Full text of "Fourth International congress on school hygiene, Buffalo, New York, U.S.A., August 25-30, 1913. Transactions. Edited by Thomas A. Storey with the assistance of Frederic A. Woll and Julian Park"

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ROM PAINTING BY URQUHAR

ROSWELL PARK, M.D., M.A., LL.D.

PROFESSOR OF SURGERY (1883-1914). MEDICAL DEPARTMENT
UNIVERSITY OF BUFFALO

CHAIRMAN CITIZENS" COMMITTEE

MEMBER PERMANENT INTERNATIONAL COMMITTEE

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Bxth Jf^bvmv^ 15, 1314

FOURTH INTERNATIONAL

CONGRESS ON SCHOOL

HYGIENE

BUFFALO, NEW YORK, U. S. A,
AUGUST 25-30, 1913

TRANSACTIONS

VOLUME II

Edited by Thomas A. Storey

with the assistance of Frederic A. Woll

and Julian Park

1914

Printed and Bound by
THE COURIER CO. OF BUFFALO

197-199 Main St., Buffalo, N. Y.

CONTENTS OF VOLUME II

Ipapers

SECTION I

THE HYGIENE OF SCHOOL BUILDINGS, GROUNDS, MATE-
RIAL, EQUIPMENT AND UP-KEEP

SESSION I SCHOOL BUILDINGS AND THEIR EQUIPMENT

Some American School Rooms g

Linnaeus Neal Hines
Supernormal Environment in Its Relation to the Growing Child , 17

Josephine E. Young
The Hygienic and Sanitary Conditions of School Buildings in the

Netherlands ^i

A. J. Schreuder
The Hygienic Construction of Schoolhouses From an Architect's

Standpoint 35

W. H. Kilham
The Planning of Schoolhouses Against the Fire Hazard • • • 39

Frank Irving Cooper
Modern Methods of Sewage Disposal in Rural, Country, and City

Schools 48

William T. Towner
Sanitation of the Rural Schoolhouse in the State of Vermont . . 54

Henry D. Holton

Discussion by B. Franklin Royer
School Houses in Norway 60

M. K. Hakonson- Hansen
Sanitation of the Consolidated Country School . . . . . . 65

William Gray Swank
Sanitary Conditions That Should Operate in Selecting a Proper

Site for a City, Rural, or Village School Building .... 72

William H. Brainerd

SESSION II— OPEN-Am schools

Fresh Air Schools in New York City 80

I. Ogden Woodruff

Discussion by Frank H. Mann
Open Window Schools in Buffalo 9^

Franklin W. Barrows
The Architecture of Open Air Schools 9^

John V. Van Pelt

Discussion by Duncan B. McEachern
Results of Open Air Treatment in Public Schools of Newark, N. J. 103

George J. Holmes
The School Room Window ^^^

Byron U. Richards

PAGE

Effect of Indoor and Outdoor School Life on the Physical and

Mental Condition of Children 125

Harold Brown Keyes
Vitalizing School Children 135

Walter W. Roach
Porvenir de la Escuela Al Aire Libre .144

Luis Miro Quesada
El Aire Libre de la Pedagogia Cientifica la Tuberculosis-Profilaxis

Escolar 154

A. Vidal y C. Robertson
The Open- Air School in Scientific Pedagogy . . . . . . . 166

A. Vidal and C. Robertson

Discussion by John W. Brannan

SESSION III— THE VENTILATING, HEATING, AND CLEANING OF
SCHOOL BUILDINGS (PART I)

Ventilation of Gymnasia 174

J. H. McCurdy

Discussion by A. Caswell Ellis and John W. Shepherd
Some Phases of Ventilation 190

D. D. Kimball
Ventilation and Recirculation 197

Luther H. Gulick

Discussion by C.-E. A. Winslow
The Ventilation of School Buildings 206

Herbert M. Hill
Studies of Fresh Air Conditions in New York Schools . . . . 211

C.-E. A. Winslow
Air Washing as a Means for Obtaining Clean Air in Buildings . 227

George C. Whipple and Melville C. Whipple
The Effect of Conditions of School Room Heating and Ventilating

on School Attendance 243

Charles H. Keene
The Primary Purpose of Ventilation to Facilitate the Maintenance

of the Constant Temperature of the Body 248

Theodore Hough

Discussion by A. H. MacKay

SESSION IV THE HEATING, VENTILATING, AND CLEANING OF

SCHOOL BUILDINGS (PART II)

An Experiment in School Room Ventilation 259

Frederic Bass
Some Experiments on the Ventilation of a School Room . . 288

J. W. Shepherd
The Physiologic Cost of Insufficient Protective Clothing 'zqc

G. W. Fitz
Purification of Air and Water by Means of Ozone 106

J. C. Olsen

PAGE

Ventilation und Heizung der Schulraume ^12

Hugo Selter
Der Einfluss der Kalten Fiisse auf die Geistestatigheit der

Schulkinder *. . . . -zi8

J. Brandau
Book Disinfection — A Neglected Factor in §chool Sanitation 337

L. B. Nice
Proper Ventilation of School Buildings 343

M. G. Overlock
Ozone in Ventilation 345

Milton W. Franklin
Die Reinhaltung der Schulraume 363

Dr. Schoenfelder

SECTION II

THE HYGIENE OF SCHOOL ADMINISTRATION, CURRICULUM

AND SCHEDULE

SESSION V STATUS OF SCHOOL HYGIENE AND METHODS OF

INSTRUCTION IN CITY, VILLAGE, AND COUNTRY SCHOOLS (PART I)

What the State Shall Do in the Care and Supervision of School

Children 372

Eugene Hoffman Porter
The Present Position of the School Hygiene Movement in England 380

Ralph H. Crowley

Discussion by Herbert F. True
State Program of Education in Hygiene in New Jersey . . . 394

George A. Mirick
Hygienic Conditions Among the Native School Children of Alaska 400

William Hamilton
Rural School Hygiene in Michigan 405

Burton S. Tefft
Legislation Scolaire Frangaise • • 4^3

Felix Martel
Parents' Part in School Hygiene 4^6

W. H. Heck

SESSION VI STATUS OF SCHOOL HYGIENE AND METHODS OF

INSTRUCTION IN CITY, VILLAGE, AND COUNTRY SCHOOLS (PART U)

Safeguarding Rural School Children 4^2

G. S. Lasher
Improvements in the Sanitary Conditions of the Rural Schools of

Wisconsin ^^^

Walter E. Larson

Discussion by J. George Becht
Oakland System of Health Inspection . ." • 439

N. K. Foster

Discussion by B. Franklin Royer
Medical Inspection in Valparaiso (Indiana) Public Schools . . 44o

Otis B. Nesbit

PAGE

Sanitary Inspection of the Rural Schools of Pennsylvania . . . 452

Samuel G. Dixon
School Medical Inspection in Rural Districts of Pennsylvania . 461

Samuel G. Dixon

Discussion by Alexander C. Abbott
Hygiene in the Philippine Schools 471

Allan J. McLaughlin
L'Organization de I'lnspection Medicale des ficoles au Bresil . . 473

Clemente Ferreira

SESSION VII — STATUS OF SCHOOL HYGIENE AND METHODS OF
INSTRUCTION IN CITY, VILLAGE, AND COUNTRY SCHOOLS (PART IH)

The Medical Inspection of Public Schools in New York State . . 482

Thomas E. Finegan

Discussion by W. E. Struthers
The Evolution of Hawcreek Township . 490

James H. Morrison
Health Direction in the Public Schools . 497

Clinton P. McCord

Discussion by C. Edward Jones, Frederick E. Downes, and Albert
Vander Veer
Two Years' Work in the Schools of Lynchburg 506

Mosby G. Perrow
Hygiene of the Rural Schools . . .510

James A. Nydegger

Discussion by James A. Nydegger and John A. Ferrell
A Statistical Study of the Physical Defects of Three Hundred

Thousand Rural School Children . 519

B. Franklin Royer

Discussion by Harold B. Wood and B. Franklin Royer
A Practical Method of Promoting School Hygiene in Small Cities 529

J. L. Ludlow
The Status of Hygiene in the Schools of York County, Nebraska 547

Alice Florer

SESSION VIII — STATUS OF SCHOOL HYGIENE AND METHODS OF
INSTRUCTION IN CITY, VILLAGE, AND COUNTRY SCHOOLS (PART IV)

Methods in Use in Colleges for Women for the Maintenance and

Advancement of the Health of Students 556

Anna J. McKeag
Some Problems in the Administration of a Department of Hygiene

and Physical Education in a Woman's College 560

'Amy Morris Romans
The Importance of Teaching the Conservation of Nervous Energy

to Our Advanced Women Students 567

Elizabeth Leiper Martin

Good Roads and Good Health -574

Mrs. F. De Garmo
Hygiene Instruction in the Gardner School of Valparaiso ... 580
Margaret C. Beer

SECTION I

The Hygiene of School Buildmgs, Grounds, Material, Equipment,

and Up-keep

SESSION ONE

Room A. Monday, August 25th, 2:00 P.M.

SCHOOL BUILDINGS AND THEIR EQUIPMENT

L. N. HiNES, Chairman

Dr. Henry R. Hopkins, Buffalo, N. Y., Vice-Chairman

Program of Session One

Linnaeus Neal Hines, Superintendent of Schoolsf Crawfordsville,
Indiana. ''Some American School Rooms."

[Josephine E. Young, M.D., Chicago University. "Supernormal
Environment in its Relation to the Growing Child."

A. J. ScHREUDER, M.D., Director of Medical Pedagogical Institute,
Arnhem, Netherlands. "Hygienic and Sanitary Conditions of
School Buildings in the Netherlands."

: Walter H. Kilham, Architect, Boston, Mass. "The Hygienic Con-
struction of School Houses From an Architect's Standpoint."

Frank Irving Cooper, Architect, President Boston Society of Heat-
ing and Ventilating Engineers. "The Planning of School Houses
Against the Fire Hazard."

William T. Towner, Secretary New York Society of Architects, New

York City. "Modern Methods of Sewage Disposal in Rural,

Country and City Schools."
Henry D. Holton, A.M., M.D., President of the Austine Institute for

Deaf and Blind, Vermont. "Sanitation of the Rural School

House in the State of Vermont."

Papers Presented in Absentia in Session One
(Read by Title)

M. K. Hakonson-Hanson, Head Master in the Common School,
Trondhjem, Norway. "School Houses in Norway."

William Gray Swank, M.D., City Health and Sanitary Officer, Craw-
fordsville, Ind. "Sanitation of the Consolidated Country
School."

William H. Brainerd, Architect, Boston, Mass. '-'Sanitary^ Con-
siderations That Should Operate in Selecting a Proper Site for
a City, Rural or Village School Building."

8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SOME AMERICAN SCHOOL ROOMS

Linnaeus Neal Hines

The opportunity of the teacher is supreme in all matters pertaining
to the teaching of correct living to the coming generation. The child
is forming his life habits and these habits can be made correct as well
as incorrect. If every child everywhere from to-day on is taught just
how to conserve his health, then we need not concern ourselves to any
great extent as to how the child will live when he becomes an adult.
The impressions of youth are the most vivid and the most lasting. The
teacher takes the child when he is ready to form his habits of life. The
great work she may do will find its fullest fruition in the coming genera-
tion. If we can surround the children in our schools with the proper
physical as well as other conditions and then teach them correct habits
of living, the next generation will be what we want it to be.

The problem in hand is not merely a school problem; it is a com-
munity problem as well. In the United States at least, where every
public enterprise rests directly or indirectly on the will of the people, the
school will not be for any considerable length of time very much better
or very much worse than the people want it to be, either as to the physi-
cal condition of the building or the quality of teaching that is done in
the building. The most skillful teacher or school administrator, anxious
for better things, first creates a public sentiment for those better things
and straightway he has them. This is also a community problem in
a wider sense in that the school is serving the community directly as to
making a healthier, more contented and more efficient citizenship. The
opportunity of the school is tremendous.

The elements of the problem of hygiene in every school in this coun-
try may be enumerated as follows : securing a teaching body that knows
what it ought to know of school hygiene and that is willing to apply and
enforce all the laws of correct living in and about the school room;
developing in the community adjacent to and supporting the individual
school an understanding of and sympathy with the attempts of the
school authorities to secure proper living conditions for the pupils while
in school ; developing on the part of those that control the school finances
a willingness to spend whatever money is necessary to secure proper
arrangements in regard to heating, lighting and other things that go
towards making up proper surroundings for the pupils; the making of
the school so near perfect in a sanitary way and so attractive that the
pupils will want their homes to be like the school; the maintaining of

SOME AMERICAN SCHOOL ROOMS g

competent, energetic and brave-hearted health officers and medical
examiners that have the power and the disposition to over-ride ignorance
indifference and opposition and accompHsh the thing that ought to be
accompHshed; a general community realization that the world of to-
morrow will be what we make out of the children of to-day. These
are the principal elements of every school hygiene problem, no matter
what the clime in which the school may be located and no matter
what other elements may be introduced into a given situation.

In some of the literature sent out in advance, advertising this Congress,
we were given figures to the effect that of all pupils in the (United States)
schools twenty-six per cent, suffer from eye strain, six to twelve per cent,
suffer from enlarged tonsils, twelve to twenty-four per cent, suffer from
nasal obstruction, two to five per cent, suffer from defective hearing,
fifty to seventy-five per cent, suffer from decayed teeth, ten to thirty
per cent, suffer from nervous disorders, five to twenty per cent, suffer
from some deformity, one to fifteen per cent, suffer from skin diseases,
one to sixty-seven per cent, suffer from pediculosis of the scalp. This
list of defects does not cover the entire range of children's disorders or
the troubles that may come out of children's being grouped together
iunder unfavorable surroundings. This array of facts demands that
; something more shall be done in the way of caring for the health of the
children in our schools. A constant supply of fresh air, good light, the
right kind of clothing, plenty of baths and an abundance of nourishing
'food ought to be the portion of every child in every school in all lands.
Medical inspection of and administration to the physical condition of
'these little citizens ought to be on the program of every school corpora-
ition. It was long ago "demonstrated that efficient medical inspection
[betters health conditions among school children, safeguards them from
[disease, and renders them healthier, happier and more vigorous." And
this gospel is spreading throughout civilized countries. If it were not
so, this Congress could not be held, with any considerable attendance.
Every state legislature in the United States and the Federal Congress
have considered, within the last few years, acts that had for their pur-
pose the bettering of living conditions in the schools. The very fact
[that we hear so much of "playgrounds," "open-air schools," "school
lunches," "medical inspection," and kindred terms in the general as well
!as the professional press, means that the people are coming to demand
better school conditions for their children and better opportunities all
paround.

Each generation must try to mend the mistakes of the generation
just passed. Each generation suffers from the mistakes of those that
have gone before. The work of improving the health of the children
in school in many places is retarded because of the necessity of using

10 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

buildings erected in another time. Many cities in particular do not have
sufficient room for their schools because of the high prices of real estate.
Some time, perhaps, in some far off age, people will learn that room to
educate boys and girls is more important than room to conduct a depart-
ment store, a wholesale grocery or even a brewery. Practically every
city school in the United States needs more room not only within its
school buildings but in its playgrounds. This condition prevails all too
generally, also, in rural districts where land is cheap compared to city
prices. The old idea has been that almost anything will do for a school
and the school has had to put up with almost anything. The public
gets what it pays for. The disposition to cut down the amount expended
for education since the beginning of organized instruction for the young
has retarded and interfered with the proper administration of almost
all schools. There is a disposition to talk about the amount of money
that is being spent on the schools. There is a further tendency to cri-
ticise those that administer the schools because greater results are not
obtained. If the huge school hygiene program that is upon us and that
is to be given an impetus in all countries by this very Congress is to be
put through, then more money must be forthcoming. There is no other
way. As was said before, the public gets what it pays for. In the
United States practically two billion dollars are spent annually for al-
coholic beverages and less than three hundred million dollars for public
education. If our schools could be considered by our nation as important
as our drinks, every child would have a proper education under proper
surroundings. The condition that prevails in our own country probably
prevails in every civilized nation. Nothing except religion is as import-
ant as education, yet both religion and education measured by financial
expenditure are not the most important things. All our school hygiene
dreams as well as our other dreams will come to pass when the peoples
really think them important enough to call for the spending of much
larger sums of money. The wonder is that those that administer the
schools have been able to accomplish so much when the limited funds
and the low salaries that universally prevail are taken into consideration.
The one that undertakes to make a general survey of school condi-
tions any where ought to have some such ideas and ideals as those that
have been outlined. At the risk of being prolix, the writer has gone into
a general view of school conditions. With this background, one can best
invade school corporations, view actual conditions and partially at
least succeed in finding the causes of the conditions that are not right.
An inspection of hundreds of school rooms in this country leads one
readily to believe that not all the money has been spent that ought to
be spent in providing proper housing for the children in our public
schools. A personal survey of actual conditions in American cities, a

SOME AMERICAN SCHOOL ROOMS 1 1

survey that began with the Atlantic Coast and ended with the great
inter-mountain region of the West, as well as an indirect survey of many
country schools, leads one to the view that in spite of all talk about prog-
ress and advanced ideas there is much yet to be done. The survey in
hand includes not only personal inspection of many rooms but reports
that stated at least a few facts about many other rooms. In all, at
least one fact as to physical condition was obtained about almost 2,000
school rooms, 1,973 to be exact, scattered so widely that the picture
here drawn may be said to reflect somewhat accurately conditions as
they are in our country. The set of facts obtained is not uniform for
all the rooms in question and, consequently, this report must necessarily
be incomplete.

The temperatures recorded ranged from sixty degrees to seventy-
six degrees Fahrenheit. The temperatures were taken down as shown
by the thermometers in use in the school rooms. In all too many cases
the school room thermometer was cheap and inaccurate. One room
was at 60 degrees, two at 64, ten at 66, thirteen at 67, three at 73, one
at 75, and ten at 76 degrees. The great majority of rooms in which tem-
peratures were taken, one hundred and forty-four, showed temperatures
ranging from 68 to 72, with most of these at 70, which seems to be
accepted standard temperatures for the American school room where
any attempt is made to regulate carefully the amount of heat in the room.
A lower temperature would doubtless be better for all concerned.

In regulating the temperature in the school room, as much care
should be taken with the location of the thermometer as with the excel-
lence of the instrument. In this survey thermometers were found all
the way from three to seven feet from the floor. In two buildings in a
large eastern city 68 thermometers are placed seven feet from the floor.
The temperature seven feet from the floor is not, under usual conditions,
the temperature where the pupils are down in their seats. Further, the
average teacher is not of such physical proportions that he can look at,
on a level, a thermometer placed seven feet high. Reading such ther-
mometers is likely to be troublesome and inaccurate. The great majority
of thermometers are placed from five to six feet above the floor and on
the walls. The best place for a school room thermometer is at or near
the middle of the room and suspended from the ceiling so that it will be
no higher than the pupils' heads when seated in their desks. A tem-
perature reading, under such conditions, will show just what it ought
to show, how warm it is where the children are. In only 29 rooms re-
ported on as to this matter (29 out of 215), were the thermometers sus-
pended from the ceiling so as to swing near the level of the pupils' heads.

Another objection to placing the thermometer on the wall is that it
will record the temperature of the wall behind it as well as that of the air

12 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

around it. It does not take much imagination to figure out about how
much firing it takes to keep at seventy degrees a thermometer hung on
a cold brick wall in the dead of winter. The temperature of the air
about the pupils doubtless in most of such cases runs many degrees
above seventy, to the great injury of the children's health.

Furthermore, the thermometer should not be placed near windows,
especially if the windows are used at all for ventilation. And every
school room window in even the coldest weather ought to be open at
least a part of the time — at recess times at least. In many instances
the school room thermometer is hung on a nail driven in the window
casing. Its work can not be accurate under such circumstances. Out of
319 city school rooms, widely scattered over this country and actually
visited in this survey, five had no thermometers. This shows a big
majority with thermometers when we take into consideration the report
of Dr. F. B. Dresslar, at the 1912 meeting of the National Education
Association on "The Hygiene of Rural Schools." Dr. Dresslar reported
that of 1,296 typical rural schools scattered over 19 states, two-thirds
had no thermometers and that in the one-third remaining "it is mani-
festly clear either that many teachers know next to nothing about keep-
ing a school room at the proper temperature, or else the conditions of the
buildings are such that they can not keep their i;ooms at even tem-
perature." The mistakes of improper temperature in the school room,
together with poor ventilation, take away the energy and life of children,
dull their minds and too often make their school work a failure.

As to lighting the city school rooms visited, out of 319 rooms, 174
received light from the left side only; 97 from the left and rear; 14 had
cross lights ; 7 from the right only ; 8 from the right and rear ; 5 from the
rear only; 5 from the left and front. The few remaining had combina-
tions of directions that were unusual and injurious. Other reports
that were obtained and that concerned rural schools almost altogether,
some fifteen hundred schools, showed only 30 school rooms with light
from one side, 1,112 with light from two sides, 381 with light from three
sides and 51 with light from the front as well as from other directions.
As will be seen readily from the above figures, the practice in regard to
lighting school rooms varies. The results are greatly in favor of the
city school room, although there were instances where the city condi-
tions were as bad as anything in the country. For instance, two city
school rooms were found in which it was necessary to use artificial light
and 34 rooms were entirely too dark. Six city rooms had no opening
on the outside but opened on interior courts.

In the matter of heating, 77 city rooms were found in which the heat
was obtained from steam or hot water pipes in the rooms. The ventila-
tion was, of course, by means of the windows. Fifty-two rooms had a

SOME AMERICAN SCHOOL ROOMS 1 3

combination of direct radiation and the gravity system, 411 had the
gravity system, and 772 depended on stoves for heat. Almost all of
the stove-heated rooms were found in the country. Only here and there
was a school room found in the city where a stove was in use.

Three hundred and seventy-five rooms were reported as depending or
were found to depend on the windows for all ventilation. Of the more
than three hundred rooms personally inspected only a third had air
conditions that could be called excellent. The other ranged from fair
to very bad. The poorest system of all as to heating and ventilating is
to throw the responsibilities of these things on the teacher while she is
at work in her room. She has other things to do and she forgets. The
next best thing is to throw these responsibiUties on the janitor, but the
best way of all is to have high-grade automatic systems that take no
attention from teachers and that get results.

Of the city schools visited practically all showed evidences of being
swept not less than once per day and most of them looked well kept
otherwise. The drinking water accommodations in fifty per cent, of
the buildings could be called good, in twenty-five per cent, fair and in
the rest questionable. The water conditions in the country schools
were generally classed as poor. The colors of the school room walls
were generally some shade of green or gray, or they were dingy from not
having been cleaned or painted in recent times.

To go into further particulars, it hardly seems possible to believe
that one big eastern city has a school building in ;kvhich the light is ad-
mitted into the various school rooms from every possible direction.
This particular building has one room into which the light is admitted
from the left and the front, another room into which the light is admitted
from three sides, another room into which the light is admitted from the
back, another room in which there are cross lights, another room in which
there are only two windows, one in front and the other on the left in
front, another room in which it is necessary to keep artificial lights going
throughout the day and other rooms in which the light conditions are
almost beyond belief. Now the trouble is not that the school adminis-
tration of this particular city is not progressive or not informed. The
city in many ways stands among the leaders in this country. The
building itself dates from the middle of the last century. There is appar-
ent lack of funds with which to rebuild on the same spot or in a different
part of the city. Real estate is too valuable, so most of the people say,
for school purposes. Modern science has been able to make some modi-
fications in the ancient architecture of this school building but, for the
good of the children that must attend school within its Walls, this build-
ing ^ould be torn down and a modern one put in its place. However,
in enumerating conditions in this fearfully bad school, not every thing

14 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

can be laid at the door of the hesitating tax-payer. In every room the
thermometer was placed seven feet from the floor. The ventilation in
this unsanitary institution was obtained from the windows, the air
was only fair, and conditions in a general way were deplorable.

Another building in this same city was visited. The fame of this
particular school extends throughout the country. It is what may be
called a modern building and is in many ways admirable in its construc-
tion and the care taken of it. However, there were found some condi-
tions that need attention. The halls are dark. Several of the rooms
have their only windows opening on a court that is closed on all four
sides. A few rooms had direct radiation. The temperature ranged
from 66 to 73 degrees. In one room all the pupils were seated facing
the windows and in anothpr room all of the pupils had their backs to
the light. One room had no thermometer and another room had a broken
thermometer. A good point was that the light came into rooms from
the left, with a few exceptions. The air in the rooms was good. It
was thoroughly washed and tempered before introduction into the school
rooms. It did not have the deadening quality that the air has in the
average school room and in most places of public meeting. Hundreds
of thousands of dollars were spent in the construction of this building,
and a big sum is spent annually in maintaining it. In spite of all this,
however, there is need of improvement. The moral to the situation is
that no matter how expensive a plant may be and how up-to-date it
may be the constant .attention of experts is needed to keep it as it should
be.

A visit to an unusually 'large school in another section of this same
city revealed some marked conditions, when we take into consideration
the modern thought on school buildings. The building was kept clean,
but there were other things to which to object.- The heating was entirely
by direct steam radiation. All the ventilation was by means of. windows.
The thermometers were placed from six to seven feet from the floor.
In many instances the thermometers were near windows and, of course,
could not record accurately the temperature in the school rooms when
the windows were open and not even when closed, on account of the
leakage of cold air at the windows. In a few instances the thermometers
were placed at the ends of long rooms where they could not possibly
record the real conditions prevailing as to temperature. In some rooms
the light was admitted from the right. In other rooms the light was
abominably bad. On the fourth floor the rooms were directly under the
roof and the arrangement of windows in each of the rooms is so bad that
the entire fourth floor ought to be closed up by legal action. In one of
these rooms three small windows placed close together furnish the only
outside light. In another, two small windows serve this purpose. In

SOME AMERICAN SCHOOL ROOMS ' jr

several other rooms the windows range from two to six in number but
in no instance was the lighting satisfactory. The temperature in nearly
all of these attic rooms ranged above seventy. There is need of some
health missionaries there.

Still another building in the same city was visited and showed some
interesting conditions. It was erected in the fifties. It contains 15
recitation rooms with direct steam radiation in all of them. The light
is admitted from two directions in most of the rooms and in the others
it comes in from only one direction. In the latter instance the rooms
are too dark. Ventilation is by means of windows. Common, cheap
thermometers are used in regulating the temperature. The cloak closets
are in the recitation rooms and the odors from drying clothing pervade
^the rooms on damp days. This building should be abandoned.

A visit to a large building in another Atlantic seaport city showed
[favorable conditions, everything considered. This particular building
[takes care of the education of some 5,000 children. In the main, condi-
[tions are satisfactory, but the crowded district in which the school is
[located furnishes so many problems that it seems almost absolutely
[necessary that more room be provided not only for playgrounds and
similar purposes but for getting many of the children a few stories nearer
'the earth. Some of the rooms in this building are lighted from the right
[side only. This fact is due to an arrangement that throws several of the
[school rooms together for chapel purposes. The plant is well kept
ind the teachers seem anxious to pay all necessary attention to the
[physical condition of their charges.

Inspections in other parts of the country, in city schools, showed
(conditions in the main somewhat above the average indicated above.
[The newer cities do not have the old buildings to contend with that the
)lder communities have and many of the newer cities have a spirit of
^progress that demands the best things. Here and there was found a
building that was a brilliant exception in that it seemed to be almost
r^^perfect in its condition, the care taken of it and the generally wholesome
[influence that it exerted over the lives of the children that attended it.

This paper has detailed some very bad conditions in order that the
lesson of improper school conditions may be made more impressive.
^There is much that is hopeful in the public school system of this country,
[not only in methods and their effectiveness, but in all problems of sani-
tation as well.

The general points that may be put forward in conclusion are as
follows :

Everywhere in our country there is the spirit of progress in matters
of school sanitation.

1 6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Whenever our people get ready to spend as much money on public
education as on some of the unnecessary and harmful things in which
they indulge, there will come to pass readily all the things of which we
dream.

There is a larger expenditure of sanitary appliances and measures
now in our schools than ever before.

City schools spend more for such appliances and measures than do
country schools.

The health supervision of city schools is more extensive and intensive
than in country schools.

In heating, lighting and ventilation, city schools have the advantage
over country schools.

The one great opportunity to lay the foundations of public health
is found in the public schools.

Every school should have plenty of light, plenty of good, pure, un-
baked, life-giving air, good water, bathing facilities, roomy playgrounds,
school-prepared noon lunches, and all other things that go to the making
of health.

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 17

SUPERNORMAL ENVIRONMENT IN ITS RELATION
TO THE GROWING CHILD

JosepAine E. Young

The data in this report were procured from the children of the experi-
lental pedagogical department of the University of Chicago which is
the nature of a large private school, and is called the School of Edu-
Ltion. The children come from the homes of the very rich, the well-
to-do, and the faculty of the University. The report deals with 404
iris and 201 boys.

Measurements were made by expert physical education teachers
'ained in anthropometry. The studies in haemoglobin were carried
mt by Dr. Maria Blair Maver, a physician of large experience in clinical
iboratory work. Uniform methods and instruments were used through-
mt.

The environment from which the children come varies. The faculty
:hildren live in ordinary material surroundings. A group of the others
ire brought up in great luxury — nursery maids and automobiles being
le order of the day. The rest, largely in the majority, are the children
►f successful business men who, nevertheless, pursue a relatively simple
ife. These children are free from care, but not entirely from labor or
["esponsibility. They walk back and forth to school unaccompanied,
id, in general, express themselves with considerable freedom. Of 266
lildren in the Elementary School, 145 were breast fed, 26 both breast
md bottle fed, making 68 per cent,. 52 only were bottle fed. Most of
lem summer in the country, and many of them sleep out of doors, the
Lverage number of hours of sleep being ii>^. 69 have had adenoids or
tonsils, or both removed. The hygienic condition of the school is as per-
fect as equipment, science, money, and faithfulness can make it.

The accompanying tables are measurements of height, weight and
mg capacity taken in the school year of 191 2 and 13.

1 8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

kilos itL.

'h''' /£

£f

4u,t!m.b:U

r»*

•^

Ur,til> r-.m.

■u

^"i

1
1

.,/

,*r

..-'■

9^,

^•-••■■'

..-'•■"

(i>

FIGU

RE 2

n f-

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD lO

C3d

1 1

a,
n

1 1 1 1

H > ^

1 1 1

H > ^

B
o

en*

3
o

^ 1

J5d W

J« W

n 3
3 pT

0) ■
3

3*^

o ^

<J (yQ

•t

(T)

P- P*

;

S-

• *

\ ><

Ck> )-i

! ^

•

• 3

Ol M

'-'

•

4:>. 4^

-F».

•

^ a\ Ol

4- Ki

Cfl

J_,

^ 00

Oi Kj

K) Cji

CN-f^

4i>

4=^ k:

•n

Ol o

Cji

ONOi Kj

•-t

M Oi

0\ Ol

C*i

K) H<

•

. Ol

Ol xO

H-l

•

• t

„

. Ch

• ■'M

• ^

•

* .^

oo-vi aNOi4^oi Kj M ovo ooM

Age

>H M M to to C»i Oi
. • HHl000^V|VOC*i^^l0

No. of
Cases

•-1

o
o

• ■MOOOXM ONvbdivboi

to
to

•vl

School of
Educ't'n

Oi to to to to

: : : -. : ; ; m po o\ o* m

to M di bo CT\

Smedley

to to to to . .

....... 00 ^ 4». K) . .

•" w di bo 4>. • ''

H.E.
Laboring

o* to to to .

: : : -. -. . ; ; p -^ oi to •
• • . . • '• ' ' •<! ' bo ■

;•

H.E.
Non-Lab.

• 4^ Ol 4^ to Oi to . to .

Faculty

Ol 4^ to to to to to

• • . . . HI Oi .VI M \0 4^ O

• • • • ' io ON ^ vb 4i. 4^ w

to
to

Automo-
bile

c
o'

• 4i.CK>. .OiOitOtOtOtO-

: ' ^ ^ '. : pN c^ 00 ^ c\ ck» •
: • .^4 bo • • vb 4*. Ol bo to vb •

Tonsils
Enlarged

• . 4^. 4i.4^C>ia>t0t0t0t0

1 ; OJ;"MpN^Ot000vOt04^

• ..^'oiONM^^oitobovb

Tonsils
Removed

OO^J 0>0i4^0i to M OO OOM

Age

tOtOOitOOii-itOtOMMM
"vj'MOiOi t04^ OnO MOi HH O

.No. of
Cases

School of
Educ't'n

OiOiOi4^45>.OiOia)tOtOtO. •
0Jl0p004^vp4>'p-MOlOi; :

4^. .^i to * * Oi ON bo to ' • •

Smedley

. . 4^4^OiOal0t0t0t0. •

. 4i»M^toooa\.^t-<.
: : : 6i 4=^ M bo .^ to ' vb .* '

H.E.
Laboring

. 4i.4i.OJC/i(0t0t0t0. .
. cnioooOovoa\4i.tO; .^

■ • ' in ' Ci \o CO 'h <> (J» '• '

H.E.
Non-Lab.

. 45»4i.C»iC/JO0Oi to to i-i .
.vOvOOl 0N4^0i OOOlvO ;

' ' ' to ' to Ol b\ to to di b\ .'

Faculty

4i. Ol 4i. Ol 4^ Oi Ck> OJ to to to to •

t^oN^-f^pN-f^ 004^ oo-^t ^ oi :

bodiOi to w-f^ w6ivb4^"<l iH .

Automo-
bile

4^ Oi C/i to to to to •

M 00 w 00 ^ 9° ^ '.

'. '. '. I 'd>^'oi4^oibo.

Tonsils
Enlarged

. oi4i*4^OiOiO»O0 to i-i
• . • 4iOOO\OltOOlOOltO

:::•••• di '' "^ '

Tonsils
Removed

/; /t age

FIGU

iE3

'?■

/
/

"//'

c^i:-n.

■ 5

F*<alt«..

wtm.VU
Tji. ll illl

/*»'

-k

ft"

-.7

»iiia< r«m«

^mI

<7
/

/)r

1 /
/

;;«

it*

/
/

C'"'

/ y

/ti

//>/ /

//;

7 1

"figui

IE 4

l-f-

'<l~

7 >

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 21

Age

00 VI

0\Cn4^CK> W HH O^ OOviON

No. of
Cases

School of
Educ't'n

Smedley

C/J C^ OJ W KJ w M

: : : : : : "P '^ ? p^ ? ^ ?

H. E.
Laboring

' rTl rTi lo k5

: : : : : : : en •-• o\ •-. : :

4^ K>

H. E.
Non-Lab.

0«> OJ K) Ki • •

• • • ; ; • : Cn O Cn O : :

': ':

: : 5 ^ 5 1 1 ^ : ^\
vb m vb vb

Faculty

; I I • ;4^cnOOJtoOO\'<l
b 4^ " ON d> bo '

Automo-
bile

Tonsils
Enlarged

\b bo ' bo '

': ':

• cnCn-(i>.-f^OiOi to •-( HH
; ;4».Cn00OCh>U>OivppN

Tonsils
Removed

•

Age

00 VI

0\Cn4^C>i to 1-1 OvO Oovi o\

i-iK)i-iK>K)t-Hi-ii-i

No. of
Cases

School of
Educ't'n

Cn OovO OOiVi pN'poovp-p>. p\ p
vovb b\b as 6i b'^ ^h 'a\ ho ho <ji k>

• • • • ; • ; H^ cn o cn O cn ^p

di -i^ ' k) cn 4^ ON

Smedley

i i

'. '. c!n ^ 4^ o> Oi to to • •

• ; to "v| j-c cn p Cn p ; ;

* M ii.. Cn "^ di to ON

H. E.
Laboring

! ! : '. ^ ^ ^ oi Oi hi i^ • •

. . _• ; Oi \o JO On j-i "n4 jH ; ;
b Jh -<i 4^ di 6i 00

H. E.
Non-Lab.

': ':

• cnCn-P>.-^.4^OJC»t0t-i-
: VO vp JO p -p- 00 HH ON Oi :
bo cn ' 6i ' d> * '<-*

Faculty

Automo-
bile

4^ 0\a\cj\u\4^4i-(^<^ ^ '^ !rLi

pop OMD HH^ ?o?o-^ ?°? ?°*
boboCncn4i''6i' mojoj

. . . . ^vOOopcnONjHM;
cn k) * * vb ^ Cn

Tonsils
Enlarged

; r

bo ' * bo

Tonsils
Removed

22 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

1 ^

fiCU

}arfld

—

Ton/,!} ri

K.vU.

•

/
/
/
/

\
\

^''

ST.—

l¥

i? I

FIGURE 5

FIGURE 6

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 23

00^ a\Cn4^CA> K> M OvO OOM

Age

. • M M i-i K) 10 C*i W

No. of
Cases

: : : 5^ J^ !^ .^ J^ r* 1^ r^ 1^

School of
Educ't'n

Smedley

• * ' • • • • -^ On 6i dj I-i '

H. E.
Laboring

H.E.
Non-Lab.

M KJ Ki I-I K) M 1-t •

Faculty

• OJ \0 C/J 00 C/» vO 00 •

Automo-
bile

• ' • • • vb M vb bo ON 4i 4^

• * ' ' ■ K>N>HH1-II-<1-II-I

;■

Tonsils
Enlarged

C/J vD 00 -vj •vj ca

K)«\JK)»0IH»HI-IIH

Tonsils
Removed

OOC/lOi MVO OOMC/i

00^ ONCn-f*.C*i M 1-1 OvO 00^

Age

K)K)C^MOiHHK)tOMMi-i
"^^JC/iCn»04^ as 0 HHOi 1-1 0

No. of .
Cases

School of
Educ't'n

4^ '0\ 4^ in OS ' ' ho bs 4^ '

10 K> JO HH JH HH ►-! M M M

z^ ^ ^ '>-> 0 00 Os in -i^ h '>-i 0 ■
4^ Oi W-M mC/j onK) O^OOO^O^vO

Smedley

H.E.
Laboring

;

H.E.
Non-Lab.

:::::: : : : : : : .

'. .*OiK>i-it-ti-ii-ii-ii-iM

Faculty

i-i^j\0 Oovo^Cn4^tn

K)K)JO»OtOj-IMMHIMMM.

M«ll Ih4^«<J OOnO bo-^ MWvb •

Automo-
bile

K>»OKJK>K>_tOK)MMMMHH.

HHbo6lV34^HHl-l\bb\M»-'t-«- 1

Tonsils
-Enlarged •

'. ' '. tOK)»OMWI-IMM

Tonsils
Removed

.* .* . \oCn4^'cc'os-<l4^4^sO

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

These will bear some study. To get a comparative estimate, they
have been placed in juxtaposition to Smedley's well-established norms
of Chicago Public School children, and to those of Boston laboring and
non-laboring children taken by Bowditch for the Hoesch-Ernst compila-
tion. The first striking fact is that the School of Education children
average five centimeters more in height and between 2;^ and 3 Kilos
more in weight than Chicago Public School children. The same is true
of vital capacity. An interesting fact in connection with this data is
the statement of a noted pediatrician of Chicago who knows as physician
many of these children. He says that in at least 100 cases- both parents
are smaller than the child, and seems to feel that, granting good condi-
tions, the stock may improve.

Blood pressure and haemoglobin records, as shown by the tables, are
also worthy of study.

Tables of blood pressure on both height and weight bases.

Height.

Weight. Boys.

Cm. Elem. Boys.B. Pr.

Kilos. Lbs. B. Pr.

I 10-120-3 . 5-3 .9-93 6 cases

i6-22-(35.2-48.4) -83 2 cases

i20-i28-3.9-4ft-ioo 13 "

22-27-(48.4-59.4) -102 17 "

128-136-4. -4.3-106 18 "

27-32-(59-4-70.4) -106 23 "

136-144-4. 3-4. 6-107 16 "

32-37-(7o.4-8i.4) -109 7 "

144-152-4.5-4.9-111 2

37-42-(8i.4-92.4) -112 3 "

Girls.

Girls. Kilos.

106-112-3.6 -3.9 -85 2 cases 17-22

112-120-3.9 -4 - 96 4 " 22-27

120-128-4 -4.3 - 99 13 " 27-32

128-136-4.3 -4.6 -102 33 " 32-37

136-144-4.6 -4.1 -loi II " 37-42

i44-i52-(4.io-5.i) -109 34 " 42-47

i52-i6o-(5.i -5.4)-io6 76 " 47-52

i6(>-i68-(5.4 -5.7)-io8 46 " 52-57

i68-i76-(5.3 -5.6)-io3 4 " 57-62

62-67

Lbs.

B. Pr.

(37 •■4- 43.4) 94

5 cases

(48.4- 59-4) 97

19 "

(59.4- 70.4) 103.

4 30 "

(70.4- 81.4) 105

26 "

(61.4- 92.4) 103

27 "■

(92.4-103.4) 107

43 "

(103. 4-1 15. 4) 105

37 "

(115. 4-125. 4) 109

22 "

(125. 4-136. 4) 108

13 "

(136. 4-147. 4) 105

7 "

Comparative tables of Blood Pressure, according to weight:

Lbs.

30-40
40-50
50-60
60-70
70-80
80-90
90-100

Sch. of Ed.

103.4
105
108
107

Michael

95
100
107
112
116
122
126

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 2^

Examination of this table records the fact that our children seem
to be uniformly lower than Dr. Michael's carefully worked out table
made from an examination of poor Jewish Institutional children. While
the chief danger of blood pressure lies undoubtedly in the high ranges
nevertheless low blood pressures have been regarded as significant by
indicating a diminished vitality.

The haemoglobin studies were a surprise. To make them of value

;ince but little has been done with the blood of healthy children, it was
[decided to get a control series of lOO from the Jewish Home for the

'riendless. All of these children are poor, a number of the mothers

)eing tubercular. They are well, though simply, fed four times a day.

"hey are practically all below the Smedley norms, in physical measure-
lents, some of them very much so. Comparative tables are given be-
low. These include Cabot's statement that children between the ages

>f 5 and 15 have an average haemoglobin of 80.

Haemoglobin

Jewish

Sch. of Ed.

Age

Home

Cabot

Boys

No. of Cases

Girls

No. of Cases

82.7

82.8

85-4

82.2

86.2

87.5

Aver. 83.9

Aver

Examining these groups we find that the institutional children

iverage five degrees higher than those of the School of Education, and

[hat the latter fall slightly below the Cabot standard as well. Finding

ft difficult to explain the higher haernoglobin content of the blood of the

istitutional child, it was thought that possibly Semitic children as a

race might show this phenomenon. A control study was therefore made

ith the haemoglobin findings of the Jewish children in our own school,

mt here it was found that 60% of Jewish girls and 83% of Jewish boys

rere below the general average of haemoglobin in the School of Educa-

ion. Artificial living, perhaps, has an influence here also. Diet can

)e too rich and too sweet for the well being of the child.

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Using our own averages of haemoglobin as the standard, a simple
correlation between haemoglobin, height, weight, vital capacity, scholar-
ship and industrial ability in' the school, was attempted. The table
symbolism will bear explanation: -Hb. refers to all those children whose
haemoglobin was below the average for their age groups. +Hb. for
those above. Correlating roughly Hb. with height, therefore we find
that of those deficient in Hb. 29 were below in height, 33 above — a
difference of 4. Of those with Hb. greater than that for their group, 26
were below and 29 above, a difference of 5. This is so small as to be
practically insignificant. If we compare -Hb. and +Hb. throughout,
we will find that in no case is the number of heights, weights, and lung
capacities below normal, materially greater with -Hb. than those with
+Hb. except in the cases of lung capacity and scholarship in girls.
Good scholarship seems to occur more frequently in the anaemic than in
the full blooded. In the main, there is no correlation brought out by
this study. This fact may be accounted for on the ground that Hb. is
a constantly changing property of the blood, but one would think that
scholarship at least might be affected by anaemia. It is probable that
the order is reversed and that the anaemia is produced by too close
application to study.

Girls. Boys.

-Hb. 29 below Height 14 below

33 above " 18 above

+Hb.
-Hb.
+Hb.

26 below "
29 above "
31 below Weight
24 above "
33 below "
23 above "

12 below
17 above

13 below

13 above

14 below
13 above

+Hb.

27 below
29 above

15 below
12 above

-Hb. 29

+Hb. 24

-Hb. 15

34
+Hb. 10

37
-Hb. 5

45
+Hb. 5

below L. Cap.
above "
below "
above "
below Schol.
above "
below "
above "
below Ind. Cap.
above "
below "
above "

8 below
19 above

9 below

17 above
5 below

21 above
8 below

15 above
7 below

18 above
4 below

19 above

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 27

A Study was made of 29 Elementary, 66 High School girls, and 21
Elementary boys as to the relation between persistently rapid pulse
after exercise and haemoglobin. One method of determining the ability
of the heart to restore itself after violent exercise is that of requiring the
child to extend the arms upward so far as possible, and then quickly
touch the floor with the finger tips, this act being repeated ten times in
rapid succession. The pulse is then recorded at 15-second intervals for
a minute. Of those children whose pulses were still above 100 at the
end of the minute's rest, it was found that 75% of the Elementary
boys and High School girls had Hb. below the average, while of the
Elementary girls 63% had Hb. above the average. Hb. and weight
apparently have no connection. 64% of a group of 28 girls with weight
normal to our own standard showed Hb. below our average. In con-
nection with rapid pulse a statement has been made to the effect that
high blood pressure and persistently high pulse rates after exercise are
usually correlated. So far as our figures go, this is disproved among
our Elementary girls and boys, and University women, the latter being
not otherwise referred to in this paper. 60% of our Elementary girls
and 55% of our boys with rapid pulse had less than the average blood
pressure for the school. 53% of our High School girls showed an in-
crease. It may be remembered that in the first table blood pressure in
the School of Education was shown to be uniformly lower than that given
in tables hitherto published.

In examining the general tables with special reference to the pre-
pubertal period of boys and girls, it may be seen that instead of the
usual relatively rapid gain in development of' girls over boys, that at
no time in height or lung capacity, and in weight only at the age of
II years — and then with a difference of no more than i.i kilos — can
this relative gain be discovered.

It should be stated at the outset that scholarship and industrial
capacity are indicated by the grades A, B, C and D.

A crude correlation of mental and physical development with the
existence of adenoids and tonsils may be seen below. The number of
girls having enlarged tonsils is 62; of boys 25.

Of the boys in scholarship 78% are A & B

22% are C & B
Of the girls in scholarship 82% are A «& B

18% are C & D
Of the boys in Ind. Cap. 82% are A & B

i8%areC&D -
Of the girls in Ind. Cap. 89% are A & B

ii%areC&D

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

•ged tonsils.

Ht.

Wt.

L. Cap.

Schol.

Ind. Cap.

Hb.

Boys % no. above average

. 45

below "

Girls % no. above

below "

55 .

Note: To understand the above table and those immediately following like it,
reading percentage number above or below, in Ht., Wt., etc., it may be of value to state
that an average was made of each age for the various measurements separately. Each
individual of that age was then compared with the average of his or her age group,
for that measurement and marked plus or minus as he or she fell above or below the
group. It must be borne in mind that boys of the special group are everywhere com-
pared with boys of the general group, and girls similarly with the group of girls as a
whole.

The sum of the averages for the different ages in Ht., Wt., Grip, and
L. Cap. of the above group as compared with the sum of similar averages
of the school as a whole is in

Sum of averages : 1 1 32 . 3

186.2

13.7

Boys

Height 37 less for boys . 03 %
Weight 9 " " " .047"
L.Cap. .8 " " " .05 "

Girls

Sum of averages: 939.3

217.4

. " 23.3

Height 5 greater for girls .005%
Weight 4 " " .018 "
L.Cap. .5 - " " .021 "

Adenoids and Tonsils Removed:

Ht. Wt.

Boys % no. above average 37 37

below " 63 63

Girls % no. above " 63 52

below " 37 48

L. Cap. Schol. Ind. Cap.

69 71 85

31 29 15

63 72 87

37 28 13

Hb.

32
68
50
50

Sum of the averages for the removed Adenoids and Tonsils Group;
School of Ed, Boys.

Sum of averages: 1249.3 Height 25 less for boys .02 % "

Weight 9 " " ,026 "

347.6
168.

L.Cap.

.03

School of Ed. Girls

Sum of averages: 1255.8 Height 15 greater for girls .012%
315 -5 Weight 3 less " .009 "

159- L.Cap. .8 greater " .005 "
In this group there is practically no variation.

SUPERNORMAL ENVIRONMENT IN ITS RELATION TO GROWING CHILD 29

There remain two interesting economic groups, both of which may be
profitably compared with the average for the school, namely, the faculty
children and those living in luxury who will be referred to as the auto-
mobile group.

Faculty Children:

Ht.

Wt. L. Cap.

Schol

Ind

. Cap.

Boys % no.

above 37

32 36

below 64

68 64

Girls % no.

above 53

45 52

below 47

55 48

Sum of the averages for the Faculty Group :

School of Ed.

Boys

Sum of averages: 1000.

3 Height 16 less for boys

.016%

255.

0 Weight 3

.01 "

16.

4 L.Cap. .2 greater

.01 "

School of Ed.

Girls

Sum of

averages: 1255

.8 Height equal for

girls

315

. 5 Weight 4

less for gir

s .012

159

L.Cap. 1.6

greater "

.01

((

Smedley Boys 35 greater, girls 24 greater in

Ht.

2 "

" 18 '

' "

Wt.

6 less

" 25 '

( ti

Grip

)

21 greater, "35

< <<

L.Cap.

Automobile Children:

Ht.

Wt. L. Cap.

Schol

Ind. Cap.

' Boys % No

. above 36

32 69

below 64

68 31

Girls % No

above 37

39 43

below 63

61 57

Sum of the averages for the Automobile Group :

School of Ed. Boys

Sum of averages: 1092. i Height 33 less for boys .03%

256.3 Weight 15 " " .05 "

14.9 L.Cap. 16 " "1.06 "

of Ed.

Girls

Sum of averages:

1729.8

Height 4 less for girls

.002%

<( n

473-

Weight 14 "

.029 "

(( <<

23-3

L.Cap. 2 greater "

.08 "

Looking at the tables for the sums of the averages of the four special
groups, it will be noted that the only appreciable variation from the
average of the school, as a whole, is in the lung capacity of the boys
of the automobile group, and here it is very little.

30 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The apparently slight advantage, if any, of the child whose adenoids
and tonsils have been removed, over the child with enlarged tonsils re-
maining intact, is very surprising. It is quite possible that a study of
individual children before and after removal of tonsils, especially if con-
tinued on into the High School and College, would give us very differ-
ent data, especially in those children who before operative interference
were subject to frequent colds and sore throats — whose sleep at night
was disturbed by snoring and emeresis — and who, in the day time, suf-
fered unconsciously from lack of oxygen. Considering the intimate re-
lation of the diseased lymphatic structures of the throat to rheumatism
and deafness, it would, perhaps, be safer to remove them in every case.

To summarize:

1st: Children of the rich are much taller and heavier and have
greater lung capacity than public school children.

2nd. Boys and girls are lower in haemoglobin and blood pressure
than so-called "less favored" children.

3rd. The pre-pubertal increase in development of girls over boys is
not seen on our charts.

4th. While the boys of the pre-pubertal period compared with
girls show relatively and absolutely greater growth than boys of the
public school, they also show when divided into groups representing
physical handicaps or economic variation a slightly greater loss of
vigor and development than girls of the same groups. This is to a
larger extent true of haemoglobin.

5th. Of the four special groups studied, children whose tonsils have
been removed show better physical measurements and conditions than
those whose tonsils are enlarged and intact, though the difference is
very much less than might be expected. This will bear a different kind
of study.

THE HYGIENIC AND SANITARY CONDITIONS OF SCHOOL BUILDINGS 3 1

THE HYGIENIC AND SANITARY CONDITIONS OF
SCHOOL BUILDINGS IN THE NETHERLANDS

BY
A. J. SCHREUDER

,adies and Gentlemen:

I will give you a short statement of the hygienic and sanitary con-
ditions of school buildings in Holland, hoping to contribute to
your appreciation of my little country. According to the desire of
the Congress Committee that our Congresses should give more attention

o the hygiene of the country schools, this paper deals in first line with

uch schools.

It is a well-known fact that Holland takes the first place in Europe
in regard to the hygiene of school buildings. This does not mean that

ygienic conditions of any school in Holland are better than those of
any other school in any other country. But for aught I know, there is

I no other country in the world where the minimum standard of hygiene,
to which every school of the country has to adhere, is as high as in Hol-
land. This minimum applies to the town schools and the smallest
country schools, to municipal schools and to private schools.
The strict rules for the construction and equipment of school build-
ings have been maintained and made severer in the course of time by
succeeding governments of every political party. Since the State makes
high demands, it also contributes to the costs of construction and main-
enance, not only of the municipal but also of private school buildings.
I shall now give a review of the principal demands:

I. Grounds and Site.

The State makes no general binding instructions, but the school

luthorities must avoid as far as possible neighbourhoods detrimental

[to health and teaching, when choosing a site. When submitting the

•proposed plan to the Government for approval, a map of the neighbour-

[hood with a radius of 600 feet must be furnished. The Government

las however stipulated that the school buildings must stand free from

>ther buildings, unless this cannot possibly be avoided.

Where the level of the ground has to be raised, in order to make the
^building water-free, the level has to be increased to 20 inches above the
highest water-level of the neighbourhood. This is of the greatest
importance from a sanitary standpoint in "watery" Holland.

32 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

2. The Building.

The State requires that the floor shall be made at least 8 inches
higher than the highest point of the adjoining ground.

No school building may have any inside communication with any
dwelling place, not even of the principal nor of the janitor.

The outer wall has to have a thickness of at least 9 inches for one-
storied buildings, and 13 inches for two or more storied buildings. But
this rule has been made still severer by the requirement that an outer
wall, situated between south and west must be a "double wall" having
an air space with a total minimum thickness of 15 inches.

There are no special requirements as regards the placing of the various
rooms, as this depends too much on local conditions. The corridors
must be well lighted and must be at least 7 feet 6 inches wide. The
staircases must also be well lighted and at least 4 feet wide, and must
be provided with railings on each side and shut off on the open sides by
solid gates.

3. The Class Rooms.

No school-room may contain more than 56 pupils. In most schools
the rooms do not contain more than 48 pupils.

The floor area provided for each pupil must be at least 8 square feet,
the space at least 100 cubic feet. The height of the rooms is at least
14 feet. The distance between the blackboard wall and the front seat
must be at least 4 feet, and if the blackboard is not attached to the wall
this distance has to be increased to at least 5 feet.

The distance from the blackboard wall to the back of the back seats
may not be more than 21 feet.

The passages between the seats and along the walls have to be at
least 2 feet wide. The walls and ceiling have to be of a light and plain
colour. Curved ceilings are not permitted. The floor must be flat
and tight and not made of stone, unless paved by a material completely
insulating it.

The doors may not have any direct communication with the open air,
and all doors have to be made to open outward.

4. Illumination.

The ratio of window to floor area must be at least i to 5 if the light
is not interrupted by trees or buildings, and i to 6 if that is the case.

The windows must be situated as far as possible to the left of the
pupils; windows in the blackboard wall are not permitted. The whole
room must be sufficiently lighted and if the daylight is too strong, it

THE HYGIENIC AND SANITARY CONDITIONS OF SCHOOL BUILDINGS 33

has to be moderated. The bottoms of the windows must not be more
than 4 feet above the floor; the top must be as near as possible to the
ceiling.

5. Heating and Ventilation.

No special system of heating is required. In the large towns the
schools are often provided with hot-water heating systems. Most of
the country schools are heated with stoves, which have direct communi-
cation with the cold air coming from outside. In this case the ventila-
tion apparatus for the removal of foul air must be placed on the opposite
side of the room. There must be an apparatus for artificial ventilation
in each room. Besides, the upper sash of the windows must be arranged
so as to be easily opened, and there must be at least one window which
can be wholly opened.

6. Sanitary Appliances.

The number of closets and urinals must be sufficient and in propor-
tion to the number of pupils. The closets for boys and girls must be
separated.

The closets and urinals having communication with the school-room
must be separated therefrom by a passage. These passages or the
closets may not have a direct communication with one another and
must be situated in such a manner that they can be easily controlled.
Each closet and urinal and each passage must be sufficiently ventilated
and lighted.

The minimum dimensions of closets and passages must be: Length,
3 feet; width, 2^ feet; height, "jyi feet. No special system is required.
In the small country schools where only latrines (necessary cess-pools)
or even pails can only be provided, the law requires a complete disin-
fecting system. Water closets are compulsory, even where there is
a water supply.

The floors of the closets must be made of water-tight material; the
walls plastered to at least 4>^ feet above the floor, of a material which
can be easily cleaned by water.

Coats, etc., are not permitted in the school-rooms; properly lighted
and ventilated cloak rooms must be provided throughout.

7. School Furniture.

As regards the school furniture it is only required that the benches
may not contain more than two seats each and must be provided with
proper hip supports. The blackboards must be unpolished; polished
boards are not allowed.

34 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

And herewith I have finished my review. I should like to point out
again that those are the minimum demands which apply to every school
building throughout Holland, also to the one in the smallest village.

I quite sympathize with the desire of the Congress Committee to
draw special attention to hygienic conditions of rural schools. This
problem has been solved in Holland in quite a satisfactory manner.
If I add that the cleaning of the schools is quite sufficient as a rule (the
Dutch people are known for the cleanliness of their houses and streets)
then you will fully understand that the high reputation of the Dutch
school buildings is well deserved.

THE HYGIENIC CONSTRUCTION OF SCHOOLHOUSES 35

THE HYGIENIC CONSTRUCTION OF SCHOOLHOUSES
FROM AN ARCHITECT'S STANDPOINT

BY
W. H. KiLHAM

So much advance has been made in the general matter of the hygienic

onstruction of schoolhouses that it seems as if the last word must have

een said as far as the architects are concerned. No longer is the school-

00m air re-breathed by fifty pairs of lungs; the common drinking cup

as been replaced by the bubbling stream; dust, once the bugbear of

janitors, has fled before the combination of rounded corners and vacuum

leaner and the school-room is sunny, well lighted, warmed to a uniform

;emperature and in fact, almost sterilized by the various devices calcu-

ated to conserve the health of teachers and pupils. The schoolhouse

of to-day, compared with that of thirty years ago, seems to be almost a

perfect structure.

But there is another side to this. This germ-proof, dustless building
is also a very costly one. City after city passes large appropriations to
rovide the "most modern schoolhouse that can be built." With their
mplicated equipment the construction of these buildings brings a for-
idable load on the helpless taxpayer. How many of the requirements
of one of these buildings are fads and how many are in the class of things
eally worth while?

About the most important single item of schoolhouse expense, both
construction and maintenance, is that of heating and ventilation,
et us just examine for a moment into the matter of the supply and
emoval of air for the class room. The laws of Massachusetts and many
ther states provide that no new schoolhouse shall be occupied until
fter the installation of apparatus capable of delivering at least 30 cubic
eet of warmed outside air per minute to each occupant. In a large
uilding this can only be satisfactorily accomplished by providing a
onderous arrangement of boilers, fans, ducts and uptakes which sucks
nto the building the vivifying air from out of doors, draws it through
d over steam coils which rob it not only of every particle of moisture
ut also whatever freshness it ever possess, then sometimes after attempt-
.ng to restore the moisture by a "humidifier" or "air washer," delivers
cooked, devitalized and sterile to the children, who take it as a sub-
titute for the winds of heaven. This sort of air is the present supply
or not only school-rooms and assembly halls, but — think of it ! — gymna-
siums as well. The successful working of a "plenum system" as above

36 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

described, depends absolutely on the outside windows being kept closed,
as otherwise the air would forsake its prescribed path in each room from
the inlet register via forty pairs of lungs to the outlet and immediately
find an exit by the nearest opening.

In my young days I attended a public school which had been built
in the year 1874 and was regarded as a model of all that a schoolhouse
ought to be, but the subject of ventilation had at* that time not been
seriously considered by architects. A hot air register in the floor, with
a wooden ventilating duct about a foot square was then considered a very
up-to-date arrangement. When the air of the school-room, in winter,
got to an impossible point our progressive teacher would order a girl
to the piano open all the windows and put us through a standing series
of .exercises done to lively music, until refreshed and invigorated we sat
down for another go at the books. The pupils of this room had the
cobwebs cleared out of their brains J)y draughts of real outside air —
and there was no expense about it. To-day a twenty-room school building,
costing say $110,000.00, of ordinary plan has to cover 900 more square
feet and contain perhaps 40,000 more cubic feet on account of space
devoted to vertical lines of stacks. These stacks built of brick or other
fireproof materials, together with the horizontal ducts cost perhaps
$10,000. The cost of the plenum system over direct heating apparatus
in such a building would be about $5,000.00. The extra consumption of
coal might be variously estimated but probably amounts to not less
than 75 or 100 tons per year.

Experiments with open-air classes have perhaps not yet demonstrated
that perfection has been attained but the testimony in general shows
that pupils in these rooms make a great advance both mentally and
physically. It seems to me that much school work especially of the
kind done in "study hours" could be profitably carried on in rooms
built with windows only on one side so as to eliminate draughts and made
to open the entire size of the brick opening and kept open, the extreme
cold in winter possibly being tempered by direct steam coils. Recita-
tions and blackboard work could be conducted in absolutely open rooms
on the roof, made with glass sides to close when the wind is too strong.
I was about to say, when it stormed, but in these times when the no-
school signal sounds at the least intimation of rain, the remark seems
unnecessary.

The gymnasium ventilation mentioned above is another anomaly.
A town near Boston has recently built a splendid public gymnasium
which I happened to pass on a fine October afternoon when the air was
like wine and the cool autumn breeze a tonic to mind and body. The
spacious playground in front of the building was absolutely deserted.
I entered the building to see what it was like. In the great hall, warmed

THE HYGIENIC CONSTRUCTION OF SCHOOLHOUSES

JP IT

by the expensive "plenum system" where the sunlight, streaming through
the high windows of the roof lit up the millions of dust particles in the
air, thirty or forty high school boys were practicing football tactics.
Possibly the tactics were dark and fearful secrets, only to be elaborated
in private, and not shown to the light of day until the fateful moment,
but at any rate the oxygen of that beautiful afternoon had no place in
the hygiene of that particular high school.

I spoke just now of the possibility of building open-air rooms on the
oofs of large school buildings and in this connection I feel like speaking
a word for the roof playground. The expense of making a roof surface
ui table for a playground has frequently prevented its construction.
When built these playgrounds have generally been made of slate tiles
set in cement over waterproofing on a roof structure of tile or reinforced
concrete. Why should not a roof of second-class construction be built
on the principle of a ship's deck with splined planks made tight with
oakum and waterproofed underneath and used for a playground? Cer-
tainly the cost per square foot would.be less than that for city land!

The school-room floor is perhaps the part of the building on which
the least progress has been made. Wood, the wearing surface generally
used, is liable to wear out soon if not of the very best quality, it shrinks,
leaving cracks to collect dirt, splinters, and is more or less absorbent.
Its principal value, aside from cost, lies in its ability to receive the screws
which fasten the furniture and the furniture can be moved without too
reatly disfiguring it. Battleship linoleum, which has been tried, has
the disadvantage of not holding screws and being badly disfigured by
the holes. The same objection applies to all the various cement prep-
rations that I know of. A ready market awaits the advent of a smooth
impervious floor surface which will stand water and is adapted for
fastening down and changing furniture. Rounded corners at the junc-
ion of floors and walls have been insisted upon by many school-house
anitarians. Unless perfect mechanical execution can be attained, it
ems to me that the principal value of this device, especially in these
ays of vacuum cleaners, lies in the moral effect which it produces upon
the beholder. The cove moulding, if of wood, generally shrinks away
from the floor and if of some cement-like substance a perfect joint has
to be formed with the floor material. I recently visited a great new
hospital near Boston where everything, particularly architectural
beauty, had been sacrificed to theoretical practicality. The floors were
pf battleship linoleum and the coved bases of cement, all perfect. But
the joint between the two! Rough, uneven, of varying widths, it se-
creted more dirt and held it safe from any form of cleaner than any
wooden floor would have done.

In England the open fireplace with its fire has long been the undis-

38 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

pensable adjunct of every school-room. With the help of casement
windows kept liberally open these fireplaces have kept the class
room air fairly good, although the rooms are frequently small and badly
crowded from our point of view. But now the 'central ventilation' is
creeping in and the fireplace draught is prevented, although I found
last fall one intelligent schoolmaster to whom I commented on the
absence of a ventilating register. "Oh, yes, we have it, sir," said he,
"we only hung a picture over it," and pushing a picture aside he disclosed
a small and inoffensive grating in the wall which was hardly a formidable
rival to the fireplace.

I am conscious that the arguments I have advanced may seem weak,
reactionary and absurd to those familiar with the problems of school
operation. Under thfe prevailing laws indirect ventilation to the extent
of 30 cubic feet per minute per person is obligatory and probably rightly
so, for in working with open windows the personal element plays per-
haps too prominent a part and the difficulty of supervision becomes too
great. But if it is possible to give the children invigorating air and
incidentally reduce the enormous cost of schoolhouse construction, I
believe the matter is worthy of investigation and the gratitude of parents
and taxpayers will await the successful investigator.

THE PLANNING OF SCHOOLHOUSES AGAINST THE FIRE HAZARD 39

THE PLANNING OF SCHOOLHOUSES AGAINST THE

FIRE HAZARD

Frank Irving Cooper

Uneconomic economy — the saving of a certain amount of money by
cheap construction — results in the ultimate loss of much valuable
property and still worse occasionally results in awful destruction of human
life.

The only remedy for this condition lies in the enactment and enforce-
ment of strict state regulations. The people as a whole favor efficient
fire protection but the trouble is that when it comes to the question of
a single building the local public almost always votes for the cheapest
construction. Officials in charge are always ready to make their admin-
istration look more economical by cutting out safety appliances in the
foolish hope that no occasion will come for their use. Yet not only is
the number of fires increasing but the danger in the case of a single
fire grows greater owing to the habit of centralization; small school-
houses are replaced by a large central building and unless this be built
fire-resisting and divided into isolatable sections the peril of loss of life
is enormously increased.

The public attitude toward such buildings as theaters and factories
in which private owners are responsible for the lives of patrons or em-
ployees, has forced proper attention to be paid to the fire hazard in these
buildings and the result is an enormous saving in property as well as the
lessening of danger. Municipal buildings and especially schoolhouses
I should be treated from the same point of view.

Legislatures will enact the necessary regulations and executives will
^enforce them only when public sentiment demands and the public as a
whole is heedless, except when feverishly aroused by some great catas-
trophe. Underwriters have perhaps the most complete information
IS to fires and fire dangers; their rate scales, based upon the law of
[averages, show the marked difference between protected and unprotected
[buildings, and the differences in value between different forms of fire
protection, but it is of no especial interest to them to instruct the general
[-public as to their findings while the public will never of itself pause to
[make deductions from insurance rate scales affecting public buildings.

Only the most thoughtful and farsighted among the school officials,
.realize the perils and responsibilities of their position while having charge
of scores of children in buildings often little better than firetraps. The

40 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

great majority of teachers are so absorbed in their specific task of in-
struction that they have little time to consider such dangers and still
less time to spend in vain efforts to awaken the public to the situation.
But it is chiefly the teachers and superintendents who are responsible
for the move toward centralization owing to their desire for increased
efficiency in administration regardless of the increased fire peril.

Architects have the greatest knowledge of planning and construction,
they know the fire resistance of materials and have the greatest chance
in planning new buildings to convince the committee in charge, of the
necessity of the best protection against fire. It is to the interest of every
architect that his building shall be constructed in the best possible
way and that his public shall know why it is best. In case of accident
due to poor arrangement it is the architect who receives well-deserved
public censure.

While all school buildings should be erected of fireproof materials
throughout such construction is usually prohibitive by reason of its first
cost. Even the City of Boston now builds its outlying school buildings
of second-class construction and conditions justify the architect who
designs this class of buildings. But no architect and no school authority
can be justified who omits such simple and inexpensive methods of con-
struction as are herein recommended which insure a building that will
resist fire a sufficient length of time to allow complete emptying even
without previous fire drill practice.

This paper will consider buildings of second-class construction, these
being 90% of all school buildings erected. The small number of first-
class construction buildings are in large towns or cities and are ade-
quately protected by building regulations.

In planning the school building the architects should aim to use the
simplest form of skeleton.

The skeleton is determined by the main halls and corridors of the
building. The stairways are fixed by considerations of convenience in
going from floor to floor, safety in case of fire and* ease of exit.

Mr. H. F. J. Porter, the authority on fire drills, has said it was im-
possible to limit the number of people per story to the capacity of a
stairway.

Safety must be reached by having two sets of egress of ample pro-
portions, one set located on each side of a division wall but each accessible
from every part of each floor.

Fire division walls in the modern school building is a proposition
which the school authority is slow to accept.

It has been my experience that school authorities are difficult to im-
press with the necessity of providing against fire. In one of the largest
high school buildings in Massachusetts whose main corridor is over 300

THE PLANNING OF SCHOOLHOUSES AGAINST THE FIRE HAZARD 4I

feet long, two cross partitions of wired glass had been designed to divide
the building into three sections, these partitions were removed over the
architect's protest because the school authorities claimed the corridor
monitor could not have an unobstructed view of the entire corridor if
these fire partitions remained.

How far the authority of a school monitor could control that corridor
in case of panic is a question for the mothers and fathers of children
who attend this school.

While it is difficult to plan for fire division walls in school buildings
it is usually possible to provide two independent ways of egress from
the schoolroom to stairways situated far apart and so separated that no
fire is at all likely to occur which will effect both stairways simultaneously.
This method of providing escape has been approved by the Massachusetts
State Inspectors. (See figure i.)

The high school building at Bennington, Vermont, is planned to
meet Mr. Porter's method of providing horizontal escape by having
across the main corridors doors which are held open by a chain with a
fusible link. The chain running from this link is also attached to an
electric catch which is released by the same current that sounds the
fire gongs. Sounding the fire gongs closes the door across the corridor
thus dividing the building into two sections each with its independent
stairways. This will allow of safe escape for a much longer period than
could be had with the usual open corridors and staircases. (See figures
I and 2 — fire door at A.)

Staircases should always be in plain view and the architectural
treatment of the corridor at stair points should be such as to suggest
the way of exit. All stairways should discharge directly to the outside
of the building and not into corridors.

The outside walls at point of discharge should be brought to the edge
of the door frame, doing away with the angle which in many cases of
panic has caused loss of life. (See figure 3.)

Staircases should be built in wells shut off from corridors by doors
glazed with wired glass; these doors should have no locks nor latches,
should swing out only and should have self-acting door closers.

Both stairs and their supports should be fire-resisting, neither slate
nor marble should be used for treads unless supported under their entire
width and length.

Turns in stairs should always be accomplished by landings or plat-
forms. No winders should be allowed. There should never be less than
three nor more than fifteen risers between platforms nor should a plat-
form or landing be less than four feet wide. In large school buildings
stairs should extend to the usually flat roof, from which there should be
a separate escape to the ground.

42 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The last parts of a building to succumb to fire should be the stairs.
All doors should invariably swing in the direction of the outgoing

passage. . i . j • •. j

Doors to stairways should have automatic closmg devices, exit doors
should have an approved type of push bar device that will unlock the
bolts by pressure against the bar.

Some authorities have omitted all locks on classroom doors and there
is much in favor of this method wherever it is not necessary to secure
rooms against misdemeanors.

All locks to schoolrooms, closets and exit doors should be those that
can never be locked against the outgoing person.

Book lifts should always be enclosed by solid walls or be lined with
metal from top to bottom.

While from the point of the fire engineer wood furring should never
be employed, yet the difficulty of securing damp-proof solid walls, when
the plastering is placed directly on the outer masonry walls, and the cost
of metal furrings or tile lining necessitates wood furring as the only
method left for the architect under the appropriation.

Wood furrings should be stopped off by plaster at the floor and ceil-
ing and midway between. Even metal furrings should be fire stopped
to prevent the spread of fire by draughts of superheated air or flaming
gases.

There are other places where fire stopping should be used, some of
which are shown by the accompanying illustrations. (See figure 4.)

The casing of walls with wood sheathing should be entirely done
away with, not only because it is a help to the spread of fire, but on
account of its unhygienic properties, harboring germs and making places
for the lodgment of dust. Its place should be taken by hard plaster,
to which is glued burlap.

The well designed modern school building has all ornamental wood-
work omitted and the necessary wood trim about doors, windows and
blackboards reduced to minimum.

Cast iron construction members, if unprotected, is considered unre-
liable by fire engineers and should not be used.

The architect should advise against pitched roofs for school buildings
not only because it is difficult to design such a roof in a fire-resisting
manner, but also on account of the tendency of school authorities to
make use of the attic space, which is liable to be stored with rubbish
and cast away furniture.

The roof covering, if possible, should be of tile or slate imbedded in
a suitable roofing composition, after this comes a metal roofing over heavy
asbestos paper, or composition gravel or slag using 300 pounds of slag
or 400 pounds of gravel per 100 square feet of roof.

THE PLANNING OF SCHOOLHOUSES AGAINST THE FIRE HAZARD 43

All school buildings should be equipped with chemical fire extin-
guishers of a type approved by the National Board of Fire Underwriters.
Additional protection should be planned for by providing an efficient
standpipe of two and one-half or three-inch pipe connected to the public
water mains and located at some central point and having hose connec-
tions on each floor including the basement. As a matter of precaution
a small pet cock should be placed on this stand pipe to allow inspection
of water service. At each hose connection there should be a sufficient
ngth of Underwriters' hose with play pipe to reach any part of that
articular floor. This hose should be supported by a swinging rack in
hich the hose is folded layer by layer or else by a rack where the hose
looped over wooden pins which drop out when the hose is run out.
The necessity of safeguarding large property values from destruction
y fire caused automatic sprinklers to be invented ; they are chiefly used
factory buildings and have reduced the average loss per factory fire
om over $10,000.00 to $265.00 and so far as records show no life
s ever been lost in a sprinkled building when the sprinklers were in
rder and working. There is nothing sensational about the work of
utomatic sprinklers; they save lives by striking at the fire itself and
checking it before it has become a dynamic force for devastation. At
the same time they sound an alarm, warning every one that they are
fighting fire somewhere in the building.

Statistics show that every week ten school buildings are destroyed
by fire in the United States.

The Collinwood fire, with all its horrors, may be repeated any day,
so little have the lessons taught by that fire been heeded. Yet auto-
matic sprinklers installed in school buildings would practically render
such a catastrophe non-existent.

A rapidly-spreading fire costs many lives. No fire can spread
rapidly under sprinklers.

That the automatic sprinkler has become known and approved by
school authorities is shown by the example of this City of Buffalo, where
its public school buildings, i to 62 inclusive, its Central High School
and its Lafayette High School all have the basement protected by auto-
matic sprinklers.

In addition to the usual alarm gongs about the building, there should
e an alarm to the fire department. This can be effected by having a
standard alarm box placed within the building, or as in the case of the
Boston schools, an auxiliary to the gong alarm may connect the school
alarm with that to fire headquarters. The system allows ringing the
school gongs without notification to the fire department; but the fire
department cannot be called without sounding the school gongs.

Boiler rooms should be placed outside of the buildings. When this

44 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

is not possible boiler and heater rooms should be isolated by means of
brick walls having thoroughly fire-resisting doors with automatic closing
devices. Should the floor over the boiler be of ordinary wood joist con-
struction on account of small appropriation, the joists should be filled
in solid with mortar or mineral wool and the ceiling be of thick plastering
on metal lath wired to metal furrings.

All ceilings of cooking and manual training rooms should be treated
in the same manner as the ceilings over boiler rooms.

Prof. A. D. F. Hamlin has said that the " schoolhouses of any com-
munity are gauges of its enlightenment," also "it requires only the
diffusion among the people of correct information on the subject to secure
from them all that is necessary for the erection of suitable and creditable
school edifices."

I believe this is true, yet it is difficult to put conditions plainly before
the people and secure their action.

In one New England town a high school building of three stories was
being, built, with wood laths for plastering, the committee in charge of
erection would not permit the change to metal lath on account of expense.
A public appeal to the townspeople however, made it clear to the com-
mittee that the safety of the children against the saving of $1,000.00
was not to be considered. Wire lath was then voted.

Any informed and awakened public will demand that an architect
shall design school buildings which shall meet the demands of the edu-
cators and protect the lives of the school children. When law holds
him criminally responsible for faulty planning and construction reform
will be immediate.

How the position of the architect is now controlled by public opinion
was clearly stated by Mr. George Bruce in a manual published in 1903.
He says: "Schoolhouse designs are made to be accepted rather than to
educate public taste. The architect must try to please the taste or fancy
of prospective patrons, when he is thrown into close competition, he can-
not afford to deal in ideals, he must meet conditions."

And Mr. E. M. Wheelright, in his book on school architecture, pub-
lished two years before the above, stated: "In one large Ohio city, where
the authorities pride themselves upon the low cost of schools, there is a
building four stories in height, with'stud interior partitions, furred walls,
and no fire stops. No metal or brick ducts are provided for ventilation;
the foul air is supposed to find its way through the hollow spaces in floor
and walls to the space between roofs and the ceilings of the upper rooms
and from thence through ventilators to the outer air. A more imper-
fect system of ventilation and a more ingenious fire trap could not well
be devised."

Mr. Wheelright's book was largely distributed and without doubt

THE PLANNING OF SCHOOLHOUSES AGAINST THE FIRE HAZARD 45

1 1 t4U J Uu I ' M'

c=__p=_j^ n_^''i^'L'^'''°'' "^ '-I

rRE3MVlA>4 " Jf^ SEMI OH,
' If-^'l III I I »-<

1-,'^ Lecture Room

ftHYBlAAJ. jIaA

TMIR.D FLCiOR. PLAN

DOTTED 1.IA<ES ON SECOND AWD THIRD FIOORS
PLAA<S SHOW HOW PUPJLS MAY APPROACH THe
3TAIR.WAV-S

niGn 5cnGDL dvildiiig at divc^lx mass

COOPZR. & Daiixt Archit£ct5, Dosto>n

>NOTE THAT EACH RCDVI HAS TWO SEPARATE
AND INDEPEAIDEAIT MEANS OF EXIT TO STAIRWAVS"
STA1R.WAYS A/<D Al-1. PARTITIONS ARE TMOROUGHOr
FIRESTOPFED AND aMOICESTOPPED

L SurFLYI

I Room
Recitation 5 I

R.OOM r- H

_-. ^ J __l. .^_H

■^ — Loggia ■-~F —
Ik ■ ■ Ju j;

C O R- R, I D O R.

ItCJTATrON
R.OOM

GROY/ID nrJDR. PLAJH

FIGURE I

CLASS Room

MOCIZONTAl. PIR^ ESCAPE

46 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

was in the hands of many Ohio authorities, but nothing was done to
oblige safer school buildings until one May morning came a fire in the
CoUinwood schoolhouse. You all know the result, 167 of the children
in that schoolhouse were burned to death. Yet it is stated in Insurance
Engineering that "within three months after the CoUinwood fire plans
for an exact duplicate of that building were submitted to the Ohio authori-
ties."

Mr. Elliott, Consulting Architect of the Ohio State Buildmg Code
Commission says, "Numerous actual cases have proved that the moral
effect of the Collinwood fire amounted to nothing."

These facts are before the people. Let them place laws upon their
statute books that shall demand right construction and safety and give
heavy penalties for those violating the law.

This movement is already started. A chart of the laws of each
state upon this subject shows a general public awakening and in many
states an encouraging sense of responsibility.

In legislation upon this subject the State of Ohio is in the lead.
Will other states have to repeat Ohio's experience in the Collinwood fire-
before they will follow her good example?

tiaeran

AOTTl the two IADEP£/)DE/<T ways of S£ACH\na THE STAIR. HAU.S IF COR.R.1 DORS ARE
FILLED WITH SMOICf APPROACH MAY BE MADE TMROVOH CLASSROOMS

Ormz or DooKSfTc. CJovoooii. to ^m Halls

es4^:

FIGURE 2

THE PLANNING OF SCHOOLHOUSES AGAINST THE FIRE HAZARD 47

"^L^.^c^""- 1 EPICAL DrTAii or

mjmcLdGmimimi

3i\mio

SlA\a.CA5l5 TO E)E BVILT \H WELL6 MAYING WALLS
riEE5TOPPf D WITH MA50A)RY. PLASTEEfD WITH
CfMn/<T PLA5Tf It ON WIBf LATH « APPtCACHED
rRDM CORRIDOC5 &Y DOOB^ GLAZED WITH WIRfD
GLASS THE5C DOORS TO HAVE NO LOCUS -NOIL-
LATChL5, iWWO OVT, AND HAVE ^Lf •ACTI/<0 DaDeClQ5rR6

PLAU or 3TAIII flAlLS AT GROYmriOC^ jKTTa OT OVTSIDCrNWAHCTIKim

3cAus :?^'wi-o*' Showing }/oh Durm fxjrJjTa£5..

ALL STAIXW^YS TO LEAD aUtOTJ-Y TO OUTS/OC OT Ol/lLDlf/a^
NO STAlRyMY TO D/SCWRG£ //fTV A COKK/DO/L.

FIGURE 3

TYPICAL DTTAIL!) CT ri2r5TOfPIAG

5naT70

r-^

hf^

1 morfaro.

dlbists

Linjer

flRE5TOPPiy*3 ^ETWEE/^ THE
X>I5T5 ON -TOP Of GieOEBS

^, . Joists

riRTSrOPPlAG AT
WALL GIRT

riRE5T0PPI/«G AT SILL
or FRAME WALL

flBESrOPPmO AT WAIIIi TADLC
CT ORICK, BYILDIMOS.

flBESTOPPIW WHERE fU3DR^ CfTAIL.SHOWI/(0 SLEEVES
JOISTS ENTER. MiOC WALU5 fOU STEAM PIPES RUNNING
T>4RO FLOORS

METHOD OF flRT PROOF IjNG THE
Cril-I/«)G Cr DOLLEC ROOM

OnnNf-.g TT) MAVF WIgF LATH FASTC/^ED

Dii?Ecri.v TO jwars wiTMOLrr punRi^a-

FIGURE 4

48 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

MODERN METHODS OF SEWAGE DISPOSAL IN
RURAL, COUNTRY AND CITY SCHOOLS

William T. Towner

One phase of school hygiene that has not received the attention
to which it is entitled is that of Sewage Disposal of Rural and Country
Schools and yet, I believe, this is a most important subject, if not the
most important in the matter of school-house architecture. We may
discuss the proper methods of lighting; the orientation of the building;
the fire hazard; the dust problem; cleaning and humidifying the air;
ventilation; re-circulation and all the different angles to school hygiene,
but no matter how perfectly a school building may be -constructed as
regards the above phases, without proper and sure methods of disposing
of the sewage wastes from the building, to just that extent is that build-
ing inefficient and all other hygienic principles, no matter how perfectly
worked out, are consequently nullified.

It is only within recent years that complaints have been made in
the large cities about the foulness of the waters in rivers and streams,
into which empty the sewage and household wastes and street washings ;
and yet there is, to the ordinary observer, only a small portion of the
waters and streams which can be really called a nuisance, but with
increasing population and use, the nuisance will become greater. The
proper disposal of sewage from large cities — and small — as well as from
rural and country schools is an engineering subject to which unusual
value must be attached, for, with successful methods, the fly nuisance,
the typhoid germs, the tubercular germs and all other disease trans-
mitting agencies, will be abated, and not until then will we experience
perfect hygienic conditions. The adoption of laws regulating the con-
struction of school buildings is of only recent occurrence and that only
in a few states, but in none of those laws, so far as I have been able to
find, is there any provision for sewage disposal. Thirty cubic feet
of fresh air per pupil is required; but how is it possible to supply that
fresh air if the surrounding grounds are saturated with the wastes from
the toilets?

No matter where the toilets may be or how perfect the fixtures may
be or how well ventilated; no matter what means you may have taken
to have your school building thoroughly modern and up-to-date, your
most important duty to the pupils of that building will be sadly neglected,
unless greater thought is given to the subject of sewage disposal.

MODERN METHODS OF SEWAGE DISPOSAL IN SCHOOLS 49

I The children of to-day are facing more strenuous times than was
the case thirty years ago and perfect school hygiene must be guaranteed
them that they may be enabled to overcome disease, pests and mis-
fortunes better and more simply than their parents did.
; How often we see school buildings in the country and small villages,
jwhere there are no sewage facilities which appear to be excellent examples
of school-house architecture, depending altogether on a cesspool arrange-
ment, one receiving tank and one overflow for taking care of the sewage?
~ know of a number of cases of buildings, where there are 700 and 800
upils in a building, and the cesspool perhaps not over twenty feet
way, and you can always locate that cesspool by the swarms of flies
overing over the spot. In such an arrangement as this, there is pos-
tively no protection against contamination. The strata of the soil,
o matter what it may be, will certainly conduct all the wastes to the
earest well. Therefore, cesspools are to be condemned in my estimation.
A short time ago, the University of Illinois issued a bulletin showing
hat after testing 868 wells, 520 were unfit for use under 85 feet deep
and 13% 100 feet deep were unfit; all caused by cesspools.

Pure air, good drinking water, good, healthy, earthy soil are abso-
lutely necessary to sustain life and neither of these three essentials can
be secured if we permit the soil to become permeated with sewage wastes.
There are only two effective methods of Disposing of Sewage at the
present time ; and which of these is preferable is a point I do not now feel
qualified to decide. Those two methods are: (i) The Hygienic Bac-
terial System, (2) The Incinerating Process.

A system that will dispose of sewage almost as soon as deposited

and before it leaves the school building, is the system that will solve the

|^K)roblem. It can be disposed of bacterial action by the installation

I^K)f a series of tanks — clear water only being discharged from the last

one — in which there is nearly 90% purification. It can be used for

watering lawns, sprinkling streets or can be discharged into any ditch.

