SCHOOL HYGIENE AND THE NEED OF MEDICAL

SUPERVISION IN ALL OUR SCHOOLS.*

By H. ERNEST SCHMID, M.D., White Plains, N. Y.

For more than a quarter of a century I have been closely identified with our free public schools, most of which time as president of the Board of Education.

I know we medical men are very apt to shirk all responsibilities outside of our professional work. This is altogether wrong. Physicians have duties toward the State just as other men have. I have always taken for my example as a citizen the late lamented Professor Virchow. The most industrious of scientific workers, he yet always found time to take a most active part in the political life of his country. But he always labored in that department in which his scientific knowledge would make him of most value. Where could we medical men then find ourselves of more use to the commonwealth than in the educational fields? And there our very professional attainments can be put to great advantage to the State. I say to the State, for the State's life depends on the evolution of our free public schools. A higher and higher state of education alone is a surety of the perpetuation of the free institutions under which we live. And a higher and higher educational development cannot be thought of without a more and more perfect teaching and enforcement of hygienic laws. To neglect the hygienic condition of the pupils is to neglect their mental growth and impair their future civic virtues. Civic virtues! This word always makes me swerve for a moment from whatever I may be considering, and deliver myself of a few words on the most important of all-obedience to the laws. Have you ever thought of the terrible fact that we are the most unlimited law-breakers in the world? We make no end of laws, and when they do not suit us we break them without the slightest hesitation. In my several official capacities, when I considered it my duty to enforce obedience to laws, I've been met with the utmost opposition, and been esteemed a personal enemy. Whence arises this moral defect? I am perfectly sure it comes

*Read at the Twentieth Annual Meeting of The New York State Medical Association, New York, October 19-22, 1903.-"New York State Journal of Medicine," January, 1904.

from the lamentable lack of enforcing obedience at home and in school, and lawless children make lawless citizens.

Unfortunately, many of our people confound liberty with license-think it manly in a boy to be uncontrollable and irreverent to his elders, and liberty-loving in a man when he breaks an inconvenient law. Gentlemen! If there be a bad law repeal it, but while it is in force keep it. Pardon this digression.

Therefore medical men should take upon themselves the duties of school board trustees whenever possible. Since a large proportion of the ill-health of a community is found in children of school age, it is very natural that we should inquire if perhaps this be due to defects in school hygiene, and if a large portion of it might not be prevented by improvement in that direction. Teachers and parents alike in many instances do not realize, for example, that the children's eyesight can be impaired, normal growth prevented, the blood poisoned and the body starved because of lack of knowledge of how schoolrooms should be arranged, and what hours should be devoted to study. For all these reasons I have endeavored to direct your attention to the great importance of school hygiene, as well as can be done in a short address like this. How important it is you will readily see. Everything, in fact, is of importance regarding the school, which exists for the greater elevation of the state of society and which can be assisted so essentially by the home, and will, in turn, educate the home. In the construction of its buildings and its administration the school should be supplied with and guided by whatever best and newest hygienic science has discovered in reference to it, and, as I said, but a moment ago, while the home can aid the school greatly, if desirous of doing so, sound hygienic teaching, in turn, can often reach the home far better and more quickly than in any other way, through the reflex influence of the school on the home. The people must come to the conviction that any educational plan which neglects the relation of mind and body in its hygienic and ethical import is to be rejected.

"Mens sana in corpore sano" is as true to-day as when it was first uttered. The preservation of health is an almighty factor in building up character. With these introductory remarks I desire to claim from you your serious attention to my words, no matter how far short they will fall from what they would want to effect.

The first to be considered is the selection of a proper site (hygienically proper) for a schoolhouse. The law in regard to it is not what it should be. In all places (with few exceptions in dis

tricts where a special legislation has been enacted) it is chosen by a district meeting. It should be in the power of the boards of education. I have seen repeatedly district meetings packed by a certain party and a site voted and extravagantly paid for which was totally unfit for a school building. I have, therefore, succeeded in establishing a law by our State Legislature which empowers boards of education in villages of 5,000 or more inhabitants to select sites for new school buildings themselves.

A site should have perfect drainage capacity of the soil, which depends on whether it is of fine or coarse grain. This drainage capacity of the soil, of the lot, the amount of its slope and its nearness to streams, surface or underground, make the healthfulness of it. It must be so shaped by nature that it not only carries off easily refuse and excreta from within the building to be erected upon it, but also surface and rain water flowing over the ground. If it is not perfectly dry it should first be underdrained. If you look to all this and can say that no malarial influence can prevail there; that light, and with it cheerfulness, will be bound to reign within the house; that pure and plentiful water which cannot possibly be contaminated can be introduced into it and as easily removed from it, after having been used; that a proper system for removal of sewage exists within, as well as a perfect system of ventilation, carrying off all respiratory impurities, and that complete dryness of foundation walls and roof is foundthen will you insure a healthy habitation.

