should be at least ten feet above the already drained and asphalted ground, should be made double, with paraffine-coated paper intervening, and all joints accurately joined. It will be readily seen that the building would be entirely free from permeation by ground air, both on account of the asphalt court and the air-tight floors. The walls should be tinted light green and the ceilings white; and to insure a free transpiration. of air, paint should not be used, but some preparation of lime. To prevent as much as possible the accumulation of dust and other impurities, and to facilitate the cleaning process, the junction of wall and ceiling and wall and floor should be rounded. In other words, there should be no corners in the building. This is really less expensive than the old-fashioned square corners and fancy borders.

Well-lighted and well-ventilated side rooms should be provided for the reception of outside clothing, umbrellas, overshoes, and particularly for the lunches, which are frequently overlarge; for the stale odor of decayed animal matter, which we all remember when we look back on our school days, has more than once, I will warrant, formed a culture medium for the propagation of various germs that in their dissemination have contributed to the ill health of school children. Therefore, under no consideration, should children be allowed to carry their lunches into the class-rooms.

The halls should be very wide, both to insure free ventilation and to furnish a play or calesthenic room for the children, who, at regular intervals, should be required to leave the class-rooms for a period sufficient to insure a change of air. They are then returned to their respective class-rooms, and the halls flushed with fresh air. This work should be systematically performed by the janitor, under the personal supervision of the teachers. It is reasonably certain that this system

of ventilation, regular exercise, and change of position is not only an excellent aid to the more elaborate artificial systems of ventilation, but is in some cases as efficient, if not more so, than any other method.

Now, as to the size of the school-room. It is very desirable, if not necessary, that a child of an average age of fifteen years should have about 663 cubic meters of fresh air per hour. Now, there are several ways of providing this, and it is an important point, as it involves a question of expense in any case. The least expensive and most certain way to insure each pupil 663 cubic meters of fresh air every hour would be to actually allow that much for each desk in the class-room, and by flushing the room every hour, by raising the wall and ceiling windows, to ventilate the room without a special ventilating apparatus. Thirtythree and one third cubic meters to each pupil would require flushing every half hour, and so on, in this ratio, could the air space be decreased, and consequently the inconvenience of flushing the room at short intervals be increased. A model class-room following the above scale should be about 10 meters long, about 7 meters wide, and 4 meters high, to contain forty persons, including the teacher, and each person having about 7 cubic meters of initial air space. Now, by the flushing process, the air would have to be completely changed ten times or thereabouts every hour; therefore, it will be readily seen that other methods of ventilation must be resorted to so as to keep the fresh air ratio at the same standard and at the same time not disorganize the class every six minutes. Now, by having the rooms emptied every half hour and the windows raised, we will obtain 14 cubic meters of fresh air per pupil; that will leave 52% cubic meters per pupil to be acquired by other means during the hour. This can be done, and a great deal to spare, by having in the center of each class-room a quadrilateral brick fireplace, with four grates, each about one cubic foot in size, and with iron fire-backs, which shall form a chamber in the center not less than 4 cubic feet in size. This should be connected to four sheet or galvanized iron cylinders, with their outlets under the rooms. After the air is heated in the chamber it will rise and pour out into the room about 3 feet above the floor, through small square holes, whose aggregate dimensions shall be 4 cubic feet. In Sajous, 1892 (I forget the reference), it has been suggested to plug each hole with cotton gauze saturated with lime water, which in uniting with the CO2 and SO2 will form the carbonates and sulphates of calcium, and thus prevent the entrance into the room of the noxious gases in the hotair chamber. The grate just described, when built in a wooden pavilion school-house, is attended with comparatively little expense, whereas in the old three- or four-story buildings it is necessary to have steam fans and other expensive heating and ventilating apparatus. A Bury window ventilator should be inserted in the top of each window, which latter, by the way, should extend nearly up to the ceiling.

2

LIGHT IN SCHOOL-ROOMS.

Next to ventilation, light is the most important subject. We will not dwell here on the statistics of diseases of the eye in school children, but it would perhaps be worth while to suggest a plan for the bettering of those same statistics. In the first place, the old idea that studyrooms should face toward the north is as absurd as it is in some case impracticable. In the day time light may be always obtained by ceil

ing windows, and irregularities in the intensity of the light may be readily corrected by sliding curtains. Green sliding curtains should be provided at all of the windows, and the teacher should see that curtain windows, which, by their position might transmit too much light or light in the wrong direction, are closed.

The relation of good light to the position of the pupils should be noted at different times of the day, and advantage taken of this by causing every pupil, at a given signal, to turn his desk and chair, both of which can be mounted on casters, in the direction indicated. Every child should be required to wear a large eye shade while in the classroom, and it would be interesting to note the changes in the eye statistics after four years of observation in the average city grammar school. The curtains of the windows should be so arranged that the light can only enter from the left side of the pupil. When admitted from the right side, the shadow cast by the pen in writing interferes with good vision; if admitted directly in front of the pupil, the glare will injuriously affect the eyes; while if it enters from behind, the book or paper of the pupil will be so much in shadow as to compel him to lean. so far to the front in bringing his eyes nearer to book or paper that myopia is very likely to be developed. The teacher should watch each and every pupil, and discourage the practice, so commonly seen in school children, of bending over book or paper. If it is found that there is a reason for this, such as beginning nearsightedness, the parents of the child in question should be advised to consult a physician. Where it is done through carelessness, it should be prohibited, and the offender marked for a breach of deportment. We all know the relation which bending over books bears to myopia, and we also know that nine out of every ten school children have the habit referred to, and we have only to take the trouble to look up the statistics to be assured as to the result. In examinations of over 30,000 pupils of grammar and high schools in Germany, Austria, Russia, and Switzerland, it has been found that the average proportion of myopia is a fraction over 40 per cent, varying, in the different classes, from 22 per cent in the lowest to 58 per cent for the highest classes.

In some particular schools, for example in the high school of Erlangen, the percentage in the higher classes was 88 per cent, in the gymnasium of Coburg 86 per cent, and in the gymnasium of Heidelberg the proportion of myopic students in the highest class was 100 per cent in 1887.

These interesting statistics were prepared by Dr. Rohé, and they show very plainly that myopia increases progressively from the lowest to the highest class.

ARTIFICIAL LIGHT.

There should be no artificial light in a school building, as with a good location, and well-arranged windows, there should be plenty of light during school hours. This will 'not only spare the children's eyes, but it will save pollution of the air, and also a considerable bill each month, which fact I mention in favor of pavilion schools as money-savers.