Such a system as this has been adopted not only by a number of

schools but also by communities and cities. Waste waters, however,

IM[rom wash-basins, etc., should not be run through the Sewage Disposal
^^ystem, as the soaps, etc., being disinfectant retard the action of the
Bacteria. I believe that it will only be a short time before the United
States Board of Health will require all sewage to be disposed of before
leaving the house. Sewage contains within itself its own means of
destruction — Bacteria .
i^ft In a properly constructed system, the Bacteria will multiply very
^ ^rapidly, and the heat generated by the depositing of the Sewage, breeds
he Bacteria germ which liquifies the Sewage.

50 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Under the Hygienic Bacterial System, I shall subdivide as follows:
(i) Sub-surface Irrigation System.
(2) Septic Tank with Contact Beds,
/^j " " " " " and Sand Filters.

(4) " " " Percolating.Filters.

(5) System of air-tight cells connected to each other

and operated as I shall describe.

The first four (4) subdivisions I shall ignore for the time owing to
the limit of time and space; and shall describe the last, which in my
opinion is the best of this kind.

This system is composed of a series of air-tight cells of suitable capa-
city, constructed of material to make them water tight, the cells being
connected with one to another near the bottom, except the first and
last cells, which are not connected to each other. The first cell is the
inlet cell with the inlet at the top, and the inlet pipe pointing downward
toward the bottom of the cell inside. The last cell is the outlet cell,
with the outlet at the top, near a level with the inlet, and the outlet
pipe extending from toward the bottom of the cell, inside, up through
the top and outward, just at the top. All cells are covered and sealed
with air-tight covers, making the System water tight. The System is
filled with water before using, and is always full of water, which removes
the air. As the inlet and outlet are at the top, no water is discharged
until it is forced out.

The principle of the System is this: The Sewage enters the System
from the drain, through the inlet pipe and into the first cell, necessarily
forcing out as much water through the outlet pipe as the amount of
Sewage deposited. This water discharged is, of course, clear. The
Sewage deposited will rise to the top of the first cell, and as more is de-
posited, it will also rise to the top, as the cells are full of water. In a
short time enough sewage will accumulate to generate heat which breeds
bacteria; this bacteria liquifies the sewage and purifies the water, con-
suming all the poisonous matter. As more sewage is being deposited,
it forces the clear water at the bottom of the cells through the connec-
tions at the bottom, and at last through the last cell and the outlet.

As the sewage all rises to the top and the clear water goes to the
bottom and the connections are at the bottom, nothing but clear water
can pass through the connections into the next cell. Of course, when
too much sewage is deposited for the first cell to liquify, some of the
impurities pass through the connection into the next cell, and there
rise to the top in a like manner, and so on in each cell, until it is thor-
oughly liquified and purified, leaving nothing but pure water to be dis-
charged. This process of liquification and purification goes on in each

I S(

MODERN METHODS OF SEWAGE DISPOSAL IN SCHOOLS 5 1

ell where all sewage is deposited, and on a smaller scale in each suc-
ding cell than the one preceding. The bacteria are multiplying
ast,- in cell No. i where all the sewage is deposited, and on this cell
he greatest amount of liquification goes on. To make sure that the
ystem discharges no impurities, always use enough cells so that when
he water reaches the last cell the solids are all decomposed or liquified
nd the water thoroughly clarified ; then it has an extra cell to go through
efore being discharged. In smaller Systems the decomposition or
iquification is practically all effected in the first cell, with a very small
mount or no impurities at all passing into the second cell; then there
s no chance for impurities passing into the last cell. In larger systems
Iways use at least one extra cell so there will be no chance of any im-
urities being discharged.

It is a well-known fact, stated by scientists and bacteriologists,

hat 99% of the ordinary sewage at the time of being deposited is water,

ith less than 1% of impurities, or poisonous matter. Of course, when

lowed to stand in the open, and it is exposed to the ground or atmos-

here the 1% grows and pollutes the ground and air with impurities

and disease germs. But it. can be readily seen that when deposited

to a System such as this, the 1% of impurities is easily liquified and

ecomposed.

Sewage deposited in this System that has a capacity of one hundred
gallons daily will not leave the last cell until about one hundred gallons
are run into the System to replace the one hundred gallons already in.
Therefore, we get the most important action of Bacteria known by
bacteriologists, which is restj undisturbed solids, which accumulated
Bacteria. In this system we get much rest] not much disturbance of the
solids, no agitation of the Sewage already in the cells.

Air in sewage makes sludge; there is no air in the System described
nd, therefore, no sludge or formation of scum. The System is entirely
filled with water, leaving no space for air. It generates heat and breeds
Bacteria without air or light, and is the only System that does this. With-
out the presence of air, gases do not form, sewage never sours, and germs
multiply faster. All septic tanks breed the germ with air. It is claimed
by some that the small amount of germs discharged by the septic tank
are not dangerous. Care is taken so that this System does not discharge
any, but if any should be exposed to the air from any cause they would
immediately die, as germs bred without air cannot live in the air and the
taking on of oxygen would immediately kill them. For this reason
we can discharge the clear water from our System into any open ditch,
and the death of the Bacteria is sure. As the Bacteria multiply, the young
devour the old, so there is no chance of accumulating too many.

This System can be installed in aijy capacity desired, the size being

52 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

based according to the average number of persons to use the school,
the larger the size the more cells should be used. The System may be
installed under the ground outside the building, and the discharge
water, which is clear, run into a drain, or into any open ditch or water-
way, or may be allowed to seep away in the soil if it is poroused. The
System is then covered with earth, and the ground can be used again
for the same purpose it had been, as it never needs cleaning out or atten-
tion of any kind and never be replaced or dug up. It may also be placed
in the basement on the floor, and the discharge run out into the cellar
drain. Either way, it is out of sight. No odor comes from the System.

Sanitary journals, scientists, bacteriologists and all health officials
are agitating the disposal of sewage (excteta) by sanitary methods,
and discontinuing the polluting of streams, waters and the ground and
atmosphere, and discharging nothing but clear, odorless water into
the soil or waterways. This System makes this possible. It is a long
step forward in the widespread movement throughout the world toward
sanitary conditions. It is past the experimental stage.

The System that I have described is one that has been put in use
in a number of school buildings and communities by A. M. C. W. Russell,
a sewage disposal engineer of Chicago, with the most satisfactory results.

The City Chemist of Burlington, Iowa, reported, some time ago,
an analysis of the water discharged from a system, installed as above
described, as follows: Nitrogen, as free Ammonia, .030 parts in one
million, and Nitrogen as Albuminoid Ammonia, .289 parts in one million;
only a slight excess of organic matter as compared with the standard
for drinking water.

Incinerating Process. The other method I mentioned, the Incin-
erating Process, seems to be gaining favor among engineers and scien-
tists, but having adopted this method of Sewage Disposal in some
school buildings with none too good results, I hesitate to dwell at length
on this method, although assured that much more complete apparatus
is now being made providing for greater combustion and the positive
removal of all sewage wastes without odor of any kind. It must be
remembered that the cost of maintenance in an incinerating process is
continual and expensive because of the necessity of constant fire and
attention of the janitor.

This System should not, of course, be installed in any but fireproof
buildings and every part of the apparatus should be of fireproof mate-
rial. •

There are two forms of Incinerators: (i) the lever acting and (2)
automatic acting. In small school buildings the lever acting Incinerator
should be used for it is not necessary to have the fire burning all the

MODERN METHODS OF SEWAGE DISPOSAL IN SCHOOLS 53

time. At the bottom of the bowl in the lever acting Incinerator is a
rotating paddle wheel or scraper. This is operated by a hand lever
with an up-and-down motion, much as a chain is pulled in connection
with an ordinary flush closet. The excreta is scattered upon a drying

learth directly over the fire grates. Through and around this drying
^hearth, the air is constantly drawn by the draught through the stack
land unless the deposits are too great, it will be constantly and thoroughly
[dried, ready for combustion.

For larger school buildings the automatic acting Incinerator is recom-
[mended. The operating parts of this are very simple. The cover is

tlways closed when not in use, and when raised, a receptacle drops into
[place to receive the deposit, when cover is permitted to fall the deposit
is dumped into the fire, thus keeping the receptacle always sterilized

md ready for use.

In connection with these Incinerators is an evaporating tank for
liquids, with properly covered urinating facilities. Properly installed
and cared for there seems to be no reason why there should be odors,
but to safeguard against any possibility, the use of formaldehyde gas
mechanically applied to prevent odor from the burning of excreta is
recommended.

Flies are excluded from all parts of the System. Any kind of fuel
may be used. A chimney stack of course, must be used in connection
with this method and it should be lined inside with an impervious mate-
rial and a ventilator should be put on top to cause draught; as stated
hereinbefore, there is a growing tendency to consider the Incinerating

Vocess as the most hygienic system of Sewage Disposal.^

The two methods described in this paper are applicable to any
school, no matter whether rural, country or city.

54 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SANITATION OF THE RURAL SCHOOLHOUSE IN
THE STATE OF VERMONT

Henry D. Holton

Four hundred years ago when our forbears came to this continent
their souls were filled alone with religious fervor, they recognized that
in order to secure civil and religious liberty it must be on a basis of an
educated and enlightened mind. To that end they erected what came
to be known as "The Little Red Schoolhouse by the Roadside." Of
these in Vermont there were 1,363, now reduced to about 800. The
one-room schoolhouses have been the mark for much unjust criticism,
with urgent recommendations that they be abolished. The critics are
not well informed, the one-room rural schoolhouse will continue by
reason of local conditions. The demand must be, and is that all such
school rooms must conform to, and be equipped with all sanitary arrange-
ments. In the last few years a large number of them have been so
equipped. The number of these remodeled houses is increasing each
year, and in a short time all will be provided with the requirements as
prescribed by the State health authorities.

In this small State in which the largest city has only about 20,000 or
25,000 inhabitants, there has been expended, in the last 15 or 20 years,
on new schoolhouses, and in putting already existing schoolhouses in
sanitary condition over two million dollars, making a tax of 176 per
cent, upon each dollar of the grand list. It is true that the one room,
as well as the larger buildings were constructed when sanitation was
unknown; these one-room houses were quite uniform in being about
20 feet wide, 25 feet long and 10 feet high. No attempt was made to ven-
tilate, but to be sure to keep out the cold air so that none would suffer with
the cold. The window surface was equally deficient. The number of
pupils, often being from 30 to 50, reduces the floor space so that elbows
touched. The development and teaching of sanitary science has pro-
duced a great change in school architecture. While these one-room
buildings remain for the accommodation of pupils they must be made
to conform to regulations relative to air space, light and other sanitary
requirements. The regulations of a rural school should embrace a suffi-
cient area of land to give a reasonable playground, from one-half to one
acre, according to the number of pupils to be accommodated, ground to
be dry. A supply of pure running water should be secured if possible.
If this cannot be secured a tank should be provided located in the upper

SANITATION OF THE RURAL SCHOOLHOUSE

part of the room, so that sufficient head can be acquired to have a
bubbling fountain. This tank to be filled every day.

Lighting. The windows must be numerous, large enough, and so
arranged as to give ample light to every part (and corner) of the room.
The window space should be one-fourth of the floor space, and must not
be less than one-fifth. There must be no more space between the top of
the window and the ceiling than is required to finish the building, and
the window-sill must be four feet from the floor. The light must be so
arranged as to fall upon the pupil from the left, or left and back, never
from the front. There must be curtains of a grey or buff color for all the
windows — two to each window — hung in the center of the window so
that either the upper or lower half, or both, can be shaded.

Ventilating and Warming the House. If it were possible to point out
the most objectionable feature of the one-room schoolhouse it would
be that there were not means provided for any ventilation whatever.
Many of these buildings are now provided with the "jacketed stove"
for warming and ventilating ; when a furnace for any reason cannot be
installed, with the attending ventilating pipes this method is simple,
inexpensive and satisfactory.

The heating apparatus must be of sufficient capacity to warm the
room to 70 degrees Fahrenheit in any weather. This air should be made
moist by passing over water. Not less than 30 cubic feet per minute
of pure air for each pupil should be supplied, and it should be so intro-
duced that there shall not be uncomfortable draughts. The difference
in temperature between any two points on the breathing plane shall
not exceed 3 degrees. The ventilating flues shall be of sufficient size
to readily introduce and remove the requisite amount of air from the
room. In rural houses of one room where a furnace is impracticable,
the above conditions can most economically and satisfactorily be met,
as suggested, by the use of the "jacketed stove," Figure i.

The ordinary wood -burner stove may be surrounded by a casing, or-
jacket, of galvanized iron, with proper air space of six to nine inches
between jacket and stove. Fresh air should be conveyed .from the out-
side of building through tin tube to space under stove. The vent, or
foul air pipe (also of tin), should be set on legs with an opening at the
bottom, 12 inches from the floor, to run straight up through the roof
as high as the chimney. This pipe should be placed on the same side of
the room as the stove. The stove-pipe should enter this at not more
than six feet from the floor, passing up as far as possible before it leaves
the vent pipe for the chimney. There should be a door in the jacket
at the rear end of the stove which can be opened for pupils to warm their
feet. A room 28 x 30 x 12 would have 10,080 cubic feet of air. Thirty

56 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SUPPORTS

DAMPER

DOIOR

riOR

fOOT-WlARMER

■vi

STOVE
DOOR

D/AMPER

FRESH AIR PIPE

FIGURE I

pupils in this room would require at least 900 cubic feet of fresh air per
minute. To supply this amount of fresh air would require a tube 24
to 30 inches in diameter. In order to properly warm this volume of
air in the coldest weather it would be best that there should be two of
the jacketed stoves, each receiving fresh air through an 18 or 26-inch
tube. The foul air vent should be of corresponding size. All of these
pipes should be provided with dampers to regulate the inlet and outlet
of air. School Directors should not only see to it that their teachers
are instructed how to use these dampers properly, but they should be
sure that their instructions are carefully followed. In locations where
it is impossible to construct and maintain water closets, there should be
two out-houses provided, at least twenty feet from the school building,
with a high board fence between them, so that they could be afforded
comparative privacy. Each closet should be provided with a box of
dry earth, and a second one of hyperchloride of lime. It should be the
duty of the teacher, or some one designated for the purpose, to see that
the deposits were covered with these two articles each day. The closets
to be cleaned every two to four weeks. It is true that the one room,
as well as the larger school buildings were constructed when comparatively
little attention had been given, not only to school sanitation, but to
general hygienic conditions. Having, however, brought a large number

SANITATION OF THE RURAL SCHOOLHOUSE 57

of school buildings up to the modern sanitary requirements, the work
should not be halted but continued until all are thus transformed.

And this work should be continued and perfected and pupils thor-
oughly imbued with the importance of each individual adopting, as a
part of their educational equipment, the sanitary principles demon-
strated in the school building. For this reason it is especially important
that medical inspection of all schools should be adopted to the end that
it would require the observance of all sanitary regulations regarding the
school building, as well as insuring proper observation and care of pupils.
For a long time it has been apparent that there were many pupils in our
schools who, for various reasons, were unable to meet the requirements
adopted by educators. After considerable investigation, it seemed that,
there were both physical and mental reasons for this. Often the mental
ability to master the tasks assigned them depends in a measure upon
their physical defects, hence this inspection is not alone for the purpose
of discovering and preventing communicable diseases, but also to as-
certain the physical and the mental reason for the pupil's inability to accom-
plish successfully the school work. School Inspectors should use especial
care in examining the general conditions to which the observant teacher
calls attention, with reference to the causes that have produced them.
These are: emaciation, pallor, pufifiness ot the face, shortness of breath,
swelling in the neck, general lassitude, flushing of the face, eruption of
any sort, a cold in the head with running eyes, irritating discharges from
the nose, evidences of sore throat, vomiting, frequent requests to go out,
which teachers are inclined to consider as a desire to shirk, but are how-
ever often indications of physical trouble of some sort. The mouth
may be the source of disease germs, especially if the teeth are diseased.
By all means examine carefully the teeth.

Nervous trouble should be investigated, particularly if symptoms
develop which are not usual for the pupil — restlessness, inability to stand
or sit quietly, irritability, fainting, momentary loss of consciousness, as
well as other nervous manifestations are often the precursors of serious
nervous diseases and of total depravity. The mentally defective are
usually unable to profit by the ordinary methods of instruction, they can
not fix their attention upon any exercise. As soon as the teacher's direc-
tion is withdrawn their attention ceases. If they apparently take an
interest in anything it is soon forgotten. These cases should have care-
ful and repeated examinations. Much is said to-day about the overwork
in schools. The reply is that the course of study is for the average or
normal child. May we ask what constitutes the normal child? We
believe that the spurring on of pupils favors, or even induces various
nervous diseases. We should never lose sight of the fact that the period
in the child's life from six to sixteen is the period of development; the

58 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

period of preparation for puberty, which entails a complete upheaval
of mental and physical powers — a revolution, a reconstruction, a read-
justment. Pedagogy and medicine must join forces to prepare our
children, both physically and mentally, for the duties of citizenship.
The Medical Inspector should give particular attention to the sanitary
condition of the schoolhouses, ventilation, lighting and heating; the
source -of the water supply; the closets, especially in rural schools, and
should keep in mind the abolishment of the' common drinking cup.
We are aware that objection has been made to medical inspection of
schools. Practically the objectors have no ground on which to base
their opposition. So long as the State compels its children to attend
school for a given period the burden rests on the same power to see to it
that they are physically in a condition to receive and assimilate its
teachings. Further it is incumbent on the State to see that no harm
comes to them, keeping in mind that the efficiency of the child does not
depend alone upon the mental training, but upon its physical health
and vigor.

However the time for consideration and argument relative to medical
inspection of schools has passed. Its adoption by so many States and
its satisfactory operation has established its necessary usefulness. We
kno^ of no school having once installed medical inspection that has
subsequently abandoned it. However it remains for the States that have
neglected to adopt it to secure its beneficent results. The pupils in
schools not subject to medical inspection have a right to demand of
their States reparation for the deficiency from which they may suffer.
They have a right to have the schoolroom properly warmed, lighted and
ventilated, to have their mental capacity tested and to be placed in
suitable classes. They have an equal right to have their physical sound-
ness and capacity determined and thus be able to correct any imperfec-
tions that exist.

discussion of
Dr. Holton's Paper

B. Franklin Royer, M.D.

I am not inclined to agree entirely with Professor Scott nor alto-
gether with the engineers who advocate keeping windows closed so that
the Plenum system may operate exclusively. After an experience for
years with every sort of ventilating scheme in hospitals, from the old-

SANITATION OF THE RURAL SCHOOLHOUSE

tashioned push and pull Plenum, operated by fans forcing the air through
radiators and into hospital wards and with fan exhaust systems, up to
le later method of exhaustion by means of aspirating coils in vent
)Oxes gathering together a series of galvanized iron sleeves with inlets
)laced at various positions near the floor of the building, the heat out-
lets being eight feet above the floor, up to the modern split Plenum, I
mfess to being something of a rebel. In fact, I have no hesitancy
whatever in opening windows any time its suits my pleasure. The open
dndow, it is true, does break in a little on the system but the break
:arcely affects, and in most systems does not in any way affect, the in-
>ming heated air, and affects but little the exhaust system that is sup-
)osed to be taking up the impure air. No system should be constructed
that will not permit of window use occasionally and especially during
lild weather.

60 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SCHOOL HOUSES IN NORWAY

M. K. Hakonson-Hansen

As long as there was no instruction, in the present meaning of the
word, the idea of gathering children and young people in schools did
not naturally occur to the people. But when once this institution was
created by the social necessities at that time it continued yet longer
and went through a lengthy development before the demand for proper
school houses was spoken about. This demand came naturally with
the development, and just as the school institution came to us from
the South from Greece and Rome, so also has the governing type of
school buildings come from the South, viz. from Germany. In every
case this refers to the towns. As regards the country school buildings,
it is to be noted that a more national Norwegian style of building, has
been adopted also in erection of the school houses.

It was in the i8th century, that here, in Norway, people first began
seriously to talk about schools as a social institution. The advanced
schools (University or Latin schools) had existed, for a long time, but
they belonged to the Church, which in those days, was a State within
the State, and therefore the people stood rather far from it. These
University schools had really, more or less, their own church premises.
Just as the school was on the point of becoming a social institution, at
the same time there arose a house-question which could not avoid bring-
ing the people a little nearer, for once at least, quite to find its solution
with them.

To begin with, we find a royal ordinance of the 13th of January, 1736,
"regarding the confirmation of the growing youth and their confirma-
tion in the mercy of the Baptism," and according to two decisions of
this ordinance the teacher, i. e. here the priest, "shall let them (the chil-
dren) come to live in his house." A step further a royal ordinance of
the 23d of January, 1739, reads, which among other things, decides,
that there shall be erected "permanent schools," yet so that where the
population is very scattered, "the teacher" shall go there from one
parish or farm to another, to gather the children and give them instruc-
tion.

We pass over, in this our short description, a whole course of years
in which the development considerably exploded the foundations of all
the older legal decisions. Then came the law of the 12th of July, 1848,
about board-school departments in towns, which decides (as in par. 8)
that each class, with its distinct teacher, "shall have a special teaching

SCHOOL HOUSES IN NORWAY 6 1

>om, furnished with the necessary school requirements with sufficient

ipace." It continues, in the same paragraph, as follows: "By the

lecision, how far every school shall have its own special school house,

>r more schools could be held in one and the same building — it ought to

considered that never more children are taught in the same house

lan can be done consistently with morality and good order." There

not yet required anything more decided than " sufficient space."

Regarding the board school department in the country, 12 years later,

iz, the 1 6th of May, i860, a law came into existence which in par. 3

lecides "that if at least 30 children can each day visit the same school

this is to be held in special premises, erected or let, and furnished in

fvery respect for this purpose." In the same legal decision it is further

Ided, as follows, "that if certain circumstances make the keeping of

school inadvisable in their own building, the school can be held as an

ambulatory school, yet that creditable premises be given thereto."

according to the demands of the present time for school houses, only a

jw, in the meantime, and yet fewer of the rented premises, which

rere given to the ambulatory schools, could be recognized as creditable

even suitable. But since that time the development has advanced

[uickly enough and Norway has followed, in some measure.

In reality, greater progress has been made than what the law ex-
presses. The law at present in force regarding public schools in the
>untry -is of 26th of June, 1889. Par. 13 of this law says: "As
rule, there shall be erected or rented special premises for every public
:hool." However, the school in small circles {i.- e. concerning infant
;hools) and in public school circles, where the number of pupils gathered
[o not exceed 20, is to be held as ambulatory by the people of the district
far as convenient room can there be obtained. And thereafter fol-
►ws this important decision: "Before any scheme for the erection
\f a new school building is agreed upon, the health and superintendent
immissions shall have had occasion to express themselves regarding it.
"At the same time the health commission shall have had an oppor-
tunity of expressing its opinion about the other rooms, which are
intended to be used as a school. No room, or house, must be used as
a school, which has been forbidden by the health commission in this

Iespect."
j This last repeated legal decision must be considered as a great advance,
t is also therefore taken up in the corresponding law for towns, which,
tesides, has a decision (par. 14), as follows: "The rooms which are
used as public schools shall be sufficiently large and suitable for the
purpose. Each school shall be supplied with sufficient furniture and
playing ground, as also with such means of instruction as are necessary
for common use under the instruction."

62 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The law of the 27th of July, 1896, goes still a step further concerning
the higher board school, which (par. 65) in all, says as follows: "The
superintendent has to see to it that the premises of the schools are always
in accordance with the requirements of hygiene and of instruction.
Every scheme for new building, or rebuilding of the school premises,
must be laid before the health commission, before it is acknowledged
by the superintendent. Every school shall be supplied with playing
ground, furniture and means of instruction according to the further
decision of the superintendent."

The above is all that Norway's legislation has to say on the question
as to how a school house shall be arranged. As we will have seen from
these legal decisions, steady progress has been made from the incomplete
to a state of things almost perfect. The last mentioned legal decision
even recognizes *'the requirements of hygiene," and thus may one
say that it begins to dawn.

In the meantime, it is clear that from the vagueness with which these
decisions are expressed, there must arise in the people's minds many a
question such as: What is meant by a usable room? When are the
rooms sufficiently large? What is meant by sufficient furniture? What
are the requirements of hygiene? etc. The governing department
concerned has therefore, in time, frequently had reason to express itself
and has done so by means of circulars to the school authorities in the
communities. These circulars shall here, briefly, be mentioned:

1. The circular of the 23d of March, 1886, regarding the outfit of
the school premises. Here are given instructions about the situation
of the school building as well as the condition of the ground and its prepa-
ration. The corridors ought to be at least '2.4 meters wide and the
class rooms should have a height of at least 3.5 meters, together with
a floor space of at least 1.4 square meters, for each pupil. The air-cube
for each pupil shall not be less than 5 cubic meters. The window-space
must be at least one-sixth of the floor space, etc.

2. The circular of the 15th of February, 1898, about ventilation of
the school premises.

3. The circular of the i8th of June, 1898, regarding the drawing
room fittings and equipment. Both these last mentioned circulars are
illustrated.

4. The circular of the 14th of May, 1900, about building and fitting
of handicraft rooms. There is required in this circular an air cube of 10
cubic meters and a room height of at least 3 meters, together with a
floor space of at least 1.8 square meters for each pupil. There are
further given detailed rules for the erection of joiner's benches.

SCHOOL HOUSES IN NORWAY 63

5. The circular of 1887 about the procuring and manufacturing of
school desks. There are here given the measures of quite common, one
and two seated school desks of the Olmutzer or Chemnitzer type.

6. The circular of the i8th of April, 1906, regarding fitting of the
gymnastic premises.

In all these circulars the minimum requirements are set forward

which a modern school hygiene can accept, but which can be recognized

>nly in a strong financial respect. In all larger town communities the

requirements put forward are as a rule exceeded, so that the pupils are

)ffered better conditions during their stay \j^ the school premises.

As above mentioned, it is the German building type which is the
governing type in the towns here in Norway: the great brick-stone
luilding with 20 to 30 instruction rooms and with corridors along the
:entre. The Norwegian school building which, usually, has 3 floors,
liffers, however, essentially from the model, so that, as a rule, nothing is
expended on exterior fittings. The facade is a gray, unbroken space
^here the repetitions become tedious and the ceiling has hardly ever
my resting point for the eye. The aesthetic requirements are not even
lirectly connected with the hygienic. However it must be recognized
that the realization of the idea of beauty through the eye creates a good
impression which is hardly without a hygienic significance.

The dimension of the class rooms turns, not seldom, about 6.5 x 9.0 x
.75 meters. If it is considered that the maximum fixed by the law for
mpils is 35, the size of the rooms must therefore be considered as very
jood. The lighting of the pupils' places is generally good, especially
the natural light, as the size of the window space stands in good pro-
>rtion to the size of the room. As artificial lighting the Aureske glow-
ing or electric light is installed. In the solution of the question of venti-
lation, on the contrary, we are here in Norway somewhat undecided,
)ecause at one time it is the difference of the temperature which shall
'be the driving power; at another time it is the fan-system, and a third
_time it is the overheated air, which shall procure the necessary circula-
tion of air.

In the country, the ambulatory schools are on the point of disappear-
ing. Every school circle has now, as a rule, its own house, if it only
:onsists of one class room and a residence for the teacher. The Nor-
wegian government department for church and instruction matters
las given out common drawings for country school houses which have
)een of great use.

What happened in the towns during the law of 1848: It is also, a
|ong time, out of force that one bought on account of the community
greater common residential houses which were arranged for the use of

64 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

the schools. Where school houses are needed, new ones are now always
erected and perhaps we stand at present in front of a time with quick
new building in the most of our towns, because people begin increas-
ingly to understand that the evening instruction in the public schools
must be removed as it is of less value. The evening instruction in the
higher school has been reversed a long time ago.

Finally, a few words about school conditions in the country, in Fin-
marken, the most northern part of Norway. The conditions here
become special as a greater part of the population consists of the
wandering nomadic Lapps. In order to get these children sufficiently
taught, means have been token to erect boarding-schools at the public
cost. It is natural that these houses be built and fitted, as far as pos-
sible, according to the hygienic requirements.

SANITATION OF THE CONSOLIDATED COUNTRY SCHOOL 65

SANITATION OF THE CONSOLIDATED COUNTRY

SCHOOL

William Gray Swank

In considering the subject of the sanitation of the consolidated

untry school, the writer will try to confine his discussion, as nearly

s may be, to those phases of the subject of school sanitation that appeal

ith special force to those responsible for the physical welfare of the

upils of the country school.

Most questions of school sanitation concern the town and city school
uthorities in the self-same way that they do those in charge of the country
hool ; but because of difference in environment some questions of sani-
tion must be met and solved in an entirely different way by those
esponsible for conditions in the country schools. There are also some
hases of the question of the sanitation of a large school that give the
ity school authorities no trouble at all, but which are well calculated
o worry and concern the rural school Trustee. For instance, the selec-
on of a site, favorable in situation as to drainage, and soil, and as to a
robability of securing a bountiful supply of pure water, as well as the
cation of the school in its relation to the length of the routes over
hich the pupils must be conveyed from their homes to the school at
ublic expense; the method of transporting the pupils from their homes,
attered over a territory of from twenty to forty square miles; the dis-
sal of the filth and dejecta from the pupils without any public sewer
r public water systems; and the care of the horse stables that are an
invariable accompaniment of the large country school. In addition to
these questions that of a bountiful sanitary water supply must be solved

■'n a manner entirely different from that in the city.
As all other questions of sanitation are alike for city and country
schools, they will be passed with only a word ; for the writer would not
be able to say anything new in regard to them, or if he should say some-
thing new, he would not presume to speak with authority. The ques-
tions of light, heat, air-space, ventilation, the flushing of school rooms
with fresh air at each intermission by throwing wide-open the doors
and windows, cleanliness of floors and furniture and methods of securing

I id insuring such cleanliness, adjustable seats and desks, cloak rooms
ith facilities for drying wraps, sanitary drinking fountains, play-rooms
——

66 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

thoroughly and at length by many and divers experts. So I shall not
touch upon them.

But in regard to those questions that effect the country school alone,
the last word has not yet been spoken. The sanitary engineer and the
physician may be agreed upon all of them, but the country school Trus-
tee and the tax-payer who foots the bills and who votes upon the expen-
ditures are not yet informed upon them, or, if informed, not yet con-
vinced of their vital significance. The vital importance of a high, dry,
rolling situation for the schoolhouse, with an underlying formation of
such nature as to insure good natural drainage, and so located with rela-
tion to adjacent grounds as to furnish an outlet for under-drainage that
will insure a dry basement, and for a sanitary sewer system — I repeat,
the vital importance of these items in helping to decide on the site of the
consolidated school is not understood by the patrons, nor even by the
school Trustees themselves when the selection of such a site interferes
with the equalizing of the length of the various school-hack routes.
Allied to this question and inseparable from it is the question of a dry
basement. Further, physicians, sanitarians and school men and school
patrons are not agreed upon how many miles, and during how many
hours, the average six, eight, ten or twelve-year-old child can be carried
over rough heavy roads twice a day in a cold, poorly- ventilated — or a
hot, poorly-ventilated — rough-riding school wagon, with from fifteen
to twenty-five other such children, without injury. Neither are the
sanitarians and the school officers agreed upon what kind of out-door
privies shall be installed where out-door privies must be used; nor
whether it is necessary to have out-door privies warmed in cold weather,
nor whether it is necessary to have them connected to the school build-
ing by dry covered walks to protect the children from exposure in passing
from the warm school-rooms to the privy. They are no more nearly
agreed on the question of the danger of the privy-vault as usually con-
structed and maintained. The merits of the "dry-earth" privy are still
a bone of contention between the sanitarians and the school men,
especially between the sanitarian and the school janitor. The incon-
venience, the filthiness and the menace to the health of the pupils, from
the "dry-closet" system — the crematory system — is not yet generally
recognized. And the value of the sanitary water-closet and sewer sys-
tem for disposal of the filth of the school is not yet at all appreciated by
many persons who have to do with these questions in the country schooL
The question of disposal of the stable filth so that it will not be a breed-
ing place for flies has hardly been thought of in connection with the
school. These unsettled questions, to the almost entire exclusion of all
other questions of school sanitation will serve as the basis for this article.
It is not necessary to state here, what every reader already knows, that

SANITATION OF THE CONSOLIDATED COUNTRY SCHOOL 67

all these questions would be easily settled, and without dispute, but for
the false ideas of economy that still becloud the vision of many school
officials and school patrons.

The Site of the Consolidated Country School. If a school district four
or five miles by five or six miles in extent is of reasonably similar con-
tour, with a suitable site at or near the center of this territory, and if
a bountiful supply of pure water can be secured at this site, one of the
most vital questions connected with the health of the school is settled,

nd besides being settled right, is settled to the satisfaction of everyone
concerned. The school-hack routes then can easily be arranged so that
no large number of pupils will be carried to school over very long and
rough routes while others are being carried over comparatively short
routes. But when an ideal site (not forgetting any of the vital points
before enumerated) cannot be found at or near the center of the district

the "center of the district" referring always to that location which will
allow the school routes to be of practically equal length) then by all
means convenience in reaching the schooljshould be sacrificed to a very
considerable extent, if thereby the ideal site can be secured. For, while
every reasonable effort should be made, not only to shorten all hack
routes, but to equalize them, the location of as nearly a perfect building
spot for a school as is possible is such a sacred thing that no ordinary
questions of convenience or expense should be allowed in any way to in-
terfere with the selection of such site if it can be found. Instead of
sacrificing or compromising on the site question in order to equalize the
length of the routes, the right thing to do is to make the roads more
perfect on the longer routes so that lighter rigs, which could make better
time — even auto-busses — could be put into service, thus, while carrying
the children a slightly longer, or even a decidedly longer, distance than
the other children are compelled to ride, they would not be on the road
as long a time ; and it is the time spent on the road and not the length of
the ride — if the riding is not too rough — that is objectionable. More
will be said, however, on the transportation of pupils, under another
heading.

I^B The Water Supply. Now we have the site selected. Ideally this site
^^hould be a sandy, gravelly knoll, in reasonable proximity to a wood-
land and adjacent to, or within a reasonable distance from a rivulet or
stream or other natural drainage. Next we drive at least a six-inch well
down, down, down till we reach a bountiful supply of good, wholesome
water, and pleasant to the taste. We must not forget that water for a
school should be such that all the children, if possible, will like it; for
surely nothing is of more importance to the health of the child than
plenty of pure water, unless it be plenty of pure air. The absolute

68 • FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

necessity of a first-class water supply cannot be too strongly empha-
sized. Of first importance, of course, for drinking and for what, in the
home, would be called domestic purposes, then for sanitary purposes in
connection with the school water-closet and sewer system, and finally
for fire protection.

The Dry Basement — Its Importance. While water is a splendid thing,
and absolutely necessary at school, there is one place about a school
building as well as any other building where we do not want water, and
that is in the floor and walls of the basement. In these times when
vocational teaching is so common in our schools, not only are the play-
rooms and the gymnasium in the basement, but the rooms where the
various vocations are taught — the dining-rooms in connection with the
cooking school, the kitchen and also the children's lunching rooms are
all located in the basement as well. Therefore a considerable part of
the time of nearly every pupil in the school is spent in the basement;
and as the lower layers of the air in a basement are difficult to heat,
because the hot air furnace commonly in use is never located lower than
the basement floor, it is of the very greatest importance that no precau-
tions should be omitted that will help to insure a perfectly dry basement.
Books on school architecture will indicate technically how this may be
done; but here a few words will suffice to indicate the measures that
should be used to secure a safe basement.

First, of course, is a favorable site with a naturally drained sandy
or gravelly subsoil. Next is thorough under drainage — deep drains
of die all around near the foot of the walls and shallow tile drains all
about the grounds. All down spouts from the buildings should be con-
nected with these drains unless the water is carried to cisterns where it
is stored for domestic use, or for fire protection. The surface of the
ground should be graded to slope away from the building. The floor of
the basement should be of reinforced concrete eight inches thick, ex-
tending at least two feet beyond the full width of the walls, and the
walls, which should be of reinforced cement, should be built in one piece
with the basement floor, so that there will be no joint between the floor
and the walls to let in water. Everyone knows how impossible it has
been heretofore to keep moisture out of a cellar and. to keep dry the walls
of a building below the grade line ; but now it is an easy matter, if the walls
and floors are built right, and in one piece and if a good water-proofing
mixture is used in the cement. If it be considered too costly to make
the whole of the concrete material waterproof, it will be perfectly ade-
quate to mix the water-proofing material with the cement that is used
in the lower and in the upper one-inch of the floor and the outer and the
inner one-inch of the walls. Of course the work rooms in the basement

SANITATION OF THE CONSOLIDATED COUNTRY SCHOOL 69

IBshould be an excuse for a failure to use the necessary precautions to
IH^secure a dry cement floor.

Transporting Pupils To and From Schools. Space will not permit
me to discuss at length the question of how long a route (in miles, or in
hours) can be maintained with safety nor of the best kind of vehicles
to use. A long article could be written to advantage on either of these
questions. In as few words as. possible it can be said with emphasis that
the health of the child will be greatly jeopardized if day after day he is on
the road an hour in going to school and an hour in returning. I can
imagine conditions so ideal, however, that the child might safely be on
the road this long. But these ideal conditions would have to include
an easy riding rig with well cushioned seats and high backs, reinforced
with coil springs like a good carriage seat, and the seats divided into
spaces with arms to prevent the crowding of the little children by the
larger ones. The conveyance should have to be well ventilated and well
heated and not overcrowded. There is no doubt that the automobile
will be the conveyance used as soon as we are sensible enough to build
good permanent roads. Whatever the style of the conveyance, it must
be under the care of a good safe driver who has such powers of authority
and discipline over his company of children that the hour on the road
will be an hour of bodily rest and mental recreation, instead of an hour of
bodily torture, and to the timid little boy or girl, an hour of terror, as it
often is to such a child crowded into a rough-riding hack full of big,
rude boys and so cold that the said big, rude boys are almost driven to
be boisterous, not to say riotous, in order to keep warm. Thick dry
rugs should cover the floor of the hack in the cold season, and a safe and
efficient method of heating the hack should be installed in every convey-
ance. For the common wagon-like school-hacks that are in common use,
the W. H. Miller Hot Air Furnace, manufactured at Crawfordsville,
Indiana, seems to fill the bill better than anything else I have ever seen.
It is a little charcoal-burning furnace, absolutely fire-proof and gas-
proof, that fastens under the middle of the body of the hack. It has a
radiator in the floor of the hack that lets the fresh warm air enter as
needed. Anyone can adjust it to almost any hack with a few screws or
bolts. In auto hacks or light rigs which make the trips in a half hour
or less, it may be that robes and foot-warmers will suffice.

Water Closets and Sewerage Systems. Now we have the pupils gathered
at the school. What preparations have we made — what care taken —
to preserve them from their own filth — from disease-producing condi-
tions that are bound to arise where large numbers of children are brought
I together? We are taught that some of our most destructive acute dis-
I

li
I

70 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

eases could be stamped out, almost, if we were only sensible enough and
practical enough to go to the trouble and expense of getting rid of our
excrement and protecting ourselves from other domestic filth, in a safe
and sanitary way. Of course all sanitarians are agreed that there is
only one ideal way— really only one way that ought to be considered—
for a good country school plant and that is the sanitary water-closet
system with a sanitary sewer carried a suitable distance away into a
stream or into a septic tank system.

What can I say here that will help some school official who reads
this to get a firmer grasp upon the truth that there is nothing else relating
to the health of the pupil that is of such vital and far-reaching importance
as is the subject of this section? It justifies the most extravagant lan-
guage and the most positive statements. The question of economy
should not be permitted to enter into the question at all — much less a
stinting, parsimonious spirit, in deciding what shall be done in regard
to a closet system. There are but two systems to consider at all-
there is no middle ground, no other system — (or lack of system) that ought
to be thought of but these two, namely, (i) a thoroughly equipped
pressure-tank sanitary water-closet system with a sanitary sewer into
which all the filth of the whole institution, including the washings from
the school stable, empties and is carried away from the school site; (2)
the "dry-earth" privy for the reception of the human excrement and an
equipment of incinerators for the domestic filth and garbage from the
school kitchen and lunch rooms, and suitable dry fly-tight bins or pits
for the stable filth.

Of course the first is the only one to be thought of if a sufficient water
supply and a suitable drainage site can at all be secured. The final
cost of the labor of caring for any other system if this labor is taken
into the question is greater than the cost of a thoroughly equipped dry-
earth system of privies and of the other above mentioned disposal
appurtenances.

It is unnecessary to advance arguments in favor of the first method
over the second. Everyone sees at a glance the advantages of the one
over all others. The only question is that of cost.

But it may be profitable to show the advantages of the dry-earth
system of privies over all other systems, excepting, all the time, the
sanitary water-closet system. In the first place it is the only safe
system and costing so little in skill or time or money to install. Under
certain circumstances these items cut quite a figure and are of real
importance. In the second place, atid of more importance if possible,
is the fact that the simple old fashioned privy system is the system that
will be used by the vast majority of the individual children when they
have grown up and become heads of families, especially if they continue

SANITATION OF THE CONSOLIDATED COUNTRY SCHOOL

"o live in rural districts. Then what could be more important, more
sensible, and withal more practical — these times of teaching the practical

lings of every day life — than to make choice of necessity and institute a
system of simple dry-earth closets at the consolidated educational center of
\he country community, and teach the growing-up citizen, as well as the
\rown-up ones, how to use and how to care for the only one kind of family

mvy that should euer he countenanced in these days of advanced thought on
sanitation. I am almost persuaded to advocate the construction of a
mple dry-earth privy at every country school to be used and cared
[or by the boys of the higher grades, even when a sanitary system of water-
:losets is in use; that the coming heads of families may learn in a prac-

ical manner this all-important lesson of home sanitation. But where

le weight of necessity may also be added to the scale, the question is

lettled — nothing can outweigh the importance and value of it. The

iractical lessons of caring' for other domestic filth from kitchen and
Itable, can be and should be taught by example so that the lessons will

)e carried to the rural homes to impregnate the minds of the parents,

and set in motion methods of home sanitation that will work for good

in these country communities that are often, if not always, so far behind

the times in the knowledge and practice of the laws which conserve the

.health of the individual and of the public.

72 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SANITARY CONDITIONS THAT SHOULD OPERATE

IN SELECTING A PROPER SITE FOR A CITY

RURAL OR VILLAGE SCHOOL BUILDING

Wm. H. Brainerd

The Ideal School Site.

The essential sanitary problems of a school are:

1st. To provide a place for instruction, where it may be given
with the minimum of fatigue and strain for pupils and teachers.

2nd. To provide hygienic conditions for the necessary accessories,
such as corridors, toilets, playrooms and playgrounds.

The question assigned to me for presentation is how these problems
are affected by the site. I have chosen to treat this question under the
following heads, arranged as nearly as possible in the order of their im-
portance :

I. Exposure to light.

II. Surroundings.

III. Space.

IV. Access.

V. Proper conditions of soil.

While this arrangement of subjects is based on relative importance
for an ideal site, it is by no means certain that they will have the same
relation of importance in the selection of an actual site. Good space
and access may well outweigh a slight advantage in surroundings.

I. Exposure to Light. The primary purpose of a school building
is to provide a place where teaching may be done. Our concern in the
matter is that the effort necessary to impart and receive instruction
shall none of it be wasted in overcoming adverse conditions which can
be avoided by reasonable forethought. Leaving out the consideration
of schools for the blind, which are so few in number as to be negligible,
all instruction is dependent on the use of the eyes. To make satisfac-
tory use of these organs we must have light, and that sufficient, both
in quantity and quality. This is true in all grades, from the work

Iff

SANITARY CONDITIONS IN SELECTING SITE FOR SCHOOL BUILDING 73

ith charts in primary classes to the blackboard exercises in geometry,
r the reading of German and Greek texts in the high school. This
ondition is equally essential for the clear demonstration and execu-
ion of exact work in mechanical instruction or domestic science. All
hese operations require light, in large amount and without glare, in
rder to avoid nervous strain and fatigue.

This is the primary demand of a room for instruction. There are
Iso secondary uses for light. There is nothing that will so sweeten
nd vivify the air of a class room or work room as sunshine, even though
t be for a small portion of the day, and this secondary use of light with
unshine is as desirable for the corridors, playrooms, toilets and such
ecessary accessories in a school building as for the class rooms; but it
true that the latter have the first claim to such light, because they
re used for a larger portion of the school period than are the accessories.
xpressed in terms of site, this means that the ideal location should
have light on all sides.

As I have said before, the light must be in abundance, but we must
onsider the use of the individual room before we assign to it a specific
exposure. Sunlight sometime during the day is desirable for all the
instruction rooms, but if it continues too long in them it may occasion
such a glare as to be as bad as none at all. The nervous strain which
it causes upon the eyes may more than offset its cleansing effect in the
room. A flood of westerly sunshine which is helpful in a corridor or
stairway may be distressing in a class room.

Our investigation and experience lead us to select exposures for.
class rooms in the following order of preference: ist, easterly; 2nd,
utherly; 3d, westerly. If the building contain^ few class rooms, the
act shape of the lot is not essential, since we can generally obtain
suitable exposures with a little study. For large buildings, a site ad-
itting of the major axis running north and south, or better still, north-
ast and southwest, is desirable, assigning to the class rooms the east-
erly and southerly exposures, while assembly hall, stairways and other
ccessories, are given westerly and northerly exposures.

In selecting a site in a crowded city, sometimes every consideration
ut light for the class rooms has to be waived. One notices in the
uildings for the Borough of Manhattan in New York City, so excellently
lanned by Mr. Snyder, that while he does most thoroughly light his
ass rooms, apparently little attention can be paid to the location of
e rooms in relation to points of compass, because of the restricted
oice in sites available in the city. To get light for all accessories,
e is obliged to make shift as best he can. However, these difficulties
ue to restricted sites do not seem to prevail in this country anywhere
utside of New York City.

74 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

We have not alluded to exposure necessary for circulation of air,
since the conditions which we consider necessary to provide proper light
are sufficient to ensure a proper quantity of air. The quality will be
determined by the surroundings.

II. Surroundings. The requirement that these should enhance,
not detract, that they should be neither noisy nor noisesome, is axio-
matic. That a boiler shop or the smoking chimney of a power house
are undesirable neighbors, no one will question. The value of many
a site in town or country which was excellent when selected has been
impaired in these later days by the noise arising from electric cars or
the constant stream of automobiles on some great thoroughfare. Rail-
road and freight yards, too, are not desirable neighbors. And even
in the peaceful country, the noises from a farmyard may not add to
studious quiet. The brook and water garden which have been the pride
of some old private estate do not necessarily add to its value as a site for
a high school.

All these, however, are negative considerations. There are other
matters to be considered on the positive side. Hills or trees, which
shelter the site from prevailing cold winds, are desirable. I recall with
a shiver that old building located on one of the highest points of a wind-
swept western prairie, and, besides this, raised on a mound, with its
entrance of many steps exposed to the full fury of the northwest blasts,
to which I used to struggle on cold winter mornings to receive instruc-
tion; and how, many times, the girls of the class were almost blown
from their feet because of the force of the wind.* In revisiting the
school during the pas^ year I was pleased to notice that by the growth
of trees, the wise placing of other buildings, and the shifting of the
entrance to the southerly side, access to the building has been made
reasonable, even in extreme weather.

Beauty of outlook whereon the eye may rest is also one of the positive
qualities, and should be sought for its hygienic value in quieting and
stimulating the mind.

The surroundings in their effect on the architectural effect of the
building should be carefully considered, so much may be added to the
beauty of a building by an appropriate setting, and this beauty is a real
asset, being constantly before the pupils to add to their joy and pride
in their work and their building and to foster the civic pride of the whole
community. The appreciation that is being shown for beauty, and the
efforts made to attain it, in all that concerns a building, is one of the
hopeful signs of the times.

*The strain, both physical and nervous, caused by such conditions, can better be
imagined than described.

SANITARY CONDITIONS IN SELECTING SITE FOR SCHOOL BUILDING 75

III. Space. This must first provide for the actual ground area
f the building and its necessities of light. To refer again to the
orough of Manhattan in New York City, these absolute necessities
em to be all that can be obtained for the grade schools; and to obtain
ven these they are obliged to construct buildings four to six stories
n height. Under such conditions one must be content with the bare
ecessities and endure the added strain caused by the extra stairs and
amped playgrounds.

In the average case, grade-school class rooms will be provided in
o stories. In such case the area occupied by the building should
ot exceed twice the net area of the largest number of class rooms in
ither story.

In the greater part of this country, costs for construction and for
eating prevent the use of one-story buildings. California, however,
ems to find them feasible; these should provide ideal conditions for
;ase of access and for quiet during hours of instruction.

For school accessories, the first requirement is for playgrounds. School
authorities in England, Germany and America agree that from 30 to
50 square feet per pupil should be provided for this purpose.

If these playgrounds can be protected by the building, or placed
on the southerly slope of a sheltering hill, it will materially add to their
usefulness in northern latitudes during winter.

t Other needs that arise in connection with the individual school
should be kept in mind. Athletic fields, school gardens, and even
larger spaces for practical instruction in horticulture and agriculture
are sometimes desirable, especially for rural schools.

All these have hygienic value insofar as they add to the ease and pleas-
ure of instruction.

I In cities and towns, municipal parks and fields may provide all the
accessory space needed, particularly if the school site can be placed
djacent to them.

IV. Access. That the ideal site should, for ease of access, be central
to the district served will be granted by all ; but it is harder to get agree-
ment on what is the meaning of central in this connection.

We have seen a rural school house on our central western prairies
carefully located at the crossing of two roads which provided equal access,
measuring the feet and inches, from the extreme limits of the school dis-
trict; but the roads were minor ones, frequently unbroken in winter, and
the site itself, while ample in size, had a northerly slope, down to a marsh.
In such a case the central location by feet and inches is not central for

Ittendance, and has been gotten at the expense of hygienic conditions.
Many times the question of central location is one of transportation
I

76 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

rather than of geography. We have had this fixed in our mind by
experience in New England country towns where the convenience of
trolley service frequently makes a site central in spite of geographical
considerations.

Care should be taken that the site is not located directly contiguous
to trolley lines or main automobile thoroughfares, where the children
in their play may thoughtlessly rush into danger.

V. Conditions of Soil. These must be such as will provide a dry
basement and playgrounds. While moisture is needed in the air sup-
plied for ventilation, this moisture should come from a source whose
purity is known and which can be controlled. It must not be ground
air from an uncertain source.

Earth full of decaying vegetable or animal matter, with the result-
ing gases and germs, or oozing with water cannot be used in this state.
However, since these conditions can be corrected by underdraining,
refilling and grading with proper materials, and waterproofing the
basement, the problem becomes financial rather than sanitary.

In cities where the choice in sites is restricted and costs vary greatly,
it may many times be wise to spend money in improving the soil condi-
tion of a site otherwise acceptable. In towns and rural districts the
range of choice is generally sufficient to avoid any large expense for
special preparation of the site. In such districts, the more vital ques-
tions are those of water supply and disposal of excreta. As these are
to be discussed in detail in other papers, I will only mention them.

I present to you two lantern slides showing what application we
have made of the principles which I have enunciated in the develop-
ment (ist) of a rural, and (2nd) of a town site for grade schools.

The first is in the Pond End School, Waltham, Mass. An old site
in a farming district.

This is partly a level space and partly a rocky hillside sloping to the
southwest, and is between two main roads near their junction. The
building contains three class rooms, all on the first floor, and may later
have a second story. The slope of the land and the desire of the author-
ities for a frontage on Winter Street have forced us to face two of the
class rooms to the southwest; the other is lighted from the southeast.
The surroundings and setting of level road in front, great elm at the
left, and the background of wooded hillside, are almost ideal. The
level space at the left and the site of the old building (shown in outline)
make a good playground, sheltered by the hill and shaded by the tree.
The basement is protected from the ground water from the hillside
back of it by a foot drain.

We were fortunate enough to have a water supply from the town

SANITARY CONDITIONS IN SELECTING SITE FOR SCHOOL BUILDING 77

system. The excreta are cared for by a septic tank system, located
)n the other side of the road in front. This replaces the privy shown
It the rear of the old building.

The second slide is of the Adams School, Lexington, Mass. This
site is practically level. The street and access are on the west.

The street happens to be that by which the British retreated on
lat memorable 19th of April, 1775.
The building contains eight class rooms and an assembly hall, arranged
two stories. Later, four rooms are to be added at the rear.
The soil is the loam of an old orchard overlying gravel, and that
turn overlying blue clay and boulders. At the rear there is a munic-
)al playground of several acres, lying at a lower level.
We have arranged the building for the class rooms to have easterly,
'southerly, and westerly exposure, the assembly hall being on the north.
The children's playgrounds and entrances are on the south and west,
sheltered by the building. Everything is kept well back from the street,
to avoid the noise and danger from electric cars and automobiles. The
boiler room, the only portion of the building going below the dry gravel,
is protected by a foot drain with outlet at the rear. There is a supply
of water from the town system. The sewage is temporarily disposed
>f by a leaching cesspool, but will eventually go to a sewer which is
planned for the street.

I wish to sum up briefly the points made:

L Exposure to Light.

The first purpose of the school is instruction.

The first need of instruction rooms is light, for the use of the eyes
and apparatus.

t Light must be in abundance and without glare.
Sunlight should reach all instruction rooms, and others so far as
possible. Long-continued, hot sunlight is not desirable in class-rooms.

The desirability of exposure for class-rooms is in the following order :
Easterly. Southerly. , Westerly.

For large buildings a site permitting the major axis to run north-
Lst and southwest is most desirable.
Class rooms having the easterly and southerly exposure.
Assembly hall and accessories westerly and northerly exposures.
If the site provides sufficient exposure to light, the circulation of
lir will be sufficient in amount.

78 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

II. Surroundings.

These should enhance, not detract. They should be neither noisy
nor noisesome.

Light and quiet should not be impaired.

Beauty has positive hygienic value, by soothing and stimulating
the mind.

III. Space.

The space must be sufficient to allow of low buildings — generally
two stories, never more than three stories except in crowded city dis-
tricts.

Open playground space .from 30 to 50 square feet per pupil.

Other needs, such as School Gardens, Athletic Fields, etc., should
be considered. A southerly sloping hillside is many times desirable.

Substitutes for accessory space may occur in adjacent municipal
grounds or even in quiet side streets.

IV. Access.

Site should be central to district served. This may be a question
of transportation rather than of geography.

Site should not be exposed to the noise and danger of contiguous
railroad or street car lines, or main automobile thoroughfares.

V. Conditions of Soil.

Must provide for a dry building. This generally is more a matter
of expense than of actual soil. A well-drained site with, if possible,
a sand or gravel subspil is desirable.

In rural and town schools the range of choice is generally sufficient
to provide a suitable location. In older towns and in cities more im-
portant considerations may make wise the expenditure necessary to
overcome poor soil conditions.

SESSION TWO

loom A. Tuesday, August J'26th, 9:00 A.M.

OPEN-AIR SCHOOLS

John W. Brannan, M.D., Chairman
Calvert K. Mellen, Buffalo, N. Y., Vice- Chairman

Program of Session Two

Ogden Woodruff, M.D., Physician to the Open- Air Schools, New
York City. "Fresh Air Schools in New York City."

RANKLiN W. Barrows, A.M., M.D., Medical Inspector of Schools,
Buffalo, N. Y. "Open Window Schools in Buffalo."

[OHN V. Van Pelt, New York City. "The Architecture of Open-Air
Schools."

George Jenkinson Holmes, M.D., Supervisor of Medical Inspection,
1^^ Newark, N. J. "The Results of Open-Air Treatment in Public

H Schools in Newark, N. J."

^^n3. U. Richards, M.D., Medical Director of Public Schools, Pawtucket,
R. I. "The School Room Window."

tAROLD Brown Keyes, M.D., Physician to Horace Mann School;
Instructor, Department of Physical Education, Teachers' College,
New York City. "Effects of Outdoor and Indoor School Life
on the Physical and Mental Condition of Children."

^ALTER W. Roach, M.D., Supervisor of School Medical Inspectors,
Fourth and Fifth Districts, Philadelphia. "Vitalizing School
Children."

Dr. Luis Miro Quesada, Professor of Pedagogy, University of Lima,
Peru. "Porvenir de la Escuela al aire libre."

Dr. Antonio Vidal, Buenos Aires, Argentina,

and
Dr. Carlos Robertson, Buenos Aires, Argentina. "The Open Air

School in Scientific Pedagogy." Joint paper.

80 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

FRESH AIR SCHOOLS IN NEW YORK CITY
A COMPARATIVE STUDY

BY ■

I. Ogden Woodruff

The title "Fresh Air Schools in New York City" suggests a rather
wide range of subject. We all know something about fresh air classes
and so much has been written on them in general that I am going to
ask you to bear with me while I cover a rather narrow field.

The work reported upon in this paper has been undertaken by me
in the capacity of physician to the outdoor classes of the Board of Edu-
cation of New York City, and it has been made possible only through
the interest and generosity of the Committee on the Prevention of
Tuberculosis of the Charity Organization Society, which furnished me
the assistants and financial support necessary to make such a study
practicable.

During the last two years I have suggested that while glowing gen-
eral accounts have been published concerning the improved condition
of the children treated in fresh air classes, practically no attention has
been paid to the fact that the problem — as our fresh air classes are
conducted — is a complex one.

In some cases — particularly in the classes for the tuberculous children
— the children have had a great increase in their diet, and their amount
of exercise has been markedly restricted. This combination of factors
has produced a gain in weight much beyond the normal and this has
been the factor in the reports upon which most emphasis has been laid.

All of the benefits derived has been attributed by the general public
to the fresh air, and unthinking persons who have put poorly nourished
children in the cold fresh air, without giving them additional nourish-
ment, have been discouraged because the gains in weight have not
been as satisfactory as many previously reported. Thus the fresh air
work has been hurt because proper consideration has not been given to
other important factors besides the changed environment (notably to
the school feeding).

Now I believe that no careful study has ever been made to estimate
the relative influence of the changed air and temperature conditions
and the additional nourishment received, or to phrase it more popu-
larly, the relative value of fresh air and feeding in this type of class;
and it is with this question, together with the influence of the home

FRESH AIR SCHOOLS IN NEW YORK CITY 8 1

onditions, especially of poverty, in producing subnormal children, that
am going to deal.

The ideal is generally prevalent that the chief reason for malnutri-
on and anemia in school children is under-feeding at home, with poverty
the ultimate cause.

On this basis there are those who contend that placing poorly nour-
hed and anemic children, without feeding in the cold fresh air would
use them to burn up a portion of their already inadequate nourish-
ent to maintain their body temperature, and that consequently not
inly would we fail to benefit them, but we would actually work to
eir physical detriment.

A well known authority on the hygiene of school children recently
Id me that in a New England town this past winter he managed to
stpohe the opening of a fresh air class in which there were to be a num-
er of poor children until the authorities had provided for extra nourish-
ment, and he did this because he believed that without feeding the
ildren would actually be injured.
Now this is a contention requiring serious consideration, for the
view is an entirely logical and rational one if the premises on which
I^R is founded are correct; namely, that under-feeding due to poverty
^is the chief cause of malnutrition.

So far as I have been able to find, no careful investigation has ever
I^Been made to ascertain if there is any definite relationship between
r^^overty and malnutrition in school children; and at present then we
shall have to realize that the assumption that poverty is the chief
cause of such malnutrition has not yet been supported by proof. Con-
sequently there is a possibility that malnutrition may be due to other
causes not yet determined ; or if due to under-feeding, that the insuffi-
l^ftient nourishment may be caused by lack of appetite, especially for
^^^atty foods, or to lowered powers of assimilation, instead of poverty.
With such premises it is conceivable that with the increased bodily
tone and appetite, which are notable among children after a stay in
the fresh air class, they might eat and assimilate sufficient food to main-
tain their nutrition, even though feeding were not given in the school.
If such were the case, perhaps fresh-air classes could be run much
ore economically than at present when feeding is deemed necessary;
or at any rate, classes could be organized with benefit to the children
even if funds for additional nourishment were not available.

It can be seen from the foregoing that the fresh air classes are not
a separate, isolated feature of the school system. Their problems are
intimately interwoven and go hand in hand with the problems of two
important features of school hygiene — school feeding and malnutrition —
which are demanding so much attention to-day.

82 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

On this account I have thought the subject of sufficient importance
to warrant a special study.

In-order to ascertain the relative effects of fresh air and feeding,
I simply divided the fresh air classes into two groups. To one I gave
additional nourishment at school. The food value of this (milk and
crackers) amounted to 350 calories daily. The other children received
no nourishment.

The results from the two groups were then compared. For the pur-
poses of statistical study it was essential to compare such results as
could be reduced to figures. Consequently an especial study was made
of the weight, nutrition and' hemoglobin. The influence of the home
conditions, especially the economic, was studied by getting as accurate
data as possible regarding the family income and general living condi-
tions and by comparing the degree of malnutrition and anemia on ad-
mission and the physical progress during the year of those children
from homes of poverty, with those in comfortable circumstances.

It was realized that for the work to be of any value, extreme accuracy
in the examination and compilation of records was essential as well as
a searching analysis of school and home conditions, to ascertain if any
factors were present which by their predominance in either group might
tend to influence the results.

I have taken a good many precautions to insure the accuracy of
our basic figures. All figures have been checked and rechecked and
care has been taken so far as possible to eliminate variations due to
personal element; for example:

The hemoglobin determinations were all made by one physician —
Dr. Nilsen, and the data of the home conditions were all compiled by
one individual, a trained social worker, one of the Board of Health
nurses. Finally all the figures were checked and compiled by an
expert statistician.

The children were primarily selected for the class because of their
anemia or their malnutrition. Only when the parents* refusal to co-
operate rendered the filling of the class otherwise impossible did we
introduce more normal children.

The compilation of the data relative to the physical condition of the
children on admission is given in Chart "A," which shows that we have
to deal with groups of children closely approximating each other in nutri-
tion and degree of anemia. The children on feeding were 9 months
older and correspondingly taller and heavier. They were kept in the
class, if possible, throughout the entire year, and this was accomplished
in most cases in 11 of the classes. As the other three classes failed
notably to meet these conditions, no attempt was made to study the
results obtained.

FRESH AIR SCHOOLS IN NEW YORK CITY

CHART *'A

^Hq^llVa^UlbliiiitntkinaillipytaH

and Respective Gains and Losses.

t/y0assJi^urai/iPlaiifltn?ttdi/y3assJifu/rst/iG/tien 'i/olal&assyt^u/Ks tn ^ed. G^oniro/ /inures i/Z ^/ue

Classes

Feeding

Kumhcr

6asc5

103

^ve.ra^e On Admission

^^^liL.,

46.8

ffe^y^^

565

/f^diimdin/uf/t JCtrntyiifhc^t.

6.6

vRvera^e Gains or Losses

73.4 1.4

//%!^

4.4

■4^iUriiUm. Xumy/aSt/i

4.0

Non
Feeding

129

48.4

5^6

745

3.6

3.7

Total

■=

232

45.0

5+3

6.8

742

\.\

3.9

47.8

53.2

1.3

821

1.2

3.8

as]

In all, we have studied the results in 232 cases, of which 103 were
on feeding and the remainder received no nourishment. In point of
attendance and duration of time under observation, conditions are
almost identical in the two groups.

Those on feeding averaged 156 school days' stay in the class, with 89%
of attendance; and the others, I55 days' stay, with 90% of attendance.

Incidentally, all the children went home to luncheon, in order that
the variable of restricted exercise due to remaining in school during the
noon hour should not operate in either group.

CHART B^

Mitions on Adniissionandll^fiainslrMte

JPerccnta^
of eases

/ZoAi ^^e^sUngr In. (3^r&e.r7,. ^oir£2,ls tn. ^e.c6.

Annual
Income

Under

♦600.

♦600:
^900.

Don
Jtediy

39.31:36

Average on Jldmission

9^ Malnutrition

5W^

feediii}

6S5260

44'.+3.44 7.2 837.8

%td

^vcrli^e Gains or Losses

%Hcmo^lobin

non
Feediy

iSiiis'mm^w

73 6.5 6.8M.1 1654323 34

0hal

Weight Obs)

^;fea»

mmi\m\\

% Nutrition

non

^^k^TM

% Hemoglobin

non

5.85.85.

23523.1

tmn

84 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

In Chart "B" I have endeavored to compare economic conditions in
the homes in the two groups. A division of the income arbitrarily into
three grades has been made, merely because of the difference of opinion
as to what constitutes a living wage. Some maintain that $600, others
that $900 a year should be considered the minimum income.

You will see that in the matter of income the two groups lend them-
selves well to comparison, as the percentage of children in each grade of
income is about the same in the two groups. The slight differences
between the two groups are not of much importance, however, as the
other figures in the chart show that, contrary to expectation, there seems
to be little difference in the degree of anemia and malnutrition or in
the rate of progress in the class whether the income be under $600 or
over $900.

These findings are very similar to those I obtained last year in a
corresponding analysis.

An analysis of the children's sleeping rooms with reference to light,
air and overcrowding likewise, both this year and last, furnished negative
results regarding the physical condition of the children.

While these findings are entirely at variance with what current
opinion has led us to expect, their chief value to us now is, that they
enable me to show, before examining the results of this year's work that
we are dealing with two groups of children so closely resembling each
other physically, and under such similar conditions in school and at home
that for purposes of comparison, the only variable of importance is the
additional feeding, the influence of which we are desirous of investi-
gating.

In connection with this work, a small group of 24 children, all of
one indoor class, who offered themselves for the purpose of comparison
have been kept track of to compare their changes in weight and hemo-
globin at the end of the year with the results of those children in an
outdoor class. Their condition on admission is given in Chart "A."
There we see that they were approximately of normal weight and aver-
aged about 82% of hemoglobin.

Results. Taking up first the gain in weight, I have constructed
a weekly Weight Chart **C," which shows much more clearly than
mere figures the gain in weight in the two groups and in the control
class during the year.

The class on feeding is indicated by a heavy continuous line.

The non-feeding by an interrupted line.

The control class by a lighter continuous line.

FRESH AIR SCHOOLS IN NEW YORK CITY 85

CMARTC

ileeumolative Average Weekly
Gains in Weight (//>5)

S60 . .

S20 ,

**' ^^J^^'^ J.

-» , ":2 :;^:^^>v;

3^^ /M—. "

•2 2«» - -,^ wi

f.ja ^'-^Jl-i- " ^xZ'^^

1- /^^-Z_ :t:::::

^.00 ^cL__:lIi.

^ '.■.i___^i___^

'20 tA_ A ^pHinA riaccAc

r / rccain"?v.iasscs

/ y • 1^" iion-iteuingUd>M:s>— — -

^/|L Control Class

± :.Lij.i II 1 i II 1 1 11 1 1' ---

Week[y Intervals from Sept25, 1912
toc)une5,19I3.

ou can see immediately that the gain in weight for the group on
'ceding approximates much more closely to that of the normal children
in the control class, while those not on feeding lag perceptibly behind.

The sharper rise at the beginning of winter in the class on feeding
is probably due to an earlier donning of heavy clothing.

A partial explanation of the difference in gain of weight between
the feeding and non-feeding classes is due to the difference in height.
The normal increase in weight for a group of children averaging about
50 inches and gaining i and 4-10 inches is about ^ lb. greater than for
children an inch and a half shorter.

I Referring to Chart "A" again, however, we see that despite the
smaller gain of the non-feeding classes, their increase is sufficient to
keep up the nutrition they had on admission and even to add a bare
fraction to the credit side of their account.

Most of these non-feeding children were from poor homes and a
eference to Chart "B" shows that those children in the group from
homes with smaller incomes gained equally well and that there was no

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

These results are very interesting. In the non-feeding group we have
children coming mostly from poor homes, under-nourished, placed out-
of-doors with no additional nourishment, and yet who gained enough to
maintain their nutrition despite their handicaps.

These children were from schools chiefly in the so-called poorer
districts of the city and in widely separated areas. So far as we could
get them they were the most anemic and poorly nourished in each
school, so they may be considered as representing fairly the under
nourished school children in the city.

That these children maintained, even those from the poorest families
and in the non-feeding classes, the weight they had on admission, shows
that they had sufficient food at home to supply their average daily
needs. That these children gained on an average of three pounds apiece
shows that there was food at home for them in excess of what they needed
for daily consumption, even though their daily requirement in winter
was presumably increased by their exposure in the cold fresh air. Under
thes6 conditions if their malnutrition had been due to poverty there
should have been, not a gain, not even merely a maintenance of weight,

CHART "D"

/Iverage Gain in Hemoglobin %
According to Hemo^obin % on admission

iJ-eeding and ^^foji-feeduig Gfasscs)

fl(

oc>

(X)

■

III

■*

J2,

-2

-Z

•I

Hb.^on^Idmission
I- Under 70%

2- 70-74

3- 75-79

4- 80-84

Teeding

Non-Teeding -

—

::>i

tc<J

'Aa

FRESH AIR SCHOOLS IN NEW YORK CITY

but an actual loss during the year, a condition which did not occur in
a single case under our observation. It seems fair from this to assume
that poverty is not the ultimate cause of malnutrition in the great
majority of cases among school children.

In the matter of hemoglobin the difiference in the gain in the two
groups is almost nil, being a matter of only 3-10 of 1%, each class
gaining an average of about 4%.

An analysis of the hemoglobin gains shown in Chart "D" illus-
trates very well how closely the gain approximates in the two groups.
The open rectangles represents the feeding and the shaded the non-
feeding; the rectangles are arranged from left to right according to the
per cent, of hemoglobin on admission and indicate from under 70%
to over 85%; the height of the rectangles above or below the base line
represent the amount of hemoglobin gained or lost.

It shows in each case a striking gain of the very anemic, somewhat
Igreater in the non-feeding class, and an unexpected loss in those over
80%, which is greatest in those children whose hemoglobin is highest
;on admission.

CHART"E

Tlvera^ Gain in Hemoglobin %
According to Hemoglobin^ on admission-

88 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

This loss indeed at first glance suggests that there is not very much
difference in results between the more nearly normal children in the
fresh air class and those In the control class, who average 82% hemo-
globin and lost on an average about 4%.

However, Chart "E," a chart similar to Chart "D" analyzing
comparative hemoglobin results of the fresh air class with those of the
control class, shows that the losses of the children with over 80% of hemo-
globin is really much greater in the indoor class; and that between 70%
and 75% there is also a loss as opposed to the gain in the fresh air classes.
Here the rectangles with the heavier shading represent the indoor class.

To explain these complexities one must enter the always dangerous
realm of speculation, but I cannot help venturing a suggestion which
seems to me fairly simple and reasonable.

Clinical pathologists seem to agree that the hemoglobin precentage
in childhood varies considerably at different periods of life, and that
in general in children the normal percentage is considerably lower than
in adults, probably below 85% as measured by the adult standard.

It is quite likely then that the hemoglobin determinations over 80%
may well be normal for these children we have had under observation.
Their failure to gain, or even their slight loss, suggests that the general
environment of a child during the winter, with increased housing, and
artificial and frequently too great heating of both homes and school
tends to produce anemia. This tendency even an additional five hours
in an open window class cannot entirely overcome.

But, to observe the control of the class, it prevents the development
of as much anemia as occurs under usual methods of living. With the
distinctly anemic child it stimulates markedly the blood-forming organs
and raises the hemoglobin to an appreciable extent.

Now what of practical value can we draw from these results?

First, as just suggested, from a comparison of the hemoglobin results
in the control cla§s and the fresh air classes, it is likely that during the
winter our usual living conditions have a tendency to produce anemia
and lowered physical tone. It is to be hoped that more recent studies
in heating and ventilation will show us how to live that we may in a
large measure overcome this; but at the present time between the ven-
tilation we now enjoy and the arrival of millenium, the health of our
children can be much improved in school by a marked extension of the
open-window classes.

Second, proof is yet lacking of a casual relationship between poverty
and malnutrition as found among school children. Probably poverty
is not the cause in the great majority of cases. During the last two
years of the children selected for the fresh air classes, a study of the
home conditions has failed to show that either poor economic or hygienic

FRESH AIR SCHOOLS IN NEW YORK CITY 89

conditions were a potent factor in determining either the degree of
malnutrition and anemia or the progress of the child in the fresh air class.
Fortunately, the Association for Improving the Condition of the Poor,
of New York City, is planning an exhaustive investigation of the subject
of malnutrition during the coming winter. Meanwhile we shall have
to consider malnutrition as due either to individual susceptibility or
to other factors not yet determined.

Third, with a lack of proof of the relationship between poverty and
anemia, and the results in our non-feeding classes, we feel that poorly
nourished and anemic children even from poor homes, can be placed
in the fresh air in school and without school feeding and kept there
during the cold of winter, not only without physical injury, as shown
by their maintenance of nutrition during the year, but with actual
benefit to them, as indicated by the marked increase of hemoglobin
in the very anemic and the general gain in mental and physical tone,
with which all of us in our outdoor class work are familiar.

The practical application of this is, that I believe a fresh air class
can be started in a community with the expectation of benefiting the

(children even if funds are not available for feeding. By this I do not
in any sense wish to be considered as advocating running these classes
preferably without feeding, for it seems that one thing our results show
conclusively is that:
Fourth, we cannot hope to improve appreciably the nutrition of
these children by merely placing them in the fresh air.
Now we shall always include in a group of children picked out for
the fresh air classes those who are poorly nourished, those convalescing
from illness, those exposed to tuberculosis or with a family history of
the disease. The nutrition of these children we wish to raise to as high
a point as possible; if we can, to a point beyond the normal. If we are
going to attain a proper measure of success in this respect it is certainly

■necessary to include additional feeding as an integral part of the work.
Now in this paper you may have noticed I have not used my results
to emphasize the particular value of the fresh air class and the necessity
for it, but merely as an exposition of some of the problems connected
with this branch of school work. To my mind, the outdoor classes need
no defense. Their usefulness and value have long since been established
even if chiefly by means of the intangible gain in "mental and physical
tone," which is noticeable in the children.

■ When I see a girl whom her teachers tell me is listless, does poor
work, and frequently faints in the class room, when I see such a girl
after a month or two develop energy and ability to work ^nd go through

Ew^inter without a single attack of syncope, I know the class is doing
good, without reference to weight and hemoglobin determinations.

90 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

When a class as a whole tell me they have had no colds all winter
long— something outside of the previous experience of any of them, I
know that somehow or other their general resistance is raised ; and when
a teacher tells me, as one did, that her children on coming to her were
so listless at the end of the day that she had to give them any work
requiring concentration in the morning, and that after three or four
months their condition was so changed that they became progressively
more alert as the day advanced and took the hardest work just before
3 o'clock, then I know and we all know that the physical condition of
these children has markedly improved.

Whether further studies in ventilation will show how we can pre-
vent our school children from running down and becoming listless and
anemic, and that we can also build them up indoors, remains to be seen,
but for the present the fresh air or open-window class is the best prac-
tical means at hand for accomplishing this result. Feeding or no feed-
ing let us all urge its widespread adoption.

DISCUSSION OF

I. Ogden Woodruff's Paper

Frank H. Mann

The work done by the Committee on the Prevention of Tuberculosis
of the Charity Organization Society, of the City of New York, through
Dr. Woodruff, in connection with certain problems of the fresh air
class has, we believe, settled in part, at least, the question of the necessity
of feeding these children. As Dr. Woodruff well says, there is prac-
tically unanimity of opinion in regard to the value of the fresh air
classes. The good that they do is apparent to the most casual observer.
No one who has seen the children on admission and watched their prog-
ress during the year and seen them at the close, could doubt for a mo-
ment the good resulting from treatment in the fresh air. The con-
census of opinion is doubtless overwhelming in favor of the wide exten-
sion of these classes for anemic children.

One of the most serious drawbacks to the extension of these classes
has been the matter of funds. It is well known that the feeding of the
children has been the largest element of expense. The cost of equipping
kitchens, paying for service, as well as the purchase of the food has
deterred many communities from undertaking this most desirable work.
I have had occasion, as Secretary of the Tuberculosis Committee, and as
being intimately connected with this experiment described by Dr. Wood-
ruff, to come in contact with a great many persons from all parts of the

FRESH AIR SCHOOLS IN NEW YORK CITY

country interested in the establishment of fresh air classes. I have
[found always that the element of expense for feeding the children in

;hese classes has been a serious handicap.

We have demonstrated, we believe, that without extra feeding in the

'schools, children from the poorer families can be taught in the open air

[to great advantage. It is admitted by Dr. Woodruff that additional

:ood given in the schools does mean an increase in weight and a slight

increase in nutrition ; but it has been fully proven that in other respects,

n the increase of percentage of hemoglobin, in the increase of bodily
:one and vigor, in the increase of mental ability, children taught in the

»pen air without extra feeding improved more rapidly than the same

;lass of children in the closed class rooms.

While it may be claimed that this does not finally settle the desir-

.bility of school feeding, it must at least be admitted that it does answer
the query as to the necessity of school feeding as an indispensable part
of the program in the development and extension of fresh air classes.
Perhaps, indeed, a few individuals could not advantageously be taught
in the open air without additional diet, but certainly the vast numbers
of anemic children who would profit by the open air treatment without

jxtra diet, should not be made to wait until this very moot question of
school feeding is finally settled.

One other thing I think is important to observe. It is certainly true
of our work in New York City. The fresh air classes have proved
to be not only beneficial in themselves, but a means to perhaps a much
larger end. I refer to the influence of these classes on the whole ques-
tion of better ventilation of the public school buildings. In March of
1912, the Board of Education of the City of New York appointed a
committee of its own members "to investigate and report regarding the
subject of ventilation in public school buildings." I believe that the
agitation for fresh air classes by the Committee on the Prevention of
Tuberculosis, together with the general agitation for better ventilation,
was the direct cause for the appointment of this committee. The com-
mittee made a very full study of the whole subject and presented a series
of recommendations looking towards the better ventilation of all class
rooms in all school buildings. Among these recommendations was the
following relative to the fresh air classes themselves — "Your com-
mittee recommends that every possible encouragement and facility be

fiven by the Board of Education to open air classes, especially when

>arents desire such classes for normal children." The report in its en-
tirety, including all of its recommendations, was adopted by the Board.
I There is but one conclusion to reach and that is that fresh air classes
or anemic children should be extended as widely and as rapidly as
)ossible.
I

_2_m

1^;

92 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

OPEN WINDOW SCHOOLS IN BUFFALO

Franklin W. Barrows

For years past our city has been blessed by the presence of a few
courageous teachers who would dare to brave the wrath of principals
and even of janitors in order that they and their pupils might breathe
the air just as it comes to us, fresh from the purifying billows of our
great lakes, Erie and Ontario. In spite of rules, remonstrances and
threats these teachers have loved fresh air more than any theories of
ventilation and have persistently kept their school windows open wide,
the year round. Perhaps these open rooms, with their bright, rosy-
cheeked girls and boys have been the strongest argument in our city
for a real open air school. At any rate, when the Department of Educa-
tion started our first fresh air class they placed the children in charge of
a teacher who had already demonstrated her ability to get fresh air into
a room in spite of any and all "systems" of heating and ventilation.
I mention this important fact because it shows that our open air school
was merely the continuation, under somewhat more favorable condi-
tions, of a campaign that had been waged for years by a few of our
most progressive teachers. I call them progressive because wherever
you find an intellectual worker using his or her full share of oxygen, you
find one who excels in mental vigor and efficiency.

In most of our American cities the open air school has made its
advent under the management and support of private philanthropy.
In some cities a portion of the initial expense for room and equipment
has been paid by organized benevolence and the balance has come from
the public treasury.

In Buffalo, while the Department of Education was subjected for
some months to a brisk campaign of exhortation from societies and
committees interested in child hygiene, these agencies limited their
activities strictly to a policy of agitation and goading. No one thought
of raising any money or providing leaders for the important work of
founding and maintaining our first Open Air School. Whatever success
we have attained in this good work is due, therefore, to the efforts of
our Department of Education and the Health Department.

Our first Open Air School occupies an ordinary school room with
windows on the east side only. The sashes are hung on pivots so that
they may be swung into a horizontal position and admit the maximum
amount of air. The desk-seats are movable and can be pushed into

Itf

OPEN WINDOW SCHOOLS IN BUFFALO 93

ne corner of the room to give the children space for exercising or resting
n their recUning chairs. By shifting the furniture in this way the room

ccommodates comfortably twenty pupils. This is merely an open

indow school room.
Across the hallway is the Domestic Science Room where the Open

ir Class meets at noon for a well served hot dinner. Adjoining this

00m is the lavatory with its clean, white wash bowls, toothbrushes,

nd individual towels and cups for each pupil. Warm blankets, leggins,

nd moccasins are provided so that no one suffers from cold.

You will naturally ask if a fresh-air environment can be secured
a school room of this sort which merely opens to the full all. the win-

ows on one side. Our experience answers this question emphatically
the affirmative. Except on the most sultry days, when children

ould be easily assembled out-of-doors for their school program, the

entilation of this room has been quite adequate. In the coldest winter
weather the temperature has hovered between 20° and 38° Fahrenheit
while the activities of the school have gone on without interruption.
In short, we may say that the history of the class and the results attained
in this room present a satisfactory parallel to the best type of Open Air
Schools.

It is not my intention to give a large array of details concerning
this severely simple experiment of our city. It should suffice us to know
that the program of the school follows the usual lines in accordance with
the tradition "Double rations of air, double rations of food, half rations
of work." The children receive some form of light nourishment at
the beginning and end of the session and a good square meal at noon-
time. From calculations made by the domestic science teacher we
know that every child receives in this way about 1,000 calories per day
in the form of easily digested food, besides the two meals that he eats
at home. Due emphasis is placed on exercise, especially on singing.
Manual training and lessons in domestic science give variety to the pro-
gram for the week but take the pupil out of the open air room for an
occasional period. With all the freedom and spontaneity that character-
izes the life of this particular room, discipline is not forgotten for a
oment, and the weaklings who are too prone to be peevish and selfish

n entering, soon acquire habits of courtesy and mutual helpfulness
"which give to the class a delightful air of good fellowship and loyalty
to the institution. This improvement in the morale of the children
may be due partly to the excess of oxygen, but is chiefly the result of
expert management on the part of the teachers, who prize character

uite as much as physique.
As this class is housed in the same building with several hundred

ormal children, great precautions are taken to exclude all sorts and

94 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

conditions of contagious disease. No cases of active tuberculosis are
accepted and if a child develops any symptoms of this or any other
contagious trouble he is at once carefully examined, and if necessary
excluded until the suspicion is cleared up.

The enrollment of the class seldom exceeds twenty. The grand total
of pupils, from the first day to the present, is slightly over one hundred,
ranging in age from six to seventeen years and comprising all sorts and
degrees of physical defects, such- as anemia, weak lungs, weak hearts,
nutritional disorders, chronic appendicitis, asthma, nervous disorders —
including one epileptic — mouth breathing, spinal curvature, and various
deformities resulting from disease or accident.

Each child receives a careful physical examination on entering
the class. This is the beginning of an active and persistent campaign
for the medical and surgical relief of all his removable defects. Great
credit is due to the teachers for their enthusiastic work in following up
the recommendations of the medical inspector. Through their labors
about two-thirds of the children have received relief from dispensaries,
hospitals and private practitioners. Teeth, tonsils, adenoids, defects
of vision and hearing, skin diseases and nutritional disorders have
submitted to treatment because the teachers have insisted and per-
sisted until they have brought the child and the doctor together. Or-
thopedic appliances have been secured for the cripples, and the little
girl with appendicitis was relieved of her chronic misery by an operation
at the hospital.

It is no wonder that, with such zealous care, and with the wholesome
influences of the open air room the pupils have gained an average of
yi pound per week during their attendance at the school. One girl
gained twenty pounds in forty weeks; another added to her emaciated
body seven and one-half pounds in six weeks. Comparatively few of
the pupils have remained in the class for more than one year. As soon
as they are sufficiently improved to return to their former classes they
are "promoted" although there is a feeling among them that it is a mis-
fortune to graduate from the Open Air Class.

While the children of this room are all debilitated in some way or
other, and on that account are obliged to make special efforts to get
to the Open Air Class, and while some of them travel long distances
on street cars, the attendance record for these twenty pupils is better
than that of the ordinary grades. They cannot afford to be absent
from their school and they manage to get there in all sorts of weather.

If the children realize instinctively their need of this open
air school why cannot their elders take the hint and supply this need
by enlarging the school to accommodate hundreds instead of scores,
and by helping the most delicate pupils to and from the school? We

OPEN WINDOW SCHOOLS IN BUFFALO

are glad to say that our city has begun to meet the growing demand
by opening a second fresh air room in another quarter of the city. This
room has windows on two sides — also sunshine — and accommodates
thirty children. As it has opened very recently we have no statistics
^^at hand concerning its work.

ll^ This is but a brief summary of our short experience with open window
iHfchool rooms. Our plant is by no means ideal. We would prefer
specially constructed buildings, apart from our large public schools,
ith such accessory aids as baths, parks and school gardens. We do not
ssess these alluring features in our open air schools. But we do not have
abandon the schools for want of these luxuries. We have secured
Excellent results worth striving for, right inside of an ordinary public
^^chool building. We have hundreds of rooms in the city that can be
^fcened to the air on one or two or three sides ; in some of them we have
■Sunshine too. And we have thousands of children whose minds and
bodies would rejoice in the exhilaration of such an environment. We
needn't reserve our good supply of fresh air for the weak and debilitated
child. It is good enough for the so-called "normal" child, too. For
this reason we hope to see these simple open window school rooms
opening up by the hundreds all over our city, and changing the des-
tinies of many nice little boys and girls who are regarded by their teachers
i^as not being particularly smart. We want a whole lot of plodding teach-
■^■rs to appreciate the significance of such little items as CO2 and 80°
"^rahrenheit.

On the whole, we rather like the Open Window Room. The idea
can be applied to any room, dungeon, den or other place of confinement
in which school is kept. In some respects our Open Air Class is better
off than the more modern schools that dwell in tents and shacks. We
have less interruption during storms of wind and rain; the roof never
blows off, as in some of the canvas houses ; the glass doesn't smash under
atmospheric pressure as in some schools of the conservatory type; our
school is never hopelessly frozen up; it never had to be thawed out,
d the pupils never get wet feet in their efforts to secure fresh air.
Considered merely as a station in our progress toward the ideal,
the open air school room is full of suggestion and delight.

