School hygiene

Introduction To The American Edition

The present century is discovering that the care of children is the most important thing in the world. Except in so far as children possess vitality, integrity and intelligence, nothing is worth while. In the past our cities have been built as if manufacturing and commerce were the great aims of the world. The discovery of childhood is the supreme achie-^ment of our day. The time is coming when cities will be built so that children may be well and happy, so that the treasures of past civilization, the precious inheritance of the achievements of the human spirit, shall be passed on to them most effectively.

One of the leaders in this world-reconstructing view is Professor Leo Burgerstein, who has taken as his special theme the health of the school child, realizing that children in school are kept in school and under school influence, most of the hours of most of the days of most of the years of childhood. He says that the school must itself become a health-promoting agency, and the school curriculum a means which shall so influence the children that those who take part in it shall be better off in health and vigor than those who do not. The world is indebted to Professor Burgerstein for his scientific achievement, for his

V vi INTRODUCTION

breadth of scholarship, as well as for the practical nature of his teachings.

This little book will bring to those American readers who are not already familiar with Professor Burgerstein's larger work in German, his general point of view with reference to this whole subject of the health of the school child.

Luther H. Gulick, M. D.

New York, October, 1913.

Preface To The Third Edition

The preface to the first edition closes with the words: *Tt is difficult to set forth the results of an investigation in a way so as to be readily understood b}^ all, I shall be happy if I find that I have succeeded in this endeavor." The rapid sale of the second, extensive edition has shown that the chosen way was the right one.

In addition to a change of text and enlargement of the index, the new edition of this little l)ook, which has won many friends and received much recognition, has been altered only to include our present knowledge of school hygiene. A few parts have been omitted, some chapters have been made more comprehensive, and new and more instructive illustrations have been added. The great increase in material with no corresponding increase in the size or price of the book is due to the good management of m}^ publishers, and 1 take this opportunity of expressing to them my thanks for their services.

I desire also to thank my honored friend, Mr. Arthur Lieberman of Vienna, for his kind assistance in correcting proofs.

Leo Burgerstein, Ph. D., LL. D.

Vienna, April, 1912.

vn

MEASUREMENT EQUIVALENTS

1 meter

1 meter

1 centimeter

1 centimeter

1 millimeter

1 square meter

1 square centimeter

X degrees Centigrade

3 . 3 feet

100 centimeters

.39 inch

10 millimeters

. 039 inch

1 , 2 square yard

. 15 square inch (Xxl.8)+ 32 = X degrees Fahrenheit

Vlll

Contents

(The figures in parenthesis refer to the number of the page.)

Introduction to the American Edition v

Preface vii

Introduction xv

I. THE SCHOOLHOUSE I. General Planning and Erection

Planning (1)— Site (2)— Cottage Plan of Schools (4)— Location of Schooliiouse (7) — Water Supply (8) — Wells (8) — Drinking Fountains (9) — Construction (11)— Schoolhouse Entrance (12) — Waiting Rooms (12) — Cloak Koonis (12) — Lavatories (13) — Indoor Playgrounds (14) — Arrangement of Rooms (15) — Ground Plans (16) — The Classroom (18).

2. Lighting

Light Measurement (19) — Angle of Light (20) — Direction of Light (23)— Windows (24)— Curtains and Shades (25)— Light Reflectors (25)— Artificial Lighting (20)— Diffused Lighting (27)— Direct Lighting (28)— Gas Lighting (29)

3. Ventilation and Heating

Condition of the Air (29)— Dust (32)— Airing (33)— Ventilation (34)— Heating (36)— Stoves (37)— Gas Heaters (38) — Steam Heating (40) — Hot-water Heating (40).

4. The Classroom and its Equipment

Size of Classroom (42)— Walls and Ceiling (44)— Floor (44) — The School Desk (46) — Adjustable School Furniture

ix

X CONTENTS

(49) — Desk Dimensions (51) — Movable Desks (56) — Posture (58) — Blackboards (59) — ^Lavatory (59) — Expectoration Receptacles (59).