I need not take up your time in telling you that the dampness from improperly constructed walls must have a bad effect upon the health of the inmates. I take for granted that this is all properly looked after by even a most ordinary set of trustees; but to the student of school hygiene there are many important matters which an ordinary builder, or even an architect, not conversant with school needs, will generally overlook; no, will often not know at all.

From the special investigations of physicians, architects and engineers the conclusion has been arrived at that the ideal classroom should be oblong in shape, and, if possible, 30 feet long, 25 feet wide and 13 feet high, with a seating capacity for 40 pupils. Such room would give to each pupil 183 square feet of floor space and 2433 cubic feet of air space. Light should always come in at the side of the room (preferably the left side of the pupil) or the side and back. Now the dimensions of the room in length and breadth must be governed by the distance pupils can

see without straining the eye and also the distance they can hear clearly the words of the teacher.

It has been proposed to put more pupils into primary grade rooms, because the desks in them are naturally smaller, but this could not be done without danger to eyesight and hearing; the number of cubic feet of air space would be lessened for each child, which would mean so much less oxygen (the food of the child par excellence) for each.

In the above dimensions of an ideal classroom there would be found a good deal of space not occupied by desks, but this would be especially useful in primary schoolrooms for conducting different exercises. You must recall to mind this important need, that primary pupils must not be kept quietly seated more than onethird of the school hours. Smaller children do not only become restive and in that state illy attend to their tasks, but exercises of various kinds to call into play muscular activity are imperatively called for at that age for the sake of mental as well as physical development, and not altogether only for relief from fatigue of long-continued sitting. Have not all of us who are fortunate enough to be fathers of children observed how wonderful is the activity of the little ones? Could we grown men and women keep up with them during a whole day? Certainly not. But their nature demands this tireless activity. How terrible, then, would it be for these little ones, untrammeled in the day's wide-awake hours of activity, to be suddenly placed in a room and upon a seat for hours every school day, with no material change of position! It would make the school hateful in their eyes at once. Blessed, then, is the kindergarten, with its playful instruction! Have any of you ever visited and seen the doings there? If not, do so, and you will be astonished at the quickness of perception instilled there. Children, whose minds have received the first training of the power of observation there, can be traced all through the grades for brighter and quicker intelligences.

The best and most hygienic school desks are no guarantee against defective posture, ending in permanent disastrous distortion of the body, which was assumed from fatigue and inactivity.

Some of you may perhaps know that quite a controversy has been carried on regarding vertical and slanting handwriting. All manner of claims were made for the slanting kind, but all of them were made unmindful of the great question which should be answered before deciding for the one or the other. It is this: What

effect has the learning or exercising of the one or the other upon the health of the child? Then there can be but one answer: The learning of the slanting writing is most injurious to many children, for they must then assume a constantly strained position, which the vertical does not call for. I am perfectly aware that 75 per cent. of the pupils would not be hurt by it, being endowed with more vigorous frames, but 25 per cent. are always found among 100 children, in whom a deformity could readily be produced. This is a fact based upon statistics. Therefore, do not suffer any to say: "It did not hurt us when we went to school”— a narrow, selfish and thoughtless expression and unworthy the make-up of an intelligent person. But when one tries to be a reformer it is frequently expressed by the common multitude. mit me to tell you, in relation to this statement, how a distinguished German investigator found that of 1,000 cases of curvature of the spine 564 developed it between the seventh and tenth years of their lives, which is at a time when with the beginning of the second dentition an increased growth of the whole skeleton takes place.

To continue the description of the ideal classroom I would say that according to the above authorities the window-sills should be 33 feet from the floor and the windows extend up to the ceiling. The amount of glass space should be at least equal to one-fourth of the floor space, and better still one-third. The divided window shades, which come from both top and bottom of the windows, are to be excluded, and only those that roll from the bottom, that the light may come in from above and be more evenly diffused by striking the ceiling first. The walls should be painted, not calcimined, for obvious reasons, the best color being a greenish-gray. There should be plenty of space before the blackboards to give the children freedom of motion.

I come now to a very important matter, which is the proper treatment of the children's eyes and ears. Since sight is really the chief medium of education, it cannot be too carefully looked after, and yet it is a fact that myopia is most frequently (if not altogether) developed during school life, and this is because during that period of growth the eye is more liable to change in form, and children have much greater power of accommodation than adults, and hence hold objects more closely to the eyes. From this looking at objects so very closely they are called to look at the blackboard from their seats,