96 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE ARCHITECTURE OF OPEN AIR SCHOOLS

John V. Van Pelt

The number of words and time at my disposal are so limited and the
subject of open air school architecture so large, that I shall have to
confine myself to dogmatical statements or to expressions of personal
belief, without adducing the arguments that uphold the statements.
Unlike the architecture of the ordinary school where experiment has
prescribed the type, open air schools have not yet been built and tried
out. Ferry boats have been adapted to the use, open air school rooms
have been built or altered from old school rooms as minor parts of
buildings, roofs covered and uncovered have been turned to the purpose,
but the complete school, planned in all its details toward the one end
and of an advanced type, is yet to come.

In describing the ideal conditions to which I think such a school
should conform, I have in mind a type slightly less radical than what is
sometimes known by the title, namely, a school that is entirely out of
doors with little more than a roof, and is typified by those at Shrews-
bury House and Bradford in England. On the other hand, something
that is considerably more open that what has been styled the low teni-
perature school, such as the Graham School, or than such schools as
School No. 21 in New York, where the rooms have been adapted from
the regular type by merely changing the pattern of the windows and
keeping them open. In other words, I propose a building so constructed
that the air in all parts of rooms where the children remain, will be
continually replaced by outdoor air that has only sojourned a few seconds
within the limits of the building, yet not a building that is entirely
without heat.

First, I wish to consider general aspects of the plan formation. The
ground for such a school should be sandy or gravelly without too much
clay, so as to preclude a humid condition in the entering air. It should
be protected from the wind, pine, spruce, etc., forming an excellent
screen ; but these trees should not be too close to the building and should
not cast a shade upon it. City schools should be so situated that sun
will not be cut off from them by adjacent skyscrapers. This is also
important because the high buildings of our later construction cause
concentrated air currents that would render work in an open air school
almost impracticable, by blowing papers and material about and forcing
dust and dirt up and through the school. Exposed conditions, such as

THE ARCHITECTURE OF OPEN AIR SCHOOLS 97

Riverside Drive in New York City, would be objectionable, rendering
it difficult to protect the school rooms from violent storms.

The orientation of the school should be such that sun will enter all
class rooms during a part of any day in the year. This is especially
important in such rooms as study rooms, where the children sojourn
for a protracted period. As the rooms are all open, it is not so important
that the greatest length of the building be across the direction of the
prevailing wind and it is important that it be not across the direction
from which storms are likely to come; but* no room dedicated to the
children should be in a pocket so that free circulation is impeded.

Toilets are to be placed so that odors cannot reach the open class
rooms. An unsanitary condition of this kind will become particularly
objectionable in warm weather.

It is essential that the plan be so arranged that all class rooms, study
rooms, the auditorium and wherever the children remain shall have
ventilation on two or more sides and to really fulfill conditions properly,
the room should be open on at least two sides that are opposite each
other. Corner rooms with windows on the sides perpendicular to each
other may be satisfactory when there is a sufficient amount of wind;
'but when there is little movement in the atmosphere, a dead corner
with eddies is likely to retain the air in certain portions of said rooms.
On the other hand, if rooms are entirely open on two opposite sides
without protection, a storm or misty rain will carry completely across
the room. For this reason, an open gallery is advantageous. Such a
one is shown in the ideal open air school originally prepared to illustrate
the important contribution to this subject made by Dr. S. A. Knopf
in his paper at the International Congress on Hygiene and Demography
in Washington, D. C, September, 191 2, and will be found in the plans
and model that I have on exhibit at our present Congress.

General plans may be divided into three classes: The "U" or "H"
plan, where the wings are about open courts, the "T" or "Star" plan,
where the wings radiate from a center, and the enclosed court plan.
The last named is not so good, and all plans should so enclose the courts
that the latter are open on at least one side which is not the north. This
is to insure the entrance of the sun into all parts of the court during
some part of the day.

I see no objection to building three stories high above basement
or higher, if means of ascent can be provided. Open galleries and open
staircases are good, provided they are protected from snow and sleet.
A great advantage is that children passing between the cold rooms do
not undergo a sudden change of temperature. Snow and ice are par-
ticularly dangerous in the staircases.

98 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

An objection to placing class rooms on the ground floor, is dust
and odors from the street and the general impurity of the air.

Overhanging cornices are good, because they afford protection from
rain for the open windows; but on the top floor they cast a shadow.
A glass cornice, like a marquise, might be extended at the top of the build-
ing, or such protection might be constructed over each of the large
windows. It would certainly be unusual in its appearance and difficult
to make it appear architecturally attractive. -

The auditorium should be so situated that it can be thrown entirely
open. It may be convenient to have it arranged so that it can be closed
for special exercises, when visitors are present.

Under a second head, I am grouping some recommendations for the
details of the building.

Class rooms should have predominant unilateral light, that is, the
light on the left of the pupils should be stronger than that from other
directions.

Blackboard space must be preserved, especially behind the teacher.

Sills may be three feet high on the side whence the light comes,
namely, the maximum for the ordinary sill. Higher than that, they
cast a shadow. It has been found in the experiments made by Mr.
C. B. J. Snyder, architect of the Board of Education of New York City,
that low sills are disadvantageous, because they create draughts around
the pupils' feet, taking away warmth, do not materially improve the
general condition of the air and are of no advantage to the respiratory
organs.

If blackboard space is maintained opposite the lighting windows,
large windows should open up the room above these blackboards; but
it is not good to place children immediately under a high sill, as the cold
air dropping down on them may be objectionable.

Class room windows must be so arranged that any side from which
comes a heavy driving storm or a drifting mist can be closed. In such
schools as the Providence School, one of the first open air schools of the
country, hinged windows were tried. Mr. Snyder has experimented
with these and they have not been found as advantageous as pivoted
sash dividing the windows into three parts, the upper half of the lower
sash opening in so that it projects above the head of a full grown person.
Still more recently the scheme of operating the two upper sash together
and the lowest sash independently has been adopted. Such sash some-
what inclined to the outside, form a protection from slanting rain, throw-
ing the water out of the building. Double hung windows are possible
running up into pockets in the head of the windows and below the sill
of the window above so as to leave the entire opening free. They are
somewhat difiicult to operate and do not afford any protection.

THE ARCHITECTURE OF OPEN AIR SCHOOLS 90

In the U or H plan, if the court is not wide, the noise from class rooms
opposite each other is objectionable. I will take up preventives later
in discussing acoustics.

Class rooms may have the floor warmed. This would slightly temper
the air and keep the children's feet from becoming cold, tending to dry
them if they had not come to school with rubbers. This will also be
referred to later. Wood floors are good to walk on, as they are not too
hard, and very durable; but rain, snow and dampness soak into them
and are objectionable. Linoleum is good, especially if it can be cemented
down. It wears out rather easily and is therefore expensive. What
is known as composition floors are somewhat expensive, but come within
a possible range of prices. They can be made in different ways, and a
type should be selected that is not too hard under foot. If the floor is
heated, it must necessarily be of a material that will not be affected by
the heat. For this reason the warmed floor shown in the design I have
made is attained by metal plates separated by composition.

Coat rooms should be well ventilated, but kept reasonably warmed,
that is about 65° Fahrenheit. This will appear quite warm to the
pupils coming from the class rooms and halls, and a higher temperature
would be uncomfortable before the smaller children could succeed in
adjusting their clothes. It may be suggested that coat rooms could be
omitted, in that the children wear about the same clothing in the
class room that they do out of doors. If they have to come to school
through snow and storm, their outer wraps should be taken off and dry
wraps put on, and I believe it would be better to pjrovide a proper place
to keep such wraps, allowing the damp ones to dry.

Furthermore, exceptional cases occur where fragile or anemic chil-
dren suffer from time to time from the cold. This has been noted
in the Graham School reports, and the warmed cloak room offers an
excellent place where their vitality may catch up. Although limited
space may seem to force wardrobes in the class rooms, I consider it a
bad solution. In such case a warmed room for recuperation should
be provided on each floor.

Toilets must necessarily be warmed, as the children have to remove
some of their clothes, and in very cold weather plumbing pipes would
freeze. A temperature of 60° to 65° is ample. Anything higher than
this would be bad. Toilet rooms should be screened to prevent insects
from entering through the open windows. As in all schools, an auto-
matic means of flushing toilets should be provided, as the children
cannot be relied upon to do this properly.

In laboratories, manual training rooms, etc., provision often has
to be made to maintain such a temperature that liquids under study
will not freeze, and where fine and delicate work is done, the temper-

lOO FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ature cannot be allowed to go quite as low as where some protection
for the hands may be worn in cold weather. Furthermore, below a
certain temperature it is not easy, and for some persons, not possible
to perform very delicate work. Steam radiators should be introduced
in such rooms and if a number of small radiators are scattered about,
the heat can easily be graduated by turning on one or more and allowing
the others to remain empty. Provision must be made for draining
these radiators rapidly.

Rooms for visitors should be provided where the temperature is not
allowed to fall too low, and heat will probably be required in the prin-
cipal's and teachers' rooms.

In spite of the fact that such a school is open and a considerable
amount of heat lost, the fact that the average temperature of the build-
ing is kept so much lower than is ordinarily the case, will probably
show a slight saving in coal over the usual type of school house. Suffi-
cient experiment along this line has not yet been made to definitely
determine the proportion.

Hot water systems cannot be used, owing to the danger that pipes
and radiators may freeze. Hot air is useless, as it cannot be controlled
in such a building. Steam or water vapor are therefore the only pos-
sible means of heating, and water vapor is hardly effective enough
under the conditions that usually obtain.

Heating the floors of the rooms has already been mentioned. The
floors should not be overheated, chilblains would probably result to the
children, in the cold rooms the steam that would form would probably
be objectionable, a high degree of heat would cause odors. About 40°
centigrade is a maximum temperature for a floor surface.

The acoustics in such a building play an exceedingly important role.
In an auditorium they must receive special study, as the open windows
supply the equivalent of total absorption, and furthermore, allow exte-
rior sounds to penetrate. This would make speaking in the rooms
more dead, and in the noisy quarters of a city, exterior sounds would
become predominant. In the class room, the question becomes quite
important. Up to the present time, sufficient attention has not been
paid to the acoustics of the ordinary school. At the new Brierly School
in New York City an effort has been made to introduce a reasonable
proportion of deafening material. Absorbent felt has been placed on
the ceiling and this has been covered by a muslin blind-nailed, on which
paper has been pasted, the latter being decorated in waterproof color
to give a smooth surface. In the open air room, where class rooms
are opposite each other, across a somewhat narrow court, the sound
would be thrown over to the opposite room and would cause reverbera-
tion in the court. This would be increased by a non-absorbent wall

THE ARCHITECTURE OF OPEN AIR SCHOOLS loi

and opposite the windows of the first room, notably if large blackboard
spaces covered the reflecting wall. In certain cases it is possible that
the reverberation in the room would be sufficiently reduced if absorbent
material were placed on the ceiling of the rooms, and sound entering the
class room might be sufficiently absorbed if the reverberation were
kept down. On the other hand, conditions might exist as previously
noted, where a concentration of sound from a reciting class, might be
thrown out of the window and into the opposite clas3 room in sufficient
proportions that the direct sound would be objectionable. It will appear
from this that a special study of the acoustics for each class room should
be made. In order to obviate the difficulties mentioned, in the drawings
here exhibited I have shown a glass screen that might be built in front
of the windows, deflecting the travel of the sound to a certain extent,
without preventing light from penetrating the room. If the screen
were inclined away from the head of the windows and Luxfer prisms
introduced the sound would be dissipated and the light increased, but
such increase might not be desirable.

It is surprising that the medical profession which has occupied
itself so considerably with the light and color of the walls in class rooms,
should have been so oblivious to the nervous strain created by the dis-
cordant sounds in recitation in class rooms, or, on the other hand, brought
about by imposing too rigid silence and restraint on small children,

In the matter of light, the general color of the class rooms should be
that of the ordinary room, except that it must be kept in mind that to
light a wall reflecting a glare from the snow on a winter's day, would
be trying. As a much larger quantity of light will probably penetrate
the rooms than ordinarily enters the class room having glass areas of
only 20% to 25% of the floor area, the walls of the room might advan-
tageously be somewhat darker.

It is due my audience to explain that although the complete open
air school contemplated in the foregoing paper is still unrealized, I have
felt that I could speak authoritatively because of extended experience,
on the one hand, in building schools of various types, and on the other,
in some twenty years of theoretical study and practical experi-
ment in the construction of sanatoria for the treatment of tuberculosis.
These are the two types of building that must be parent to the new ideal,
and in closing I can not do better than urge that as you investigate
details beyond the scope of this curtailed resum6 they be studied simul-
taneously in exponents of both of these types.

102 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

discussion of the papers of
Drs. Woodruff and Barrows, and Mr. Van Pelt

Duncan B. McEachern

Mr. Chairman, Ladies and Gentlemen:

The point was raised by Dr. Barrows that the cost of feeding Hmited
the appHcation of the Open Air School. I want to thank Mr. Van Pelt
for his presentation of the architectural needs of such schools. I believe
it answers Dr. Barrows' contention.

In his scheme he made provision for heat through the floors, radiators,
etc.

It stands to reason that food requirements are greater in cold than
in moderate temperature conditions. There is evidently some con-
fusion between the cold air and fresh air advocates. What we are after
is fresh air. Humidity is the crux of the situation. We have also been
led astray by the so-called tuberculosis experts, who desire to apply
their narrow specialty, and confine the use of such rooms to tubercular
children. If a tubercular child is worth saving, surely the healthy,
normal child deserves consideration, before he has contracted the disease.

Scientific technique, if governed by narrow specialism of this kind,
will interfere with, rather than promote, the growth of open air rooms
in the public school.

I can best illustrate my point by referring to a statement of Madame
Montessori, in which technique and specialization have resulted in failure,
or in at least obscuring the real issue. The orthopedic experts have
been exercising their ingenuity and skill in developing an adaptable
desk for children with spinal curvature, after the regulation desk has
been the chief factor in producing the pathology. And she hints at the
weird possibility of some future orthopedic expert advocating surgery,
or other measures, as a supplement to desk improvements. And the
spectacle of our children being regularly suspended by the chin is a
possibility, if sufficient pressure is brought to bear upon school boards.
When the whole proposition is best answered by throwing out all the
desks.

Similarly, if we are governed by the ideal architectural requirements
which Mr. Van Pelt has outlined, we may make all our rooms open-air
rooms.

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N. J. 103

RESULTS OF OPEN AIR TREATMENT IN PUBLIC
SCHOOLS OF NEWARK, N. J.

George J. Holmes

Open air treatment in Newark has been conducted on two different
plans: The Pavilion Type and the Open Window Type; likewise for
two different types of children: The tubercular and the ansemic, frail,
under-weight non-tubercular.

Both types of classes were born of necessity, as pupils so afflicted
were numerous and to make no provision for such seemed a failure on
my part to perform my whole duty.

History of Open Air Movement in Newark.

The establishment of the first open air class took place in September,
191 1. This was the Pavilion Type and was used to accommodate
ansemic, frail, under-weight pupils. Later this class was removed to
another building, being housed in an open window class room.

The Pavilion Type Class, less than a year later being devoted to the
care and instruction of pupils afflicted with pulmonary tuberculosis, who
because they were a source of danger to others, were excluded by the
Department of Medical Inspection from attendance at a regular class.
This movement has grown slowly until now there are in our city one
Pavilion Type Class for tubercular pupils and three Open Window
Classes for ansemic, frail, under-weight pupils.

The Pavilion Type Open Air Class.

Equipment. This consists of a frame pavilion standing about two
to two and one-half feet above the ground, covered entirely by a roof,
open on three sides but having protection for the feet and limbs afforded
by the front, and sides being built up about three feet from the floor.
This allows a free circulation of air but protection from the wind and
storm.

The floor area of this pavilion is 750 square feet. A canvas shield
is provided which can be put up and fastened in place on any side, to
keep out the wind and storm when coming from a certain direction or
to shut out too strong a cross light, but the latter is hardly ever required
as the desks are movable so that the light is always being received in
the proper direction.

104

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

These desks and seats are individual and of all sizes, as this is an
ungraded class. Each desk and seat is provided with cleats, making
them firm but movable. A portable blackboard and the usual books
and other equipment are furnished.

The personal equipment consists of caps, gloves, overcoats, sweaters,
reclining chairs, sitting-out bags, soap-stone foot warmers, tooth brushes,
sputum cups, paper handkerchiefs, and paper towels. Each article
is marked with the child's name. Car fare to and from school is also
furnished.

In a stone building against which this pavilion is placed there are
installed cupboards and drawers for storing away equipment of the

FIGURE I
Pavilion Type Open Air School

pupils, also a stove for heating the soap-stone foot warmers, which is
operated with charcoal. There is also sufficient space for storing the
desks, seats, blackboards and teacher's desk at night, which are easily
carried in and so protected.

Alongside the pavilion and store-house is a large frame building
which might be called the dormitory, in which there are two large rooms,
separated by a sliding partition. Each room has a floor space of 1,400
square feet. The light and window surface is large, coming from all
sides but one. The ceiling is 15 feet high, thus affording two large,
airy rooms, well lighted.

The room with the southwest exposure is utilized as a rest room
for pupils and it is here that the reclining chairs are placed and where
all pupils are required to take their after dinner rest and sleep for an hour.

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N. J. I05

The remaining room is used for a dining-room and kitchen, one corner
of which is railed off for a kitchen, in which space is installed a coal
stove, hot water boiler with gas heater connection for summer use,
two gas stoves with ovens, sink with hot and cold water connections,
two kitchen tables. The railing, separating the kitchen from the
dining-room, is fitted with a flat top which acts as a service table.

There are installed in the dining-room proper four long wooden,
highly polished tables with chairs sufficient in number to accommodate
the forty-five pupils enrolled. For the sake of better discipline and
order the boys and girls eat at separate tables.

A pantry and cold closet adjoin the kitchen, in which are stored

FIGURE 2
Open Air Pavilion for Tubercular Pupils

the ice box, dishes and food stuffs. All windows and doors are screened
to keep out the flies.

The basement of this building provides for both girls and boys;
sanitary drinking fountains, toilets, wash basins and a steam heater,
which latter is never used except to keep the basement dry.

The above-mentioned buildings are located on a knoll overlooking
Weequahic Park, which is not only pleasing to the eye but affords plenty
of clean, fresh air.

The Operating Staff consists of a head teacher and assistant, a janitor
and his wife who acts as a cook. Besides the above whole time employees,
there is provided the daily services of a medical inspector and frequent
visits of a school nurse.

I06 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Qualifications for Entrance. Up to date no pupil has been permitted
to enroll in this class unless it is evident, after a medical examination,
that he or she suffers with pulmonary tuberculosis.

The cases are discovered by the medical inspectors in the various
schools. Immediately the diagnosis is made by a medical inspector
the case is assigned to a school nurse to visit the home, whose duty it
is to obtain and record, on a printed form, a complete record of the
family history, previous history of the pupil from birth, present history
of pupil and social history of family, also obtaining written consent for
the examination of the pupil by the Supervisor of Medical Inspection.
The pupil then visits the Supervisor at his office, accompanied usually
by one or more relatives. The Supervisor at this time conducts a com-
plete examination, covering the general condition of the pupil, recording
weight, per cent, of haemoglobin, height, the condition of the eyes, nose,
throat, heart, lungs, etc. Should the diagnosis of pulmonary tuber-
culosis be confirmed by the Supervisor the Von Pirquet Tuberculin Test
is at once conducted and its results afterwards recorded at subsequent
visits. Recommendation is then made by the Supervisor to the Super-
intendent for the transfer of such pupil to the Tubercular Class.

By this method it is evident that few mistakes in diagnosis will be
made. In our city the tubercular class or school only accommodates
forty-five pupils, with the results that there has been a waiting list of
thirty or more pupils who have been examined and found tubercular;
because of this limited accommodation only the positively tubercular
pupils and much needy cases have been enrolled, making it doubly sure
that all pupils are pronounced tubercular subjects.

Curriculum.

Daily Plan of Operation of School. The school session is from 8:45
to 3 'p. m. On arrival at school each morning each pupil is given a break-
fast consisting of the articles set forth on the menu. On finishing the
breakfast the mouth temperature of all pupils is taken and recorded.
On completing this all pupils file into the basement to wash their teeth,
face, and hands. Then each pupil whose temperature has not been
abnormal, puts on its outer garments, the character of which depends
on the season of the year. Class instruction then begins in the open
pavilion and continues up to th€ noon hour. In all about three hours
of serious instruction is given.

No pupil having a temperature of 99.5 or over is permitted to attend
school session, but is compelled to recline in his or her chair in the open
on the piazza, wrapped in the blanket and sitting-out-bag should the
weather require it. On first establishing the school there were quite

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N. J. I07

a number of such cases daily, but now it is only the new pupil, enrolled
from time to time, that has to be so treated.

At noon the class instruction ceases and a short recess follows, then
dinner, consisting, as will be seen by consulting the menu, of a hot,
well-cooked, substantial meal of fair variety. After dinner teeth are
again washed and pupils attend to their toilet, then enter the rest
room. No conversation is permitted and as a rule nearly all the
pupils sleep during this hour. This is not the case with the new pupils
on first entering the class, but after the first week they seem to fall
right into the spirit of the place and sleep, eat, work and play as they
find the others are doing.

FIGURE 3
Rest Period at Tubercular School — Dining Room at the Side

After the rest hour there remains about one hour more of the school
session which is employed in manual training or other occupational
study.

This school is an all year school having only two breaks in the ses-
sions; one week at Christmas and another week before the fall term
in September. This is not done for pedigogical reason but for health's
sake. It is found that invariably after the pupils return from their
mid-winter and fall vacations that they have lost in weight, which is
due undoubtedly to the pupils running wild, not getting sufficient rest
and food.

For this reason, therefore, with tubercular pupils it is considered
wiser and cheaper to retain them in school the year round, where they
can be properly supervised and not lose the advantage already gained.

I08 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Diet. It will be seen by consulting the daily menu that the Super-
visor, through the Board of Education, offers the pupils a varied, whole-
some diet, keeping in mind the need chiefly of good rich milk, eggs,
and a rich carbohydrate diet with sufficient proteid diet.

The Newark Board of Education is one of the few Boards offering
to its pupils such generous school meals, paid for entirely out of the
school funds. The results justify the expenditure.

BREAKFAST

DINNER

SUPPER

Rice and milk

Mutton broth with barley

Cocoa

Cornmeal mush and milk

Split pea soup

Raw egg

Oatmeal and milk

Vegetable soup

Bread and butter

Cream of Wheat and milk

Boiled mutton

Hominy and milk

Hamburg steak
Creamed codfish
Lamb stew
Baked beans
Baked potatoes
Mashed potatoes

•

Stewed Lima beans

Spaghetti with tomatoes and cheese

Bread and butter

Fruit tapioca

Apple sauce

Prunes

Bread pudding with raisins

Rice pudding

Caramel custard

Stewed peaches

Peanuts and dates

Bananas

Chocolate ice cream

Health Supervision. This school receives the daily visit of a medical
inspector whose duty it is to inspect each pupil for the presence of con-
tagious or infectious disease; to consult with the teachers and nurse
regarding any pupil in particular; to conduct a complete physical ex-
amination of each new pupil on arrival, recording his findings and mak-
ing his recommendations in writing to the parents; to refer such pupils
requiring treatment to the school nurse with the request to make a home
visit and cooperate in the cure of each defect or disease; to weigh each
pupil weekly, recording the weight on forms supplied, investigating
and recommending for treatment and special care all pupils not gaining,
or losing in weight, or running an abnormal temperature ; to recommend
to the Supervisor regarding the cure and arrest of the disease and the
transfer of the pupils cured back to the regular school.

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N. J. IO9

No pupil has been transferred back to its regular school or permitted
to go off roll definitely without the weight, height, and haemoglobin
index being recorded and definite recommendation, stating that the
medical inspector finds the pupil well and the disease arrested, and not
then unless his findings are corroborated by the Supervisor after a care-
ful physical examination.

The school nurse follows up the recommendation of the medical
inspector in respect to each pupil, visiting all the homes, consulting
with the parent or guardian with regards to the physical condition of
the pupil and his needs; making observation of the home conditions
with respect to the housing, especially the sleeping apartments; inquir-
ing into the nourishment of the pupil at home; his hours of rest; and
instilling in the parent an interest in what is being done for the pupil
and a cooperation that, with very few exceptions, has been appreciated
with the result that teeth have been repaired ; tonsils and adenoids have
been removed ; glasses obtained and a variety of other surgical and med-
ical treatments instituted with the resulting benefit to the pupils.

Sanitary and Health Instruction. Each new pupil and periodically
all pupils are taught through practical talks given by the physician and
nurse with the aid of a portable exhibit, the origin, means of infections,
prevention and cure of tuberculosis. They are also taught the use of
the sputum cup, the necessity of guarding against infection of others
by the destruction of sputum, the use of the handkerchief while cough-
ing, the necessity of having their own tooth brush, towel, face cloth
and dishes — in fact all that is known and practical for them to learn
and put into daily use.

Enrollment. The total enrollment of the tubercular class since
its origin to July ist, 1913, is 80.

The total enrollment for the year 191 3 was 62. The average enroll-
ment for the year beginning July ist, 1912, and ending July ist, 1913,
was 43 >^. The average attendance for that same period was 37>^.

The average enrollment for the year beginning September, 191 1,
and ending June 30th, 1912, was 35. Average attendance for the same
period was 30.

Considering the fact that this school is located at the extreme south-
ern boundry of our city, that it is only reached by one car line which
makes travel difficult many times in stormy weather, also that the school
draws its patrons from all sections of the city, many of whom have to
travel two or three miles to school, also the fact that all of these
pupils are sick and subnormal in health, it will be granted that this
showing in average attendance is very good.

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

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OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N.J. II3
Diagram Illustrating Gain in Haemoglobin.

FIGURE 6

25 to 50% in haemoglobin

3.79% of total enrollment
50 to 75% in haemoglobin

37-98% of total enrollment
75 to 100% in haemoglobin

58.23% of total enrollment

FIGURE 7
25 to 50% in haemoglobin

1.26% of total enrollment
50 to 75% in haemoglobin

5.07% of total enrollment
75 to 100% in haemoglobin

93-67% of total enrollment

Analysis and study of information and facts obtained through
investigation of family histories, previous histories and observations
of pupils in the school has uncovered some very interesting data.

Of the eighty pupils so far enrolled the average term enrollment
has been eleven months plus. The average age of the boy, on entrance,
was ten and one-half years; the average age of the girls on entrance
was twelve years; the average total age of both girls and boys was ten
and three-fifths years. The average per cent, of haemoglobin on entrance
was 78.9%. The average height on entrance was 54.5 inches; the
average weight on entrance was 62.4 pounds. The average number
of pounds below normal in weight as compared with the height, on
entrance, using the Bowditch Scale of Weights, was 9 pounds.

Forty-one and one-eighth per cent, of the total enrollment on investi-
gation gave a family history of tuberculosis. Forty-seven and one-half
per cent, of the total enrollment have been in direct contact with a case
of pulmonary tuberculosis in their homes.

Ninety-one and one-fifth per cent, of the total enrollment showed,
on examination, positive physical signs of pulmonary tuberculosis.

Ninety-three and seven-tenths per cent, of the total enrollment
gave positive reaction to Von Pirquet Tuberculin Test. On conduct-
ing a physical examination of both boys and girls enrolled it was found
that there was an average of 2.6 physical defects other than those found
in the lungs.

114 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Results. During the period beginning September, 191 1 to July 1st,
1913, the following results have been obtained:

Sixty-one per cent, of those enrolled have had the disease in the
lungs arrested.

Sixty per cent, of those enrolled h?ive been cured.

Thirty-nine and one-half per cent, of the total enrollment have im-
proved.

One-half of one per cent, of the total enrollment have not improved.
This latter is a very small percentage, as in this number are included
four pupils who died, two pupils who were at the school a very short
time (one to attend a school in another city, the other because she was
too small to make xhe trip daily on the cars to and from school) and
left the school.

The average gain in weight has been eight and one-quarter pounds.
The average gain in haemoglobin was 7.5 per cent.

The per cent, of those having physical defects and receiving treat-
ment for the same was 57.5 per cent. This treatment took place while
the pupils were enrolled in the school, and is directly the results of the
efforts exerted by the department of medical inspection, through its
physician and nurse. Their efforts in behalf of the. defective pupils
awoke a spirit of interest and cooperation in the parents, with a result
that teeth were repaired, tonsils and adenoids were removed, glasses
obtained as well as many other surgical and medical measures. None
of this treatment was given in school, but was obtained at free clinics
connected with the hospitals or from private physicians or dentists.

Thirty-three and seven-tenths per cent, of the total enrollment
have been transferred back to their regular classes in other public schools.
Of this number none so far have had to return for further treatment.

Occasionally a parent offers slight objection to the enrollment of
a pupil in the tubercular school for fear he or she may be retarded
scholastically. No doubt there are some educators who feel doubtful
about the mental progress made in such an open air school. Our records
kept with care during the period this school has been in operation, show
that 81.2 per cent, of the total enrollment received and were entitled
to promotion, while 18.8 per cent, failed of promotion. This is a very
small per cent, when it is known that it includes those that died, those
that left school after a very short period of attendance and one
pupil that is undoubtedly feeble-minded.

The mortality of the school since its opening has been one-half of
one per cent., the total number of deaths being four, one of whom
it is reported by the city health records as being directly due to diph-
theria, the other three to pulmonary tuberculosis.

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N.J. II 5

Cost of Maintenance. The annual cost per pupil for salaries, supplies,
repairs, etc., based on the average enrollment and for ordinary expenses
for the year 1912 was $120.92. Of this amount $66.04 was for salaries;
$44.26 for text books and educational supplies; $0.13 for miscellaneous
items and $3.36 for repairs, and $7.13 for miscellaneous supplies.

The annual cost per pupil for the year 191 3, covering the same
items as previous year was $109.94. Of this amount $60.93 was for
salaries, $41.15 for text books and educational supplies; $6.13 for mis-
cellaneous supplies; $0.31 for miscellaneous items and $1.42 for repairs.

FIGURE 8
Rest Period at the Morton Street Open Air Class

Conclusions. It must be apparent on considering the above men-
tioned facts that pulmonary tuberculosis in its incipient stage is com-
rparatively common in pupils of elementary school age.

That pulmonary tuberculosis will be frequently discovered on con-
ducting a careful, painstaking physical examination.

That on discovering physical signs in the chest, accompanied with
[failing health, a positive Von Pirquet reaction, the exclusion from a
regular class is justified and the transfer to an open air class imperative.^

That pulmonary tuberculosis in children, discovered in its incipient
stage, is curable without exception by placing the patient in a healthful
environment, properly clothed and fed.

That medicine plays a very small part in the cure of incipient tuber-
culosis.

That in pupils of primary and elementary school age, suffering with

Il6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

pulmonary tuberculosis, over 93% gave positive reaction to the Von
Pirquet Skin Test.

That contact with a case of pulmonary tuberculosis in the home
readily causes infection of the child ; that children in contact with a case
of pulmonary tuberculosis in the home will react positively to a Von
Pirquet Skin Test even though there are no physical signs of disease
or clinical symptoms.

That provision should be made in open air classes for the care of
other forms of tuberculosis, such as glandular, bone and joint tuber-
culosis.

FIGURE 9
Pupils at the Morton Street Open Air Class Receiving Nourishment

That no harm would result through infection by placing in the
same school all forms of tuberculosis regardless of the particular part
of the body affected.

That incipient tuberculosis can be cured in children without neglect-
ing their education, without breaking up the home or the expenditure
of large sums of money.

That instead of inheriting a predisposition towards tuberculosis
from the parent, which is commonly held responsible for the appearance
of the disease in the offspring, the child has received through contact
with the diseased subject an absolute infection which lies dormant and
under adverse conditions of physical health or environment takes on
renewed activities, developing some later clinical signs of disease.

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N.J. II 7

Open Window Type Open Air Classes.

These classes, three in number, differ from that provided for the
care of tubercular pupils in that they are located in regular school build-
ings. In describing these classes I shall make no reference" to one as
it has been in operation only a few months and so has not produced
many results.

These classes are simply the regular class rooms located high up
on the third floor of each building above the dust line, having a south-
easterly exposure with large window space. One row of seats have been

FIGURE 10
Montgomery Open Air Class

removed allowing greater floor space for exercise. The rules govern-
ing the classes are that the windows shall be kept open at all times;
that the enrollment shall be kept at thirty; that the heat shall be kept
turned off; that the pupils shall have an hour's rest in their reclining
chair on the roof of each building each day ; that no pupil shall be enrolled
in the classes or discharged from the classes without the recommendation
of the medical inspector and the approval of the Supervisor of Medical
Inspection.

Qualification for Entrance to Classes. To be assigned to such a class,
each pupil must be subnormal in weight or general health. This in-
cludes pupils who are anaemic, frail, under-weight or convalescing from
disease. Each pupil is required to submit to a complete physical exami-

Il8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

nation by the medical inspector which includes weighing, measure-
ments, and ascertaining the per cent, of haemoglobin.

Diet. The only nourishment supplied to these pupils is milk, so that
the wonderful gains in weight cannot all be attributed to the nourish-
ment received.

Curriculum. The curriculum of these classes does not differ from
the regular class with the exception that they are smaller, ungraded,
and time is taken for more exercise and rest in the open air.

The personal equipment consists only of blankets, sitting-out-bags,
and reclining chairs. All pupils are permitted to wear their hats and
coats in the classroom when the temperature is low.

Health Supervision. This consists of the daily visits of a medical
inspector for the detection of contagious disease and general super-
vision of the health of the pupils; the monthly weighing of pupils and
recording of same; the examination of pupils for the detection of disease
or defects; the home visits of the nurse to bring about the correction of
defects, diseases, and improvement of health of pupils by urging that
treatment be obtained, that home sanitation be improved, diet and hours
of rest properly regulated.

Analysis of the facts taken from the records of the two classes for
the school years 191 2 and 191 3 are as follows:

Total enrollment for the two school years 124

Maximum enrollment for each class 30

Average " " the year 1912 (for two classes) 25 . 5

" " " 1913 " 28.5

age on entrance 9 . 26

height on entrance 49 . 5

weight on entrance 53-33 lbs.

per cent, of haemoglobin • • 71 • 75%

Total number of physical defects 410

Average " " " 3.3

Per cent, of total enrollment that were subnormal in weight (as to height) . . 82%

Per cent, of total enrollment who were normal in weight (as to height) 15%

Per cent, of total enrollment who were above normal weight (as to height)... .33
Average time on rolls 6^ months

OPEN AIR TREATMENT IN PUBLIC SCHOOLS OF NEWARK, N.J. II9

RESULTS.

Per cent, of those having physical defects who received treatment directly

due to efforts of the Department of Medical Inspection 72.75%

Average gain in haemoglobin 11.15%

" weight 3 .47 lbs.

Per cent, of the total enrollment cured 62 . 5%

" " " " • " improved 32.3%

" '* " " " not improved 5-2%

" " " " " who were transferred back to their regular

class 73-5%

Cost of Maintenance of Each Class.
(Based on the Average Enrollment.)

School

Average
Enrollment

Salaries

Text Books
Etc.

Misc. ^

Total
Per Pupil

Montgomery....

$42.10

$6.41

....

$48.51

Morton

42.13

12.31

$0.56

5500

120 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE SCHOOL ROOM WINDOW

Byron U. Richards

Soon after assuming the duties of Medical Director in our Public
Schools, I found myself confronting a peculiar problem.

The air was hot and dry in many rooms, less objectionable in others,
and I was pleased to note almost ideal conditions, in respect to ventila-
tion with reasonable temperature, in many of our smaller outlying school
buildings.

As there was no uniformity in this respect to be found, I became in-
terested to know the reason.

I learned that in many instances, the window only, was made use of,
for the interchange of outside air, to replace the class room product.

In other buildings, the scientific mechanical system had been in-
stalled, but the teachers had never failed to supplement this system,
with the open window. And yet in a third class, the holy precepts of
the unopened window were observed, the air was thoroughly baked
and dried, to the highest degree attainable, and all draughts and varia-
tions in temperature carefully avoided.

The teachers followed with commendable zeal the janitors' instruc-
tions, falHng short in no respect, but exceeding authority in one particu-
lar, viz., the temperature, which was nearly always far above that sanc-
tioned by the School Committee.

It was on account of this difficulty, and my desire to obtain improved
conditions in our over-heated school rooms, that my attention was
directed to the school room window.

In this paper I wish to consider the window only, leaving to other
men more able than I, in this Congress, to discuss the merits, if any there
be, and also the faults, which are many, of the mechanical system of
ventilation.

Architectural writers use much space in describing the theory that
we should have in our school rooms just one-sixth as much window
space as floor area, and if posts and other obstructions interfere, dis-
cussion is lengthened on the subject of position of the windows, in rela-
tion to these obstructions.

It is very strange that architects and others often overlook so simple
a fact as that the casements and sash take up much space in the window ;
in the aggregate it has been determined to be about twenty-five per cent.
I know an instance, where a room had been guaranteed a certain number
of square feet of window space, but by careful measurement of casements

THE SCHOOL ROOM WINDOW 121

and sash, after their installation, they were found to take up about
twenty-six per cent, of the opening intended, bringing the real glass area
to floor surface not quite one to seven and a half, instead of one to six.

Architects also hold opposing views on the question of window group-
ing. Some authorities on school room architecture claim the windows
should be as near equally distant, the one from the other, as conditions
will allow, leaving the strength of the walls unimpaired, while others
prefer the effect of grouped windows.

I believe the latter plan is best. Give us more window space, and
group the units as far as possible, which can be easily accomplished in
these days of steel construction.

The units for window space should be large. This fact is appreciated
in studios, galleries, and industrial plants of all kinds, and has been of
late approved by leading architects for school buildings.

An objection has been made to the large window group, that heat
radiation thereby becomes more rapid. This fault could be overcome
if found necessary, by installing the double glazed window pane. If this
is done however, care should be exercised in setting the glass very dry
and clean on the inside surface, otherwise the lighting willbe imperfect.

Buildings with this style of window arrangement are, in my judgment,
more artistic without as well as cheerful within.

Altogether too much censure has been made of the rear window light.
Light from the left side of the room only is all very well, provided there
is enough of it and the room is not too deep, but in this country we fre-
quently have rooms, thirty-six or more feet in depth with light admitted
only from one side. This, so far as I can learn, is not the custom abroad,
twenty-four to twenty-eight feet being about the limit for rooms lighted
in this way.

The principal objection to rear light is that it becomes front light to
the teacher. But the evil, if such it is, has been unduly magnified. I
have talked with many teachers of experience about this matter, and
only one had any objection to make, and that was due to a temporary
condition, namely, a glaring white cement wall had just been built near
the school, which at first reflected a high light, but took on a subdued
shade with a little age, and this teacher could then find no fault.

Teachers want more light in their rooms in which they can be happy,
and are too busy to stare at the light in any one direction.

I cannot understand why the top portion of tlie window opening
should be treated so differently from the rest of the window, unless for
outside artistic effect. Yet many transoms are not intended to be open,
some are made to open, little or much, as the case may be, many so
intended are immovable from one cause or another, some have clear
glass, some ornamented, and many are plain but opaque. When a tran-

122 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

som is Open as little as many are made to be, it affords a narrow current
of air, which, being colder than that of the room, falls down on the heads
of the children, and discomfort ensues. Even this poor use of the top
portion of the window is better than to make no use of it at all, but the
transom should be a large portion, or component part of the entire win-
dow, and its complete opening made possible. To accomplish this the
transom should be hung by the center horizontal pivot.

The use of shades for school room windows is an important matter.
Nearly all agree that the outside blind and the inside shutter should not
be used.

The top hung shade on the spring roller, as now almost universally
used, becomes a nuisance if the window is to be opened in the upper half,
owing to the rattle and flapping occasioned by the currents of air. The
best method for shading depends upon the style of window used. The
large horizontal pivoted sash should carry its own shade, including roller,
spring and catch, and for other windows the side supported, sliding
fixture, as the "Britting" so universally used in Washington seems to
answer all requirements.

Windows in our large cities, at any rate in their congested districts,
should have sashes either of metal, or wood covered with metal, as a pro-
tection from fire. The window is the most vulnerable part of a building,
made otherwise nearly fireproof, and when an adjoining stucture burns,
the brick schoolhouse becomes a wall of protection in every other part,
but no very high degree of heat is required to cause the frail wooden sash
to give way. The glass falls in and a current of air is formed which
carries the flame directly into the building. The school house belongs
to the city and should be made a means of protection in its vicinity,
rather than a menace.

We know that fire danger in our public schools is small, but we re-
member well the holocaust at Collinwood, O., five years ago, where 175
children perished. We are therefore compelled to believe that all urban
school windows should be fire proof, not only as to metal sash and case-
ments, but also the wire reinforced glazing should be installed. That
this is an important matter, I need only refer to a recent fire in one of the
upper floors of the tower of the Metropolitan Building in New York.
Such a window installation as I have described, no doubt saved at least
that portion of the great building.

What shall we require for school room windows after determining
their size, position and arrangement?

First — They must be secure.

Recently a large window of modern type was blown entirely from a
Massachusetts school building, and that no accident resulted thereby is

TitE SCHOOL ROOM WINDOW I2'i

truly fortunate. A few years ago the writer was called to attend a child
in one- of our public schools who had received a fatal injury resulting
from the neglect of this cardinal virtue.

Second — All sections of the window should move easily.

I have been greatly surprised to find so many immovable window
sections in the school rooms, and also to find so many more that could be
opened only a little, or if completely raised, the full strength of a man
was required. Such windows may quite as well be nailed down or bolted
when their operation is required of a frail school teacher.

The vertical sliding window is an example of this kind, ideal where
the style of building will permit of its installation and if it could be made
to work easily. '

Third — A proper device for locking, either open or closed, must be
found.

Obviously the window must be tight when closed that neither water
nor dust may gain entrance, and it becomes equally important that th^
sash should be firmly held when open, for a window sash, or curtain,
that rattles in the wind becomes a most disquieting influence in any
room.

Fourth — We must insist on a window that can be easily and safely
cleaned.

I know of no duty on the part of school officials that has been and is
more neglected than that of keeping the school room windows clean,
and as this reasonable act of cleanliness will certainly be demanded in
the future, we shall need windows that can be cleaned with the least
labor and the greatest degree of safety.

Fortunately this important feature has not been overlooked in the
development of the modern window.

Fifth — And finally the requisite of paramount importance — The
window must allow one hundred per cent, of opening.

Open a window a few inches at the bottom and a current of air blows
unpleasantly and I believe dangerously, on the children sitting near
such a window, and with a transom only, open, the condition is but
slightly better. But with the entire aperture of the window made use
of, which can be done in temperate climate to the well being of all, dur-
ing a large portion of the school year, no unpleasant air currents are
felt, and it is the writer's persona,! experience that children may occupy
seats near such windows throughout an entire school year without
onqe complaining of a "draught," their only fear being that they might,
against their wishes, be returned to the stuffy school room from which
they came.

124 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

I am forced, therefore, to the opinion that our school rooms need
less artificial heat, and the children more frequent interruptions in their
mental work for physical and breathing exercises, and if I am correct
in this, then we must have windows that will open, not only readily
and easily, but entirely.

Fortunately the architect who is in sympathy with this direct method
of ventilation has a large variety of windows from which to choose.
Much depends, of course, on the style of building and the character of
material used. For the thick walls of brick and stone the inswinging or
outswinging window hinged on the side casement, with a large transom
pivoted in the center, and used very generally in France, is an ideal win-
dow, yet the heavy sash of this type, especially if wooden, occupies a
large per cent, of the window opening, and when equipped with proper
fastenings is apt to be rather expensive for adoption in public schools.

The sash supported by pivots allowing rotation, either vertical or
horizontal, has appealed very strongly to me. Such a window section
carries its own roller curtain, and when set at an angle affords an excellent
awning. It can be easily kept clean, the work all being done on the in-
side, thus subjecting the cleaner to no liability to injury. It can be
easily opened and as readily closed.

My limited time precludes even a recital of the names of the many
window makers who have very kindly given me their assistance on this
subject, some of whom are making an exhibit at this Congress.

I prefer the window sash that is held in the desired position by a
strip, a spring, a fixture or by friction, rather than by the cord and
weight, as the latter takes up much space and the casements must there-
fore be made correspondingly large.

Much time and thought has been given to this subject in recent years
and while it is too much to believe the last word has been spoken, or per-
fection attained in window construction, yet we believe much has been
accomplished and when the ideal window, as to style, material and opera-
tion has been devised and its adoption in our public schools made general,
its beneficial and far reaching influence will equal that of any factor in
the entire field of school hygiene.

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE

125

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE

ON THE PHYSICAL AND MENTAL

CONDITION OF CHILDREN

Harold Brown Keyes

In one of the highest sections of New York City exposed to the air
from ocean, river and country, there are located on the roof of Teachers'
College, New York, two open air school rooms. These are an integral
part of the Horace Mann School. One accommodates sixteen children
in the fourth grade, the other seventeen children of third grade rank
and eleven children of second grade rank. These open air rooms are
of permanent structure, each with one side completely open to the out-
door air, and with at least one other side so built with windows that
more than half of the side can be completely exposed to the elements,
and always to early sun. The roofs contain each a large window some-
what shaded from the glare of the sun. The sides which are completely
open face to the south and are never closed ofif except when rain would
beat in upon children and furniture. At such times a canvas covering
serves to shut out rain.

Open Air Class

126 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

A seating scheme is so arranged that desks can be moved to any
part of the floor space at will and in addition when the sunshine does
not reach all the children at once the desks most in the sunshine are
occupied first by one-half the children, then by the others, so alternating
that each child is exposed to as much healthy sunshine as is possible
to obtain. Care is always taken to guard blackboards and pages from
the sun's glare.

A fairly large roof playground immediately adjoins these open air
rooms and this is well equipped with playground apparatus. Here the
children spend a fair share of their time, here receive their instruction
in physical exercise, and also indulge in normal play. Frequent pauses
are made in studies to have the children exercise in the room to insure
mental relaxation and an active blood circulation.

During the morning lunch is partaken of and each. child is urged
to drink something hot, and all are expected to do this in cold weather.

All instruction in special branches as well as in the 3 R*s goes on
in the open air so that the children go indoors only for the general
assembly. All children are carried to the roof school in the elevator
to eliminate the exhausting and harmful effects of climbing stairs.

In the fall of 1912 the decision was made to carry out accurate com-
parisons between these outdoor children and corresponding indoor
children of the same grades, both as to the physical condition and im-
provement, and as to mental condition and improvement. For this
reason the invaluable assistance of Mr. Pearson, Principal of the Horace
Mann Elementa;ry School and of Professor Norsworthy of the Depart-
ment of Psychology, Teachers' College, Columbia University, was
offered to carry out the mental tests. The teachers of the various
rooms likewise generously assisted, and the physical examinations were
carried out in the Department of Physical Education, Teachers' College.

It seems well to speak of the conditions under which the open air
children were selected. In admitting children to these classes the pref-
erence was given to those children who seemed to be less robust than
their classmates, those who had not gained during the previous year
as much as was desirable, those whose past histories showed either
physical or nervous weakness or severe illnesses; in short those children
who seemed to be especially in need of the most healtfl-giving surround-
ings. These selections were made by the Principal and School Physician.

The children were examined as follows: Careful physical measure-
ments were taken at the beginning of the year of all the children compared.
These measurements were taken with the body stripped, so that no
discounts had to be made for clothing. One person did measurements
on all the children, both at the beginning and end of the period. The
writer made all the physical examinations both at the beginning and

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE

127

Roof Playground — Open Air Class

end, one person tested all the eyes and ears at the beginning. and end.
Mr. Pearson, and Professor Norsworthy did separate mental tests both
at the beginning and end of the year. All these tests were taken as
near together as possible. Thus as much as was possible we tried to
eliminate the element of personal differences in judgment.

In taking our physical measurements we left out unimportant ones.
We recorded only age, weight, height, girth of chest at fourth rib, girth
of chest expanded at fourth rib, breadth of chest, depth of chest, lung
capacity, strength of forearms, strength of back muscles and chest
muscles. Then a routine physical examination followed, including
test of eyesight, hearing, condition of eyes, nose, throat, tonsils, teeth,
skin, glands, spine, feet, heart and lungs.

At the end of the year all these tests were repeated. The results
I will now give you.

In studying the results of the physical tests we found that in all
classes the indoor children were older than the outdoor children. Those
of the second grade rank were six months older than the open air children,
those of the third grade two months older while the fourth graders
averaged six months older. These facts, then, bring up the question
whether or not the outdoor children, who had originally been chosen
because they seemed to be under weight, or less robust, or who suffered
in comparison, made the poorer showing because they were compared

128

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

with children some of whom were half a year older, as well as because
they really were below par. Consistent with both these facts we observed
that at the beginning of the year the indoor children excelled in height,
weight, girth of chest, chest expansion, breadth of chest, depth of chest,
lung capacity, strength of arms and strengths of back and chest, in all
three sets of rooms where comparisons were made. Furthermore,
although the open air children in some cases gained more during the year
than the indoor children, the original lead was too great to be overcome
and so at the end of the period the older indoor children of the same
grade rank still had a higher average in all measurements without ex-
ception in all rooms.

Let us consider for a moment some of the measurements, first in the
second grade, as follows:

Duration of tests — 6 months:

INDOOR CHILDREN

OUTDOOR

CHILDREN

Average

gain

in weight

1.3 K. or

2.8 lbs.

1.3 K. or

2.8 lbs.

" height

2.8 cm. or

I.I inches

3.2 cm. or

1.3 inches

" girth of chest..

tt tt tt

i.o cm. or

.•4 "

1.4 cm. or

.6 "

expanded ....

2.3 cm. or

•9 "

2.7 cm. or

1.0

" breadth of

chest

.3 cm. or

.1 "

.2 cm. or

.07 "

" depth of chest

— .1 cm. or-

- .05 "

— .1 cm. or

— .02 "

Gain in

lung capacity

4. cu. in.

4.8 cu. in.

It <(

strengthof ft. arm....

2.1 K. or

5.1 lbs.

1.7 K. or

3.7 lbs.

<< <<

It. "...

1.8 K. or

4. "

1.7 K. or

3.7 "

It tt

upper back. .

1.0 K. or

2.2 "

2.1 K. or

4.6 "

<i tt

chest

1.4 K. or

3.1 "

2.9 K. or

6.4 "

So it is seen that the younger outdoor children, out of doors for the
first time in a school year, gained consistently more in every direction,
except weight, which gain was identical with the indoor gain, and breadth
of chest and strength of the forearms.

The records for the third grades expressed as averages were as fol-
lows :

Duration of tests-six months: ^^^^^^ children

Average gain in weight 1.6 K. or 3.5 lbs.

height 2.6 cm. or i.o inches

chest girth 1.3 cm. or 0.5 "

" " expanded. 1.5 cm. or 0.6 "

" breadth 0.9 cm. or 0.37 "

depth 0.0 cm. or 0.0 "

OUTDOOR children

1.7 K. or 3.7 lbs.

lung capacity. . . .
rt. arm — strength
It. "

upper back "
chest "

8.0 cu. in.
1.4 K. or 3.
1.4 K. or 3.1
2.0 K. or 4.4
2.8 K. or 6.2

lbs.

2.8 cm. or

1.8 cm. or
1.7 cm. or

.2 cm. or
— .3 cm. or-

5.9 cu. in.
0.8 K. or

2.1 K, or
2.0 K. or

3.2 K. or

I.I inches
.7

.7 "
.07 "

-.13 "

1.7
4-5
4.4
7.0

lbs

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE 129

Briefly summarized, the outdoor class improved more in six of these
measurements, the indoor improved more in four and the classes were
even on one (strength of back). The outdoor class improved more
in height and weight and girth of chest.

The tests in the fourth grades are of especial interest for the following
reasons: Some of these outdoor children were spending their second
year on the roof school. They had a better attendance record than did
the second out-of-door class, which improved so well. Despite these
points the indoor fourth grade showed a much better record of improve-
ment than did these outdoor children.

The results are as follows:

INDOOR CHILDREN OUTDOOR CHILDREN

Gain in weight 2.1 K. or 4.7 lbs. 1.5 K. or 3.3 lbs.

" height 2.8 cm. or I.i inches 2.6 cm. or i. inches

girtfi of chest 1.3 cm. or .5 " 1.6 cm. or .6 "

" expanded 2.3 cm. or .9 " 1.5 cm. or .5

" breadth of chest 4 cm. or .17 " .4 cm. or .17 '*

" depth of chest o cm. or o " — .2 cm. or — .08 "

lung capacity 9.3 cu. in. 3.7 cu. in.

" strength of rt. arm 2.6 K. or 5.7 lbs. 1.8 K. or 4.0 lbs.

" It. " 1.9 K. or 4.2 " 2.2 K. or 4.7 "

" back 2.5 K. or 5.7 " 1.4 K. or ^3.1 "

" " chest 3.2 K. or 7.1 " 2.1 K. or 4.7 "

Briefly summarized, the indoor class improved in eight of the eleven
measurements, one was tied and the outdoor class excelled in two. The
indoor class gained more in both height and weight than did the outdoor
children. Thus these results are almost the reverse of those found in
the other two grades.

The question has come up whether this lack of proportionate gain
may not be due to the fact that these children had their best growth
the first year they were out-of-doors, or whether they have not yet over-
come the condition which caused them to be in the open air originally.
A further point will come up under the question of attendance.

We had wondered if the eyesight of the outdoor children would
suffer any from added exposure to sun and the necessity of looking at
blackboards and books on which sun might shine. In no case did we
find any defect coming on during the term such as would be shown with
Snellen test type.

I then made a careful study of the attendance records comparing the
attendance of the second grade indoor and outdoor children, the attend-
ance of the fourth grade indoor, with that of the outdoor fourth grade,
then comparing the attendance of the fourth grade outdopr children with
their own attendance record in 1910-11, the last year in which they at-
tended school in an indoor room. The results were as follows: First,

130 FOURTH INTERNATIONAL CONGRESS^ ON SCHOOL HYGIENE

the record of the indoor children actually considered in the physical
tests showed an attendance of 884%, whereas the outdoor children
actually tested in the physical examinations showed an attendance of
88.7%, a better record of .3% in favor of the outdoor class. To make
the test more distinctly a roorfi comparison we averaged the attendance
of the entire indoor second grade to get actual room conditions and found
an attendance of only 80.2%, whereas the entire room of outdoor chil-
dren showed an attendance of 88.7%, a superiority of 8.5% in favor
of the outdoor class, so attendance was decidedly better for outdoor
children.

The difference in the fourth grades were again, not as striking. The
attendance of the fourth grade indoor children actually tested was 95.5%.
That of the outdoor children was also 95.5%. But if room conditions
were considered, and this seems the fairer test, the attendance for the
entire indoor fourth grade was 92.8%, where the entire outdoor fourth
grade had an attendance of 95.5%, a better ranking of 2.7% for the
outdoor children. In these tests just mentioned, those children who
entered school at an extremely late date or who left at a very early
date were not included.

To find out the effects on attendance of outdoor and indoor air on
the same children the records were searched and fourteen of the present
outdoor fourth grade were found to be indoors in 1910-11. Their at-
tendance as a group was totalled and put on a per cent, basis, and was
found to be 90.7%. The attendance for these same fourteen children in
1912-13, while out-of-doors, was 95%, a better record of 4.3% in favor
of outdoor schools. One must keep in mind, however, the fact that
these children were this year two years older than when the first attend-
ance was recorded.

A record of contagious diseases was kept during the year. In the
three outdoor classes there were five cases of contagious disease; in the
indoor classes there were fourteen cases of contagious disease. Again
in this case it is only fair to keep in mind that there were more children
in the indoor classes and therefore more opportunities for contagious
disease. If these cases are reduced to percentages the record of outdoor
children shows that 12.5% had contagious disease while 17.9% of indoor
children had contagious disease. Another very significant point is that
no contagious diseases "went through" an outdoor room as happened
in one of the indoor rooms. This seems to me to be in itself a powerful
argument in favor of outdoor schools.

The question of absence for illness came up even in' our own tests
as we found that when outdoor children were wanted they were present
whereas indoor children were absent more often. Indeed at the end of
the year we felt that in the fourth grade indoors the more robust children

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE 131

were the ones who were examined because they were the ones in school.
This may be a large factor in the excellent showing made by that room
and should be kept in mind.

Mr. Pearson and Miss Norsworthy carried out their separate mental
tests with these same children in the third and fourth grades on whom
we did the physical and health tests. They have kindly allowed me
to quote their results. These tests were given at the beginning and end
of the year and improvements noted. The identical tests were given
to the corresponding indoor and outdoor grades so that valuable results
were obtained.

Miss Norsworthy first gave four tests for maturity and intelligence.
These were as follows : The children were given a page of letters arranged
in rows, but with the letters of the alphabet chosen indiscriminately.
They were given a definite time to mark all the letter A's seen. This
was repeated at the end of the year and improvement noted. Each
child was handed a list of words such as cross, rough, noisy and was
asked to write the opposite of the word on the paper. This again was
later repeated and improvement noted. The third intelligence test
consisted of a harder list of words and the children were asked to write
their opposites in a given time.

■ The fourth test was as follows : The children were shown a large card
on which were words arranged thus: ** kitten her scratched cat the he
because frightened dog the." They were given a definite time to look
at the chart and arrange it into a sentence thus: "The cat scratched
the dog because he frightened her kitten." A similar test was given
at the end of the year and improvement noted. The four tests for
memory were given as follows: The children were shown a chart con-
taining forms, thus :

// rj

X r V

FIGURE 3

They were given a definite time to look at these forms, the chart was
removed and they were asked to reproducee the forms. A second test
similar to this was given with more difficult forms. The third test
consisted in reading to the pupils a memory passage of about one hundred
words. The children were then expected to reproduce as many ideas
as possible in a given space of time. It was marked on the basis of ideas

132 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

reproduced. The last test was the addition of columns of numbers in
a given time.

As stated above all these tests were repeated at' the end of the year
to note the improvement as the test was to find whether the outdoor
or indoor children improved the more. Thus eight sets of tests have
been considered.

In the third grade in the sixteen possibilities the outdoor class had a
higher rank in nine instances. But more important the outdoor class
improved more during the year in absolutely every case. It will be
recalled that these children were two months younger than the indoor
children.

In the case of the fourth grades the outdoor children excelled in ten
of the tests, but again, what is more important, the outdoor children
showed the greater gain in seven of the eight possibilities.

The chart is produced on following page in detail.

Mr. Pearson's tests were of quite a different type as they were given
definitely on subjects actually taught in school. They were two in
number for each grade, one in formal English, the other in Arithmetic,
given to the corresponding grades at the beginning and end of the test
time for the purpose of judging the improvements made in actual school
subject. The chart is produced on second page following.

Briefly the results were: In formal English the third grade outdoor
class not only had higher averages than the indoor class but improved
20% whereas the indoor class improved 13% during the year. The
outdoor fourth grade also had higher averages and improved 7% in
arithmetic, while the indoor class lost 3%. The results in English were
only slightly different. The indoor third grade did have higher averages
but the outdoor class improved 20% while the indoor class improved
only 6%. The fourth grade open air children not only had higher
averages in arithmetic than did the indoor children but improved 41%
while the indoor children improved 35%. The outdoor children averaged
99% in the final arithmetic tests.

EFFECT OF OUTDOOR AND INDOOR SCHOOL LIFE

133

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134

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

RESULTS OF COMPARATIVE TESTS
Formal English

GRADE

Number of
Pupils

Average
Dec, 1912

Average
May, 1913

Improvement

III

Open-air

Dec. 1 8
May 12

37%

57%

20%

III
Indoor

Dec. 22
May 27

35%

48%

13%

IV
Open-air

Dec. 15
May 15

64%

71%

Indoor

Dec. 29
May 22

63%

60%

-3%

ARITHMETIC

III

Open-air

Dec. 14
May 12

48%

68%

20%

III

Indoor

Dec. 28
May 24

69%

75%

IV
Open-air

Dec. 14
May 14

58%

99%

41%

Indoor

Dec. 28
May 23

53%o

88%

35%

I owe special credit to Miss Janet Seibert of the Department of
Physical Education for help in the compilation of these statistics, and
to Miss Maud March for the assistance in the examinations.

VITALIZING SCHOOL CHILDREN

135

VITALIZING SCHOOL CHILDREN
An Open Window Experiment in Philadelphia

Walter W. Roach

As parents realize more and more the value of fresh air,- there is a
growing demand for the teaching of their children in open window class
rooms. It is a logical process of reasoning, easily understood, that
since fresh air has been found a boon to invalids and sickly children
it is even more important to supply an abundance to well children that
they may remain well.

At the Alexander Dallas Bache School in Philadelphia, September,
1 9 12, we decided to study the effect of low temperature class-room work
on the educational processes of the children. Two groups of normal
third grade pupils were available for the test ; one group occupied a room
heated and ventilated in the usual manner, and the others, with the

Bache School

136 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

consent of their parents, were taught all through the winter in a class-
room with the windows wide open. Both groups of children followed
the regular school program, and we observed their work closely.

The windows of the one room were kept constantly down from the
top and up from the bottom, and the room was cut off from the regular
heating plant of the building. The ordinary desks were removed, and
replaced with chair desks which could easily be moved by the pupils
themselves to clear the floor space for frequent physical exercises. As
cold weather approached the children were provided woolen sweaters,
worsted caps, soft woolen blankets and knitted woolen gloves. Thus
their lower extremities were protected from the cold floor, with no
disturbance of the circulation.

Week by week during the Fall and Winter and Spring we weighed
and examined these pupils, watched their study and their play and com-
pared their scholarship with that of the children in the warm air room.
The children from both rooms came from the same kind of homes, so
that the test was as fair and as accurate and searching as possible. As
might have been expected, we found at the end that the pupils in the
open-window room had gained on an average more than twice as much
in weight as those in the warm air room. They kept wholly free from
colds, and were much more regular in attendance than the others.
They were also more alert, free from day dreaming, quicker to learn,
needed less review work and were better behaved. In health and happi-
ness, in development both of mind and body, the children of the room
with open windows had a clear advantage over the others.

At the end of the Winter term these facts were reported in a Public
Health Journal and the information there contained was passed on in
a gratifying way by many daily newspapers in different parts of the
country to their readers and to members of school boards generally.

The experiment was not made primarily to prove that fresh air is
good for healthy normal children in school. In these days the gospel
of sunshine and pure air is accepted and ought to need little preaching.
Many school boards do not however, practice the doctrine that their
members believe in and preach. The average school-room is maintained
at too high a temperature, and ventilation as a rule is poor.

But there is nothing original or remarkable in giving to a child the
fresh air that Nature intended it should have. It might with truth be
said that the opening of a school-room window is the simplest thing
in the world. As a muscular act, it is. But this experiment was directed
toward legislating school-room windows open, and it is the result of that,
that I wish to inform you to-day.

There are in our city 298 school houses, with 4,000 class-rooms for
about 180,000 children, and these class-rooms have 12,000 windows.
In many of these the ventilation was poor. Day after day I visited

VITALIZING SCHOOL CHILDREN

137

different schools of the district and found the temperatures ranging
from 68 degrees Fahrenheit to 76 degrees. High temperatures and low
relative humidities were frequent. In but two schools of my district
was the air washed and humidified.

The suggestion of an open-window room found response from one
Principal with an open mind, and the experiment started. I knew from
the experience of Mr. Watt of the Graham School, in Chicago, and the
fresh air schools at Charlottenberg and other places, that the pupils
would become accustomed to the cold air as the season advanced and
like it. That their parents would note the physical improvement in

The class seated. These photographs are intended primarily to show the open
windows and are purposely taken against the natural light, without flash powder.

their children and like it. That under out system of mid-winter pro-
motions these third grade youngsters would be promoted and compelled
to enter a fourth grade warm-air room, and we would hear from them,
and from their parents in protest. And this is just what did happen.
Let me read a few letters — samples of many received by that Prin-
cipal during the first week after the promotions were made.

"Mr. Bishop: Will you please keep Bessie in the open air room as her health is
greatly improved since she has been in it. She has not had a cold all winter. The

138

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

fresh air agrees with her so well I would be thankful if you could keep her there still."
Signed by Bessie's mother. «

" Miss Adams: Will you please to put Sadie in the open air room. She does not
like the warm air room, some how or other." Signed by Sadie's mother.

Mr. Bishop: Dear Sir: " I am so sorry since Earl has got out of the open-window
room. He ate so good and seemed to have such good health, while he was there, and
if it would be possible for you to put him back again I certainly would be glad and I
know he would be glad himself for he was always telling me how good he felt. Please
let me know if you can put him in the fresh air room again." Signed by Earl's mother.

do."

Mr. Bishop: Please let Ellsworth go back in the cold air room whatever you
Signed by his father and mother.

"Mr. Bishop: Would you kindly put my boy John back in the open-air room
again, as I think it is not healthy for him in the closed room." From his mother.

These children have learned from experience what ventilation of
a room really meant, a.nd what proper ventilation of their lungs meant;
By using that which Nature furnished from day to day in the matter
of fresh air and humidity we had set an example to the children in ven-

Pupils moving their desks to side walls to clear floor space for physical exercises.
Time necessary, one minute. After exercise it takes one minute to replace them and
resume class work.

VITALIZING SCHOOL CHILDREN

139

tilation which they carried to their parents at home. By giving them
cool, fresh air five hours a day, five days a week at school, and showing
their parents that they thrived on it, we secured for them twelve or more
additional hours each twenty-four in fresh air by inducing those parents
to keep their bedroom windows wide open at night.

At the same time we were driving home to the school authorities
the idea that this group of normal and subnormal children could be
taught better in fresh cool air than in warm vitiated air, and that by
simply throwing open the school-room windows we could secure ideal
conditions.

Almost anyone on reflection, will be impressed with the futility of
expecting a maximum progression, physical and mental, when children
are housed in overheated rooms, with little or no moisture, compelled
to sit in uncomfortable positions and perform tasks prodigious and com-
plicated to feeble and inactive minds resulting from undernourished
and devitalized bodies. It so impressed the District Superintendent of
Schools of this District, for about this time he wrote to Dr. Martin G.
Brumbaugh, the Superintendent of Schools of Philadelphia somewhat
as follows:

"The splendid results achieved in the open-window class at the
Bache School, lead me to file this application for the establishment
of the following additional classes of this nature (with a list).

"It is our intention that children be admitted only on the recom-
mendation of the Medical Inspector, approved by the Medical Super-
visor, and further approved by the District Superintendent. This is
one of the new movements in education that is recognized as worth
while. Properly organized it permits the Medical Inspector to fortify
the body structure without interrupting the mental training of the
child. The beneficial results of the work are at all times visible to
teacher and parent alike. The class at the Bache School was largely
visited and favorably commented on by many of the visiting Superin-
tendents in February." (The Annual Meeting of School Superintend-
ents of the National Educational Association.)

The Director of Physical Education of the Board of Education
was favorably impressed and observed these children with helpful
interest, and the school authorities acted favorably on resolutions to
organize such classes as an integral part of the system, and provided
finances for equipment.

The experiment was a complete success, in that it resulted in
ruling for open windows. If its recounting to-day may result in opening
more windows for equally deserving children in other places than Phila-

140 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Class at exercise^ — Chest lift. Arms up and back to Y stretch position.

delphia we will be gratified indeed. And if a few more words will add
to such possibility, pardon my expressing these conclusions:

The beneficial effect of open windows on the health and scholastic
progress of pupils can be attributed to the following:

Volumes of pure, fresh, cool air roll into the room with none of its
vital qualities impaired by artificial handling.

Nature's proper proportion of moisture is mixed with this atmos-
phere, and Nature's variation is a beneficial change. Ventilating
engineers have made the mistake of trying to establish a norm, and
sticking to it.

The bracing effect of cold is stimulating to health and renders
children more resistant to infecting bacteria and disease. It creates
a desire for exercise — a natural physiological demand for increased
circulation. To meet this need a series of short physical exercises are
provided at frequent intervals between lesson periods, but never pro-
longed to cause fatigue nor violent enough to excite perspiration. There
are also marches and drills which prevent air stagnation in the room
by breaking up convection. The lungs are thoroughly ventilated as

VITALIZING SCHOOL CHILDREN

141

well as the room. Expired air at body temperature and exhaled gases
at over 90° Fahr. set free in the cold room, rise to the ceiling and pass
out the upper window openings, being replaced by the pure air coming
in the lower window openings.

The physical exercises are designed to maintain chest elasticity,
affording opportunity for normal lung expansion and the children are
encouraged to a better breathing habit. This means more thorough
aeration of the blood, with resulting mental stimulation.

We attribute their freedom from "colds" to the following:

Children from close, overheated rooms passing on dismissal into
cool, moist atmosphere outside the building have the respiratory mucous
membrane suddenly chilled and do "catch cold;" whereas these children
in the open rooms breathe a mixture of/ air and moisture at a temper-
ature more near that of the outside atmosphere. They do not encounter
such a sudden change at recess or on the homeward journey and do not
"catch cold." They keep well, like school, and are more regular in a
attendance. It can safely be said that the chief cause of "colds" is
not exposure to cold as such, but on the contrary depends on exposure
to the over-heated and confined air of close school-rooms and living
rooms.

Our Bache School children, both classes, were carefully weighed
each week. The physical gains are a matter of record at the school.
It was found that the children in the warm-air room gained less than
half as much in the average, pound for pound, as the children in the
open- window class, and the latter grew as would naturally be expected
of children of their ages living a robust outdoor life. The mental tests
were made by the school principal through a series of memory exercises,
and spelling and arithmetic examinations which eliminated the ques-
tion of the merit of teaching. The averages were calculated for each
group, and the open-air children showed emphatically the greater
advancement. Percentage of promotion January 1913, 3rd grade
warm room 75.0; 3rd grade open window 88.1; January 1914, 3rd and
4th grade warm room 76.4; 3rd and 4th grade open window 82.8.

In order to show the children themselves actually at work, and the
nature of the physical exercises employed, we took a moving picture
of the class at the school, and through the kindness of the Congress
management we are able to give you a clear idea of how they do it in Phil-
adelphia, by the lantern.

Personnel of the Two Third Grade Classes.

There was no selection of the pupils except that those in the open-
window room were placed there on the written request of their parents,
following a circular letter explaining the purpose of the experiment.

142

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

OPEN WINDOW CLASS.

I Charles A. . .

2 Edwin B.. . .

3 James G. . . .

4John K

5 Howard A. .

6Milford B. . .

70tto C

SMaurice C . .

pRaymond C.

loEarl S

1 1 Raymond H
i2George G. . .

laJohn Z

i4WilliamD..
isThos. O'D..
i6E>avid A. . . .
ivBruce McF..

iSjohn B

igWilliam S. . .
2oCharles V. . .
2 1 John Bd. . . .
22Frank B. . . .
23 Herbert R. .
24James L. . . .
2SWilliam M..

26May L

27Ray W

28Mary K. . . .

29Agnes S

3oCath. McC .
3 1 Rebecca B. .
3 2 Evelyn S... .

33Ada M

34Mary A

3 5 Florence E. .

36EvaG

37AlbertaH.. .

38Agnes M

39Bessie N. . . .
40 Marie M. L.
4 1 Dorothy M.
42 Rachel G. . .
43Gladys A . . .
44Sadie T

Age.

13 yrs. I mo.
13 2

Wt.

82 lbs.

7ii

6SJ

67i

68i

57l

57i

57f

56i

S5i

58^

S6i

54i

68i

67i

65§

63J

62§

62^

^^
6of

63 i

56i

58i

52§

4ii

46i

59i

49i

High. Chest

57 in.

54!

53l

54l

5Si

49?

5ii

Sif

49i

5ii

5ii
5oi

50I

53i

48I

54^

55?

49^

50^

50f

51^

52^

49i

54i

47^

27 in.

24i

24f

25^

24I

24f
24i
25i
23i

23 A

23i
26^

24 IT

24J

23l

22J
23t

23 A

24i
23f
22f

25i

2IH

23i
2I§
24f
27i
23f

23i

25i
25i
25i
23l
27§
23i

23 i

24f

245

2li

22t^

24i

2li

WARM ROOM CLASS.

I George B. . .

2 Bernard H...

3joseph A... .

4 Joseph O... .

5 Edward J.. .

6George A . . .

7Harry W... .

SWilliam G . .

9jamesF. . . .
loThomas B. .
1 1 Edward A...
1 2 Joseph McF
i3FrancesE. . .
i4WilliamO...

isAlex. B

i6Amerego S...
i7Lewis R. . . .
iSWarrenMcC
i9Gilbert M..
20 Edward N . .
2iWilliamR..
22George D. . .
23Lewis D . . . .
24Thoraas M..
25Raymond B.

26Hy.T

2 7 William A...
2 8 Joseph G. . .

29Emil A

30 William G. .
3iHarry F. . . .

32RuthR

3301gaU

34RuthK

35MildredD..
36Marian A. . .

37jennie U

38Mildred M..

39Carrie C

4oLillian P. . . .

41 Katie T

42Marg.McC.
43EthelK....
44May N

Age.

Wt.

High.

Chest

12 yrs. omo.

88ilbs.

61 in.

26 in

88i

80^

56i

79^

70i

69J

53i
52i

24-

25i
24

68f

53i

67i

52J

67i

53^

66 i

645

5li

23J

62i

61^

50:

61.

52i

60I

23*

6o-;

51*

23 :

56i

49*

56i

55i

50!

52^

48*

2 •

6ii

52i

1055

993

6oi

281

755

25I

69i

23*

55*

5ii

23*

23i

58i

22*

57i

23*
22|

49i

49l

23 i

53*

23*

Total 2669 lbs.

Avg. wt. 6o|i

25 Boys 1526 lbs.=Avg. 61 5V lbs.

19 Girls 1 143 lbs.=Avg. 60^ lbs.

Total 2893 lbs.

Avg. wt. 6512

31 Boys 2004 lbs.=Avg. 64?? lbs.

13 Girls 889 lbs.=Avg. 68 1\ lbs.

To plainly illustrate the physical condition of the two classes of
children the following charts are submitted. Vertical lines represent
the years of age, horizontal lines pounds of weight, and the curved lines
the normal average weights of children for different ages. The phys-
ically sub-normal or under-weight-for-age of each class are shown by
the irregular lines joining the numbered black dots below the curves
in each chart. The numbers alongside the dots correspond to the num-
ber opposite the children's names in each class list of pupils.

It will be noted (Chart A) that there were eighteen markedly under-
weight children in the open-air class, three of them between eight and
nine years, the normal age for this grade, three between nine and ten

VITALIZING SCHOOL CHILDREN

143

years (one year retarded), five between ten and eleven (two years retarded) ,
three between eleven and twelve years (three years retarded) and four
from twelve to thirteen years (four years retarded.)

CHART A.
Open Window Class

CHART B.
WArf77 Air Rporr)

70
»0

SO pounds
40

/■

7^ —

y'^*°\-

•"

^'l^r

normal

^?\

» <

J *

10 /

1 /2 /3 H

Si poui}<J*

In the other class (warm room) (Chart B) there are nineteen phys-
ically sub-normal pupils, six between nine and ten years of age (one
year retarded), six between ten and eleven years of age (two years
retarded), two between eleven and twelve years of age (three years
retarded) and four between twelve and thirteen years of age (four years
retarded). These retarded children, waterlogged at third grade when
they should have reached the sixth or seventh, had already lost many
years of opportunity, and cost the board of education many, many
dollars more than necessary.

144 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

PORVENIR DE LA ESCUELA AL AIRE LIBRE

FOR

Luis Miro Quesada

El nino, que como alguien ha dicho, "es un pajaro de los campos mas
que un pajaro de jaula," necesita del aire, de la luz, y de la libertad,
para conservar la salud del cuerpo y del espiritu. Y es esto tan cierto,
que las escuelas al aire libre prueban que basta Uevar a ellas a los escola-
res enfermos de las ciudades para que alii curen 6 mejoren. Los in-
formes respecto k 6stas coinciden todos, con una uniformidad que causa
impresion, en el punto relativo a los provechosos resultados en ellas
obtenidos; cualquiera que sea el pais y la escuela de que se trate. Si
tales son sus beneficos efectos en el limitado radio que hoy tienen, parece
indicado ampliar su esfera de accion. Mas concretamente : el regimen
higienico y el aire puroqueson, en la actualidad, privilegio de los ninos
enfermos, han de proporcionarse, tambien, a los sanos, para impedir
que enfermen. Lo que ha sido, hasta ahora, solo labor curativa de
caracter restringido, debe convertirse en una gran obra de indole pre-
ventiva, llamada a evitar los peligros que la escolaridad urbana entrafia.

En el momento presente, la escuela al aire libre ha salido ya del
campo de las experiencias y ha dejado de constituir un problema para
la higiene escolar. Diversa en su modalidad en los distintos paises,
tiene, en el fondo, el comun objetivo de dirigirse a la misma clientela de
ninos debiles, escrofulosos, anemicos, cardiacos y, principalmente, pre-
tuberculosos no contagiosos; y, coincide siempre, como hemos dicho,
en el resultado satisfactorio que en su prop6sito alcanza. Este hecho,
anotado invariablemente, explica el unanime entusiasmo que las escue-
las al aire libre despiertan y la rapida propagaci6n de ellas. Estudiemo-
las, pues, en sus rasgos generales y veamos, luego, la conveniencia de
aplicar la esencia del sistema a las necesidades de la ensenanza popular.

La escuela al aire libre nace, como se sabe, en Charlottenburg, Ale-
mania, en 1904. Con analogo objeto al sanatorio para ninos, establecido
dos afios antes en Pankow-Schoenhausen, pero con un caracter escolar
de que este carecia, la escuela de Charlottenburg esta destinada "a
todos los ninos que no pueden soportar una presencia de cuatro 6 cinco
horas en las aulas comunes muy pobladas, en razon de su debilidad
general 6 de defectos de constituci6n (anemia, escrofulas) 6 de enferme-
dades especiales de ciertos organos (corazon, pulmon, etc.)." La escuela
de Charlottenburg esta situada en el bosque y su tipo es de externado;
tos alumnos desde que ingresan k ella, muy de manana, hasta que la dejan,

PORVENIR DE LA ESCUELA AL AIRE LIBRE 145

k las siete de la tarde, pasan la mayor parte del dia y juegan al aire libre
hacen cinco comidas sanas y nutritivas, estudian, solamente, dos horas
y media los mas avanzados y dos horas los que lo estan menos. El
feliz exito de este sistema no se hizo esperar y la escuela de Charlotten-
burg que el primer ano fu6 abierta por muy corto tiempo lo es, mas
tarde, desde el mes de Abril hasta fines de Diciembre. "Los resultados
obtenidos desde el pun to de vista de la mejoria de la salud de los nifios
fueron tan satisfactorios, dice el Doctor Dufestel, que se decide desar-
rollar esta institucion y que la escuela de bosque de Charlottenburg ha
servido de prototipo k muchas otras." (i) En estos cortos afios, en
efecto, se crean en Alemania las de Mulhausen, Munchen-Gladbach,
Eberfeld, Magdebourg, Leipzig, Dresden, Lubeck, Dortmund, Buckow,
etc., inspiradas en las mismas tendencias que aquella.

Se establecen, luego, escuelas analogas en Suiza, (Zurich, Glarisegg,
Grunau). La primera de estas, la de Zurich, es interesante porque crea
el tipo de la escuela de internado de este genero, que habia de ser luego
imitado, en cierto modo, en Alemania (Hohenlychen) en Inglaterra
(Knolls Green, Londres), en Austria-Hungria (Szombatchely) y, princi-
palmente, en Francia, en la escuela de Vernay (Lyon). Responde
esta escuela d la idea del Doctor Grancher, cuando escribia: "los nifios
reconocidos como atacados de tuberculosis en sus comienzos, deberian
ser colocados en un sanatorio escuela, donde ellos continuarian sus
estudios bajo la vigilancia estrecha de un medico que viviera alii." Se
escoje, pues, para la de Vernay, los nifios de las escuelas lyonesas pre-
tuberculosos, no contagiosos y con posibilidad de curarse, que deben
permanecer tres meses en aquella, haciendo vida al aire libre, tomando
cinco comidas por dia y estudiando solo tres horas. La estadia en la
escuela de Vernay, ha producido, segun el Doctor Vigne, medico en
aquella, un importante aumento de peso (2 kilos 800 por termino medio)
y modificaciones favorables obtenidas en los sintomas pulmonares, per-
ceptibles a la auscultacion y 4 la mensuraci6n toracica; en todos los
ninos, aun en los mas gravemente atacados.

En Inglaterra, el London County Council, fundo, en 1907, alentado
por los resultados favorables de la escuela de Charlottenburg, una
semejante en Bostall Wood. Como en aquella, s61o fueron admitidos
los ninos enfermos, pero curables 6 susceptibles de aprovechar los ben-
eficios de su estadia en la escuela. Al aiio siguiente se abrian dos nuevas
escuelas de la misma indole en Londres, una en Halifax y otra en Brad-
ford. Debemos citar, tambien, las recientes de Marble thorpe (Lei-
cester) la de Roby (Liverpool) la de Uffculme (Birmingham) la de
Warwick etc., y, particularmente, la de Sheffield, mas antigua que estas
ultimas, y de cuyo buen exito, semejante por lo demas al de todas las
otras, informa el Profesor Williams, de Londres, diciendo que los ninos

146 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

"ganaron en peso, en perimetro toricico y en aparencia, acrecentan-
dose su poder de observaci6n."

En los Estados Unidos, prescindiendo del ensayo hecho en 1904 en
Puerto Rico, la primera escuela al aire libre, en forma, fue fundada el
27 de Enero de 1908, en Providence (Rhode Island) por las autoridades
escolares y debido k los esfuerzos de la "League for the Suppression of
Tuberculosis," para nifios sospechosos de hallarse atacados de este mal.
Los favorables resultados alcanzados, indujeron a imitar este ejemplo
y k establecer esculas analogas, a iniciativa de las ligas contra la tuber-
culosis, en Boston, New York, Chicago y en Hartford, Rochester, Paw-
tucket, Buffalo, Cambridge, Pittsburgh, etc. Lo que llama la atenci6n
es la variedad de sistemas empleados en los Estados Unidos. Asi, en
Providence, fue establecida la escuela en un segundo piso de una cons-
trucci6n de ladrillo, con una gran sala abierta por uno de los costados,
para recibir el aire y la luz en abundancia; en Boston, se le situa en un
parque publico; y, en Nueva York, la escuela al aire libre se crea en
conexion con el "Out Door Camp" mantenido por el "Bellevue Hos-
pital," sobre un "ferry boat" (barca 6 chata de rio, a vapor) en el "East
River." Tres escuelas mas, semej antes, se abren en New York en otros
tres "ferry boats" y una en el tejado del edificio que ocupa la "Vander-
bilt Clinic;" y en este camino de crear nuevas escuelas al aire libre en
que ha entrado New York, lo siguen, tambien, los otros estados de Norte
America.

Pero, aunque diversas en sus modalidades, en este pais, las escuelas
al aire libre, el sistema, en el fondo, es el mismo: abundancia de aire y
de luz, buena ahmentacion y poco trabajo intelectual; y, los efectos
producidos son siempre altamente satisfactorios. Ya en Providence
se habia observado que las pruebas de la hemoglobina hechas con los
nifios manifestaban una variacion de 74 k 84, desde la entrada k la
escuela, en el mes de Enero, hasta la salida en el mes de Junio; y, el
profesor Thomas E. Balliet, dice que "los resultados obtenidos en
^stas, han sido, en todos los casos, favorables, en grado verdaderamente
notable;" y, agrega que; "los nifios, con raras excepciones, ganaron
rdpidamente en peso y condiciones de vitalidad y el proceso de la tuber-
culosis, frecuentemente se detuvo" (2) Y, cosa analoga sucede en Italia;
ya sea en Roma, donde siguiendo el ejemplo de los Estados Unidos, se
crea en 1910 una secuela de ese genero sobre la terraza de un edificio
escolar y en vista de lo satisfactorio del ensayo realizado, ocho escuelas
mds; ya, en Genova, donde se establece una escuela al aire libre, en el
campo, en 1910 y otra en 1912; y, en Milan, Brescia, Venecia, Padua y
Verona, ciudades que tambien las tienen ya; y, lo que Italia a este
respecto acontece, no es sino una nueva prueba del feliz exito que las
escuelas al aire libre en todas partes alcanzan.

PORVENIR DE LA ESCUELA AL AIRE LIBRE 147

Ahora bien, los sorprendentes resultados obtenidos con las escuelas
al aire libre se deben, sencillamente, a que 6stas responden k las necesi-
dades de una educaci6n dada en condiciones higienicas y racionales.
Proporcionar a los ninos que ingresan a ellas el aire y el alimento que
les falta y reducirles el trabajo que les sobra, he aqui el secreto que
explica el invariable y favorable exito de esas escuelas. Pero y es esto
lo que mds debe llamar nuestra atencion, si el triumfo de la f6rmula:
"doble racion de aire, doble racion de alimento y media raci6n de trabajo,"
aplicada a las escuelas al aire libre, es la prueba de la bondad de estas,
significa, a la vez, la contra-prueba de que la ensenanza en las escuelas
comunes se da en condiciones antihigienicas y desfavorables.

Es, precisamente, la carencia, en las escuelas, del aire puro indispen-
sable, la mala alimentaci6n de la mayoria de los alumnos y el excesivo
trabajo que estos realizan dentro y fuera de aquella, lo que caracteriza
hoy, con diferencias de simple detalle, la ensenanza publica obligatoria
en todos los paises, y lo que explica los perniciosos efectos que esta
produce sobre la salud de los escolares.