5. Other Rooms, Grounds, and Facilities of the School

Gymnasium (60) — Playgrounds (61) — School Gardens (63) —

, School Baths (63) — Swimming Pools (65) — Rooms for

Domestic Science (66) — School Feeding (66) — Toilets

(67)— Urinals (71)— School and Dwelling (72)— Cleaning

(73)— Fire Regulations (74).

II. THE HYGIENE OF INSTRUCTION I. General Considerations

Fatigue (75)— Constitution (78)— Defective Children (79)— Special Classes (80) — School Age (81) — Co-education (82.)

2. Number of Pupils and Curriculum

Number of Pupils (88) — School Hours (91) — Carrying of Books (92) — Inspection for Personal Cleanliness (94) — Length of Instruction Periods (94)— Recesses (96) — Order of Subjects (101)— The One or Two-session Day (102).

3. The Hygiene of Different School Subjects

Reading (106) — Writing (109) — Vertical or Oblique Writing (111)— Handwork (116)— Domestic Science (116)— Manual Training (116) — Gymnastics and Play (118) — Singing (122).

4. Homework, Examinations, etc.

Homework (123)— Extra Work (127)— Examinations (127 — Graduation Examinations (Reifepriifungen) (128) — Overwork (130) — Punishments (131)^Corporal Punishment (133) — School Suicides (135) — Other Punishments (136)— Vacations (136)— Summer Vacation (137)— Mid-

CONTENTS xi

term Vacations (138) — Suspension of School on Warm Days (139) — Vacation Colonies or Camps (140) — Excursions in Vacation (141) — Recreation Day Camps and Open-air Schools (141).

5. Boarding Schools Open Air Boarding Schools (143).

III. INSTRUCTION IN HYGIENE

Hygiene in Training Schools (146) — Hygiene in I^lementary Schools (148)— Hygiene in High Schools (149)— Alcohol (150)— Tobacco (151)— Sex Hygiene (152).

IV. SCPIOOL DISEASES AND MEDICAL INSPEC- TION OF SCHOOLS %

Contagious Diseases (154) — Myopia (Nearsightedness) (150) — Spinal Curvature (157) — Subnormal Children (158) — The School Physician (159)— School Nurses (165)— School Clinics (166) — Historical Survey of Medical Inspection (167).

V. HYGIENE OF THE TI^ACHING PROFESSION

Difficult Schoolroom Conditions and Nervous Strain (173) — Overtime (174) — Consulting the School Physician (175).

Bibliography 176

Index 178

ILLUSTRATIONS AND DIAGRAMS

FIG . PAGE

1. Pavilion school at Drontheim, Norway. Perspec-

tive 5

2. Pavilion school at Drontheim, Norway. Ground

plan 6

3. Ground and cross section of a school unit at Dron-

theim, Norway 6

4. A drinking fountain reciuiring no cup 10

5. Ground plan of a one-room Danish schoolhouse. . 13

6. Plan of the first floor in a London public schiol

accommodating twenty classes 14

7. Ground plan of a public school (thirty-two classes)

in Frankfort, Germany 15

8. A school and its grounds at ^'iroflay, France ... 17

9. Photometer by Wingen 19

10. Pleier's camera for measuring the angle of hght. . 20

11. Photograph taken with the Pleier camera for meas-

uring the angle of light 21

12. Measuring the light on the desk farthest from the

window 22

13. Diffused lighting by Welsbach lamp 27

14. The Meidinger stove 35

15. Ventilation by temperature differences 36

16. The Meidinger stove, interior view, showing ven-

tilating system 37

17. Steam heating 39

18. Plan of a schoolroom with benches each accom-

modating two pupils 43

xiii

Introduction

It is a well-known fact that the beginnings of many modern activities can be traced back thousands of years. Such is the case with school hygiene, for evidence of its existence has been found as far back as the days of Greece. Even the modern form of school procedure is much like that of a far-removed age; the schoolhouse of the present with its equipment agrees in some respects with the schoolhouse and equipment described by Furttenbach.* ^here have been times in Germany when public opinion was disposed to consider with indifference a sound physical development in relation to school work. Even to-day, while the teaching profession generally appreciates the importance of school hygiene from a theoretical standpoint, in actual practice we are still feeling the effects of the earUer prejudiced times, and much progress needs to be made. Nevertheless, the right of the child is one of the demands of the times, and this demand includes the protection of the child's health in pubHc institutions.

