Health and the school; a round table

Introduction

Recent years have witnessed notable advances in our comprehension of the conditions governing the health of children. We have been astonished at the number of defects found among them; we have received new convictions in regard to provision for air and play ; and we have become acquainted with better methods for warding ofif disease.

Nor is our attitude on this whole matter by any means so theoretical as it was even a few years ago. Indeed, the extent to which all this knowledge is finding application, in communities of all sorts, is striking. Herbert SpcLci . charge that people were generally far more interested in the health and general care of their horses, cattle, and hogs than in that of their children will hardly hold much longer. And it seems likely that good health will soon rank £rst, in the minds of teachers and parents, among the things that make up a good education.

The realization of this promise will mark a revolution in the practice of the schools ; for, in times past, they have really, if not consciously, sacrificed health for the acquisition of knowledge. Training institutions for teachers have even been among the worst offenders in this respect. But observation is teaching us that, while neither knowledge nor health can be wholly neglected, the former is far inferior to the latter as a condition of

vii viii INTRODUCTION

success. School instruction in physiology and hygiene is still almost a farce, to be sure; but a better time is in sight.

In consequence of the striking advances in this field, there is pressing need of literature that summarizes both the theory and practice at present accepted, and in a style making the facts thoroughly clear and interesting to the ordinary reader.

The present volume helps to meet this need in a most effective way. It accomplishes three things : From widely scattered sources it brings together the theoretical facts pertaining to health, that seem well established, and that are most valuable ; it suggests how these facts have been applied, and, to some extent, shows the extent of that application up to the present time; and it presents all this matter in a surprisingly simple and attractive manner.

While excellent judgment seems to have been shown in determining what should be presented, the style of presentation is specially worthy of attention. The method is conversational, the subjects of conversation being just such questions and objections as the thoughtful, really interested, but perhaps skeptical person would desire to ask; and these are answered in a remarkably direct and convincing way.

F. M. McMuRRY.

Teachers College,

Columbia University, New York City.

Preface

The present widely aroused interest in matters of health has developed a great need among teachers and parents and public officials for practical guidance. The sickness and health of children are not really controlled by fate and the doctors, as many parents and teachers assume, but by those who regulate the daily conditions under which children live — parents, teachers and government officials. If these controlling powers are not thoroughly informed and intelligently alert, no amount of national agitation and legislation will secure the health of children.

It is comparatively easy for people with no technical training to learn a few fundamental matters concerning health — what normal health is, the conditions essential to its maintenance, the detection of many organic defects, the approach of acute diseases, and the effect upon individual children and their associates of allowing removable defects and diseases to continue.

This book sets forth the health problems which must be met in every school and family, and furnishes a working program for parents, teachers, school boards and boards of health.

The material has been put in the form of conferences such as might take place in any town which is successfully solving the problems connected with the health of its children. While most of the problems under discussion are focused in the school and the home, the people

X PREFACE

taking part in the conferences are not limited to teachers and parents. The health of children is a concern not exclusively of anxious parents or faithful teachers, neither of which groups has yet been very successful in securing it. Healthy children are vitally needed by the whole community which has to exert its highest intelligence and power to produce them.

In the following conferences the zeal of teachers and the solicitude of parents are supplemented by the scientific knowledge of a physician, the experience and sympathy of a social worker, and the practical sense of a successful business man.

The characters are not of course transcribed from life, nor is it claimed that the investigations and reforms credited to them have as yet all taken place in a single town. Each one, however, has taken place in some town. Every statistical item reported has been secured through actual investigation, in various cities and states.

The time has come for such scattered investigations and reforms to be included in the health program of every town. Many communities realize this, but are uncertain how to begin their novel task. It can only be accomplished through groups of active citizens for whom the conference method in this book may serve as a suggestion for procedure.

ACKNOWLEDGMENT

Grateful acknowledgment is made to the following persons for criticism and constructive suggestions in the preparation of this volume :

WilHam H. Allen, Director, Bureau of Municipal

Research, New York, Author of Civics and

Health.

Frederick Almy, Secretary, Charity Organization

Society, Buffalo.

