Essentials of educational hygiene

Preface

The remarkable movement for the improvement of school and community health in the last decade has brought the school into such close and intimate relationship with the health work, of the home and the community that ^^ school hygiene" is hardly broad enough as a term to include the various health aspects of the bringing up of children. On the other hand, the term ^^ child hygiene" is too broad. The title ^'Educational Hygiene" has been adopted for the science and art of health preservation and promotion which the school can more or less directly promote through its various health agencies. When the school nurse visits the homes and improves the health of the children below school age as well as that of the pupils of the school, and when school physicians provide for consultation hours for mothers, whether patrons or not, the old-time school hygiene is broadening out into educational hygiene. This movement has but begun, and will inevitably continue to expand.

Educational hygiene, furthermore, is desirable as a term, since the subject is now taking its place in professional schools for the training of teachers as correlative with educational psychology, educational sociology, educational philosophy, educational history, educational administration, and the Hke. As educational administration was once termed school administration, so educational hygiene was once termed school hygiene, and the desirability of the change in college courses is probably not less for the latter than for the former.

This comparatively new science is broad in scope, covering as it does the five divisions : medical supervision, physical education, school sanitation, the teaching of hygiene, and the hygiene of instruction. Obviously, very few persons can

Vi PREEACE

make any just claims to being experts in this entire field, and exceedingly few persons have had very much practical and scientific experience in all of them.

This volume is an attempt to bring together in organized form the latest information and advice of leading speciahsts in all the large phases of the subject. The hygiene of children from the standpoint of the school in its relationship to the home and community, from the pre-school period up to the college, is sketched in such detail as is possible in so comprehensive a volume. There has been a constant temptation to add chapters on many new phases of the school-health movement, but the editor has tried to limit himself to certain '' minimum essentials," and to give references to the voluminous Hterature which treats at length the many topics discussed here only briefly. Each chapter and parts of many chapters easily furnish topics for much-needed books, some of which have already been provided by contributors to the volume. Effort has been made to lead the reader on from these condensed statements to the monographic literature.

The school as a public agency ministering to the dominant needs of the community in the interests of the state is always kept in mind. Each contributor has attempted to show how the public educational agencies may improve their assistance to the solution of the grave problems of national health and vitaHty. Several chapters are comparatively unique in this respect, such, for example, as those on public co-operation for school-health progress. These give a point of view much needed by the' many educators who have neglected educational sociology in their professional studies. A chapter on the health of the teacher was planned, but omitted because the matter, though of great importance, has received little scientific study, and because each teacher should have access to the little book published on this subject by Professor Terman.

To the many persons who have so kindly lent their assist-

PREFACE Vll

ance in contributing to the volume, to his wife, to those who have furnished photographs from many parts of the world, and to the pubhshers for their cheerful co-operation, the editor is sincerely grateful.

L. W. R.

Washington, D. C.

PART ONE Health Sociology CHAPTER PAGE

I. Public Health and the Public Schools . . i

By Louis W. Rapeer, M.A., Ph.D., President, Federation for American Childhood; Director, National School of Social Research, Washington, D. C.

II. The Public-Health Movement 22

By E. H. Lewenski-Corwin, Ph.D., Secretary Health Committee of the New York City Academy of Medicine.

III. Health and Heredity 45

By Chas. B. Davenport, Ph.D., Carnegie Institution, Cold Spring Harbor, Long Island, N. Y.

IV. The Home Hygiene of Children 59

By Ernest B. Hoag, A.M., M.D., Supervisor of Educational Hygiene, Pasadena, California, and Lecturer in Leland Stanford, Jr., University.

V. Public Co - operation for School - Health

Agencies 82

By Clarence A. Perry, A.B., Director of Division of Recreation, Russell Sage Foundation.

VI. The Social Centre and Educational Hygiene . 103

By Edward J. Ward, A.M., Specialist in Community Organization, U. S. Bureau of Education, Washington, D. C.

ix

CONTENTS

PART TWO The Administration op Educational Hygiene

CHAPTER PAGE

VII. The Initiation of a System of Educational

Hygiene in a School System no

By the Editor.