As the father of modern school hygiene we acknowledge the eminent physician, Johann Peter Frank, who, in the second volume of his great work, " System einer vollstandigen medizinischen Policey,"t sum-

xvii xviii INTRODUCTION

marized the meaning of school hygiene. The science has, however, been broadened and made effective only during the past fifty years, when medical specialists, in the interests of scientific knowledge, have examined large numbers of school children to determine what disturbances of health are traceable to school life. In the train of these examinations many thorough investigations were taken up to determine the physical condition of school children and the state of sanitary equipment of the schoolhouse; and much knowledge has been gained and many hygienic improvements have been introduced. In comparison with research in these directions, the hygiene of instruction made its appearance relatively late, and is therefore far from being cleared up sufficiently. The demand for it must come from the schools, its teachers, and the specially trained school physicians. The hygiene of the teaching profession, developed in the spirit of modern scientific research, is likewise only in its infancy.

Practical hygiene so far as it concerns all matters of the school will succeed only when schoolmen generally, teachers, and the pupils themselves, understand the rules of health. As for the actual instruction in hygiene in the school, the subject is so comprehensive that it is impossible that all teachers shall be experts in this particular field; hence a demand has gradually arisen for a person especially trained in this branch of school work, namely, the school physician.

It is important that the teaching profession take an active interest in school hygiene; there is no better

INTRODUCTION xix

way toward realizing the ideals of the science or of verifying the results of research.

The fundamental points to be emphas'zed in this book have thus been indicated. Their discussion, which will be concise, will include matters of theory and practice in various countries. It will materially aid the advance of the science if teachers everywhere will accept the suggestions concerning the theory and practice in other lands in the spirit in which these suggestions are made, and as an incentive to progress in their own schools.

I

1. General Planning and Erection

The problem of schoolhouse planning differs from the ordinar}^ house planning in this respect that almost every condition is altered. In a dwelling house the place where one sits to read is near the wi|^dow; in a schoolroom even the corners far removed from the windows must be used for this purpose. The very moment the threshold of the schoolhouse is crossed, the difference is apparent; many feet passing over a threshold bring in an unusual amount of dust. The school stairways, too, must at times bear the weight of crowds, and rooms which must accommodate many individuals make proper ventilation a serious matter. In fact, the characteristics of the schoolhouse serve to emphasize the difference ])etween it and the dwelling.

Planning. — In order to avoid mistakes which cannot be remedied later, when the schoolhouse is being planned close attention must be given to the hygienic aspects. This requires careful study at the outset, a fact which has unfortunately been learned by experience in those communities where it has been found that an attractive appearance does not always mean good planning or suitable situation. Schoolhouse planning demands experts. In rural communities good model plans might be edited by the municipal authorities. In this way, even a small community could erect a satisfactory schoolhouse and be stimulated to undertake the work because those immediately interested, as, for instance, business men, could superintend the matters of planning and erection. It is, of course, of material help toward the securing of good schoolhouses if the state is able to assist by subscribing loans without interest. Small and average-sized cities may succeed in securing good plans by initiating a building contest. The sketches submitted in the contest should be passed upon by an expert in school hygiene. The primary aim in all cases must be to secure ideally hygienic conditions as far as the finances will permit. This necessity must precede all claims to beauty; panem et circenses, not the reverse, should be the rule. In the larger cities the aim should be a comprehensive study of schoolhouse construction in other countries as well. This study should include a review of the existing literature on the subject, and also the personal observations of an architect especially interested in this branch of his profession.

Site. — It must be emphasized again that not every building will do for a schoolhouse and that the schoolhouse demands special construction. The choice of a site is important. The essentials are: quiet, air as good as the locality permits, and light which is not interfered with by adjoining buildings. A further essential is that these conditions be assured for the future. It happens frequently, especially in small towns, that an otherwise desirable schoolhouse is placed entirely without necessity on a thoroughfare, merely because the town is proud to show it. The noise and dust of the thoroughfare prove disturbing factors. If the building must be put on a principal street, by all means let the corridors be on that side while the classrooms face the rear; ])ut a more favorable location should be found, if possible. Furthermore, in small places the plans should be such as to admit of the addition of annexes or stories.