Ellen C. Babbitt, Child Helping Department, Russell

Sage Foundation.

Alice C. Boughton, Superintendent of Lunches,

Home and School League, Philadelphia. Martin G. Brumbaugh, Superintendent of Schools,

Philadelphia.

Richard C. Cabot, M. D., Assistant Professor of

Clinical Medicine, Harvard University. Arthur D. Dean, Chief, Division of Vocational

Schools, State Education Department, New York. James Mapes Dodge, Chairman, Link-Belt Company,

Philadelphia.

Samuel T. Dutton, Superintendent, Horace Mann

School, Teachers College, New York.

Edward C. Elliott, Director, Course for the Training of Teachers, University of Wisconsin. Luther H. Gulick, M. D., Director, Department of

Child Hygiene, Russell Sage Foundation.

xii ACKNOWLEDGMENT

Samuel McC. Hamill, M. D., Professor of Diseases of Children, Philadelphia Polyclinic Hospital and College for Graduates in Medicine.

W. W. Keen, M. D., Professor Emeritus of Surgery, Jefferson Medical College, Philadelphia.

Frank M. McMurry, Professor of Elementary Education, Teachers College, New York City.

Rudolph R. Reeder, Superintendent, New York Orphanage, Hastings-on-Hudson.

Ella Flagg Young, Superintendent of • Schools, Chicago.

Acknowledgment is also due to the following, for the use of illustrations :

Board of Recreation, Philadelphia; Bureau of Health, Philadelphia ; Bureau of Municipal Research, Philadelphia; Child Hygiene Association, Philadelphia; Department of Health, Chicago; Home and School League, Philadelphia ; Horace Mann School, New York City ; National Cash Register Company, Dayton, Ohio; New York Orphanage, Hastings-on-Hudson; Playground and Recreation Association of America ; Review of Reviews, New York ; Russell Sage Foundation, New York ; Seybert Children's Village, Meadowbrook, Pa. ; Society for the Relief and Prevention of Tuberculosis, St. Louis ; State Board of Health, Virginia ; Taylor Instrument Companies, Rochester, New York ; The Detroit Saturday Night, Detroit, Michigan; World Book Company, Yonkers. New York.

Part I The Breakdown Of The School In Its Health Program

PAGE

I. Are Education and Health Incompatible?

Are our schools and homes producing healthy or defective children? — Should the schools add responsibility for health, and thorough training in hygiene, to their already numerous obligations? — If the aim of education in school or home is to prepare adequately for the efficient life of which health is an indispensable factor, is not the home or school that does not secure the highest possible degree of health and vitality for its members a failure? ......... i

II. Health Census of a School

Astounding number of pupils found with removable defects, — adenoids, enlarged tonsils, decayed teeth, impaired vision, spinal curvature, anaemia, malnutrition, etc. — An account of these defects and the resulting functional derangements — poor assimilation, nervousness, fatigue 12

III. Sanitary Inspection of a School Building

Sanitary conditions described, — ventilation, heating, lighting, drinking and toilet arrangements, cleaning of building, adjustment of desks, etc. — Means of correcting faulty conditions. — Standards of sanitation summarized . . 29 xiv CONTENTS

IV. A School Child's Day

PAGE

A study of the daily program: number of hours of work, rest, exercise, and recreation desirable. — Necessary alternations of kind of work and of work and rest . . 55

Part II The Opportunity Of The School For Pro- Moting Health

V. Cooperation with Parents in Securing Medical Aid

Cooperation between school and home indispensable. — School and health boards in need of authority to require necessary treatment. — General education a more fundamental corrective than general coercion. — Methods by which health officers, teachers, and enlightened parents can enlist the cooperation of ignorant or indifferent parents, — home and schools associations, public lectures, bulletins, exhibits, personal visits . • • 77)

VI. Provision for Medical Aid

Really expert medical service now available only for the very rich and the very poor. — Dangers of mediocre medical service and the need for adequate expert service for families of moderate income. — Experience of life insurance companies in furnishing free medical advice and treatment. — Plans for cooperation in securing competent medical, surgical, and dental service. — Drift toward public medical service ..... 84