VIII. The General Administration of Educational

Hygiene 127

By the Editor.

IX. A Plan of State Co-operation for School- Health Progress 147

By Geo. A. Mirick, A.M., formerly Assistant State Commissioner of Education of New Jersey.

X. Rural School-Health Administration . . . 153

By W. I. Larson, S.B., State Inspector of Rural Schools, Madison, Wisconsin.

PART THREE The Divisions and Practice of Educational Hygiene

I. medical supervision of schools

XL The Standardization of the School Medical

Service 171

By the Editor.

XII. The School Nurse and Her Work .... 204

By LiNA Rogers Struthers, R.N., First Municipal School Nurse of America, recently Supervisor of School Nurses, Toronto, Canada.

CONTENTS

XI

PAGE

XIII. School Feeding .217

By Louise Stevens Bryant, Ph.D., Lecturer on Psychology at the Pennsylvania School for Social Service, Philadelphia; formerly Assistant in the Psychological Clinic, University of Pennsylvania.

XIV. Open-Air and Open- Window Schools ....

By S. C. KiNGSLEY, A.M., Director, Welfare Federation, Cleveland, Ohio.

II. SCHOOL SANITATION

XV. Rural School Sanitation 255

By A. C. MoNAHAN, B.S., Rural School Specialisil, U. S. Bureau of Education.

XVI. Hygienic School Environment 280

By L. N. HiNES, A.M., State Superintendent of Public Instruction; Editor of the Educator Journal, Indianapolis, Indiana.

XVII. School Sanitation Standards

By the Editor.

ni. the hygiene or instruction

The General Hygiene of Instruction . . .

By Arthur K. Beik, Ph.D., Professor of Psychology and Hygiene, New York State College for Teachers, Albany, New York.

XIX. The Hygiene of School Subjects By Arthur K. Beik, Ph.D.

XU CONTENTS

IV. THE TEACHING OF HYGIENE

CHAPTER PAGE

XX. The Teaching of Hygiene in Elementary

Schools 358

By J. Mace Andress, Ph.D., Head of the Department of Psychology and Child Study, Boston Normal School, Boston, Massachusetts.

XXI. Health Teaching in High Schools .... 380

By W. S. Small, Ph.D., Specialist in School Hygiene and Sanitation, U. S. Bureau of Education, Washington, D. C.

XXII. Industrial Hygiene and Vocational Education 404

By the Editor.

XXIII. Sex Hyglene and Sex Education 413

By Ira S. Wile, M.S., M.D., Editor Medical Review of Reviews; Lecturer in the New York University School of Pedagogy.

XXrV. Play and Recreation at the Rural School . 433

By S. H. Curtis, Ph.D., Lecturer on Public Recreation, Olivet, Michigan; formerly Secretary of the Playground Association of America.

Chapter I

The Public-Health Problem. — In a recent volume Price Collier has asserted that "the earth will be as cold as the moon before all men reahze that the only neal wealth is health"; 1 and certainly the experiences of the past seem to warrant his conclusion. Health is and will always remain a fundamental value of life, practically inseparable from life itself. Yet on every side, the world over, we are confronted by the fact that health, including normal physical development, longevity, and splendid bodily resistance, is being only very inadequately achieved by millions of people. When a third of all the children born with such cost into a civilized community like America die before the age of five, when the draft disclosed that more than one-third of the flower of America's manhood was physically unfit for military service, when the average term of life of our people is some twenty years shorter than it should be, and when illness, deformities, and multifarious physical defects are afflicting the race with an immense and overburdening cost, it would seem that every agency which the state has at its disposal would be vigorously engaged in preventing and eliminating from the world, or lessening to a fraction of their present destructiveness, these enemies of health and vitality. ^ "Germany and the Germans" (Scribners).

Instead of such universal and united resistance to a common foe, what do we find ? In the first place, we find a great private medical profession that lives by the diagnosis and cure of existing ailments, but not primarily by their prevention and final ehmination from the world. Outside of China disease has long been the friend, not the enemy, of physicians, for it has been disease that has brought to them their livelihood. To slay the food-bringer has not been the poHcy of the past, and it is one of the greatest glories of the present that an increasing number of physicians are becoming willing to make such sacrifice. Unfortunately, the social situation has demanded the wrong thing. It should be made the physician's chief mission and means of liveHhood to banish from the earth the enemies of health and physical perfection.