Es indudable que, el aire que en las escuelas urbanas respiran los
ninos, lejos de ser provechoso para su salud les es perjudicial. El aire,
en efecto, no muy puro de las ciudades, se altera aun y vicia rapidamente
en las salas de estudio de aquellas, donde, la exhalacion pulmonar de
los escolares, los gases que se desprenden de las funciones de digesti6n,
las secreciones cutaneas, el polvo y los micro-organismos contenidos
en la habitacion y en los vestidos, las combustiones debidas a los apara-
tos de alumbrado y calefacci6n, etc., producen necesariamente ese re-
sultado. Este natural efecto de la aglomeraci6n de alumnos, en recintos
por lo general estrechos y cerrados, es tanto mas dificil de salvar cuanto
que la ventilaci6n artificial de las clases, costosa y delicada para esta-
blecerla, no da, frecuentemente, el fin deseado y, que la ventilacion cor-
riente, efectuada cuando los estudiantes abandonan las salas de estudio,
tiene el iriconveniente de que el remedio se aplica cuando el mal que
resulta de la permanencia, mas 6 menos larga, en recintos cerrados,
esta ya producido. Ahora, segun refiere el Dr. L. Henchoz, las obser-
vaciones hechas en Paris, por el Observatorio Municipal, han venido k
descubrir una proporcion media de 192 litros de acido carbonico por
100 ms. de aire en los diversos establecimientos escolares; habiendose,
en la sala de estudio de un liceo constatado, asimismo la presencia de
352 litros de 4cido carb6nico por 100 ms. de aire; y, las experiencias
de Scharling, que ha encontrado 2.9% de acido carbonico en la exhala-
ci6n horaria media de un escolar y de Fischer, que ha comprobado que
en una sala de clases cuyas puertas y ventanas permanecen cerradas
durante dos horas, se halla, k los cinco minutos 1% de C.O2, despues
de 50 minutos 2.9%, y k las dos horas 4.3%, demuestran que el aire

148 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

que los alumnos respiran es, frecuentemente, nocivo. Y tanto lo es,
que los experimentos de Brown Sequard y de Arsonval inyectando k
conejos los productos de la exhalacion pulmonar del hombre, han venido
k probar la toxidad del aire expirado.

No es necesario detenerse a examinar los desastrosos efectos que el
aire viciado, cargado de acido carbonico ejerce sobre el organisno, ya
que es sabido que el produce debilitamiento en las funciones de nutri-
cion, disminucion de vitalidad y aun la anemia misma; que tiene una
influencia perniciosa sobre el sistema nervioso y sobre los gl6bulos
rojos de la sangre y que, lo que es mds grave aun, predispone a la tuber-
culosis; porque, como lo hace notar el Dr. Bewhest, medico' inspector
y profesor de higiene en Budapest, "la respiracion en el aire insalubre
se efectua solo superficialmente, de suerte que los pulmones y particular
mente el vertice de estos no se llenan suficientemente de aire y vienen
k ser asi un terreno propicio k la formaci6ny aumento de los bacilos de
la tuberculosis."

Contribuye, tambien, y de manera capital, al debilitamiento general
organico de los alumnos, estado preparatorio de las mks graves enferme-
dades, el excesivo trabajo mental y aiin material, realizado por 6stos
dentro y fuera de las escuelas. "Ciertamente que Uds. no sabrdn
nada nuevo, exclamaba el Dr. Mathieu, presidente del Congreso Inter-
nacional de Higiene Escolar de Paris (discurso pronunciado en la sesi6n
solemne de apertura) si yo les digo que los programas estan en gran
medida sobrecargados. La pedagogia de manana que sera la pedagogia
natural, la pedagogia fisiol6gica, debera resolver este problema, mejorar
la educacion intelectual y disminuir el tiempo consagrado al estudio y a
la ensenanza." No voy a insistir en este punto, ya que higienistas y
pedagogos estan, unanimemente, de acuerdo en la necesidad de aligerar
los programas; pero, quiero si hacer notar que el mal enunciado por el
Dr. Mathieu se aumenta con la viciosa costumbre de dar a los alumnos
labor escolar para realizarla fuera de la escuela y con el hecho, mks
grave aun, y bastante frecuente, de que los ninos trabajen en la indus-
tria k la vez que concurren a aquella.

Ya en el Canton de Vaud, en Suiza, se habia notado que en el campo,
muchos ninos "en pie desde las 5 de la manana, rendidos por los duros
trabajos agricolas, ingresaban a la clase a medio despertar, incapaces
de todo esfuerzo intelectual que hiciera su ensenanza provechosa." (3)
Una investigacion general hecha por la "Societe Suisse d' Utilite Pub-
lique" y a la cual respondieron trece cantones, puso de manifiesto que
"de 280,000 ninos, 118,000 trabajaban en explotaciones agricolas;"
y, que "de 30,000 ocupados en las industrias de la paja, de la pasama-
neria, del tabaco, del bordado y de la relojeria, 825 trabajaban diaria-
mente 6 horas, y 1,100 mas aun; mil ninos, mks 6 menos, trabajaban

PORVENIR DE LA ESCUELA AL AIRE LIBRE

149

el domingo, 109 k partir de cuatro -de la manana, 576 k partir de las
cinco, 206 hasta las diez de la noche, 121 hasta las once y 35 hasta des-
pues de las once."

El Dr. Platzhoff Lejeune, hacia notar, con este motivo, en el seno
de la "Societe Vaudoise d' Utilite Publique" la "insuficiencia de las
disposiciones de la ley sobre las fabricas;" pero, en realidad, el caso
enunciado se presenta aun dentro del respeto a aquella ley misma,
siempre que el limite de edad para trabajar en una fabrica sea
menor que el fijado para la escolaridad obligatoria. Tal sucedi6
en Zurich, en que una comision escolar del Canton pretendio inutilmente
prohibir a un alumno de 14 anos trabajar en una fabrica, fundandose
en una ley escolar de ese Canton que prevee la cii-cumstancia de que un
nino no puede ser obligado a labor superior k sus fuerzas, sea en el seno
de la familia, sea fuera de ella; decision de la que protesto el padre de
aquel, haciendo presente que la ley federal sobre las fabricas autoriza
a los escolares de 14 anos a trabajar en un taller, siempre que no pasen
de II las horas diarias de labor; (4) y, esto acontece, tambien, en todos
aquellos Cantones de la Suiza, en que se fija en 15 anos la obligacion de
concurrir k la escuela, mientras que desde los 14, en virtud de la ley
citada, pueden los ninos emplearse en trabajos industriales.

Este mismo y delicado problema lo tienen planteado todos los paises;
pues cuando se prolonga como es debido los anos de ensenanza obliga-
toria, como sucede en Suiza, se tropieza con el inconveniente senalado
y, cuando se restringe esta hasta hacerla coincidir con la edad determi-
nada para el trabajo industrial, se resiente la instruccion ; como lo expresan
uniformemente los pedagogos en los paises en que tal cosa acontece y
como lo manifiesta, tambien, el hecho de tenerse que recurrir, mds tarde,
a las clases para adultos, como medio de completar la primera y defi-
ciente ensenanza recibida. Hay pueblos en que no se osa Uegar siquiera
hasta la obligacion escolar completa y se buscan soluciones a medias,
como la de exigir que los ninos ifrecuenten la escuela durante un cierto
numero de dias consecutivos cada ano (de dos a cuatro meses general-
mente) ; 6, despues de haber aceptado, en principio, la regla de la asidui-
dad escolar, se admite, sin embargo, la posibilidad de sustituir la fre-
cuentacion de las clases de dia por los cursos de noche; 6, se exige, por
ultimo, un certificado de escolaridad, limitado al conocimiento de la
escritura, la lectura y de algunas nociones elementales.

En esta oposici6n entre las necesidades de la ensenanza y las exigen-
cias del trabajo industrial, resulta siempre aquella, en una li otra forma,
sacrificada a este; y, menos mal, cuando se establecen limites precisos
entre ambos de manera que no puedan confundirse, porque facil es com-
prender cual ha de ser el funesto efecto ejercido sobre el debil organismo
de los ninos por un trabajo material duro que viene a agregarse k una

150 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

labor mental, generalmente recargada; ya que como es sabido, la fatiga
muscular y la fatiga intelectual, producer! los mismos fenomenos de des-
asimilacion y de depresion organica.

Por otra parte, muchos alumnos van k la escuela, sin haberse desa-
yunado. " Frecuentemente para el nifio pobre, la mejor comida es
aquella que toma en la cantina de la escuela." El Dr. Mathieu refiere
que un maestro de Paris le manifestaba que tenia comprobado que "los
ninos no podian trabajar sino d partir del momento en que estaba abierta
la cantina escolar." Podra resistir un escolar en estas condiciones, y
sin respirar siquiera el aire puro que le es tan necesario, la excesiva labor
intelectual que se le impone?

Los resultados no se hacen esperar. La escuela es hoy el peor ene-
migo de la salud de los ninos. Schmid Monard, despues de haber exami-
nado mas de 10,000 ninos de ambos sexos, en las escuelas de Italia, ha
podido constatar que "los males e indisposiciones de todo genero aumen-
tan con la frecuentacion escolar;" y el Profesor Shuyten, al estudiar
las enfermedades que la escuela produce 6 desarrolla, llama, particular-
mente, la atencion respecto al hecho de que "existe entre los alumnos
una fatiga cronica es decir, permanente, que crece a traves del ano
escolar y se localiza en el hemisferio cerebral izquierdo." El Dr. Gran-
cher habia ya encontrado en las escuelas de Francia un 15% de ninos
pretuberculosos y esta cifra aumenta, enormemente, si consideramos en
ella los ninos atacados de otras enfermedades, 6 cuyo estado de debilidad
los prepara para contraerlas. "Si examinamos la juventud de las
escuelas de la edad de seis a catorce afios, dicen los Drs. V. Klima y F.
Hanza; (5) notaremos que ella sufre de un cierto debilitamiento y que
ella misma esta amenazada por los primeros sintomas de enfermedades.
El porcentage de los niiios d^biles y enfermizos es enorme y, en ciertas
escuelas llega, del 80 al 90%."

Si tenemos actualmente escuelas, como las ordinarias, en que lo
general es que los ninos pierdan la salud y lo excepcional que la conserven ;
y, escuelas, como las de aire libre, en que al contrario lo raro es que los
niiios enfermos no sanen, esta indicada la urgencia de inspirar aquellas
en el modelo de estas. Combatir la tuberculosis y las enfermedades
infantiles en la escuela, no es contentarse con pretender curarlas cuando
ellas aparecen, sino evitar que ellas se presenten. La higiene escolar
debe tener un caracter preventivo antes que curativo. Mientras no
se destruya la causa del mal poco haremos con combatir el efecto ; y , la
causa, ya lo hemos dicho, estd en la inaceptable base antigienica en que
reposa hoy la. ensenanza obligatoria.

Y, tocamos aqui un punto en que la higiene escolar se confunde con
la pedagogia social. Las democracias que gozan del derecho indiscutible
de imponer la ensefianza, tienen el deber de fundar ^sta al suministrarla

PORVENIR DE LA ESCUELA AL AIRE LIBRE 1 51

sobre bases higienicas y humanas. Est a obligacion es tanto mas impe-
riosa, cuanto que la mayor parte de los niiios que se ven precisados a
aprovechar de la instruccion publica y gratuita pertenecen a las clases
pobres y, estan por esta causa mas predispuestos a las enfermedades
escolares.

Las condiciones generalmente anthigienicas en que viven los obreros,
su mala alimentacion, el esfuerzo exajerado que la moderna industria
les demanda, la existencia febril que llevan en las ciudades congestionadas
en que habitan y trabajan, reperecuten dolorosamente sobre sus hijos;
que van a la escuela sin haber gozado de su infancia, con una naturaleza
pobre y debilitada por la herencia recibida y por el medio insalubre en
que se ban desarrollado, para acabar de perder en aquella lo poco de
salud que les resta. Son conocidas las observaciones de Niceforo en
las escuelas de Lausanne, que demuestran que los ninos pobres tienen
"la talla, el peso y el perimetro toraxico inferiores 4 los de las clases
acomodadas;" y, los medicos escolares tienen ya comprobado que es
dentro de las clases mas necesitadas que deben buscar el contingente
para las escuelas al aire libre y los sanatorios, porque alii se encuentran
los enfermos de todo orden y, principalmente, los candidatos a la tuber-
culosis.

Las escuelas al aire libre para todos los ninos resolverian el problema,
ya que ellas son, no simplemente mas higienicas sino tambien mas peda-
gogicas, como lo hacen notar entre otros, Balliet, Dufestel y Lacabe
Plasteig, que ponen de manifiesto el hecho de que los progresos realizados
desde el punto de vista intelectual son sensiblemente superiores en aque
lias que en las urbanas, y que "con sus dos horas de labor cotidiana, se
conservan los ninos al mismo nivel mental que los de las escuelas de la
ciudad, y pueden a%i pasar, facilmente, su certificado escolar."

Se dice, sin embargo, que las escuelas al aire libre son costosas. No
lo son tanto, en verdad. En Charlottenburg, se ha llegado a reducir
a un franco cinco centimos, el gasto diario por niiio; cantidad bien
pequena, por cierto, si se tiene en cuenta la importancia del fin que
satisface. Con la quinta parte de lo que inverten las naciones de Europa
en sostener la paz armada, podrian realizar la indicada reforma en la
ensenanza popular, Pero, es preciso reconocerlo, por una de esas curi-
osas anomalias de la civilizaci6n actual, los paises soportan bien hoy en
el mundo, los gastos, por excesivos que sean, cuando ellos tienen por
objeto ponerlos en aptitud de destruir vidas humanas, pero no cuando
van dirijidas a salvarlas.

Por lo demds, lo importante no es adoptar exactamente el tipo
de las escuelas al aire libre en las escuelas ordinarias, sino adaptar estas
de acuerdo con las necesidades de la ensenanza general, a la esencia del
sistema que ha producido en aquellas tan provechoso resultado y, asi,

152 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

suministrar a los nifios el aire puro que necesitan, dar a los que
tienen necesidad de ello, el indispensable alimento, y, establecer para
todos una labor mental adecuada, excluyendo por completo todo
trabajo industrial son los principios racionales higienicos en que la
ensenanza, y particularmente la popular y obligatoria, debe estar
fundada.

Algo de esto se esta haciendo teoricamente, el Congreso Interna-
cional de Higiene Escolar de Paris, sanciono el principio de que, "en
las escuelas ordinarias seria util abrir clases de aire puro;" y, practica-
mente, se realiza ya esto en algunas escuelas publicas, particularmente
en las norte-americanas ; y, las cantinas escolares, hasta hace poco
desconocidas, se desarrollan, rapidamente, en todos los paises, al extreme
de que una sola de las veinte cajas de distrito existentes en Paris, la del
distrito 15, reparti6 en un aiio a los escolares, 547,352 comidas gratuitas
y 203, 947 de paga. Pero, la obra de reformar la escuela popular, desde
el punto de vista higienico y social, no puede quedar reducida, como
actualmente sucede, a esfuerzos aislados y a una accion, con frecuencia
de caracter privado, necesariamente restringida y deficiente, sino que
ella debe corresponder a los poderes publicos, que tienen el deber de
organizarla de modo integral y con indole de generalidad. A ellos toca
en efecto, velar porque el trabajo del taller no venga a sumarse al de la
escuela para aniquilar a los nifios ; a ellos interesa, asimismo, que reciban
estos el aire puro que su salud demanda; y, ellos, por ultimo, estan Uama-
dos a acudir en ayuda de aquellos pequenos infelices para quienes existe
la obligacion de asistir a la escuela, pero no el derecho de ir a ella sin
debilidad y sin hambre.

Se impone, pues, la necesidad de convertir la higiene escolar en una
verdadera funci6n social de proteccion a la infancia. Si hoy el estado
se cree en la obligacion de dictar leyes a favor del proletariado, a fin
de reparar las desigualdades sociales injustas de que este resulta victima,
ique de extrano tiene que procure reparar, tambien, las que sufren los
ninos pobres, mas dolorosas aun por tratarse de seres inocentes, que
perdieron desde el nacer el derecho a la felicidad? Y, en este caso, la
ciencia viene en apoyo de los sentimientos humanitarios, porque ella demu-
estra que solo una ensenanza sujeta estrictamente a los principios de la
higiene fisica y mental, es capaz de impedir que se malogren o pierdan
en la escuela tantas vidas en flor. Ahora bien, al estado interesa pri-
mordialmente, protejer y defender la infancia, porque asi "salva la
semilla" y asegura su propio porvenir. Es, en efecto, a la postre un
negocio productive, cualquier dinero invertido en la escuela en la defensa
de la salud y de la vida humana. Es por eso, que debe aprovecharse
de esta a donde concurren los nifios diariamente y por largas horas, y
de los seis a los catorce 6 quince afios, es decir, en ese periodo de la vida

PORVENIR DE LA ESCUELA AL AIRE LIBRE I53

en que "la mas potente regeneraci6n natural se manifiesta," para afirmar
su buen desarrollo fisico y psiquico.

Cuando estas ideas se apliquen, poco importara que la trasformaci6n
se efectue adaptando k las nuevas necesidades las actuales escuelas; 6,
lo que es mejor, llevando estas fuera de los centres muy poblados, al
campo si posible fuera, donde los ninos encuentran el aire puro, la luz
solar y los espacios abiertos que tanto necesitan. Lo que interesa es
que la escuela sea mas libre y alegre y que la ensenanza se d^ con "un
minimum de claustracion y de sedentaridad escolares." Y, lo que es
mas sustancial aun, es que se asegure mas que la instrucci6n la salud
fisica y moral de los alumnos. La higiene escolar y la pedagogia social
tienen a su cargo, de consuno, la tarea de realizar esta noble obra; alta-
mente util para toda democracia, que debe aspirar a que los ninos, sus
ciudadanos del manana, sean y se conserven sanos y felices y amen k
sus semejantes y al pais en que ban nacido.

(1) Dr. L. DUFESTEL.

Hygiene Scolaire.

(2) ''Open-Air Schools and the Children Who Should Benefit From Them''

Informe presentado por el Prof. Thomas B. Balliett, Decano
de la Escuela da Pedagogia de la Universidad de Nueva York,
al Congreso Internacional de Higiene Escolar de Paris.

(3) Annuaire de V Instruction Puhlique en Suisse (1912).

(4) Annuaire de V Instruction Puhlique en Suisse (1913).

(5) ''Programme des Colonies Feriales {de vacances) et Sanitaires des

Enfants."

Informe presentado al citado Congreso por los Dres V. Klima,
medico de la ciudad de Praga y F. Hanza, Consejero Imperial
y Director del Sanatorio Real para los ninos escrofulosos.

154 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA
LA TUBERCULOSIS-PROFILAXIS ESCOLAR

Creaciones e impulsiones en el Sistema Escolar Argentine

FOR LOS DELEGADOS ARGENTINOS

A. ViDAL Y C. Robertson
(Exposicion del Dr. Antonio Vidal : Sesion 29 Agosto.)

La "Escuela al aire libre" (Open-air schools: Ecoles en plein air:
Scuole air aperto: Waldschuelen), han atraido estos ultimos afios y
continuan atrayendo poderosamente la atencion de higienistas y
pedagogos. Las instaladas hasta la fecha han mostrado a la evidencia
sus ventajas. Debido a ello y a los juicios emitidos con respecto a su
porvenir por autoridades no contestables en materia de fisiologia peda-
g6gica e higiene escolar, juicios invariablemente favorables y con fre-
cuencia entusiasticos, el conjunto 6 sistema de esas fundaciones ha
crecido notablemente. La base cientifica en que el sistema asierta, va
entretanto y por modo progresivo, adqueriendo consistencia. En los
relatorios y trabajos presentados a la sesion ultima del "Congreso
Internacional de Higiene Escolar:" Brannan y Balliet (Nueva York);
L. Williams (Bradford); R. P. Williams (Sheffield); Randi (Padua);
Vignes (Lyon) ; Sisto (Buenos Aires) ; Lacable-Plasteg (Paris) ; Neufert
(Charlottenburgo) ; Querton (Bruselas) ; Wolff (Muelhausen) ; Tluchor
(Vienna); Bexheft (Buda-Pesth) ; Kirkby (Bradford), etc., pueden
hallarse con datos descriptivos sobre las obras existentes, elementos
constitutivos de dicha base. Pero no es solo este Congreso el en que
se refleje interes por cuestion de tanta actualidad. Ella se ha ventilado
asimismo con empeilosa atencion en diversas asembleas de ambos mundos.
Uno de nosotros. Dr. Antonio Vidal, habia seguido y tratado personal-
mente (introducida bajo enunciados distintos), en varios congresos
Americanos, de medicina y de ciencias: Montevideo (1907); Santiago
de Chile (1908); Rio de Janeiro (1909) y Buenos Aires (1910), tuvoocasi6n
de reanudarla en la ultima asamblea internacional contra la Tubercu-
losis (Congreso de Roma; Mayo de 1912). Las observaciones biblio-
graficas y criticas sobre la elucidacion y amplia y brillante que del asunto
se hiciera en Roma, consignaronse en un trabajo que bajo el titulo:
"Organization Prophylactique des Ecoles" se publico en los "Archives
Internationales d'Hygiene Scolaire." En dicho estudio, mostrabase
la estrecha vinculacion creada hoy en dia entre ambos grandes problemas

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA 155

tecnicos y sociales: el problema escolar, higieno-medico-peciag6gico, y
el problema profildctico de la Tuberculosis; y, senalabanse, ademas,
ciertos aspectos nuevos del magno asunto, encarado de modo k destacar
los lazos de conexi6n existentes y k crearse, entre las direcciones de
accion que expresan estas dos palabras "Tuberculosis" y "Escuela."

Si se hiciera el computo preciso (La operacion no ha sido hecha que
sepamos) de las escuelas que funcionan hoy en dia en Alemania, Estados
Unidos, Francia, Inglaterra, Austria-Hungria, Italia, Suiza, Argentina
y otros paises, bajo el principio general del "Aire libre," se obtendria
una cifra importante.

Pero esa cifra no nos revelaria sino una parte de la obra reformadora
que viene realizandose a partir del precioso experimento escolar de
Charlottenburgo, en 1904. Nos reflejeria solo el movimiento habido
en cuanto concierne a establecimientos de instruccion, k escuelas propia-
mente dichas. Transformaciones materiales y funcionales de mucha
importancia y de direcci6n muy pratica, quedarian excluidas. Esas
por ejemplo, que no afectando sino parcialmente la escuela publica,
comun, habilitan en esta una 6 mas "Secciones" 6 "Clases al aire libre"
(Fresh-air rooms). Hay pues que poner en cuenta esta reforma, de
efectuacion relativamente facil ; mas hay otras todavia que, en el mismo
sentido, contribuyen a mejorar, k higienizar la vida escolar, en las grandes
ciudades sobre todo.

Nos referimos ahora a las distintas obras 6 instalaciones comple-
mentarias que sin ser propiemente escuelas al aire libre, proveen a los
escolares de aire puro y de alimentos a la veces, proporcionandoles
ademas siquiera en una parte del dia, espacio para sus juegos y un si tic
de sano reposo y esparcimiento despues de la tarea.

La naturaleza y amplitud de estas instalaciones, como sus otros
rasgos, son variados, como es vario el nombre que Uevan: " Recreaciones;"
"Jardines;" " Estaciones ;" "Campos de Juego;" "Plazas." Hay
algunas que representan una adoptaci6n feliz: Bastiones abandonados,
trozos de ribera, cubierta de barcos, etc. Todas y cadauna representan
organos que integran el '' Sistema de aire libre.'' Prestan servicios de
utilidad suma k los centros densamento poblados, alii donde las crea-
ciones anteriormente aludidas son dificiles.

Finalmente para caraterizar de modo completo el movimiento refor-
mador, es absolutamente preciso acordar sitio k la serie de reformas
materials (aireaci6n y ventilacion, ampliaci6n de locales, etc.) y funcio-
nales, que, si bien pertenecen por su indole k la higiene escolar comun,
han sido en realidad y siguen siendo impulsadas, sobre todo por la cre-
ciente propaganda surgida k raiz de la fundacion de Charlottenburgo.

Efectivamente, es menester convenir en que ha sido poderosa esta
influencia demostrativa, que ha logrado veneer la indiferencia de muchos

156 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

espiritus, atrayendolos a la causa de la instrucci6n saludable. Tanto
es asi, que acaso pudiera estimarse de mas ventajas todavia para la colec-
tividad esa accion indirecta que la muy feliz directamente ejercida por
las escuelas de aire fresco y puro. A ese titulo solo, valdria la pena de
sostener con ardor su instauracion,

Es, pues, concibiendo unidas todas estas transformaciones venta-
josas que en vigor no se prestan a una apreciacion numerica, que debemos
apreciar la positiva significaci6n del movimiento reformador.

En el momento actual, pensamos que el estudio general de la cues-
tion aparte las resenas descriptivas siempre utiles de esta 6 aquella
fundaci6n comporta el logro de los tres objetivos que siguen:

I . Definir y clasificar (dando los antecedentes de cada uno y
la razon de su origen) los diversos tipos de escuelas y de institu-
ciones varias, parecidas 6 formando unidad, k que antes aludier-
amos, asignando a cada tipo sus condiciones materiales y sus
cardcteres y modos funcionales.

2. Prescribir-labor concretamente tecnica, con destino a una
determinada colectividad escolar 6 aun, con alcance mayor, a
un sistema pedagogico dado. El plan de creaciones, reformas
6 instauraciones de aire libre que sea conveniente imponerla.
Clara indicaci6n serd hecha en eses plan de las determinaciones
correspondientes k cada una de las tecnicas: medica, arqui-
tectural, pedagogica, y

3. Estudiar, con amplitud un tanto mayor que la habitual
el movimiento cientifico que est4 produciendose en torno a las
realizaciones pedag6gicas en cuestion, que las impulsa y deter-
mina.

En lo que dejamos dicho y a lo que va a seguir, procuraremos esbozar
las tres direcciones de labor, deteniendonos algo mas en la ultima. A
prop6sito de la segunda, nos permitiremos presentar rapidamente las
instituciones "all'aperto" de la ciudad de Buenos Aires, cuya mas
adelantada expresion constituyan la sus Escuelas Para Ninos Dehiles.

Las fundaciones al aire libre dejimos, son variadisimas. Lo son en
cuanto a su magnitud y rango, a su naturaleza y fines, medicales y
pedag6gicos; a los atributos fisicos del medio que las circunda; a su
manera de funcionar; al regimen de trabajo y de vida a que est^n sujetos
los pupilos. Si no todos, casi todos, ademas, poseen modalidades propias,
rasgos fisionomicos caracteristicos. Radicadas en plena ciudad, 6 en los
suburbios 6 alrededores, 6 en plena campana; en el bosque, en la playa,
en el llano 6 la montana. Emplazadas en distintas latitudes ya funcionan
en verano, ya en inverino; en dos 6 tres estaciones; 6 bien combinados

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA I57

los medios, durante todo el ano. Sea que forman unidad en lo peda-
gogico, 6 que sean solo fracci6nes de unidad, destinanse a ninos de tierna
6 media infancia, k adolescentes ; a ninos sanos puramente; 6 k predis-
puestos y enfermos 6 a dos 6 tres de estas categorias, con 6 sin deter-
minadas maneras de separacion. La permanencia de los ninos es solo
de horas-externado 6 de todo el dia, no reintegrandose al domicilio sino
para el descanso nocturno; 6, enfin, igual k la de un franco internado.

La matricula del escolar es anual 6 es peri6dica, de algunas semanas
para que se renueven los grupos beneficiados, como proceden ciertos
establecimientos Franceses e italianos, etc. Si penetrando mds en
el detalle nos deuvieramos en otras, particularidades ; y si sobre todo
atendiesemos, en lo pedagogico y social, a la formas y maneras posibles
de realizacion, multiplicariamos las variedades.

Que clasificacion hacer de estas fundaciones? Tenemos recojidos
y ordenados los elementos que tal vez nos permitirian arribar a una
aceptable, si siquiera provisoriamente. Preferimos, no obstante diferir
el proposito. Habiendo uno de nosotros, el Dr. Vidal, llevado k cabo
personalmente el ano anterior (19 12), en cumplimiento de una misi6n
.oficial que le confiara el gobierno Argentino, el examen detenido de las
principales escuelas 6 instituciones europeas de aire libre, poseemos
datos suficientes para un ensayo de ese genero; ensayo comparativo y
de clasificacion que acaso pudiera rendir algun servicio. Pero optamos
por hacerlo conocer cuando lo hayamos madurado mas.

Ha de permitirnos, sin embargo, anticiparnos aqui una sugesti6n
nacida de esas observaciones sobre el terreno y que ha podido ya rendir-
nos fruto. Esta era la idea sugerida: reunir hasta donde posible, en
creaciones ulteriores, los elementos de bondad, de superioridad, compro-
bados en el propio funcionamiento de las distintas obras. Porque no
tomar, pensamos entonces y seguimos pensando hoy, lo bueno que en
tal 6 cual orden de cosas, respectivamente tienen, v. gr: la escuela
historica de Charlottenburgo; la recreacion de Padua, impulsada por
el Dr. Randi, y que ha iniciado el movimiento en Italia; las escuelas
de Roma; la magnificamente instalada de Muelhausen; la de Lyon
con larga permanencia en la campana, que el Dr. Vigne nos ha de-
scripto, etc.?

Las obras de aire libre en la ciudad de Buenos Aires, y sobre las
cuales ha de permitirsenos algunas referencias, contienen incluidos
armonicamente recompuestos elementos de probada significaci6n.
Tanto como la prevision del cuerpo medico escolar y de las autoridades
de la ensenanza, en primer termino del Presidente del Consejo de Educa-
cion, el Dr. J. M. Ramos Mejia, que las sustubiera y ejecutara con
inteligente decision-han cooperado a ello, tal vez, diversas circumstan-
cias ocasionales.

158 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Entre esas obras, tienen el primer rango en el sentido que tra tamos
las Escuelas para ninos dehiles. Su nombre solo, define uno de sus
caracteres mas salientes, el de ser destinadas k la infancia debilitada,
fisiol6gicamente deficiente, y, por lo mismo, predispuesta. . Mediante
riguroso examen medica, se extraen de la masa escolar los sujetos que
ban de ser los pupilos del establecimiento escogiendolos de entre los
ninos que mas necesidad tienen de recibir esa suerte de beneficios. Es
pues un severo y logico criterio selectivo, selecci6n a la inversa, natural-
mente el que guia el procedimiento.

Otros caracteres acentuados de estas Escuelas (ellas son al pre-
sente dos, en pleno f uncionamiento ; dos por instalarse y varias mis,
proyectadas, en el molde ya creado) son los que brevemente se marcan
en seguida : emplazamiento en parques centrales y subrubanos ; instala-
ci6n, moblaje y utilaje, adecuados; observacion medico-fisiologica y
antropometrico constante, por especialistas ; personal ensenante escogido
k prueba de competencia; exposici6n al aire libre y 4 la luz, alimentaci6n
ejercicios y juegos; reposo y sueno, empleo del tiempo; programa y
horario de trabajo; todo esto, prescriptb y fijado mediante observaci6n
y prolijo discernimiento ; en sintesis, para no deternernos en detalles:*
Son componentes de la institucion aquellos elementos cuya bondad, cuya
excelencia aun ha sido ya verificada, sea en el estranjero, sea en el propio
terreno de la experiencia: y su combinacion, biiscase obtener la maxima
eficiencia.

Si bien ninguno de esos componentes elementales, como se podia
colegirse de lo dicho, tenga en rigor derechos de originalidad, es lo cierto
que el conjunto resultante de su recomposicion, en lo material y en lo
funcional, tal como en el momento actual hallase efectuada, imprime 4
las escuelas al aire libre para ninos debiles de la ciudad de Buenos Aires,
una fisonomia genuinamente propia. Y por lo que hace a la eficacia de
los medios empleados, a la regularidad y valia de los resultados obtenidos,
las comprobaciones son eternamente demostrativas. Ellas se muestran
k lo vivo, por asi decir, en el nino mismo: a aspecto exterior, disposici6n
al trabajo, presteza en los movimientos; alegria, vivacidad de espiritu,
etc. Pero se las inquiere y recoge tambien regularmente, con precisi6n
tecnica, en el curso del periodo escolar. Registranse asi periodicamente
datos y cifras correspondientes al examen medico-fisiol6gico, y antropo-
metrico de todos los escolares.

El aumento en el peso los diametros toxucicos y capacidad respira-
toria, en la accion omamometrica y en la riqueza globular de la sangre,
interpretado en el conjunto de la poblacion escolar hase manifestado
muy satisfactoriamente (fuera de algun interes, sin duda, analizar con
la luz de una de estas manifestaciones parciales en su generalidad, fre-
cuencia, grado, sentido progresivo, oscilaciones, etc., compararlas entre

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA

159

si e interpretarlas tomando en cuenta los distintos factores individuals;
pero deseamos no particularizar nuestro estudio en punto alguno).

Sobre todo si se consideran, comodebe hacerse los cambios notados,
en relaci6n k los antecedentes individuates de cada nifio, k sus lesiones
6 enfermedades anteriores, k sus modalidades fisiol6gicas o tendencias
hereditarias. Pues, como facilmente se alcanza, en buen niimero de
ninos escogidos en la forma que lo estdn estos, la simple detenci6n
de un proceso denutritivo, y mds un mejoramiento siquiera ligero,
denotan una transformacion definidamente favorable. Transformaci6n
que en muchos casos habria sido notable. Por cierto que los efectos
ventajosos alcanzarian grado mayor si se obtuviera la permanencia
continua de los ninos. Pero no; la influencia favorable se interrumpe
durante horas ; el regimen saludable de la escuela altera con el con tanta
frecuencia malsano en lo fisico y en lo moral tambien del propio hogar.
Ello no obstante por mas que deba primar aqui la raz6n de salud y de
vida, el hecho es que practicamente, la transformaci6n en internados
de las escuelas de aire libre, es problema casi insoludable. Mas adelante
vozaremos de nuevo el punto. (Los razgos y caracteres de las " Escuelas
para niiios d^biles" de la ciudad de Buenos Aires, son expuestos con
detallada precision en la memoria que con destino k la presente sesi6n
del Congreso ha redactado el Dr. Cassinelli, medico que estk desde aiios
al servicio de aquellas.)

Hecha asi brevemente la presentaci6n de la mks importante y avan-
zada, entre las obras del aire libre creadas en la Republica Argentina,
examinaremos algunos aspectos de la cuesti6n que no hemos considerado
todavia, 6 solo muy ligeramente.

La proporcion en que los grupos escolares son beneficiados por las
instituciones de aire libre, es uno de esos aspectos. Todos habrdn de
reconocerlo, sea cual fuese el punto de observaci6n, una 6 mks ciudades
alemanas, francesas, italianas, etc., la cifra de ninos favorecidos por las
nuevas escuelas es bien pequeiia. Lo es en absolute; lo es en relaci6n
k la cantidad de sujetos que han menester premiosamente de medios
reparadores; y lo es sobre todo en atenci6n k la poblaci6n infantil en
conjunto. La cual, si no en su totalidad, en su fraccion mayor, hdllase
expuesta en las grandes urbes a la influencia debilitante, destructora,
del aire impuro y de elevada termalidad. iSerk, pus, necesario fundar
mas escuelas del g6nero? Ciertamente. Pero ello no bastarfa, por
mucho que se recurriese, como estk indicado proceder, k instalaciones
de reducido costo, y aun cuando se llegari al limite razonablemente
permitido. iQue hacer entonces? Recurrir k las instalaciones parciales
y complementarias de que antes hablamos, instalaci9nes parciales al
servicio de una agrupaci6n infantil limitada, de una 6 mas escuelas, v.
gr: espacios libres y jardines, altillos y azoteas ("roofs"). Clases al

l60 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

aire libre, de modo general (fresh air rooms). Instalaciones comple-
mentarias, al servicio mas bien de una colectividad de cierta considera-
ci6n, como la poblacion escolar de una ciudad: estaciones, plazas, jar-
dines, etc. Pero aun con eso realizado en la posible escala, no se habria
satisfecho sino parcialmente las indicaciones. Una amplia prescripci6n
se impone, modificar las clases de las escuelas publicas y privadas, y
modificar estas escuelas mismas, en lo que toca a higiene material y
funcional. Las modificaciones, es claro, seran dictadas con arreglo k
los mismos principios fisiologicos que hicieran nacer. Mucho puede
con la constancia lograrse en tal sentido la personal experiencia nos lo
ha probado. En la ampliaci6n de ventanas y aperatura de nuevas
bocas de aire; en las realizaciones que operen cambios favorables en la
termalidad y ventilaci6n de los locales ; en la obtenci6n de combinaciones
favorables, en punto k numero, situaci6n, tiempo y modo de trabajo de
los niiios; en la ejecucion de reformas varias, que no podriamos especi-
ficar aqui, hay todo un programa de labor tecnica, ingrata y dificil no
pocas veces, pero positivamente util. Labor tecnica en la cual tienen
su parte el arquitecto, el medico, el institutor, y el i los funcionarios
que gobiernan la enseiianza. Y, naturalmente, la direcci6n, la orienta-
cion de ese programa no deberia ser otra que la instrucci6n sana, repara-
dora, fisiologica; la misma por consigniente que las obras y escuelas de
aire libre. Se observara por alguien, tal vez, la poca significaci6n que
tienen casi todas las reformas que acabamos de hacer referenda; y ello
es verdad. Pero lo es si se las considera parti cularmente, una 4 una,
y en los casos singulares; deja de serlo, si ellas, por la constancia y gen-
eralidad con que se ej ecu ten, se adicionan en un vasto con junto. En-
tonces los efectos pueden alcanzar notable cuantfa. Claro es que para
obtener efectos asi adicionados se precisa contar con una fuerte organi-
zacion de la higiene escolar. Organizacion 4 la vez tecnica y ejecutiva.
Queremos decir que sepa desprender con precisi6n y amplitud las pre-
scripciones del caso, pero que tambien pueda cumplirlas y hacerlas
cumplir. No hay duda que ello va obteniendose con lentitud, pero
progresivamente, k medida que los modernos conceptos de sanidad
infantil, salvando la esfera limitada de los profesionales y especialistas,
penetran en el espiritu de los gobernantes, de los hombres con infiuencia
en el manejo de la cosa piiblica. Precisamente para lograr esa difusi6n
y penetretacion de nociones y conceptos utiles k la comunidad, nada
tan eficaz como la efectuaci6n misma de las transformaciones vinculadas
con las ideas que se trata esparcir, nada como la ejemplificacion. Y
esa sin duda que radica el principal {^eneficio de las obras al aire libre.
Con las ventajas que aportan a la salud de un grupo de ninos, cuentanse
las que traen a la colectividad, imponiendo k los ojos de todos su incon-
testable eficacia. Por ellojes que no subscribiriamos sin alguna reserva

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA l6l

la proposicion del Dr. Stokler de Paris, para condena, el costo excesivo
tratandose de las nuevas escuelas. Porque si bien convenimos en que
del combatirse lo inmoderado y lujoso, pensamos tambien que a una
colectividad, una ciudad, convienele, aun a costa de erogaciones, ofrecer
realizaciones que contengan excelencias de todo orden, las cuales con-
stituiran la mejor de las propagandas.

Hemos hablado en lo anterior de instalaciones materiales y de cam-
bios funcionales y de regimen. Una explicacion es conveniente. El
aire puro y fresco, por mas que sea el primer elemento constitutivo de
una "Escuela al aire libre," no es el linico. Con el se combinan el
alimento reconstituyente y sano; el reposo, el sueiio prolongado; los
ejercicios y juegos espontaneos a sus horas; la labor intelectual redu-
cida, facil, distribuida, etc. En una palabra, sabiamente recompuestos,
los elementos de un buenregimen, derivados de claras normas fisiologicas.
Regimen de prevencion profilactica; de reparaci6n 6 curacion; de labor
escolar y de vida: conteniendo en su unidad resultante, mas 6 menos,
segiin los casos de cada una des estas direcciones 6 necesidades. La ya
abundante literatura cientifica registra en el particular regimenes excel-
entemente condicionados para los diversos tipos des establecimentos.

De la propia manera, al considerar como al presente lo hacemos no
una determinada fundacion al aire libre, sino el propio AIRE LIBRE,
en distintas 6 en todas las fundaciones (escolares principalmente, se
entiende), entendemos comprender bajo el titulo de este trabajo todos
aquellos componentes del regimen.

Hasta aqui el asunto que nos ocupa se ha venido tratando de mode
particular y concreto; limitdndose los autores al examen definido de
tal 6 cual escuela 6 instalaci6n, 6 aun al con junto de escuelas de una
ciudad, parte de naci6n, o nacion. Por cierto que no desconocemos
el loable fin de esos trabajos de presentaci6n y descripci6n. Por el
contrario los repu tamos de suma utilidad. Tan to es asi, que uno de
nosotros tiene publicados algunos y en preparacion otros de tal orden
(Estos ultimos, con la valiosa colaboracion del Dr. L. Mathe, de Paris).

Pero juzgamos que en el actual momento cientifico y pedagogico,
se impone de veras la tarea de abordar ademas el vital problema desde
otros puntos de vista, mas amplios y generales. Agrupar los hechos,
fundamentar y detallar las indicaciones y necesidades; formular neta-
mente las prescripciones, las realizaciones aconsejadas; pero, sobre
todo, coordinar las ideas de suerte a ir elaborando lo que no ha de tardar
en constituierse firmemente: un cuerpo de doctrina; tales seran los objeti-
vos. Ya que no pudiesemos pensar en satisfacerlos, medianamente
siquiera quisimos por lo menos indicarlos, esbozand9 aunque pobre-
mente los rumbos de la investigaci6n tecnica y de la aplicacion
practica.

1 62 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Por lo que hace k la base cientifica que substenta 6 habra de sub-
stentar al referido cuerpo de doctrina; pensamos, sin que nos sea dado
detenernos en mayores desarrollos, que estd en vias de adquerir la firmeza
que hoy le falta. Los progresos de la fisiologia experimental y de la
fisiquimica biol6gica, penetrando en la intimidad de los cambios organi-
cos, nos pondrdn en terminos cientificos lo que hoy en parte no pequefia
poseemos tan solo empericamente. Y, dominando que sea el mecan-
ismo en la acci6n del calor de la luz y de la radiacion solar, del aire, de
los agentes fisicos que rodean al hombre, no es posible dudar que un
fuerte, incontenible movimiento se ha de producir; hacer la vida natural
simple, higienica. La escuela, pensamos, la pedagogia, si es previsora,
si quiere Uamarse "fisiol6gica," si quiere merecer la calificaci6n de
"Nueva," debe seguir ese movimiento; aun propusarlo.

En trabajos sucesivos, uno de nosotros (Dr. Vidal) proseguird esta faz
fisiol6gica de la gran cuesti6n k la par de la faz tecnica que mks de inme-
diato interesa a esta asemblea. Aspecto este ultimo, en el que ser^n
comprendidas, aparte las direcciones y formas de acci6n m4s arriba
sefialadas, las prescripciones diferenciadas en atenci6n k las condiciones
de salud de la poblaci6n. De las poblaciones escolares de cierta impor-
tancia, entendemos decir, cifrando decenas 6 centenas de mil; como
V. gr: las de grandes nucleos urbanos. Es en parte de estas vastas
colectividades, efectivamente, estudiadas con criterio t^cnico en cuanto
hace relaci6n a la defensa de los d^biles, al tratamiento de los enfermos
y d la graduada y sana instruccion de todos, que nos debemos plantear
el problema pr^ctico de las prescripciones de aire libre.

Mas para arribar con acertado y prdctico criterio k prescripciones
utiles, precisase antes clasificar en grandes secciones categorias de nifios
6 masas escolares. Estas serian, anticipandonos k lo que ha de fundarse
mks tarde seriamente, las primeras grandes divisiones a trazar:

(a) Nifios sanos en medio normal. Ninos en buena situacion de salud, instruyen-
dose en un medio que pueda ser calificado "normal" 6 en todo casoque no sea parte
mayormente de la normal; y cuyo labor se ejercite en condiciones fisiologicas-sanitarias
aceptables.

(b) Ninos sanos en medio predisponente 6 nocivo. La salud de los escolares de este
grupo es buena tambien, pero las condiciones de labor 6 el medio fisico, 6 ambos son
malsanos, sino determina damente, predisponentemente.

(c) Ninos debiles, predispuestos, halldndose en la zona limite. Entre los sujetos
definidamente sanos y los enfermo, reconocese la situacion de gran niimero que encuen-
transe en una como "zona intermediaria;" ninos organica, herediteriamente "predis-
puestos," con lesiones ganglionares, otros, fisiologicamente debiles."

{d) Ninos positivamente enfermos, que requieren para su instruccion y vida un
mediofisico y condiciones especiales, pero pudiendo convivir y formar clase con otros
escolares.

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA 163

(e) Ninos enfermos que requieren regimenes particulares y aun establecimientos
especiales. Los procedimientos de instruccion y los procedimientos de curaci6n deben
actuar conjuntamente; por consiguiente, horario de labor, empleo del tiempo, curriculum
todo debe ser singularmente compuesto y aplicado.

Por supuesto con esta divisi6n debe vincularse otra de orden que
diremos nosol6gico-fisiol6gica de los escolares, en cuyo, detalle no
podriamos entrar ahora. Del propio modo, nos limitaremos k advertir
que dentro de esas grandes divisiones, caben subdivisones ordenadas (El
criterio prdctico, apenas si es necesario indicarlo, es el que ha de primar;
pues, en materias de este orden, no cabe extremar el rigor cientffico.)

Ya que no podemos detallar en esta ocasi6n procedimientos en medios,
se nos ha de permitir que, rapidamente, refiramos los desarrollos explica-
tivos que acabamos de hacer k la situaci6n real, concreta que los sugiera.
Es a la poblaci6n escolar de la ciudad de Buenos Aires que aludimos, k
su estado 6 situaci6n con respecto al problema en estudio. (Avancemos
desde ya, como informaci6n titil, que por lo que hace k dicha situaci6n,
comparativa k la de otras grandes ciudades, ocupa la capital Argentina,
una posici6n relativamente ventajosa.)

Buenos Aires tiene hoy aproximadamente 1,400,000 habitantes.
Su poblacion escolarizada (totalizando, desde nustros puntos de vista:
escuelas privadas y piiblicas; maternales 6 infantiles; primarias, elemen-
tales; de labor u oficio; secundarias y normales; especiales; varias es de
200,000 unidades- Ahora bien, de esa suma, puede estimarse como resul-
tado de examenes y observaciones realizadas en aiios, consecutiva y
sistematicamente, por los medicos de ambos cuerpos t6cnicos (ensefianza
primaria y secundaria y especial) que de 3,500 k 3,800 ninos 1.8% per-
tenecen a las ultimas categorias de nuestra divisi6n de mks arriba. Son
ninos positivamente enfermos, necesitando de un cambio de medio y
de regimen. En una cantidad mds de vez y media mayor que esa: de
5,500 a 6,000 (2.8%) apreciamos la de escolares de toda condici6n que
se encuentran en la zona limite entre salud y la enfermedad, escolares
d6biles y predispuestos que han menester tambien de un cambio en sus
condiciones de trabajo y de vida. Finalmente, apreciamos en una
cantidad mucho mayor: alrededor de 15,000 ninos (7.5%), los que,
aunque sanos, necesitan en grado y modo varios, les sean cambiadas
las condiciones defectuosas en que cumplen la labor escolar (aqui no
son predispuestos los niiios, pero el medio los esta predisponiendo, cuando
no enfermandos. Si, pues, adicionamos los tres guarismos, tenemos
que, en cifra entera veinticinco ninos necesitan mks 6 menos premiosa-
mente que les sean impuestas transformaciones ventajosas en orden
k higiene material y funcional. De otro modo en armqnia con las ideas
que substentamos : 25,000 ninos que reclaman para si los beneficios de
la instruccion nueva y sana, del regimen de aire libre.

l64 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Ahora bien que cantidad de esos ninos es la que hoy realmente obtiene
esos beneficios? La vigesima parte apenas, pues no sobrepasan de 1,200
los escolares que obtienen provecho de las distintas obras de aire libre
instaladas untimamente en la ciudad de Buenos Aires. Que indicacion
subsiste, entonces? La de estudiar y trazar en concreto y con la ampli-
tud requerida el cuadro de prescripciones que realizan las deseadas trans-
formaciones. Se esta en la obra y confiamos decididamente en su
inteligente realizacion.

Anticipari^mos con agrado que algunos puntos de ese cuadro pre-
scriptivo; m^s preferimos resumir de modo general, teniendo siempre
en vista las necesidades de una colectividad escolar de cierta impor-
tancia, las indicaciones relativas al sistema de creaciones nacidas en
Charlottenburgo.

Pero antes ha de permitirsenos decir una palabra aunque tal vez
no fuera precisa despues de las consideraciones en que hemos abundado
para justificar el titulo que hemos dado k la presente contribuci6n.
Titulo que, aparte de aparecer a primera vista un tan to pretensioso
difiere de los comunmente empleados para tratar la materia en estudio.
Es que, propiamente, como se ha visto, nuestra mente no ha sido tanto
presentar uno 6 muchos establecimientos, una 6 muchas obras, 6 aun un
conjunto de obras: sino, mds bien contribuir k que se inicie la coordina-
cion en sistema de esas obras. Ciertamente, debian interesarnos las
instalaciones k cielo descubierto ; pero lo que mas nos atraia y queriamos
examinar era la propia instrucci6n al aire libre. Por eso hemos tomado
k este "Aire libre," substanciandolo en cierto modo, asignandole cali-
dades y formas diversas de realizaciones y hecholo el objeto de nuestro
modes to esfuerzo. Si hay una ciencia del aire libre segun el tan justo
concepto de la pedagogia nueva, si quiere ser renovadora y grande real-
mente, debe asimilarse sus indicaciones y preceptos.

Conclusidn: Indicaciones Generates.

1. Crear con destino k la educaci6n comun de ninos, predispuestos,
d^biles y a6n definidamente enfermos de cierta categoria, anemicos,
escrofulosos, pretuberculosos y aiin determinados tuberculosos, etc.,
un numero suficiente de escuelas bien situadas, salubres al maximum y
provistas de los elementos materiales y de otro orden que requiera su
funcionamiento en el modo y caracter que hoy en dia, bajo el doble
aspecto, fisiologico y pedag6gico, se asigna k la "Escuela al aire libre."

Con los actos de creacion, los de perfeccionamiento, de suerte k exaltar
y k combinar en lo posible, los buenos rasgos de las escuelas de Charlot-
tenburgo, Muelhausen, Padua, Lyon, Boston, Chicago, Buenos Aires.

2. Fundar en plena campana, k titulo de establecimientos depen-
dientes del conjunto escolar urbano, y bajo regimen del internado modelo,

EL AIRE LIBRE DE LA PEDAGOGIA CIENTIFICA 1 65

una 6 mas escuelas, de grado y tipo destinto, para alumnos predispues-
tos y enfermos a quienes est6 particularmente indicada la vida fuera
de la ciudad.

Algunos de estos internados, conviene sean el nucleo de colonias
de funcionamiento estacional 6 periodico, y al servicio de los mismos
propositios.

3. Afectar, originariamente 6 por transformaci6n de estos estable-
cimientos ex-urbanos, uno de los mismos 6 mis de uno (de situaci6n
ventajosa en montana, valle salubre, etc.), a la instrucci6n de niiios
tuberculosos y padeciendo otras enfermedades, que les obligue k excluirse
del regimen comiin.

4. Habilitar sobre todo alrededor de ciudades importantes en
parajes bien escogidos, en jardines y parques; en la proximidad de bos-
ques, en riberas y playas, estaciones, recreos, plazas, espacios destinados
al reposo, recreo y juegos, y que bajo modos y nombres distintos, con-
stituyan fundaciones complementarias del sistema escolar.

5. Incluir en el piano de toda escuela que se constituya, un local
6 mas de uno, destinado k las clases al "aire libre."

6. Habilitar para dichas clases en las escuelas ya construidas, los
sitlos que mejor puedan llenar el fin espacios libres, altillos, y azoteas,
glorietas improvisadas, etc.

7. Realizar, con las anteriores creaciones € instalaciones, en el
conjunto de las escuelas comunes, en todas, transformaciones que se
fundamenten en los mismos principios. De modo general; cada escuela
debe sufrir en grado mayor 6 menor reformas que la orienten hacia el
"pleno aire."

8. Dedicar atenci6n singular k la formaci6n personal capaz de
llenar debidamente las funciones que el funcionamiento de estas escuelas
6 instituciones requiere.

9. Contener las indicaciones y acciones anteriores dentro de un
Plan Tecnico, que armonice las faces del problema: fisiologica y
medica; arquitectural ; pedagogica; administrativa y social.

(Este plan adoptado k una ciudad, no puede ser igual k los " Esquemas
defensives: v. gr: los de Londres, Paris, Edinburgo, Roma y otros ulti-
mamente hechos conocer, en la mira principal de la Tuberculosos.)

10. Propiciar, en fin, el estudio de la justamente nombrada " Ciencia
del aire libre," cuya amplitud venidera se advierte claramente y cuyo
justo concepto conviene difundir: es de ella que provendrdn buena parte
de. las reformas las mas definidamente utiles acaso inscriptas en el pro-
grama de la Pedagogia fisiologica.

1 66 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE "OPEN-AIR SCHOOL" IN SCIENTIFIC PEDAGOGY

Initiatives of the Argentine School System

by the argentine delegates

Antonio Vidal and Charles Robertson

The "Open-Air Schools" (Ecoles en Plein air, Scuole all'Aperto,
Waldschuelen) have during the last few years drawn the special atten-
tion of hygienists and educators throughout the world. Those already
established have shown to be of great advantage. Due to the high
and competent opinion, and the enthusiasm of the authorities on physio-
logic pedagogic and school hygiene, the "Open-Air Schools" have greatly
increased. The scientific basis and the progress of these has gained
consistency.

The works presented at the last "International Congress on School
Hygiene" are works of reference, containing descriptive data: Brannan
& Balliet (New York) ; L. Williams (Bradford) ; R. P. Williams (Sheffield) ;
Randi (Padua); Vignes (Lyon); Sisto (Buenos Aires); Lacable-Plasteg
(Paris); Neufert (Charlottenburg) ; Querton (Brussels); Wolff (Muel-
hausen); Tluchor (Vienna); Bexheft (Buda-pesth) ; Kirkly (Bradford),
and others. The interest was not only shown at this last mentioned
Congress, but is noticeable at the various educational meetings through-
out the world. One of us, Dr. Antonio Vidal, has personally followed
the movement, and has attended several American conferences dealing
with this most important subject, having presented papers under different
titles, but all referring to the same subject. He attended for instance,
the Medical and Scientific Congress in Montevideo in 1907, Santiago,
Chile, in 1908, Rio de Janiero in 1909, Buenos Aires in 1910, and also
presented a paper referring thereto to the International Congress against
Tuberculosis, Rome 1912. The bibliographic and criticisms of this
last Congress are contained in a work entitled "The Prophylactic Organi-
zation of Schools," published by the International Archives of School
Hygiene. In this work up-to-date technical and social informations
are given in detail, with special reference to tuberculosis as related to
the school system.

If an accurate account could be given of the " Open- Air Schools "
operated to-day in Germany, the United States, France, England,
Austria, Italy, Switzerland, the Argentine Republic and elsewhere,
facts and figures of the greatest interest could be given. But these
facts and figures would represent only a minimum part of the progress
made since the experiment of, Charlottenburg was established in 1904.

THE OPEN-AIR SCHOOL" IN SCIENTIFIC PEDAGOGY 167

We shall refer here to some auxiliary works and installations which are
not strictly "Open- Air Schools" but having similar features and func-
tions.

The character of these auxiliary installations, such as "Recreation
Grounds, Gardens, Stations, Play Grounds, and Squares" is similar to
the "Open-Air Schools," and are considered most practical. Riversides,
decks, and so forth, are all included in the "open-air system," rendering
valuable services wherever a dense population is found, and where it
is difficult to establish the "Open-Air Schools." In order to character-
ize more fully the reformatory movement, it is necessary to mention
the real and material reforms taking place, such as improved ventila-
tion, increase in the size of the buildings, and their rooms, etc. Based
upon the experiment of Charlottenburg. The demonstrative effects
have been eminent and powerful, and above all convincing in favor of
sanitary education. The actual up-to-date movement has three lead-
ing features to be considered :

1. To define and classify the various types of schools and institu-
tions which are similar and forming units. Designate to each particular
type its material conditions and functions.

2. Prescribe the technical work collectively and within a pedagogic
system.

3. To study in detail the scientific movement produced in favor
of the pedagogic problem. We shall attempt to outline the various
details of the aforesaid movement, referring more specially to the "Open-
Air Institutions" of the city of Buenos Aires (The School for Feeble
Children).

The open-air institutions are varied as to their magnitude and rank,
medical and pedagogic character, according to their environment and
management, some of them, if not all, have subdivided and special
characteristics. They are established in the center of the cities, in the
suburbs, or in the country, in the forests, on the beach, or in the moun-
tains. Working according to the various latitudes, in the summer, or
in the winter, some throughout the year. They- are designed for the
infant of delicate health, or children • predisposed to sickness, and also
for healthy children. The children are subject to some hours in the
open air, or during the whole day. The registration of the pupils is
annual or periodical, for some weeks, in order to renew the various
groups benefited by the institution.

In 191 2 Dr. Antonio Vidal had the special and official mission to
visit the leading European "Open-Air Schools." He investigated the
institution of Charlottenburg, the Recreation Institution of Padua,

1 68 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

the schools in Rome, the magnificent institutes of Muelhausen and Lyon.
His observations have been to some extent applied to the various institu-
tions of the Argentine Republic, and have so far given the best of results.

The "Open-Air Work" in the city of Buenos Aires has become very
important and have received the support of the medical body of the city,
of the authorities of the Department of Education in general, of the
President of the Council, Dr. J. M. Ramos Mejia. Others, have also
given their valuable support and cooperation. The schools for the
feeble children, already referred to, are the most prominent of the
open-air institutions.

The children are selected, undergoing a severe medical examination.
Two of these schools are about to be established, and others are under
consideration, to be erected in central parts or suburbs, with adequate
furniture and fixtures, constant medical attention (specialists), and a
competent staff of teachers.

These pupils will be exposed to the air and light, receive special
nourishment, exercises and diversions, rest and sleep. In one word
these institutions are based upon foreign models, and if possible improve-
ments are introduced by local experience, in order to obtain maximum
efficiency. Notwithstanding the fact that there is nothing original
attached to the "Open- Air Schools for Feeble Children" of the city
of Buenos Aires, yet they have their own characteristics. Their
results are positive and demonstrative. This is noticeable through the
appearance of the pupils: their willingness to work, alertness of move-
ment, joyfulness, vivacity of spirit. The increase in their weights and
measures, the remarkable improvement of the respiratory organs
(breathing capacity), the omanometric actions, the globular richness
of the blood, as manifested in general is very satisfactory. The changes
are favorable, considering each individual child, its previous sickness,
and its physiological and hereditary tendencies.

It is easy to observe the improvement among the special selected
children, and if it was possible to keep them for a longer period of time,
the improvements, the advantages, and the results would be even greater.
But the process of improvement is interrupted by the home, where
unhealthy physical conditions are prevailing, and at times the moral in-
fluence has an adverse effect. The paper presented by Dr. Cassinelli
to this Congress, refers in detail and accuracy to the activities of these
schools for feeble children of the city of Buenos Aires. Con-
sidering the various "Open-Air Schools" established throughout Ger-
many, France, Italy and elsewhere, the amount of children benefited
by them is limited. Limited if considering the quantity requiring such
schooling. It is therefore necessary to establish a greater number of
these special schools, and should this be impossible in some sections

THE "open-air school" IN SCIENTIFIC PEDAGOGY 1 69

of the world, it would be of value to establish, and make use of the
auxiliary institutions already referred to, such as gardens, roof-gardens,
open-air classes (fresh-air rooms). In a general way make good use of the
open air spaces available in the various cities. It is also necessary to
modify and improve the class rooms of the private and public schools
through larger windows, and other air channels, and in general modify
the present ventilation system if defective, through favorable combina-
tions, designed and organized by professionals: Architects, medical
doctors, teachers and other officials of public education. But, in order
to materialize all of these favorable features, a perfect organization
of school hygiene is indispensable, and whatever progress is made at
the present time in this direction is due to the broad-mindedness of
public men, taking a keen interest in the childhood of the various nations.
Thus far we have referred to the material part, and the functions
of the various "open-air" institutions, but it is of greatest importance
to explain, however, that the fresh air obtainable everywhere is not the
only factor. The nourishment, the rest, prolonged sleep, physical
exercises, diversions, reduction of actual intellectual work are factors
of the greatest importance, in one word a regime composed of physi-
ological elements, a regime of prophylactic prevention. In some future
work one of us (Dr. A. Vidal) will pursue the physiological features of
this question, together with the technical features of interest to this
Congress, including the forms of actions, co-ordinating, and classify
the various centers of population, also classify the different sections
of the school masses, divided as follows:

(a) Healthy children in normal centers. Educated in centers
classified as "normal," under acceptable physiological and sanitary
conditions.

{b) Healthy children educated in centers lacking proper sanitary
conditions, or at least are so predisposed.

(c) Feeble children, predisposed to sickness, living in the limited
zone, between healthy and sick children. In other words, living in a
intermediate zone.

(d) Sick children, requiring special physical conditions, yet able
to be with other children.

(e) Sick children requiring special regimes, even special establish-
ments.

The above-given division is, of course, subject to some subdivisions.
While unable to enter here into details, we beg to submit, however,
some of the figures relating to the school population of the city of Buenos

170 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Aires. With a population of about 1,400,000, the school population
as distributed, in private, and public schools, infantile or kindergartens,
primary, elementary, secondary and normal schools, is about 200,000.
It has been observed through medical and technical investigations that
3,500 to 3,800 children, or about 1.8%, belong to the last divisions
given above of the total school population. They are positively sick
children requiring special regimes. About 5,500 to 6,000, or about
2.8%, are in the limited zone; 15,000 or 7.5% healthy children, yet re-
quiring improved conditions. A total of about 25,000 should receive
the benefit of the "Open-Air Regime." Of this total, however, only
1,200 children are benefited by the open-air institutions of the city of
Buenos Aires. In order to remedy this deficiency, it will be necessary
to study and materialize the various transformations, based upon the
experiences of the institution of Charlottenburg and others.

Conclusion and General Indications.

To establish "Open- Air Schools" as forming part of the general
educational system, in favor of feeble and predisposed children, and in
favor of those suffering anemia and predisposed to tuberculosis, and even
those having tuberculosis. These schools to be established in a suffi-
cient number, well situated, and disposing of all the necessary elements,
both from a physical and pedagogic point of view. In building these
schools, the advantages of those already established in Muelhausen,
Padua, Lyon, Boston and Chicago, should be taken into consideration.

To establish in the country, and as forming part of the urban school
system, one or more schools for feeble children, or in favor of those
predisposed to sickness, requiring out-of-town life.

To establish similar institutions in the mountains, in favor of chil-
dren predisposed to tuberculosis, those having tuberculosis or similar
sicknesses.

To establish in or within the limits of the larger cities: Gardens,
playgrounds, if possible in the neighborhood of forests, rivers or beaches.
To be considered as auxiliaries of the general school system.

To establish in each ordinary city school to be built, fresh-air school
rooms.

To use in the city schools already established, all available open
spaces, such as courts and roofs, etc.

Give special and careful attention to the selection of competent
staff required by these special institutions.

THE "open-air school" IN SCIENTIFIC PEDAGOGY 171

discussion of
Papers on Fresh Air Schools

Dr. John W. Brannan

Dr. John W. Brannan of New York, in reply to a question from some
one in the audience as to what the good effect of the cold fresh air could
be due to in the case of children who were so thoroughly wrapped up with
extra clothing that the air could not touch their bodies, suggested that
possibly the observations of Rowland and Hoobler made several years
ago in the children's service at Bellevue Hospital, might furnish an expla-
nation. These physicians placed children suffering from acute pneumonia
upon the open balconies of the hospital, and left them there throughout
the twenty-four hours. They found that the cold fresh air had a re-
markable effect in raising the blood pressure to a high level and main-
taining it there throughout the period that the children were in the open
air. Supposing that the blood pressure had fallen to 70 when the pa-
tients were in the ward (the normal level at a given age being 80) the
pressure rose to normal soon after the children were removed to the bal-
cony and remained there so long as they were left in the outer air. If the
children were returned to the ward, the blood pressure dropped to its
previous level. If cardiac stimulants, such as strychnine, caffein, whiskey,
camphor, etc., were given the pressure would rise, but drop again as
soon as the effect of the drug had passed, but if the patients were returned
to the balcony the pressure rose and remained high without any drug
stimulation. Doctors Rowland and Roobler attributed this rise of
blood pressure when the children were on the balcony to the stimulating
effect of the cold fresh air upon the vasomotor system, the stimulus
being transmitted through the nerve filaments in the mucous mem-
brane of the nose and mouth and in the skin of the face. They noted
that the sicker the children and the colder the air the more marked the
effect on the blood pressure. Therefore, it is in the winter months
that the open air treatment is especially indicated. Naturally the
good effect of the open air upon the blood pressure is reflected in the
mortality. Whereas the percentage of deaths among the children
which has been treated in well ventilated wards was about 25%, it fell
to about 12% when the children were placed out of doors and kept there.
It is possible, therefore, that the effect of cold fresh air is somewhat
similar in the case of the anaemic children whose bodies are so thor-
oughly wrapped up that the fresh air can only exert its effect through
being breathed, and by stimulating the mucous membranes of the
mouth and nose, and the skin of the face.

SESSION THREE

Room A. Wednesday, August 27th, 9:00 A.M.

THE VENTILATING, HEATING AND CLEANING OF
SCHOOL BUILDINGS (Part One)

J. H. McCuRDY, M.D., Chairman
Joseph Dana Allen, Buffalo, N. Y., Vice-Chairman

Program of Session Three

J.^H. McCuRDY, A.M., M.D., M.P.E., Young Men's Christian Associa-
tion College, Springfield, Mass. "Ventilation of Gymnasia."

D. D. Kimball, Consulting Engineer, New York City. "Some Phases
of Ventilation."

Luther H. Gulick, M.D., New York City. "Ventilation and Re-
circulation."

Herbert M. Hill, Ph.D., City Chemist, Buffalo, N. Y. "The Ven-
tilation of School Buildings."

C.-E. A. WiNSLOW, M.S., Associate Professor of Biology, College of the
City of New York, Curator of Public Health, American Museum
of Natural History, New York City. "Studies of Air Condi-
tions in the New York Schools."

George C. Whipple, Professor, Harvard University, Cambridge, Mass.,
and

Melville C. Whipple, Harvard University, Cambridge, Mass. "Air
Washing as a Means of Obtaining Clean Air in Buildings."
Joint Paper.

Papers Presented in Absentia in Session Three
(Read by Title)

Charles H. Keene, A.B., M. D., Supervisor of Hygiene and Physical
Education, Minneapolis, Minn. "The Effect of Conditions of
School Room Heating and Ventilating on School Attendance."

Theodore Hough, Ph.D., Professor of Physiology, University of Vir-
ginia, Charlottesville, Va. "The Primary Purpose of Ventila-
tion to Facilitate the Maintenance of the Constant Temperature
of the Body."

174 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

VENTILATION OF GYMNASIA

BY
J. H. McCURDY

I. Introduction.

Habitations — houses, factories, schools, gymnasia, offices, theatres,
trains, street cars, etc., are largely good or bad dependent upon the air
conditions. Dissatisfaction with the air in buildings is prevalent. The
advocates of the open air schools and of the outdoor treatment of tuber-
culosis tell us to live out-of-doors. The architects and engineers tell us
they have given us just what the doctors ordered, which is true. Some
of the doctors are disgusted with their prescription. They have opened
the windows in certain hospital wards with good results. Some archi-
tects say cut out all mechanical ventilation systems and they will save
25% to 30% (Gardner i) on the first cost and on maintenance. The
inference of the architects and engineers suggests the solution of all
our difficulties if we would throw out all artificial systems and simply
open the windows. Most children and adults could not do the work
required of them under the temperature conditions of the open air
school of the tubercular hospital during the winter season in northern
climates. All the textile industries, for example, require warm, humid
air. Dust and noise from the street often compel the closing of windows
in school buildings even when outside temperature is high enough to
allow them to remain open without uncomfortable drafts.

Most of the men here assembled could not do their work in tempera-
tures much below 60° F. The Chicago Commission on Ventilation (2)
in their 191 1 report recommend 60° to 68° F. as the proper temperature
for the schoolroom. They designate as a cold room, one with a tem-
perature of 55° to 60° F. Under these conditions of temperature (60°
to 68° F.) it is impossible to keep the normal humidity of outside air
during cool weather up to the normal amount without adding moisture
artificially. With atmospheric pressure at approximately 30 inches
and the temperature at 0° F. a cubic foot would hold 0.481 grains of
moisture, at 32° F. it would hold 2. 113 grains of moisture.

" 70° F. " " " 7.98 " "

Vapor or space at 0° F. and 50% relative humidity would contain

approximately 0.24 grains of moisture per cubic foot. This vapor on

being heated to 70° F. would still contain its absolute humidity of .24

grains of moisture per cubic foot, but its relative humidity would drop

VENTILATION OF GYMNASIA jyc

from 50% to 3% except as the air passages and skin of pupils become
water jugs which were continually emptying water from the bodies of
the pupils into the air of the room. Air at 32° F. and 50% relative
humidity would contain approximately 1.056 grains of moisture per
cubic foot. This air on being heated to 70° F. would then have a relative
humidity of 13% unless moisture was added from the pupils, walls or
fixtures in the rooms. I have not found any figures showing the effect
on room humidity of varying moisture conditions in different types of
walls, e. g., concrete, brick, etc.

The text books of physiology assert that all expired air is warmed
nearly to body temperature and is nearly saturated with water vapor
at about body temperature. If this is true under all outdoor and indoor
conditions the amount of moisture needed to saturate each respiratory
volume is the same whether the air breathed in be cold air at 10° F. or
this same air warmed up to 70° F. without the artificial addition of
moisture and then breathed. Before much more is said we need to
know first, whether expired air is always saturated ; second, whether it
always approaches body temperature; third, whether dry air is harmful
to bodily tissues or functions.

The school room relative humidity does not ordinarily rise above
25%. More often its range is from 16% to 23%. Tuttle(3).

II. Description of the Springfield Ventilation Plant.

I will not attempt more than a general description of the plant, as
a careful description has already been given by Professor Affleck(4) in
a preliminary report. The College aimed in building its two gymnasi-
ums to make them halls of health in fact as well as in name. The archi-
tect and engineer cooperated with the owners in considering the build-
ing as a health factory. In building factories the use of the building
is the first consideration. This is not always true with public buildings.
Architectural beauty is often put before utility or health.

In the general instructions of the committee to the architect and
engineer the owners insisted upon thorough ventilation. Basing their
idea of the needs of the individual upon Smith's statement concerning
the production of CO2 during active exercise they (5) found that

a man at rest produced 161.6 C C of CO2 per minute

walking two miles an hour. . . .569.3 C C "

" three " " " ... .851.2 C C " " "

during tread mill work 1581.9 C C "

They asked the architect and engineer to build a yentilating plant
which would handle 300 cubic feet per minute per individual. The
owners were told 'that this was ten times the present requirements for

176 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

school buildings, and that it would be necessary to nail the pupils in
their places to prevent their being sucked into the ventilating plant;
that the scheme was prohibitive from the expense standpoint. Dart-
mouth College they said had just put in a ventilating plant which fur-
nished double the amount required by school room law, or 60 cubic feet
per minute per individual.

The ventilating plant according to anemometer tests made by
R. D. Kimball Co., April 8th and 9th, 1913, introduced 21,430 cubic
feet of air per minute into the West Gymnasium, or 306 cubic feet per
minute per individual with a class of. 70 men as a basis. The air motion
was never uncomfortable for gymnasium classes. Double this amount of
air, orj6oo cubic feet per minute per individual was moved without
uncomfortable sensations for a class of 50 by turning all the air from the
East Gymnasium into the West Gymnasium. An interesting experi-
ment was tried on a Public Recreation Congress assembled in the West
Gymnasium in April, 19 12. With all the doors and windows closed
30,000 cubic feet of air were introduced each minute at 63° F. The
baldheaded people vainly tried to find the open window. A little later
the air temperature was raised to 65° F. This gave apparent comfort
even to the baldheaded members of the audience.

The expense item at first could only be answered by saying that
good things came high. After the building was practically complete
the author suggested to the engineer to connect the plenum and exhaust
rooms so that the air could be recirculated in warming the building
for early morning use in cold weather. So far as I know this is the
first time air has been washed, treated and returned regularly for use
during the active exercise period. The significance of this innovation
is shown by the studies of Whipple and Kimball. The idea of recircula-
tion of the air during the active use of the building came later as a result
of committee discussions, and an examination of the work particularly
of Fliigge and Paul. Dr. Luther H. Gulick, President of the American
School Hygiene Association, in 1911 appointed a committee on ventila-
tion. As chairman of the committee he presented to us a manuscript
resume of the literature by Flugge(6), Paul(7), Heyman(8), Ercklentz(9)
and Hill(io).

A careful study of the literature indicated that the essentials in good
ventilation were maintenance of proper room temperature, a perceptible
air motion and adequate moisture content rather than keeping the CO2
content of the air down to four to six parts in 10,000. According to
Flugge(6) the regulation of the heat, moisture, circulation, odors and
amount of organic matter are more essential to health than CO2 content.

Fortunately the ventilation plant which was arranged to keep down
the CO2 content in the gymnasium by furnishing over 300 cubic feet

VENTILATION OF GYMNASIA 1 77

of air per minute per- individual could also control temperature, air
motion, moisture content, odors, bacteria and dust. It was found that
the recirculation scheme which had already been arranged for economy
in early morning heating could also be used during the periods when the
gymnasium was in active use.

III. Striking Features of the Plant.
I. Its flexibility.

(a) The air entering the rooms may be, aside from leakage,

1. Entirely outside air heated, washed and humidified or

not as desired.

2. Entirely air drawn from the room heated, washed and

humidified or not as desired (recirculated air).

3. Any percentage combination of outside and recirculated

air.

{b) The air leaving the room may be, aside from leakage,

1. Exhausted from the rooms directly outdoors.

2. Exhausted from the rooms into the plenum fan room for

return back to the gymnasium. This recirculated
air may be heated, washed and humidified or not
as desired.

3. Any percentage combination of this air may be delivered

outdoors or returned to the rooms through the
plenum fan room where it may be heated, washed or
humidified or not as desired.

2. The large volume of air supplied per minute per person.

An estimate based on the classes for 1 912-13 in the West Gym-
nasium gives for the junior class of fifty men 400 cubic feet
per minute per individual, freshman class of ninety men
222 cubic feet per minute per individual. Ordinary school
requirements you will remember are 30 cubic feet per minute
per individual.

3. Appreciable air movement.

The rate of air movement at the inlets to the room is 350 feet
per minute and at the outlets 400 feet per minute as tested
by R. D. Kimball Co. (I I).

4.. The intake of large volumes of air at a low temperature, 60-65° F.,
rather than a small volume of air at a high temperature, 100-
I40°F.

5. The low room temperature, 60° F. prevailing during the exercise
periods from 1.30 to 6 p. m.

178 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

6. The moderately high relative humidity for indoor winter conditions,

46% to 50% (Knapp, p. 54) as compared with averages in nine
school rooms ranging from 16% to 23% (Tuttle, p. 35).

7. The removal of dust, bacteria and odors.

Professor Whipple (12) in his conclusions states "That air washing
makes use of a process very efficient in nature, and is capable of removing
from air a large proportion of dust, bacteria and solid particles, and fur-
ther that there are absorbed nitrous and ammoniacal vapors and organic
compounds of uncertain composition which impart odors and unpleasant
qualities to the air." He further says, "That recirculation as practiced
at this institution has provided a plentiful supply of air with no apparent
sacrifice of wholesome properties. It is a safer source of supply than
outside unwashed air and has further effected a decided economy in the
consumption of fuel for heating purposes."

8. The possibility of using recirculated air, or canned air as it has

been called, without any dangerous increase in the CO2 air
content and without any personal discomfort.

9. The inexpensiveness of recirculation as compared with pumping

through the building outdoor cold air continuously.

The total cost of recirculation with the external temperature at
0° F. was estimated by R. D. Kimball Co. as 52 cents per hour as com-
pared with $1.07 per hour for using outdoor air. The computation
was based on a room temperature of 65° F. The figures include the cost
of steam, electricity for fan motors and the interest and depreciation
on the plant.

IV. Resume of Work at the College Gymnasium by Samson ('13)
and Knapp ('14).

Samson's work was presented in June, 1912, and Knapp's in June,
191 3. Each represents thesis work at the College for that current year.
Outdoor dry bulb temperature range: Ranee M F V

Samson, Jan. 26-Mar. 20 18-56" F 25-42 or 29 out of 38 observations
Knapp, Jan. i6-Apr. 10 16-63° F 30-49 or 77 out of 127 observations

Analysis of Knapp's range of outdoor temperature:

No.
10-19° F— 4
20-29 — 22

30-39 — 41
40-49 — 36

50-59 — 19
60-63 — 5

— 127

VENTILATION OF GYMNASIA I^q

Indoor dry bulb temperature:

Range M F V
Samson, 54-70° F 59-68 or 25 out of 38 observations
Knapp, 51-72° F 60-69 or 85 out o.f 127 observations

Analysis of Knapp 's indoor temperature:

No.
50-59 °F— 37
60-69 — 85
70-72 — 5

— 127
Outdoor relative humidity range:

Range M F V
Samson, 29-100% 46-78% or 24 out of 38 observations
Knapp, 43-100% evenly distributed over 127 observations

Analysis of Knapp's outdoor humidities:

No.
40-49% — 8
50-59 — 22
60-69 — 32
70-79 — 21
80-89 — 30
90-100 — 14

127

Indoor relative humidity range without humidification:
Range MFV
Samson, 29-56% 29-44% or 7 out of 10 observations
Knapp, 17-49% even distribution 18 observations.

Analysis of Knapp's indoor humidities without humidification:

MFV No. observations
(d) Fresh air direct 17-49% 13

(f) No artificial ventilation doors and windows closed 19-35% 2

(g) Air recirculated and mixed with fresh air 33-39% 3

Indoor relative humidity range with humidification:
Range MFV
Samson, 36-90% 44-71% or 19 out of 28 observations
Knapp, 23-64% 30-59% or 75 out of 93 observations

Analysis of Knapp's indoor humidities with humidification;

(a) Air recirculating: 32-63% 40^59% or 40 out of 56 observations

No.

Humidity 32-39% 9

40-49% 16

50-59% 24

60-63% 7

i8o

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

(c) Fresh air direct: 23-53% 30-39% or ^4 out of 29 observations
No.
23-29% 8
30-39% 14
40-49% 5
50-53% 2
(e) Air recirculated and mixed with outdoor air: 50-64% even distribution, 8 observa-
No. [tions.

50-57% 4

58-64% 4

A Still further analysis of Knapp's data shows that 14 out of 18
observations without humidification had a relative humidity below
40%, while 62 out of 93 observations with humidification had a relative
humidity of 40% or above. Four out of five observations with the
outside air below freezing without room humidification showed a relative
humidity below 22%, while 28 out of 33 observations under similar
temperature conditions with humidification showed a relative humidity
above 40%.

An analysis of men's choices concerning the best temperature and
humidity may be summarized (according to Knapp, p. 64) as follows :

Temperature
Min. Max. Range Mean M F V Median AD S D

53** 67** 14" 60.3*' 62'' 60.3° + 2.30'' + 2.9*'

Humidity

Min.

Max.

Range

Mean M F V

Median

17%

68%

51%

44.2% 46%
50%

46%

+ 10.2%

+ 12.4%

The men preferred a temperature of about 60° F. and a relative
humidity of from 46% to 50%. A comparison of the freshman and
junior classes shows no class variation. Both the freshman and junior
median temperature choices were 60°, the freshman median relative
humidity value was 46.5%, the juniors 47%.

Outside vs. recirculated air choice, both humidified.

Recirculation Temperature

Min. Max. Range Mean Median AD S D

53 67 14 60.3 60.3 +2.1° +2.9°

Outside air

54.5 63.5

58.8

Recirculation Humidity

36% 68% 32% 53.1% 53%

Outside air

27% • 53% 26% 36% 34%

+1.9 +2.4

+5.9% +7.1%

+5.8% +7%

VENTILATION OF GYMNASIA l8i

You will note that the outside air relative humidities are lower than
the recirculated air. This is due to the fact that the humidifier was
set for a lower humidity when the observation was taken. In spite of
this difference in humidity the men were unable to differentiate between
outside air and recirculated air. The outside air forced into the build-
ing without washing or humidifying had a median temperature of 60.5°
and a relative humidity of 30%.

Effect of Recirculation on the Temperature and Humidity with
the Air Washer Running.

The question has been asked whether the temperature and humidity
rise with continued recirculation. Twenty observations were taken
between January i6th and February 19th, 1913, in the exhaust duct
where the air would be throughly mixed. The first readings were
taken after the fans and washer had been running one hour and forty-
five minutes. The class session began at the time of starting the fans and
continued throughout the tests. The second reading was taken on the
average two hours after the first one. The temperature fell in 14 out
of 20 observations from 5° to 2° between the first and the second test.
It remained the same in three observations and rose in three. The
variability in any case was never more than 2° F. Both the relative
and absolute humidity increase slightly but not more than 2% of relative
humidity, or .1 of a grain per cubic foot of absolute increase.

Recirculation has effected real economy in operation. Body heat
from the men has required us to turn off all direct and indirect radiation
from the gymnasiums and fan room during the periods of exercise. As
a matter of fact we have had to run the air through the air washer
water at about 50° to 54° F. to keep the room temperature down.

At the discussion of Affleck's report on the first year's work by
Samson at the Montreal Convention of the American Physical Educa-
tion Association in 1912, Prof. T. A. Starkey of McGill University
raised a question regarding the accuracy of the government sling psy-
chrometer for low humidities. Geer in his study last year found the
error of the instrument not to exceed 2% for ordinary room tempera-
tures when compared with chemical hygrometry. For temperatures
around the freezing point he found the instrument inaccurate, first,
because of the long time of whirling needed to reach the low temperature
point with the wet bulb, second, because a small error in reading, e. g.,
.5 of a degree would change the relative humidity 5% or 6%. At room
temperature a .5° error would only change the reading about 2%. He
compared the results by chemical absorption of a known quantity of
air with those of the sling psychrometer in a closed room where temper-

1 82

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ature could be accurately controlled. He used the dehydrating power
of concentrated sulphuric acid as the method of removing the moisture
from the air. This moisture was then weighed and the relative humidity
computed and compared with the records of- the sling psychrometer
taken at the same time (see Geer, p. i6).

Effect of Recirculation on CO2 Content.

Recent studies by Flugge, Paul, Erklentz, Benedict and others
seem to have shown conclusively that a considerable increase of CO2
content has no relation to immediate bodily comfort even if it rises high
as 100 to 150 parts in 10,000. Provided the temperature, humidity
and air movement be kept at the proper points, the school laws requiring
that the CO2 content be kept down to eight parts in 10,000 have now
no reason for existence.

We found the College plant at Springfield during recirculation of
air could control within normal limits temperature, humidity, air move-
ment, bacteria, dust and odors. The actual determination of the CO2
content in the gymnasium while recirculating the same air during the
active exercise of large groups of men seemed the next step. It seemed
necessary to determine how much the CO2 would increase in the room
with the large output from the men during active exercise, and whether
it might not even increase above the high limit of 150 parts in 10,000
set by Flugge and others. The determination of CO2 during these ex-
periments was made by Peterson and Palmquist apparatus as modified
by Dr. Rodgers of the New York State Labor Department. (Home, p. 3.)

We found by experimentation the following facts: This data is
taken from Home's thesis for the current year 1912-13. The men were
doing vigorous exercise, calisthenics, dancing and apparatus exercises,
for one and one-half hours. The observations were taken after the men
had been working for one hour.

CO2 Tests Before the Use of the Gymnasium.

Table I
CO2 Per 10,000 OF Air
Track Floor

Date

Time

AvC02 No. AvC02 No.
Tests Tests

Remarks

I9I3

Jan. 21

1 2-1

4.-

3.8

Tests

on floor were made about

Jan. 22

11-12

3.8

4-~

3 feet above the floor

Jan. 31

11-12

3.5

Feb. 3

11-12

3-4

4.2

Feb. 4

11-12

3-5

Feb. 18

I I. 30-12

3.5

3-5

Average

3.7

3.75

VENTILATION OF GYMNASIA

183

These tests show that the CO2 content in the gymnasium air before
use is practically that of outdoor air. The fans were not running during
these tests.

Direct Ventilation.

The air >vas drawn from out doors and forced directly through the
ventilation system to the rooms. The plenum exhaust fans handled
enough air to change the entire amount in the room (180,000 cubic feet)
every nine minutes.

Table II
CO2 Per 10,000 OF Air
Track Floor

No.

Date

Time

AvC02

Tests Av CO2

Tests

Men;

Exer.

Remarks

1913

Jan. 31

4- 15-4.30

6.5

7.-

Feb. 3

4.20-4.30

Feb. 20

4-55-5.25

Feb. 21

4.25-4.55

Feb. 28

4.50-5.10

Mar. 3

5.15-5.40

Mar. 5

4.40-5.00

Exams*

Mar. 4

2.45-4.45

Mar. 7

4.00-4.30

Tests taken on floor were

Mar. 10

5.30-5.40

taken

at 5 ft. 5 in.

Apr. 7

4.50-5.20

Apr. 8

5.00-5.15

—

••

Average 7.21 . 7.16

*This test is not included in average.

The CO2 content of the gymnasium air during exercise is nearly
double that of the gymnasium air before the gymnasium has been used.
The increase on the breathing level (5 ft. 5 in.) was from 3.75 to 7.16
parts in 10,000. On the gallery level the increase was from 3.7 to 7.21.
An examination of the table shows that only once did the CO2 rise above
8 parts in 10,000, and then only up to 8.2 parts in 10,000. The tests
showed the CO2 content ordinarily between 7 and 8 parts in 10,000.

