CHAPTER IV. THE HYGIENE OF SCHOOLS AND OF SCHOOL (Part 1)

CHAPTER IV. THE HYGIENE OF SCHOOLS AND OF SCHOOL CHILDREN. THE SCHOOL CHILD. By compulsory education the State forces children between the ages of six and twelve or fourteen to be sent to, and to be kept in, school for the greater part of the day during six or eight years. These years are the most important in life. They represent a period of formation, growth, and development. Having compelled the child to remain in school dur- ing the most important period, it is the duty of the State to take care not only of the mental growth and development of the child, but also of its moral and physical condition and development. Not long ago it was deemed sufficient for the State to provide means and teachers for the cramming of the child's intellect with rudimentary knowledge of the elementary sciences. At present, broader ideas pre- vail. The child is the greatest asset of the State. The child's mental and moral development and growth go hand in hand with its physical growth and develop- ment. The school influences not only the child's mental growth, but profoundly affects its physical well-being. No care of the school child is therefore complete that does not take into consideration the physical condition and the bodily growth of the child saioor. rill 1. 1) 1 }0 as well a■^ the prcx cut ion of the ex il iiilliK'iicc^ nt scIkioI life yi]nm its licultli. What arc tlu- iiilliiciiccs of school ami scliool WW- on tlie physical wcll-lx'iiij; of the cliiltr.' Tliese influences may l)c ^roupc<l as follow >: 1. The influence of the school and the school room. 2. The influence of the age and growth of the child. :!. The influejice of tlie methods of teaching and of the mental training given. 4. The influence of the herding together of a large numher of children. The Influence of the School and School Room. Xo pvr- son of tender age may remain for six or seven hours a day during six to eight years in a place without being profoundly influenced by the condition of the place. The hygiene of schools begins, therefore, in the proj)er construction and care of school houses and school rooms. The Influence of Age and Growth of the Child. The child when it enters school at the age of six years weighs on the average forty-three to forty-five pounds, and its average height is forty-three to forty-four inches. When the diilil leaves school at fourteen years of age its average weight is one Inmdrcd pound> and its average height five feet. During this period the physical being of the child undergoes remarkable transformation; it is extremely sensitive to external influences, and its health must be carefully nurtured and promoted. It is imjxTative, therefore, to strictly supervise the personal hygiene of the child, its nutrition, clothing, dentition, physical development, etc. Mother and school are bound to take care not onlv of the 150 HYGIENE OF SCHOOLS AND OF CHILDREN child's unripe mind, but also of its unripe and growing body. This is accomplished by physical examinations of the child on its entering school, by supervision of, and provision for, its proper feeding, by the guiding of its muscular exercises, by providing baths, play- grounds, etc. The eyes of the children need very careful atten- tion. The light of school rooms, as well as the distance of the desks from the slate-boards, etc., must be properly adjusted, so that no harmful effects to the eyes ensue. One of the diseases which are so frequently among school children is myopia. It is a disease directly due to school life, to study, to defective light and illumination, to improper positions, faulty seats and desks, defective methods of writing, too small print, and too much eye-strain generally. Children who come to school with some degree of weak vision gradually develop more pronounced near-sightedness, which increases in each grade of school. Thus in one New York school the percentage of myopics in lower grade 8 was 8 while in the higher grades it was 20.2. The teeth of the children very often are effected by various defects and diseases, and these lead to certam malformations of the mouth, improper breathing, improper mastication, and improper development. With the ignorance prevailing among many classes of the population, it is impossible to depend upon the parents for the proper care and treatment of the irregularities of dentition, and the school through its dental surgeons should take care of this important field of hygiene. SCHOOL CHILD l.')! Tlu-n- ;irr ccrtMiii diseases of the hoiic, rickets, (lefonnities ot" the spine, etc. Tiie latter especially are due to improper i)ositioiis in school and may he prevente(l hy taking proper care of the children within the school, hy the adjustment of seats and desks, and hy strict supervision on the part of the teachers of the positions and attitudes of the children (hiring school work. One of the most important defects among a large class of ciiildren is mahnitrition. This is often flue not so much to the lack of sufficient food as to the ingestion of improper food. Recent investigations have also shown that a great many children come to school breakfastless, and that many of them content themselves with but a very slight luncli, often con- sisting of ingredients insufficient for nutrition and improper for digestion. It is absurd to endeavor to teach the child and to train its niiud while its body suffers from lack of nourishment. A healthy mind can exist only in a healthy body. It is the duty, therefore, of the school to provide for the proper feed- ing of the school children during school hours. This feeding should be given at a nominal cost to those who can afford it, and without any cost whatever to tho.se children whose parents cannot afford the expen.se. Influence of Teaching and Mental Training. —The methods (tf teaching and the subjects taught have an important influence, not only upon the mind, but also upon the body of the child. The unscientific