This Utopian condition is, indeed, coming swiftly upon us in the very rapid increase of pubHc agencies manned by doctors and nurses in great numbers. Such pubKc hygienists as Winslow prophesy, indeed, the complete or almost complete sociaHzation of health service in the next few decades.^ Great insurance societies are finding it to their advantage to keep their policy-holders well by periodical examinations, health instruction, nipping incipient ailments, and by sending visiting nurses to those who need their help. Our governmental health service, in the form of local, State, and national health departments or bureaus, has a far greater motive for disease prevention, but it is in general, though with many brilliant exceptions, exceedingly inadequate and inefficient. These bureaus, however, are everywhere so increasing their staffs that preventive medicine is really making fairly rapid progress. Many agencies, more or less efficient, are steadily tending to make the work of the old-time curative-medicine doctor less necessary, and in many places the clash between the factors

1 "Efficiency in the Public-Health Campaign," in the North American Review, June, 1913. A free bulletin of the New York State Board of Health, Albany.

for eliminating the causes of disease and for treating disease after it has come into being is not as mild as, to the outsider, it may appear. The inevitable movement will be to push the curative doctor over into the field that for the time being cannot, by the best efforts, both pubHc and private, be conquered by preventive measures, including hygiene, sanitation, physical development, etc.

Because of the comparative lack of development of preventive medicine and public-health agencies, we see, in the second place, more clearly than ever before, a great host of only partially utilized agencies for reducing or eliminating our disgraceful and enormous death, illness, and physical-defects losses. Fundamentally, of course, the elimination of unnecessary ill health depends upon the two factors of nature and nurture, of eugenics and hygiene. Doctor Davenport shows briefly in a later chapter the considerab^ and largely unguessed-at influence of heredity upon the amount of disease and physical defects among human beings. Ideally, of course, we should all be the offspring of physically and mentally perfect parents. This would be our greatest insurance for the possession of Hke characteristics. To help in some measure to bring about such a happy state, to eHminate many of our most terrible losses in the way of feeble-mindedness and gross physical imperfections that are inheritable, and to give sound biological advice to the hygienist working with environment, in order that he may prevent the bringing out of native weaknesses — these are the objects of many eugenic agencies now springing rapidly into being.

Public-Health Agencies. — Certain factors in heredity are, then, of utmost importance to the hygienist, but his chief work falls in the field of nurture, of environmental control.^ It is the duty of the state to insure, within reasonable Hmits, that its children and future citizens be well born; but the duty which is far clearer and simpler at present is that of providing such environmental control of the population, young

1 See Winslow, "Man and the Microbe," Popular Science Monthly, July, 1914- and old, that disease, premature death, and physical defects may be reduced to a minimum. The public agencies for such health-control may be briefly and tentatively classified as follows :

1. Medical or health supervision of the population.

2. Securing in all ways a sanitary environment.

3. Medical or health research.

4. Educational control of the population.

Since this is a free country, where very much depends upon the choice of the people, the last-mentioned means, educational control of the population, far outweighs in importance all the others. Every agency of health amehoration soon discovers and heralds abroad that the progress of health measures depends absolutely and finally upon the education of the people, old and young. If laws for health improvement are to be enacted, they must have the support of an enlightened public both before and after they are passed; if health measures are to be practised they must through some form of educational effort be made habit. In short, the most fundamental means of health improvement is through education in the habits, knowledge, ideals, and the physical development which go with socially efficient right living, personal and public. Such education begins at birth and lasts throughout life. It can only be partially monopolized by the public educational, or schooling, system. And yet, since the educational system is extending its beneficent influence over those of pre-school and post-school age, and, moreover, since it influences individuals in their most plastic and formative period, that of childhood, the public school stands out easily as the greatest single instrument for health promotion possessed by the civilized world.