In rural districts, in order to have a generally accessible schoolhouse, one must take into account the lay of the land, the distribution of the population, and the state of the roads. Instead of a separate school for each small village, it might be desilable to have one large school for a number of villages. The pupils might be brought to the school by conveyances, as is the system in vogue in certain parts of the United States, where several of the states have already pa:?sed legislative enactment on this point. It would be most helpful, both from the standpoint of hygiene and from that of school attendance, if in rural districts it were possible during the inclement season when the snow lies deep and transit is difficult, to organize a system whereby particularly the smaller children may be carried in conveyances alternatively by the farmers to and from school. In the northern part of Scandinavia, where the farms are widely scattered, it has been found feasible to form so-called Wander schulen. In these, a number of children are fully taken care of for a number of weeks, until the teacher must move on to the next post.

When quiet and good air are aimed at it is well to remember that these conditions are not likely to be secured where school buildings are situated in the vicinity of railway stations, near laundries where chemicals are used, or near factories. It would be a distinct advance if this matter could be controlled by law, for instance, the prohibition of such establishments within a mile of the schoolhouse.

Cottage Plan of Schools. — In large cities, a realization of these ideals — quiet, good air and good light — is not easy, but the evils might be minimized if the municipal authorities would look ahead a few decades in the growth of their city and restrict certain sites in the suburbs for the use of schoolhouses and playgrounds. In the meantime, such tracts of land might be leased out for agricultural purposes. Some large cities have built their schools on the plan of one schoolhouse to so many thousand children, but this procedure does not always express a wise, far-sighted policy, for while the proportion of school children to the total population (in most countries from 13 to 20 percent) is known, in some sections, for instance where a factory is being set up, the school population will increase out of all proportion to the provisions that have been made. To meet such needs, large school barracks must then be constructed in haste. Such cheap, lightly built structures, while they sometimes admirably relieve a temporary need and have been known to give good service for years, are not to be recommended for general use, and should merely serve as an emergency measure in large cities. It may be that from some of the advantages of the school barracks has originated the cottage plan of school building, i.e., instead of one large schoolhouse, a number of smaller, separate units. The advantages here are better air and less mutual disturbance; it is easier to clear the rooms in case of fire, and the closing at times of epidemics need only concern one unit. On the other liand, drawbacks are again met with in the tax put upon the central heating system, and if shower baths are used the danger in cold weather of having

Fig. 1. — Pavilion school at Dronthoim, Norway. Perspective.

the children pass after the bath from one building to another. The comparatively large amount of space required for the pavilion school renders it not generally practicable and for this reason but few such schools have been erected, though they are to be found here and there, especially since Beutner in Ludwigshafen (Germany) has supplied a model. Figs. 1 and 2 show examples of the Hakonson-Hansen pavilion at Drontheim in Norway. The schoolhouse is of wood, centrally heated by steam and ventilated mechanically. The house in the rear of Fig. 2 is the gymnasium

STREET

SCHOOL UNIT

Thouse I'^^^

PLAYGROUND FOR GIRLS

SCHOOL UNIT

5 ID 50 TOm

Fig. 2. — Pavilion school at Drontheim, Norway. Ground plan.

Fig. 3. — Ground plan and cross section of a school unit at

Drontheim, Norway.

where classes in physical exercise and training for sloyd work are conducted. Fig. 3 shows the ground plan and a cross section of one of the pavilions, with six classrooms, each accommodating 36 pupils.

Points relating to the size of school plots will be taken up later; it is sufficient to say here that the grounds can never be too large when play spaces are taken into consideration. School buildings should never be placed on sites formerly used as refuse dumps, on ground where underground currents of water come near the surface, or in marshy places.