VII. Teaching Children the Art of Health Training children in the knowledge and practice of health laws and safeguards one of the most important functions of the school. — Scope and methods of instruction

CONTENTS XV

PAGE

in hygiene and sanitation. — Sex instruction essential. — Psychological factors involved in successfully establishing health habits, — example, motive, practice . . 103

VIII. Health Supervision in Schools

Five functions included in school health supervision, — medical inspection, examination, and treatment; sanitary supervision of school buildings and homes ; hygienic regulation of school and home activities; health instruction of pupils and parents; physical education of children. 128

IX. Scientific Management in Health Supervision

Study of an actual medical and sanitary inspection system, and applications of efficiency tests. — Competent physicians and a well-devised plan not sufficient guarantees of effective work. — Accurate information regarding work done and results accomplished the basis for effective supervision . • 147

X. Red Tape

Plan and forms for recording and summarizing facts regarding physical examinations, recommendations for treatment, treatment obtained, inspection of school plant. — Method of using such records for directing and controlling inspection service ..... 174

Part III A Program Of Child Hygiene

XI. Health Begins at Home

The home as active as the school in producing physical defects of children. — Children in a large proportion of homes defective. — Parents generally unaware that it is necessary to study and practice child hygiene in bringing up children. — Account of actual cases typical of the xvi CONTENTS

PAGE

common failure of parents to realize that what seem grave constitutional defects are merely the result of violation of health laws, — ill-selected or superfluous diet, imperfect mastication, bad ventilation, insufificient exercise or rest. — Responsibility of the family physician for teaching hygiene to his patients. — The underlying principles of wholesome living, simple and few . . . IQi

XII. Air

Air the most vital of physical necessities. — Much fatal illness due to unwholesome air. — A fresh-air regime necessary for the health of children. — How to secure it — sleeping porches, window tents, outdoor schools, proper house ventilation 203

XIII. Food

A specially selected diet necessary for children. — Necessity of making this highly nourishing and digestible. — Proper balance of food elements. — The value of various common articles of food. — Suggested menus providing food elements in proper proportions .... 217

XIV. Clothing

Comfort and cleanliness the two main considerations. — Clothing that protects sufficiently but neither constricts nor oppresses. — No arbitrary standard of children's clothing possible. — Choice to be intelligently made according to climate and vigor of children. — Use of the thermometer in regulating dress 233

XV. Playgrounds

Excessive housing, a danger of modern civilization. — Outdoor play essential to children's healthy growth. — How to secure it. — Provision made for playgrounds in various cities. — The playground movement .... 243

CONTENTS xvii

XVI. Health Habits

PAGE

Habits that promote personal health. — Physical habits : breathing, eating, elimination of waste, exercise, posture, cleanliness, rest. — Mental habits : cheer, courage, self-control. — Habits that promote community health : practices that prevent the scattering of unclean matter and disease germs ....... 259

XVn. Calling the Doctor

How to choose a physician. — Choice to be based upon the adequacy of his training, his professional standards, methods, and activities, and his acknowledged success. — — When to call a physician. — The meaning and gravity of certain symptoms ....... 283

XVni. Health Problems in Children's Institutions

The discussions in the preceding chapters all applicable to conditions in children's institutions or boarding schools, — additional problems involved in such institutions. — Methods of counteracting the undesirable efifects of herding children together night and day. — How to avoid contagion and the devitalizing eflfect of routine. — Institutional diet, clothing, and recreation . . 298

Part IV Socialized Health: A Forecast

XIX. The Relative Cost of Health and Disease

Every step in the conquest of disease attended by an enormous saving in money and in human happiness. — Money efficiently spent for health conservation a highly paying investment. — Economics of disease prevention 2 xviii CONTENTS

PAGE

illustrated in Panama. — Health supervision in schools a fundamental and economical means of developing good health, and standards of healthy living, among all the people ......... 316