Educational Hygiene. — In its widest sense, then, educational hygiene is broader than the school, including, as it does, all agencies for the promotion of health measures through education. The boards of health, the newspapers and magazines, the public lecturers of the American Medical

Association, the leading insurance companies, the antituberculosis and other societies, and many other agencies^ are very largely engaged in the field of educational hygiene. In the narrower sense, as used in this volume, educational hygiene is the name given to all the phases of health promotion work which may be and are undertaken by schools, especially pubHc schools, from kindergarten through college, for people of all ages, but especially for those between the ages of four and twenty-four.

We have for some time had the science of educational psychology, used especially in the training of teachers. We have also educational sociology, educational administration, educational history, etc., and it is high time that we have an educational hygiene. The exclusive emphasis upon educational psychology in the past has led to a lop-sided knowledge of the educational process and the nature of children. The pathological and physical child is at least as important from the state's point of view as is the ignorant and mental child. This volume attempts to treat of the health and physical well-being of the people, old and young, as it can be affected by public schools. The future extensions of the school in this direction are beyond prophecy.

That the school may directly affect the health and normal physical development of persons who do not at the time attend the school as pupils hardly needs demonstration, and will be plentifully illustrated in the following pages. When school physicians and nurses have consultation hours for mothers with babes in arms, when the nurses go day after day into the homes to help improve home hygiene, when the schools are used as social centres for the health education and recreation of the community, when there is health vocational guidance in and after the school period, when schools use newspapers and various civic organizations for the promotion of

*See Dresslar on "Public Health Teaching Agencies" and "Methods and Means of Health Teaching," in the 1912 and 1913 Reports of the U. S. Bureau of Education.

the health of the children and community, then we have an influence that is far broader than the old-time ^'school hygiene/' an influence that may very appropriately go by the name of educational hygiene.

The various phases of this rapidly developing science we shall briefly sketch as medical supervision, physical education, school sanitation, the teaching of hygiene, and the hygiene of methods of teaching and management.

The National Health Problem. — Before we can say what the schools, through the development of educational hygiene, can do for the health and happiness of our nation, it is necessary for us to face the actual health problems of the people and nation. The principal problems of the people and nation set the principal problems for their pubHc educational systems. If the educational systems of the country can be helped to concentrate their energies upon the really big problems of Kfe instead of upon so many little or obsolete ones, their social efficiency can undoubtedly be marvellously increased.

The principal phases of the national health problem are shown in the number of preventable deaths, in the prevaiKng and preventable amount of illness, or morbidity, and in the number and preventabihty of physical defects which lower vitality and xeduce working efhciency and happiness. In a somewhat careful investigation, pubHshed elsewhere,^ the writer has attempted to compute from mortality statistics and other sources, by the methods used by Hfe-insurance statisticians, the nature and extent of the national and school health problem. We can here only briefly summarize our relatively inaccurate and tentative findings, in the assurance, however, that great as they may seem the results are probably not exaggerations.

Death Losses. — The death losses to our country are enormous and largely preventable. The judgment of the best

^ "School Health Administration," published by Teachers College, Columbia University, chapters I and II. (Out of print.)

experts versed in mortality statistics and in the results of various forms of hygienic improvement here and abroad agree pretty well with Professor Fisher's estimates of preventability given in his book on "National Vitality."^ His estimate^ arrived at with the assistance of thirty experts in health matters, is that in general about 42 per cent of the deaths of persons in the United States could be reasonably prevented or postponed, ^'if knowledge now existing among well-informed men in the medical profession were actually appKed in a reasonable way and to a reasonable extent." An examination of his tables showing his estimates of preventability for deaths, from the manifold causes, will convince most intelligent persons that they are fairly conservative and that they are based on present data, counting not at all on the assured advance in preventive medicine. ^

Some of the leading facts relating to this great problem are as follows:

1. One-fifth of all the children born each year in this country die before they are a year old, approximately a halfmillion. Where there are fairly efficient and developed health agencies, such as boards of health, carefully conducted infant-mortahty campaigns in this country have cut this death-rate to about one-tenth of these proportions.

2. Half of the persons born in our country die before they are forty years of age, and about half of these before the age of five.