Location of Schoolhouse. — A much discussed question is the location of the school building with respect to the point of the compass. The great influence that the sun has as a hygienic agency is well expressed by the forceful old Italian saying that, ''Where the sun never goes, the doctor must go." Sun^ine is especially important for the physical and moral health as well as the happiness of children. On the other hand, the sunlight which falls directly on the page when the child is reading or writing is harmful to the eyes. Curtains or screens are then necessary. It must also be remembered that a very sunn}' room well filled with children is decidedly uncomfortable in summer. Local conditions, such as a mild or a severe climate, strong or badly nurtured children, distribution of class hours, etc., play important parts. For the health of the children, sunny situations are on the whole preferable to the northern exposure . which has recently been advocated. The value of sunshine is not to be overlooked when ideal situations can be obtained. In the large city, where a schoolhouse must be placed of necessity in a-street with other houses, the choice of location of the rooms is naturally strictly limited to their distribution within the schoolhouse.

Water Supply. — The quality of the water supplied to a school is a matter of the utmost importance, as impure water may be the source of dangerous disease. Filters are not to be recommended because they soon become choked with bacterial organisms and are sterilized with difficulty. At the first appearance of an epidemic which points suspicion to the water supply, care should be taken to sterilize all water used for drinking purposes. It should be boiled for at least half an hour in bottles placed in a kettle filled with water. A little cold tea or lemon juice added to the boiled water takes away the flat taste.

A central water supply is gradually being recognized as a necessity in all large communities, for a badly situated or a badly managed well is too apt to become a source of epidemics.

Wells. — In country places, which lack a central supply and where it is not always possible to have scientific supervision to insure purity of the water, especial care should be given to the location of the well; the site must be absolutely without question. Unfortunately rural wells are often a mockery of the laws of hygiene. Hence the school well should be a, model to the community. To inculcate this lesson in the children, on occasions it might be desirable to show a plan and cross section of a good well to the older pupils, and to explain to them the dangers of a bad location. Concerning a good situation for a well, the points are briefly these. If the ground has good filtration powers, a vertical depth of about 5 meters insures water free from bacteria; the filtration of water running obliquely to the well must also be considered. At all events, deep wells of at least 8 meters are superior to surface wells. It goes without saying that there should be no toilets, lavatories, or manure heaps nearby, or even within a radius of 10 meters. Wells should be dug to the depth of at least 5 meters, and the shaft should be water-tight. It is desirable to project the coping of the well about 30 centimeters alcove the ground; the cover also should be water-tight. It is better not to have the well-pipedrop in the middle of the shaft. The spout of the pump should project beyond the well covering, and the trough to carry off the water should be water-tight and lead at least 5 meters away, so that there %hall be no soaking in of dirty water. Drilled or driven wells are to be advocated where the ground is adaptable.

The school well has been discussed at length because investigation has proven that in rural districts it is frequently' found to be a menace to public health, and the opportunity of calling attention to this evil may often ])e presented to those informed on this important matter of hygiene.

Drinking Fountains. — The drinking fountain is next in importance to the water supply. In most schools the only provision made is the common drinking cup, in some a few tum})lers are provided for a whole class of children. It will generally be found that school children rarely rinse the common cup ; or if they do, the operation lacks thoroughness. The saliva adhering to the rim can only be efficiently removed by a strong flow of water, and there is little inclination on the part of children to do this thoroughly and sometimes also there is a lack of time. The serious consequences can readily be foreseen; a child infected with diphtheria may spread the disease among those who drink after it out of the same cup. Individual drinking cups, one for each child, should be used in place of the common cup. For those who are too poor to buy a cup, some charitable provision might be

made. This individual cup should be kept in the school bag or in a special place provided for it in the desk similar to that provided for the inkstand, or else the cups should be left in a designated spot and numbered for identification, the younger pupils having stars, or a cross, or half moon to identify theirs. It devolves upon parents and teachers to instruct the children not to lend their cups to others.

Where running water of sufficient pressure is available, a drinking fountain may be set up, one that requires no cup, but from which the water gushes directly into the mouth when a valve is pressed, as shown in Fig. 4. When the child has finished drinking, he releases the valve and the jet ceases, but the water continues to flow below the valve, washing away the drops which have fallen back from the

I

Fig. 4, — A drinking fountain requiring no cup.

mouth. In this way the lips of the drinking person do not touch the opening of the fountain which is below him in the depth of the basin. Fountains such as these were introduced into a Vienna school in 1906 on the occasion of an anniversary.* It is greatly to be desired that other cities will follow the example of this school by the introduction of equally hygienic improvements on similar occasions. In the United States fountains are used extensively as a result of the legislation wliich has been passed prohibiting the use of public drinking cups. While New Jersey, Florida and Indiana led the other states in this action against the common cup, there are at present more than a dozen states and fully as many cities which have done away with the use of public (Mips in schools.