XX. Compulsory Health

Health important not merely to the individual and his family but to the community ; therefore a civic obligation as well as a right. — The work of home and school often undone by the failure of health officials to protect the community from contaminated water and milk, unsanitary streets, sewers, public conveyances, smoke, etc. — The health problem of a community, of which school health supervision is but one part, to be considered as a whole, each activity to be supplemented and supported by all the others. — A forecast : Every child with a sound physical inheritance and, from babyhood up, kept free from preventable defects and diseases. — Extermination of contagious diseases. — Sanitary schoolhouses, playgrounds, gymnasia, and swimming pools for 100 per cent, of the children. — Municipal nurses, dentists, and physicians always available to give expert advice, instruction, and treatment as desired. — Dispensaries and hospitals adequate to the entire need. — Each school a center for health instruction not only for children but for adults. — Public and private agencies working together in effective cooperation. — An educated and exacting public sentiment demanding thorough public enforcement of the best sanitary standards . . . 340

FULL-PAGE ILLUSTRATIONS

FACING PAGE

"Health and Happiness" ....... 52

"There's No Fun Like Work" and "What Are They Raising?" 60

"Baby Saving Show, Philadelphia" ..... 200

"Good Cheer and Health at Three Cents" . . . 218 '■'

"Hitting the Health Trail" and "A Winter Prescription" 2,^6 -

"The Eternal Spirit of Play" and "The Most Effective

Argument for Playgrounds" ..... 252

"On the Toboggan to Health" and "Bringing the Beach to

"Every House a Home" ... ... 314

PERSONS TAKING PART IN THE CONFERENCES

Mr. Young. Superintendent of schools. He is trusted and admired by the whole town, and is regarded by his school board as a model of progressive efficiency.

Mr. Martin. A member of the school board, also a widower with many cares. He is unenlightened, but eager to learn.

• Mr. Ross. A self-made business man, satisfied with his work and with society. He is constrained by his superior wife to assume an active interest in all social welfare movements.

Mrs. Ross. An awakening woman, whose husband's money has given her leisure to look around. This has aroused in her a sense of social responsibility.

Miss Parsons. A social worker, whose active sympathies and penetrating mind command a following wherever she moves.

Dr. Latta. a physician, new in the town. His elaborate and spotless office equipment is the scorn of most of the old practitioners who view his new-fangled methods and notable successes with jealous alarm.

ARE EDUCATION AND HEALTH INCOMPATIBLE?

Mr. Young. — A profound movement, destined to accomplish great results, is stirring our entire country. On every hand we hear the question, "How can we better our schools ?" As a people, we are finding out that popular education has not kept up with the procession. We see every day the last miracle of science or invention instantly appropriated by the industrial and commercial world. We see the efficiency of industrial institutions keyed daily to a higher and higher pitch. Why is it not so with our schools? Why do they not profit by the last scientific discovery or invention as do our railroads and factories and department stores?

Is there no branch of science which can specially serve our schools, and whose every advance means equal advance in our system of education? Though the schools have been slow to realize it, there is evidently one science, the most important of all, that is intimately connected with their efficiency. This science in its recent unprecedented development has benefited humanity far more wonderfully than any other. It is the science of medicine, the knowledge and control of health and disease. Its discoveries lie at the service of our schools.

Healthful schools and healthy children have suddenly become the demand of the day. I believe we can have both, if we determine to; if we are willing to act on even a part of the modern medical knowledge that is ours for the asking. Like most school men, I have been long in waking up to this vital matter, which a recent experience revealed to me with sudden force.

Last week my youngest little girl came running to me to know when school was to open. As she eagerly questioned the number of days before she was to enter school, and with forty other children be crowded into a classroom for long hours of weary work for young brains and little fingers, I wondered how long her cheeks would stay rosy and the spring in her step remain. I confess to my shame that I began to question whether I could not arrange to get her into some private school, where her physical comfort and welfare would receive more careful attention than her class standing. Then an accusing thought struck me. If I could not trust my own child's precious body to the schools that are under my direction, what about the 5,000 other young bodies that are gathered in these schools every day ? As the sense of this overwhelming responsibility came upon me I was stung with remorse, for I reflected that the most we had ever done for the physical welfare of these 5,000 children was to see that the school buildings were sufficiently heated, and that contagious diseases were somewhat guarded against.