and irrational methods of teaching as yet prevailing in many schools do much harm to the mind, inju- riouslv iiiHuence the nervous svstem of the chiM. and 152 HYGIENE OF SCHOOLS AND OF CHILDREN do harm to the physical condition of the body. The preparation of a child for useful future citizenship does not mean the stuffing of his mind with useless book knowledge, to be forgotten as soon as he is out of school. The methods of teaching should be rather a training of the growing brain and mind, to gather for itself useful facts and to garner knowledge for its own use. The old hot-house methods of child cul- ture are rapidly giving way to new natural methods of mental training. Especially harmful to the child's nerves and physique are the present systems of competitive examinations, and the obsolete methods of pimishment, etc. The Influence of Crowding a Large Number of Children in the Schools. — This is the greatest evil of school life and the greatest danger to the health and lives of school children. A child in school comes in close bodily contact with other children, with a consequent possi- bility and probability of catching and spreading infec- tious diseases. The infectious diseases of school life may be grouped as follows: Diseases of the Eye. — Conjunctivitis, blepharitis, pink-eye, granular conjunctivitis, or trachoma. Diseases of the Skin. — Pediculosis, ringworm, scabies, impetigo, favus, molluscum contagiosum. . General Infectious Diseases. — Rotheln, measles, scar- let fever, diphtheria, t^-phoid, miunps, whooping-cough chicken-pox, etc. The diagnosis of the \ari()iis infectious diseases is within the province of the medical inspectors of schools. The exclusion of the children is made under the recommendation and order of these physicians. SCHOOL iirii.Disa ir)3 The school nurses should h;i\c, ;iiul usujilly do h;i\c, m'U('i";il kuowlcd^c of ihc initial syni])1onis of the xariou^ infectious diseases. This medical iii^t laict ion is i^ixcn to the nur>e> in their medical ciuTicnlmii, and may therefore he omit teil hei-c. THE SCHOOL BUILDING. 'riic school is a place where children of tender ii<ro remain daily for lont;- hours. The ])liysical, mental, and moral condition^ of the children durinu' their school life is partly influenced by their sojourn in the school huildin^. 'Die ])reser\ation, therefore, of the liealth of the children demands that the school huildin^ he constructed and maintaine<l in the best sanitary condition. The sanitation of the school buikhnjf should l)efj;in l)efore its construction. The site for the school huild- \\g should he selected from anioufj the best in the town or cit> . The soil should be dry, porous, well-drained. The location should be distant from factories, mar- kets, boiler sh(>j)s, saloons. ele\ated railroa<ls. and other establishments which for one or more reasons may become ()tVensi-e and be a miisance to the school. It is advisable to surrouinl the school building with pIa\f;rounds and, if possible, with a j)ublic park. There should be -ery little economy practised in the purchase of the site for the school building: and in the constructittn of the building itself. Mxcept in 'ery small localities no school building' should be of frame construction. Brick, stone, or reinforced concrete should be used. 154 HYGIENE OF SCHOOLS AND OF CHILDREN The school building should be limited in height and should not contain more than four or five stories, preferably fewer. The school building should be constructed of fireproof materials and its inner trim- ming should be made fireproof. The cellar and the lowest story should be dry, well lighted and ventilated. They may be used for the location of boilers, machinery, etc., but should not be used for workshops, gymnasia, or any other similar purposes. There should be plenty of entrance and exit doors at frequent intervals. These should be broad, light, and fireproof, and should be sufficient to empty the building within a very short time in case of fire or panic. The size of school buildings is best limited. It is better to construct three buildings for two thousand children each than one building to accommodate six thousand children. The walls, floors, and ceilings should be soundproof and also proof against dust, damp, and vermin. Some buildings demand a minimum of thirty square feet of floor space for each child. The surfaces of walls and ceilings within the school should be smooth so that dust cannot adhere to them, should be easily washable, and painted with bright tints. The subdivision of the school house into school rooms should be made by solid partitions if possible, reserving one floor with movable partitions for general assembly rooms, etc. The rooms should not be less than thirteen feet in height. The usual size of a school room is thirty by twenty-five feet. sciiooi. /ill 1.1)1 \r; 1').' Lighting. Tlic windnw .irc.i of school lioiiscs should Hot l>f Ic^^ th;iii oiic-t'oiirt h of the (loor spiicc. The ti'|) of the windows shoiilil ix- ;is iicnr th<' ceiling; ;,s possiMc and should reach to ahoiit four feet from the floor. The best wiiite fjlass, or preferahly plate, should he used for the j)aiies. Kxcessi-e jjlare should he coti- trollcd hy appr(»|)riate shades from the top and the bottom of the windows, hllectric lights should i)e used for artificial illumination. Ventilation and Heating. There has heeti luueh eoutroxersy as to the projx-r methods of \cntilation for school huildiMfis. There is no douht whatexci- that school buildin^.s, with the lar^^e luunher of chil- dren in the school rooms, cannot be ventilated properly l)y natural means, or 1)>- means of windows or opeu- iufj:s in the windows, walls, or ceiling's. There cannot be too nnich fresh air introduced into the school rooms. Provision >hould he made for artificial mechanical N'cntilation in all school buildint^s. The installation of a proper mechanical ventilatin<]: plant is an enpneerin^^ i)roblem, the solution of which should