Recirculation Tests.

In these tests the air was returned from the gymnasium to the air
washer where it was washed and partly refrigerated by passing through
vat water at 50-54° F. This cooling was necessary to keep the relative
humidity from increasing.

1 84

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabli

: III

CO2 Per 10,000

OF Air

Gallery

Level

Breathing Lev(

il
No. M«

No.

Date

Time

AvC02

Tests

Av CO2 Tests

Exer.

Remarks

1913

Jan. 20

4.30-6.00

10.-

8.-

Jan. 21

4.00-4.45

Jan. 22

4-30-5I5

Jan. 25

3.20-5.00

Jan. 29

4.55-5.00

Fan not running*

Feb. 4

5.00-5.30

Feb. 5

5.00-5.45

Tests taken on floor were

Feb. 6

2.15-3-55

taken at a height of

Feb. 7

4.25-4.50

5 ft. 5 in.

Feb. 10

4 55-5. 35

Feb. 13

4.40-4.55

Feb. 18

3.55-4.05

Feb. 18

2.25-3.10

Feb. 19

4.35-5.05

Average

9.33

♦This test is not includec

average.

As the table shows, there is a fairly constant variation between 7.5
parts and 9 parts in 10,000. The gallery level shows an average of 9.33
parts in 10,000 as compared with 8.33 parts on the breathing level. I
have no explanation for the gallery level being regularly higher. These
figures are not about the safety range on the old basis. Richards &
Woodman state in their text "Air, Water and Food," p. 26, that the
CO2 in school rooms should not rise above 8 or 9 parts in 10,000 and
in lecture halls not above 9 to 1 1 parts.

Window Ventilation.
, (Fans not Running.)
All the windows, 56 in number, with 415 square feet of window sur-
face, were open wide.

Table IV

CO2 Per 10,000 OF Air

Track Floor

No. No. No. Men

Date

Time

Av CO2 Tests Av CO2 Tests Exer. Remarks

1913

Apr. 10

2.55-3.

5.9 2 5.- 2 64 Strong breeze from west

Apr. 14

320-3.

5.7 2 5.4 2 41 No wind

Apr. 22

3.00-3.

6.- 2 5.6 2 70

Average

5.8

5.3

VENTILATION OF GYMNASIA 1 85

This table shows the lowest CO2 content of any of the exercise tests.
These observations were unsatisfactory because of the warm outside
air which allowed all the windows to be opened wide. It is hoped we
can follow through tests next year under winter conditions which will
show temperature, humidity, CO2, odors, bacteria and dust conditions.

Diffusion Test.

Table V

Feb.

18, 1913

West Gymnasium

Hour

Place

CO2

Remarks

3 . 55 Track on east side

8.5

About 50 men on floor exercising

4.05 Center of floor 5 ft. from floor

since 2 P. M.

7-5

As men were leaving floor just before
ventilation plant shut down

4 . 30 Same

6.5

Plant shut down at 4.5 and everyone
was kept off^ floor

5 . 00 Same

5.-

Same

5.30 Same

Same

6 . 00 Same

4.5

Same

6.30 Same

4-5

Same

This test was undertaken to find how long the CO2 content would
remain up to a high level. You will note that the CO2 content sank
down to 5 parts in 10,000 in less than an hour with all windows and doors
closed. At the end of another hour and a half it had only sunk to 4.5
parts in 10,000. Apparently the diffusion is slower at the lower levels.

Conclusion.

1 . Research workers should determine more definitely what changes
take place in the air breathed in under varying air conditions of tem-
perature and humidity. We need to know definitely whether air is
always saturated and raised to body temperature on leaving the air-
passages.

2. We need to know whether dry air is harmful to bodily tissues or
functions.

3. Considerable air movement in rooms unquestionably adds to
the comfort of the occupants.

4. Drafts are not uncomfortable if the moving air is near room
temperature. Ten times, 306 cubic feet per minute per individual,
the air required by school law, was moved, not only without discomfort
but with increased comfort.

1 86 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

5. Expense can be materially reduced by using recirculated air
even when the entire cost of ventilating machinery and its upkeep is
included. Kimball's figures show the cost for recirculated air to be
52 cents, for direct ventilation of the same thoroughness $1.07 in the
plant at Springfield.

6. The most comfortable air for gymnasium use has a dry bulb
temperature of 60° F. and a relative humidity of 46 to 50%. Bald
headed people suffer some discomfort with large air movement if the
dry bulb temperature goes as low as 63° F. They seem comfortable
at 65° F.

7. Proper room temperature, perceptible air movement, adequate
moisture content, low bacteria and dust content, and the elimination
of body odors are the essentials in healthy air.

8. Large CO2 content in the air does not seem to render it unhealthy,
at least so far as immediate discomfort or efficiency are concerned.

9. This series of studies shows that a recirculation plant is possible
which will furnish air like the best outdoor air, i. e., after it has been
washed by rains, cheaper than by ordinary means of ventilation.

10. With recirculation the CO2 content never rises aboye 14 parts
in 10,000, and ordinarily not above 9 parts in 10,000.

11. It is possible to control humidity, keeping it up near average
outdoor conditions. This means raising the relative humidity roughly
from 25 to 50, or as some authors suggest, to 70%.

12. The government sling psychrometers are accurate within 2%
for ordinary room temperatures.

Bibliography.

1. Gardner, A. C. Ventilation. Architectural Review, June, 1912,

pp. 61-63.

2. Evans, W. A., M.D. Report on Methods of School Ventilation by

the Chicago Commission on Ventilation. The Journal of the
American Medical Association, November 28, 191 1, pp. 1 757-1 759.

3. TUTTLE, C. S. A Study of Air Conditions in a Public School in

Springfield, Mass. Graduate thesis for 19 13. In library of
International Y. M. C. A. College, Springfield, Mass.

VENTILATION OF GYMNASIA

187

4. Affleck, G. B. The Ventilation of Gymnasia. A preliminary

report. American Physical Education Review, April and June,
1912, pp. 255-266 and 455-468.

5. Smith, E. Carbon Dioxide Output During Rest and Work. Schaf-

fer's Physiology, Vol. I., p. 716.

6. Flugge, Dr. C. Uber Luftverunreinigung, Warmestaumg und

luftung in Geschlossenen Raiimen. Zeitschrift fiir Hygiene,
Vol". 49, 1905 s. 363-387.

7. Paul, Dr. L. Die Wirkungen der luft bewohnter Raiime. Zeits-

chrift fur Hygiene, Vol. 49, 1905, s. 405.

8. Heyman, B. Uber den Einfluss wieder eingeathmeter Exspira-

tionsluft auf die kohlensaure Abgabe. Zeitschrift fur Hygiene
und Infektions-Kraukheiten, No. 49, 1905.

9. Ercklentz, W. Das verbal ten Kranker gegeniiber verunreinigter

Wohnungsluft. Zeitschrift fur Hygiene, Vol. 49, 1905, p. 433.

10. Hill, L. New Ideas in Ventilation. Domestic Engineering (Am.)

58 13:50, Jan., 1912.

15. Benedict, Francis G. Composition of the Atmosphere witb
special reference to its oxygen content. Pub. No. 166, Carnegie
Institution, 19 12. Price, $2.

DISCUSSION OF

J. H. McCurdy's Paper

Dr. a. Caswell Ellis

Dr. McCurdy, what was the cubical content of the room, what
were the exposures, and what number of students were in the room while
the experiments were made?

Dr. McCurdy. — ^The cubical content of the room was 185,000 cubic
feet, it was exposed on three sides, with large windows on each side, and
a skylight. From fifty to seventy students at a time used the room.

Dr. Ellis. — ^A room with 185,000 cubic feet cubical content holds
enough air to give 50 students 30 cubic feet each per minute for two

1 88 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

hours and three minutes without a particle of leakage. Furthermore,
it is found in ordinary engineering practice that, in loosely constructed
buildings, the leakage from the outside equals the volume of the room
every thirty minutes. This gymnasium is very large, but it is unusually
exposed and has many windows. The leakage would, of course, vary
with the temperature, but, if it were one-fourth of what engineers have
found it wise to allow for, there would be a leakage of more than 30
cubic feet per minute for each of fifty students. The experiment there-
fore shows nothing whatever as to the effect of recirculated air, as there
was enough fresh air either already in the room or leaking in to supply
more than the standard requirements of fresh air.

I want to emphasize the warning of Prof. Winslow that the greatest
care to be exercised both in making and interpreting ventilation experi-
ments, and in talking to laymen. Real harm is being done. For in-
instance, it was reported around this Congress that Dr. McCurdy had
proven that washed and recirculated air could be breathed all day
without harm. You see now that such conclusion is not justified.

In my efforts to secure a school hygiene law in Texas, I was met by
the statements that a man in a box had breathed the same old air over
and over again and suffered no harm as long as it was stirred and the
heat and moisture removed from his body, and that some distinguished
hygienists had said that there was no evidence that we need fresh air
In school rooms, that all we need is to stir up the air and carry off the
body heat and moisture. Such statements are wholly unwarranted.
It is true that it has been shown that a strong healthy man can remain
comfortable in foul air, if it is cooled and stirred much longer than we
thought, and that no immediate evidence of injury is noticeable. But,
our methods of determining when one is injured by such experiences
are wholly inadequate. I can take arsenic or chlorate of potash for
a day or so and no evidence of injury is noticeable, but if I keep it up
for several months, serious injury results. Children are in school five
hours a day, for nine months a year, for twelve or more years. Further-
more, some of these school children are diseased, all are throwing off
gaseous body sewage from lungs, alimentary tract and skin to such
extent that within half an hour the average unventilated school room has
distinct odor of putrifying organic matter. The fact that some investi-
gators fail to find any volatile organic poison in such putrid air, while
others do find it, would seem to indicate that our methods of determining
the presence of such poison are inadequate rather than that such poisons
are not present. All other body excreta are poison and it would be pass-
ing strange if these were not.

Until the known facts are very different from what they are now,
it would seem to be criminal folly not to furnish school children the

VENTILATION OF GYMNASIA 1 89

present standard requirement of thirty cubic feet of fresh air per pupil
per minute.

Undoubtedly the experiments of recent years have valuable results
that cannot be questioned, such as the need for holding down temper-
atures, removing body heat and moisture, for stimulating the skin by
slight changes in temperature and for properly humidifying the air.
All of these can be accomplished without lessening the supply of fresh
air and without any serious changes in our present systems. We need
more of careful experimentation and less of rash conclusions.

DISCUSSION OF

J. H. McCurdy's Paper

John W. Shepherd

Dr. McCurdy's experiments have shown that it is possible to re-
circulate air in a gymnasium occupied by men at exercise, without the
carbon dioxide content rising above a percentage that is usually con-
sidered a safe index, provided the air he washed during the recirculation.

I should like to point out two other possible conclusions than the one
which Dr. McCurdy has reached, neglecting the factor or air leakage.
These conclusions are :

1 . That the system of air washing which he used is efficient in pre-
venting the carbon dioxide content from rising higher than it did and
also efficient in removing the objectionable products of respiration
formed during the exercise and expelled into the atmosphere.

2. That a person may use air with a lesser percentage of oxygen
than that usually found in out-door air, provided the air containing
the lower percentage of oxygen is free from possible contamination
through rebreathing, and furthermore, provided one does not continue
in this atmosphere for a period longer than an hour or two.

The point upon which I wish to insist is that the experimental work
reported in this paper is not necessarily evidence in favor of restricting
a supply of air for ventilation purposes; neither can one conclude that
people may breathe recirculated air over and over, even for a short
period of time, unless it is efficiently washed between successive re-
circulations.

190 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SOME PHASES OF VENTILATION

D. D. Kimball

Possibly the most important phase of the problem of ventilation at
the present time is the very general spirit of inquiry and investigation
which is so manifest. But while many of its important problems are
being attacked, but little effort is being applied to, and but little
progress is being made in, the question of what really constitutes the
best ventilation, that is, what is the most desirable atmospheric condi-
tion for various classes of people in different kinds of buildings. This
would seem to be the fundamental problem in ventilation, for with this
question answered the problem of how to maintain the most desirable
condition becomes a question of engineering only, and hence a problem
very easy of solution.

During recent years many experiments have been conducted to
determine the effect of different elements of ventilation, such as tem-
perature, humidity, air movement, air volume, ozonization, recircula-
tion, etc., but none of these investigations have seriously attacked the
problem of the fundamentals of the optimum atmospheric conditions,
that is, the most desirable combination of these various elements for all
conditions.

It is quite probable that the collection and correlation of all of the
data secured in all of these investigations would go far towards clearing
a much befogged subject. Genuine cooperation between the many in-
vestigators in the field of ventilation might, and doubtless would, go far
towards making possible some sound conclusions, or at least it would
give to all a great deal of helpful information and furnish guidance and
suggestive material in many cases for the further prosecution of inves-
tigations.

For the purposes of collection and correlation of data, and the dis-
semination of the same, it may be that the recently appointed and or-
ganized New York Commission on Ventilation would serve as the most
efficient medium. It is probably the only investigating body now at
work on this problem which is provided with means (both in a financial
sense and in the sense of having a sufficient organization) to properly
carry out such a plan and to carry on investigations and research work
aiming to prove or disprove the varying theories advanced, and to under-
take such further experiments or investigations as may be necessary to
fill in the voids between experiments previously or concurrently made

SOME PHASES OF VENTILATION igi

by Other investigators, or to do such other experimental and research
work as may be necessary to complete the solution of a many-sided and
perplexing question.

Through the generosity of Mrs. Elizabeth Milbank Anderson, The
New York Association for Improving the Condition of the Poor has been
provided with a fund of $50,000, or such a portion thereof as may be
required, to cover the expense of a thorough study and investigation
of this problem. At the suggestion of this Association Governor Sulzer
appointed the following gentlemen as members of the commission:

Prof. C.-E. A. WiNSLOW,
Prof. F. S. Lee,
Dr. J. A. Miller,
Prof. E. L. Thorndike,
Prof. E. B. Phelps,
D. D. Kimball.

The problem involves public health, physiological, medical, psycho-
logical, laboratory and engineering phases, and therefore an expert in
each of these branches is included in the make-up of the Commission.

An office of the Commission and laboratories have been secured at
the College of the City of New York. Two adjacent rooms are avail-
able, one of which is to be used as a Control Room and the other as an
Observation Room, although subjects under observation may be placed
in either or both of the rooms, with the same or different atmospheric
conditions in the two rooms.

These rooms are inside rooms, lighted from the ceiling, so located as
to be entirely unaffected by outside weather conditions. In the Control
Room there is now being installed a complete model or experimental
ventilating plant, including a motor driven fan supplying fresh air which
is to be taken in through the roof. From this fan the air will pass over
heating coils and thence through an air washer and humidifier, or through
a dryer, and from either of these devices, as desired, or in mixed quan-
tities from both, the air passes over reheaters which may or may not
be in operation, and thence into the two rooms. The system is divided
into two parts, each part serving one of the rooms, so that the atmospheric
conditions in the two rooms may be different or the same, as willed,
for the purpose of making comparative tests. Temperatures ranging
from that of out-of-doors to 106 degrees in zero weather and humidities
ranging from nothing to saturation can be provided in these rooms.

Another fan, with direct connected motor, is provided for maintaining
an exhaust from both rooms. This may discharge out through another
portion of the building or back into the intake duct for tests on recir-
culated air.

192 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The air may enter or be exhausted from the Observation Room at
any or all of four levels in the height of the room.

Speed control devices are provided in connection with the motors,
so that any quantity of air may be supplied or exhausted, from 800
cubic feet per minute (400 for each room) down to practically nothing.

An elaborate system of automatic temperature and humidity con-
trolling devices is provided to maintain any desired temperature and
humidity conditions in both rooms.

Provision is made for the installation of disk fans to provide air
currents as desired.

Provision is also made for the introduction of ozone or ozonized air
at various points of the system or directly into the rooms. Observation
and measuring openings are provided.

The system is so arranged that there may be readily combined there-
with a cooling plant for experimentation in artificial cooling.

The atmospheric conditions in the Observation Room will be con-
trolled entirely from the Control Room. Direct means of communica-
tion are provided between the two rooms.

A complete outfit of instruments is being provided, including several
Peterson and Palmquist CO2 determining machines (Rogers modified
pattern. Sling Psy chrome ters, wet and dry bulb thermometers [direct
reading and recording]. Pi tot tubes, Annemometers, Ergometers, etc.)

Auxiliary to the above apparatus three animal cages are provided,
two to be located in the Observation Room, and one in the Control Room,
so arranged' that differing atmospheric conditions may be maintained in
each.

This plant will be used in an effort to determine the effect of any
possible chemical or physical condition of the atmosphere upon human
or animal subjects. Both physical and psychological effects will be
measured, mental and physical tests being applied. Blood pressure,
pulse and respiration rates, bodily temperature and other desirable
measurements and records will be made,

•Supplementary to the work done in this laboratory other experiments
will be conducted in a respiration calorimeter to be constructed by the
Commission at the College of Physicians and Surgeons.

For the purpose of a practical application of the results of the experi-
ments above contemplated arrangements have been concluded to install
an experimental ventilation plant in two rooms of a new school build-
ing in New York. These rooms will be so arranged that air may be
supplied through the ceiling or floor, immediately at the desks, or through
either of two of the walls of both rooms. Likewise, the air may be ex-
hausted through floor or ceiling or through either of the two walls.

SOME PHASES OF VENTILATION

193

Window ventilation may be tested here also. Two similar rooms
occupied by a similar class of pupils will be used as controls.

In cooperation with this Commission, Dr. J. H. McCurdy, at the
International Y. M. C. A. College, at Springfield, Mass., will continue
and extend his experiments of the last two years with recirculated air.
Also Prof. Phelps will continue at the Mass. Inst, of Technology his
experiments upon moisture elimination and absorption, the effect of
different clothing materials, and the study of other physical problems.
Other tests and experiments in cooperation with the Commission are
being arranged. Open air schools and hospitals will be studied.

This Commission seeks and offers cooperation from and wijth all who
are investigating this important problem. It is believed that much
time may thus be saved in reaching satisfactory results, and that the
work of every investigator will be greatly facilitated.

During the last two years a most interesting and extended experiment
upon the use of recirculated air has been conducted at the International
Y. M. C. A. College, under the immediate supervision of Dr. J. H.
McCurdy and Prof. G. B. Afifleck. During the heating season of 1912-13
a serious effort was made to cover as many phases of the problem as
possible. To this end a voluntary association was formed to cooperate
with Dr. McCurdy and Prof. Affleck, including Prof. G. C. Whipple,
Mr. M. C. Whipple, Prof. C-E. A. Winslow, Mr. C. E. Pearce and the
author. The air when recirculated was passed through an air washer
and special attention was given by Mr. Whipple to chemical and micro-
scopical studies of the water and air. Mr. Whipple performed a vast
amount of work, both at the college and in his laboratory at Harvard
University, the results of which he can give in detail.

Messrs. Home, Knapp and Geer, seniors at the College, gave valuable
assistance throughout the season by making and recording carbon
dioxide, temperature and humidity tests, and also "comfort" records of
the students. Some very conclusive data as to the most comfortable
atmospheric conditions in gymnasia was obtained.

While it may not be stated as a result of these investigations that the
recirculated air when washed is as good as outside air when washed, it
is apparently better than outside air unwashed, being freer from dust
and bacteria and not appreciably less in oxygen or higher in carbon
dioxide. Increased efficiency in air washing apparatus will improve
the quality of the recirculated and washed air.

The fact that the use of recirculated air for ventilating purposes
(assuming that its quality is found to be entirely suitable) makes possible
a reduction in coal consumption of approximately two-thirds or, in other
words, makes ventilation possible without greater expenditure for fuel
than that required for direct heating without ventilation, makes the

194 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Study of recirculated air a most worthy one. Such a reduction in
operating costs would eliminate one of the serious objections to the
artificial ventilating system. The cost of instaUing the ventilating
system is practically the same whether the air be recirculated or not.

Another set of most interesting tests of the possibilities of recirculated
air is that of Prof. Bass, of the University of Minnesota, made in the Jack-
son School in Minneapolis, described in a paper read before the Summer
meeting of the American Society of Heating and Ventilating Engineers.
In this series of tests an effort was made to determine also the minimum
"amount of air which, when introduced directly at or near the pupil's
face, would give results equal to the results obtained from standard
methods of school room ventilation. The amount of air used per capita
was approximately seven cubic feet per capita. With this amount of
washed and recirculated air introduced directly in front of the pupil's
face, no appreciable effect was noticeable on the pupil's school room work.
If the air used in either method of ventilation were outside air the re-
duced cost of operation (i. e. coal used) due to the less amount of air
used would be an important factor but with the use of the recirculated
air the difference in operating costs largely disappears. The less amount
of air to be handled would reduce slightly the cost of installation but the
elaborate duct system required would make the difference slight.

It is doubtful whetljer the length of the time involved in these tests
warrants definite conclusions, or whether a study of what is ideal school
room ventilation is not more important at this time than the question
of how results equal to the results at present obtained by standard school
room ventilation may be secured with a less amount of air.

In Prof. Bass' experiments ozone was regularly used with the recir-
culated air and it is stated that it seemed essential, the teachers com-
plaining of stuffiness when the fan supplying ozone was out of use for
twenty or thifty minutes. In contrast with this experience it is to be
noted that ozone was not used at the International Y. M. C. A. College
nor did there seem to be any need thereof. This may be due to the
vastly greater quantity of air per capita used. The introduction of the
air directly at the face, the course of the air then being up and away from
the body, raises the question of whether the neglect of air currents about
the body for the elimination of heat and moisture, is serious.

Extensive investigations in ventilation have been conducted during
the past year by the Chicago Ventilation Commission.

Among other experiments made or contemplated may be mentioned
those on ozone in the Schenectady schools, a few tests on school room
ventilation in Boston, New York, Toledo and elsewhere, tests on factory
ventilation by Dr. C. T. Graham-Rogers and the extended study made
by Prof. Winslow and Prof. Baskerville on existing atmospheric condi-

SOME PHASES OF VENTILATION

195

tions in New York City schools, these studies covering both the arti-
ficially and naturally ventilated school rooms. In connection with these
studies it is to be noted that the best of the artificially ventilated rooms
was found to be as good as or better than the best of the window-ventilated
rooms. Every school room may, with a proper equipment and a good
janitor for the building, be kept at all times as well ventilated as the best
ventilated room found, while weather conditions, varying winds, and the
impossibility of securing proper attention on the part of the average
teacher to the matter of ventilation in addition to other duties make
impossible satisfactory ventilation by means of windows, except in rare
cases. It should be vastly easier to get one man per building capable of
operating a ventilating plant than twenty to fifty teachers.

One of the most important, perhaps the most practical if not the
most serious, phase of the problem of ventilation, rarely receiving con-
sideration in gatherings of this nature, is little appreciated by the student
or investigator of ventilation, and of it probably little is known by those
most concerned or those directly responsible for school building construc-
tion. It is a fact that the chief reason for the failure of the artificial
ventilating system is, not lack of information as to desirable atmospheric
conditions or the inability of the engineer to provide the same, but the
attitude of the school boards, building committees and school architects
towards the matter of a sufficient expenditure for a complete ventilating
plant.

The first responsibility lies with the school boards or their building
committees because of their failure to see that the sum allowed for the
ventilating plant is sufficient to give the best that science can devise, to
see that the architect does not use any of the money which should be
spent on the ventilating plant in the enlargement or ornamentation of
the building. Criticism of the architect is not intended in the state-
ment that in not one school building in ten is" the engineer allowed to
work out what he knows to be the best possible ventilating plant for the
building. The vast majority of plants are the result of a compromise
(some of them very poor ones from the standpont of the engineer) be-
tween the request of the engineer for freedom to design the right thing
and the insistence of the architect (who is usually in charge of the work)
that the amount allowed for ventilation shall be the very minimum so
that he may meet the demands of the Committee (often most unreason-
able) for more space or equipment than can be properly provided for
the appropriation granted.

The engineer is very often obliged to put one radiator in a room where
two or three would be much better, is usually obliged to omit air washers
and humidifying systems, sometimes is obliged to omit temperature
controlling devices, and frequently is obliged to use inferior materials.

196 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

And all to enable the architect to give to the board a building as big as
he promised, or as big as some other architect offered, or a building as
big or pretentious as the citizens expect, or a building as cheaply built
per cubic foot as some other supposedly "similar" building in the same,
or a neighboring city.

Similarly, through the employment of cheap janitors many good
ventilating systems are rendered inefficient. The employment of capable
janitors paid proper wages will not only bring about the better operation
of the plant but a sufficient reduction in fuel costs to more than pay the
increased salary.

Unless the authorities can be made to see the seriousness of these
phases of the problem and these difficulties can be eliminated all of the
good work in investigations which is being done will go for absolutely
naught, for if the schools do not now get the best that may be had what
hope is there that they will get better when better becomes known?

VENTILATION AND RECIRCULATION 197

VENTILATION AND RECIRCULATION

Luther H. Gulick

It is the purpose of this paper to summarize and correlate our present
knowledge of what constitutes air at its best for human use and how
we may secure these conditions permanently and economically.

Air may be considered with reference to its two main functions —

1st. With reference to gaseous exchanges in the body — ^The compo-
sition of the air.

2nd. With reference to heat control — The condition of the air.

The Composition of the Air. — Oxygen. — It used to be assumed that the
exact percentage of oxygen in the air was an important factor in deter-
mining the quantity of this element absorbed and used by the body.
We now know that within certain rather wide limits the per cent, of
oxygen has nothing to do with the case. The "factor of safety" (Melt-
zer) in the functioning of the oxygen taking and carrying apparatus is
such that under any of the conditions found in ordinary life the amount
of oxygen taken in and consumed is determined solely by the demands
of the body, and not by the percentage in the air, i. e., a horse cannot
drink any more out of a lake than he can out of a trough. The experi-
mental data referred to show that the oxygen consumption of the body
is not in any way affected by lessening the oxygen in the air till it has
been reduced from 21% where it is normally, to about 15%. We also
know that such lowering of oxygen is never found except under the con-
trolled conditions of the laboratory. In other words a tight shut school
room full of pupils without any artificial ventilation will not suffer from
lack of oxygen. They probably will suffer but not from oxygen starva-
tion. The exchange of gases through cracks in doors, windows, as well
as through walls, floors and ceilings is so rapid as to maintain a practi-
cally uniform atmospheric balance in gases. To be even more explicit
the oxygen content in the air in a room or building — even a modern one
— cannot be reduced enough through breathing as to lessen the oxygen
consumption of those in the room. Hence no attention whatever needs
to be paid to oxygen percentage and supply.

198 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

2. Carbon Dioxide. We used to be told that this gas was a poison
and even in minute quantities vitiated the air rendering it harmful for
consumption. Later on we were told that while not proven to be harm-
ful in very small percentages that it was our best measure of the extent
to which the air had been vitiated by breathing. Indeed people have
lived and worked for hours and days in calorimeters with an atmosphere
so laden with this gas that a match will not burn in it. In this atmos-
phere their mental and physical faculties are normal. They have no
subjective way of knowing of the presence of the gas.

The oxygen and CO2 matter is so generally misunderstood that I
venture to quote.

The most recent and exhaustive work on this subject is "The Composi-
tion of the Atmosphere," by Francis G. Benedict, Director, Nutrition
Laboratory, Carnegie Institution. He says in a personal letter summar-
izing his published findings, "The amount of carbon dioxide and oxygen
I found on Washington Street, Boston, in the most crowded part of the
city in the middle of the day time was exactly the same as that found in
the middle of the Atlantic Ocean. Also, when I went into the subway
shortly after the rush hour, the carbon dioxide in the air was but .06,
and the oxygen, 20.90, as against surface air .03 and 20.93. Similarly
in the New York subway, at the Grand Central Station and up on 96th
Street, or along there we found .06 and 20.90, respectively, showing that
there was a very sight vitiation of the air, and there must have been
even in these enclosed tubes, tremendous movements of air. * * *
"In fact, I believe there is no evidence whatsoever to show that there is
any possible increment in carbon dioxide obtaining in school rooms,
or any possible decrease in oxygen obtaining in school rooms that, by
the widest stretch of imagination, could have any possible effect upon
the health of the pupils."

Instead of CO2 being a poison we now know it to be necessary to life.
Carbon dioxide is always found in the blood, respiration ceases when it
is removed. The air in the pulmonary alveoli contains 500 parts per
10,000 of it under ordinary conditions. The removal of this gas by
modern methods of intratracheal respiration results in the patient ceas-
ing to breath. That is, the body needs to have about 5% of CO2 in
the lungs. In the light of this we see how negligible is the 4 parts per
10,000 found in outside air in altering the 500 parts per 10,000 needed
by the body CO2 in the air seems to have no effect till it reaches a
percentage high enough to increase the percentage in the alveoli and
thus to alter the CO2 balance of the organism. It is thus a normal and
necessary gas and its presence in the air in used rooms cannot be in-
creased to such an extent as to be of danger.

VENTILATION AND RECIRCULATION I99

3. Organic Matter. In no field has physiological controversy been
more active, than with reference to organic matter in the expired air.
The more refined methods of physical and chemical analysis possible
under modern laboratory conditions have failed to show any toxic
organic matter in expired air. Rosenau's work alone appears to raise
doubt but it is unsubstantiated and seems by those most competent to
speak on this subject to be open to question.

It is true that organic matter is given to the air by decaying matter
in the mouth, by pathological conditions in the nares and especially the
posterior nares and from the skin. This may be harmful and must be
removed but does not constitute the "anthropo toxine" or "crowd
poison" usually referred to.

4. Odors. Our evidence on this subject is mainly negative. It
seems as if unpleasant odors should produce harm in proportion to their
unpleasantness. We only know that we rapidly become habituated to
such odors and that as yet we have not been able to trace any permanent
direct result from them. Through arousing disgust — before habitua-
tion sets in — physiological effects may be produced. They should be
removed.

5. Dust and Microorganisms. Air taken from out-of-doors is often
laden with dust. In cities this is most objectionable because of the
character of the dust of the streets. Although the recent work by
Chapin has allayed our fears from droplet and dust infection nevertheless
air should be as far as possible both dust and germ free.

The Condition of the Air. — Temperature Humidity and Air Motion
are so related that they should be considered together. The value of
recirculation is to be found in the superior control which can be secured
through it over these three factors and their relations to each other.

So far I have shown that ventilation has but little to do with helping
or hindering the gaseous exchanges of the body i. e. with respiration.
The world has quite largely assumed the contrary and has thought that
because respiration involved air i^ovements in and out of the lungs and
ventilation involved air movement in and out of rooms that therefore
ventilation was to aid respiration and the factors involved were the same
in both cases — namely the composition of air. Hence ventilation in-
vestigations have concerned themselves mainly with a study of such
composition. Lately, however, owing to the work of Flugge, Hill,
Atwater, Benedict and others we see that the ill effects of badly ventilated
rooms are usually to he found related to body heat and the vasomotor system
and that hence the primary purpose of ventilation is to aid in the proper
control of body heat.

200 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Temperature, humidity, and motion of air are for this reason
matters of primary importance. It is also necessary to consider them
together for in this respect they mutually condition each other. Into
the complexities of the subject we cannot enter but simply note a few-
facts.

The hotter the air the less is the body able to rid itself of heat. The
colder the air the more heat it abstracts from the body. But — as air
becomes heated its capacity for water greatly increases, hence it will
the more readily absorb water from any available source. This is the
reason why taking air from out of doors, heating it gives us the charac-
teristic hot dry air of the class room. The body evaporates rapidly into
this hot dry air — this evaporation has a vigorous cooling effect. This is
the reason why a hot dry day is not so exhausting (heat accumulating)
as a hot moist day.

A cold damp day seems colder than a cold dry day because the body
loses heat to the moisture.

For these reasons a room at 68° with ordinary out door humidity
may feel as warm as a dry room at 75° — and far more comfortable for
in the latter case the body is rapidly giving off its moisture.

Motion of air still further adds to the complexities of the subject.
A person sitting in a closed non-ventilated room will very soon have
about himself a slowly changing layer of air which his body has humidified
and warmed. On very hot days his breath may not even rise but stay-
ing on a level with his head may aggravate the difficulty. Thus there
is formed an "aerial blanket" of hot moist air covering him. The real
temperature under such conditions is the temperature of the blanket
not that of the room. The reason for the cooling effect of a wind or
an automobile ride is to be found in the rapid removal of the air from
next to the body.

With a low out door temperature we have by means of furnaces in-
creased the heat to about 70° and then sent it to our class rooms. This
air while adequately moist at 10° is now exceedingly dry. It abstracts
moisture from the skin of the body as well as the mucous membranes of
nose, throat, mouth, and air passages of the children thus cooling them
off. To keep the children warm under these conditions of excessive
dryness the air must be much hotter than it otherwise should be, hot
enough in most cases to flush the skin and produce the symptoms of ill
ventilation. Errors are commonly made on the side of over heating —
this at first seems a lesser evil than does under heating. This over-
heated excessively dry air is forced through modern school buildings at
the rate of 2,000 cubic feet per person per hour and then is forced out,
carrying with it the moisture that has been absorbed from the occupants.

The ordinary signs of ill ventilation namely, flushed skin, dull head-

VENTILATION AND RECIRCULATION 201

ache, perspiration, somnolence, mind wandering, restlessness are not
found where the air is cool, humid, in pleasant motion and free from
odors and dust. These are the quaUties of so-called "fresh air." It is
now my intention to show that such "fresh air" can be better secured
by recirculating the air than by other methods.

II.

During the past winter the gymnasium building of the Y. M. C. A.
Training College has been ventilated for weeks at a time by using the same
air over and over again. It has been renovated only by natural leakages.
This building is a large and modern one including two gymnasiums,
laboratories, offices, and class rooms. It is used more completely and
continuously than any other gymnasium of which the writer has knowl-
edge. This experiment is peculiarly convincing because of the fact that
a person doing vigorous exercise vitiates the air from three to eight times
as rapidly as a person does at rest. That is, oxygen is consumed and
carbon dioxide, sweat and odors are given off from three to eight times
as fast as under ordinary conditions of rest.

Extensive and exact determinations have been made as to these
various elements as well as to volume of air moved, humidity, and tem-
perature.

The feelings of the students have been regularly ascertained and
their health and working capacity, both mental and physical, as care-
fully measured as was feasible. The various exercise, class rooms and
offices have shown splendid air conditions whether the test was the
feelings of the students, the impressions of visitors fresh from the out-
side, or actual examinations of the air itself. This building with its
ventilation apparatus and practice was erected and is administered
under the direction of Dr. James H. McCurdy, who with Dr. Whipple
and Dr. Kimball are presenting reports to this Congress.

The advantages secured by this system are:

1st. As Dr. Whipple has shown the air is kept more free from dust
and bacteria than is the air even in their rural situation. This is accom-
plished by washing the air in the same way that air is washed by rain.

2nd. Soluble odors are removed by the same process. Street odors
do not enter the building.

3rd. The great difficulty found in the heat, humidity relation is
obviated, for

4th. The expense — including cost deterioration ' fuel — operation
etc., is reduced from $1.07 per hour to 52 cents per hour. This is

202 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

largely due to the saving of heat units. Under one set of conditions the
outside air must constantly be brought up to school room temperature.
Under recirculation only the heat losses have to be replaced. When we
take this viewpoint — namely that ventilation is primarily related to
body heat control we see at once that we are concerned about ventilation
in hot weather as we are in cold. In this case however by using cold
water to wash the air it may be io° or so cooler than the outside air there-
by'greatly increasing its "freshness" and the comfort of the worker.

Ill

We are now able to account for the prevalent acute dissatisfaction
with ventilation. For example, such men as Dr. John W. Brannan and
Dr. W. Gilman Thompson are saying that the more perfect the system
the worse the results in the great New York hospitals under their charge.
We now see that the trouble does not rest primarily either with the
ventilating apparatus nor with its operation. The trouble is that we
hygienists have set up false standards. We have said, give each pupil
1, 800 cubic feet of out door unbreathed air per hour. We now know
that the important thing is not either the quantity or the history of the
air — the important thing is its condition. We have striven for absolute
evenness of temperature although we know well that variation in tem-
perature is a necessary element in vasomotor stimulation. We have been
extreme in our endeavors to avoid air that has already been used.

The great change in our standards is due to our discovery that the
purpose of ventilation is not at all what we had supposed. The air
serves the body in two more or less overlapping groups of ways — one
relates to being the means of the gaseous exchanges of the body — the
other relates primarily to heat control.

On the other hand the heat control of the body is influenced by the
condition of the atmosphere in which the body is immersed. This is
exceedingly variable and it is to bring about the best conditions of air to
which ventilation should address itself. To repeat; this fundarnental
change of standards. Ventilation seeks to control the conditions of the
atmosphere in which the body is immersed rather than to control its
composition; because its composition is practically stable and needs no
attention while its condition is exceedingly changeable as well as im-
portant.

The ideal ventilation for a school building consists in recirculating .and
properly conditioning its contained air. The advantages are that the air
may be kept under more health giving conditions through more perfect
control of temperature, humidity air movements, dust, odors, and also
because of the financial saving.

VENTILATION AND RECIRCULATION

203

That is, we have now arrived at such a knowledge of ventilation that
it is possible to have indoors and practically all the time these conditions
which are found out of doors only when nature is at her best. Man has
at last accomplished with reference to the air he breathes and in which
he is enveloped what he learned to do years ago with reference to the
water he drinks — Have it at its best all the time.

Partial Bibliography

Zeitschift fiir Hygiene und Infections Krankheiten. Vol. 49, 1905.
(Pub. in Leipsig by Von Veit & Co.)

This epoch making series is as follows:

1. pp. 363-387.

Ueber Luftverunreinigung, Warmestaung und Luftung in geschlos-
senen Raumen, by Prof. C. Flugge (Breslau).

2. pp. 388-405.

Ueber den Einfluss wieder Eingesthmeter Exspirationsluft auf die
Kohlensaureabgabe, by Dr. Bruno Heymann (Breslau Institute).

3. Die Wirkungen der Luft bewohnter Raume, by Dr. med L. Paul
(of the Hygienischer Institute der U. Breslau).

4. Das Verhalten Kranker gegenuber verunreinigter Wohnungsluft,
by Privat dozent Dr. W. Erchlentz (Breslau).

Amos, Harold Lindsay: Organic Matter in the Expired Breath.

The Jrl. of Experim. Med., Feb. i, 1913, p.
132.

Atwater, W. O. and Bene-
dict, F. G. :
Benedict, F. G.:

Billings, J. S., M.D.,
Mitchell, Weir, M.D.,
Bergey, D. H., M.D.:

Courtade :

Crowder, Thomas
M.D., Chicago:

R.,

"The Respiration Calorimeter."

The Composition of the Atmosphere — Car-
negie Nutrition Laboratory.

"The Composition of Expired Air and Its
Effects Upon the Animal Life."

L'air expire n'est pas pur. Archiv Internat.
de Laryngol. Vol. 31, 1911, p. 504-

"A Study of the Ventilation of Sleeping
Cars." Also contains an excellent bib-
liography. Reprinted from the Archives
of Internal Medicine. Jan., 191 1, Vol. 7,
pp. 85-'i33.

204

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Gaussin :

Gulick, Luther H.:

Hill, Leonard,
Flack, Martin :

Kratschmer :

Michaelis, George V. S.:
Reichenback, Heymann:

Report of the Departmen-
tal Committee on
Rietschel, G. :

Rosenau, Milton J.,
Amos, Harold L.:

Thompson, W. Gilman,
M.D.:

University of Minnesota:

Recherches experimentales sur les altera-
tions de I'air. These de Paris, 1902.

Discussion of Report of Com. on Variable
Temperature. Proceedings of the Sixth
Congress of the American School Hygiene
Ass'n.

The Influence of ozone in ventilation. JRL.
of the R. Society of Arts, Feb. 9, 1912, p.

344-

Ueber, Reflexe, Atmung, Kreislauf. Sit-
zungsber, d. K. K. Akad. d. Wiss. zu Wien,
Vol. 62, 1870.

"Sanitary Considerations in Ventilating and
Humidifying Cotton Mills."

Beeinflussung der Korperwarne durch Ar-
beit und Beschrankung der Warmeabgabe.
Zeitschrift fiir Hygiene, Vol. 57, 1907.

Humidity and Ventilation in Cotton Weav-
ing Sheds. London. 1909.

Die Luftverunreinigung in Schulen. Ge-
sunde Jugend. Vol. X, 1910.

Organic Matter in the Expired Breath. The
Journal of Med. Research, Vol. XXV,
No. I, 1911.

Ventilation Problems in Hospitals and
Schools. Heating and Ventilating Maga-
zines, 1912.

"Stable Ventilation, Purpose, Scope, and
Need for Such Work," November, 1906.

discussion of
Luther H. Gulick' s Paper

Charles-Edward Amory Winslow

When any new discovery is made, such as the discoveries which have
thrown so much light on the subject of ventilation during the last ten
years, we are always apt to magnify the novel truth and over emphasize
it, so that we tend to lose sight of what is valid in the older body of

VENTILATION AND RECIRCULATION 205

knowledge. Such discussions as we are holding here to-day have a wide-
spread influence for good and for ill. They will go all over the United
States and to other countries and will be studied and quoted by many
who are not technically trained and may be misunderstood and may do
harm if their bearing is not made altogether clear.

I am sure that Dr. Gulick and I are in close accord as to the applica-
tions of recent discoveries to the practical art of ventilation and that he
feels as I do that a supply of fresh air by mechanical means is still essen-
tial in most school rooms. I fear however that certain phrases in his
brilliant address might be understood and may be cited in favor of the
view that ventilation is a thing of the past.

What has been made clear during the last ten years is that the chief
end to be aimed at in air conditioning is to maintain a cool atmosphere
free from excesses of dryness or moisture and more or less actively in
motion. As a rule, however, this requires the supply of fresh air just as
truly as did the older aim, the removal of supposedly poisonous waste
products of respiration. If you calculate the amount of air necessary
to remove the heat produced by the body, assuming that the incoming
air is to be at 60 degrees and the outgoing air is not to rise above 70
degrees (without allowing for loss of heat through walls), the necessary
air supply works out at just about the amount necessary to dilute carbon
dioxide, that is, at 2,000-3,000 cubic feet per person per hour. Inci-
dentally such a supply of fresh air, needed under ordinary conditions for
temperature regulation, will remove odoriferous organic matter at the
same time. We need ventilation, or the supply of fresh air by some
means, not less but more than ever. We have simply learned that the
quality of the air as well as its quantity is important, that it must be
cool and not too moist or too dry, as well as ample in amount.

206 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE VENTILATION OF SCHOOL BUILDINGS

Herbert M. Hill

There are still those who believe in the ventilation of school houses
by means of open windows, and Buffalo can show an active up-to-date
open air school.

An experience covering twelve years as a pupil and ten years as a
teacher in a building ventilated by windows has convinced me that
notwithstanding the many contrivances to aid window ventilation it
is and unsatisfactory means for the attainment of fresh air. I think
I may safely venture the assertion that no such means of ventilation
can make a building free from the characteristic school house smell.

The use of heated stacks to produce a natural ventilation has been
proven to be expensive and dangerous from a sanitary point of view.
I have tested one school building in the West in which it was necessary
to heat the air in the rooms to over 90° F. in order to produce a reason-
able amount of air. I have seen school houses with partition walls
nearly three feet thick to accommodate the large flues required in natural
ventilation.

I have tested school buildings in Rochester, N. Y., Evanston, Chicago
and Peoria^ 111., Cambridge, South Boston and Boston, Mass., and in
Buffalo; my experience covering a period of fifteen years. I find that
school buildings with a mechanical system of ventilation the only eco-
nomical and sure ones to furnish certain and continuous air supply.
Of the two types of fan ventilation the plenum system rather than the
vacuum to my mind best guards against the introduction of cold air
from outside and prevents a condition I found in a Boston school where
a vacuum fan in a garret was driving foul air from the garret gathering
chamber into a toilet room in the school.

My method of testing schools is as follows: On a day when the
temperature is below freezing outside I visit the building with a corps
of men, one to take and record the pressure of stem at the boilers and
the speed of the fan every fifteen minutes; one to take the temperature
of the air in the air chamber and to note the condition of the bypass
dampers every fifteen minutes; one to take hygrometer readings in all
rooms ; one to read with an anemometer the amount of air entering each
room and to measure the size of the inlets; one to read and measure the
outlets and one man to aid in keeping so far as possible the doors and
windows of class rooms shut during the time of making the tests.

THE VENTILATION OF SCHOOL BUILDINGS

207

The men make anenfometer readings over the face of each inlet
and outlet, five half minute readings being taken along each diagonal
of the opening, also obstructions, both gratings and deflectors being
removed at the time. When all room have been found to receive their
specified amount of air or as nearly as possible to it samples of air are
taken from each occupied room with precautions as to distance from
pupils and position of inlets and outlets and these samples after about
thirty minutes allowed for time for the reagents to absorb the carbon
dioxide are tested to find the content of CO2 in the room from which
the sample came. A sample of air is also collected out of doors and this
is tested for CO2 in the same way.

According to the latest specifications in force here the amount of
carbon dioxide in a room receiving 3,000 cubic feet of air per seat per
hour must not exceed seven parts per 10,000. The tests, however,
have to be made from the necessities of the case with the difi^users off
the inlets and the results do not fairly represent the carbon dioxide in
the room because of lack of proper diffusion. Experience has shown
that with inlets the size of those in our schools the diffusion gratings
are necessary to prevent uncomfortable draughts and even with them
on these draughts are sometimes felt, thus showing that diffusion is not
uniform.

Under ordinary conditions I find that the moisture in the air is about
19 per cent, of saturation as shown by the sling psychrometer. The
introduction of 60 per cent, or higher gives the rooms a steamy smell
causes condensation on the windows, walls and blackboards and makes
the clothing feel sticky. 45 to 50 per cent, of saturation causes con-
densation on the windows in our coldest weather but makes a comfort-
able and pleasant working atmosphere.

To show the efficiency of plenum ventilation there is appended the
record of a grammar school in this city showing as follows: ^

Room Inlet " Outlet

2236 cubic feet per seat

2962

2236

No seats

....

4628

2801

3371

2360

2559

1716

3273

1835

2856

2206

3641

2740

3363

2185

3841

2664

3391

1998'

Inlet covered

....

2979

2760

208 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

oom

Inlet

Outlet

2330

1154

2819

1912

3054

2467

3243

2865

3788

2772

3938

2647

3664

2260

3349

2673

3736

2134

3585

2204

3512

2030

This building contained 24 class rooms, was well lighted with ample
floor space, was direct heated with tempered air and automatic temper-
ature control. The temperature varied from 68 to 72 degrees. A
summary shows that sixteen rooms received 3,000 cubic feet of air per
seat per hour or better; four rooms received above 2,800 cubic feet; three
received above 2,000 and two were not measured.

Of the outlets seventeen rooms passed out over 2,000 cubic feet per
seat per hour, 3 more than 1,800 and three less than 1,800. It was
thought that the air might be better distributed in this building and a
readjustment of dampers was made with tests showing as follows:

Room

Inlet

Outlet

3048

2209

2668

2289

3172

2173

2823

1844

3059

2034

3263

2776

2858

2110

3085

2206

3019

2403

3268

2424

- 2667

1938

2501

1532

3036

1718

3258

2960

2980

2483

2928

2341

3418

2253

3376

2304

3295

2050

2842

■ 1882

2578

1738

A summary shows there are here twelve rooms above 3,000 and nine
above 2,500.

THE VENTILATION OF SCHOOL BUILDINGS

Another grammar school shows results as follows:

Room
I

3
4
6

7
9

II
14
15
i6

17
i8

20
21
22
23
24

209

Inlets

Carbon Dioxide Air Space

Seat

3080

6.8

165

3100

6.3

165

3025

8.1

165

3186

7-20

165

2794

7.8

165

3021

5-7

165

3020

7.0

165

3020

6.2

165

3092

6.3

165

3620

6.6

203

3280

6.5

203

3512

7-6

203

3522

6.9

203

3060

6.8

203

3485

7-5

233

3345

7-5

233

3591

233

3400

8.3

233

3438

9.2

233

3418

7.8

233

Attend
28
36
32
38
48
33
49
30
32
32
40
29
29
29
27
30
27
35
27
28

Nineteen rooms show 3,000 cubic feet or better, one room shows
below 3,000 but above 2,700.

Room

Inlet

Carbon Dioxide

Air Space

Seats

Attei

1566

4.8

165

2074

165

1567

165

3236

165

2924

165

1255

165

1497

165

2129

165

1848

165

1737

165

1866

165

1544

165

* 1733

165

1980

165

2176

165

1395

165

708

165

2365

165

Specifications for this building were 1,500 cubic feet of air per pupil
per hour.

210 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

These results were shown in test runs of the school building made
to show whether the building specifications had been complied with.
Tests made at other times and under conditions of ordinary running
show much less efficiency because the fan is run at less speed and the
apparatus to supply moisture has in some cases been neglected altogether.
Under such conditions I find it customary to open windows and doors
into corridors and to generally upset the ventilating system. This
matter of operating even a good plant is so much under control of the
janitors of the buildings, men with multifarious duties, that it would
seem that some means of checking their operation of the plants under
their care must be found or the ventilating apparatus is largely useless.
I have advocated the use of automatic recorders on each fan and that
the reports be checked each week by someone in authority.

My conclusions from what I have observed in this matter of school
ventilation are:

First. A mechanical system, preferably a plenum system, is necessary
in large school buildings to furnish the required amount of pure air.

Second. 2,500 cubic feet of air per seat per hour is a safe amount to sup-
ply in a room with 150 to 200 cubic feet of air space per pupil as it holds
the carbon dioxide to safe limits and can be supplied without perceptible
draughts and without undue expense for iron and mason work.

Third. All outlet flues should be from one-fifth to one-fourth larger
than the inlet flues to care for the reduced temperature and pressure
of the outgoing air.

Fourth. The standard for carbon dioxide for the amount of air and
the air space specified should be not more than ten parts in 10,000.

Fifth. Each room should be supplied with a hygrometer and the
percentage of moisture be kept in each room between forty-five and fifty.

Sixth. If the rooms have direct heat, the control thermostats should
be set by a thermometer located near the middle of the room and at
about desk height from the floor. The temperature maintained should
not be above 68° F. nor below 65° F.

Seventh. The outlet flues from all rooms should be carried through
the roof. The flues from the toilet rooms separate from the flues from
the class rooms.

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS 211

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

C.-E. A. WiNSLow

There has been wide-spread discussion and vigorous criticism of the
conditions of school-room air in America during the past few years but
singularly little in the way of actual detailed scientific study. When
therefore, my colleague, Prof. Charles Baskerville, and I were invited
by the Committee on School Inquiry of the Board of Estimate and
Apportionment of the City of New York to undertake a thorough survey
of existing conditions in New York school-rooms we gladly welcomed
the opportunity to secure a body of data of this kind. The work was
planned to give as fair an idea as possible of actual atmospheric con-
ditions in the schools of the city under their normal methods of opera-
tion. For this purpose we selected ten typical schools, ranging from
modern and well-managed fan ventilated schools, to older buildings
in congested tenement districts ventilated without fans, and including
buildings of various sizes, from one of the largest high schools down to
a four-room country school in Richmond Borough. These ten schools
were studied somewhat intensively, being visited once a week between
December 2, 1912, and February 14, 1913.

In order to broaden the base of our observations, twenty-two other
schools were visited on one or more occasions between February 14 and
March 15, 191 3. Each "visit" was made by a squad of three men who
spent practically the whole school day in making determinations of
temperature and humidity and carbon dioxide in the field and in col-
lecting samples for the enumeration of dust particles and bacteria. All
together we have made 1854 observations of temperature, and 1845 of
relative humidity, with 773 determinations of carbon dioxide, 684 of
bacteria and 658 of dust particles.

The classical test for air quality is carbon dioxide, coming straight
down to us from the days when the object of ventilation was held to be
the removal either of carbon dioxide itself, or of some subtle morbific
matter of which it was a measure. It has of course long been demonstrated
that carbon dioxide in itself, under natural conditions, never approaches
a concentration at which toxic effects are manifest and practically all
the experimental work of recent years has tended to show that the sup-
posed organic poisons of respired air are non-existent. The classic
conclusion arrived at by Fliigge in 1905 has not been challenged with
success and may be still quoted with approval, as follows: "Numerous

212 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

researches, with accurate experimental methods and with exact regard
to thermal conditions, on both healthy and diseased subjects, have
shown that the chemical variations in the composition of the atmos-
phere, which occur in inhabited rooms through the gaseous excretions
of men, do not exercise an injurious effect on the health of the occu-
pants."

The discussion of organic matter in the air has, however, been given
a new turn in recent years by the claim of Rosenau and Amoss that
specific proteid compounds of human origin could be detected in respired
air by the delicate physiological reaction of anaphylaxis. It should be
noted that there is nothing in Dr. Rosenau's work to suggest in any way
that these substances are poisonous. Nevertheless, as a test of a special
kind of organic pollution of the air the method seemed a promising one
and we have devoted considerable attention to the problem. A detailed
series of investigations was made under our general direction by Dr.
D. R. Lucas in which he was able easily to demonstrate the presence
of such specific proteid substances in the saliva under carefully controlled
conditions, but was unable to detect them in material condensed from
the breath or in air heavily contaminated by the respiration and exhala-
tions of dogs and human beings. We were forced to conclude that
"there is at present considerable uncertainty as to the presence of such
specific proteid substances in demonstrable amounts in respired air
and that there is absolutely no evidence of the presence of any organic
substances of a deleterious nature in such air." Similar experiments
carried out simultaneously by Dr. Charles Weisman at Columbia Uni-
versity and published as a Doctor's Dissertation have led to the even
more definite conclusion that "the results of these experiments disprove
the statements of Rosenau and Amoss that the breath contains "vola-
tile" protein and that such "volatile" protein is an important respira-
tory factor."

In spite, however, of the lack of any evidence as to the presence of
organic poisons in respired air, the determination of carbon dioxide is a
valuable test, because it is an excellent index of air change. The amount
of carbon dioxide formed by respiration and combustion being fairly
constant its concentration measures quite accurately the amount of fresh
air supplied which is a vital factor in the control of temperature and
humidity and is also of importance in the removal of offensive odors,
from mouths, bodies and clothing.

Our determinations of carbon dioxide were all made in the field with
the portable Petterson-Palmquist apparatus made by Eimer and Amend,
modified and improved for our special purposes in certain minor details.
773 determinations in all were made with this apparatus and the distri-
bution of the results is indicated in Table I below and, graphically.

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS 213

in Figure I, where are plotted distribution curves for all our five routine
determinations in the whole series of 32 schools.

TABLE I

Distribution of Carbon Dioxide Determinations in Air of New York Schools.

Carbondioxide, parts per 10,000. 4 5 6 7 8 9 10 11 12 13 14 15-17

Per cent, of observations in each

class 4 II 15 17 19 12 8 6 3 3 I 2

The general average value for all schools was 8.1 parts per 10,000.
Sixty-six per cent, of the observations fell below 8.5 parts which may-
be considered a very satisfactory result on any standard. Twenty-nine
per cent, of the tests showed between 8.5 and 12.5 parts, which would
have been considered high on the older standards established when
carbon dioxide was held to be a measure of some mysterious poisonous
matter in the air. The present tendency among physiologists and san-
itarians is to allow a more liberal standard, however. Dr. J. S. Haldane,
Dr. Leonard Hill and Dr. M. S. Pembrey in testifying before the English
Departmental Committee on Humidity and Ventilation in Cotton
Weaving Sheds favored a standard of 12 parts per 10,000 for factories
and I see no reason why a more rigid standard should be enforced in
school rooms. There remain 6% of the tests, however, showing over
12.5 parts, which are clearly excessive. These were associated, of
course, with overcrowding and deficient air supply in individual rooms.

Supplemental observations made in four schools during evening
sessions (when there is no artificial ventilation) showed some very high
carbon dioxide values ranging in one case with gas burning up to 26.0
parts. This is a special problem which deserves more attention than
it receives in many cities.

Passing from the gaseous to the suspended constituents of the
atmosphere, dust particles and bacteria are the principal objective
points in air analysis. We have made routine determinations of both
in all our work, although their sanitary significance is somewhat dubious..
Dust particles were enumerated by counting the particles visible under
a two-thirds inch objective, the method recommended by the Committee
on Standard Methods for the Examination of Air of the American Public
Health Association. This seemed to us preferable to the counting of
ultra miscroscopic particles by means of the koniscope since it is presum-
ably only the comparatively large fragments which are important; and
we preferred counting rather than weighing the particles because the sani-
tary significance of dust in the air depends apparently bn the irritating
efl^ect of sharp particles upon the respiratory tract and a number of
fairly large fragments must be much more harmful than a single very

214 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

big one. The dust particles were collected by means of a sugar filter,
air being drawn through by an ordinary double suction pump (the air
being measured by a standard Brazilian meter) or by an ingenious com-
bined pump and meter manufactured by Wallace & Tiernan of New
York City.

The general distribution of dust counts for all schools (658 observa-
tions) is shown in Table II and in the second curve of Figure I. It will
be seen that the largest number of samples showed between 200,000
and 400,000 particles per cubic foot. The general average for all schools
was 601,000 particles and twenty per cent, of the samples showed 800,000
or less, with a few values ranging up to 2,000,000 and over.

TABLE II
Distribution of Dust Determinations in Air of New York Schools.

Dust particles per 200,000 400,000 600,000 800,000 1,200,000

cubic ft Under to to to to to Over

200,000 400,000 600,000 800,000 1,000,000 1,400,000 1,400,000

Per cent of samples

in each class 8 34 25 13 9 3 3 5

The sanitary significance of these results is probably not great.
Dust particles constitute a serious menace to health in industrial estab-
lishments, grinding shops, granite cutting sheds and the like since the
hard metallic or mineral particles which are found under such condi-
tions form a controlling cause in the development of industrial tuber-
culosis. The particles which we found, were for the most part minute
and chiefly organic in nature. In the counting cell they separated into
two layers the greater number, floating on the surface, being barely
visible under the microscope and consisting in large part of mold spores,
while the less numerous particles settling on the bottom included larger
shreds of vegetable fibre and inorganic particles. There is no reason
to suppose that particles of such small size and of such nature as were
found exert any influence on health.

In certain cases we found higher numbers of dust particles due to
special local conditions. One school where a great deal of building
and paving was going on in the neighborhood showed less than 500,000
dust particles per cubic foot in only 44 per cent, of the samples taken,
over 1,000,000 particles in thirty per cent, of the samples taken and over
2,000,000 particles in four per cent. Another school, near a large power
house, always showed a characteristic prevalence of coal particles in
the air. On the other hand, certain schools in very clean districts
were notably free from dust, as was the one school studied which was
provided with an air washer. In this latter case, sixty-six per cent.

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

215

BACTERIA

P£Fl CUBIC FOOT.

DU5T PARTICLES
P£a CUBIC Foor.

ffoofioo 600,000 iicioeo i^o^ooo i»ioooo /*}>o,ooo /ioo^ooo

TEMPERATURE
OCQRC^S FAHRENHEIT.

te TO ft 7* 7t ra

RELATIVE
HUMIDITY
'/» SATURATION.

CARBON DIOXIDE

PARTS ivm 10.000

of the samples showed less
than 500,000 particles per
cubic foot and only nine per
cent, showed over 1,000,000.

An air washer might well
be installed in any school
where the air is loaded with
a special excess of dust from
any local cause. Where, how-
ever, such conditions as we
have observed in most of the
New York schools obtain, that
is, where the air contains half
a million to a million particles
of very fine, largely organic,
dust per cubic foot, it does not
seem to the writer that there
is any sanitary warrant for de-
manding its elimination. So
far as we now know such dust
is entirely normal and innoc-
uous.

Our determinations of the
microbic flora of the school-
room air were made, after a
number of preliminary tests of
other methods, by filtering the
air through fine sand, shaking
up the sand in water and plat-
ing the water — the procedure
recommended by the Com-
mittee on Standard Methods
for the Examination of Air of
the American Public Health
Association. Samples were
collected with the same pumps
used in the dust determina-
tions. The plates were made
on litmus-lactose-agar and in-
cubated at the room temper-
ature for five days. At the
end of this time all visible
colonies were counted, includ-

FIGURE I

21 6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ing, of course, many molds and yeasts, as well as bacteria. The curve
on the chart is labeled "bacteria" but the counts include all microbes
capable of development under the conditions used.

We examined in all 684 samples of school room air for microbes,
the general distribution of all results being indicated in Figure I. The
most frequent result is twenty-five microbes or less per cubic foot, but
the rarer high results pull the general average up to 96. As indicated
in Table III, however, 68% of the samples showed counts of 100 or less,
and only nine per cent counts over 200.

TABLE III
Distribution of Microbic Counts in Air of New York Schools.

Under

Sl-

lOI-

151-

201-

251-

Over

Bacteria per cubic foot 50

ice

150

200

250

300

Per cent, of samples in each

class 41

These counts include all sorts of organisms, from all sorts of sources,
which are able to withstand drying long enough to be lifted up and blown
about in the air. Most of them, of course, are of no sanitary significance;
and the values, averaging under 100 per cubic foot and in most samples
much less, must be considered satisfactory by comparison with the
results reported by Tenon (40-60 bacteria per cubic foot in quiet hos'-
pital air) by Hesse (60 bacteria per cubic foot in a class room before
the students arrived, raised to 430 during the hour and 1,000 just after
the class had left), and by Soper (140 bacteria per cubic foot at remote
end of Fulton Street subway station).

In order to obtain an estimate of the bacteria of human origin which
might at times include pathogenic forms, we made all our plates on
litmus-lactose-agar as noted above and isolated all red colonies which
appeared on the plates. It is well established that acid forming strep-
tococci are among the most abundant forms in the human mouth, while
they are absent from sources which have not recently been exposed
to human or animal pollution. The numbers of these organisms in
school-room air was found by Prof. Baskerville and myself in prelimi-
nary experiments of a year ago to be quite small. We then found among
30,000 colonies isolated from 750 plates, exposed in schools with window
ventilation, only ten mouth streptococci.

In the present study, in the examination of a total of 174 cubic feet
of air, we found fifty-two mouth streptococci, or thirty for every 100
cubic feet of air. The average number of mouth streptococci for the
individual schools ranged for the most part between ten and thirty-

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS 21 7

five per lOO cubic feet. In one crowded school in a poor district, it
rose to seventy-five per lOO cubic feet, and in a school in a good semi-
suburban district, no streptococci were found in 8 cubic feet of air.
The general average of thirty mouth streptococci per lOO cubic feet
gives a ratio of about one of these forms to 320 total bacteria.

The trend of epidemiological evidence is strongly against the spread
of disease germs by quiet air, as is best illustrated by the practice of
some of the most modern hospitals, in which various contagious dis-
eases are successfully treated in open wards with no precaution against
air infection, provided only that the spread of disease by direct contact
is rigidly excluded. Our bacteriological results seem in harmony with
these deductions from practical experience. Since a child breathes less
than 100 cubic feet of air during an average school period, our counts
mean that each day some twenty-five mouth streptococci may be
breathed in. These mouth streptococci must, of course, be far more
abundant than pathogenic forms; and at a rate of twenty-five mouth
streptococci per day the chance of ingesting pathogenic bacteria from
the air is seen to be a very slender one.

There seems to be absolutely no basis at present for the use of ozone
or any other disinfectant designed to eliminate bacteria from the general
air of school-rooms. When there are crying needs of school hygiene
and sanitation to be met it is unjustifiable to spend money in meeting
dangers like the danger of air infection, which the evidence at hand
strongly suggests to be non-existent.

The most important properties of the atmosphere from a health
standpoint are its temperature and humidity. To quote again from
Fliigge, ''Whenever in closed crowded rooms certain impairment of
health ensues, such as headache, dizziness, nausea, etc., these symptoms
are to be attributed solely to heat retention." Since overheating is
the chief practical evil to be avoided in the control of school room air
we devoted a great deal of attention to the matter of temperature. The
field squad in their visits to the schools obtained temperature and hurnid-
ity records by the use of the U. S. Weather Bureau Standard Sling Psy-
chrometer and in addition we installed in each school during the period
of observation a Tycos thermograph (obtained from the Taylor Instru-
ment Company of Rochester, New York), which gave us a continuous
record of temperature during the whole twenty-four hours. We obtained
by this method 364 different records of the entire course of the tem-
perature changes in one selected room in a school during the whole
school day.

The general results of the 1854 temperature observations made by
our field squads with the sling psychrometer are indicated in Table IV
and plotted in the central curve of Figure I.

2l8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

TABLE IV

Distribution of Temperature Records in New

York Schools.

60° 62"" 64° 66° 68°
Temperature degrees ¥..'... Under to to to to to

60° 61° 63° 65° 67° 69°
Per cent, of observations in
each class i 2 4 11 21 27

70° 72° 74°
to to to
71° 73° 75°

20 9 4

Over

75°

It is evident that these records as a whole indicate very good con-
ditions. The temperature curve centers closely, as it should, about
68°. The table shows only 14% of all records over 71° and only 5%
over 73°. Sixty-eight per cent, of all records fall between 66° and 71°,
a reasonable and equable temperature.

On the whole this result must be considered highly creditable and an
indication that the children of the New York schools for the most part
enjoy good atmospheric conditions, free from objectionable overheating.
An examination of particular schools, however, shows that this general
curve covers up markedly different conditions in individual cases. In
certain schools conditions are uniformly good but in others they are
distinctly bad. The curves for three typical schools are plotted for
comparison in Figure II.

School 33 is a well managed fan-ventilated school and as the curve
indicates conditions are almost perfect. Out of 143 records in this
school, 137 were between 64° and 71° and only 3 over 71°. The next
curve, for school 49, represents conditions in an old-fashioned school
ventilated without fans. Here conditions were much more variable,
and overheating more frequent. 129 out of 154 records were between
64° and 71° and 19 over 71°. School 84 is a fan- ventilated school which
is carelessly operated. Out of 135 records 86 were within the limits,
64° to 71°, and 41 or about 30 per cent were over 71°. This indicates
a condition of gross overheating which must be seriously detrimental
to the health and efficiency of the children.

These records obtained by our field squads are confirmed and sup-
plemented in a very conclusive and interesting way by the automatic
temperature records obtained by the thermographs. Four of our charts,
two for good and t\v^o for bad schools, are reproduced herewith in Figures
III and VI. Figure III shows the admirable conditions maintained
in School 33, to which reference has been made above. It will be noted
that for the twenty days our clock was in the school the temperature
was maintained with perfect regularity close to 65°, never once in the
rooms where the clock was placed rising over 70°. Figure IV shows
a record almost equally good. Here the janitor allows the building to

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

219

cool off rapidly after three o'clock, an economical procedure if not
carried to the point of chilling the pupils.

Figure V shows a striking contrast to the last two figures, giving a
clear picture of the exaggerated variations in temperature which occur
in a carelessly operated school, provided with fans which, however, are
often not in operation. Out of 113 sling psychrometer records in this
school 32 or twenty-eight per cent, were over 71° and 13 or eleven per
cent, over 73°. The thermograph records are the worst obtained any-
where. On the most spectacular day, January 9th, starting in at 63°
at 8 o'clock, the temperature was rushed up to 80° at 10:30. Then in
a fit of remorse on the part of the janitor, or a spasm of self-defense on
the part of the teacher in the particular room where the clock was placed,
the temperature was reduced to 53° at 11 :i5. The relief was short lived,
however, for the thermograph registered 81° at 12:30, and stayed over
72° for the rest of the day. On 18 out of 28 days for which we have

COMPARISON
TEMPERATURE CURVE5
PUBLIC 6CH00L5 N05. JJ, 45, 6^.

^ ^

< N

■ p

/=.S. NO. 35
^.3 NO.Q^

<y]3 To

62 **■ i'6 6'5 rfe ^

DEGREES FAHRENHEIT.
FIGURE a

220 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THERMOGRAPh RECORD

- OF -

PUBLIC SCHOOL N0.33 BRONX

JAI!.- 7

JAN. - <3

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FIGURE 3

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

221

THERMOGRAPH RECORD
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FIGURE 4

222 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

records in this school the temperature reached 75° and on 6 of them it
reached 80°. Figure VI shows very bad conditions as to overheating
in a naturally ventilated school. During the six days for which we have
records the temperature was almost constantly between 75° and 80°
and once reached 87°.

THERMOGRAPH RECORD
- or -

PUBLIC SCHOOL NO. 1 QUEENS

wM//. <P

^AJT. 7

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JAN. /O

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STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

223

In another school, one of our investigators found the temperature
as it entered four different rooms from the ventilating ducts to be re-
spectively 64.5°, 83.1°, 98.3° and 125.0°. On the first reading taken
at the inlet in the last room a thermometer graduated to 130° was burst
by the heat.

THERMOGRAPM RECORD

- OF -
P. 5. NO. 25 MANHATTAN

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FIGURE 6

Humidity observations were made by our field squads as noted above
by the use of the sling psychrometer (1,845 records being obtained).
The general distribution of results is shown in Table V and in the fourth
curve of Figure I.

TABLE V

Distribution of Relative Humidity Records in New York Schools.

31- 36- 41- 46- 51-

Relative humidity per Under 16- 21- 26-

cent. saturation. ... 15 20 25 30

Per cent, observations

in each class 6 9 14 17 16 13

35 40 45 50 55

56-
60

Over
60

The range of relative humidity is seen to be a wide one. 60% of
all observations fall between 20 and 40% of saturation, and the general
average for all schools is 35%.

In the case of relative humidity one is somewhat at a loss for a basis
on which to found a practical sanitary interpretation of the results.
Extravagant denunciations are often heard of the school-room "as dry
as the Desert of Sahara" but it must be remembered that many dry
climates are sought out on account of their healthfulness and I am not
familiar with any serious physiological experiments which indicate
whether the relative humidity in a school-room should' be 25%, 50%
or 75% of saturation.

224 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The main factor in producing the dry air of the school room (for
records 90% of which are under 50% saturation must certainly be con-
sidered relatively dry) is, of course, the heating of the outside air, with-
out the supply of the additional moisture which air can hold at a higher
temperature. The only way to overcome this dryness of the air is by
artificial ventilation combined with humidification. We studied two
examples of this in school 6, Brooklyn, and in part of School 2"]^ Man-
hattan. In these cases the effect of humidification was apparent though
not very marked. School 6 gave 116 out of 155 records or 75% under
50 per cent, saturation and 31 or 21 per cent, below 35 per cent, satura-
tion and in the humidified half of School 27, sixty-five out of 78 observa-
tions were below 50 per cent, saturation and 45 below 35 per cent.

For the purpose of estimating the value of fan ventilation, curves
for all the schools, classified on this basis, are brought together in Fig-
ure VII. Of course, it must be understood that by natural ventilation
it is meant simply that fans were not running. In almost all cases,
ducts and often heating coils were there and air was undoubtedly pass-
ing through them. So, on the other hand, where fans were in operation,
windows were often open and outside air passing in or out through them.
The distinction is made solely on the fact that fans were or were not
in operation in connection with the particular room in which each test
was made.

The general results for the two classes of schools are on the whole
remarkably alike. The fan ventilated schools show more dust, more
humidity, more carbon dioxide and a somewhat more equable tempera-
ture; but none of the differences are very great or very significant.

The high humidity and high carbon dioxide in the fan-ventilated
schools can best be accounted for on the assumption that in the window
ventilated schools on the whole there is actually more air supplied than
is blown in by the fans in the other group. The higher dust counts may
perhaps be due to the same thing, less air to dilute dust produced within
the school, or to the fact that air entering at a high velocity through
a duct brings in more dust from outside, than does air coming in more
slowly through window openings. In dust and carbon dioxide, the
fan-ventilated schools appear slightly inferior to the others. In
humidity they are better (if dry air be a disadvantage). In tempera-
ture they are also somewhat better, showing less observations over 72°.

So far as temperature is concerned, however, it should be noted
that the curve for the fan-ventilated class conceals wide variations
between the individual schools included in it. Of our ten regular schools
it is noteworthy that the four really good records (from the standpoint
of temperature) were in fan- ventilated schools. The three wholly or
partly naturally ventilated schools are mediocre or poor; and two fan-

STUDIES OF AIR CONDITIONS IN NEW YORK SCHOOLS

225

DISTRIBUTION or RESULTS

NATURALLY and ARTIFICIALLY
VENTILATED SCHOOLS

B/ACTERIA

PC R CUBIC FOOT.

ventilated schools are worst of alL
Either almost perfect conditions
or very poor conditions may be
obtained with fan ventilation ac-
cording to the care and intelli-
gence of the janitor in charge.

The general conclusion from
these studies must be that atmos-
pheric conditions in the thirty-two
schools investigated are on the
whole remarkably good, and that
the schools are reasonably free
from overheating. The good re-
sults obtained in the latter respect
may very probably be due to a
valuable report made a year ago
by a Committee of the Board of
Education (Hon. John Martin,
Chairman), which was followed
by an order of the Board under
datQ of November 2^], 1912, pro-
viding that the temperature of
school-rooms should be maintained
between 60° and 68° and that of
halls and passageways between
60° and 65°. The same order pro-
vided that certain specific schools
should be ventilated by opening
windows and without fans, except
in inclement weather, and that in
any other schools the principal
might obtain permission to have
the same rule in force.

During the winter of 1912-13
there certainly seems to be no
basis for serious criticism of the
general atmospheric condition of
New York school-rooms.

In certain individual schools,
however, the air supply was often
inadequate as indicated by high
carbon dioxide values and, in par-
ticular, gross conditions of over-

FIGURE 7

226 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

heating existed as a result of careless operation. We found schools in
which the temperature in one school day ranged from 53° to 81°;
schools in which a third of all the records obtained were over 71°;
schools in which the temperature for several successive days was almost
constantly between 75° and 80°. Such records as these indicate a seri-
ous danger to the health and efficiency of the children. We have recom-
mended that the conditions they reveal should be remedied by the em-
ployment of visiting engineers to make occasional studies of inlet tem-
peratures and air volumes, and particularly by the installation of an
automatic recording thermometer in each school in view of the fact
that these instruments appear to offer such a striking check on short-
comings in janitorial service.

The most important general significance of these studies would seem
to lie in their possible use as a basis for comparative investigation in
schools of other cities, since they appear to offer a fairly good idea of
the range of atmospheric conditions which exist in the school-rooms
of a large American community where considerable attention has been
paid to the quality of school-room air. In regard to carbon dioxide
and temperature we have well established standards of interpretation
and these New York studies show that with good operation of such
ventilating plants as at present exist it is quite practicable to maintain
less than 8.5 parts of carbon dioxide and a temperature closely regulated
between 66° and 70°. For dust and bacteria we have every reason
to believe that such values as we have found (25 to 100 bacteria and
500,000 to 1,000,000 dust particles per cubic foot of air) are normal
for ordinary air and have no sanitary significance. Only numbers
showing a considerable excess over these would seem to warrant any
special measures for air disinfection or air washing on sanitary grounds.
Finally, in the case of relative humidity, we have no sound basis for
interpretation of the results obtained. The records show that the air
of the New York schools is distinctly dry but there are no sound physi-
ological data available to show what degree of humidity is most favorable
for human occupancy. This is one of the points in connection with
ventilation which most needs experimental elucidation.

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 227

AIR WASHING AS A MEANS OF OBTAINING CLEAN
AIR IN BUILDINGS

George C.Whipple and Melville C.Whipple

Clean air in motion and of proper temperature and humidity is neces-
sary to indoor comfort. This is, perhaps, as succinct a statement as can
be made of atmospheric requirements according to modern views. Our
concepts of ventilation are undergoing a change. SHght reductions
in the amount of oxygen or slight increases in the amount of carbonic
acid in the air we breathe are no longer feared. The human body can
automatically adapt itself to slight changes in the proportion of these
gases. It is more difficult for the body to adapt itself to temperature
changes and these may cause more or less discomfort and damage. The
heat relations of the body are complicated, involving heat production
within the body, affected by food and by physical and mental exercise;
heat transference within the body from the interior to the surface; and
heat elimination at the surface, for human beings live normally in an
atmosphere cooler than the body. Heat elimination is itself a compli-
cated matter: it is lost by conduction, by convection, by radiation; it
is affected by the temperature and humidity of the air, by the clothing
worn, by the perspiration produced and evaporated. So complicated
are these relations that we have not yet solved them. We do not yet
know the best combination of indoor temperature and humidity for our
greatest bodily comfort and efficiency.

We do know, however, as a matter of universal experience that it
is uncomfortable to remain in air that is still, or as we say that is "dead. ' *
If the air that we exhale remains so near our faces that we rebreathe
a considerable portion of it at each succeeding breath a feeling of oppres-
sion and discomfort ensues. Air stagnation also forms an atmospheric
cloak about our bodies which affects their heat conditions. Mere
stirring of air often changes discomfort to comparative comfort; witness
the effect of the introduction of fans in the New York subway cars.
The benefits of sleeping in a cold room in which the warm exhaled air
quickly rises so that the next breath is new air, and the benefits of out-
door sleeping are due in great measure to the motion of the air. No
system of ventilation can be regarded as satisfactory that does not cause
a sufficient circulation of the air.

Another thing that we need to appreciate is that the air that we
breathe should be clean. So anxious have we been in the past to make

228 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

sure that the carbonic acid did not exceed some illogical, arbitrary
standard that we have overlooked this most patent and obvious need.
Of course, the extremes of this quality of cleanliness have been recog-
nized. We know that people who work at dusty trades, in dust-laden
air, sicken and die of diseases that gain a foothold in the lungs; and we
send our sick to the mountains and the seashore and spend our vacations
in the relatively clean air of the woods and fields and upon the waters.
Cleanliness is the great thing to be desired in air as it is in water. From
time immemorial water that is grossly foul has been regarded as danger-
ous, but it is only within a generation or so that water which is only
moderately contaminated has been regarded as dangerous. A clean
water supply is now a watchword of our modern cities. If precedent
is followed we shall come to regard as undesirable much of the air that
would not by present day standards be called unclean, as well as air
that is grossly laden with dust and foul gases.

Modern cities are dust producers. Streets and pavements and even
sidewalks are worn by friction of the traffic, especially in this age of the
railroad and automobile ; car wheels are ground to metallic dust ; fabrics
turn to lint; fuel burns with products of smoke and ashes. Dust is being
continually produced both within and without our factories and houses.

Recent studies made by us in several cities have shown that the
number of dust particles in the air just above the sidewalks is very
large, even on quiet days. At the air inlets of some of the commercial
buildings in Boston the numbers of particles, as determined by micro-
scopical counts, ranged from 100,000 to nearly 1,000,000 per cubic foot
of air. With active wind movement the numbers are probably much
higher, but even with the lesser number mentioned the number of parti-
cles inhaled by a person in an hour would be a million and a half. To
be sure the particles making up this vast number are very tiny, ranging
from 0.5 to 15 microns in diameter, with an average of about 3 microns
(.003 millimeter) and their combined bulk is not large.

Air contains more dust near the street level than at higher eleva-
tions. Tests made on May 13, 1913, at the South Terminal Station,
Boston, where air is taken in at the roof, showed lower dust counts
than air taken at the street level at various office buildings in the busi-
ness district of Boston. Tests made at the John Hancock Building
on June 6, 191 3, showed that at the street level the air contained 483,000
dust particles per cubic foot; at the 5th story there were 233,000, and
at the loth story, 140,000 per cubic foot. Tests made on July 2nd,
1913, in New York at the Metropolitan Life Insurance Building and the
Woolworth Building, the last named being the highest building in the
world, showed similar reductions in the amount of dust in the air in the
upper stories. For example, at the Woolworth Building the air at the

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 229

Street level contained 221,000 dust particles per cubic foot; at the loth
story there were 85,000, at the 30th story 70,000, and at the 57th story
27,300. The dust counts at the Metropolitan Building were somewhat
lower than at the Woolworth Building, the number at the street level
being 173,000, and at the 50th story 21,000 per cubic foot. The lower
counts at the Metropolitan Life Building may possibly have been due
to the fact that this building is situated near Madison Square and is
more isolated than the Woolworth Building which is located down
town in a more crowded section. Both sets of observations were made
on warm quiet days.

TABLE I.

Table Showing the Number of Dust Particles per Cubic Foot at Different Elevations in
Various Well Known High Buildings in New York and Boston.

Boston, Mass.

New York City

Floor

John Hancock
Building

42d Street
Building

Metropolitan
Life Building

Woolworth
Building

June 5, 1913
2:50-5:35 P-M.

July 3, 1913
2:25-4:40 P.M.

July 2, 1913
2:35-5:15 P.M.

July 2, 1913
10:10-12:40 A.M.

NUM

BER OF Dust Pari

icLEs PER Cubic I

'cot

Sidewalk
2nd
3rd

483,000
306,000
300,000

122,000
104,000

173,000
94,000
71,000

221,000
163,000

5th

7th

loth

233,000
139,000
140,000

70,000
49,600

51,300
50,000
38,000

111,000

109,000

85,000

nth
14th
20th

37,600
34,000
32,300

36,300

75,000

30th
40th
5otht
57th*

33,300
24,000
21,000

70,000
41.300

27,300

|662 feet high.
*7i6 feet high

230 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

TABLE IL

Table Showing the Number of Bacteria and Dust Particles in Air Taken at Different
Elevations from John Hancock Building, Boston, Mass., June 5, 1913.

Floor

Bacteria per Cu. Ft.

B. Coli

Molds
per Cu. Ft.

Dust Particles
per Cu. Ft.

Gel. at 20°

Agar at 38°

Sidewalk
2nd
3rd

1330

1200

417

37
83

Its

5th

7th

loth

720
310
330

43
33
17

0
0
0

15
10

233,000
139,000
140,300

Winslow has shown that the air of many of the New York schools
contains even larger numbers of dust particles than thos6 above men-
tioned, ranging from 400,000 to 1,000,000 per cubic foot. Studies by
the authors at the gymnasium of the International Y. M. C. A. College
at Springfield, Mass., have likewise shown that the indoor air contains
dust particles in numbers usually more than 100,000 and sometimes even
400,000 per cubic foot. Such results are naturally to be expected, for
indoor air is merely the outdoor air drawn in through the ventilating
ducts, the inlets to which are often badly located, while to this outer
air is added the dust resulting from friction and air movement of
various kinds indoors.

Unclean air contains bacteria and other living organisms as well
as lifeless dust particles. The bacteria are usually much less numerous,
than the dust particles. Our investigations at the John Hancock
Building show that at the street level the air contained 1,330 bacteria
per cubic foot capable of developing on gelatin at 20° in 96 hours, while
at the loth story the air contained 330 per cubic foot. Speaking broadly
it was found that there were from 200 to 300 times as many particles of
dust as bacteria. The bacteria capable of growing at the temperature
of the human body were still less numerous, there being only 30 such
bacteria per cubic foot found at the street level and 17 at the loth story.
The sample from the 3rd story, however, contained 83 per cubic foot,
evidently an erratic observation. No attempt was made to determine
the particular species of bacteria in these samples, but tests were made
for the presence of B. coli and only once was this organism found,
namely, in the sample collected at the 3rd story. Molds were also
present to the extent of 20 per cubic foot at the street level and 3 at
the loth story.

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 23 1

Winslow's Studies of bacteria in the air of rooms, and especially in
the air of sewers and drains, showed a conspicuous absence of patho-
genic bacteria. Even in the case of sewer air and drain air the numbers
of B. coli found were surprisingly small. Our own results corroborate
Winslow's findings. Yet in air, just as in water, B. coli may be regarded
as an index of undesirable contamination. In this connection it will
be remembered that Dr. Chapin, the well known health officer of Provi-
dence, R. I., holds that the danger of transmission of disease by the air
conveyance of bacteria is extremely small.

Dust and bacteria do not constitute the only undesirable substances
found in unclean air. Chemical examinations of the water from air
washers in Boston disclosed the presence of ammonia compounds, nitrites,
chlorides, sulphates, free sulphuric acid, and iron. The amounts of
these substances varied with the locations of the intake ducts. Washers
receiving air from the street level showed greater quantities of impuri-
ties in the water used for washing than those taking air from a height.

Mention has been made of the dust particles and bacteria in indoor
air and of their tendency to outnumber those in outdoor air. The other
constituents of indoor air are likewise subject to change. Chief among
these are the substances that give rise to odors. Everyone is familiar
with the odor of a poorly ventilated room after occupancy by a number
of persons. This is due in part to the presence of expired air and to
body emanations that accompany physiological processes. The same
condition prevails wherever people congregate in restricted quarters,
such as halls, churches, theatres, and cars. To some extent the inten-
sity of these disagreeable odors is dependent upon the degree of activity
of the occupants: witness the characteristically strong odor of a gym-
nasium. During the course of the Springfield experiments an increase
of the odor of the air after the men began exercising in the gymnasium
was very noticeable to one standing in the exhaust air duct.

There is no expression more common than that of "fresh air." Just
what is meant by this term? It certainly does not involve the factor
of air temperature to any extent, for we use the expression both in winter
and in summer, and at times when the outside and indoor temperatures
are the same. Neither does it involve humidity. In the opinion of
the writers it may be regarded as practically synonymous with clean
air in motion, air that is free from dust, from bacteria, and from malo-
dorous or offensive organic emanations and poisonous substances.

Too little attention has been paid in the past to the cleanliness of
the air supplied to our buildings. Fresh air inlets are often located
with the grossest disregard for the quality of the incoming air. It is
not uncommon to see them placed on the sidewalk level, or facing a
vacant piece of ground that is swept by clouds of dust, or where smoke

232 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

or objectionable odors may be taken in. In one of the buildings of
Harvard University the air inlet is placed near a main entrance where
automobiles stop and start, and the odor of spent gasoline frequently
permeates the building.

The effect of forcing unclean air into buildings is to nullify the result
aimed at by ventilation, that is to provide a supply of fresh air. The
presence of dust, bacteria and odors not only renders the conditions
uncomfortable and deleterious to health but it results in attempts at
window ventilation, and this means poor ventilation, unequal heat
distribution and draughts.