While we have been patiently studying new ways of directing our long-suffering children's minds, we have never thought to find out whether the avenues to their minds were open; whether their eyes and noses and mouths and ears and brains were in shape to do business ; whether the physical conditions under which the chil-

EDUCATION VERSUS HEALTH 3

dren were working were the best possible ; whether the home conditions were wholesome; whether the children were learning habits of health.

We school people have already far more educational theory than we practice, but do we know anything about the theory and practice of children's health ? I would not trust my little girl's physical care to any one who knows as little about it as I do. I have always left it to her mother and the doctor; but, heaven forgive me, for eight years now I have been partly responsible for the health of 5,000 boys and girls, and what have I been doing? What have we all been doing? Leaving the matter to Providence and the parents, many of them more ignorant than ourselves.

We have calmly taken for granted that the general health of the children should decline through the winter, and that coughs and sneezes should punctuate all the recitations from autumn to spring. We have accepted as inevitable the fact that June finds the children pale and nervous and worn, as they issue from the school mill which they entered so buoyantly in September. Now, I want to know whether this physical deterioration is a necessary price of education. I wish to lose no time in finding this out, for, if it is really so, I am not willing to continue in a business that actually damages children.

I need help in investigating this question. I therefore propose that we devote the year's study to the health of children, in school and home; and that to-night we try to arrive at some conclusion concerning this question : Are education and health incompatible?

Mr. Martin. — If Mr. Young's earnest words were not so evidently prompted by deep conviction, I should suppose he intended his gruesome question as a joke. Are education and health incompatible? How can they be? Have not improved health and longer life followed step by step Mrith increasing education?

Dr. Latta. — They have followed step by step with a certain form of education, that of the scientific laboratory, which has indeed diminished disease and lengthened life; but our common schools are still producing quite reverse results, as they have always done.

Mr. Martin. — I find it hard to follow you, sir; but if there is actually any ground for doubting the wholesomeness of our schools, as a member -of the school board I want to know it. If my five children are likely to be physically handicapped through the very process of education I want a chance to think that over, too.

Mr. Ross. — Now, before we let ourselves be carried ofif our feet by Mr. Young's enthusiasm, let us question a little the purpose of our schools. It is to teach, isn't it? Is it not stretching matters a little to demand that the schools should add to their already great responsibilities the care of the children's health ? Let the schools stick to their task of teaching which, with no disrespect to anyone present, I may say they do none too well.

Mr. Young. — Does Mr. Ross realize that one of the greatest single factors in keeping down the efficiency of our schools is the never-ending stream of absence, from which no class is free, and that absence in turn is largely due to sickness? If we are teaching none too well, which I grant, it is, partly at least, because we are teaching none too likely children. The sick absentees and the ailing children present are too often the pacemakers for their classes. It is not an inspiring idea. If, as Mr. Ross says, the business of the schools is merely to teach, our town will certainly not get its money's worth of teaching until the schools demand that the

EDUCATION VERSUS HEALTH human material sent to them to work on is in as good condition as modern science knows how to make it.

Dr. Latta. — That is far from being the case at present. Investigations under the Russell Sage Foundation

NO

DEFECTS

DEFECTIVE TEETH

DEFECTIVE BREATHING

HYPER-

TROPHIED TONSILS

ADENOIDS

ENLARGED GLANDS

THE HANDICAP OF PHYSICAL DEFECTS.

The diagram shows the number of years required by defective and non-defective children to complete the eight elementary grades; according to data collected and published by the Russell Sage Foundation.

indicate that not less than 6o per cent, of American school children are handicapped by removable physical defects, and that, as a result, they are making 9 per cent, slower progress in their studies than they should. Children with seriously defective teeth, according to these investigations, fall six months behind in eight years. Half the school children of the nation— ten million — have bad teeth. Children with adenoids require a year and a month of extra schooling to complete eight grades. One-eighth of our twenty million children have adenoids. Children with enlarged glands require a year and two months over time. Nearly half of our children have enlarged glands. How much longer are we going to tolerate this enormous and unnecessary waste of time and educational effort, to say nothing of the vitality of the children?