Construction. — There is no special need for dwelling upon the hygienic side of building materials or construction further than to say it is generally conceded that a cellar is desirable, though not absolutely necessary when there is a good foundation of concrete and floors which will keep out the cokl. It is well to prevent the rise of ground water in the walls by using layers of insulating nt^aterial in the foundation under the floors. Onl}^ dry and moisture proof material should go into the making of partitions. To get the necessary warmth and required freedom from noi^e it is best not only to deaden the beam coverings and flooring, l^ut also partly to fill up the intervening spaces. Certain newly devised building materials,

*The model was a good, cheap one invented by Oreffice of Padova (Italy).

made of iron and concrete, are admirable for filling in. House fungus, the presence of which may become unhygienic and a source of expense when it requires removal (though not considered a poisonous growth) may be avoided by the use of thoroughly dried wood. Staircases which are absolutely fireproof both as to the treadway and its covering are essential. The new schoolhouse should not be thrown open for use until it is thoroughly dried out.

Schoolhouse Entrance. — No schoolhouse, not even the smallest, should discharge its pupils directly into the street. In large schools, at least one entry for every three hundred pupils is desirable. In the entry room of every schoolhouse, large enough provision should be made to have the pupils wipe their shoes thoroughly before coming into the classrooms. Since the prevention of dirt in the house is easier attended to than the operation of cleaning, the pupils should become accustomed to make systematic use of the dust mats, etc., from the beginning of their schooling.

Waiting Rooms. — Waiting rooms situated near the entrance are most desirable in city schoolhouses, for the convenience of those who escort the children to and from school.

Cloak Rooms. — Of especial concern to the health of the school population are the rooms where wraps and umbrellas are deposited. If these articles are kept in the schoolroom itself, the warmth of the room and the dampness of the clothing together will soon cause deterioration of the local atmosphere. It is by all means desirable to have a special cloak room. Such accessory rooms have gradually become an acknowledged necessity in many countries. (See Fig. 5.) It is also recommended that in the cloak room provision be made for drying the damp footwear of the children and that each child might have a pair of dry shoes and stockings for change. Cloak rooms should, of course, be well heated in winter and well ventilated at all seasons; children who come early to school might be appointed to attend to these conditions. Hallways may also be used as wardrobes.

Fig. 5. — Ground plan of a one-room Danish schoolhouse.

Lavatories. — The cloak rooms found in the London schools deserve special commendation, because of the hygienic provisions they make for the cleanliness of the pupils. As the children come in, a teacher inspects them, and those who are in need of soap, water and a towel, are accorded these privileges. There are four washstands for every one hundred children of the school. (See Fig. 6.) In respect to that much involved question, the hygiene of the towel, we should like to suggest that in schools not frequented by the very poor, each child should bring his own towel with him to school and carry it home to be dried. The very poor children could have towels given to them. Indoor Playgrounds. — School children should have a well-warmed room in which to spend the recess in inclement weather. (See Fig. 8.) As it is generally admitted that the needed amount of play space for each child, even in large cities, is at least one-half

J Boy's Stairs

Boy's Stairs

.10

Fig. 6. — Plan of the first floor in a London public school accommodating twenty classes.

square meter of space, the amount necessary for this purpose can easily be computed. The free space thus available for the recreation of the children may be augmented by the wardrobe space, i.e., where the clothing is hung in the corridor in a wire cage open to the air. On the whole, it would seem to be wise to make the corridors only just as wide as is absolutely necessary, and the stairways not more than a meter in width (but increasing the number of such stairways), in order that the common recreation hall for all the classes on a floor may be as large as possible. Fig. 6 shows a hall of this character. It admits of easy supervision and may be used as an assembly room by a number of classes.