Supplying buildings with unclean air may often be obviated by a
judicious choice of location for the inlet duct. A change of location
from near the street to some higher point, or from one side of a building
to another may greatly improve the quality of the influent air.

Crowded buildings and dusty city streets will often render it impos-
sible to secure clean air from the outdoor atmosphere, without resorting
to artificial purification. Fortunately this purification can be accom-
plished. Just as unclean water may be made wholesome by the employ-
ment of Nature's process of filtration, so can unclean air be purified by
the application of another efficient process of Nature, namely, air-wash-
ing. The purifying effect upon atmospheric air of a heavy fall of rain
is well known. A shower is said to freshen the air. Not only are
suspended particles removed, such as dust and bacteria, but gaseous
impurities, such as acids and ammoniacal vapors, are dissolved and
removed, leaving the air sweet and clean. A determination of dust
particles in the air after a heavy rain at Harvard University showed
only 25,000 particles per cubic foot, whereas in dusty weather the
numbers would have been measured by hundreds of thousands. This
figure compares favorably with a determination made over the water
of Long Island Sound at a point several miles from the shore, when the
air- contained 18,000 dust particles per cubic foot.

To ascertain the efficiency of air-washing as a means of purification
the authors made a study of this method as carried on at several build-
ings in Boston and Springfield, Mass.

The process of air washing consists of passing the air horizontally
through a chamber in which water is falling in drops, as rain, or into
which it is sprayed. The sprays are obtained by forcing the water out of
perforated pipes or through nozzles placed across the ducts. When the
sprays intersect they are said to form a curtain. The object is to bring
the air and water into intimate contact. Besides the washing chamber
there are heating or tempering coils in the ducts or in a separate chamber,
and devices for controlling temperature, a primary object of air washing
in the past having been that of conditioning the air with respect to its

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 233

temperature and humidity. The water used for washing is circulated
by means of a pump so that it may be used over and over in the spray
chamber for a considerable time. If desired this water may be cooled
so as to influence the temperature of the air. Several forms of air wash-
ers are on the market, essentially similar in principle but differing in
details of construction.

Although it has been known that air washers tended to clean the
air, and they have sometimes been introduced for that very purpose,
their efficiency as a means of air purification has not been determined.
Accordingly the authors undertook a few preliminary studies in order
to get data to serve as a guide in planning a more complete investiga-
tion. These studies were made at certain installations in Boston and
Springfield, where washers made by difTerent companies are in use and
included chemical and bacteriological analysis of the air before and
after washing, and analyses of the water before its use and after different
periods of use. At Springfield the studies formed a part of a more
extensive series of ventilation studies made at the gymnasium of the
International Y. M. C. A. College during the winter and spring months.

The washers in Boston referred to by the letters A, B, C, D, and E
were supplied with air taken from inlets placed as follows. They were
all in the business district.

Washer Position of Inlet

A. 8th story, on the roof.

B. Above street entrance.

C. Second story, back side of the building.

D. Street level, just above sidewalk.

E. Street level, just above sidewalk.

The analyses of air and water were made by the standard methods
of the American Public Health Association, supplemented by the use
of special apparatus. The results are given in Tables III and IV.

234 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

TABLE IIL

Table Showing Removal of Bacteria and Dust Particles from Air by Various Air

Washers, Boston, Mass. , »

Source of
Sample

Date
1913

Bacteria per

Cubic Foot

Molds

per
Cu. ft.
(Gela-
tine)

Dust Particles
per Cubic Foot

Gelatine at 20°

Litmus Agar at 38°

Number

of Air

Number

Per Cent
Removal

Number

Per Cent
Removal

Washer A

Outside

Washed

Feb. 3

50%

10
0

229,600
30.500

87%

Outside
Washed

Feb. ID

no
13

88%

0
0

....

8
3

111,100
58,000

48%

Outside
Washed

May 13

1000
300

66%

7
7

178,300
124,700

30%

Washer B

Outside

Washed

Feb. I

27
17

37%

55%

158,300
71,300

55%

Washer C

Outside

Washed

Mch. 13

13
3

77%

3
0

100%

0
0

248,000
72,000

71%

Washer D

Outside

Washed

Mch. 13

57
7

88%

3
3

■

13
3

241,000
104,000

57%

Washer E

Outside

Washed

May I

187
no

41%

65%

20
13

729,300
531.000

27%

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 235

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236

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Comparison of the dust counts in the air before and after passing
through the water showed that in the case of the five Boston washers
the percentage removal ranged from 27% to 87% and averaged 54%,
while the removal of bacteria ranged from 37% to 88% and averaged
64%. Generalizing from the data given in Table III, it is fair to say
that the air washing process as practised removed about two-thirds of
the suspended particles, including dust, bacteria and molds.

The nature of the substances removed by the washers is shown by
Table IV. Quantitatively these figures mean little, apart from a knowl-
edge of the volume of water used and the number of times that the same
water had passed through the air, and exact data for this could not be
obtained. From a comparison of the analyses of the tap water before
use with the washer water after use it is evident that many substances
were removed from the air besides dust and bacteria.

When street air was passed through a washer it required but a few
hours for the water used to resemble sewage in appearance and analysis.
A comparison of the analyses of washers B, D, and E, with those of
C and A given in Table V, shows how much greater was the amount of
dust removed from air near the street level than at higher elevations.
The intake ducts of these washers were at the street level, the second
story, and the eighth story respectively.

TABLE V.

Average Analysis of Washer Waters

(Results Expressed in Parts per Million)

Water before
Use

Intake at
Street Level

Intake at
2nd Story

Intake at
8th Story

Turbidity

Total Residue

Loss on Ignition

Kjedahl Nitrogen

Free Ammonia

I
- 37.0
17.0
0.179

O.OIO

•35

69
495 0
148.0
2.390
2.064
14.9
152

35
238.0
78.0

0.510

0.280

6.2

7-5

8
86.0
20.0

0.343
0 III

Oxygen Consumed

Iron

4-4
8.0

The presence of sulphurous acids in the air of the business district
of Boston was responsible for an interesting phenomenon. These acids
resulted from the formation of sulphurous gases during the combustion
of coal and, being soluable, were removed from the air and dissolved
by the water in the air- washing process. As long as the water contained
alkalinity the sulphuric acid was neutralized, but after a certain length

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 237

of time an excess of acid was present. This condition was found in
several washers. Where it occurred in a washer constructed largely
of copper the acid dissolved this metal and formed copper sulphate.
As a result there was established a sort of automatic process of disin-
fection, and the numbers of bacteria found in the washer water were
very low.

TABLE VL
Results of a Series of Analyses upon Water from Air Washer, Using Recirculation of

Air and Water.

Determination

Tap

2
Water

Jan.13 j Jan.15

12 hrs.
Jan.13

4
Washer

20 hrs.
Jan.15

5
Water

29 hrs.
Jan.20

31 hrs.
Jan.20

57 hrs.
Jan.29

Temperature
Turbidity....

Color

Odor

Total Solids

Loss on Ignition

Fixed Solids

Total Organic Nitrogen —

Albuminoid Nitrogen

Free Ammonia

Nitrates

Nitrites

Oxygen Consumed (5 Mins )

Chlorine

Hardness

Alkalinity

Incrustants

Iron

Free CO2

35.0
8.0

27.0
.032
.058
.004
.000

•05
2.6

2.5
8.0

3-5
4-5
0.15
30

(Result s Expre
.. i 43°

o : o
17 ; 15

IV IV

36.0

8.0
28.0
.046
.044
.002
.000
•05
2.8
2.5

"2.0
4-5
0.15
30

ssed in

52°

37
2a

Parts pe r Millio

48,
16.
32

Total Bacteria
Gelatine 4 days at 20° ... .
Litmus Agar, 2 days at 38
Amorphous Matter

(Standard Units per c. c.)
Epithelial Scales

(Number per c. c.)

35
o

.220

.110

•954
.040
.07

4.2

2.7
195
145

i.o

56°
10
43
3a

67.0
25.0
42.0

150
304
055
,09

5
,8
.0
■5

2.2
3-7

51"
II
70
3a

84.0
18.0
66.0
.250
•174
1-574
.155
.11
5-2

3-5
30.0
21.0

9.0

3.6

3-5

n)
54"
II

73
3a

950

22.0

730

.300

.164

1.608

•145

37.500 85,ooO| 131,000

.. I .. i 50
730 I 684 I 156

5-5

3-5

32.5

22.5

10. o

4.0

155.000

246

54"
15
65

4s\*«
4m/
106.0
22.0
84.0
.420
.244
2.228
.144
.15
5.9
3.5
36.5
30.5
6.5
4-4
4.0

180,000

12
1044

*The first twelve hours
gymnasiums.

**Odor equals sour and musty.

were in the nature of a blank run withput occupants in the

2SS

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The gymnasium of the International Y. M. C. A. College at Spring-
field afforded an opportunity of studying a new phase of the problem
of air washing, namely, that of purifying air that had passed through
an occupied room. It was suppUed with air from a ventilating plant
provided with an air washer, operated at such a rate that the air in the
room was changed every 9 to 12 minutes. This plant was well adapted
for experiment for the reason that air could be taken in from the out-
side and washed, or the exhaust air from the room could be returned
through the washer and again forced into the gymnasium. Comparison
could thus be made between the use of outside air and of rewashed air.
As in the Boston experiments analyses were made of the air before and
after washing and of the water after different periods of service. Fre-
quent tests were made under different conditions of operation. The
results appear in Tables VI to X.

TABLE VII.

Comparative Numbers of Bacteria Upon Exposed Plates, Using Recirculation of

Air and Water.

Date

Number
Minutes
Exposed

Total Bacteria upon Plate

Molds
per Plate

Sample

Gelatine at 20°

Litmus Agar at3 8°

Number

Per Cent
Removal

Number

Per Cent
Removal

Gelatine

Using Recirculation
Exhaust Air

1912

12/12

45 sec.

130
12

91%

18
2

89%

Washed "

Exhaust "

1913
1/13

2 min.

89%

15
2

Washed "

Exhaust " 3 P.M....
Washed " " ....

Exhaust " 4 "

Washed " " ....

1/20

I min.

170
39
52
36

777c
31%

62%

25
6

Exhaust " 3 P.M...
Washed " " ..
Exhaust " 4:15 " . .
Washed " " ..

1/29

I min.

55
36
46
30 .

35%
35%

39%

87%

12
II

7
2

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 239

TABLE VIII

Results of Analyses of Water From Air Washer After Short Time Tests
Using Outside Air and Recirculated Air

Determination

Tap

Water

Washer

Using

Outside

Air

3
Washer
Before
Using

4
Washer
Recir-
culation
Without
Use

5
Washer
Recir-
culation
With
Use

6
Washer
Recir-
culation
Without
Use

Date of Test

Period of Test

Time of Sampling

Temperature

Turbidity

Color

Odor

Total Solids

Loss on Ignition

Fixed Solids

Total Organic Nitrogen,
Albuminoid Nitrogen . . .

Free Ammonia

Nitrites

Nitrates

Oxygen Consumed

Chlorine

Hardness..

Alkalinity

Incrustants

Iron

Total Bacteria
Gelatine 4 days at 20° . .
Litmus Agar 2 days at 38 '

Molds on Gelatine

Amorphous Matter

(Results
Mar. 4

I P.M.

o
13

30.0

lO.O

20.0
.100
.048
.018
.000

•05
2.7

1-7

II. o

6.5

4-5
0.2

7
o
o

Express

Mar. 4

6 hrs.

3:30P.M

38° F.

66.0
32.0
44.0
.300
.140
.218
.016
.06
3
9
5
o

7-5
2.5

90,000

200

1,000

ed in Par
Mar. 17

9 A.M.

36.0

17.0

19.0
.100
.068
.006
.001

trace
2.6

1-3
lo.o

6.5
3-5
0.4

380

184

ts per M
Mar. 17

4 hrs.

I P.M.

54° F.

5
26
3a
49.0
20.0
29.0
•136
.108
.404
.007
.06
3-5
1-5
19-5
n.5
8.0
0.8

12,000

800

638

illion.)
Mar. 17
4 hrs.*
6 P.M.
50° F.

5
21

3a
46.0
17.0
29.0
.108
.092
.362
.005
.06
3
7
5
o

5
7

20,000

■ 75
300

574

Mar. 18

4 hrs.

I P.M.

55° F.

510

18.0

330
.144
.114
.508
.007
.06
4.0

2.5
20.0

13-5
6.5
0.8

2900

55
200
238

*The number of men hours for this period was 180.

When the exhaust air left the gymnasium it had a noticeably sour
and musty odor. After passing through the washer this was almost
completely removed and the returned air was fresh and sweet. At the
same time the "gymnasium odor" was acquired by the washer water
and could be easily detected in the sample bottles. THe washer water
was also found to contain large numbers of bacteria and many epithelial

240

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

TABLE IX.
Quantitative Determinations of Bacteria in Air.

Sample

Date
1913

2
Bacteria

3
per Cubi

Gelatine at 20'

Number

Per Cent
Removal

4
c Foot

Litmus Agar at 38"

Number

Per Cent
Removal

Molds
per cu.
ft. (Gel-
atine)

Using Outside Air
Outside Air 1:30 P.M...
Washed Air 2:00 P.M.. .
Exhaust Air i:io P.M...
Exhaust Air 3:45 P.M...

Outside Air 2:10 P.M.
Washed Air 2:40 P.M.
Exhaust Air 1:30 P.M.
Exhaust Air 4:00 P.M.

(Without Washing)
Outside Air 4:00 P.M..
Exhaust Air 4:30 P.M..

Recirculation, With Occupants

Exhaust Air 2:30 P.M

Washed Air 2 130 P.M

Exhaust Air 4:15 P.M

Washed Air 4:15 P.M

Exhaust Air 2:15 P.M.
Exhaust Air 5:15 P.M.
Washed Air 5:30 P.M,

Recirculation, Without Occu-
pants

Exhaust Air 10:55 A.M

Exhaust Air i :o5 P.M

Washed Air i :25 P.M

Mch. 4

Mch. II

Mch. 18

Feb. 13

Mch. 17

Exhaust Air 12:00 P.M
Washed Air 12:35 P-M

Mch. 17

Mch. 18

7
27
37

17
12

57
130

23
300

193
44

100
10

483*
93
66

170
83
63

86
60

74%

29%

77%
90%

29%

24%

30%

3
o

13
30

6
153

3
o
o
o

26
17

7
7

17
3

57%

100%

35%

82%

*Possibly influenced by taking sample too soon after starting fans.

scales derived from the skin of the men exercising on the floor. Dust,
bacteria, molds, nitrogen, and iron were removed from the indoor air
by the washer at Springfield to about the same extent as by the washers

AIR WASHING AS A MEANS OF OBTAINING CLEAN AIR IN BUILDINGS 24I

TABLE X
Quantitative Determination of Dust.

Number

Date

Dust

Per Cent

Sample

1913

Particles
Per Cu. Ft.

Removal

Remarks

Using Outside Air

Outside Air 1:30 P.M

Mch. 4

103,000

Mild. Thawing.

Washed Air 2:00 P.M

98,300

Light breeze.

Exhaust Air I :io P.M

56,300

Exhaust Air 3:45 P.M

115,000

Outside Air 2:10 P.M

Mch. II

17,200

Cloudy. Light breeze.

Washed Air 2:40 P.M

13,000

24-5%

Heavy rainfall pre-

Exhaust Air i :30 P.M

63,000

vious night.

Exhaust Air 4:00 P.M

87,700

(Without Washing)

Outside Air 4:10 P.M

Mch. 18

124,000

Slightly above freez-

Exhaust Air 4:45 P.M

200,000

ing. Brisk S. W.
winds. Washer idle.

Recirculation, With Occupants

Exhaust Air 2:30 P.M

Feb. 13

415,000

Temperature below

Washed Air 2:30 P.M

149,000

64%

freezing. Light to

Exhaust Air 4:15 P.M

266,000

brisk wind.

Washed Air 4:15 P.M

((

122,000

54%

Exhaust Air 5:10 P.M

Mch. 17

171,000

Temperature about

Washed Air 5:40 P.M

91,300

47%

freezing. Light to
brisk W. wind. Fair.

Recirculation, Without Occu-

pants.

Exhaust Air 10:45 A.M

Mch. 17

131,000

Temperature about

Exhaust Air i :io P.M

97,000

freezing. Light to

Washed Air 1:20 P.M

59,700

39%

brisk W. wind. Fair.

Exhaust Air 12:10 P.M

Mch. 18

90,000

Slightly above freez-

Washed Air 12:25P.M.......

57,000

37%

ing. Fresh to brisk
S. W. wind.

tested in Boston. The results indicated that under the conditions
there existing the exhaust air could be washed and returned to the
gymnasium with entire safety and comfort to the occupants of the room
and with no apparent sacrifice of wholesome properties. The carbonic
acid was not reduced by the air washer — and theoretically it ought not
to be reduced — but this fact did not at all affect the acceptability of the
washed air to the occupants. The details of these experiments are

242 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

described in The American Physical Education Review, December
1913. GeneraHzing from these results, it may be said that the recir-
culated air after washing was cleaner than unwashed outdoor air, but
was slightly less clean than the outdoor air after washing.

The advantage of washing and recirculating the air lies in the great
saving of heat in cold weather. Mr. D. D. Kimball, who designed
the ventilating plant at Springfield, estimated that when the outdoor
temperature was 32° F. the saving in cost of operation effected by recir-
culating washed air was 40%, while with an outdoor temperature of
0° F. the saving was 50%. The use of less coal at Springfield, when the
air was being recirculated instead of being drawn in from outdoors was
plainly evident and was commented upon by the engineer in charge of
the Springfield plant. In the summer the washer may be operated as
a cooling plant to keep down the temperature of the indoor air, or with
the windows open it may be shut down to save expense.

The common standard of 30 cubic feet of air per capita per minute,
which is now generally applied to schoolhouses, was based upon the idea
of keeping the carbonic acid down to a fixed amount. When it became
recognized a few years ago that carbonic acid was a negligible factor,
some made the inference that a smaller volume of air would suffice.
They failed to consider that circulation of the air is of itself one of the
essential elements of indoor comfort and a necessary feature of good
ventilation.

The cost of heating large volumes of cold air has naturally stood in
the way of efficient ventilation of schools and factories during the .cold
weather. Another difficulty has been the low indoor relative humidity
produced by heating outdoor winter air to a comfortable room tempera-
ture. If, therefore, both of these objections can be overcome by wash-
ing air and using it over and over, so as to furnish an ample supply
of clean air in motion the method is one that has much to commend it.
Naturally there would be a limit to the continued use of the same air,
but ordinary leakage and the possible use of a small percentage of outside
air would prevent the concentration of any substances not removed
by the washer.

Our study of the subject of air washing has led us to believe that
it is one of the vital elements of ventilation in localities where it is
difficult to obtain a supply of clean air, and that the recirculation of air
thus washed is deserving of serious consideration from the standpoint
of economy. It is very evident that the air washers now in operation
are not giving as high a degree of efficiency as might be obtained with
better designs and more skillful operation and the details of the process
should be submitted to careful scientific research.

EFFECT OF HEATING AND VENTILATING ON SCHOOL ATTENDANCE 243

THE EFFECT OF CONDITIONS OF SCHOOL ROOM

HEATING AND VENTILATING ON SCHOOL

ATTENDANCE

Chas. H. Keene

The following report concerning "The Effect of Conditions of School
Room Heating and Ventilating on School Attendance" is based almost
entirely on the amount of absence from various class rooms during the
past school year. The precentages reported are the percentages of
absence, so that a high percentage shows a condition of poor attendance.
Other things being equal, the attendance in a class room is a fair index
of the health conditions in that room, particularly when the attendance
of one room in a building is compared with the attendance in other rooms
of the same building or district, of the same or nearly the same grade.

We have in our city about 21 so-called portable buildings, which are
really one-room school buildings heated and ventilated by means of a
jacketed stove, so arranged that cool air from the outside enters the room
about the base of this stove, is heated, rises to the upper part of the
room, spreads over the room, settles, and is withdrawn from the room
by a gravity foul air duct, the room opening of which is situated at or
near the floor level. This is really a gravity system, with the addition
that the teachers are at all times allowed to open class room windows
if they wish. As a matter of common observance, most of them do
wish to frequently. The conditions in these rooms are practically
always good. The ''school odor" which is so commonly present in
schools ventilated by the usual ventilating system, is practically never
present. In these portable rooms the teachers are almost universally
pleased with the conditions. We have frequent requests from grade
school teachers to be transferred to these rooms, but very rarely do we
find a teacher in one of these rooms desiring to be transferred to a large
building.

The writer of this report does not wish to advance any particular
theories, but simply wishes to set forth a series of figures based on the
actual attendance. Such a report, covering only one year, must neces-
sarily be in the nature of a preliminary one.

The average absence by grades was figured for the lower three grades
separately, as most of the portable buildings contain some one of these
grades. The average absence for all third grades in the city was 3.64%,
of all the second grades was 3.84%, of all the first grades was 473%-

244 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Before going into the body of this report, which is mainly upon
these portable buildings, I wish to speak of School No. i. In one room
of this building, a fourth grade room, certain experiments were carried
on under the supervision of the engineers, whereby every child was
given a supply of air directly in front of his face, which was supposed
to be properly humidified and to have the proper amount of oxygen
and ozone. The records for the year show that the average absence
from this room was 4.29%, whereas the average absence in the ordinary
rooms of the fourth and third grades in this building was only 3.09%.
So far as I have been able to find out no records were kept of the gain
in weight of the children of this room as compared with the gain in weight
of the children of other rooms, so that about the only basis of judgment
as to the healthfulness of these rooms depends upon the average amount
of absence. The artificial conditions thus obtained seem, therefore,
to be detrimental.

As regards the main topic:

School No. 2 had six portables located in the school yard — three 5th
grade, two 4th grade, one 3d grade. The average absence for these
portables was 3.71%; the average absence for the whole building, not
including these portables, was 3.82%.

School No. 3 had one portable annex, a ist grade room, having an
average absence of 3.02%, as compared with the average 1st grade
absence for the whole city of 4.73%.

School No. 4, a group of four isolated portables, had an average
absence of 3.9%. The average absence of the nearest large building,
School No. 5, was 5.46%. Taking the comparative figures of these
rooms by grades, the third grade portable rooms had an average absence
of 3-73%» while the third grade absence in the large building was 5.7%;
the 2nd grade absence in the portables was 2.68%, in the large building
it was 5.15%; the first grade absence in the portables was 5.55%, in the
large building it was 5.72%. These figures are universally in favor
of the portable buildings; moreover, many of these children had a long
distance to travel over streets lacking sidewalks and proper breaking
out in snow- time, so that the large amount of absence in the ist grade,
which is in excess of the average .for the city, is to be expected.

School No. 6 was a group of two portables in the same school district,
even more inaccessible than the above group. Its 2nd grade absence
was 5.26% as compared with 5.15% in the large building, and its ist
grade absence was 5.66% as compared with 5.72% in the large building.

School No. 7 had two portables adjacent to the building, containing
3d and 5th grades. Their average absence was 4.05%, as compared

EFFECT OF HEATING AND VENTILATING ON SCHOOL ATTENDANCE 245

with the average absence for the wjiole building of 3.75%. These
seem to be the only rooms in the whole group of portables, having access
to a warmed and proper toilet, which have an absence in excess of that
of the nearest large building. The cause for this I have been unable
to discover.

School No. 8, a single isolated portable of the 1st grade, shows an
average absence of 5 -08% as compared with the absence of the nearest
large building in the 1st grade of 4.39%- Here the children were obliged
to use an unheated, outhouse toilet, which undoubtedly accounts to
some extent for its large percentage of absence.

School No. 9, a group of three portables containing from the ist
to the 4th grade, had an average absence for the 1st grade of 4.01%, as
contrasted with the 473% for all the 1st grades of the city. The average
for all three of these portables was 3.12%. The average absence of the
nearest big building for the lower three grades was 3.15%.

School No. 10 was a group of four portables in a very isolated region
lacking sidewalks and proper snow breaking, containing ist and 2nd
grades. The average absence was 5.53%. This apparently high aver-
age is undoubtedly due to conditions outside the class room, as the par-
ents objected very strongly to the outdoor toilets which were necessary
here. This undoubtedly forced up the percentage of absence.

School No. II, a group of two portables in an isolated region, con-
tained 1st and 2nd grades. The average absence for the group was
4.10%. The nearest big building had an average absence in its ist
and 2nd grades of 4.33%, while the absence of the ist and 2nd grades
of the whole city was 4.32%.

School No. 12 had one portable, a 3d grade, in the school yard. This
is a Jewish district and the percentage of absence is very high, owing
to holidays and other things over which school conditions have little
control. The average absence for this particular room, however, was
6.75%; for all the 3d grade rooms in this building it was 7.97%; for all
the grades in the building it was 8.64%.

In summarizing, we find that the figures are in favor of portable
buildings in every case, except at Schools Nos. 7, 8 and 10. The cause
of the poor showing of the latter two has been discussed. It may be
said that other conditions have caused this favorable result in attendance.
This might be if only one or two of these portables were considered,
but when the results are so markedly in their favor throughout the city,
it seems fair to assume that there is something in the buildings them-
selves that makes their conditions more healthful, and the only con-

246 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ditions in these portable buildings that vary from those in the large
buildings are the method of heating and ventilating.

Whether this improved condition is due to the jacketed stove or to
the benefit of opening the windows at any time, it is hard to say. My
personal belief is that it is very largely due to the latter.

In addition to these portable buildings handled on a gravity jacketed
stove system, we carried on in our schools three open window classes.
In these rooms a whole grade of children is placed in a room whose win-
dows are kept open, there being put in the lower sash a cheese cloth
screen to prevent direct draft upon the children, and the temperature
of the room being maintained at about 55°. The children are allowed
to wear extra wraps if they desire, but they are given no extra nourish-
ment, nor is the routine of the class in any way changed. They are
not selected in any way whatsoever, except that we obtain the consent
of the parents before putting a child into this room. We simply say
to the parents of the children in a certain room in the building, "Are
you willing that your child shall enter a room similar to the above?"
Practically all of them are, and we then open the windows and put in
a cheese cloth screen.

In School No. 13, the absence for this open window class, which was
opened about February i, varied as follows: From November i to
February i, when the room was run as an ordinary class room on a sup-
posedly modern, fan, plenum system, the average absence was 5.3%. On
February i, the windows were opened and cheese cloth screens installed.
The average absence from February i to May i dropped to 3%. The
teacher of this class in a recent letter states that ''the establishment of
this room was highly satisfactory and beneficial in many ways. We had
throughout the remainder of the winter, the best attendance I have
ever had in an entering room. The air was at all times fresh and in-
vigorating and we are hoping to be allowed the privilege of continuing
its use next year." During this time, February i to May i, the average
absence of the other ist grade rooms in this same building was 5.3%,
which is considerably above the average for the city.

Another of these open window rooms, a 4th grade room, was opened
about February i in School No. 14. The average absence in this room
from September I to February i was 2.37%. The average absence
in the room from February i to May i was 2.88%, an increase of .5%.
In the other 4th grade rooms in this building, the average absence from
September i to February i was 5.11%, and from February i to May i
was 6.21%, an increase of over 1%. All the third grade rooms in this
building from February i to May i had an average absence of 4.28%
and the average absence for the whole building during the time was 3.66%.

EFFECT OF HEATING AND VENTILATING ON SCHOOL ATTENDANCE 247

In School No. 15 one of these open window rooms was opened a year
ago last March. Its effect was so pleasing that it was continued during
the whole of the school year just passed. Owing to an epidemic of
measles, the average absence was high, 4.01%, but even this is con-
siderably below the 4.73% which is the average of all ist grade rooms
in the city. These children were kept in the room throughout the year.
Their weights were taken at the 1st of November, January and May.
For purposes of comparison, the weights were taken in two other ist
grade rooms in the same building. The children in these latter rooms
made an average gain of 1.45 pounds, the children in the open window
room made an average gain of 1.85 pounds, which is 27% more gain
than was made by the children in the ordinary ist grade rooms.

We have known for some years that children put in open air class
rooms and given extra rest and diet, as has been done for tubercular
and sick children, will improve remarkably in their general condition
and make marvelous gains in health. During eighteen weeks in our
own open air school in Minneapolis, the children made an average gain
of 3.3 pounds, two of them gained over 9 pounds; one gained 6.6 pounds
and made a double promotion in that time. We have not known, how-
ever, whether this increase in weight was due to the type of curriculum,
to the rest, to the open air, or to the increased diet, or to all these com-
bined. It seems fair to assume, however, from these comparative
weights, that a very large proportion of the gain is due to nothing but
unadulterated fresh air, which is neither baked nor stewed. If we can
maintain class rooms in the public schools on an open window basis,
we are making an immense saving, not only in the installation of costly
ventilating apparatus and in the fuel now wasted in producing an exces-
sive temperature, but we are also benefiting very largely the children
in our schools, and are acquainting their parents with the fact that
fresh air is essential, not only in school, but in the home.

Some things are worthy of further study. Will these conditions
of better attendance in class rooms heated by a jacketed stove, where
the teachers have the privilege of opening the windows, continue through
a series of years? Second, and this we propose to examine into more
carefully during the coming school year, does the gain in weight of the
children in this type of school room compare favorably with the gain
in weight of children of like grade and circumstances, in ordinary school
rooms ventilated by the fan system? We have seen remarkable gains
in weight in open air schools and our recent work shows very favorable
extra gain in open window classes. If the figures on the children cared
for by the jacketed stove system are in favor of the combination of
jacketed stove and open window, what shall be our attitude towards
the costly and apparently inefficient system of forced ventilation?

248 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE PRIMARY PURPOSE OF VENTILATION, TO
FACILITATE THE MAINTENANCE OF THE CON-
STANT TEMPERATURE OF THE BODY

Theodore Hough

The study of the subject of ventilation* during the past few years
has resulted in drawing a sharply marked line between two different
but not mutually exclusive explanations of the mode of action of the
air of an inhabited room.

The first of these explanations regards the effects of inadequate
ventilation as an intoxication of one kind or another, i. e., a harmful
effect upon the organism of some material added to the atmosphere of
a room from the bodies of those inhabiting it. It is unimportant, for
purposes of this classification, whether this material comes from the
lungs, mouth, or nasal cavity, or from the skin; or whether the poison-
ing is of the kind shown in ordinary pharmacological actions like those
of strychnine, or digitalis, or whether it involves an anaphylactic reaction.
The essence of the theory is that we are dealing with the poisonous action
of some foreign constituent of the air on the human body.

According to the other explanation the air of a badly ventilated
room reproduces the atmospheric conditions of a warm, calm day of
high humidity, and the effect of poor ventilation is primarily and largely
due to the combination of high temperature, high humidity, and defi-
cient movement of the air about the bodies of those in the room. That
these physical conditions of the atmosphere are harmful no one will
deny, nor can any on^ doubt that the badly ventilated room does pro-
duce effects which closely resemble those of a sultry day. It is, however,
as we shall see, a fair question whether the physiological effect of bad
ventilation and of a sultry atmosphere are essentially identical.

What, then, are the salient features of experiments bearing upon
these two explanations? It does not fall within the scope of this paper
to give a summary of the literature; but it will assist us in getting our
bearings to describe briefly the most significant points. In the first
place it is fair to say that all efforts have failed to demonstrate in the

*In this paper we assume that the initial atmosphere of the inhabited room consists
of pure air of normal humidity, and deal with the physiological action of this initial
air when changed by the presence of human beings in the room. Such conditions as
the lowering of the relative humidity by heating cold air are supposed to be remedied
before the air is supplied to the room.

THE PRIMARY PURPOSE OF VENTILATION 249

air of a badly ventilated room a foreign constituent which exerts a poisonous
action upon being taken into the lungs with the inspired air. Carbon dioxide
must be definitely acquitted of any such action. As to other constiu-
ents, it may be said that although the odor of the air of a crowded room
is sufficient evidence of the presence of foreign matter, the experiments
supposed to show that this foreign matter, organic or inorganic, when
rebreathed is poisonous have failed of confirmation when repeated
under properly controlled conditions. In this connection attention
should be called to the fact that harmful results obtained by the sub-
cutaneous injection of material obtained in one way or another from a
vitiated atmosphere do not prove that this air is capable of poisoning
the body when it is rebreathed,. nor is it an ultra-refinement of logic
to say that the only acceptible proof that the bad effects of poor venti-
lation are due to the poisonous action of foreign constituents is to repro-
duce these effects by rehreathing the foreign material in concentrations
in which they occur in the room, and with other unfavorable concomitant
atmospheric conditions of such rooms excluded. It is not too much
to say that no such proof has yet been given.

These considerations apply to the very striking experiments of
Rosenau which show that, when the air of a confined space inhabited by
one animal is cooled so as to condense certain substances out of it, sub-
cutaneous injection of this condensed material sensitizes another animal
so that a second injection of the blood serum of the first animal produces
an anaphylactic reaction. These experiments are very important,
for at present they constitute the only evidence in our possession of the
existence of poisonous material in the air of an inhabited room, but
attention must be called to the fact that the anaphylactic reaction has
not been produced in a sensitized animal by rebreathing the vitiated air.
Until this is done we are not justified in accepting this as the solution
of the problem before us. We take this position at the same time that
we fully recognize the suggestiveness of the work and express the hope
that future experiments along this line will contribute materially to the
solution of the physiological problem of ventilation.

The role of the physical conditions which we sum up under the
term "sultry" atmosphere in producing the effects of poor ventilation
is indicated by numerous observations and experiments. I have already
cited in another paper the experience of a friend of mine in ventilating
a crowded lecture room. He found that no complaints of bad ventilation
came if he kept the temperature of the room at 68° F. by forcing in
cold air, but had such complaints if the temperature was much above
70° F., although it often occurred that the actual amount of outdoor
air supplied in the latter case was greater than in the former. It is
significant, too, that these complaints were not usually of the tempera-

250 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ture of the room but of its ventilation. It would be a fair reply to this
to say that it is only when the room temperature rises above 70° F. that
perspiration begins to be secreted by the sweat glands and that the
"crowd poison" may be some material volatilized from the perspiration.
Here the cabinet experiments add to our exact knowledge.

When one or more persons are enclosed in a comparatively small
air-tight cabinet and thus exposed to the vitiated air which gradually
accumulated therein, there is experienced sooner or later and often
in very intense form the effects of inadequate ventilation. But these
effects can be lessened or delayed, by anyone of three means: (i) by
absorbing the excess of water vapor; (2) by the use of an electric fan;
or (3) by preventing the rise of temperature of the air of the cabinet.
A combination of any two or of all three of these procedures is more
effective than is any one taken alone. Fliigge and his pupils have,
moreover, found that if by the use of a nose or mouth piece provided
with suitable valves, the subject within the cabinet breathes the pure
air from outside the same results are. obtained as when he breathes the
air of the cabinet. In this form of experiment the subject is not breath-
ing the "crowd poison," although the surface of his body is exposed to
the sultry atmosphere of the cabinet. On the other hand if the subject
of experiment remains outside the cabinet but breathes (through the
nose or mouth mask) the air of the cabinet vitiated by the presence
of a second person no bad effects are felt. While it is fair to urge that
these experiments are lacking in any objective test and that the subjects
of the experiments may have mistaken their feelings of discomfort for
the effects of bad ventilation, yet the fact remains that they record no
ill effects whatever when the physical atmospheric conditions to which the
skin is exposed are kept ideal, even though they are breathing into their
lungs a highly vitiated air. If bad ventilation acts solely or chiefly by
the poisonous action of a foreign agent in the atmosphere, why were
no ill effects experienced when the subjects of these experiments were
exposed to this hypothetical "poison "? I see no answer to this except
that conscious or unconscious leaning toward a certain theory made the
subjects incapable of correct observation. I can only say that on the
basis of my personal experience with certain cabinet experiments I am
inclined to give little weight to this explanation of the results.

It will assist toward the practical solution of our problem if we con-
sider certain objections which have been raised against the theory we are
now considering. We are peculiarly liable to regard the problem of
ventilation as a simple problem, involving only a single factor or at most
a group of cognate factors, while, as a matter of fact, it may be a problem
involving several factors of very diverse character. Hence an objection
to a certain solution, although really nothing more than an indication

* THE PRIMARY PURPOSE OF VENTILATION 25 1

that the problem has been only partially solved, may be mistaken for
a conclusive argument against the solution.

The first objection I shall consider is that many persons find the
effects of a sultry day qualitatively different from those of bad ventila-
tion. These subjective differences, however, may be partially if not
largely due to the well known individual variations in the sensitiveness
to odors; for if the odor of "polluted air" produces unfavorable effects,
it becomes a real factor in the physiological as well as the practical
problem of ventilation. It makes no difference whether the effect is
entirely "psychic," for a psychic effect is as real a thing as a toxic effect;
and it would be the height of absurdity to say that we should not pro-
vide for the person who suffers from these psychic effects of the odor
6i the air. We will all admit, then, that the air must either be renewed,
or purified in the process of recirculation.

But to admit the reality of these effects is by no means to say that
the physical conditions of the atmosphere as above outlined are not of
primary importance in the problem of ventilation. The writer of this
paper is most unfavorably affected by the odor of the air of a badly
ventilated room whenever he is conscious of it, indeed the effect in his
case can properly be described as a very real physical depression; and
yet he has remained without any discomfort whatever for an hour in
a closed cabinet, the air of which had an overpowering odor to the
attendant upon opening the door. The subject of experiment was
unconscious of the odor and it did not influence him. In this same
series of experiments, unless the temperature was kept down to 70° F.
and excessive humidity prevented, marked discomfort was invariably
the result; and this discomfort was essentially the same as that exper-
rienced in a poorly ventilated room or on a warm muggy day in summer.

A second objection is that out-of-doors a stagnant, humid atmos-
phere does not become particularly uncomfortable at a temperature
of 73-75° F. whereas the badly ventilated room of this temperature
is distinctly oppressive. But there is usually one great difference
between the two cases. In the crowded room there is rarely any con-
siderable movement of air about the bodies of those in the room ; on the
other hand it is distinctly the exception to have no breeze whatever
on a sultry day out of doors ; and even in the house we usually get some
movement of air by opening windows and doors. Now it is precisely
the formation of an "aerial blanket" about the skin which is a most
important, if indeed it is not the most important source of trouble in
the crowded room. This aerial blanket acts, of course, by interfering
with the loss of heat from the body, by diminishing both convection
of heat and evaporation of perspiration; and I doubt whether anyone
sitting still out of doors on a perfectly calm, muggy day of 73° to 75° F.

252 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

temperature would fail to note at least the partial correspondence
between his discomfort and that which he experiences in a crowded
room. It must not be forgotten that it requires only a very slight
movement of air to get rid of the aerial blanket ; less in fact than would
ordinarily be dignified with the name "breeze." This is generally present
on the sultry day, especially out of doors; it is usually absent in the
crowded room.

I think that in stating this atmospheric aspect of ventilation this
factor of air movement has been neglected in our attention to the factors
of temperature and humidity. It is not anyone, nor any two of these
factors which must be watched. It is all three, and this because all
three have the common result of raising the temperature of the skin,
thereby introducing into the body the conditions which lead to discom-
fort, lassitude, headaches, etc.

A third objection which has been urged against the theory is that
the vapor chamber of a Turkish bath presents the combination of lack
of air movement, high humidity, and high temperature; and yet while
exposed to this atmosphere we do not experience the depressing effects
of bad ventilation ; on the contrary the vapor bath is stimulating. This
objection is certainly not well taken. A temperature of 120° F. or more
produces very different physiological effects from those produced by a
temperature of 75-100° F. It is well known that hot water stimulates
both the nerves of heat and those of pain, and that in the stimulus from
very hot water that of pain preponderates ; and the same thing is true of
hot, moist air. Possibly, too, the elevation of body temperature may also
contribute to the stimulating result of the Turkish bath. That the physi-
ological effect of high temperature (e. g. 120° F.) differs qualitatively, and
not simply quantitatively from that of lower {e. g. 90° F.) temperature is
also shown by the fact that a lukewarm bath generally lowers arterial
blood pressure while a hot bath generally raises it. Probably the ex-
planation of the effect of the higher temperature in both cases is the
introduction of a new physiological complex through the afferent channel
of the nerves of pain. It should also be remembered that, as shown by
Head and Rivers, there are two groups of afferent nerves included under
the "heat nerves;" the epicritic fibres, whose end organs respond to any
elevation of the temperature of the skin, and the protopathic fibres,
which respond only to temperatures of 37° C. and higher. The specific
reflex connections of these two groups of fibres has not as yet been in-
vestigated; but it is quite possible that this also plays some role in the
different effects of moderate and strong heat stimulation. At any rate
enough has been said to show that the objection in question is not at
present logically valid.

Summing up the main points of the foregoing discussion, it would

THE PRIMARY PURPOSE OF VENTILATION 253

seem fair to say that there is at present no conclusive proof of the pres-
ence of a toxic agent in the air of a crowded room but that the possi-
bihty of this is not excluded. The effect of inadequate ventilation is
probably a complex matter in which several factors contribute to the
result. We know 'and must reckon with some of these factors, while
probably others are as yet unknown. Two at least seem to be established
namely, the influence upon the organism of conscious sensations of smell,
and the unfavorable circulatory and other adjustments forced upon
the body in order to maintain its normal temperature under the atmos-
pheric conditions of increased temperature, humidity, and stillness.
It is, moreover, probable that the influence of these several factors
varies with different individuals, according to their sensitiveness to
disagreeable odors, the thickness of their subcutaneous layer of fat,
or the intensity of their reaction to the atmospheric conditions in ques-
tion. It is also modified by a psychic factor; for the man or woman
who firmly believes in the existence of "crowd poison" and who con-
sciously or unconsciously identifies this crowd poison with the odor-
iferous foreign matter will suffer ill effects as soon as he becomes con-
scious of the odor, even though the physcial condition of the atmos-
pher may be ideal; on the other hand, the man who is not worried by
the odor of the air or the man who is unconscious of it may notice no ill
effects in the same room. The influence of inadequate ventilation no
doubt also differs according to what one is trying to do when exposed
to it. It may be negligible in the case of one doing a routine, mechanical
task, but very marked in another whose work requires close attention
and accurate thinking.

If the writer seems to appear in the role of a partisan of the view
that the problem of ventilation is primarily a problem of the mechanism
of temperature regulation of the body, this is not because he would
belittle other possible factors, far less close the door to further investiga-
tion; but rather because he believes that everything indicates that this
factor is of prime importance ; that it is invariably present in a poorly
ventilated room; that it inevitably affects unfavorably every inhabitant
of such rooms; and that it must be cared for in practice, no matter
what else we may try to accomplish. Any practical efforts at ventila-
tion which neglect it are sure to fail and those which provide for it are
sure to be at least measurably successful. In other words, it is a real
advance in the practical hygiene of our subject to recognize that the
primary problem of ventilation is not the removal of poisonous material
which would otherwise be breathed into the lungs, but the maintenance
of the physical conditions of that portion of the atmosphere in immediate
contact with the surface of the body in such form as will place the mini-
mum burden upon the mechanism of temperature regulation.

254 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

In the above discussion we have not touched upon the very impor-
tant question of the physiological action of these unfavorable atmos-
pheric conditions, for it is not possible to treat them within the limits
of this paper. Doubtless this physiological action is complex, consist-
ing partly of undesirable changes in the distribution of blood whereby
certain organs are deprived of their normal supply in order to rush all
the blood possible to the skin; partially to the conscious discomfort
of an overheated and moist skin, and partially to some as yet imper-
fectly understood effect upon the oxygen-carrying function of the blood.
Especially suggestive are the observations of Barcroft and his co-workers
on the effect of moist heat upon the dissociation curve of blood. (Journal
of Physiology, 1913, XLV, p. xlvii.)

In conclusion let us consider some practical application of the theory
that the physiological problem of ventilation is primarily a matter of
the mechanism of temperature regulation in the body:

1. When the temperature of the atmosphere about the surface
of the body is kept at about 68°-7o° F. the problem of ventilation is
largely solved. "Foul air," i. e. air having a distinctly disagreeable
odor must of course be removed ; but at this temperature the unpleasant
odors seem to be less intense, probably because of the smaller secretion
and evaporation of the perspiration.

We may call this the critical room temperature, for it is the dividing
line between those temperatures at which the body becomes chilly and
those at which it must take active measures to get rid of the heat neces-
sarily produced in its life processes. The correction of too low a room
temperature is the problem of heating; the correction of the conditions
above this critical temperature is the primary problem of ventilation.
So long as the room temperature is kept at the critical point, humidity
and air movement are negligible factors, so far as the regulation of the
temperature of the body is concerned. Renewal of the air is necessary,
but the less draft produced in accomplishing this the better. This
statement, however, holds true only for this critical temperature.

2. If it is not possible to keep the temperature of the air immedi-
ately about the body at 68°-70° F., the first recourse must be to those
measures which favor the prompt evaporation of the perspiration. To A^
be strictly accurate, it is not the temperature of the air immediately
about the skin, but the temperature (and perhaps the water content)
of the skin which determines the comfort or discomfort of the subject.
Air at 85° F., if fairly dry and in motion, may through the effective
evaporation of the perspiration keep the skin at the same temperature
as comparatively still air at 70° F. In other words the two cases present
identical physiological conditions, although this physiological condition

THE PRIMARY PURPOSE OF VENTILATION 255

results from very different physical properties of the air immediately
about the body. Consequently in practical ventilation there are two
rules to follow at room temperature above 70° F. The first is to keep
down the humidity of the air as much as possible; the second and more
important is to keep the air about the body in motion; if in doing this
it is renewed, so much the better. The first requisite on hot days is
a breeze; and the most important practical problem in the ventilation
of a crowded room is to secure this breeze, so as to maintain the tempera-
ture of the skin at the optimum point, i. e., the point which it has in a com-
paratively dry atmosphere of 68°-70° F. when the subject is at rest.
Sometimes this is best secured in one way, sometimes in another. Thus
if cool air can be admitted from outside it is better to open windows
wide or in other ways to admit this air. If, on the other hand, the out-
side air is very hot, it is better to admit it only sparingly and depend
upon electric fans to produce the essential movement of air.

To put the same thing in another way: On a hot (e. g., 90° F.) day
a room may be better ventilated when its temperature is kept down
by opening the windows only enough to secure moderate renewal of the
air and keeping the cooler air within in movement by the use of fans,
even though the renewal of the air be very imperfect, than it would be
when the air is thoroughly renewed by sending in large quantities of
hot and perhaps humid air from outside. In this and all similar cases,
the first thing to make sure of in meeting the problem of ventilation is
not the renewal of the air breathed but the maintenance of the tempera-
ture of the skin as nearly as possible at jvhat we have called the optimum
point. At 68° F. no great amount of movement of air is needed ; indeed
it is not desirable; at 80° F. it is necessary; and for precisely the same
purpose in the two cases, in order to maintain the proper skin tempera-
ture.

Finally, to avoid misunderstanding, it must be distinctly under-
stood that we only assert that the regulation of these atmospheric con-
ditions which come into relation with the mechanism of temperature
regulation in the body, are of first importance; we do not assert that
this alone is important. We simply insist on this as something which
must not be neglected, indeed must be first attended to in practical
ventilation, and we insist upon this without in the least denying that
other factors may and do need attention.

256 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

discussion of
Papers of Drs. McCurdy, Keene and Hough

A. H. MacKay

I recognize that the small degree of exhaustion of oxygen and in-
crease of carbon dioxide in school room air are not of themselves the most
serious defects under ordinary conditions. The more indeterminate
gaseous excreta from the lungs and skin have always appeared to me
to be the more serious, notwithstanding the assurance from some quarters
of their non-toxic character. It may be but a fancy, but the air of a
badly ventilated crowded public meeting seems to have the physiological
effect, among others, of acceleration of the pulse, while depressing the
power of attention and inducing sleepiness. The stale odor of the vacant
unventilated school has always a powerfully unpleasant psychological
effect. I fancy that any system of ventilation saving the expenditure
of heat by washing and returning the air, should wash out very thoroughly
these offensive organic substances and odors. The elimination of
carbon dioxide may be assumed to be approximately proportional to
these more subtle and indefinite excreta. Its measurement, therefore,
will indicate very nearly the gei^eral degree of the defilement of the air.
What I should like to know is the character and effects of this air defile-
ment, and the character and efftciency of the washing of the air which
is being returned for rebreathing?

SESSION FOUR

Room A. Wednesday, August 27th, 2:00 P.M.

THE VENTILATING, HEATING AND CLEANING OF
SCHOOL BUILDINGS (Part Two)

Frederic Bass, Chairman
Dr. Arthur Schaefer, Buffalo, N. Y., Vice-Chairman

Program of Session Four

Frederic Bass, B.S., Director, Engineering Division, Minnesota
State Board of Health. "An Experiment in School Room
Ventilation." . .

John W. Shepherd, A.M., Head of Department of Science, Chicago
Normal College. "Some Experiments on the Ventilation of a
School Room."

George W. Fitz, M.D., Formerly Assistant Professor of Physiology
and Hygiene and Medical Visitor, Harvard University. "Physi-
ologic Cost of Insufficient Protective Clothing."

John C. Olsen, Ph.D., Professor of Analytical Chemistry, Polytechnic
Institute, College of Engineering, Brooklyn, N. Y. "The Puri-
fication of Air and Water by Means of Ozone."

Professor Dr. Selter, Dozent fiir Hygiene, University, Bonn. "Ventila-
tion und Heizung der Schulraume."

Papers Presented in Absentia in Session Four
(Read by Title)

Julius Brandau, M.D., Kassel, Germany. "Der Einfluss der kalten
Fiisse auf die Geistestatigkeit der Schulkinder."

Leonard Nice, Ph.D., Professor of Hygiene, University of Oklahoma.
"Book Disinfection — A Neglected Factor in School Sanitation."

258 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Melvin G. Overlock, M.D., State Inspector of Health, Worcester,
Mass. "Proper Ventilation of School Buildings."

Milton W. Franklin, A.M., M.D., Manager Ozone Department,
General Electric Company, New York City. "Ozone in Venti-
lation."

Dr. ScHOENFELDER, Stadtbaurat und Kgl. Baurat, Elberfeld, Ger-
many. "Die Reinhaltung der Schulraume."

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

259

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

Frederic Bass

The standards of ventilating practice as applied to closed rooms
of human occupancy have in the past been almost universally quite
crude. It has been determined that when the carbon dioxide content
rises above 10 parts per 10,000 in an occupied room odors will be notice-
able. With the ordinary system of ventilation in use in school rooms,
30 cubic feet of air per minute per person is necessary to secure immunity
from odor.

Many laboratory experiments have been conducted upon single
individuals which show that no deleterious physiological results are
apparent when the carbon dioxide rises to 200 parts per 10,000, whether
as a metabolic product or artificially introduced. Such experiments
have also shown that the oxygen content of the air is sufficient when
it is above 19%. Further, it has been found that air must be kept
in motion under these conditions in order to maintain comfort.

^P'EPMfl

■■

'^fljl^ll

■li

^^^^^M ^, ' ^^^^^^1

FIGURE I

26o

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

If these conclusions are sound as applied to the practical conditions
of a school room, it should be unnecessary to take air from the outside
of a building, raise the temperature from 30 degrees to 130 degrees F.
and after passing it through the room, exhaust it at the higher tempera-
ture into the outer air. The ordinary leakage through walls, crevices
and past occasionally opened doors is sufficient to provide more than
enough oxygen for respiration and to carry away the excess humidity
and bodily heat. In such a room, the air would have to be sensibly
in motion.

FIGURE 2

The writer believed it would be desirable to apply these principles
under normal school conditions, and having obtained a grant from the
research fund of the University of Minnesota, fitted out a school room
as described below.

A room was selected on the first floor of the Jackson School in Minne-
apolis. The air to be delivered to the pupils in the room was taken
in through a window in the basement and passed over two Vento radi-
ators to a Webster air washer and humidifier, thence to a heating coil,
from which the air was blown to the outlets in the room by means of
a Sirocco blower. This apparatus was loaned through the courtesy

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

261

of the Morgan-Gerrish Company of Minneapolis. The main duct
from the blower was carried along the ceiling at one end of the basement
room immediately below the room in which the pupils to be the subjects
of the experiment were located and from it three ducts were extended
parallel to the rows of desks. From these ducts, the air was carried
through two-inch risers extending through the floor to each desk in the
room above, at which points it entered the room through funnel-shaped
orifices.

Previous experiment with a single desk and funnel ventilator had

FIGURE 3

shown that with seven cubic feet of air per minute, the head and shoulders
of the pupil could be surrounded by air moving at a velocity sufficient
to carry away the breath, but still not great enough to be objectionable.
In this way it was made certain that each pupil would actually receive
the air both in quantity and quality that was desirable, and by means of
a number of openings in the ceiling, through which the air was drawn
by an exhaust fan, it was made equally certain that the exhaled air
would be immediately removed from the room.

In the preliminary experiments to determine the best type and loca-
tion of orifice for admission of air to the room, the first form experimented

262 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Upon was an elongated orifice or slit in the front edge of the desk. Fig-
ures I, 2 and 3 show views of this orifice. The funnel type shown in
Figure 4 gave a much better distribution of air and for other reasons
was much better adapted for use in a school room and it was accordingly
adopted. Figure 5 shows the school desks themselves with a jiumber
of these orifices in position. Figure 6 is a view in the basement room
below the room fitted out, and shows the heating coils, washer, blower,
regulating devices, as well as the system of pipes used to distribute the
air to the desks. In addition to the inlets at the desks, two lines of six
inch pipes, with i inch by 2 inch rectangular orifices one foot apart

FIGURE 4

were placed along the two sides of the room at a height of six feet from
the floor; approximately 50 cubic feet of air per minute was blown
into the room through these openings.

The cumbersome appearance of this apparatus is due to the fact
that the washer, blower and heating coils were loaned and it was neces-
sary to use the particular apparatus available, although it was larger
than necessary. The direct radiation in the room, the temperature
of the entering air and the temperature of the water in the air washer
were automatically regulated by thermostatic control put in by the
Johnson Service Company. The piping and sheet metal work was

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

263

done by the Waterman-Waterbury Company of Minneapolis. In
addition to the above described apparatus, an ozone generator was
installed by A. R. Willford of Minneapolis. The ozone was generated
by an electrical current at 9,000 volts. It was forced into the pipe
system by a small Sirocco fan. The ozonizer was calibrated by the
potassium iodide method. The ozone was introduced into the room
in the proportion of one part to 1,000,000 parts of air. The heating of
the room was performed by direct radiation controlled by Johnson
thermostats.

Operation. The room was supplied with about 8>^ cubic feet of
air per minute per capita and the velocity of the air as it reached the

FIGURE 5

faces of the pupils was at the center of the current about i^ foot per
second. During the period the characteristic odor of ozone was per-
ceptible in the room and apparently kept the air in an acceptable and
pleasant condition, for on one occasion the Sirocco motor-blower set
which forced the ozone into the air current was temporarily disconnected
and the teacher, now knowing what had happened, within half an hour
felt it necessary to open the windows and to call attention to the marked
change in the air.

A group of pupils in the room described was selected for physiological
and psychological tests. A control group of children of the same grade

264

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

and general characteristics of race and living conditions was selected
in a nearby school where an ordinary fan ventilating system delivering
about 30 cubic feet of air per minute was installed.

The description of the experimental work may be divided into three
divisions, as follows: (a) Physical records, including measurements
of air velocities and volumes, temperature records and humidity obser-
vations; (b) Physiological observations, including bodily temperatures

FIGURE 6

and blood pressures, and (c) Psychological tests, including division,
substitution and motor tests. The physical records and the manipula-
tion of the plant was performed by W. J. Bingen, a post-graduate student
in the College of Engineering; the physiological observations were made
by Dr. E. J. Heunnekens, and the psychological work and computation
was performed by Mr. H. D. Kitson, a post-graduate student in the
College of Science, Literature and the Arts.

The detail of the tests is given in an Appendix.

The results of this study show that the change in ventilation made
at the Jackson School produced no appreciable effect upon the work

AN EXPERIMENT IN SCHOOL ROOM VENTILATION 265

of the children in the tests with the possible exception of a slight difference
in substitution work, which may be explained on other grounds. This
conclusion is substantiated by the work of the children in the following
forms of psycho-physical activity; (i) solving problems in short divi-
sion, a task involving a high type of selective thinking and memory
processes; (2) learning to make substitutions, a task partly mental and
partly motor; (3) movement of the index finger, a strictly motor act.
In neither the division or motor tests is there indication of any effect of
change in ventilation, and the slight difference observable in the second
week's substitution work is not outside the range of chance error. The
work was examined with reference to total amount, rate of improve-
ment, and rate of fatigue, and in all these respects, except that cited
above, the work of the test group showed practically no variation
from that of the control group where the ventilation was unchanged.
Generally speaking, the results of the tests in the two groups showed
parallelism. The work in division, however, showed a very marked
divergence. The test group showed an average gain of 64% in this
test while the control group showed but 25%. This difference aroused
suspicion and an investigation showed that the test group had been
coached by the teacher. This unfortunate occurrence made it impossible
to compare the total work done in division of ^e two groups.

Conclusion. From the standpoint of the engineer, it is interesting
to know that it is possible to renew the air of a fully occupied school
room for a period of three hours (with recess period as usual) without
the use of outside air other than that which leaked through crevices and
occasionally opened doors and other minor openings, and during this
period to keep the air sweet and comfortable. It is further interesting
to know that the continuation of this form of air renewal day after day,
five hours each day (three hours and two hours) for three weeks had
no perceptible effect upon a group of school children under careful
observation by expert observers making physiological and psychological
determinations. The conditions in the room were such that the teacher
and pupils were perfectly content and satisfied at all times and unaware
of the fact that they were not being treated to the air of the street instead
of the renewed air of their own room. At one time during the test, a
small fan supplying ozone failed and the effect was noticed within a few
minutes by the teacher, who felt that the air was "stuffy," although
she had no way of knowing of the accident. Apparently in this case the
ozone alone kept the air of the room in a comfortable condition. Ozone
has an affinity for water-vapor, and if there were enough of it, humidity
might be reduced by it, but in this experiment there, was not enough
ozone to materially affect the humidity. The humidity due to evapora-

266 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

tion from the pupils may have been partially removed by condensation
on the cold surfaces of the distribution pipes in the basement and by
the air leakage from the room. /

The psychological tests were carefully planned and executed; their
value for such work cannot be doubted, for the delicacy is admirably
fitted to detect and measure the elusive effects which have been usually
described as "sense of oppression," "dullness," "restlessness," "sleepi-
ness," and others due to poor ventilation. The work done by Mr.
Kitson in analysing and arranging and correlating his observations
indicates a standard of completeness not often reached in tests of venti-
lation conducted outside of laboratory conditions, but it is the work of
a character worthy of consideration in the preparation of standard
phychological or physiological field tests.

The physiological tests made by Dr. Huennekens were quite complete
so far as they went, but circumstances made it impossible to make
blood counts or haemoglobin tests as would have been desirable. There
is undoubtedly a large, undetermined personal equation in the blood
pressure determinations. The temperature observations lead to no
valuable conclusions.

The apparatus for the experiment delivered to each child, whether
at his seat or at the blackboard, a refreshing current of cool air, with a
small quantity of ozone. The hunpdity was moderate, averaging
32.6%, as was the temperature, averaging 68.8° F. The velocity of
the center of air current two feet away from the desk funnel, or at the
usual position of the face, was one and one-half feet per second. The
oxygen content might have been low and the carbon dioxide content
might have been high, but since so many investigators have conclusively
proven that under such conditions as obtained in this experiment these
were negligible factors, these determinations were not made. There
are further desirable data that might have been taken had it been pos-
sible; the temperature and humidity of the air in the control group
would have been recorded, variations in humidity each day in both
groups, actual measurements of leakage among the physical factors,
blood counts, haemoglobin tests, conditions and environment of pupils
outside of school, histories among the physiological data, and more
extended physiological tests. A longer period of observation would
have been desirable but was impossible under local limitations.

The results show conclusively that in rooms and auditoriums only
occasionally used, such as lecture rooms, theatres, churches not sub-
jected to repeated occupancy by the same persons, the revolving and
renewing of air by proper treatment is as desirable as the use of outside
air. Outside air ducts and indirect heating coils are entirely unneces-
sary. It seems probable, too, that persons may intermittently occupy

AN EXPERIMENT IN SCHOOL ROOM VENTILATION 267

rooms ventilated by renewed air for a great length of time, certainly
for periods as long as three weeks, without suffering or even exhibiting
any effect either consciously or unconsciously.

It would seem to me that the time has come when old standards
of ventilation and methods of ventilating practice should be radically
altered. More extensive, comprehensive, complete experiments along
the lines of this limited work need to be performed, and as a tesult of
such experiments, a new science and a new practice of ventilation of
buildings should be established.

The psychological work of this investigation was done by Mr. H. D.
Kitson, M.A., and a large part of the work done and description herein
are his. Any success attained has been due to his work.

APPENDIX

Physical Records. The performance of the fans and other apparatus
had been determined previously to the beginning of these experiments
by Mr. E. J. Lewis, a mechanical engineer of Minneapolis. The dis-
tributors on the desks were controlled by means of individual dampers
so that approximately seven cubic feet of air per minute was supplied
through each. This rate was continued throughout the experiment
as well as for two weeks before. The temperature was recorded by a
Draper's self-recording thermometer and the humidity of the room was
observed each day at lo A. M. by the use of a "Hygrodeik" hygrometer
which had been calibrated. It was found that this instrument is easily
accurate to i% provided the wick is kept clean. Both instruments
were located on a shelf on an inside wall about six feet from the floor.

It will be seen from the table below that the average temperature
of the test room in the Jackson School was 68.8 degrees F. and that
the average relative humidity was 32.6% during the test. During the
first week in which psychological observations were made, the average
temperature was 68.4 degrees P., and during the latter week, 68.8° F.
The relative humidities were 35.6% and 29.8% respectively. The
highest average daily temperature recorded was 71.9° and the lowest
65.1°. The highest humidity observation was 50% and the lowest

25%.

,^The temperature at the Adams School was kept at 70°. No humidity
records were kept, but in all probability these were not materially dif-
ferent from those in the Jackson School since during the three week
previous to the first test week the humidity in the Jackson School aver-
aged 33.3% when outside air was supplied, as against 32.6% during

268

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

the three weeks when the renewed air was supplied, which would seem
to indicate that the revolving of the air did not greatly affect the humid-
ity in this experiment.

Inside

Av. Temperature

Av. Rel. Humidity

Av. for Wk.

Av. 3 Wks.

Date

Inside Outside

T. H.

Feb. 1 8

70.7

67.7

X 20

68.4

68.5

69.1

7-9

8.8

68.4

33-3

1-1 .

Mar. 3

66.8

7-5

8.6

8.5

68.5

29.8

9-3

70.

70.4

71.9

. 0.8

69.3

67.3

68.2

8.5

8.4

68.8

32.6

67.9

69.2

68.8

68.6

35-6

9-4

7.6

Physiological Observations. These included observation of tempera-
ture and blood pressure during two weeks, one immediately preceding
and the other during the last week when the air of the test room was
rotated. They were made upon ten children in the morning and ten
in the afternoon, the children being tested twice on the first test week
and three times during the second test week. Each child was tested

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

269

at the same hour throughout the five tests, the morning measurements
being made from 9:45 to 10:30, the afternoon measurements from 1:45
to 2:30. This brought them before recess and was done in order that
the measurements might not be affected by the excitement resulting
from play at recess. The average temperature of the average child
for the first week was 98.67, m. v. .32; for the last week, 98.46, m. v. .28.
The corresponding blood pressure measurements were 1 10.13 i^- v.

FIGURE IS
Ergometer in Use

5.47 and 106.25, m. v. 5.48. The temperature tests showed no appre-
ciable difference. The blood pressure readings showed a difference,
however, of 3.8 and is to be regarded as probably significant when con-
sidered in relation to the error of difference which is 1.7. If these blood
pressure tests may be regarded as a fair sample, the chances are only
about four in 10,000 that this difference is not significant. It is to be
said, however, that the blood pressure tests have a loy^ coefficient of
correlation, that for the first and second days being .54, for the last
two days, .56 using the method of unlike signs. This low correlation

270 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

casts doubt upon the reliability of these results as it indicates a pro-
nounced individual variation under the same conditions. On the other
hand, the difference is somewhat more significant in view of the fact
that the decrease in blood pressure for the three days of the last week took
place in 16 out of the 19 cases, and is in the direction opposite to and
in spite of the fact that there may have been considerable emotional
excitement due to the strangeness of the proceedings during the first
week. In spite of this, which might have tended to reduce the blood
pressure more in the first week than in the second, there is a decrease
of blood pressure in the second week, after the ventilation had been
changed.

Psychological Observations. The pupils in the room above described
were tested to determine their mental progress at the same time that
they were tested physically. It was important in the latter tests to
eliminate the effect of increased facility which would be acquired by
repetition, also to allow for fatigue which would have a tendency to
reduce the amount of work the longer it continued. In order to isolate
the effects of ventilation, the control group of pupils was chosen in an
adjoining school so that the average of the tests in the control group
would be practically the same as that in the test group. The control
group was tested in the same manner and for the same periods as was
the test group, only a week later.

It was assumed that the two groups were equally efficient in the
activities required, this assumption being based on the similarity of their
averages in the first series of tests. Both groups averaged the same
within one per cent. The work of the control group was a trifle higher
in all the tests of the first series, so the assumption was made that this
difference would remain constant, and in comparing the work of the two
groups for the second week, it was allowed for by deducting the amount
of difference. This placed the two groups on the same level at the
beginning of the second test week, and it was assumed that any devia-
tion which then appeared in the work of the test group could be ascribed
to effects of ventilation change. The tests were given on the last hour
of the morning of each day in order to have the effect of the indoor
ventilation at its maximum.

Division, substitution and motor tests were used in forms to be des-
cribed shortly. Promptly at eleven o'clock A. M. the tests were started,
ten minutes being devoted to each activity in the above order. For
the division test, each child was given a paper upon which were printed
140 problems in short division. The divisors were 6, 7, 8, and 9 used
in rotation, and the dividends contained three digits. The numbers
were so arranged that each problem came out even with two figures

AN EXPERIMENT IN SCHOOL ROOM VENTILATION 271

in the quotient. Owing to the impossibility of combining the nine
digits in such a manner as to furnish new problems each day, the same
problems were given every day. Careful instructions were given before
each of the three tests and two minute practice allowed in each one
the first day so as to permit of slight familiarity and prevent misunder-
standing of the instructions. After instructions and preliminary prac-
tice the papers were laid face downward upon the desks and the children
were told to write in the upper left hand corner date, name, age and
birthday. When all had finished, the children turned over their papers
and the signal was given to start, timing always being done with a
stopwatch. At the expiration of five minutes, signal was given and
each pupil drew a line underneath the problem he was then working.
This was done in order to furnish a means of comparing the work of the
first five minutes with that of the last five minutes.

For the substitution test a sheet of paper was given each child con-
taining the letters of the alphabet arranged in two horizontal rows
across the top. Underneath each letter was placed some number
which lay between ii and 36 inclusive. These numbers were arranged
in chance order. The rest of the paper was covered with seventeen
rows of squares, ten in a row, each square containing a numbei; and a
space underneath in which to insert the letter which accompanied
that number in the key above. The arrangement of the numbers in
the key was varied from day to day. The procedure of this test was the
same as that for division. A sample of each test sheet is attached.

The motor test consisted of the sidewise movement of the index
finger described by Bergstrom, with a modification in the manner of
holding the rest of the hand in position. It was manifestly impossible
to obtain kymographic records of the work of each child, so a simple
ergometer was devised which would be adapted to group tests and obtain
fairly accurate measures of movement against a slight pressure (the
wire agitator described below). In this ergometer, the finger is inserted
into a circular hole in a lever, which, when raised up and down, moves
a slide back and forth. This slide runs horizontally in a standard
which contains a hollow tube 5-32 inches in diameter. On top of this
standard, which is three inches high, is a round wooden bowl serving
as a hopper. When this is filled with steel balls f/g inch in diameter,
they drop down one by one into the tube and rest upon the slide to which
the lever is attached. This slide, which is exactly }/s inch thick, con-
tains a small hole just large enough to accommodate one of the steel
balls. As the slide is moved outward by the raising of the finger-lever,
it carries out the steel ball from the standard and drops it into a recep-
tacle at the side. Then as the lever is pulled down, the slide moves
back into position and another ball drops into the 3^ inch hole. The

272 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Standard is mounted on a thin base and clamped to the right side of the
desk, with about two inches projecting beyond the edge of the desk.
On the under side of the base is a small ledge upon which the middle
finger rests. The forearm rests upon the desk. At the conclusion
of the test period the receptacles which catch the balls were collected
and their contents weighed, from which it could be determined how
many times the child raised his finger the required height.

Since the balls tend to clog at the mouth of the tube, a wire extending
through the bottom of the hopper into the top of the finger-lever agitates
the balls with every movement of the finger. Where a short test is made,
however, a vertical brass tube two feet in length replaces the hopper
and the wire may be dispensed with. This arrangement affords a move-
ment that is practically without friction.

It is to be noted that the structure of the apparatus compels the
child to raise his finger to a certain height in order to have, the move-
ment counted. Every upward stroke of the lever must be high enough
to carry the slide beyond the edge of the standard or the ball will not
drop. On the other hand, every downward stroke must bring the lever
clear down to the base or the hole in the slide will not lie underneath
the hijle leading from the hopper. This regulating of the lift insures
a movement of the finger throughout a wide amplitude, and brings
about a fatigue effect which cannot be secured by only a moderately
high lift.

This instrument, though not possessing the refinements of the Berg-
strom ergograph, nevertheless lent itself very satisfactorily to the present
experiment. It is easy to adjust and easy to operate; can be adapted
to any size hand by using an*aperature in the lever farther from or nearer
to the axis of the lever. Furthermore, the element of interest is always
present — an important desideratum in dealing with children. It is
made of hard maple and can be manufactured for fifty cents.

Various modifications of method can be employed; the time can be
divided into several periods by the use of different receptacles. In
the present experiment the record of each test was divided into two
parts by the use of two differently colored boxes which were shifted at
the end of five minutes, thus securing a measure of the first five minutes'
work to be compared with that of the last five minutes.

The method of scoring was as follows: In division, every correct
solution was given a value of three. For an error in the first figure
of the quotient, two was deducted, and for an error in the second figure
one was deducted. For every example omitted, one and one-half
was deducted. Under this system of scoring the highest score attained
by any individual during a ten-minute period was 335, the lowest 10.

In substitution, every square correctly filled counted one; for each

AN EXPERIMENT IN SCHOOL ROOM VENTILATION 273

substitution omitted, one was deducted. The highest score attained
by any individual during a ten-minute period was 144; the lowest, 24.

In the motor test, scores were obtained by weighing the total number
of balls dropped by each individual and dividing by the weight of the
ball. The highest score made in ten minutes was 1093; the lowest, 123.

The tests were chosen with a view to selecting activities of as varied
nature as possible, so that there might be several chances of detecting
ventilation effects, and if they were discernible, that they might be ob-
served from several angles. That this end was attained is evident
from the comparatively low correlation of the tests with each other.
The work of the control group in division correlates with their work
in the motor test by .06; substitution with motor, by .49; division with
substitution, by .3^ (using the method of rank differences). These low
correlations show that the functions exercised by the three tests are
quite diverse. Division work requires a high type of selective thinking
and good memory for multiplication tables. The motor test measures
voluntary ability to move the finger rapidly and continuously. Success
in the substitution test requires quickness of perception and the ability
to adjust oneself rapidly to new conditions. Inasmuch as the arrange-
ment of the numbers in the key was varied every day, the child was
obliged in addition to adjusting himself to the new arrangement, to
also work against the habit he had formed the day before. All three
tests require close attention, and in the substitution and motor tests
there is opportunity for considerable economizing of effort by the gradual
elimination of useless movements.

The value of the tests as constant measures of the work of one child
relative to the work of another is indicated by the following table of
reliability coefficients, computed by the method or rank differences.

Correlations in Work of the Control Group

No. of Cases

First and second days' work in division .91 25

Fourth and fifth " " " .90

First and second " motor work .87 19

Third and fourth . " " " 89

First and second " work in substitution ,83 28

Fourth and fifth " " " 75

Inasmuch as the substitution test seemed least reliable of the three,
the first day's work in this test was compared with that of the tenth
day, and a correlation of .77 was found. These high reliability co-
efficients indicate that the tests are good tests.

A feature that commends them- for use with children is the high
interest-value they possess. The children welcomed the test-hour

274

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

with demonstrations of joy, and maintained, on the whole, a considerable
amount of zeal. A few words of encouragement and commendation
were given each day, and positive suggestion made that they do even
better than they did the previous day. At the conclusion of the first
day's work in division and substitution in each school, the children
were asked to write down which of the tests they liked better. The
preferences were as follows:

Test Group

Division 7

Substitution 32

Absent 2

Control Group
6
32
3

Individual differences in performance were great, but the extremes
were similar in each group as shown by the following table :

Division

First Week Second Week

Test Group Control Group Test Group Control Group

Lowest score 10 11 29 26

Average score 98.1 99.9 160.2 125.4

Highest score 215 242 335 309

Substitution

Lowest score 35 32 24 24

Average score 65 . 3 64 . 3 70 . i 73-3

Highest score 119 107 144 129

Motor

Lowest score 164 123 154 194

Average score 423-3 440-4 519-9 549-2

Highest score 708 784 850 1090

From this examination of the tests it appears that they are admirably
suited for measurements of work in ventilation effects. Their value
in use with groups is evident from the tendency of each child to retain
the same rank in the group in successive tests. Their value as group
tests is further shown by the similarity with which the two groups
worked as will appear in the results. In addition to the extreme simi-
larity of the averages in all three tests, there was a corresponding simi-
larity in extremes. The same test was preferred by an equal number
in each group, and the effects of practice and fatigue were almost exactly
the same upon both groups.

The tests measure functions that are quite diverse, as the low corre-
lations indicate. This makes them especially valuable in measuring
effects whose exact nature is not known. It is further evident that the
different tests also check each other as to effects of subjective disturb-
ances. It is to be regretted that the division results were injured by

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

275

interference, still the clearness with which this interference is shown,
is excellent evidence of the delicacy of the test.

After ehminating the records of all children who were absent on any
of the test days and who were thus deprived of practice, together with
one who was pronouncedly feeble-minded, and thus unable to do some
of the work, the number of records finally used out of the test group
was reduced to 28 for each division and substitution. The number
of motor records used out of the test group was further reduced to 17
owing to the fact that some of the children experienced difficulty with
their machines while others broke them. Although these were furnished
new machines, each child working steadily, still it seemed advisable to
use only the records of children who retained the same machines through-
out the tests. The control group was reduced in the same manner to
25 for division, 28 for substitution and 19 for motor. The total amount
of work done each day by the average child is as follows:

Division (Mar. 3-7) 67 . 3

Mar. 24-28 133.7

Sub., 1st week 54.

2nd week 69 . i

Test Group (Ventilation Changed)
Mon. Tues. Wed. Thur

86.8 105,5

163.7 161. 5

63.7 68.

70. 70.

109.6
161. 4

65.6

71.

Fri.
120.8
180.7

75-2
70.8

Total
490.
801.
326.5
351.

P. E.

154-
220.

54.4
64.9

Motor, 1st week Omitted 354.4 420. 459.3 468.5 1693.2 295.3

2nd week " 501 o 473.3 530.6 574.6 2079.5 304-5

Control Group (Ventilation Unchanged)

Division (Mar. 10-17) 69.5 86.0 100.6 112. 9 130

Mar. 31-Apr. 4 107.3 III. 7 129. i 139.4 I39

Sub., 1st week 52,5 61.2 68.8 66.0 73

2nd week 69.8 74.7 73.9 75.9 72

Motor, 1st week Omitted 362. i 433.0 470.7 495

2nd week.

8 1761.6 334.3
518.6 554.0 556.7 567.4 2196.7 98.8

500.
627.1
321.7
366.6

147.4

186.4

46.2

69.9

For graphic representation of results see Plates I, 2, and 3.

The curves show at a glance extreme similarity in the work of the two
groups. In view of the similarity of performance during the first week,
it is to be expected that the work of the second week will be equally
similar unless some new element is introduced. It is then in the second
week's results that one is to look for possible effects of the change made
I in ventilation.

The work of the test group differs most noticeably from that of
the control group in division. The total score made by the average
(child for the first week is 490, and for the second week, 801. This rep-

276 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

resents a gain of 64%, while the corresponding gain made by the average
child in the control group is only 25%. This enormous difference aroused
the experimenter's suspicions, and upon investigation it was found that
during the two weeks elapsing between the first and second test weeks,
the teacher had been coaching the children in short division, using as
divisors 6, 7, 8, and 9. The curve shows the results. The control
group began the second week's work in division at some distance below
the mark of efficiency attained at the end of the first week, showing
a loss in efficiency due to practice. The test group, however, began
the second week's work far in advance of the point attained at the end
of the first week, showing clearly the effect of the intervening two weeks'
practice. The occurrence of this phenomenon, while extremely inte-
resting from a psychological and pedagogical point of view, is most
unfortunate for the purpose of thfs experiment, as it thus becomes
impossible to compare the total work done in division of each group.

Inasmuch as the work of each day was divided into two five-minute
periods, it is possible to compare the two groups with respect to their
rate of fatigue. Although practice would tend to increase the amount
of work, fatigue would act in the opposite direction and the combined
effect of these two factors may be measured by a "fatigue-index" found
as follows : The total score for the week made by each child during the
second five minutes of the tests was divided by his total score for the
first five-minute periods. This was done in the case of twelve children
in each group (only that number marking the time periods according
to directions). For the first week both groups had the same fatigue-
index, .8125 m. v., .11. For the second week the fatigue-index for the
test group was .7709 m. v., .08, and for the control group, .7591 m. v., .11.
The difference is only .0018, and as its probable error is .037 it will be
seen that the slight difference is not at all significant. Thus the division
results, though not comparable en gros, nevertheless, as treated above,
show no effect of change in ventilation.

The second week's record for substitution shows a difference of 15.6
in the work done by the average child of the two groups. This difference
is in favor of the control group. It is to be noted that the difference
existing between the two groups at the end of the first week is that be-
tween 326.5 and 321.7, or 4.8. Assuming that this difference continued
in the second week, the net difference becomes 10.8. The probable
error of this difference computed by the formula P. E. of Differences =
P. E. P. E. is 17.7. The chances are even, that a difference of about
3% would occur in fifty minutes, or the chances are two out of three
that there will be some difference in favor of the first form of ven-
tilation. Since four days out of the last five tested show against the
test group under the second condition of ventilation, the chance that

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

277

it had a slight effect is somewhat increased. Subtracting the daily-
average difference between the two groups of .96, (obtained by dividing
4.8 by 5) the daily record of the last week stands as follows:

Mon. Tues. Wed. Thur. Fri.

Control Group.. 69.8 74.7 73.9 75.9 72.3 •

Test Group 69.1 70. 70. 71. 70.8

Difference .7 4.70 3.90 4.90 1.50

Subtract 96 96 96 96

Net Difference ... 3 . 74 2 . 94 3 . 94 ,54

As the difference is only two-thirds of its probable error, however,
it is not to be regarded as outside of the range of a chance error due
to the single week's sampling of the conditions.

A further comparison is made possible by computing the gain or loss
made by each individual. This is done by subtracting the total score
made by each child during the first week, from his total score of the
second week, or in case of a loss, vice versa. This shows that out of 28
children in the control group, only three actually lost, while out of the
28 children in the test group, loss occurred in eight cases. The average
gain made by those who gained is also greater in the case of the control
group, being 16%, while that of the test group was 13%. This method
of comparison is hardly justifiable, however, as it fails to take into
account the fact that the control group was slightly superior to the
other group at the start and would be expected to gain faster than the
test group.

The fatigue-index for the first week, computed for 17 children in
each group, was the same in both groups, .896 with a m. v. of .099 in the
test group average, and of .072 in the control group average. Second
week, test group .933, m. v. .15, control .883, m. v. .10. The difference
in the fatigue-index of the second week is .065. It is possible that this
difference may be significant, being a third larger than its probable error
which is .037. The fact that this difference, slight as it is, favors the
test group is hard to explain, in view of the fact that the total work
done by the control group slightly exceeds that done by the test group.
It is hardly probable that the difference in fatigue-index was not affected
in either of the other tests. The only hypothesis that offers any clue
is in connection with the peculiar habit-making process involved in
this test. It is possible that the control group, being naturally a trifle
superior to the Jackson group, were able to completely adjust them-
selves to this feature during the first week, while the other group might
still be showing the effects of this adjustment in the second week. The

278 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

true significance of this difference can be determined only by further
experimentation .

The motor records for the second week's work of the test group
shows a decided drop on the second day. As this drop is entirely out
of proportion to the rest of the curve, it is probable that some constant
error entered in — possibly a mistake in weighing the balls which record
the finger movements. Omitting the second day's work from both
records, the curves follow each other fairly regularly. The following
table gives a comparison of the motor work for the three days of each
week — Tuesday, Thursday and Friday:

Number of Movements Made by Average Child

Control Group.... Av. 1329 M. V. 291 Av. 1643 M. V. 505

Test Group 1273 257 1606 230

56 37

The difference in favor of the control group at the end of the first
week was 56. Assuming that this difference remained constant in the
second week, the net difference between the work of the two groups
for the second week is 56-37 or 19, in favor of the test group. This
difference is less than 2-ioths of its probable error (108); therefore, it
can only be attributed to chance.

The greatest difference occurring in any one day is that on Thursday
— 26. The probable error of this difference is 42. Since the difference
is only 6-ioths of the probable error, the chances are only two out of
three that there would be any difference.

A comparison of gains distributed among individuals shows a slight
average gain in favor of the test group, the difference being 24.2, but the
number of cases is so small and the mean variations are so high that the
difference can hardly be regarded as significant. The objections to this
method of comparison were discussed in connection with individual
gains in substitution.

The average fatigue-index for the first week, computed for sixteen
children in each group, is 1.016 in each group, with a m. v. of .077 for the
test group and .12 for the control group. For the second week, the
test group fatigue-index is 1.056, m. v. .15, control group, 1.060, m. v. .13.
The difference is only .004 and is only i-ioth of its probable error, which
is .045.

Thus the motor results, compared with respect to average amount
distributed gains and rate of fatigue, show no more than a chance dif-
ference between the two groups.

AN EXPERIMENT IN SCHOOL ROOM VENTILATION

279

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AN EXPERIMENT IN SCHOOL ROOM VENTILATION

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288 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SOME EXPERIMENTS ON THE VENTILATION OF A

SCHOOL ROOM

J. W. Shepherd

The best ventilation for a school building is that which most nearly
duplicates outdoor ventilation. Our own experiences, together with
the experifences of past centuries, warrant our approval of outdoor air
for breathing purposes.

It is much easier to commend outdoor ventilation than to point
out the factors and conditions that produce it. Does the mere move-
ment of air outdoors, over an area in which one is at work or in repose,
suffice for ventilation? Or does the rate of movement, or the change
of rate, or the change in direction of the movement, afifect the result?
Does the fact that most air movement is parallel with the earth's
surface instead of vertical to it, make for better health conditions?
How far is our opinion of outdoor ventilation influenced by the fact
that one is usually in greater muscular activity outdoors than indoors?
Finally, how can we discriminate between those outdoor agencies that
produce good ventilation, and other outdoor agencies that also make
for good health, for example, sunshine? These questions and other
kindred ones become significant if we attempt to make indoor ventila-
tion as good as outdoor ventilation.

Beyond doubt, our belief in outdoor ventilation dominates the prac-
tice in what, at present, we are calling open-air schools. Moreover,
almost all are agreed that wherever feasible this type of schoolroom
should come into general use. Personally I am thoroughly in sympathy
with the open-air-school movement; however, I am convinced that in
cold climates we must provide for closed schoolrooms. Instead of going
outdoors in order to circumvent our difficulties in procuring proper
ventilation, we must meet the issue squarely to the end that in cold
weather we shall provide our closed schoolrooms with outdoor condi-
tions of ventilation. The establishment of these conditions seems to
me to be a problem for our generation.

Not longer ago than a generation or two, the ventilation of a school-
room or building was of little concern. In those days we were unable
to build as well as at present. In cold winter weather the windows
rattled and cold air swept under and above the doors, and sifted in
around the windows. Through imperfections in construction, winds
helped freely to ventilate all kinds of buildings. The methods of heat-

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 289

ing school buildings also were different from those in use at present.
Stoves and open hearths were used in the earlier days. The combustion
of fuel within the stoves or open hearths necessitated a change of air
within a room or building. Moreover, this change of air was supplied
from all parts of the room, which fact within itself meant also the venti-
lation of the room. In the days when heating* was done entirely by
fireplaces of stoves, a supply of fresh air was necessary for the burning
of the fuel, and there was abundant leakage of air around the poorly
fitted windows and doors. To-day, as a rule, the fuel is not consumed
within the schoolroom, and therefore there is not the constant demand
for fresh air to enter the rooms for heating purposes; moreover, we now
have devices to prevent leakage around windows and doors. In the
ventilation of a school building to-day, therefore, we must purposely
provide openings through which air enters the room and also openings
through which it leaves. And in addition to these openings, we must
provide a means for forcing air into, through, and out of the room.

Mechanical systems of ventilation have necessarily come into being
because of the improvement in the construction of buildings and the
heating of rooms with other means than stoves and fireplaces. There
are two general systems of mechanical ventilation, and all others are
but modifications of one or both of these. The two systems are known
by contrast as the Plenum system and the Vacuum system. In the
operation of the Plenum system, the air in the rooms is kept under a
pressure somewhat greater than the atmospheric pressure outdoors,
and therefore is more dense. In the operation of the Vacuum system,
the air within the rooms is somewhat less dense than that outdoors.
Large fans are generally used in producing the increased pressure of the
Plenum system or the reduced pressure of the Vacuum system. In
both systems of ventilation it is necessary to have a circuit through
which air from outdoors is compelled to travel.