3. The average age of persons dying is gradually rising, but is still below the age of forty — near thirty-eight.

4. Approximately 1,600,000 of our population die each year — about 670,000 (42 per cent) of reasonabty preventable diseases. The economic losses due to these deaths are at least a billion dollars. These losses come in the form of public and private care of the sick and dead and in lost wages, but principally in the form of cut-off potential earnings. The value of a life at various ages can, in general, be somewhat easily

^ Also published as a government report.

DEATHS FROM ALL CAUSES IN INDIANA All Ages

Average for preceding three years

P^^yy^r Diphtheria and Croup y^M^/j^^i Suicides w^M^/^i\ Senility lOJ'O lUnclassitied Causes

Org'c Heart Disease Tuberculosis of the Lungs "Acute Nephritis and Brights' Disease External Causes (Suicides Excepted) Hemorrhage and Softening of the Brain Cancer and Other Malignant Tumors 'Co:ngenital Debility and Malformations Pneumonia

Diarrhoea and Enteritis (urnder two years) Other Diseases of the Respiratory System (T..B,. Excepted^ Diseases of the Stoma.cii CCancer Excepted) wy//y>^.yy/y>/^ Typhoid Fever

Olher Forms of Tuberculosis

7777J7? Appendicitis

S^ Cirrhosis of the Liveir

^^aOther Epidemic Diseases

Y'TTTn Intestinal Obstruction

f777^ Whooping Cough

7zz^ AciLte Bronchitis

mm Cliranic BronchiTis

7777^ Puerpenal Septicemia

^S OtTier Puerperal Accidents of Pregnancy and Laljar

y7777\ Tuberculosis Meflinoitis

^ Scarlel Fever

* Meflar'ra

I3 Simple -Meiilngilis

Hernia ^TTTTn Measles aPofiorayelilisCAcute Anterior) 3 Cerebro spinal fever 3 Unknown orill defined diseases

Cholera Nostras

Smallpox computed, and the average value for all ages used by economists is $1,700.

The table on pages 10 and 11, taken from *^ School Health Administration,'' shows in some detail a condensation of the 1910 mortality statistics made by the author, and shows also the deaths of children of school age and the age groups of most deaths. The registration area is composed of those States and cities sensitive enough to their health needs to enforce reasonable registration of deaths. It reaches about three-fifths of the population.^

Those who wish to study educational hygiene in relation to national and community health problems may well examine the following table. A very desirable addition to such study would be (i) to get a free copy of the latest Mortality Statistics from the United States Census Bureau, and (2) to get the local reports of the boards ^f health of the community and State. Any careful study of such data will immediately raise in the mind of an intelligent and socially minded student and health worker the national and school-health problem. What can we do to prevent these terrible and largely unnecessary losses?

Illness and Physical-Defects Losses.— According to the best obtainable data, about 3,000,000 persons in the United States are constantly seriously ill. Their illness causes loss of wages to a computable number, lowered vitality, and frequently death. These illnesses, largely and increasingly preventable, cause further enormous economic losses not computed under deaths, which I have estimated, using Professor Fisher's and insurance methods, as about another billion dollars annually. The losses in happiness, the evil effects of breaking up homes, and all such losses of a personal, human, and psychological character are, of course, beyond computation. From these serious illnesses and the additional physical defects and minor illnesses comes more or less directly a large portion of the most serious blots upon civilization, such as * 1910 U. S. Mortality Statistics.

lO

TABLE I Causes of Death for the Registration Area, 1910 *

All Causes.

I. General diseases

1. Typhoid fever

2. Malaria

3. Smallpox

5. Scarlet fever

6. Whooping cough

7. Diphtheria and croup

8. Influenza

9. Cholera nostras

10. Dysentery

II. Erysipelas

12. Other epidemic diseases. .

13. Purulent infection, etc...

14. Rabies

15. Tetanus

16. Pellagra

17. Tuberculosis (of lungs) . . .

Tuberculosis (other)

Rickets

Syphilis

Gonococcus infection

2 2 . Cancer and other m. tumors 23. Other tumors

Acute articular rheumatism

Diabetes

Leuchemia

Anemia, chlorosis

Other general diseases

26. 27. 28.

AU ages