Mr. Ross. — Oh, doubtless children attending school ought to be kept in sufficiently good health to prevent them from wasting their time or that of their teachers and classmates ; but it is for parents and health boards to see to this, and not for the schools. Give teachers any discretion in these matters, and they will begin to usurp the authority of the home. They will soon be directing us when to put flannels on our children and what to give them for breakfast.

Mrs. Ross. — I, for one, should not object to such consultations with my children's teachers. They care for the children through as many waking hours as I do myself. If they do not understand the physical care of children they ought to, for the children don't leave their bodies at home.

Miss Parsons. — I think that all these vexed details of what is to be expected of the schools and the teachers will clear themselves if we return to the question Mr. Young proposed, "Are education and health incompatible?" I haven't the least idea that they are, if we have the right idea of education. But if, as I suspect, our present form of education is not compatible with health, must we not ask what is the great purpose of education, and how are our schools failing to serve it?

EDUCATION VERSUS HEALTH 7

The schools, as our special instruments of education, should undoubtedly provide or insist upon whatever makes for the best education, whether the necessary factors are arithmetic books, baths, soups, or surgical operations.

Mr. Ross. — What is the best education nowadays? It used to be a thorough knowledge of the three R's, the purpose being to enable children to get along.

Miss Parsons. — Is not the purpose of education far more than that? Is it not to bring a human being to his highest possible state of healthful vitality and efficiency and human sympathy for the sake both of his own welfare and happiness and that of the community?

Mr. Ross. — That is a beautiful thought. Miss Parsons, but it is too much for a school to undertake. It requires educated ancestors and parents and money even to approximate such a product of sweetness and light. Neither physical nor spiritual perfection can be turned out by the gross from a public school.

Miss Parsons. — But at least the product should not fall short of the Maker's pattern. If our schools cannot produce saints, or Samsons, they should, at any rate, graduate well-disposed, intelligent children, who are healthy.

Mr. Martin. — Who knows that they do not? We are ready for some facts in this interesting discussion. Does our form of education damage our children, or does it not?

Dr. Latta. — It does damage some of them, sir. Besides tolerating defects that could and should be removed, it produces certain ones. The impairment of vision, for instance, begins everywhere in the lower grades and continues increasingly to the top. These imperfect eyes which the schools are making are the source of many constitutional ills that are not taken into account in public health reports. Headache, indigestion, nervousness, lassitude, and general misery are the price that a large number of our children are paying for the privi-

A PUBLIC SCHOOL MAY BE A CENTER OF INFECTION AS WELL AS A CENTER OF INSTRUCTION.

Every one of the twenty-two cases of scarlet fever indicated by the small circles was associated with the same school. Other schools in the same neighborhood were free from infection. This epidemic in Philadelphia was stopped when medical inspectors located the scarlet fever carriers in the Thomas May Pierce school and put them under quarantine.

lege of going to school and abusing their eyes. The eyes, moreover, are not the only organs that are injured in school, though the unscientific health inspection reports of many cities indicate nothing else.

EDUCATION VERSUS HEALTH 9

The backs that are twisted and bent by false positions and ill-adjusted desks are not usually mentioned. Nor is the connection often admitted between the annual crop of acute diseases and the schools that cause and foster them ; the fatal diseases of the respiratory organs, caused by bad ventilation and wrong systems of heating, and the inevitable contagious diseases that every mother expects to invade her home as soon as the eldest child enters school.

Do you know why I aim to be back in my ofifice every year at the opening of school ? For the reason that then the harvest begins, to keep up with little abatement till school closes in the summer.

Mrs. Ross. — Has not the cold weather of these months as much to do with the increased sickness of the children as their school attendance. Dr. Latta?

Dr. Latta. — Only in this way — that, as soon as frost comes, the windows in the schools, and in many of the homes, too, are practically sealed up. The children are forced to breathe unwholesome air, and the germs do the rest. The winter months should be the most healthful of all the months in the year. The cold, clear air, free from many of the summer germs, is the best tonic we know, but we grudge it to our children both in school and home.

At this point let me say that we must not lay all the ill health of our children to the school. The home is quite as responsible for it, and should come in for its full share of investigation; for, if there is one place less scientific than the school, in the care of children's health, it is the average home.