I shall briefly describe the Plenum system because it is the one with
which I began my experimental work. To begin with, it should be
understood that the Plenum system is both a ventilating system and
a heating system, the idea being that a room is heated with air which
subsequently is breathed by its occupants. The equipment for this
system is substantially as follows: There is a central room at least
as large as a schoolroom, which is known as the Plenum chamber or dis-
tributing chamber, and from which air for ventilation and heating
is distributed throughout the building. From this distributing chamber,
inlet ducts lead to all the rooms in the building, and deliver the air
into the rooms near the ceilings. All these rooms are also provided
with outlet ducts near the floor line, and these ducts lead to air shafts
connected with outdoors. Air is brought into the large central dis-

290 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

tributing room from outdoors, being drawn in and forced in by means
of a large fan. The fan is installed between a large outdoor intake or
screened opening and the distributing chamber. Between the fan and
the distributing chamber are banks of steam coils for the purpose of
heating the air before it is delivered into the distributing chamber.
In the latest improved Plenum system, this central air chamber is
divided into an upper and a lower portion, or compartments. The
upper one of these compartments receives hot air, and the lower one
temperate or cool air. The ducts that lead to the various rooms are
all connected both with the hot and cool air compartments of the dis-
tributing chamber. All ducts leading from the distributing chamber
are provided with dampers by means of which the relative air supply
for the various rooms is controlled. The temperature of the mixed
air is delivered into the rooms from the two compartments, is under
the automatic control of thermostats in the rooms.

The quantity of air delivered into the various rooms by the Plenum
system depends, most largely, on the area of the ducts and the speed
of the fan. Roughly speaking, the idea in the Plenum system of venti-
lation within a room, is that heated air distributed to the rooms at the
ceiling gradually cools, and in so doing settles down into the breathing
zone, and is then forced down to the floor and out by the fresh heated
air that is constantly being forced in at the top of the room. This view
seems satisfactory to most heating and ventilating engineers, and there-
fore the emphasis, in the ventilation of a building, is placed by them
on the quantity of air delivered by this system. In other words, venti-
lation, until very recently, had come to mean the delivery to and the
removal from a room of a certain volume of air per unit of time.

The public school buildings of Chicago are equipped with the Plenum
system, and during the last three years I have made something of a study
of, and with, this system. My study has been made within a building
of rather recent construction, and, therefore, equipped with the latest
ventilation devices. Just here may I say that I know of no better
system of mechanical ventilation than that with which I began my
study.

Quantity of Air. My first tests were made on the quantity of air
delivered in unit time per pupil in a number of rooms in the main build-
ing of the Chicago Normal College. Anemometer readings showed a
linear velocity of from 600 to 650 feet per minute, which meant at least
thirty cubic feet of air per minute per pupil, counting forty as the number
of pupils per room. From the tests made, it seems that a sufficient
volume of air is delivered to and removed from our schoolrooms for
adequate ventilation. There remains, however, a closely related ques-

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 29 1

tion, namely, whether or not the air within the rooms acts as a unit
or whether, perhaps, there may be currents of air within the rooms.

Distribution of Air. I made a study for air currents in two rooms.
One of these rooms is about 25 feet square with a 13-foot ceiling, and
contains one inlet duct and a single outlet duct. The other room is
26 by 45 feet with a 13-foot ceiling, and contains two inlet ducts and two
outlet ducts. All four of these ducts are installed in the same wall,
the inlet ducts above, and the outlet ducts near the floor. In all instal-
lations it is the practice to locate the inlet and outlet ducts on the same
wall, so as most nearly to insure a circulation of air throughout the room.
The tests on air currents were made under my supervision by a class
of manual-training students (boys) who were graduates of technical
high schools, and the work was done as part of a required course.

Two devices were used in making the tests. Toy balloons were
inflated with hydrogen gas and counterpoised in the rooms by means
of improvised weights. Small turbine wheels, also were used. These
were made from aluminum, cork and steel needles, and were especially
constructed for these tests. The blades of the turbines were made
from aluminum and set into hubs of cork. Across one end of a cork
hub and parallel with the plane of the blades, was fastened a strip of
aluminum containing a slight indentation in which the pivot of the
device turned. The fine point of a steel needle served as a pivot, and
when ready for use the turbine revolved in a horizontal plane. These
turbines were very sensitive to vertical currents of air; in fact, they
respond to convection currents from the heat of one's hand. The
counterpoised balloons were useful in tracing all air currents, irrespec-
tive of their direction, whereas the turbine wheels could be used only
in testing for vertical currents.

I shall now speak of the tests within the two rooms heretofore men-
tioned. The smaller room, 25 by 25 feet, has an east exposure. The
other walls of the room have no immediate contact with the outdoors.
The inlet and outlet ducts in this room are installed in the north wall,
and the air enters the room with a velocity of about 650 feet per minute.
When balloons were pushed into the entering current, they were hurried
across the room near the ceiling to the south wall. From the ceiling
at the south wall the balloons usually took one of two general courses,
depending largely upon the outdoor weather conditions. If the out-
door temperature was low and the wind was blowing directly against
the windows, then the balloons moved over to the outside wall, down
the wall or windows, and over to the outlet duct. If the outdoor tem-
perature was moderate, then instead of the balloons crossing over to
the outside wall, they were likely to poise in the southeast corner of the

292 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

room, or possibly move vertically down along the wall opposite the
inlet duct to within a foot or two of the floor, and then over to the outlet
duct. It was very noticeable that air currents established themselves
in aisles and other open spaces along the floor. During the winter
season the turbine wheels, when placed on the window ledges, revolved
almost all the time. Their direction of rotation indicated the downward
movement of a sheet of cold air; moreover, this sheet of cold air was
very perceptible to anyone seated near the outside wall or windows.
It might be said just here that in planning an installation, it is desirable
to have the hot air delivered across the room to the outside wall, in order
partially to overcome the influence of wall and window chill. This
plan of installation could not be carried out in the room just mentioned.
The larger of the two rooms, 26 by 45 feet, is a northwest corner
room. It has about twice as much exposure on the north as on the
west side. As already stated, there are two inlets and two outlets
in this room, and they are located in the long inside wall. The velo-
city of the incoming current of air was practically the same as in the
smaller room. Anemometer readings showed an adequate supply of air
for good ventilation. Balloons placed in the incoming current were hur-
ried across the room to the opposite wall, the outside wall with the
north exposure. After reaching the outside wall, they almost always
went vertically downward to within a couple of feet of the floor; then
they moved over to the outlets near the floor and almost directly under
the inlets. The hot incoming air driven against the cold outside north
wall and windows, reduced the influence of wall and window chill. But
in cold weather, especially with a north or northwest wind, a downward
moving sheet of cold air was very noticeable. The small turbine wheels
revolved constantly in cold weather when placed upon the window
ledges or near the exposed walls. In the central part of the room, that
is, between the two sets of inlet and outlet ducts, the balloons did not
show perceptible air currents. Furthermore, there seemed to be eddies
in close proximity to the currents at either end of the room. From
the evidence obtained in the use of the balloons and turbine wheels,
I concluded that air within our schoolrooms did not act as anticipated
in the Plenum system. My experiences throughout my experiments
have convinced me of a rather paradoxical view, namely, that the thing
which makes mechanical ventilation possible is also the thing which
makes it difficult to obtain. I refer to the fact that currents are very
easily established in atmospheric air, and it is the control of these cur-
rents that makes ventilation difficult.

Individual Supply of Air for Ventilation. My first constructive
effort in the ventilation of a schoolroom in which the Plenum system

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 293

had been installed, was an attempt to supply each pupil with his por-
tion of the fresh air admitted to the room. I wanted first to deliver
the air into the room near the pupils and secondly to take advantage
of convection currents produced by the pupils.

One of the regular schoolrooms in the Normal College was set apart
as an experimental room. This room is 24 by 32 feet, on the basement
floor, and has a west exposure. The room had a 13-foot ceiling. In the
original installation for ventilation, air entered the room near the ceiling at
the center of the east wall. The main air current was across the room
from the east wall to the west (outside) wall, then down the cold outside
wall, and back to the outlet duct near the floor in the east wall. The
changes made in the room were as follows: First, the outlet, near the
floor, was closed; then an air-tight false floor was built about eighteen
inches above the regular floor of the room, and a false ceiling was hung
about eight inches below the room ceiling; then an air shaft was con-
structed to connect the inlet duct of the original installation with the
air reservoir between the floors. The outlet duct was tapped near
the ceiling connecting it with the compartment between the ceiling
and the false ceiling. Three-inch circular holes were cut through the
false floor, and galvanized iron pipes, fitted into these openings, led
up under each desk to within an inch of the desk bottom. Openings
also were made through the false ceiling so that air delivered into the
room might move on through it. It will be noted that these changes
turned the operation of the Plenum system upside down. Instead of
the air entering at the ceiling and leaving near the floor line, this new
scheme delivered the air below the floor, and outgoing air currents left
the room at the ceiling. As already intimated, the idea in this scheme
was to furnish a positive distribution of air to all the pupils within the
room and also to take advantage of the heat liberated by them in .the
production of upward moving currents. The new installation was
tested in two ways: (i) Simple tests were made with anemometers
placed at the edges of the desks. Every test showed an up current.
(2) A more striking test than the one with the anemometer, and one
as fully convincing, or even more so, was a chemical test made with
ammonia and an indicator known as phenolphthalein. This chemical
test was made as follows: Linen strings were stretched over the rows
of desks at the height of the breathing zone for children seated at the
desks. Upon these strings, at intervals of ten or twelve inches, were
hung pieces of unsized paper made wet with an alcoholic solution of
phenolphthalein. When the room was thus dotted over with these
wet papers, it looked much like a laundry drying-room flecked with
white. Before the wet papers had time to dry, a handkerchief, made
thoroughly wet with concentrated ammonia water, was hung in the air

294 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

duct leading from the Plenum chamber, or distributing room, to the
experimental room. Within two minutes after hanging the handker-
chief in the duct, every paper on the linen threads in the experimental
room became red in color. When ammonia is added to a colorless
solution of phenolphthalein, the solution becomes red; therefore, the
change in the color of the papers was conclusive evidence that ammonia
from the handkerchief had been distributed to every piece of paper
wet with the alcoholic solution. The test was repeated at another
time with the same result. Still another test was made which contained
an added feature. In addition to the papers suspended in the breath-
ing zone over the desks and seats, others were hung on strings stretched
parallel with those over the rows of desks about seven feet from the floor,
but directly over the aisles. In this test all the lower paper reddened
in approximately the same time as before, and the upper ones reddened
soon thereafter. These tests are conclusive evidence that the air in
the experimental room is delivered to each desk, and that the movement
of the air in the room is upward, and quite uniformly so. Moreover,
anemometer tests made at the outlets of the galvanized iron tubes
before the desks were placed, .showed that each tube delivered approxi-
mately the same volume of air in unit time.

The Experimental Room Becomes a High School Room. As soon as
the before-mentioned changes in the experimental room had been made
and tested, the room became a regular high school room, in use through-
out the day. In our high school it is customary for classes to change
rooms for different recitations and, therefore, the experimental room
was occupied by different classes each hour. This arrangement added
somewhat to the difficulty of our experiments.

Source of Contamination in Respired Air. As soon as the pupils
became accustomed to the room, tests were made to determine the degree
of contamination of the air within the room. The amount of contamina-
tion due to expired air was determined by chemical tests for carbon
dioxide as an indicator. A large number of such tests were made.
The director of the Municipal Laboratory of Chicago and one of his
chemists helped to make the tests. Samples of air were taken from
the breathing zone of the different classes, and the amount of contam-
ination indicated was always well within the limit of safety. This
limit is generally considered as one- tenth of i%.

It is generally considered that the percentage of carbon dioxide in
an occupied room is only an index of the harmful agencies present,
and that the farbon dioxide itself is comparatively harmless. I am of
the opinion that the injury resulting to an individual from breathing

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 295

expired air, is due in the largest degree to inhaling air expired by others,
and not from that expired by himself. The reason for this opinion
is that exhaled air comes from an organism in which healthy tissues
function normally in their own more or less toxic, surroundings. Except
for the impurities already in the air supplied for breathing purposes,
exhaled air can contain only those things which were present in the
exhaling organism, and also in greater dilution than in the organism
itself. Experiments have shown that under certain conditions one
may live comfortably in an atmosphere highly contaminated with expired
air when the contamination is due only to the respiration of the indi-
vidual himself.

If my belief is well founded that the greatest injury from breathing
respired air comes from cross-contamination, then it is highly significant
to note that the installation in the experimental room is such as to min-
imize the possibility of pupils breathing air that has been breathed by
others. This is due to the fact that the air is delivered under each desk
and then is moved upward to the ceiling instead of being blown across
the room or of depending on diffusion or convection.

A Requirement for Ventilation. However satisfactory the quantity of
air furnished for the ventilation of a room, and however satisfactory may
be the means employed for properly distributing it, both of which in the
long run are very important, nevertheless the human body makes an
immediate demand which may overshadow either or both. Immediate
physical comfort is the standard of the human body, whatever the conse-
quences, as exemplified either in the drowsy stupor that descends on
one immersed in a hot, stifling atmosphere on a cold, wintry night,
or in the quiet repose that comes from a balmy summer breeze outdoors.
I want to insist that good ventilation shall produce immediate comfort.

One of the most prominent as well as immediate factors in the pro-
duction of comfort, is temperature, and therefore a study was made
to determine the best temperature for a schoolroom. The comfort
of the human body is largely influenced by the temperature of the sur-
rounding air, and also, at the same time, by the rate at which perspira-
tion may evaporate into the air from the body. Relative humidity
influences the rate at which such evaporation occurs, but it is only in
recent years that much consideration has been given to atmospheric
humidity in relation to temperature and comfort.

Temperature and Humidity in Relation to Comfort. It has become
traditional in this country that the best temperature to maintain in a
room is 68 to 70 degrees. There are, however, some' who urge that
these temperatures are too high, and they cite the English practice of

296 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

59 to 62 degrees as evidence of their claim. The difficulty with both
these positions is that in deciding on the best temperature, proper con-
sideration is not given to relative humidity. Any adult knows that
sultry days are much less comfortable than days of even higher temper-
ature when the atmosphere is comparatively dry. This well-known
fact of outdoor experience must be taken into account indoors, especially
since it is now recognized that in cold weather we need to humidify
air indoors. On this point of humidity may I say that the human
organism seems to be adapted to a large range of relative humidity,
but it is not accustomed to abrupt changes such as one might experi-
ence on a cold day in passing from the outdoors into a heated room.
In a word, it seems important from a standpoint of health and comfort
to maintain a fair degree of correspondence between the relative hu-
midity outdoors and indoors.

I want again to insist that any system of ventilation, to be practi-
cable, must produce a feeling of comfort, and therefore both the temper-
ature and the relative humidity of the air are important in ventilation.
Temperature and relative humidity jointly help determine comfort.

It has generally been considered that a temperature of from 68 to
70 degrees with a relative humidity of 70%, is a most desirable condi-
tion to obtain (the 70% relative humidity also is largely traditional).
In our tests it was assumed that the best temperature may or may not
be 68 to 70 degrees; and also the most satisfactory relative humidity
may or may not be 70%.

Our experimental room was equipped with an automatic temperature
control, and also an automatic humidity control. Moreover, the tempera-
ture in the different parts of the room was determined by standard
thermometers, and the relative humidity in the different parts of the
room was determined by means of a sling psychrometer. For the most
part, the tests on relative humidity and temperature in relation to com-
fort, were made by myself and a graduate student from the University
of Chicago. Frequently individual high school pupils in the room
were asked whether or not they felt comfortable, and in each case the
pupil answering did not know that any other pupil had been asked.
The teachers in charge of the room also were asked for opinions. All
these opinions, together with our own, served as a basis for record.

Before working very long, it became evident that there was a tem-
perature and humidity range within which the occupants of the room
were comfortable, and this range gave rise to what I have called the
Comfort Zone. This term, comfort zone, means that there is a maxi-
mum temperature with a minimum relative humidity, and a minimum
temperature with a corresponding relative maximum humidity between
which limits the occupants of a room are comfortable. In other words

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 297

there seems to be no best temperature and also no best relative humidity ;
but the maximum temperature at which one is comfortable will be
associated with a minimum relative humidity, and the minimum tem-
perature for comfort will have associated with it a maximum relative
humidity. Under the conditions with which we were working, we
found that a temperature of 64 to 70 degrees with a corresponding rel-
ative humidity of 55 to 30%, seems to be the limits; that is, the comfort
zone for us lies between 64 degrees and 55% and 70 degrees and 30%.
It is worthy of note that with a temperature below 67 or 68 with a
proper relative humidity, the pupils were better able to give attention
to their work than if the conditions were otherwise.

COMFORT ZONE

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C/ean ^ir for Ventilation. In the ventilation of a schoolroom, one
should give careful consideration to the source of air supply and also
to dust from the floor. The reason for this is obvious. Late in the
autumn of 191 1, some experiments were undertaken to determine what
extent the air for ventilation in the experimental room was contaminated
with dust from the floor. It was thought that air blown close up under
the desks probably would bafHe the dust stirred up from the floor. The
experiments done at that time were too few in number to warrant a
conclusion, but it is the intention during the coming autumn and winter
to complete the tests. The tests will be made, as were the earlier ones,
by bacterial counts on exposed culture plates.

Outside Wall and Window Chill. The problem of how to prevent
outside wall and window chill from seriously interfering with ventila-
tion, has never been satisfactorily solved.

298 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

With the change in installation in the experimental room, it was
necessary to make some provision for preventing a sheet of cold air
from falling down the exposed wall and windows. We tried to do this
by installing steam pipes along the window casings just in front of the
windows. The idea in this installation was to induce convection cur-
rents around the windows, and in this way prevent the downward
currents of cold air. Tests were made of the scheme in two ways: (i)
By the use of small turbines it was found that down currents of air
were established from a few inches to a foot or more above the hori-
zontal steam pipes. A second method was that of getting temperature
readings at different heights from the floor in the aisle between the
desks and the outside wall. These temperature readings showed a
variation from almost nothing to eight or ten degrees, between the floor
and the top of the desks. During the very severe weather of Jan-
uary and February, 191 2, it became evident that this installation was
only partially satisfactory. When the outside temperature was ten
or more degrees below zero, there was a cold current of air that spilled
out from the window over the top of the heating pipes above the window
sills. This fact led to a proposed installation to overcome the window
chill in another way — by means of a sheet of hot air. This new instal-
lation will be tried during the coming winter.

The Humidity Factor is a Serious One for the Plenum System. As
already stated, the Plenum system combines the heating and the venti-
lating of a building. The heating is accomplished by means of heated
air which subsequently is used for ventilation.

My experimental work has determined that the amount of air neces-
sary for heating a building in cold weather, is greater in quantity than
that necessary for ventilating. This fact becomes significant when rel-
ative humidity is taken into account. In order to increase the relative
humidity within a room, it is necessary to evaporate water into the air.
Whatever the source of this moisture, it entails expenditure of energy
which, of course, costs money; and since it is best in our climate to have
a fairly humid atmosphere in which to live, it becomes a question of
considerable importance from the standpoint of economy as to whether
or not it is best to allow the heating and the ventilating of a building
to remain combined. Air need not be humidified for heating purposes.

Aside from the standpoint of cost, there is also involved the debate
able question of whether or not one should breathe air soon after it has
been heated as hot as it is necessary when used in the Plenum system.
Physicians are not agreed upon the point, and therefore it seems desir-
able to avoid it, especially when it may be avoided without additional
cost — probably at less cost.

SOME EXPERIMENTS ON THE VENTILATION OF A SCHOOL ROOM 299

Air Washing and Relative Humidity. Wherever foul air only is
available for ventilation, the very important and vital matter of air
washing may readily take care of adding humidity to the air. I have
done nothing on the problem of air washing.

Our Next Move. We now propose to s^eparate the heating of our
experimental room from the ventilating insofar as they seem to impair
the efficiency of each other. The scheme in brief is this: We propose
to heat the room by means of hot air circulated under the floor, some of
which will be allowed to escape through proper openings under control
along the outside wall and windows, and thus force a thin sheet of hot
air vertically upward. This thin sheet of hot air is for the purpose of
destroying outside wall and window chill.

The ducts for ventilating the room will remain substantially as they
now are except that the supply of air for breathing will be independent
of that for heating; undoubtedly this will mean a lower temperature
of the air for breathing purposes, and also will necessitate a minimum
of moisture for properly humidifying the air for breathing.

The experimental room is now being fitted out in order to make tests
along the line just indicated, during the coming winter.

Acknowledgment. I wish now to acknowledge my indebtedness to
the Board of Education of the City of Chicago; the Department of
Health, City of Chicago; also to the other members of the Chicago
Commission on Ventilation. Without assistance from these various
sources, I could not have carried out my experiments.

Finally the idea toward which all my experimental work is directed
is that of keeping the schoolroom sufficiently warm to be comfortable
to its occupants, and at the same time furnish them, for breathing pur-
poses, with an individual and adequate supply of fresh, clean, cool, humid,
moving air from outdoors.

300 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE PHYSIOLOGIC COST OF INSUFFICIENT
PROTECTIVE CLOTHING

G. W. FiTz

There is perhaps no subject of such constant and vital interest,
on which there are so many opinions vigorously supported, as that of
clothing. As what we wear is a matter of daily choice, that we may
adapt ourselves to the vagaries of weather and climate, and as each
individual considers himself the ultimate judge of what constitutes
comfort for himself under these varying conditions, the subject is of
necessity clouded by a mass of personal, unscientific, more or less hap-
hazard' opinion. The chief popular attempt to mould this opinion
has been made, not by hygienists nor by physicians, who are as rarely
consulted upon this subject as upon the family diet, but by the manu-
facturers of special fabrics, who have bombarded the public with cleverly
constructed statements of the vital superiority of their particular pro-
ducts. As a result of this, there are to-day a number of clothing cults,
supported by this quasi-scientific commercial literature, advocating
the exclusive use of wool, silk, cotton, or linen, in knit, mesh, or other
form of weave, and in varying weights.

In an attempt to analyze and explain the various features of per-
sonal comfort involved in these dififerent materials and weaves, and to
establish the functions of clothing, certain physiologists, notably Rubner,
have made elaborate experiments. They conclude that the essential
features of ideal underclothing lie in its ability to remove moisture rapidly
from the surface of the body and, at the same time, to delay its evapora-
tion at the outer surface of the clothing, in order to avoid chill. The
ideal underclothing must further be sufficiently porous to give adequate
ventilation to the surface of the body and must contain fibres sufficiently
elastic to give a large air and moisture capacity, which they must retain
even when wet, thereby avoiding clinging to the skin and loss of ven-
tilation.

The material which in cool weather best meets these requirements
in underclothing, they found to be that which Nature has developed
in various forms, in her vast experimental laboratory, expressly for the
protection of animal life, namely hair or wool; and its mode of manu-
facture to be the so-called tricot, or knit, weave. The objection to the
practical use of wool which they recognize, is its first cost and its liability
to be quickly ruined by shrinking when washed.

PHYSIOLOGIC COST OF INSUFFICIENT PROTECTIVE CLOTHING 3OI

Next in value to wool, they found silk, which, although somewhat
inferior to wool in certain characteristics, has the advantage of being
an extremely agreeable and smooth fabric, which is not at all irritating
to sensitive skins. The insurmountable objection to its general use
is its very high initial cost and its lack of durability in the knit weave.

Cotton proved to be next in value to wool and silk. Cotton fabric,
however, is somewhat deficient in the essential characteristic of elas-
ticity of fibre. Therefore, when used as underclothing, it has an inferior
air and moisture capacity, and fails, even when dry, to conserve the
body heat to the same degree as wool. When moist, its inferiority is
considerably increased by the softening of its fibres and the consequent
reduction of its air and moisture capacity; the ventilation of the skin,
to which it tends to cling, is reduced, at the same time that the rapidity
of evaporation from its outer surface is decidedly increased. The heat
of the body is thereby dissipated so rapidly that chill often results.

Linen was found to be still less desirable than cotton, since it favors
an even more rapid evaporation of the body's moisture and thereby
greatly predisposes to chill.

The desirable weave for all of these materials, when used as under-
clothing, was proved to be the tricot or knit, because of the added elas-
ticity and porosity it imparts to the fabrics. In the case of cotton,
this weave contributes a firmness which somewhat lessens its tendency
to cling to the skin and to lose its porosity when moist.

The open mesh weave Rubner found objectionable in direct propor-
tion to the size of its holes, since it reduces the fabric's ability to absorb
and remove from the skin its excess moisture.

We naturally turn from the conflicting and confused opinions of
the laity with their vagaries of habit and standards of immediate per-
sonal comfort, and the conclusions of the physiologists, which are based
largely upon the physical characteristics of clothing in their relation
to the heat regulation of the animal body, to the experience of physicians,
based upon the observation of the influence of clothing upon health.
In this, we naturally expect greater unanimity of opinion through the
generalization and elimination of individual peculiarities and the for-
mulation of a consistent standard of clothing use from the standpoint
of health.

Being unable to find any satisfactory expression of such medical
opinion, I sent a questionnaire to several hundred of the most prominent
medical practitioners of America, selected chiefly from Cattell's Ameri-
can Men of Science. Rather more than a hundred replies were received.
Of these, forty odd, while expressing great interest in the subject, frankly
acknowledged total ignorance of it, and admitted an attitude based
wholly upon personal predilection, since they had paid no attention

302 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

to the clothing habits of their patients. More or less complete replies
were received from about sixty, and have been tabulated on the basis
of positive statement only. Of these, thirty-six agreed that personal
comfort was a guide to the kind and amount of clothing required.
Thirty-four stated positively that cold hands, feet, nose and ears were
reliable signs of insufficient clothing, barring the presence of chronic
cardiac or other causative disease. Only eight considered cold extrem-
ities consistent with adequate clothing and normal health. Other
criteria suggested by a few were general health, resistance to disease,
weight, and reaction to cold.

In the selection of materials for clothing, although there was not
complete unanimity of opinion on the part of those who committed
themselves, wool led by more than five to one in its favor. Twenty-
seven claimed that at all ages in cool climates wool was a necessary
protection. Only five claimed that it was totally unnecessary. Twenty-
five considered it essential as underclothing, especially in childhood;
twenty-eight considered it also essential as underclothing for old age.
Twenty-seven made it essential as outer clothing for all ages. As a
more or less complete substitute for wool in underclothing, sixteen favored
cotton, three specifying cotton mesh; seven favored linen, four speci-
fying linen mesh; nine favored silk; eight favored mixed wool and cotton.

In reply to the question as to the hygienic safety of .the present
light weight winter clothing for women and children, thirty-seven con-
demned it as unsafe; four were in doubt; eleven approved of it. Among
the deleterious effects stated to have been observed were an increased
tendency to colds and minor illnesses, poor sleep, lowered intellectual
efficiency, decreased growth and development. Twenty-two expected
from it decreased, while two expected increased, resistance to disease.
. In choice of room temperature, greater unanimity of opinion was
apparent, in that only one called for a temperature above 73° F., whereas
forty -one chose a range of 65° to 70°, with a marked tendency in favor
of 67° to 68°. The remaining eighteen were non-committal, with the
exception of four who thought higher temperatures at times necessary,
unless the great dryness of indoor winter air was neutralized by addi-
tional moisture.

The following diseases were recognized as having, in their experience,
been associated with inadequate protective clothing: Bronchitis, by
30; nasal catarrh, by 27; pneumonia, by 26; pleurisy, gastro-enteritis
and rheumatism, by 22; nephritis and tonsilitis, by 19; tuberculosis, by
18; middle ear and antrum inflammation, by 16; catarrhal jaundice,
gastritis, rheumatoid arthritis and imperfect nutrition, by 14; retarded
growth, by 13; dyspepsia and neurasthenia, by 10; osteo-arthritis and
villous arthritis, by 8. Thus many physicians are seen to recognize

PHYSIOLOGIC COST OF INSUFFICIENT PROTECTIVE CLOTHING 303

as results of underprotection by clothing, not only acute catarrhal
troubles, but also remote and essentially chronic, organic, joint and
nervous ailments, which, in their inception, may in no wise affect the
individual's immediate sense of comfort and against which he may not
therefore guard himself.

A large proportion of the prominent physicians who replied to my
questionnaire would thus seem to be in agreement with the findings of
the physiologists, that wool is the superior material for clothing and that
it is a necessary safeguard of health.

Their conclusion would appear to be borne out by the practical
experiences of men in the more trying branches of labor, where disa-
bility is quickly shown, as firemen on steamships and workers in found-
ries and other places in which perspiring men are exposed to cold drafts
of air. I remember, for example, a foundryman coming to my clinic
with a markedly painful spinal osteo-arthritis, who, when questioned
as to his habits of clothing, replied that, when he went into the foundry
the workmen all advised him to wear wool underclothes and warned
him that otherwise his back was sure to become crippled. Because of
poverty and a large family, he wore heavy cotton instead, with the
result of being permanently incapacitated for heavy work at the end of
a few years. This is only one of many instances which have come under
my observation and have convinced me of the casual relation between
inadequate protection by clothing and remote ailments of rheumatoid or
arthritic type, which are not generally recognized as being thus associated.

The deleterious effects of inadequate clothing are not confined to
adults. There is a type of child, poorly nourished and generally under-
developed in strength and endurance, with poor appetite and constantly
subject to minor ailments, who is popularly diagnosed as having poor
circulation because of habitually cold extremities. We often see in this
class marvelous improvement as a result of changing to wool under-
clothing, sufficient in amount to keep the hands and feet warm. Un-
fortunately, the change is often attributed entirely to the tonic medi-
cine which the doctor usually gives at the same time.

Many persons, especially women, are content to go through life
with cold extremities, accepting the popular verdict of poor circulation,
because they experience no particular discomfort, on account of the
essential exhaustion of the terminal sense organs of cold in the extrem-
ities. In this class, we frequently find developed, usually after the
years 30 to 35, many cases of painful joints, especially of foot, ankle,
knee and hand. The joints, on examination, frequently show distinct
enlargement, that is, are osteo-arthritic in nature. In some, the enlarge-
ment is very slight and its sensitiveness greatly in excess of that seem-
ingly w^arranted by the physical condition. We find further many cases

304 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

of nervous irritability, ranging from the ''nervous stomach" to distinct
and painful neuritis of persistent type.

This multitude of cases, such as painful joints in women and chil-
dren, colic, especially in young children, nervous states seemingly ob-
scure in their origin, malnutrition, sleeplessness, general irritability,
and neuritis, which are ameliorated or even cured by a change to warmer
clothing, constitute a mass of positive evidence which no amount of
personal prejudice or negative experience would seem competent to
overthrow. Negatively to argue that dozens of people are seemingly
able to maintain their normal equilibrium for years in spite of inade-
quate clothing is far from proving either that they may not later pay
with years of suffering, or that dozens of others do not pay earlier in life.
It is the argument used to prove alcohol incapable of harm, because
some drunkards live to be eighty.

That notwithstanding this positive evidence, there yet exists to-day
so much ignorance and conflicting opinion on the subject of underpro-
tection by clothing and its physiological cost (it will be remembered
that out of over one hundred prominent physicians, nearly half ex-
pressed their ignorance of the subject) is undoubtedly due to our failure
carefully to study the etiology of chronic diseases, and, especially, to
get adequate histories of the clothing habits of our patients. The situ-
ation is now further complicated by the great emphasis being laid upon
the stimulating effect of cold and the miracles it performs, with the
result that we are in danger of being swept off our feet in our indiscrim-
inate use of this powerful agent. We are in danger of forgetting that,
like most so-called stimulants, it has another and antagonistic side.
Brief applications of cold, especially when alternated with heat, are
marvelously stimulating to the nutritive processes and nerve control
of the body. They train its heat-regulating apparatus to broaden the
range of safe exposure to variations of temperature, and under such
training, the body unquestionably becomes better able automatically
to protect itself.

This use of cold as a stimulant and trainer of the automatic processes
of the body is, however, a very different matter from the keeping of any
part of the body constantly at a temperature below the normal of
98.5° F. Under these conditions, the delicately controlled heat-regu-
lating mechanism at once acts in defense of the vital organs by par-
tially excluding the blood from the extremities where it is being over-
cooled. The result is that the tissues of the extremities are kept in a
state of anaemia and chill. This means in a certain percentage of cases,
but apparently not of necessity in all, that the nutritive conditions in
bone, nerve, muscle, tendon and other tissue, are so changed that whole-
some development and maintenance may be impossible. In this depressed

PHYSIOLOGIC COST OF INSUFFICIENT PROTECTIVE CLOTHING 305

condition, cellular activity is often so seriously impaired that the weak
spot in the individual is made manifest, as in the form of overgrowth
of tender bone around the joints, or of an abnormally irritable state of
the nerve terminals and trunks. The cold, instead of being a stimulant,
has now become a depressant of serious menace to comfort and health.

The normal warmth of the entire body, on the contrary, means the
maintenance of cell activity at its maximum efficiency through the pres-
ence of a rich blood supply and renders the body most resistant to disease.

It thus appears that each individual has to consider whether or not,
through adequate clothing, he will insure himself against the risk of
illness or of prolonged discomfort and inefficiency during the later years
of his life. It would seem that the safest form of insurance had been
shown by physiologists and physicians and by the practical experience
of men under trying temperature conditions, to be wool clothing for cool
weather, since by its use the body has been found to be fully protected.
The expense of this insurance has by many been considered prohibitive,
not because of its first cost, but because the life of the porous wool
undergarment is so shortened by shrinkage in washing. This objection
I have proved to be easily obviated. For the past ten years my family
and I have worn in winter pure wool unions, of varying weights — a
form of garment which cannot be worn when even slightly shrunk.
By using ammonia in wash water of blood temperature and a so-called
wool soap and by avoiding rubbing except lightly with the hands, we
have not been able to discover any shrinkage or loss of original softness
and pliability. Garments originally bought large, of heavy weight
and pure wool, have remained too large even after several years of use
and garments of exact fit have remained so. From the standpoint
of economy, therefore, judged by its yearly cost as an insurance against
financial loss through illness and inefficiency, knit wool underclothing
must be considered remarkably cheap.

From the standpoint of the possible physiological cost of inadequate
clothing in lowered vitality, illness, and inefficiency, as well as discom-
fort, we must consider it extremely fortunate that nature, by its ages
of experimentation to develop for animal life the best protection against
wet and cold, has thereby provided the human animal with so adequate
a protective material.

In view of the fact, however, that there is so much confusion in
the popular mind on the subject of the proper protection by clothing
and so much neglect and divergence of opinion on the part of physicians,
and that the positive evidence of disability through underprotection,
now at our disposal, is too isolated and fragmentary to be considered
fully authoritative, it would seem that the great practical importance
of the subject demands that it be more adequately studied in the future.

306 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

PURIFICATION OF AIR AND WATER BY MEANS

OF OZONE

J. C. Olsen

Water has long been known as a carrier of germs of disease. In
the purification of water great advances have been made in recent
years so that city suppUes are now filtered and purified by the addition
of chemical substances and we now consider it criminal negligence to
use contaminated water. We still consider it a dispensation of Provi-
dence if we contract colds, influenza, pneumonia, measles or other
contagious diseases and take only indirect means to protect ourselves
from these air-born diseases. Only in the rooms of the convalescent
do we sterilize the air, clothing and room generally, but we breathe
the germ-laden air of our crowded school rooms, theatres and public
assemblies, trusting to our strong constitutions to resist the millions
of disease germs which we inhale or acquire by contact just as our fore-
fathers drank polluted as well as pure water with no thought that there
could be found any means of destroying the death-dealing bacteria.

Undoubtedly, the death rate from contagious diseases could be greatly
reduced if we had at hand means for sterilizing or purifying the air as
it passes from one individual to others as well as the clothing and fur-
niture in our living rooms. Our places of public assembly, such as
theatres, churches, public halls and schools are, undoubtedly, great
clearing houses where the germs of contagious diseases are distributed
to be carried by susceptible individuals into our homes. An interesting
study could, no doubt, be made of the number of cases of diseases of a
contagious nature occurring in a group of school children meeting in
school rooms in which the air is ozonized and compared with the number
occurring in school rooms in which the air is not ozonized.

Mr. George C. Whipple has made a very interesting study of the
value of pure water to a community. From the reduction in the death
rate from typhoid fever and other water-born diseases on changing
from a somewhat polluted to a pure water supply, he concludes that the
pure water is worth to the community from $66.71 to $121.77 per mil-
lion gallons consumed, depending upon the consumption per capita.

The value of ozonized air could be computed in a similar manner
from the aggregate doctors' and nurses' bills as well as the value of the
lives of those whose deaths are due to impure air. According to the table
used by Mr. Whipple an average child of 5-10 years is worth $2,300,

PURIFICATION OF AIR AND WATER BY MEANS OF OZONE 307

while a child of 10-15 years is worth $2,500. The aggregate would,
undoubtedly, be very considerable and many times greater than the
cost of ozonizing the air which is quite small. Of course this is con-
sidering the question from the financial point of view only. Other
considerations will suggest themselves to everyone. Observation in
offices where the air is ozonized has shown a marked reduction of the time
lost by the clerical force on account of sickness.

Modern scientific research has brought to light many means of de-
stroying bacteria and we may stop to ask what properties the ideal
disinfectant should possess. While effectually destroying bacteria it
should also be entirely harmless to human beings and should not injure
clothing, books, furniture or growing plants in our living rooms. Such
a bactericide could be continually present in the air of our living rooms
protecting us from the germs of contagious diseases just as at present
most of us live in modern civilized communities around which our Health
Authorities have erected walls shutting out impure water, milk and other
foods dangerous to health.

We find that the bactericides which have been used, such as chlorine,
sulphur dioxide, formaldehyde are all poisons which we cannot inhale
without serious injury and which seriously injure clothing, furniture
and plant life.

Chemically we find that chlorine is a strong oxidizing agent while
sulphur dioxide is a strong reducing agent. This is also true of formalde-
hyde. The natural disinfectant which continually operates is the oxygen
of the air. This is particularly efficient in the presence of strong sunlight,
the actinic or chemical rays of which greatly accelerate the action of
the oxygen of the air. Natural waters are purified in this manner.
The amount of dissolved free oxygen is now considered the best criterion
of the purity of w^ater as pathogenic bacteria cannot long survive in its
presence.

Ozone is a modified form of oxygen produced by passing the silent
electric discharge through oxygen or the air. The oxygen absorbs
energy from the electric current and passes into an allotropic modi-
fication which is more active than ordinary oxygen. This increased
activity of ozone is due to the energy which it contains. Chemically
it is given the formula O3 while ordinary oxygen has the formula O2.
When ozone comes into contact with dead organic matter or living
organic matter, such as bacteria, oxidation immediately takes place
with destruction of the organic matter or bacteria.^ Ozone is more
efficient in this respect than oxygen so that while some pathogenic bac-
teria can resist the action of oxygen, it has been conclusively demon-
strated that pathogenic bacteria are quickly destroyed by means of
ozone. When present in suitable concentration ozone has long been

308 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

recognized as beneficial to human beings whose vigor and very Ufe
depend upon oxidizing processes. There is always present in the mouth
and nasal passages a great deal of effete organic matter and bacteria
which can be ozonized with great benefit to the organism. Ozone is
not in any way destructive of clothing or furniture, but on the contrary
very quickly and effectively removes any disagreeable odors which
may be present. Plant life is not injured by ozone. When breathed
in too great concentration, irritation of the throat and nasal passages
result but no permanent ill effect results. For breathing purposes not
more than 0.3 parts of ozone per 1,000,000 parts air should be present.

Ozone as a disinfectant has therefore a number of very marked
superiorities over the commonly used disinfectants, the greatest of
which is probably the fact that it can be introduced into rooms occu-
pied by human beings who thrive in its presence while the bacteria alone
are destroyed. The question immediately rises why it has not been used
more than it has. The answer is that methods have not, until recently,
been available for its production where needed. Like so many other
of our modern conveniences and necessities it has passed its childhood
as a scientific toy awaiting the time when it can take its place as a ser-
viceable member of our adult scientific community, the telephone,
wireless, aeroplane, etc. It has also been necessary to demonstrate
its usefulness and to educate the public to its necessity in ordinary life.

On June 23rd a test was made in New York City of the air in school
rooms before and after ozone had been introduced. The test was car-
ried out together with a representative of the Board of Health by the
Board of Education, having been arranged for by the American Museum
of Safety of New York. The first test was made in a room 20^ x 22^
feet with 12-foot ceiling. It was situated on the ground floor with three
windows opening directly upon the street. The temperature of the room
was 25° C. The pupils were of grade lA and numbered 44.

All determinations were made by drawing 3 cubic feet of air through
a sterilized tube containing sterilized sand. The sand was afterwards
washed with 10 c.c. of sterile water which was plated on agar,
incubated at 37>^° C. and counted after three days, and on gelatine,
incubated at 20° C. and counted after 4 days. Moulds were also
counted. Tests for B. Coli were also made by means of ox bile.

The following tests were made without ozone :

Sample of air taken at 11:45 A.M. School in session — teacher
and six adults present. Windows open.

Total Bacteria per cu. ft 167

Moulds, per cu. ft 23

B. Coli absent

PURIFICATION OF AIR AND WATER BY MEANS OF OZONE 309

Test made at 12:00 M. — School marching out.

Total Bacteria per cu. f t 5^3

Moulds per cu, ft ^o

^- Coli absent

These tests show the condition of the air in the room with the school
in session and marching out.

A further test was made when only the adults who were taking the
samples were present. The fan of the ozonizing machine was going
but no ozone was generated.

Windows closed, fan going, six adults in the room. Sample
taken at 12:30 P.M.

Total Bacteria per cu. f t '. 133

Moulds per cu. ft , 67

B. Coli absent

Finally the ozonizer was operated for 15 minutes and a strong smell
of ozone was noticeable throughout the room.

Sample taken at 1:00 P.M.

Total Bacteria per cu. ft 7

Moulds per cu. ft 10

B. Coli absent

The reduction in the number of bacteria is so great that all disease
bacteria were probably killed and the air rendered entirely safe if expe-
rience with water-born bacteria can be used as a guide.

Experiments were also conducted in another school building in the
same crowded section of Manhattan. The room selected was in the
old portion of the building and measured 15 x 19 with a 14-foot ceiling.
The grade was 2-A with 31 pupils. There were two windows on one
side of the room which were open from the top. The samples were
taken and counts made in the same manner as already described.

School in session. Fan going for 15 minutes. Sample taken
at 2:42 P.M.

Total Bacteria per cu. ft 133

Moulds per cu. ft 17

B. Coli absent

The fan only of the ozonizer was operated during this test. After
the ozonizer had been operated for 15 minutes, another test was made.

School in session. Ozonizer operated for 15 minutes. Sample
taken at 3:10 P.M.

Total Bacteria per cu. f t 33

Moulds per cu. f t 7

B. Coli absent

3IO FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The reduction in the number of bacteria was not as great as in the
tests in the first school, probably because the windows were open from
the top, allowing constant entrance of bacteria laden air. The number
of moulds is also not so great as the room was on the second floor and
on the south side of the building.

• The ozonizer was continued in operation during the dismissal of the
school and after 15 minutes another test was made with the following
result :

Total Bacteria per cu. ft 7

Moulds per cu. ft 7

B. Coli absent

While the movement of the pupils would tend to increase the num-
ber of bacteria in the air, the continued action of the ozone reduced
the number of bacteria so that the air was finally as nearly sterile as
in the first room tested. Undoubtedly, the ozone tends to sterilize
the clothing and the dust on the floor and furniture so that while move-
ments of the pupils may increase the amount of dust in the air, the bac-
terial content of the air is decreased.

The result of these tests are sufficiently favorable to lead to the belief
that it is possible to obtain as high a bacterial purity in the air which
we breathe as in the water which we drink and that a very marked
reduction in the number of cases of disease from air-born bacteria is
possible if the air is ozonized.

The ozonater used was a Vohr Machine, manufactured by the Hud-
son Ozone Machine Co. of 120 Liberty Street, New York City.

The ozonizer proper consists of two sets of flattened aluminum
tubes fixed in wooden frames and separated by air spaces and glass
plates. The silent discharge of electricity of 9,500 volts passes from
one tube to the next and the air is forced by means of a fan through
the blue zone of electricity. The direct current of no volts which was
available was converted to alternating current. About .85 amperes
of current is consumed. The somewhat larger machine used for ozon-
izing water, style B, consumes about i ampere of current. On account
of the small amount of current used the cost of ozonizing air or water
is very low.

The ozonization of water was carried out by means of the same
ozonizing machine inclosed in an air-tight box having an opening on
the rear for the admission of air and another opening in front. To the
latter a tube is attached which conveys the ozone to a T tube where it
is sucked into the water by means of a suction pump operated by the
water pressure. The mixture of ozone, air and water is forced into a
specially constructed chamber where a thorough mixing of the ozone
and water is secured.

PURIFICATION OF AIR AND WATER BY MEANS OF OZONE 3II

The Croton water before treatment with ozone had the following
composition :

Unfiltered Unozonized Croton Water.
Bacteriological Examination:
Total Bacteria — 80
B. Coli — ^absent

Physical Examination:
Turbidity — 3
Color — 5

Chemical Analysis:

Parts per Million

Nitrites absent

Oxygen Consumed 9

Free Ammonia 026

Albuminoid Ammonia 12

The water was ozonized at the rate of 128 gallons per hour. The
ozonized water was analyzed with the following result:

Sample of Water Ozonized by Two Small Generators.
Bacteriological Examination. "

Total Bacteria none

B. Coli absent

Sample of Water Ozonized by Single Generator — Style B.
Bacteriological Examination.

Total Bacteria none

B. Coli absent

Physical Examination.

Turbidity 3

Color I

Chemical Examination.

Parts per Million

Nitrites 0025

Oxygen Consumed 5

Free Ammonia 04

Albuminoid Ammonia 113

The physical examination showed that the turbidity was unaffected
while the color was almost entirely removed. Ozonizers should, there-
fore, be used with filters if the water is very turbid.

The chemical examination showed marked oxidation of organic
matter.

It is evident from these tests that the drinking water of schools can
very readily be purified by means of ozone so as to render it absolutely
safe.

312 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

VENTILATION UND HEIZUNG DER SCHULRAUME

VON

Hugo Selter

Die Luft der Schulraume erleidet wahrend des Unterrichts sehr bald
eine Verschlechterung, die bedingt ist durch die Zunahme der Ausatem-
Kohlensaure, der sogenannten Riechstoffe, Erhohung der Temperatur
und Feuchtigkeit. Die Giftigkeit der Ausatemluft hat sich bisher
nicht beweisen lassen. Auch die neusten Mitteilungen Weichardf s
iiber das Vorkommen von Ermiidungsgift in der Ausatemluft konnten
von anderer Seite nicht bestatigt werden. Die Konstitution der Riech-
stoffe kennen wir riicht, wir wissen nur, dass sie von der Schweiss-sekre-
tion der Haut, aus kariosen Zahnen, Ausdiinstungen des Magen-Darm-
kanals und den Kleidern der Schulkinder stammen. Die Riechstoffe
vermogen bei Menschen, die von aussen in einen schlecht ventilierten,
iiberfiillten Raum treten, Ekelgefiihl hervorzurufen. Die Insassen
merken weniger von den Riechstoffen, da die Riechnerven durch das
allmahliche Auf treten der Riechstoffe abgestumpft werden. Es ist
aber doch anzunehmen, dass eine Schadigung der Schulkinder, die
gezwungen sind, monatelang in schlechter, mit Riechstoffen angereich-
erter Luft zu verbringen, eintreten kann. Die Beseitigung der Riech-
stoffe durch die Ventilation ist deshalb unbedingt zu verlangen.

Die durch schlechte Luft beim Menschen auftretenden Symptome,
Miidigkeit, Unbehagen, Schwindel, Neigung zu Erbrechen, Ohnmacht,
usw. sind nach Untersuchungen Flugge's und seiner Schiiler jedoch
weniger auf eine chemische Veranderung der Raumluft zu beziehen,
als auf eine mangelhafte Entwarmung des Korpers durch zu hohe Tem-
peratur und Feuchtigkeit des Raumes. Wurde in einem Kasten die
Temperatur auf iiber 20° C. und die Feuchtigkeit iiber 60% erhoht, so
traten bei Versuchspersonen die genannten Symptome auf; sie blieben
aus bei Steigerung des Kohlensauregehaltes durch die Ausatemluft
bis auf 15%, wenn Temperatur und Feuchtigkeit niedrige Grade zeigten.
Es ist daraus zu schliessen, dass Temperatur und Feuchtigkeit vor
allem bei der Beurteilung der Schulzimmerluft zu beriicksichtigen sind.

Wahrend friiher zur Berechnung der Ventilationsgrosse allein der
Kohlensauremassstab herangezogen wurde, und auf Grund dessen in
Schulzimmern eine mindestens dreimalige Lufterneuerung verlangt
wurde, sucht man jetzt an Stelle desselben den Warmemassstab (Berech-
nung der Ventilationsgrosse nach Warme und eines nicht zu iiberschreiten-
den Feuchtigkeitsgehaltes) zu setzen. Die Temperatur des Schul-
zimmers soil nicht iiber 20° C. und die Feuchtigkeit nicht iiber 60%

VENTILATION UND HEIZUNG DER SCHULRAUME 313

hinauskommen. Die Ventilation hatte also die Aufgabe, diese Grenzen
einzuhalten. Eine bestimmte Temperatur Hesse sich durch Regulierung
der Heizung unter Berucksichtigung der von den Schulern abgegebenen
Warme leicht erreichen, auch ohne Ventilation. Schwieriger ist die Ein-
haltung eines gewissen Feuchtigkeitsgrades, da von 50 Schulkindern
wahrend einer Unterrichtsstunde ca 1000 g Wasser durch die Ausatemluft
und Verdunstung von der Haut aus als Wasserdampf an die Raumluf t
abgegeben werden, was bei 18° C. einer Erhohung des Feuchtigkeits-
gehaltes um etwa 30% entsprechen wiirde. Um dieser Feuchtigkeits-
anreicherung durch die Ventilation zu begegnen, wiirde man bei einer
Aussentemperatur von -I- 5° C. und 80% relativer Feuchtigkeit einen
etwa einmaligen Luftwechsel benotigen, bei -I- 12° einen zweimaligen ;
bei -I- 14° und derselben Feuchtigkeit wtirden aber schon nicht geniigende
Mengen Luft zugef iihrt werden konnen, um die Feuchtigkeit der Zimmer-
luft unter 60% zu halten. Als alleinigen Massstab fur die Ventilations-
grosse die Bestimmung der Temperatur und Feuchtigkeit heranzuziehen,
scheint demnach fiir Schulen nicht angebracht. Dem Heizer miisste
denn eine Tabelle gegeben werden, aus welcher er bei jeder Temperatur
und Feuchtigkeit der Aussenluft das erforderliche Ventilationsquantum
ablesen konnte. Neben der Beurteilung der Raumluf t nach Temperatur
und Feuchtigkeit ist auch die Berechnung nach der Zunahme der Kohlen-
saure durch die Ausatemluft erwiinscht. Als Grundforderung ist
aufzustellen eine mindestens dreimalige Lufterneuerung wahrend des
Unterrichtes und Vermeidung einer Erhohung der Temperatur iiber
19-20°. Das Auftreten von Riechstoffen kann durch fleissige Benutzung
der Schulbrausebader, Beseitigung der kariosen Zahne, Aufhangen
der Ueberkleider ausserhalb des Schulzimmers vermindert werden.

Ein dreimaliger Wechsel der Schulluft wird nur durch kiinstliche
Ventilationseinrichtungen zu erreichen sein. In den Pausen kann
durch Offnen der Fenster und Tiiren eine schnelle Durchliiftung und
Entwarmung der Klassen herbeigefiihrt werden. Eine Liiftung durch
klappbare Oberfenster ist nur ausreichend, wenn zwischen Aussen und
Innentemperatur mindestens 5° Differenz bestehen. Bei kalten Aussen-
temperaturen kann diese Liiftung aber zu Schadigungen der am Fenster
sitzenden Kinder fiihren. Im Sommer ist dagegen eine Durchliiftung
des Raumes durch Offnen der ganzen Fenster zu erreichen, auch wenn
Aussen- und Innen-Temperatur geringe Temperaturdifferenzen auf-
weisen. Wie Untersuchungen im Hygienischen Institut in Bonn
zeigten, tritt selbst bei geringer oder mangelnder Windbewegung schnell
ein Ausgleich der Feuchtigkeit der Raumluft mit der atmospharischen
ein, was nur durch Diffusion bedingt sein kann.

Jedes Schulzimmer muss mit einem Zuluft- und Abluftkanal ver-
sehen sein. Fur Aborte, Schulbader und Schulkuchen sind nur Abluft-

314 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

kanale vorzusehen in die fiir bessere Aspiration der Luft ein Heizkorper
gestellt wird. Die Zuluft ist in Verbindung mit der Heizung zu bringen,
um sie vorzuwarmen und dadurch Zugbelastigungen der Kinder zu
vermeiden. Bei Ofenheizung verbindet man den Zuluftkanal mit dem
Raum zwischen Of en und Mantel. Bei Zentralheizung erwarmt man
die Luft entweder in einer Zentralheizkammer, oder lasst sie an Heiz-
korpern, die in den zu den Klassenzimmern vertikal auf warts fuhrenden
Kanalen auf gestellt sind, vorbeistreichen. Hierdurch ist aber nicht
zu alien Zeiten, vor allem nicht in den Uebergangszeiten und bei Ausser-
betriebsetzung der Heizung eine dreimalige Lufterneuerung der Schul-
zimmer gesichert. Diese ist nur zu errreichen, wenn durch einen Motor
die Luft in die Schulzimmer hineingetrieben wird. Die Pulsionsliiftung
ist deshalb fiir Schulen in i. Linie zu empfehlen. Nimmt man den
Querschnitt des Abluftkanales kleiner wie den des Zuluftkanales, so
erreicht man in den Klassenzimmern einen gewissen Ueberdruck, der
eine Zugbelastigung der Kinder durch die sonst von den Fenstern ein-
fallende kalte Luft ausschliesst. Bei dieser Ueberdruckliiftung wurde
bisher von den Heizungsingenieuren verlangt, dass die Fenster wahrend
der ganzen Schulzeit geschlossen gehalten werden soUten, da durch
Offnen der Fenster eine Storung, der Luftzufuhr bef iirchtet wurde, Aus.
erzieherischen Grundsatzen und um eine schnelle Entwarmung der
Klassenzimmer herbeizufiihren, ist aber in den Pausen das Offnen der
Fenster und Tiiren vorzuziehen. Diese Verbindung der Fensterliiftung
mit der Ueberdruckliiftung lasst sich technisch ermoglichen, indem der
Heizer wahrend der Pausen den Motor abstellt. Vielleicht wiirde
sich dies auch auf automatischem Wege erreichen lassen. Die Ueber-
druckliiftung soil jedoch nicht an Stelle einer Luftheizung treten, inderri
sie die Aufgabe hatte bei volligem Abstellen der Heizkorper die Innehal-
tung der Tempera tur von 19° C. durch die zugefiihrte Luft zu bewirken.
Hierzu wiirde eine Temperatur von 19-21° erforderlich sein, was aber
leicht zu einer Ueberwarmung der Klassenzimmer fiihren muss. Die
zugefiihrte Frischluft soil nur auf 15-16° erwarmt werden, nur so weit,
dass eine Zugbelastigung der Kinder vermieden wird. Eine Zugbe-
lastigung ist bei dieser Temperatur selbst bei mehr wie fiinfmaligem
Luftwechsel und bei einer Geschwindigkeit der zugefiihrten Luft bis
zu 5 m in der Sekunde nicht zu befiirchten, wenn die Zuluft in der Nahe
der Decke eintritt und durch ein vorgestelltes Gitter in kleinere Luft-
strome zerlegt wird. Die Ueberdruckliiftung kann auch zur Kiihlung
der Schulraume im Sommer dienen, was in sehr heissen Sommern niitz-
lich sein wird. So wurden z. B. im Sommer 191 1 in Strassburg bei den
Schulkindern Hitzestauungserscheinungen beobachtet, die sich durch
Abnahme des Korpergewichtes und Zunahme der Blutarmut bemerkbar
machten und zum Teil nicht einmal durch die langen Herbstferien

VENTILATION UND HEIZUNG DER SCHULRAUME 315

ausgeglichen wurden, sondern erst im Laufe der Wintermonate ver-
schwanden. Eine Ktihlung der Luft konnte dadurch erreicht werden,
dass man die Luft in den Kellerraumen entweder durch Brausen durch-
fiihrt, Oder an den durch kaltes Leitungswasser gekuhlten Radiatoren
der Heizungskammer vorbeistreichen lasst. Auch durch Inbetrieb-
haltung der Liiftung wahrend der Nacht ware eine Ktihlung der Raume
moglich; nach Untersuchungen Hettinger's kann dadurch wahrend der
Unterrichtsstunden von 8-11 Uhr die Raumtemperatur um etwa 4°
niedriger als die Aussentemperatur gehalten werden. Am einfachsten
ist die Kiihlung durch Brausen zu erreichen, wodurch zugleich eine
Reinigung der Luft von Staub bewirkt wird. Eine Befeuchtung der
Luft hierbei ist nur in ganz geringem Masse mogHch. In heissen Som-
mertagen soUte den Knaben gestattet werden wahrend des Unterrichts
die Oberkleider abzulegen.

Die Zuluftkanale werden am besten aus glasiertem Tonrohr
oder verbleitem Eisenblech hergestellt und miissen leicht zu reinigen
sein.

In letzter Zeit ist auch versucht worden, durch Ozonisierung der
Luft eine Verbesserung herbeizufuhren. Durch die reinigende, oxy-
dierende Wirkung des Ozons glaubte man verdorbene Zimmerluft
wieder auffrischen und ihr den Charakter reiner Aussenluft geben zu
konnen. Die experimentelle Priifung von hygienischer Seite hat jedoch
ergeben, dass diese Voraussetzungen nicht zutreffen und dass eine
Oxydation der Riechstoffe und eine Vernichtung der in der Raumluft
enthaltenen Bakterien nicht nachzuweisen ist. Die Riechstoffe werden
zwar verdeckt, aber nicht zerstort und treten nach Verschwinden des
Ozongeruches wieder auf. Das Ozon ist auch kein indifferentes, son-
dern ein ausgesprochen giftiges Gas, das schon in Mengen, die unter
der quantitativen Bestimmbarkeit Hegen, Belastigungen der Insassen
hervorruft. Bei Konzentrationen von 0,0001% treten schon Reizungen
der Atmungsorgane beim Menschen auf. Bei Versuchstieren hatte
die Einatmung der Ozonluft eine Vermehrung der Kohlensaureaus-
scheidung und Verminderung der Sauerstoffaufnahme, also eine Herab-
setzung des Atmungsumsatzes zur Folge. Die Anwendung des Ozons
in Schulraumen muss deshalb "nicht nur als uberflussig, sondern als
direkt gefahrlich bezeichnet werden. Seine Anwendung wiirde auch
andere Ventilationsanlagen nicht entbehrlich machen.

Die Heizung soil eine Innehaltung der Raumtemperatur selbst an
den kaltesten Wintertagen auf 19-20° C. ermoglichen. Von den Heizungs-
anlagen ist zu verlangen, dass die Warme gleichmassig uber den
ganzen Raum verteilt wird, dass sie schnell und gut zu regulieren sind,
und dass durch Bedienung derselben Staub oder gasformige Verun-
reinigungen nicht in die Zimmerluft gebracht werden. Bei Ofenheizung

3l6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

kann dies durch Anwendung geeigneter Dauerbrandofen erreicht werden.
Zweckmassiger erfolgt die Heizung in Schulen jedoch durch Zentral-
heizung, deren Betrieb infolge des geringern Brennstoffverbrauches auch
weit billiger ist, wie die Ofenheizung Selbst unter Beriicksichtigung der
hoheren Anlagekosten stellt sich vom wirtschaftlichen Standpunkt aus
eine Zentralheizung nicht teuerer, als Ofenheizung. Die in Schulen
gebrauchlichen Systeme sind Niederdruckdampf- und Warmwasser-
heizung. Die Niederdruckdampf heizung hat den Nachteil, dass sich
die Heizkorper sehr stark erwarmen und dass es dadurch zu einer Ver-
brennung des auf ihnen liegenden Staubes kommt. Nach den Unter-
suchungen von Esmarch und Nussbaum tritt eine Verbrennung des
Staubes ein, wenn die Oberflachen der Heizkorper Temperaturen uber
70° erreichen, es entstehen dann brenzHche Stoffe, die die Atmungsorgane
reizen, was friiher falschlicherweise einer Trockonheit der Luft zugeschrie-
ben wurde. Bei der Warmwasserheizung bleibt die Oberflachen temperatur
der Heizkorper meist unter 70°, da es bei nicht zu kalten Aussentem-
peraturen moglich ist, mit einer Wasserwarme von 50-60° die Zimmer
geniigend zu heizen. Die Warmwasserheizung hat auch den Vorteil,
dass sie generell besser reguliert werden kann. Ihre Anlagekosten sind
zwar etwas hoher als die der Niederdruckdampfheizung, der Brenn-
stoffverbrauch aber geringer. Die Warmwasserheizung muss deshalb
als die beste Heizung fiir Schulraume betrachtet werden. Auf die
Einfrierungsgefahr in den Ferien ist Riicksicht zu nehmen. Zweck-
massig ist in grosseren Schulgebauden neben der Warmwasserheizung
noch die Anlage einer Niederdruckdampfheizung, an welche die Aula,
Turnhallen und Korridore anzuschliessen sind. Die Heizkorper soUen
als glatte, auf Konsolen gestellte Radiatoren mit weiten Gliederab-
standen unter den Fensternischen angebracht sein, oder als lange,
mehrfach iibereinander geordnete Rohre an der Fensterseite verlaufen.
Bei der Ueberdruckliiftung wird auch die Stellung der Heizkorper an
der Innenseite moglich sein Die Regulierung der Heizung soil nicht
dem Lehrer iiberlassen sein, sondern in die Hand eines ausgebildeten
Heizers gelegt werden. Das Anbringen der in die Wand eingelassenen
Schau thermometer, wodurch sich der Heizer liber die Temperaturen
der Schulzimmer unterrichten soil, ha! nicht viel Zweck; es wird dem
Heizer nur selten molich sein, danach die Heizung zu stellen. Eine
sichere Regulierung ist nur moglich, entweder durch eine zentrale
Regulierung, oder durch automatische Temperaturregler. Bei der
Ersteren werden in jedem Schulraum Fernthermometer aufgehangt,
welche durch elektrische Verbindung mit einem zentralen Bedienungs-
raum dem Heizer ermoglichen, von seinem Stand aus jederzeit die
Temperaturen des Raumes abzulesen und die ortlichen Heizkorper
danach einzustellen. Noch zweckmassiger sind vielleicht die automa-

VENTILATION UND HEIZUNG DER SCHULRAUME

317

tischen Temperaturregler, die in den Schulzimmern selbst angebracht
direkt die Heizkorper regulieren. Es gibt zuverlassige Konstruktionen,
die durch Anwendung von Druckluft, elektrischem Strome oder noch
besser durch Ausdehnung und Zusammenziehung einer temperatur-
empfindlichen Masse sowohl bei Niederdruckdampfheizung, wie bei
Warmwasserheizung eine Regulierung der Ventile bewirken. Nach
den Untersuchungen Brahhees ist es hierdurch moglich, Raume be-
standig auf derselben Temperatur mit Unterschieden bis hochstens zu
0.5° C. zu halten. Wahrscheinlich ist eine Verminderung des Brenn-
stoffverbrauches dadurch zu errreichen, sodass auch vom wirtschaft-
lichen Standpunkte aus diese Temperaturregler zu empfehlen sind.

3l8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

DER EINFLUSS DER KALTEN FUSSE AUF DIE
GEISTESTATIGKEIT DER SCHULKINDER

VON

J. Brandau

Jahrzehnte lang hatte ich die vielen schadlichen Folgen der habitu-
ellen Hyperhidrosis pedum an mir selbst erfahren, nachdem ich einen
sehr schweren Gelenk-Rheumatismus in folge Infection bei der Tra-
cheotomie eines an Diptherie erkrankten Knaben, durchgemacht hatte
und trotz Anwendung aller Mittel und Bader denselben nicht los werden
konnte, denn die immer nassen Striimpfe und daher, besonders zur
Winterszeit, eiskalten Fiisse und Beine, standen regelmassig in ursach-
lichem Zusammenhang mit den Verschlimmerungen desselben und
manchen Begleiterscheinungen z. B. chronischem Bronchial-Catarrh,
Nasen- und Rachen-Catarrh, etc., die aber vollstandig verschwanden,
nachdem es mir gelungen war, ein in Form eines Fusssohlenbades anzu-
wendendes Praparat zu finden, das nach und nach den profusen Schweiss
beseitigte und in den nunmehr stets trockenen Striimpfen, warme Fiisse
herbei fiihrte und danach die Heilung aller meiner Beschwerden mir
brachte! Das war vor ca. 30 Jahren!

Hierdurch wurde ich nun aufmerksam auf die mit chronischem
Nasen- Rachencatarrh behafteten Schulkinder mit ihrem stupiden
Gesichtsausdruck, ihrer oft sehr beschrankten Intelligenz und mit ihrer
leichteren Infection bei ausbrechenden Maseru- und Scharlach-Epide-
mien, wie auch auf manche schwerere Leiden z. B. Asthma bronchiale,
Epilepsie, Tuberculose, verschiedene Magen- und Unterleibs-Krank-
heiten bei Erwachsenen mannlichen und weiblichen Geschlechts was
auch von mir in mehreren wissenschaftlichen Arbeiten (i) veroffentlicht
und andererseits auch anerkannt worden ist.

Um nun nach so langen theoretischen und poliklinisch-praktischen
Untersuchungen mit einwandfreiem und unter doppelter Kontrolle
angestellten Versuchen iiber den segensreichen Erfolg der Heilung der

I. Ueber die habituelle Hyperhidrosis pedum. Deutsche Medizinal Zeitung No.
68 und 69 von 1886. Ueber den Zusammenhang des Asthmas mit der habituellen
Hyperhidrosis pedum ebendaselbst No. 69 1887. — Ein Fall von Hyperhidrosis manuum
und pedum von Dr. E. Hohmann ebendaselbst No. 87 1887 im Verlag von Eugen
Grosser in- Berlin. — Ueber Asthma sein Wesen und seine Behandlung von Dr. Briegel-
mann, Heusers Verlag in Neuwied. — C. Spener Die habituelle locale Hyperhidrosis,
ihre Folgen und ihre Behamdlung-Jnaugural — Dissertation Halle a/S. 1888. Dr.
Kretschmann Privat-Docent in Halle a/S. Ueber die Anwendung einiger neuen Arzenei
Mittel in Band XXVIII 6 des Archivs fur Ohrenheilkunde.

DER EINFLUSS DER KALTEN FUSSE 3I9

Hyperhidrosis pedum, vor die Oeffentlichkeit treten zu konnen, wurden
im Friihjahr 1912 von mir in Miihlhausen i.E., mit Genehmigung der
Ober-Schulbehorde und der Einwilligung der Eltern, an einer Anzahl
der diimmsten und faulsten Schiiler einer Klasse der Volksschule, Unter-
suchungen angestellt, iiber den von mir schon lange erkannten Einfluss
von kalten Ftissen auf die geistige Leistungsfahigkeit derselben und
den segensreichen Erfolg ihrer Heilung. Es stellte sich in jedem Faile
heraus, dass die kalten Fiisse durch die mehr oder weniger profuse
Schweissabsonderung an denselben bedingt war, weil naturgemass
durch die Verdunstung desselben in den nassen Strumpfen, den Fiissen
rasch viel Warme entzogen wird, geradeso, als wenn dieselben von
Wasser oder Schnee nass geworden sind. Ich habe friiher schon in
meiner PoHkUnik durch genaue Wagungen der absolut trockenen
Striimpfe festgestellt, dass dieselben nach einem 2-3 stiindigen Spazier-
gang oft um 8 - 10 - 15 Gramm schwerer geworden waren!

Durch die bald eintretende Zersetzung des Schweisses, die selbst
wieder die Absonderung desselben steigert, entsteht besonders in un-
reinen Strumpfen und fiir Verdunstung unzulassiger Fussbekleidung,
der bekannte Geruch nach fliichtigen Fettsauren, und diese sind es auch,
welche das Epithel bis in die tieferen Schichten der Epidermis hinein
oftmals hochgradig mazerieren.

Es ist nun eine langst bekannte Tatsache, dass bei habitueller Kalte
der Fiisse Blutstauungen, eine Disposition zu Katarrhen, insbesondere
der oberen Luftwege entsteht, und dass ferner durch sie Zirkulations-
storungen in der Hirnrinde hervorgerufen werden, was Professor Dr.
Winternitz in Wien experimentell durch langere Anwendung eines
kalten Fussbades erforscht und dabei nachgewiesen hat, dass durch
vasomotorischen Reflex eine Contraction der Blutgefasse im Gehirn
verursacht wird, wodurch consecutiv eine geringere Blutzufuhr und
mangelhaftere Ernahrung desselben und daher geringere Leistungs-
fahigkeit stattfindet. Die in den ausseren Gehorgang wohlverwahrt
und fest eingefiigten Thermometer sinken . bald um 0.5 - 0.6° C. die
Conjunktival-Gefasse werden blasser, wahrend das Thermometer in
der Achselhohle konstant bleibt. (i) Gleichzeitig kommt es auch wohl
zu einer Anhaufung von ErmiidungsstofTen und eigenartigen, mit
Abnahme des Hamoglobingehaltes einhergehenden Schrumpfungsvor-
gangen und Zerfallerscheinungen der roten Blutkorperchen, und man
kann sich daraus leicht vorstellen, welch einen verderblichen Einfluss
die jahrelang kalten Fiisse im jugendlichen Alter nicht nur auf die geistige
Leistungsfahigkeit, sondern auch auf die Entwicklung des Gehirns
ausiiben muss!

1. Hydrotherapile von Dr. W. Winternitz, Leipzig, Verlag von Vogel 1881.

320 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Ich habe schon in friiheren Arbeiten nachgewiesen, dass die Blut-
stauungen in den oberen Luftwegen congestive Zustande mit sich bringen,
welche sich, unter Schwellung der Gaumentonsillen, Rotung und Schwel-
lung der Rachen- und Nasenschleimhaut, und erschwerter Nasenat-
mung offenbaren. Meine langjahrigen Erfahrungen haben sogar noch
viel schlimmere Folgen solcher Zirkulationsanomalien erwiesen. Durch
diese Hyperamischen Zustande wird der Einwanderung von allerhand
perniciosen Keimen Vorschub geleistet, insbesondere sind es Anginen,
Diptherie, und Gelenkrheumatismus, welche auf diese Weise entstehen
konnen.

Die Untersuchung von 22 Schulknaben im Alter von 13-15 Jahren
hat denn auch die Bestatigung erbracht, dass bei denjenigen, die mit
schwitzenden und infolge dessen kalten Fiissen behaftet waren, Affek-
tionen des Nasen-Rachenraumes entstanden. Es hatte sich ferner
herausgestellt, dass gerade diejenigen unter den Schiilern der beiden
von mir zur Untersuchung herangezogenen Volksschulklassen, nach
Aussage ihrer Lehrer, nur sehr mittelmassige Leistungen aufwiesen,
nur wenige oder gar keine Fortschritte machten, zerstreut und unauf-
nterksam waren und wenig geistige Regsamkeit zeigten. Es hangt
also zweifelsohne die oben auseinander gesetzte Anamie des Gehirns
mit ihren Folgen mit diesen Zustanden zusammen, wodurch eben sich
im Verein mit der Anhaufung von Ermiidungsstoffen die geringe Lei-
stungsfahigkeit erklaren lasst.

Um nun liber den Zusammenhang zwischen kalten Fiissen und
geistiger Leistung definitiv Aufschluss zu erhalten, musste es mein
Bestreben sein, die Kinder wahrend ihrer Schultatigkeit, erstens: unter
solchen Verbal tnissenzu beobachten, unter denen sie bisher bei Einwirkung
kalter Fiisse standen und zweitens: festzustellen, ob nach Beseitigung
des Leidens, also mit warmen Fiissen, ein Aufschwung ihrer geistigen
Leistungsfahigkeit vorhanden war. Diese Beobachtungen sind von
zwei sehr erfahrenen und tiichtigen Volksschullehrern durch pada-
gogische Massnahmen, insbesondere durch schriftliche und miindliche
Priifung auf das Gewissenhafteste vorgenommen worden. Ich musste
also zunachst darauf bedacht sein, den Fussschweiss und damit die kalten
Fiisse zu beseitigen. In meiner friiheren Praxis, die ich in meiner
Poliklinik ausiibte, bediente ich mich zu diesem Zweck noch eines von
mir komponierten sog. Liquor antihidrorrhoicus, dessen wirksames
Prinzip wesentlich in seinem Gehalt an Acidum hyprochloricum bestand,
und der als Fusssohlenbad angewandt wurde. Dieser Liquor, der be-
sonders fur schwerere Falle ausgezeichnet wirkt, und dem ich zunachst
alle meine Erfahrungen verdanke- da es ja f ruber kein sicher wirkendes
Mittel gab- ist indessen umstandlich anzuwenden, weshalb fiir leichtere
Falle und besonders in der Kinderpraxis, das viel einfachere Pinseln

DER EINFLUSS DER KALTEN FUSSE

321

der Fusssohlen mit einer Mischung von Formaldehyd und Spiritus zu
gleichen Teilen, sich empfiehlt. Mit diesem Gemisch wurden die
Fussohlen und die Zwischenraume der Zehen, je nach der Starke der
Schweissabsonderung jeden zweiten oder dritten Tag und spater seltener,
gepinselt. Schon nach wenigen Tagen verlor sich die profuse Schweiss-
absonderung, die Kinder gaben an, sich im Allgemeinen viel wohler
und aufgelegter zu fiihlen, und in ihren Fiissen eine wohltuende Warme
zu verspuren. Diese Angabe fand in dem Abtasten der Fiisse und
der Unterschenkel Bestatigung und mit dem Bestehenbleiben der
warmen Fiisse hob sich auch in auffallender Weise die geistige Reg-
samkeit und Leistungsfahigkeit der genannten 22 Schiiler, was sich
am besten aus den beiUegenden Tabellen ersehen lasst.

Um indessen eine doppelte Kontrolle zu fiihren, wurden, ausser
den darin verzeichneten padagogischen Methoden, auch noch genaue
asthesionetrische Messungen und zwar von Professor Dr. Griesbach
selbst, mit dem von ihm angegebenen Aesthesiometer ausgefiihrt, die
ebenfalls aus den Tabellen ersichtlich sind. Wahrend nun die Schwel-
lenwerte vor der Pinselung und noch in den ersten Tagen derselben im
Schulbetriebe gross waren, und von schneller und hochgradiger Ermiid-
ung zeugten, nahmen dieselben im Laufe der Pinselung unter Beobach-
tung deutlich ah. Dieser Umstand weist darauf hin, dass die Schiiler
ihre Arbeiten mit weniger geistiger Anstrengung vollbrachten, als
frtiher, und dass sie dafiir eine geringere intellektuelle Aufmerksamkeit
bedurften und infolge dessen auch weniger leicht ermiideten.

Es lag nun der Gedanke nahe, dass, und um alien Zweifel an dem
herrlichen und segensreichen Erfolg der geschilderten Behandlung
auszuschliessen, ein forcirter und intensiver Unterricht die Schiiler
auch ohne Behandlung der schwitzenden und kalten Fiisse von geringen
zu hoheren Leistungen fiihren konnte. Es wurden daher im Hinblick
auf diese Moglichkeit noch sieben weitere Schiiler derselben Klasse, die
auch mit Schweissfiissen behaftet waren, mit denen aber keine Kur
vorgenommen wurde, in Bezug auf die Gesamtergebnisse des Unter-
richts genau beobachtet und gepriift. Dabei ergab sich die interessante
Tatsache, dass die Gesamtleistungen bei diesen Schiilern sich gleich
hliehen, zum Teil sogar noch verminderten, und jedenfalls weit hinter
den Leistungen derjenigen Schiiler, denen eine Fussbehandlung zu teil
geworden war, zurilckstanden.

Ich fasse meine Beobachtungen nun mit folgenden kurzen Schluss-
satzen zusammen, halte es aber noch fur angebracht, unter Hinweis
auf die friiher in der Medizin herrschende humoral- pathologische
Lehre und auf die heute noch in weiten Kreisen des Volkes herrschende
Meinung, dass man den ,,Fussschweiss" nicht vertreiben diirfe, auf
Grund meiner langjahrigen an vielen -Tausenden von ,,Schweissfusslern"

322 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

gemachten Special — Beobachtungen und Erfahrungen feierlich zu
erklaren, dass dies ein sehr trauriger und verhangnisvoller Irrtum ist,
und dass ich niemals irgendwie schadliche Folgen durch die Heilung
des Leidens, das ausserdem bisweilen ohne irgend einen erkenntlichen
Grund von selbst vergeht und im hoheren Alter immer mehr abnimmt
und verschwindet, beobachtet habe! Ausserdem ist die griindliche
Heilung dieses Leidens, wodurch nur das allzuviele, krankhafte Schwitzen
beseitigt wird, die normale Perspiration aber bestehen bleibt,in ahnlichem
Verhaltnisse wie die chronische Diarrhoe zum normalen Stuhlgang —
gar nicht so einfach und kurz und es gehort oft eine Monate und Jahre-
lange Kur dazu, anderenfalles es sich langsam, aber sicher wieder ein-
stellt ! Jedenfalls ist dies der sicherste Beweis gegen die obenangedeute-
ten Anschauungen von der grossen Gefahrlichkeit des Vertreibens des
Fussschweisses.

In Anbetracht der unendlichen Schadlichkeit dieses heimtiikischen,
Jahrhunderte lang verkannten und noch dazu gehegten und gepf legten
Leidens richte ich an alle CoUegen und Menschenfreunde die dringende
Bitte,*demselben ihre Auf merksamkeit zur Bekampfung und zu weiteren
Erforschungen zuzuwenden zum Heil und Segen von Jugend und Alter!

Zusammenfassung .

1. Habituelle Kalte der Fiisse wird in alien Fallen durch Hyper-
hidrosis derselben hervorgerufen.

2. Ein Gemisch gleicher Teile von wassriger Formalinlosung und
Alkohol eignet sich, ohne Nachteil fiir die Gesundheit, zur Beseitigung
des profusen Schweisses und der Kalte der Fiisse.

3. Habituelle Kalte der Fiisse kann Zirkulationsstorungen im
Gehirn und kongestive Zustande in verschiedenen anderen Organen,
insbesondere auch in den Luftwegen, mit sich bringen.

4. Durch Zirkulationsstorungen in den Hirngefassen wird eine
gewisse Anamie, eine mangelhafte Ernahrung und bei langerer Dauer
eine geringere Leistungsfahigkeit desselben bewirkt und moglicher-
weise der Anhaufung von Ermudungsstoffen und mancherlei Anomalien
der Blutmischung Vorschub geleistet.

5. Hierdurch wird, wie die Vergrosserung der asthesiometrischen
Schwellen zeigt, das Unterscheidungsvermogen fiir aktile Eindriicke
herabgesetzt und die in Aufmerksamkeit, Auffassungs-und Urteils-
vermogen sowie in den Leistungen im Schulunterricht zum Ausdruck
kommende geistige Betatigung, empfindlich geschadigt.

6. Die vorstehenden, an Schiilern vorgenommenen Beobachtungen
haben unzweideutig ergeben, dass durch Beseitigung der Hyperhidrosis

DER EINFLUSS DER KALTEN FUSSE

323

und der kalten Fusse, das korperliche Befinden sowie die geistige Leis-
tungsfahigkeit der Schiller sich heben.

7. Vom unterrichtshygienischen und padagogischen Standpunkte
aus betrachtet, empfiehlt. sich daher eine rationelle Behandlung der
Schweissfiisse im schulpflichtigen Alter.

Resume.

1. Le froid aux pieds habituel est dfl dans beaucoup de cas ^ I'hyper-
hidrose des pieds.

2. Pour empecher I'exces de transpiration on peut employer sans
danger pour la sante un melange a parties ^gales d'alcool et de solution
de formaline dans I'eau.

3. Le froid aux pieds habituel peut provoquer des troubles circula-
toires au cerveau et des congestions dans differents ofganes, les voies
respiratoires entre autres.

4. Les troubles circulatoires du cerveau peuvent donner lieu ^
Taccumulation de dechets de la fatigue et a diverses anomalies du melange
sanguin.

5. II en resulte, ainsi que le montre I'augmentation des seuils esth^-
siometriques, .que la faculte de discernement pour les sensations tactiles
est diminuee et que I'activite intellectuelle, se traduisant par I'attention,
les facultes de reception et de jugement et par les progres de I'eleve, en
souffre sensiblement.

6. Ces observations, pratiquees sur des ecoliers, ont prouve avec
certitude qu'avec la disparition de I'hyperhidrose et des pieds froids
la sante corporelle ainsi que les facultes intellectuelles s' amelioraient.

7. Au point de vue de Thygiene et de la pedagogie la traitement
rationnel de I'hyperhidrose des pieds est done recommandable.

Summary.

1. Chronic coldness of the feet is in many cases due to hyperidrosis
of the feet.

2. A mixture of equal parts of the aqueous solution of Formalin
and alcohol may be applied without prejudice to health for suppressing
the excessive perspiration and the coldness of feet engendered by it.

3. Habitual coldness of the feet may induce disturbances of the
cerebral circulation and states of congestion in other organs, especially
the respiratory.

324 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

4. It is probable that accumulation of the products of fatigue and
other anomalous states of the constitution of the blood are favoured by
disturbances of the cerebral circulation.

5. The magnification of the aesthesiometric thresholds proves that
the power of distinguishing tactile impressions is diminished by the con-
dition; and that the intellectual faculties must be depressed which
are normally manifested in power of application or attention, recep-
tivity and judgment, and of dealing with school tasks in general.

6. Observations made upon school children (and tabulated above)
conclusively prove that the remedy of the hyperidrosis and the atten-
ding condition of cold extremities results in improvement of both the
physical and intellectual abilities of the scholars.

7. Both from the pedagogic point of view and from that of educa-
tional hygiene, it is accordingly desirable that excessive perspiration
of the feet should be intelligently treated during the period of the school
attendance.

Riassunto.

1° II freddo ai piedi abituale in molti casi e causato da inperidrosi,
dei piedi.

2° Per impredire il sudore profuso dei piedi ed il loro rafifredda-
mento, e da raccomandarsi 1' uso, innocuo alia salute, di una miscela
apparti uguali di una soluzione acquosa di formalina e di alcool.

3° II freddo ai piedi abituale pu6 determinare disturbi della circol-
azione cerebrale e congestione in varii altri organi e particolarment
anche nelle vie respiratorie.

4° I disturbi circolatorii cerebrali possono favorire I'accumulo dei
prodotti della fatica e la produzione di syariate anomalie della crasi
sanguigna.

5° Per tal modo, come lo dimonstra I'ampliamento del soglio estesio-
metrico, viene diminuita la facolta' di discernimento delle sensazioni
tattili, e danneggiata sensibilmente I'attivita intellettuale e quindi
I'attenzione, le facolta percettive e critiche, come pure il progresso
nello studio.

6° Le osservazioni precedenti compiute su scolari, hanno dimos-
trato in modo indubbio che curando I'iperidrosi, ed impedendo il freddo
ai piedi, si migliora le condizioni di salute fisca, e le facolta intellettuali
degli allievi.

7° Deve quindi raccomandarsi, sia dal punto di vista dell'igiene
scolastica, che da quello pedagogico, di sottomettere ad un trattamento
razionale I'iperidrosi dei piedi nell' eta giovanile.

DER EINFLUSS DER KALTEN FUSSE

325

Tabelle II

Erkliirung der AbkUrzungen.
links (linke Gesichtseite).
rectus (rechte Gesichtseite).
P. — Pinselung.

gel. B = gelinde Besserung, d. i. die FU6e sind noch etwaskalt, jedoch weniger als vor der Behandlang.
gt. B. ~ gute Bessening, d. i. warme FUBe.

z. gt. ■= ziemlich gut.

gegd. = genligend.

9./*^. usw. = Zahlen und Monat des Jahres 1912.

—

Schwel-

« .

AU-

len-

Datum

KOrperliches Befinden und
eventuell Ursache dafUr

gemeiner
geistiger

Auf-

merksam-

keit

Auf-
fassung

UrteUs-
kraft

Pinse-
lung

werte

in
Milli-

rtV

Zustand

metern

9./2.

9,5

10./2.
11./2.
12./2.

— — —

—

5,5

Etwas kalte FUfie

frisch

P.gTl.B

13./2.

Warme FUfie

" —

—

klar ge-
dacht

—

14./2.

p n

„

—

z. gt.

z gt.

p.gt.B;

—

15/2.

—

16./2.

n r: •

„

—

P.gt.B.

—

17./2.

„

—

18./2.

" I wund " (FUfie

eingeschmiert)

—

19./2.

Warme FUfie, wund

—

P.gt.B.

—

20./2.

z. gt.

—

21 ./2.

n n 1

gering

—

p-it.B.

—

2272.

„ nichtmehrwund

r- gt.

—

■ —

—

23./2.

Wohl . . .

z. gt.

—

5,5

5,6

24./2.

Warme FUiJe. mtide, um 11 Uhr

zu Bett

eiholtslch
rasch

ziemlich

z. gt.

P.gt.B.

—

25./2.

—

■ —

—

26./2.

Warme Fiifie.wund.Kopfweh

—

Tiicht wie

•

sonst

z. gt.

—

27./2.

» n ........

frisch

—

gut

P.gt.B.

—

28./2.

—

29./2.

—

f^ ,

1./3.

I) n

—

P.gt.B.

5.6

7,5

2./3.

;, „ etwas Kopfweh

—

gut

—

3./3.

— — —

—

4./3.