i)e f/]\vi] only to m(»st comi)etent persons. The combined plemnn and vacimm systems are the lu'st for school ventilation. By this method the foul air from the room is exhausted through outlet o|)eu- ings in the school room, and the fresh air is inti-oduced into the room throufjh inlet oj)eniiii,^s in the same. The advantajre of this system of ventilation is that It may l)c comliincd with a system for heatinu and coolin;j the air which is introduced into the room. In the winter the air introduced throuf;h the tubes may be warmed by pa.ssing over .steam coils, while 15() HYGIENE OF SCHOOLS AND OF CHILDREN in summer the air may })e cooled by passing through a cold chamber. Even in very small school buildings no local heating should be used. A hot-water heating plant may be cheaply installed even in small buildings. The com- bined heating and ventilating system must also make provision for proper regulation of temperature by thermostats. Water Supply. — An ample supply of pure water should be had in every school room and there should be no need for the pupils to go long distances to obtain a drink. Sanitary drinking fountains are the best and all common cups should be prohibited. The filtering plant for the water supply of the school should be installed in a central location where it can be watched and kept clean. There should be toilet accommodations of the best type on every floor of the building. The water closets should be provided with automatic f]ush so as to be self-cleansible. Provision should be made for wash rooms, shower baths, swimming tanks, etc. Cleaning. — The utmost care should be taken to keep all surfaces in the school room clean, and a routine daily, weeklj^, and periodical cleaning system should be adhered to. The obsolete method of cleaning bj' the feather duster or dry rag should be abolished. Whenever possible, vacuum systems should be in- stalled in every school room. The school funiture and other surfaces should be cleaned daily with damp clean rags. ('.»/.•/•; or rill': ciiii.i) i.\ scikioi. i.")? School Furniture. The desks, seats, ])latl'()niis, anil hiacklxtanis >li(iiil(l )v pcopcrly coiistrnctcMl. aiwl tlic desks and scal-^ of tlic pupils should hr made so as to !)(' a<l justaMe to the si/c ot" cadi cliild in order to j)rev(Mit it tVoiii a^>niniiiu' inipro|»cr attitudes while at work. The depth ol' tile school room should not l)c too urcat and liic distance of the rearmost pupil tVom the platform should not exceed twenty feet. It is liest not to ha\e the seats and desks attached to tlie Hoor. l)nt to make them movahle. Some imj)ro('d substitute is needed for the du.st- creatinj; clialk used on slate i)lackl)oards. The Supervision of School Cleaning and Sanitation. — The common method of lea\in<i; aJl ((uestions in rcf^ard to the care of the school Ituihlin.u, rooms, and furnittu'c to tlie janitor is iMitirely wronj;. Kacli scliool should be sui)ervised in its care and eh'anliness hy a trained scIiool nurse who sliould have the supervision over janitors and cleaners, and whose duty it should he to make daily and hourly inspection of all parts of th(> school aufl to see that eaeJi part is j)roperly cleaned and taken care of. The ai)j)ointnient of such a supervising; school mu'se for the cleaning and sanitation of the school l)uilding would lie of great benefit to the sanitation of the school and would greatly improxe the health of the school ehlldi'cn. THE CARE OF THE CHILD IN SCHOOL. 'I'he i)urpose of keejjing the child in s<ho(d from the age of six to fourteen and more is not only to gi\c the 158 HYGIENE OF SCHOOLS AND OF CHILDREN child a mental training and education for use in its adult life, but also to promote the physical develop- ment and growth of the child into a healthy and useful citizen, capable of holding his own in the struggle for existence. The mental and moral training of the child is given into the hands of teachers and principals, whose duty it is to devise and institute a proper system of intel- lectual activity and education and to give to the child the foundations of knowledge as well as a moral train- ing. The \arious systems of teaching and of mental training, the selection of the courses, and of the teachers to guide tJxe mental and moral training of the child, are in the pro\dnce of mental hygiene and of the science of pedagogy. The school has also a certain influence upon the health and life of the child and is the place where very often certain infectious diseases are communicated from child to child. A duty of the school authorities, therefore, is to prevent as much as possible the spread of these diseases. These functions — the care of the health of the school child, the promotion of its normal growth and development, the prevention of general, and especially of contagious, diseases — are recognized as included in the hygiene of schools and have been intrusted to the school physician and to the school nurse. FUNCTIONS AND DUTIES OF NURSES IN SCHOOLS. ]\Iedical school inspection cannot be efficiently accomplished without the assistance and aid of the hrriEs or school .\rusi-:s i.v.) school nurse. She is ;m important and intcj^^ral part of medical school inspection. Her special functions and duties in the school ma" he summed up as follows: 1. Cicneral and special assistance to the medical school inspector. 2. Preliminary insi)ection of children: (a) For detection of physical defects. (b) F'or detection of contagious diseases. 3. Visits to homes of children to investif^ate causes of absence from school. 4. Ad\ice to children and their mothers on correction of defects and improvement of health. 5. First aid and emer^jency treatment. fi. Treatment of children for certain physical defects and contagious diseases. General and Special Aid and Assistance to the Medical School Inspector. With the present organization of medical school inspection and the small number of physicians assigned to this work in schools, it is abso- lutely impossible for