Wanne FUfie. etwas Kopf-

weh, spat zu Bett

Warme FUfie

—

z. gt.

—

5/3.

frisch

—

P.gt B.

—

6./3.

„ y, wohl

—

7./3.

■ '

—

8./3.

" » '. . . .

gut

—

5.5

9./3.

Fehlt wegen Kopfweh ....

—

10/3.

Warme FUfie, wohl

—

11. /3.

•n i> n

frisch

—

gut

—

12./3.

■

—

13. /3.

„ „ „ wund . '.

gegd.

—

P.gt.B.

—

14./3. ')

frisch

—

15./3.

'• 1 "

—

5.5

16./3.

„ „ „

„

gut

—

17./3.

— — —

—

— J

—

18./3.

Warme FUfie, wohl

frisch

—

P.gt.B.

—

19./3.

—

20 /3. 2)
21. /3.

Fehlt ...'..."..!;,'!!

frisch

—

Warme FUfie, wohl

—

22. '3.

—

P.gt.B.

5,5

23./3.

•' n jj

gut

z. gt.

—

24./3.

—

25./3.

Fehlt wegen Unwohlseins . .

—

26./3.

Nicht ganz wohl

z. gt.

—

27./3.

Warme FUfie, wohl

frisch

gut

z. gt.

— '

P.gt.B.

') Schriftliche PrUfung.
*) MUndliche PrUfung.

326

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabelle II (Fortsetzung).

Datum

KOrperliches Befinden vind
eventuell Ursache daftir

All-
gemeiner
geistiger
Zustand

Auf.

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

Schwel-
len-
werte

in
Milli-
meter n

9./2.
10^.
11./2.
12./2.
13./2.

14./2.

15./2.
16J2.
17./2.
1872.

19,/2,
20J2.

21./2.
22./1.

23./2.

24./2.
25./2.
26J2.
27./2.
28-/2.
29./2.

1./3.

2./8.

3./3.

473.

5./9.

673.

7./a.

873.

973,
1073.
11./3.
12./3.
13./3.
14./3. «)
15./3.
1673.
17./3.
18./3.
19./3.
20./3.2)
21 ./3.

22./8.
23./3.
24./3.
25./3.
26./3.
27./3.

Etwas kalte Ftlfie

Warme Fttfie

„ « abends krampf-

artigeSchmerzenin d.FUfien

Warme FUfie

n „ Haut zwischen

den Zehen aufgesprungen .

Warme FUfie, Kopfweh . . .

, „ wund, etwas

Kopfweh bis Mitiag ....

Warme Fttfie, wund.ein wenlg

Kopfweh

Warme Fttfie, wund

Wohl. . " ..!" .,!!.' !
Warme Fttfie ........

„ „ kopfweh . . .

I I wohi '..!..

Warme Fttfie, wohl .....

Woiii ..."...!.!!!!!
1) • . •

WohlT. ...""...."....

Etwas mttde, sonst wohl, Fxifl*
ball gespielt (tags vorher) .

Wohl

Wohl .~ . . .

frisch

1. Std. un-
aufraerk-

sam,

2. Std gut

z. gt.

weniger
frisch

nicht frisch

frisch

frisch
frisch

frisch

ziemlich
frisch
frisch

frisch

nicht klar

gedacht

gut

z. gt.

nicht wie

sonst

gut

gut
gut

gut

gut
gut

gut

P.gel.B.
P.gt.B.

P.gtB.
P.gt.B.
P.gt.B.

P.gt.B.
P.gt.B.
P.gt.B.

P.gt_B.

feMt

P.gtlB.

P.gtB.

P.gt,B.
P.gt.B.

5,5

4.5

') Schriftliche Prttfung.
«) Mttndliche Prttfung.

DER EINFLUSS DER KALTEN FUSSE

327

Tabelle II (Fortsetzung).

Is
s

Datum

KOrperliches Befinden und
eventuell Ursache dafUr

AU-
gemeiner
geistiger
Zustand

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

inse-
ung

Schwel-
len-
werte

in
Milli-

metern

9./2.
10./2.
11./2.
12./2.
13./2.
14./2.
16./2.
16^2.
17./2.
1872.
19./2.
20./2.
21 ./2.
22./1.
23./2.
24./2.

25./2.
26./2.

2772.
28./2.
2972.

1./3.
2./3.

3./3.
4.73.
5./3.
6./3.
7./3.

8./3.
973.

1073.

11./3.

12./3.

13./3.

14./3. «)

15./3.

16./3.

17./3.

18./3.

19./3.

20./3. «)

21./3.

22./3.

28./3.

24./3.-
2573.
26./3.
27./3.

Warme FUfie

etwas Husten
wund, Husten

Woiil .."..."..■..■
Made, urn 11 Uhr zu Bett

Warme Fiifie, wund. sonst
wohl

Warme FUfie, wund

- „ nicht mehr

wund
Warme FUfie

Kopfweh
Warme FUfie

schiafrig, etwas

wund

wohl
Wohl .

wcnig wund.

frisch

ab-
gespannt

frisch

faul
frisch

z. gt.

y..gt.
z. gt.

nicht wie
sonst
gut

schwach
ziemlich

z. gt.

„ wund .
Wohl, wund

gering

unauf-

merksam

gut

ge£d.
gering

gut

spat zu Bett

„ wenig wund, spat zu
Bett, Turnverein .

Wohl, nicht wund

frisch

z. gt.

gut

gut
z. gt.

gegd.

gut
z. gt.

P.
P.gel.B
P.gt.B.
P.gt.B.

P.gt.B.
P.gt.B.

P.gt.B.

P.gt.B.
P.gt.B.

P.gt.B.

P.gt.B.
P.^.B.

P.gT.B.
P.gt.B.

P.gt.B.

5.2

5,5

5.5

5.6

4.5

6.5

Sfi

1) SchriftHche PrUfung.
>) MUndliche PrUfung.

328

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabelle II (Fortsetzung).

Datum

#COrperliches Beflnden und
eventuell Ursache dafUr

All-
gemeiner
geisliger
Zustand

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

9./2.
10./2.
11../2.
12./2.
13./2.

14./2.
15./2.
16./2.

17./2.

18./2.

19./2.
20./2.
21.^.
22./2.
23./2.
24 ./2.

25./2.
26./2.
27./2.
28./2.
29./2.

i./3.

2./3.

3./3.

4./3.

5./3.

6./3.

7./3.

8./3.

9./3.
10./3.
11. /3:

12./3.
13./3.

14./3. «)
15,/3.

16./3.

17./3.
18./2.
19./3.

20./3. 2)

21 ./3.

22./3.

23./3.

24^3.

25./3.

26./3.

27./3.

Kalte FOfie .
Warme FUfie

„ „ wund, abends
Kopfweh

Warme FUfie, wund, abends
Kopfweh

Warme FUfie, wund . . .

fl „ wenig wund
„ „ Kopfweh . .
um V2II Uhr
zu Bett, hat gelesen . .
Wohl

Warme FUfie, Kopfweh . .
„ „ wohl ....

„ „ Kopfweh , .

, , wohl ....

p „ Kopfweh . .

Warme FUfie, spat zu Bett

Wohl ..."...■.'.!! ." .*

Warme FUfie
Wohl

Mttde, spat zu Bett, Tum-
verein • • • •

Wohl

MUde, spat zu Bett, Tum-

verein

Wohl

MUde, 11 Uhr zu Bett, ge-
arbeitet

Wohl

„ etwas kalte FUfie .
Kopfweh, spat zu Bett '.

wohi.~~. . . r. . . .~ .

„ etwas mUde, 4—7 Uhr
Gartenarbeit (26./3.) ....

ab-
gespannt

frisch

nichtfriscb
frisch

schiafrig

schiafrig
schiafrig

trage

ab-
gespannt

ab-

gespannt

frisch

schwach

gegd.

zerfahren

mangel-
haft

unauf-
merksam

schwach

ziemlich

z. gt.

z.jt.
schwach

erst
schwach,

dann
ziemlich

gegd.

gut
z. gt.

schwach
gut

gut

schwach

gegd.

z. gt.

z. gt.
2. gt.

gerinj

regd.

z. gt.

P.gcl.B

P.gt.B.
P.gt.B.

P.gt.B.

P.gt^B.

P.gt.B.
P.gt.B.

P.gt.B.

') Schriftliche PrUfung.
«) MUndliche PrUfung.

DER EINFLUSS DER KALTEN FUSSE

329

Tabelle II (Fortsetzung).

o ^

5?,

Datum

KUrperllches Befinden und
eventuell Ursache dafUr

9./2.
10./2.

11./2.
12./2.
13./2.
14./2.

15./2.
16./2.

17./2.

18./2.
1972.
20./2.
2172.

22./2.
23./2.
24./2.

25.r2.
26./2.
27./2.
28./2.
29./2.

1./3.

273;

3./3.

4./3.

5./3.

6./3.

7./3.

8./3.

9./3.

1073;

11. /3.

12./3.

t3./3.

14./3. ')

16./3.

17./8.

1873.

19./3.

2073. «)

21./3.

22./3.

23./3.

24./3.

25./3.

26./3.

27./8.

Vi Stunde Zeitungen ausge-
tragen nach d. Mittagessen
(tragt Uberhaupt jeden Tag
Va Stunde Zeitungen aus) .

Kalte FUBe

Etwas kalte FUBe

Warme FUfie

n n

Warme FUfie

n n

n ri • ■ ■ ■ . . .
n n WOhl

„ „ urn Va Uhr zu

Bett, gearbeitet ......

Warme FUfie

n )t

n n

» n "

n n

Warme FUfie

n n ' •

n „ wimd, wohl .

n n n n

„ r, nicht wund . .

n n . . V

U " Va ijhr zu Bett

„ „ wohl

„ fl mUde (morgens)
Wohl

Wohl" ..."... r. .. .

Fehlt '.'.'. W. \ '.'.'.'. \\
Wohl

Wohl .". ...""...."...

AU-
gemeiner
geistlger
Zustand

Auf-

merksam-

keit

schlafrig

frischer,
geworden

frisch

schlafrig

schiafrig
frisch

frisch

schiafrig
frisch

frisch

gering

unauf-
merksam

gering

gut

gegd.

Auf-
fassung

Stimde
z- gt.,
Stunde
gering

z. gt.

gut

z. gt.

gut
z. gt.

Urteils-
kraft

gut

gut
gut

z. gt.
gut

z.jt.
•gegd.

ge£d.
gut

Pinse-
lung

P.
P.gel.B
P.gt.B.

P.gt.B.

P.gt.B.
P.gt.B.

P.gt.B.
P.gt.B.
P.gt.B.

P.gt.B.

P.gt^^B.

P.gt.B.
P.gt^B.

P.gt.B.

Schwel-
len-
werte

in
Milli-
metem

6.5

6,5

5,6

5.2

5.4

5,6

5.6

6,4

') Schriftliche PrUfung.
•) MUndliche PrUfung.

330

FOURTH INTERNATIQNAL CONGRESS ON SCHOOL HYGIENE

Tabelle II (Fortsetzung).

Datum

KOrperliches Befinden und
eventuell Ursache dafUr

All-
gemeiner
geistiger
Zustand

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

9. '2.
10./2.
11./2.
12.72.

13./2.
14./2.
15./2.
16./2.

17./2.
18. /2.
19./2.
2J./2.

21 ./2.
22./2.

23./2.
24./2.
25./2.
26./2,

27./2.

28./2.
29./2.

1./3.

2./3.

3./3.

4./3.

5./3.

6J3.

7./3.

8./8.

9./3.
10./3.
11./3.
12./3.
13./3.

14./3. >)

15;/3.

16./3.^

17./3.

18./3.

19./3.

20./3. «)

21./3.

22.^.

23./3.

24./3.

25./3.

26./3.

27 ./3.

Kalte FllBe, eln Brennen nach

dem Pinseln' . ,

Warme FUfie ........

„ „ Brennen . . .
1 "

Warme FUfie

„ „ abends vorher

Kopfweh

Warme FUfie

n n • •

^* „ wohl

Warme FUfie, wunde FUfie,
wohl

Warme FUfie, mUde vom
Arbeiten zu Ha'use . . . .

Warme FUfie, wohl .....

„ >/8l2 Uhr zu

Bett, gelesen

Warme FUfie

n n ••

Warme FUfie

„ „ wohl

n n >i .....

n n n

n n n .....

n » f .....

I I m5de,V8i2Uhr
zu Bett (Umzug)

Warme FUfie, wohl

n v ri ......

Warme FUfie, wohl ."....

Fehit ..."...".;::::

Warme FUfie, wohl

" n »i

Warme FUfie, wohl

frisch

ab-
gespannt

schiafrig

frisch

schiafrig
frisch
munter

schiafrig

frisch

ab-
gespannt

frisch

ziemlich

schwach

ziemlich

zerfahren

gut

2. gt.

ziemlich

mangel-
haft

z. gt.

gegd.
gegd.

P.gel.B.
P.gt.B.
P. gt.fi.

P.gt.B.

P.^.B.

P.gt.B.

P.gt.B.
P.gt.B.
P.gt.B.
P.gt.B.

P.gt.B.

P.gt.B.
P.gt.B.

P.gt.B.

•) Schriftliche PrUfung.
*) MUndliche PrUfung.

DER EINFLUSS DER KALTEN FUSSE

331

Tabelle U

(Fortsetzung),

Schwel-

Datum

KOrperliches Beflnden und

All-
gemeiner

Auf-

merksam-

keit

Auf.

UrteUs-

Pinse-

len-

werte

eventuell Ursache dafUr

geistiger

fassung

kraft

lung

Mllli-

Zustand

metern

9./2.

10./2.

_ _ _

—

12,2

10*

11./2.

— — —

—

12/2.

Warme FUfie

—

P.gt.B.

—

13./2.

Etwas kalte Ftifie

—

— '

—

14./2.

Kalte FUfie

schwach

P.gTl.B.

—

15./2.

Warme FUfie, abends vorher

bis 11 Uhr Musikprobe . .

—

16./2.

Warme FUfie

—

' —

—

— '

P.gt.B.

—

17./2.

Etwas kalte FUfie

frisch

z. gt.

—

18./2.

Etwas Brennen in den Fttfien

—

19./2.

Warme FUfie

J—

—

gut

P.gt.B.

—

20./2.

spat 2u Bett,

Musikprobe

—

ziemlich

—

2i.;2.

Warme FUfie

ab-
gespannt

gering

—

P.gt.B.

—

22./2.

„ ., mUde, 10 Uhr

zu Bett (21.72.)

—

. —

—

23./3.

Warme FUfie. wohl . . . . .

—

24./2.

„ 9Uhrzu

Bett

frisch

gut

P.gt.B.

—

25./2.

—

26./2.

Warme FUfie, wohl

frisch

—

z. gt.

—

27.72.

n n n

„

—

gut

P.gt.B.

—

28./2.

—

29./2.

.....

—

— •

—

1/3,

^ „ „ wund

—

P.gt.B.

8,6

'>»

273.

r „ mUde. Kopf-

«3.

weh, Musikprobe

schiafrig

gering

—

3./3.

—

4./3. .

Warme FUfie, wohl

frisch

—

gut

—

5.73.

—

P.gt.B.

—

6./3.

7./3.

p n n .....

—

8./3.

« " !!!*,..

—

gut

—

7,6

Tfi

9.73.

Etwas kalte FUfie, V9II Uhr zu

Bett, Musikprobe

schiafrig

—

P.gel.B.

—

1073.
1173.
12.73.
1373.
14.73. •)

Wohl, wund

frilch

gegd.

gut

P.gt.B.

—

* 9

r> n •

—

Warme FUfie ,' wund, bis

11 Uhr im Musikverein . •

schiafrig

—

15.73.

Warme FUfie, mUde, bis

'7*12 Uhr im Musikverein .

ab-
gespannt
etwas ab-

—

■—

gering

—

16.72.

Warme Fufie, wund, wohl .

mangel-
haft

—

gespannt

17.73.

•— — — ■

—

-»-

—

18.73.

Warme FUfie, wund, bis

11 Uhr im Musikverein . .

etwas ab-
gespannt

•~

—

P.gt.B

19.73.

Etwas kalte FUfie, wund, Re-

20.73 «)
21./3.

genwetter, schlechte Schuhe
Wohl

frisch

gut

„ wund

—

22./3.

n nicht wund

—

z. gt.

P.gt.B.

6,5

23.73.
24./3.

—

gegd.

—

** *_* * ' L^' * ' '

—

25/3.

Schiafrig,.um 2 Uhr zu Bett,
zum Tanz aufgespielt . . .

ab-

—

gespannt

36.73.
27-.73.

Munter

frisch

gut

P.^.B.

—

Wohl

—

I) Schriftliche PrUfung.
«) MUndliche PrUfung.

332

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabelle II (Fortsetzung).

Datum

KOrperliches Befinden und
eventuell Ursache dafUr

AU-
gemelner
gelstiger
Znstand

Auf-

merksam-

keit

Auf-
fassting

Urteils-
kraft

Pinse-
lung

Schwel-
len-
werte

in
Milli-
metern

1. I r.

9./2.
10./2.
11/2.
12./2.
13./2.
14./2.
15./2.
16./2.
17./2.
1872
19./2.
20./2.
21/2.
22./2.
23./2.
24./2.
25./2.
26/2.
27./2.
28/2.
29./2.
1./3.
2./3.
3./3.
4./3.
5/3.
6./3.
7./3.
8./3
9./3.
10./3.

11/3.

12./3.

13./3.

I4./3. ')

15/3.

1673.

17./3

18./3.

19./3.

20 /3. 2)

2173.

22./3.

23./3.

24./3.

25./3.

26./3.

27./3.

Kalte FUfie . . .
Warme FUfie . .
Etwas kalte FUfie
Warme FUfie . .

Warme FUfie . .
Etwas kalte FUfie

Warme FUfie

wund .

Warme FUfie, etwas Kopfweh

Warme FUfie, wohl

wohl . . . .
Warme FUfie

etwas wund .
nicht wund,

n „ wohl ....

„ n spat zu Bett

Warme FUfie, wohl ....

Fehit .

Warme FUfie, Avohl

Warme FUfie. wohl

frisch

frisch
frisch
frisch

schiafrig

frisch

schiafrig

frisch

n
frisch

frisch

z. gt.
z. gt.

gui

gut

ziemlich

z. gt.

gegd.
gegd.

gegd.
gut

ziemlich

gut

ziemlich

z. gt.
z. gt.

gut

z. gt.

z. gt.
z. gt.

P.gel.B
P.gel.B
P.gt.B.

P.gt.B.
P.g7l.B

P.gt B.

P.g^B.

P.gt.B

P.gt^.B.

P.gt.B.

P.^.B.

P.gt.B.
P.gt.B.

P.gt.B.

9.519.^

5.5

8,5

6,5

7,5

8.5

0 Schriftliche PrUfung.
'^) MUndliche PrUfung.

DER EINFLUSS DER KALTEN FUSSE

333

Tabelle II (Fortsetzung).

Datum

KOrperliches Befinden und
eventuell Ursache dafOr

AU-
gemeiner
geistiger
Zustand

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

Schwel-
len-
werte

in
Milli-
metern

1. r.

10/3.

nn.

V2/2.
13./2.
14./2.

15./2.
16./2.
1772.
18./2.
19./2.
20./2.
21 ./2.
22/2.

23./2.
24./2.
25./2.
26/2

27./2.
28./2.
29./2.

1./3.

2./3.

3./3.

4./3.

5./a

6./3.
7./3.
8./3.
973.

10/3.

11/3.

1273.

13./3.

14./3. '

15./3.

16./3.
1773.
18./3.
19/3,

20./3 s

21./3.

22/3.

23./3.

24./3.

25./3.

26.^.

27./3.

KalteFUfie

Etwas kalte FUBe

Warme FUfie !..'!!!!!

Warme FQUe

„ ., wund

n n •, einBren-

jnen an den Fiifien

Warme Fafie, wohl

Warme FUfie , wund , ein

wenig Kopfweh

Warme Ftilie, wund

» « n

•f n -i

Warme FUfie, wohl

„ r, wund

Etwas kalte FUfie

„ „ „ sonst wohl

Warme FUfie, wund

1 1 »

n » »

n p s

„ „ wohl

„ „ mUde, Kopf-
weh, schlecht geschlafen .
Warme FUfie, wohl

Warme FUfie, wohl

Kalte FUfie , Regenwetter,
schlechte Schuhe . . , .
Warme FUfie, wohl . . .

n n fl . • . •

Warme FUfie, wohl

frisch

schiafrig

frisch

frisch
schiafrig

frisch

ziemlich

frisch

schiafrig
frisch

frisch
frisch

frisch

zerfahren

genng

gegd.

schwach

z. gt.

schwach
gut

z. gt.

ziemlich
z. gt.

ziemlich

gegd.

gut

gut.

z- gt.

z. gt.
z. gt.

P.gel.B.
P.gel.B.
P.gT.B.

P.^.B.
P.gt.B.

P.gt.B.

P.gt.B.
P.gt.B.

P.gt.B.

Pgt.B.
P.gt.B.

P.gt.B.
P.gt.B.
P.gt.B.

5,5

4.9

5,5

4.5

4,9

feldt

') Schriftliche PrUfung.
2) MUndliche PrUfurig.

334

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabelle II (Fortsetzung).

Datum

KOrperliches Befinden und
eventuell Ursache dafttr

AU-
gemelner
geistiger
Zustand

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

9./2.
10./2.
11./2.
12./2.
13./2.
UJ2.
15./2.

1672.
17./2.
1872.
19./2.

20./2.

21/2.

22./2.
23./2.
24./2.
25./2.
36./2.
27./2.
28./2.

29./2.

1./3.

2./3.

3./3.
4./3.
5./3.
673.
7-/3.
8./3.
9./3.

10./3.

11./3.

12./3.

13./3.

1473. ')

15./3.

1673.

17./3.

1873.

19./3.

20./3.«)

21./3.

2273.

23./3.

2473.

2573.

2673.

27./3.

Kalte FUfie

Etwas kalte FUfie . . .
Weniger kalte FUfie

gestem

Warme FUfie

Etwas kalte FUfie . . .

Warme FUfie

Etwas kalte FUfie, wund,

fUhlt sich wohl

Warme FUfie, wund . . . .

Warme FUfie, wund

„ „ „ morgens

etwas Kopfwch

Wai-me FUfie, wund, etwas

Kopfweh

Warme FUfie, wund

„ „ , etwas

Kopfweh, doch raunter . .

Warme FUfie, wohl

„ „ wund ....

Etwas kalte FUfie

„ - - wohl . . .

Kalte FUfie, wund, Kopfweh,

bis V2II Uhr im Turnverein

Warme FUfie, wohl

Etwas kalte FUfie, wohl

Warme FUfie ."..."..

bis 8/4II Uhr

mUde, geturnt

Wohl -. . . .

Warme FUfie, wund

Wohl

„ abends vorher geturnt

Nicht ganz wohl, Kopfweh
und Schnupfen

Nicht ganz wohl, Kopfweh
his Miitag

Wohl.

frisch

frisch
munter

frisch

ziemlich
rege

rege

schwach

z. gt.

z. gt.
gut

rege

gut

—

P.
P.g7l.B
P.gel.B

—

P.gT.B.

ziemlich

P.it'.B.

P.gt.B.

gut

P.gt B.
P.gt.B.

z. gt.

gut

gut
z. gt.

P.gt.B

P.gT.B,

P.gel.B.
P.gel.B

P.g7.R.
P.gt'.B.

P.^.B.

4,5

') Schriftliche Prtifung.
«) MUndliche PrUfung.

DER EINFLUSS DER KALTEN FUSSE

335

'TabeUe II (Fortseteung).

Schwel-

Datum

KOrperUches Bcflnden und
eventuell Ursache dafUr •

AU-
gemeiner
geistiger

Auf-

merksam-

kelt

Auf-
fassung

Urteils-
kraft

Pinse-
lung

len-
werte

in
Milli-

Zustand

me
1.

tern
r.

972.
10./2.

- - -

11./2.

— — —

—

12./2.

Kalte FUfie

P.gel.B.

13./2.

Wanne FUfie

—

14./2.

„ „

—

schwach

P.gt.B.

15./2.

» » ........

— —

—

16./2.

1) fl ••

—

P.gt.B.

17./2.

„ , , wund

—

l«./2.

— -

—

19./2.

Warme FUfie, wund

frisch

zlemlich

wenig

P.gt.B.

20^.

» n »•••••

—

zlemlich

2172.

—

gering

P.gt.B.

—

22./2,

_ „ •••...•

—

23./2.

r> » )?••>••

—

24./2.
25,/2.
26./2.

» n n

—

P.gtB.

Warmr FUfie, nkht mehr

27./2.

wund

frisch

zlemlich

—

P.gT.B.

—

Warme FUfie

28./2.

„ n

•^

—

29./2.

— — —

—

1./3.

Warme FUfie, wohl

frisch

P.gt.B.

4,2

2./3.

unauf-

—

3./3.
4-/3.

merksam

_ _ _
Warme FUfie. wohl

frilch

5./3.

n V n

—

P.gt.B.

—

673.

n " n

„

—

7./3.

—

8./3.

I? » n

„

gering

—

'zlemlich

—

4.5

4,5

973.

n n n

„

—

P.gt.B.

—

10./3.

7) p t .....

—

1I./3.

» » )}

„

—

zlemlich

—

12./3.

—

13./3.

» 1) n

—

mangel-
haft

—

P.gt.B.

—

14./3. ')

frisch

15./3.

» » n .....

—

zlemlich

—

6.5

16.2.

ft n n

mangel-

—

17./3.

— — —

— .

—

18./3.

Warme FUfie, wohl, Klasse

hat gebadet

—

P.gt.B.

—

19./3.

Warme FUfie, wohl

frisch

besser

—

z. gl.

—

20./3.«)

„ „ „

— .

—

21 ./3.

•1 « n ...«.■

•^

—

22,/3.
23./3.
24./3.

•• » »

j;_

—

z._gt.

P.gt.B.

5.2

25./3.

—

26./3.

Warme FUfie, wohl

frisch

—

gegd.

—

27/3.

z. gt.

P.gt.B.

0 Schriftliche PrUiung.
^ MUndliche Prttfung.

336

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Tabelle II

{Fortsetzung).

Schwel-

Datum

KOrperliches Befinden und
eventuell Ursache dafUr

All-
gemeiner
geistiger

Auf-

merksam-

keit

Auf-
fassung

Urteils-
kraft

Pinse-
lung

len-
werte

in
Milli-

gcr

Zustand

metern

9./2.

7.5~

10./2.

_ _ —

—

11. /2.

12./2.

Warme FUfie

—

P.gt.B.

—

13./2.

, ,

—

— ■

14./2.

„ ,

frisch

—

15./2.

„ „

„

' —

—

P.gt.B.

—

16./2.

n r> ........

—

17./2.

„ „ wund

18./2.

10./2-

Warme FUfie, wund

frisch

—

Pgt.B.

—

20./2.

n » n

—

z. gt.

—

— .

—

21/2.
22J2.

n n n

—

gut

P.gt.B.

—

n » ;)«....

—

23./2.

y " »

—

z. gt.

gut

— .

5,5

24./2.

—

P.gt.B.

20./2.

— — —

26./2.

Warme FUfie, nicht wund .

frisch

—

gut

27./2.
28./2.

" I !.'!!.*!!!

—

gut

P.gt.B.

—

29./2.

„ „

1./3.

, „

P.gt.B.

5,2

6.5

2./3.

» »

schiafrig

—

3./3.

— — —

4./3.

Warme FUfie, wohl

frisch

gut

5./3.

• ••••

P.gt.B.

6./3.

Erkaitet, rote Flecke auf der

Rachenschleimhaut ....

7./3.
8./3.

Erkaitet

—

gut

4,5

9/3.

Erkilltung fast vorijei ! .* .' !

P.gt.B.

10./3.
11. /3.
12./3.

Wohl

frisch

gut

c^i

13./3.

Mude, spat'zu'Bett,* El'tern
ausgegangen, mufite kleines
Kind huten

ab-

gegd.

z. gt.

P.gt.B.

gespannt

14/3. >)

Ein wenig schiafrlg, bis
11 Uhr im Musikverein . .

15./3.
16./3.

Wohl

frisch

mangel-
haft

—

5,5

5^5

17./3.

— — —

18./3.

19./3.

20./3.«)

21. /3.

22.'3.

23./3.

Wohl

frisch

P.gt.B.

—

gui

z. gt.

P.^.B.

—

r '.'.','.'.'.'.'.'.'.'.'.'.

24./3.

25./3.
26./3.

27 ./3.

Wohl

frisch

—

gut

—

feWt

') Schriftliche PrUfung.
2) MUndliche PrUfung.

BOOK DISINFECTION-NEGLECTED FACTOR IN SCHOOL SANITATION 337

BOOK DISINFECTION— A NEGLECTED FACTOR IN
SCHOOL SANITATION

L. B. Nice

In the rapid advance of school hygiene and public sanitation no
satisfactory method for disinfecting school and library books has been
put into general use in this country. This problem has been neglected
in spite of the fact that books seem well adapted for carrying scarlet
fever, measles, smallpox, diphtheria, trachoma, erysipelas, typhoid
fever, dysentery and tuberculosis.' The increase in children's diseases
during the months of school might well be due in part to contagion
from their books.

Library books are in danger of becoming contaminated since they
are one of the chief diversions of invalids and convalescents. Such
persons are apt to hold their books in front of the face in sneezing and
coughing. Flugge placed petri dishes around tubercular persons and
found that tubercle bacilli are thrown as far as a yard in the coughing,
sneezing or even talking of such patients. Besides the danger of books
becoming contaminated by spray from the mouth and nose, many
persons have the uncleanly habit of turning the leaves with saliva-
moistened fingers.

Many pathogenic bacteria are very resistant to the effects of drying.
Measles, scarlet fever and smallpox are known to be virulent on toys,
clothing and other articles for a very great length of time. Investi-
gations have shown that bacteria retain their virulency as follows:
Cholera for i month ; Bacillus enteritidis of Gartner, 3 months ; Bacillus
Friedlander, 7 months; typhoid, 7 months; tubercle bacillus, 9 months;
Pneumococcus, 11 months; Streptococci, 11 months; Streptococci from
peritonitis, i year, 4 months; Staphylococci in pus from an abcess, I
year, 6 months; diphtheria, i year, 11 months, and tetanus, 2 years (6).

Two French investigators examined a book that had been used for
a long time in a hospital. They found on a hundred square centimeters
(about 16 sq. in.) 1,600, 2,400 and 4,700 bacteria (4). Lion made many
experiments on the number of bacteria in used books. He found that
a novel from a public library with rather dirty leaves had from 1,250
to 3,350 bacteria per 100 square centimeters. The binding of this book
had 7,550 bacteria per 100 square centimeters. An atlas of anatomy
that had formerly been used a great deal, but had been out of use for
three years showed from 125 bacteria per 100 square centimeters on a

338 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

clean page to 1,075 on an especially dirty page. Although this is less
than another anatomy book, only a short time out of use, which had
2,275 and 3,700 bacteria per 100 square centimeters, yet it is significant
that such large numbers of bacteria had resisted drying for three years

(10).

Staphylococcus pyogenes aureus was found on an old book in a hos-
pital (4) . Krausz (9) cut pieces from the edges of much used books and
from the edges of clean books. These, pieces of paper were placed in
the abdominal cavities of seven guinea pigs. The three animals inoc-
ulated from dirty books, died of peritonitis in 48, 51 and 63 hours, while
the four inoculated from clean books remained healthy. Pieces of
dirty and of clean books were placed in bouillon for 24 hours. One c.c.
of this bouillon was injected into the abdominal cavity of each of 18
guinea pigs. The four injected with bouillon from the dirtiest books
died of septic peritonitis.

Mitulescu (11) took 60 much used books that had been in the Berlin
Public Library from six months to two years. He cut pieces from the
dirtiest parts, soaked them in normal salt solutions, centrifuged the liquid
and inoculated 120 guinea pigs with the sediment. Twelve died of strept-
ococcus infection and nineteen of septicemia. He repeated the experi-
ment with thirty-seven books from three to six years old, using fifty-
seven animals. Fourteen of the guinea pigs died of septicemia and
fifteen contracted tuberculosis. It is significant to note that of the
older and dirtier books one third were infected with tubercle bacilli.

Letters have been proved to have transmitted disease. Four cases
are reported from France and Germany where scarlet fever was carried
long distances by letters (4 & 7). The postmaster in North Amherst,
Mass., contracted scarlet fever during an epidemic in 1913. He knew
of no other way in which he could have become infected except by letters
which came into his office. During an epidemic of smallpox in Kent,
England, the post-office employees contracted the disease (21).

Ten years ago a great deal of smallpox appeared in Kentucky, par-
ticularly in one county (17). This county had bought a large number
of second-hand school books from a firm in Chicago. This firm had
procured these second-hand books from Tennessee where smallpox
had been widely distributed. This indicates that the schoolbooks
were the probable carriers of the infection.

The library of the Faculty of Medicine in Bordeaux, France, was
rearranged. The people who did this work were attacked by a feverish
lumbago (4). In France a mother and baby were fatally infected by
septicemia which was traced to a library book (7). Two epidemics
of tuberculosis have occurred in Russia, one in Kharkow, and the other
in St. Petersburg among officials in the State offices (7 & 9). In both

BOOK DISINFECTION-NECxLECTED FACTOR IN SCHOOL SANITATION 339

cases there had been a tuberculous official who had moistened his fingers
with saliva as he turned the pages of the documents.

Methods of Disinfection.

Books are difficult things to disinfect. The method used must kill
all the bacteria, it must not injure the books, and finally it should be
inexpensive and easy to use. The chief disinfectants that have been
tried for books are carbo-gasoline, steam, formalin, steaming formalin
vapor under vacuum, and moist hot air.

A 2 per cent, solution of carbolic acid in 88 Baume gasoline was
recently recommended as a book disinfectant (3). I made a careful
test of this method and found it absolutely inefficient. It does not
kill bacteria (12 & 13).

Steam is a thorough disinfectant but it is injurious to books, espe-
cially to those bound with leather. On the other hand letters can be
autoclaved without any harmful effects. This was the method used
to prevent letters from spreading smallpox in the epidemic at Kent (21).

At least eight investigators have proved by careful experiments
that formaldehyde gas will not kill bacteria in closed or open books, un-
less the test pages are purposely left open and exposed to the gas. To
mention the results of one study, Ballner (i) made 204 inoculations
in the middle, front and back of large and small books. He stood the
books on end, opened them fan wise and subjected them to the fumes
of formaldehyde gas from 20 to 48 hours. Eighty-five cultures were
sterile and 119 cultures grew. The results of the other investigators
are similar (2, 4, 8, 14, 15, 18 and 19). From these results we are forced
to conclude that formaldehyde -gas at room temperature is an entirely un-
trustworthy disinfectant, since it does not penetrate between the leaves. •

Two effective methods of disinfecting books have been evolved.
One is the Rubner apparatus which uses steaming formalin vapor under
a vacuum. It employs a vacuum of 600 mm., 8 per cent, formalin and
a temperature of 60° to 65° C. It can be used for disinfecting all sorts
of articles, mattresses, clothing, etc. Sobernheim and Seligman (16)
made extensive experiments with this apparatus in disinfecting books.'
They found that 200 closed books could be disinfected at one time.
This method is not injurious to the books. The advantage of this appar-
atus is the short time required for disinfection — less than two hours.
But it is expensive to buy and to install; the apparatus is complicated
and needs skilled management.

The moist hot air method of disinfecting books has been developed
by Findel (5) and Xylander (20). The books are subjected to a tem-
perature of 78° to 80° C, combined with a moisture of 30 to 40 per cent,
for 32 hours. This method will kill tubercle bacilli in thick layers

340 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

and all non-sporing bacteria in closed books, and does not injure bind-
ings in any way. The moisture must not exceed 40 per cent, or the heat
80° C, or the books will be injured. A thermometer is placed in the
middle of the pile of books and when the temperature registered by
this thermometer treaches 70° C. the disinfection is considered as begun.
I have tested this method and find that it kills the bacteria without
injury to the books. The advantages of this method lie in its simplicity,
the ease with which it can be used and the cheapness of installing the
apparatus. The disadvantage lies in the length of time the books must
be in the disinfector before the process is completed.

The disinfection of books is still a problem. As yet no entirely
satisfactory method has been devised. We hope to be able to report
results in the near future that will clear up the difficulties.

Status of the Problem in This Country.

Letters were written to the Boards of Health of all cities in this
country and in Canada with a population over 100,000. They were asked
to give in detail their methods of disinfecting school and library books.
Forty- two answers were received. Four cities do nothing at all. Twelve
cities burn school and library books that have been exposed to contagion.
Eight burn books where the infection is serious, as in case of smallpox,
scarlet fever and diphtheria, but fumigate with formaldehyde gas in
less serious cases, or when the books are very valuable. Formaldehyde
gas is used exclusively by fourteen cities. In six of these the Boards
of Health have special closets or small rooms for fumigating books,
and in three cities the public libraries are thus equipped. In the others
it seems that the books are set on end and fumigated with the room.
One city bakes library books that have been exposed to scarlet fever
and diphtheria in a gas oven at 105° C. for twenty minutes. Finally
two cities depend on sunlight and air.

In two of these cities the Health officer sends a daily report to schools
and libraries of the houses where contagious diseases exist. One day,
for example, the list showed mumps, measles, whooping cough, chicken-
pox and tuberculosis. The books from these houses are fumigated by
the Board of Health before they are returned to the school or library.

In 191 1 similar letters were sent to the same cities and also to the
State Boards of Health. Of the States, 12 did nothing; 9 burned con-
taminated books; 17 used formaldehyde gas; 2 dry heat and one carbo-
gasoline. Sixty-four cities answered; 10 did nothing at all; 22 burned
infected books; 25 used formalin; 3 steam, one dry heat and three carbo-
gasoline.

The proportion of cities and State Boards of Health which burned
and used formalin in 191 1 is practically the same as at the present time.

BOOK DISINFECTION-NEGLECTED FACTOR IN SCHOOL SANITATION 34I

About half of the cities fumigate infected books with formaldehyde
gas and the other half burn them.

Formaldehyde gas at room temperature has been proved time and
again to be untrustworthy as a book disinfectant. It is much better
to burn all contaminated books than to be lured into a false sense of
security by such fumigation. None of the dry heat sterilizing used
would kill bacteria inside a book.

Conclusions.

Boards of Health should send daily reports to schools and libraries
of all contagious and infectious diseases.

Books that have been in the hands of such persons should be dis-
infected by moist hot air at 80° C. and 30 to 40 per cent, humidity
for 32 hours, or by Rubner's method of steaming formalin vapor under
vacuum. If neither of these methods are available the books should
be burned.

The use of formaldehyde gas at room temperature as a book disin-
fectant gives a false sense of security and should be discontinued.

We hope in the near future to have an entirely satisfactory method
for book disinfection, so that not only can books be disinfected after
known exposure to contagion, but that public library books that are
much in use and all school books can be disinfected at regular intervals
as a matter of precaution.

Bibliography.

1. Ballner, Franz. Ueber die desinfektion von Buchern, Druck-

sachen u. dgl. mittels feuchter heisser Luft. Leipzig, 1907.

2. Barbe. Desinfection des livres par les pulverisations du formol du

commerce. La Presse Medicale, Paris, August 23, 1902. 10, p. 810.

3. Beebe, W. L. Carbo-gasoline method for the disinfection of books.

J. Amer. Pub. Health Assn., Jan., 191 1. Vol. i, pp. 54-60.

4. Du Cazal et Catrin. De la contagion par le livre. Ann. de

rinstitut Pasteur. Paris, Dec, 1895. 9, No. 12, pp. 865-876.

5. Findel. Desinfektion von Buchern, militarischen Ausriistungs-

genstanden, Pelzen usw. mit heisser Luft. Zeitschrift fiir Hy-
giene. Leipzig, 1907. 57, pp. 83-103.

6. Heim, L. Die Widerstandsfahigkeit verschiedner Bakterienarten

gegen Trocknung und die Aufbewahrung bakterienhaltigen '
Materials insbesondere beim Seuchen dienst und fiir gerichtlich-
medicinische Zwecke. Zeitschrift fiir Hygiene. Leipzig, 1907.
50, pp. 123-143.

342 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

7. JosiAS. De la transmission des maladies infectieuses par les livres.

Revue de Therapeutique. Paris, 1906. 54, pp. 7-12.

8. Knopf, S. A. L'infection des livres par le bacille de la tuberculose.

La Presse Medicale, Paris, Feb. 24, 1900. 8, 16, pp. 70-71.

9. Krausz, Arthur. Ueber die Infectionsfahigkeit und Desinfec-

tion von gebrauchten Biichern. Zeitschrift fiir Hygiene. Leip-
zig, 1901. 37» PP- 241-249.

10. Lion Alexander. Untersuchungen uber den Keimgehalt und

die Desinfektion benutzten Biicher. Wurzburg. Stahel'schen
Buchdruckerei, 1895. 32 pp.

11. MiTULESCU, J. Beitrage zur Aetiologie der Tuberculose. Zeit-

schrift fur Hygiene. Leipzig, 1903. 44, pp. 397-406.

12. Nice, L. B. The Disinfection of Books. Ped. Sem., June, 191 1.

18, pp. 197-204; also Bui. Medical Library Association, 191 2.

13. Nice, L. B. Experiments in Book Disinfection. J. Amer. Pub.

Health Assn., Nov., 191 1. i, No. 11, pp. 775-777.

14. Renney, H. The disinfection of books by formalin vapour and

by dry heat; a series of experiments. J. Roy. San. Inst. Lond.,
1909-10. 31, pp. 46-48.

15. RiCKARDS, Bert R. The Disinfection of Books. Amer.

Jour, of Health. Boston, 1908. N. S. 4, pp. 325-331.

16. SoBERNHiEM and Seligmann. Bucherdesinfektion. Desinfektion.

1910. No. II. ^

17. Southern School Journal, Lexington, Ky., March. 1901. 12,

No. 3, pp. 7-8.

18. Van Ermengen et Sugg. Recherches sur la valeur de la for-

maline a titre de desinfectant. Archives de Pharmacodynamie,
Paris, 1895. I, pp. 141-298.

19. Von Schab. Beitrag zur Desinfektion von Leihbibliotheks-

btichern. Cent, fur Bacteriologie u. Parasitenkunde, 1897.
21, pp. 141-6.

20. Xylander. Die Desinfektion von Biichern mittels feuchter

heisser Luft und gesattigten, niedrig temperierten, unter Vakuum
stromenden Formaldehydwasserdampfen. Arbeiten aus dem
Kaiserlichen Gesundheitsamte, Berlin, 1908. 29, pp. 288-312.

21. Young, A. S. The Disinfection of Books. The Sanitary Record.

London, Nov. 25, 1898. 22, pp. 561-562.

PROPER VENTILATION OF SCHOOL BUILDINGS 343

PROPER VENTILATION OF SCHOOL BUILDINGS

BY
M. G. OVERLOCK

Boards of Education everywhere, from now on, when seeking appro-
priations for carrying on their work, which appropriations in 90% of cases
are justifiable, will be asked many questions relative to proper ventila-
tion of school buildings. State laws, justifiable in most cases, have
been heaped upon the manufacturer, until he is feeling the burden;
but to his credit it must be said that he complains but very little, for
he looks at the situation with a trained business eye, and is beginning
to realize, by observation, that after all, although it costs money to
maintain proper ventilation, pure air, pure drinking water, .freedom
from dust, proper removal of dust, it is purely an economic problem,
and one which yields large return in efficiency. In other words, in
most states in which factories are located, and in which machines are
built, the owner realizes the proper ventilation as the one essential element
in the production of efficiency, while in 80% of our school rooms to-day
where we are building the future generation, improper ventilation is
the obstacle to efficiency, and its highest point will never be reached
until we change the whole system of ventilation in these various rooms.

For seven years as a member of the Board of Education, of the city
of Worcester, and for five years as Chairman of the Committee on School-
rooms, I give this matter serious consideration, while six years as State
Inspector of Health, having supervision over approximately 120 school
buildings, in a limited way, and having made many visits at different
times during the day, I have arrived at the conclusion that what we
need is an entirely new system of ventilation for our school buildings.
Without going into the discussion of the evil effects of impure air, one
has but to point to the results accomplished and the changes wrought
in the physical and mental condition of pupils in outdoor schools. In
every instance the deduction can easily be done, if it will restore to health
the weakling, and thereby strengthen him rrientally. The same prin-
ciple must apply to those who are well ; to be explicit, in a poorly venti-
lated room, the efficiency of both pupil and teacher is decreased. This
must be so, for poor air means lessened vitality, lessened vitality means
less mental force. Proper ventilation must work out the same, whether
it be factory or school room. I have explained how it .has satisfied the
manufacturer, by practice, not theory, and the principle must work out
the same in the construction of mind and body, only to a greater degree.

344 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

What are the conditions, and what is the remedy? In too many of
our school buildings, the so-called fresh air is dust-laden when it enters
the school room, no attempt being made to properly screen the intakes
for fresh air, then afterwards it becomes polluted with CO2. 80% of
the installed system for its removal are inefficient and do not do their
work. This is apparent to anyone who enters a school room, contain-
ing say 40 or 50 pupils, stepping in from the fresh air a perceptible odor
is present, a perceptible lassitude is at once apparent in teacher and
pupil.

The length of this paper does not admit of a discussion of the defects
of most systems of ventilation now in use in school buildings, but I, as
well as other investigators, know they are legion.

How can they be remedied? Will it pay? Is it possible to bring
it about? The equipping of one or two school buildings in a given
locality, and then making comparison, will settle the whole question.

First of all, in all large school buildings in the city, the foul air must
be withdrawn by a system of electric fans. This system has been tried
in some localities, and found to work satisfactorily, with but little, if
any, increased cost. The surrounding of the aperature for the intake
of fresh air must be kept clean. The aperature must be of sufficient
size computed by feet to admit sufficient fresh air for use by each pupil
which can be readily estimated. The teacher in each room must watch
the thermometer and the temperature must never go above 65° Fahren-
heit. The pipes over which the cold air passes and is warmed should
be easy of access, and so placed that they can be easily reached by the
janitor and be kept free from dust. The proper humidity can easily
be obtained, in fact by a system of electric motors, which are not expen-
sive. All these changes can be brought about and then, and not until
then, will we get. proper return for the enormous sum of money expended
for educational purposes.

It is a lamentable fact that while municipalities spend approximately
one-third of their entire tax levy upon their school system, very few
have worked out scientifically the question of ventilation of their school
buildings, or have taken into consideration the effect of improper venti-
lation upon school attendance, or upon the loss of time of teacher and
pupil. When this is figured out, the amount in one year would certainly
be a surprise to the student of these subjects.

I maintain that the question of improper ventilation has a direct
bearing upon the dissemination of many infectious and contagious
diseases, which, in the end, become a burden upon the municipaUty,
as well as a drain directly upon school funds. At various times in my
writings I have advocated a course of school hygiene, supplemented by a
physical examination of school children. I have also called the attention

PROPER VENTILATION OF SCHOOL BUILDINGS

345

of school authorities to the fact that poor ventilation of school buildings
predisposes to tuberculosis.

I am now saying that a proper system of gymnastics should be in
vogue in every school in the land ; that hygiene should be one of the lead-
ing studies, for after all, in the final analysis, what good is a liberal
education, without a healthy body to accompany it.

Children are legally enforced to attend school, and surely they
should be allowed to do so without encouraging any danger which is
avoidable by ordinary means of human precaution.

346 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

OZONE IN VENTILATION

Milton W. Franklin

Early conceptions of atmospheric impurity included the belief that
carbon dioxide was poisonous and that its existence in the atmosphere
rendered the latter unsuitable for breathing. Later, with the growth
of chemical knowledge, the conviction grew that so inert and stable a
gas, practically incapable of forming chemical combinations, could
scarcely prove poisonous to the animal economy. Coincidentally there
developed the opinion that the evil effects of air vitiated by the various
processes of vital and industrial activity were due to the presence of
organic poisons. This belief gradually expanded to include bacteria
and the products of their activities. It was supposed that "Besides
carbonic acid, expired air contains various substances which may be
spoken of as impurities, many of an unknown nature, and all in small
amounts" (i).

More recently the opinion has gained ground that there is nothing
poisonous in expired air., but that all evil effects might be charged to
the presence of moisture and heat.

"Owing to the unpleasant effects often produced in badly ventilated
rooms it was long supposed that some poisonous volatile organic matter
is also given off in the breath. Careful investigation has shown that
this is not the case. The unplea'sant effects are partly due to heat and
moisture and partly to odors which are not of a respiratory origin" (2).

Throughout all this evolution of opinion, and even now, there has
persisted the belief that insufficient oxygen is at the root of all evils
arising from inadequate ventilation.

We will now consider briefly the status of each of these views:

That carbonic gas is not poisonous has been amply substantiated, for
air in which the content thereof has been artificially increased to one per
cent., with the corresponding diminution of oxygen, is not harmful,
while air in which the carbon dioxide content has been raised to one
per cent, by breathing, is highly poisonous (3). According to Haldane
the effect of one per cent of carbon dioxide in the inspired air is so slight
as to be negligible.

For the belief tharfe expired air contains organic matters there appears
to be some foundation, as e. g. the unavoidable evidence of foul breath.
The odors arising in crowded and insufficiently ventilated inclosures
give evidence of organic contents, though these may not all be expired

OZONE IN VENTILATION 347

from the lungs. "The nose may detect what the analytical methods
of the chemist fails to show" (4).

The perspiration contains about 2% of solids and much of this is
of highly organic structure and presumably easily decomposed. Sweat
contains salts, chiefly sodium chloride and organic waste products.
Of the organic solids excreted from this source, urea forms the most
important under normal conditions. Under pathological conditions,
especially when there is interference with free renal action, the amount
of nitrogenous waste excreted may become quite important (5).

The history of experimentation with the analysis of expired air is
interesting. Hammond, in 1863, concluded that there were organic
poisons in expired air. He confined a mouse under a bell jar absorbing
the CO2 with baryta water and the moisture by calcium chloride with
the result that the mouse died after 40 minutes.

Brown-Sequord, in 1889, experimenting • with mice proved to his
satisfaction the existence of organic poisons in expired air. Subse-
quently, Haldane and Smith repeated these experiments with negative
results.

In 1892 Merkel again repeated these experiments and confirmed
the results of Brown-Sequord. Various experiments conducted by
Lehman and Jessen, Rauer, Luebbert and Peters, and others, from 1890
to 1893 were productive of negative results with regard to the existence
of organic matter in the expired breath. Brown-Sequord confirmed
his previous experiences by an elaborate repetition of them in 1894.

Billings, Mitchell and Bergey were appointed by the Smithsonian
Institute in 1895 to conduct experiments for the purpose of settling the
question. In a monograph published by the Smithsonian Institute
(6) they stated that the ill effects of vitiated atmosphere depend almost*
entirely upon increased temperature and moisture, and not upon an
excess of carbon dioxide, bacteria or organic poisons; the existence
of the latter being vigorously denied. In addition to excessive temper-
ature and moisture, odors arising from the subject in various ways,
bad breath, unclean skin, unclean clothes, sweat and enteric gases are
credited with causing very disagreeable sensation amounting even to
nausea in the unhabituated.

Benedict (7) has kept persons in his calorimeter breathing and re-
breathing the same air with a CO2 content as high as 2% for 24 hours
without discomfort, the only precaution being to keep the temperature
^^^ down and to remove the moisture. It is to be noted that in these experi-
l^p ments some of the air was passed over lime and sulphuric acid every
two hours and the greater part of the moisture was removed by con-
densation, which may also remove other substances' than carbonic
I acid and moisture.
■

348 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Thus far the preponderance of evidence seems to be against the exist-
ence of organic matter in the expired breath. Quite recently, however,
the contrary opinion has been revived by the original and brilliant
researches of Rosenau and Amoss (8). Applying the principal of ana-
phylaxis on guinea. pigs with the clear fluid condensed from expired
breath, they have proven the existence of organic matter therein.

"This organic matter must, according to the interpretation of our
knowledge of anaphylaxis in the guinea pig, be protein in nature."
They further add "The logical conclusions from our results is that
protein substance, under certain circumstances, may be volatile."
Weisman and Bronfenbrenner recently have disputed these results (9).

Further evidence contributing to the proof of the existence of organic
matter in expired breath has been obtained by Weichardt and Stotter
(10) who passed the air expired by guinea pigs and air from a crowded
theatre over glycerole, and obtained an alteration in the guiacum
reaction.

The opinion, once almost universal, that aerial transmission was
the chief mode of infection of zymotic diseases has been largely modified
in recent times. One of the most notable protagonists of the view was
Dr. Edward Germano (11).

Bailey (12) speaking of tuberculosis says, "This is a disease in which
the germs from the dry sputa are carried in the air, lodged in the air
passages, and if they find the system in the right condition, they com-
mence to grow and carry on their deadly work."

Neisser's (13) experiments with various organisms lead him to the
conclusion that infection is possible with staphylococcus pyogeneous
aureus, bacillus pyocyaneus, bacillus anthracis, bacillus tuberculosis
and meningococcus but impossible for the organisms of diphtheria,
typhoid fever, cholera, plague and pneumonia.

Credence in the belief of aerial infection however has been losing
ground steadily, until it has become almost dispelled. Chapin (14)
maintains that while it is not possible at present to state with exact-
ness the part played by aerial infection in the transmission of different
infectious diseases, we are, by the evidence, forced to the conclusion
that the current ideas in regard to the importance of the infection by
air, are unwarranted. It may be fairly affirmed that there is no evidence
that aerial infection is an appreciable factor in the maintenance of our
most common contagious diseases. We are warranted then in discard-
ing it as a working hypothesis and in devoting our chief attention to the
prevention of contact infection. Contact infection with carriers and
missed cases affords a better explanation than air transmission for obscure
cases of infection. Scarlet fever and diphtheria may be cared for in the
same ward if infection by contact be avoided and cleanliness observed.

■

OZONE IN VENTILATION 349

Most diseases are not dust bourne, they may be spray bourne by cough-
ing, etc., but this is equivalent to contact infection. Tuberculosis is
most apt to be air bourne, but even this has never been substantiated
by pathology.

Flugge, Esmarch, Goldie, Frankel, Moller, Hubner and others have
shown that droplets may be found for nine meters in front and two
meters behind a person coughing. Winslow and Robinson by elaborate
droplet experiments show that there is no basis for the belief that tuber-
culosis or any disease is contracted to an appreciable extent thi;pugh
inspired air, and they are in harmony with the conviction that aerial
infection of any sort is a minor factor in the spread of zymotic disease.

Doty (15) states that, "The necessity for disinfection is confined
chiefly to infected discharges and articles about the patient that may
be directly contaminated. Room disinfection is an important factor
in the prevention of infection. We have conclusive proof that many
of our former theories regarding the transmission of infectious diseases
are wrong."

There is a growing belief that scientific proof, that infection may be
transmitted for a considerable distance by the air, is wanting. In all
probability infection by air does not occur except in the immediate
vicinity of the patient and then only in a few diseases. This, however,
as pointed out above, is tantamount to contact infection, but, in any
event, whatever danger there may be is most menacing in closely crowded
places where missed cases are always likely to be present.

An interesting aspect of the subject is presented by Trillat (16) who
has demonstrated that microbic life is very sensitive to even slight chem-
ical changes in the air. Alkaline gases like NH3 and amines from
fecal matter, etc., favor the development of typhoid bacillus and other
microorganisms.

The view that the ill effects of vitiated air are due only to excessive
heat and moisture is widely advocated. Haldane, Billings, Mitchell
and Bergey (17), Flugge (18), Baruch (19), Formanek (20), and others
have arrived at this opinion from experiments.

Respecting the influence of lack of oxygen in ventilation, there is
very little difference of opinion. The constitution of air is as follows:

Atmospheric Air. Expired Air.

Oxygen 20.93 p. c. 17.0 p. c.

Nitrogen 79-04 " 79-04 "

C02 03 " 3.96 "

Thus the oxygen is diminished approximately 4%, and only 19%,
or less than one-fifth of that taken into the lungs is utilized. Flugge,

350 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Hill and others have demonstrated in numerous experiments that dimi-
nution of oxygen to the extent met with under the worst conditions is
not inimical to health. At an altitude of 10,000 feet the density of the
air becomes two- thirds that at the sea level, and the oxygen content
of a lungful is accordingly lessened one-third, but compensation in the
shape of increased lung capacity and accelerated respiration soon over-
comes the distress at first experienced.

As contaminating factors of air, offensive odors have not been afforded
due prominence . The fact that crowd odors are organic effluvia cannot
be disputed. The sensation of smell is due to the presence in the air
of substances in a fine state of subdivision, i. e. existing in the state of
vapors, or of gases. Ramsay points out that as a general rule sub-
stances having a low molecular weight have either no smell or simply
cause irritation of the nostrils. He also shows that in the carbon com-
pounds, increase in specific gravity of a gas is associated to a certain
point with the sense of smell. McKendrick points out that it would
appear that odors of animal effluvia are of higher specific gravity than
the air and do not readily diffuse. Such smells are very persistent
and difficult to remove, and the presence of moisture increases the per-
ceptibility of odors.

The above facts are significant in connection with the results obtained
in rendering stale air more tolerable by keeping it in motion and reduc-
ing the moisture, which overcomes their tendency to remain in contact
with the subjects and lessen their activity. The sources of crowd
odor are the skin, enteric gases, localized excretions, bad teeth and fecal
matter, rather than the breath.

Aside from the role of smell as an indicator of organic contamination
of air, its physiological effects are distinct. The Smithsonian Report
cited above gives smell as one of the paramount causes of discomfort.
According to Macfie (22) bad smell may cause nausea or faintness,
and Parkes and Kenwood say that odors alone may be prejudicial to
good health.

Everyone has noted the distress consequent upon the presence of
offensive odors. Frequently when entering tanneries, glue factories
or other obnoxious plants for the purpose of making observations, men
in my employ have been so disturbed a*s to have their efficiency appre-
ciably lessened; shallow breathing and anorexia have resulted directly
with consequent lowered vitality.

Hill (23) has given considerable publicity to the contention that
organic odors are innocuous, and he cites the cases of those engaged in
disagreeable trades, and their good health and easy habituation as
evidence. This, however, is scarcely a parallel case, as the odor from
the trades are not the excreta of the men engaged therein.

OZONE IN VENTILATION 35 1

A consideration of the above data leads to some interesting con-
clusions :

1. Excess of CO2 does not constitute a danger of vitiated air in
ordinary circumstances.

2. Lack of oxygen is a negligible consideration. •

3. Heat and humidity play an important role in rendering "close"
air intolerable.

4. Organic matter exists in the air of crowded rooms. Its odors
constitute a real nuisance but its toxity has not been established.

5. Bacteria in the air are, at most, a minor factor in the conveyance
of infection.

6. The problems involved are of a complexity which renders their
solutions extremely difficult and most of them are still more or less
debatable.

Ozone. The first attemipts at the employment of ozone as an adjunct

in ventilation is perhaps to be ascribed to the fact that ozone had been

observed in regions remote from human congestion, where the atmosphere

was known to be fresh and invigorating, and to its absence from the air of

highly populous districts. In an era of conflicting scientific opinion

on questions of disease causation it is not to be wondered at that the

mysterious gas, ozone, which was enjoying a vogue among chemical

investigators, should have been hailed, in the popular mind, as the phi-

Josophers' stone of hygiene. This cult, which occupied the middle and

latter thirds of the last century, gradually evolved into a period of saner

search for sound theoretical justification of the empirically demon-

trated effectiveness of ozone. At present there still exists much differ-

nce of opinion as to the exact status of ozone in ventilation, it being

onsidered, by some, a disinfectant of polluted air, by others, as a

eodorizer, whilst yet another contingent regard it as an oxidizer of the

rganic content of vitiated atmosphere.

Experimentation for the purpose of ascertaining the effect of ozone
n vitiated air has been varied and exhaustive and it will be necessary to
[confine ourselves to a consideration of the work of only a few of the more
rominent authorities.
Scoutetten (24) demonstrated that ozone removed the odor of heaps
of decayed manure, even in the presence of the latter, and that it des-
troyed the odor which remained after the manure had been removed
from the experimental chamber.
^^ According to Schoenbein 1-6000 of ozonized oxygen, contained in

352 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

with miasms and putrid emanation. M. J. Chapuis demonstrated the
microbicidic power of ozone by drawing infected dust into cotton tam-
pons and then disinfecting them by drawing ozonized air through (25).

In 1892 Dr. Ohlmtiller (26) reported that anthrax, typhus and chol-
era bacilli, as well as anthrax spores are destroyed by ozone. Typhus
and cholera bacilli contained in sewage and water of the Spree were
destroyed but ozone apparently has little effect on dry bacteria and ba-
cilli. Two litres of ozonized air killed the bacilli which exist in pus, and
living subjects inoculated with such ozonized pus did not suffer any
inconvenience. He also pointed out that negative results in attempt-
ing to purify air, remedy unsanitary conditions and disinfect dwellings
result from inadequate ozone apparatus.

In the face of many positive findings as to the value of ozone, con-
troversy has been rife up to the present. Konrich (27) admits the effi-
cacy of ozone for water purification, but holds that for ventilation its
use is still problematical. He maintains that concentrations sufficient
to oxidize suspended organic matter would be detrimental to the living
organism, and that the most that ozone can accomplish is to cover up
odors. "The value of this," he says, "is questionable, since it removes
the only warning that we possess of the presence of vitiated air."
Schneckenberg (28) holds substantially the same view.

Luebbert (29) states that ozone purifies the air and that the exist-
ence of even a slight excess of ozone is proof of the non-existence of the
organic dust, ill-smelling particles and agents of infection.

Elrandsen and Schwartz (30) assert that there is no justification
for the statement of Luebbert. They experimented with a room of
about 14.96 cbm. capacity. The walls were covered with metal plates
painted black. They do not definitely state the amount of ozone in
the room but the concentration was about 20 to 30 mg. per cbm. of air.
Different gases, fumes, etc., were drawn into the room and mixed with
ozonized air. After varying periods of time the mixtures were examined.
They conclude that oxidation of NH3 and H2S cannot be proven, but
that the odors can be removed; trimethylamin, valerianic acid, butyric
acid, indol and skatol are not destroyed by ozone but their odor can be
disguised; tobacco smoke is not influenced so far as can be determined,
but if present in small quantities its odor can be removed ; they cannot
say that ozone purifies the air, but only that its intense odor covers
or removes other odors.

Kuckuck (31) claims that in the Heidelberg Public Baths he reduced
the bacterial content of the air to 50%, by the application of ozone.
Kuppfer (32) finds that a concentration of o.i mg. ozone per cbm. air
in bathing establishments has an invigorating and purifying effect.
Foreign odors are eliminated and the conditions generally are improved.

OZONE IN VENTILATION 353

Bail (33) says that the odor of decaying matter does not recur after
having been removed by ozone, and that small ozone concentrations
can destroy odoriferous elements in the air, therefore ozone probably
can destroy the organic impurities in expired air and animal excretions.
The most recent pronouncement on the subject has been presented
at the Ninth Congress for Heating and Ventilating in June of this year
at Coin by Prof. Dr. Czaplewski (34). From an exhaustive series of
observations he concludes that there is a wide application for ozone
as an adjunct to ventilation. He finds that ozone has a positive effect
on certain odoriferous materials and odors emitted by these materials;
some odors are destroyed and others lessened; after odors are, in part,
Jj^eferred back to odors absorbed by the walls, furniture, etc.; ozoniza-
^Kon of the air should not supplant ventilation but used as an accessory ;
^Ventilation can, in many cases, be improved by ozone; discrepancy
^ftetween the favorable results in practice and the unfavorable results
^Bf experimentation should be further investigated.

^B Experimental Results . In view of the contradictory character of
^M:he above cited reports and of the generally unsettled conditions of the
questions involved, experiments were conducted for the purpose of at-
taining definite information.

In determining the action of ozone on odors and certain gaseous
anations, the apparatus shown in figure i was used. This consisted
if two bottles of 12 L. capacity with suitable connections, a vacuum
ump and an ozonator.

One of the bottles was filled with emanation, the odor of which

as to be studied, by drawing air slowly over a mass of the material,

nfined under a bell jar, and thence into the bottle. The other bottle,

f equal capacity, was filled with ozonized air. The communication

tween the two bottles was then established and the two gases per-

itted to diffuse. After a suitable interval, usually about 48 hours,

e emanation, mixed with ozone, was drawn through a neutral solu-

ion of K. I. to free it of excess ozone, and the remaining gas examined.

Tests with tobacco smoke and with H2S proved conclusively that

ese substances were deodorized and that the absence of odor could

ot be attributed to the presence of ozone. The tests were by smelling

nd also by lead sulphide in the case of H2S. I then had further tests

nducted with a refined and elaborated technique.

Natural Food Odors. The substances employed in these experiments
rere onions, garlic and Limburger cheese. In each case the materials
rere finely divided and placed in flasks provided with an inlet and an
mtlet tube, the former reaching to the bottom of the vessel. One hun-
Ired and twenty-five cubic centimeters of the effluvium from the flasks

354

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

were separately collected in two hundred and fifty cubic centimeter gas
collection tubes by displacement of water, with which the tubes were
previously filled. The remaining one hundred and twenty-five cubic
centimeters of water were displaced in one case with ozonized air, and
in the other with air. Two tubes were thus prepared with each odor,
one containing an addition of ozonized air and the other of ordinary
atmospheric air. The tubes were at once clamped in a vertical position
and it was then a simple matter to introduce water through the lower
stopcock, which thus compressed the gas within the tube. On opening
the upper stopcock and holding the exit tube close to the nostrils, the
odor of the gas could be noted. A io% solution of ferrous sulphate
was then introduced and the tubes well shaken. The ferrous sulphate
was immediately oxidized by the residual ozone, the odor of the latter
being thereby destroyed. It was, of course, necessary to treat the tube
without ozone in the same manner, so that any possible deodorization
due to the ferrous sulphate would not be overlooked. After the ferrous
sulphate was introduced, the odor of the gas was again noted, as in the
first instance. The results of these tests were as follows:

Odor

Before Treatment with

After Treatment with

Ferrous Sulphate Solution.

Odor from

With Air With Ozone

Onions

Strong Strong

Strong None

Onion Ozone

Onion "

Garlic

Strong

Garlic

Limburger

Strong

Cheese

Limburger "

Limburger " |

These results show that odors from onions, garlic, and Limburger
cheese are actually destroyed by ozonized air.

Decomposed Food Odors. In these experiments four different raw
food materials were placed in flasks and allowed to decay. The sub-
stances employed were fish, eggs, meat and oysters. The effluvium
was collected as before and examined in the same manner, before and
after treatment with ozone and ferrous sulphate.

Odor from
Decayed Fish
Eggs
" Meat
" Oysters

Odor
Before Treatment with
Ferrous Sulphate Solution
With Air With Ozone

Very offensive Strong ozone

Odor

After Treatment with
Ferrous Sulphate Solution
With Air With Ozone

Very offensive None

OZONE IN VENTILATION

355

Definite Chemical Compounds of Disagreeable Odors. Experiments
under this heading were conducted with Skatol, Valerianic Acid and
Butyric Acid. Skatol (C9H9N), together with Indol (C8H7N) are
chiefly responsible for the offensive odor of excrements. Valerianic
acid has an odor similar to old cheese and occurs free and as ester in
cheese, perspiration of the feet and in human faces. Butyric acid is
found in sauerkraut, rancid butter and Limburger cheese. These sub-
stances, therefore, represent types of very offensive odors. A series
of experiments conducted as before did not give conclusive evidence
of these odors and it was necessary to adopt a different procedure in
order to determine whether ozonized air destroyed these odors.

The method finally adopted was to impregnate pieces of cheese cloth
(12 inches wide and 36 inches long) with the odors. This was accom-
plished by suspending the cloth in a three-gallon bell jar resting on a
ground glass plate lubricated with petrolatum. The substances were
vaporized from a watch glass supported on a heated briquette and after
two hours a definite volume of ozonized air was passed through one jar
and a similar volume of air through another which served as a control.
The cloths were then removed and allowed to air in a well ventilated
room for twenty-four hours. This was necessary to remove the resid-
ual ozone in those cases where the cloths were treated with ozonized
air and the controls were treated in like manner, so that any disappear-
ance of odor could not be attributed to ventilation. It was found in
each case that the cloths impregnated with the odors still retained
these after twenty-four hours, whereas those treated with ozonized air
were free from these odors as well as ozone. It is therefore established
beyond all question that the odors of Skatol, Valerianic acid and Butyric
acid are actually destroyed by ozone.

Offensive Trade Odors. The substance treated in this case was a
fertilizer, commonly known as tankage, and is obtained in the treat-
ment of butchers' scrap. It has a very offensive odor. The tests
were conducted as before and it was demonstrated that this odor is
completely destroyed by ozone.

A number^ of experiments have also been conducted with odors of
common occurrence in dwellings. Among these it has been established
that the offensive odor of tobacco smoke, which impregnates the cloth-
ing of persons exposed to atmosphere heavily laden with smoke, is also
destroyed by ozone. The experirhents with tobacco smoke were made
by saturating a piece of cheese cloth suspended in a box and blowing
the smoke from a pipe into the opening, so that the cloth remained in
a dense atmosphere of smoke until it was thoroughly saturated. Ozon-
ized air not only destroyed the odor but also removed the yellow dis-
colorations produced by blowing smoke through cloth.

356 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Conclusions.

1. The experiments described in this report show that ozonized
air does not merely mask offensive odors of varied nature, but it actually
destroys them.

2. It is shown that the odor of some common food materials, onions,
garlic and Limburger cheese, are destroyed by ozonized air.

3. The odors resulting from decayed raw food materials, fish, eggs,
meat and oysters, are destroyed by ozonized air.

4. The offensive odors of fertilizers are destroyed by ozonized air.

5. Several definite chemical compounds which contribute to the odor
faces, perspiration of feet, rancid butter, sauerkraut and Limburger
cheese, namely, Skatol, Valerianic acid and Butyric acid are also de-
stroyed by ozonized air.

6. The persistent odor of tobacco smoke as absorbed by the clothing,
is destroyed by ozonized air and the yellow color produced by blowing
smoke through cloth is bleached by ozone.

Carbon Monoxide. In these experiments bottles containing the mixed
gases (CO and Ozonized air), after standing for a definite length of time,
were treated with an oxidizable chemical solution in order to destroy
the residual ozone. The gaseous contents of the bottle were then
aspirated through wash bottles containing barium hydroxide solution.
The bottles were also immersed in warm water in order to drive out any
carbon dioxide remaining in the solution.

Experiment i. One bottle containing 50 c.c. of carbon monoxide
and filled with ozonized air, together with a control containing ozonized
air only, were allowed to stand over night. One hundred cubic centi-
meters of a 5% solution of Potassium Ferrocyanide were then added
and the contents thoroughly shaken. After aspirating the gas which
contains carbon monoxide through barium hydroxide wash bottles ; it was
found that absolutely no barium carbonate was formed, but the Potassium
Ferrocyanide solution was found to be alkaline, thus explaining the
phenomena. Before aspirating the controls 5 c.c. of diluted sulphuric
acid was added (in order to ensure an acid reaction) but in this instance
no definite end point could be obtained. It was found that the diffi-
culty was due to the liberation of hydrocyanic acid. The use of this
reagent was therefore abandoned and it was decided to use Ferrous
sulphate, which could not give rise to any disturbing volatile substances.

Experiment 2. Three bottles were prepared, No. i containing 25
cubic centimeters of carbon monoxide; No. 2, 50 cubic centimeters,

OZONE IN VENTILATION

357

and No. 3 was a control containing only ozonized air. After standing
over night, 100 c.c. of Ferrous sulphate solution, acidified with sulphuric
acid (5 c.c.'s dilute sulphuric acid in 100 c.c.'s of solution) were added
and aspirated as in Experiment i.

Bottle No. I containing 25 c.c.'s of CO gave 10.7 c.c. CO2.
" 2 " 50 '; '' " " 4.0 "

" 3 " no CO. " 0.4 "

The small amount of carbon dioxide obtained in bottle 3 was
apparently introduced through inefficient washing of the air used in
aspiration, but the results were indeed promising. The end point was
not as sharp as it should be in Bottles Nos. i and 2, and on further
investigation we found that the slowly precipitated barium carbonate
occluded barium hydroxide, thus causing the end point to return after
the completion of the titration. When barium carbonate was rapidly
precipitated the phenomenon was not observed. The error due to
occlusion corresponds to approximately 0.25 c.c.'s of carbon dioxide.
This can be obviated by continuing the addition of standard oxalic acid
solution until a permanent end point is obtained.

Experiment 3. This experiment was conducted along the same lines
as Experiment 2, but the time of exposure was three days in this case.

Bottle No I containing 10 c.c.'s of CO gave 8.7 c.c.'s of CO2

ii II 2 " 2^ " " " " 17 I " " "

'' 3 " no CO " 1.8 " " "

Deducting the blank, the 10 c.c.'s of CO produced 6.9 c.c.'s of CO2
and the 25 c.c.'s of CO produced 15.3 c.c.'s of CO2.

A number of preliminary experiments were made to determine the
reaction which takes place between hydrogen sulphide and ozone. It
was found that the ozone caused an immediate precipitate of sulphur
(giving a milky fluid in the presence of water), which gradually became
oxidized to sulphuric acid.

From this it is evident that the reaction of ozone on hydrogen sulphide
takes place in two stages. In the first stage sulphur is precipitated
and this in turn becomes oxidized to sulphuric acid.

Conclusions. These experiments demonstrate conclusively that
carbon monoxide is oxidized to carbon dioxide by simple contact with
ozonized air.

It is also shown that hydrogen sulphide is changed to sulphur and
water, the sulphur being further oxidized to sulphuric acid. Hydrogen
sulphide possesses a strong characteristic odor resembling that of rotten

358 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

eggs. The chemical change, which takes place under the action of
ozone, results in a destruction of this odor.

Bacteriacidal Action of Ozone. Numerous experiments to determine
the action of ozone on bacteria were conducted. Only a resume of the
results is presented. The ozonator was of a common portable type,
found in the American market, and the concentrations of ozone varied
from I to lo mg. per cbm. air, the difference being accounted for by the
varying lengths of the periods of operation and of room sizes.

Experiment No. i. The ozonator run in an open room of approx-
imately 1,000 cubic feet for twenty minutes, gave no reduction in the
small number of bacteria present.

Experiments Nos. 2 and 3. The ozonator run in a closed room of
200 cubic feet for thirty minutes removed 95.4% of the small number
of bacteria present. The test repeated with a very small number of
bacteria present in the air showed the removal of 77.9% in thirty minutes,
and 69% in one hour.

Experiment^ No. 3. Agar plates streaked with cultures of B. coli
and exposed for one hour, showed that ozone had a slight inhibitive
action.

Experiment No. 4. Although the cotton batting screen over the air
inlet may remove large numbers of bacteria from the air, the ozonator
without the cotton batting screen was found to be capable of removing
a greater number of bacteria entirely independent of cotton.

Experiments Nos. 5 and 6. B. typhosus, B. coli, and staphylococcus
pyogenes aureus streaked on agar plates, exposed to the action of Ozon-
ator products for 6 hours, and then incubated at 37° C. for three days,
showed a slightly inhibited growth after exposure of 4 to 6 hours.

Experiments Nos. 7 and 8. B. typhosus, B. coli, and staphylococcus
pyogenes aureus, dried on glass rods, and exposed to Ozonator products
for two hours, showed inhibition to the extent that no growth was visible
in the broth culture media until 48 hours incubation at 37° C. The
same organisms exposed to Ozonator products for two hours, while in a
moist condition, and then incubated at 37° C. in broth culture media,
with the result that all the B. typhosus and B. coli were killed or attenu-
ated so that growth did not appear, and the number of staphylococci
killed or attenuated so that growth did not appear until the fourth day
of incubation.

OZONE IN VENTILATION

359

All the above investigations were carried on under conditions which
were not possible to control on a strictly scientific basis. For example,
Experiments 2, 3, 4, 5 and 6 were performed in a small toilet room in
which there was a tank of water together with a flush closet. What
effect these bodies of water may have had upon the ozone content of
the atmosphere of the room was not taken into consideration. More-
over, the room was not of a size or shape likely to be met with frequently
in practice, nor were the character of the walls taken into considera-
tion; how much ozone might have been absorbed by the latter is not
known.

In Experiments i, 2, 3, 4, 5 and 6 the ozone apparatus was present
in the room in which the investigation was being conducted, whereas
in Experiments 7 and 8 the ozone products were led from the Ozonator
to the experimental apparatus as indicated.

These experiments depended, in large part, upon the bacteria
naturally present in the air, and it was found, as might be expected,
that the numbers were too small for the results to be considered as
clearly indicative of the action of the ozone, or its failure to act.

In the experiments above outlined, especially Nos. 4, 5 and 6, it will
be noted that the moist culture media was present in the investigating
chamber and undoubtedly absorbed ozone from the atmosphere.

It should also be noted that in the preliminary studies, questions of
temperature and humidity of the atmosphere at the time of the tests,
were not undertaken, it being considered more advisable to eliminate
such refinement from the preliminary investigations.

A consideration of the above facts leads to the conclusion that the
normal bacterial contents of air may be reduced by the injection of even
moderate amounts of ozone. Failures in this direction are probably
due to faulty technique. Dried bacteria on rods, tubes or threads are
affected little or not at all by ozone, but constitute no danger to health
and their resistance to ozone is of no significance.

It should be noted in this connection that whatever danger there
may be from bacteria in the air, it exists only when these are in a state
of moist suspension, e. g. droplet infection, and it is in such circumstances
that ozone is most effective as a bacteriacide. Czaplewski mentions the
drying effect of ozone as noticed in cold storage plants, and it has been
shown above that dry bacteria are comparatively innocuous.

With regard to suspended organic matter in the air, its poisonous
nature has not been conclusively proven, but its prominence in the capa-
city of a nuisance in vitiated air is self-evident and it has been suffi-
ciently demonstrated that ozone destroys organic odoriferous particles
in the air. Ozone is therefore an aerial detergent and from an aesthetic
as well as from a sanitary point of view, its use is fully justified.

360 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Aside entirely from all theoretical aspects, we must give some con-
sideration to the results obtained in practice. Bass (35) has experi-
mented with reduced air supply through individual ducts in school
ventilation, and has shown that the addition of a small amount of ozone
to the air greatly lessens the amount of air required for comfort. Leonard
Hill (36) states that the ventilation of the London Tubes has been greatly
improved by ozone and that the smell has been much less and the air
improved in every way since its introduction. Instances of the success-
ful employment of ozone in ventilation are too numerous to mention
and have been given wide publicity of late. In the tubes of the Hud-
son and Manhattan Railway there is a point at which there has been
some trouble from disagreeable odors arising from the seeping in of
sewage. A trial installation has shown that this odor, which was un-
amenable to treatment by any degree of air flushing, could be totally
and conveniently eliminated by ozone, and a modern ozone plant has
recently been installed.

A practical example of the destruction of organic odors by ozone
is afforded by a fish glue factory where recently some observations
were made. The emanations from a caldron of boiling fish scrap are
passed through water, and thence by a stack into the air. The result-
ing vapor is very offensive as the fish scrap is often in an advanced
state of fermentation. The injection of ozonized air into the base of
the stack rendered the vapor totally unobnoxious; it resembled a clean
sea fog.

I have endeavored to show that the dangers of vitiated air are due
to heat, moisture, and organic contents, and that the latter, whether
poisons or only odors, constitute a real nuisance. The first two factors
may be compensated for by stirring the air and providing sufficient
new air to absorb the heat and moisture. The average perspiration
of a man is roughly 40 gm. per hour, and this amount would saturate
approximately 3 cbm. (100 cu. ft.) of air at 65° F. (18.3° C). This
amount of air would supply more than 136 times the oxygen consumed
by a man. The specific heat of air is about .24 so that the 100 cubic
feet of air would require approximately .88 Cals. to raise its tempera-
ture I degree C. Thus by simple calculations the amount of air neces-
sary in any circumstances may be computed.

Odors may best be removed by ozone. The frequent assertion
that they constitute only an index of bad air is not substantiated unless
it can be proven that there exists a new, and at present unknown, danger
in vitiated air. Certainly we need no vicarious indicator of heat and
humidity so that smell exists only as a discreet independent offense,
or it is the indicator of its own organic poison. If the former, it should
be removed, and if the latter, it should be destroyed.

OZQNE IN VENTILATION 36 1

Conclusions,

1. Ozone is a valuable accessory to ventilation.

2. It is applicable wherever mechanical ventilation is required
and in general wherever organic odors are generated.

3. Ozone destroys, rather than masks, organic odors.

4. In breathable concentrations ozone inhibits the growth of micro-
organisms suspended in the air.

5. Conflicting results obtained in laboratory experiments can be
attributed to diversity of methods.

^^B 6. Practical results of actual applications of ozone have been uni-
^^Bformly favorable.

■ References.

^^P I. M. Foster, A Text Book of Physiology, 1891.

I^r 2. J. S. Haldane, Encyclopaedia Brit., nth edition.

3. Foster, ibid.

4. L. Hill, Sci. Am. Sup., June i, 1912.

5. D. N. Paten, E. B., nth edition.

6. Composition of Expired Air and its Effects Upon Animal Life,
Smithson. Inst., 1895.

7. Bull. 175, Offic. Exp. Sta. U. S., Dept. Agric.

8. Organic Matter in the Expired Breath, Jour. Med. Research,
Sept., 191 1

9. Chas. Weisman, Biological Studies of Expired Air. Diss.,
Easton, Pa., 1913.

10. Arch, of Hyg. 75, 265-8.

11. Zeitschr. f. Hyg. u. Infeckt.-Krankh., XXIV 403, XXVI, 66-273.

12. E. H. S. Bailey, A Text Book of Sanitary and Applied Chem-
istry, N. Y., 1906.

13. Max. Neisser, Zeitschr. f. Hyg. u. Infekts. Krankh., XXVI, 175.

14. S. Chapin, Sources and Modes of Infection, p. 314.

15. Med. Record, N. Y., Nov. 2, 1912, pp. 891-5.

16. A. Trillat, Orig. Comm. Eighth Int. Cong. Appl. Chem.,
19, pp. 71-2.

362 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

17. Billings, Mitchell & Bergey, Smith. Inst., ibid.

18. Fluegge, Zeit. f. Hyg. u. Infekt. Krankh., 49, pp. 363-87, 1905.

19. Med. Rec, N. Y., Nov. 16, 1912, p. 904.

20. Arch. f. Hyg. 38, 1900.

21. Encyc. Brit., nth edition., XXV, 252.

22. Macfie, Air and Health.

23. L. Hill, ibid.

24. H. DE LA Coux, L'Ozone et ses Applications Ind., Paris, 1910.

25. H. DE LA Coux, ibid.

26. Arbeiten. aus dem Kaiserl. Gesundh.-Amt., Vol. 8, T. I., 102,

1892.

27. Zeit. f. Hyg. u. Infekt. Krankh., LXXIII, 443, 182.

28. Gesundh. Ing., XXXV, 965-70, 1912.

29. Gesundh. Ing., XXX, 793, 1907.

30. Zeit. f. Hyg. u. Infekt. Krankh., Vol. LXVII, 391, 1910.

31. Zeit. f. Gasbel u. Wasserversorg. 9, 1910.

32. Gesundh. Ing., XXXVI, 300-3.

33. Bail, Prag. Med. Wochenschr. 17, p. 217, 1913.

34. Gesundh. Ing., Aug. 2, 1913.

35. Am. Soc. Heat. & Vent. Eng., 1913.

36. L. Hill, Jour. Roy. Soc. Arts & Sci., Feb. 9, 1912 (disc).

DIE REINHALTUNG DER SCHULRAUME 363

DIE REINHALTUNG DER SCHULRAUME

VON

Dr. Schoenfelder

Meine Herren! Dass in Raumlichkeiten mit starkem Menschen-
verkehr die peinlichste Sauberkeit herrschen sollte, daruber brauchen
im Zeitalter der Hygiene kaum mehr Worte verloren zu werden. Wenn
wir iins klar sind daruber, dass heute selbst in Bahnhofs Warteraumen,
an Postschaiternd, nur durch grosste Reinlichkeit hygienische Schadi-
gungen von den dort nur voriibergehend verkehrenden Personen fernge-
halten, Ansteckungen vermieden werden konnen, dann werden wir
Reinlichkeit in noch viel hoherem Masse verlangen in solchen Gebauden,
in denen grosse Menschenmassen viele Stunden des Tages, wohl gar
Jahre ihres Lebens zubringen, wie z. B. in Kasernen, und wir werden
die allerstrengsten Anforderungen stellen miissen da, wo es sich um
jugendliche Personen in zarterem Alter handelt.

Das Kind, das infolge gesetzlicher Bestimmungen in den Kultur-
landern vom Staate wahrend des wichtigsten Zeitabschnittes seiner
korperlichen Entwicklung in den Schulen festgehalten wird, muss von
diesem Staate erwarten, dass es auch gegen Schadigun^en geschiitzt
wird, die aus der Unsauberkeit der Schulraume ihm erwachsen konnen.

Die Reinigungsfrage beschaftigt deshalb mit Recht die Schulhy-
gieniker und Schulverwaltungen und zwar um so lebhafter, je mehr
man die Gefahren, die in der Aufwirbelung und Einatmung von Staub
fiir die Lungen der in staubreichen Berufen tatigen Arbeiter das
bestehen, beachten gelernt hat, je mehr man sich iiberzeugt hat, dass
was schon dem Erwachsenen von gesundheitlichem Nachteil sein, den
Kindeskorper in um so hoherem Masse angreifen muss.

Uber die Grosse dieser Gefahr war man lange im Dunkeln. Sie
wurde ebenso oft unterschatzt wie uberschatzt. Exakte Versuche
anzustellen hielt man lange fiir ebenso iiberfliissig, wie unmoglich. Es
ist das Verdienst der Hamburger Schulverwaltung, angeregt zu haben,
dass das Hygienische Institiut des Hamburger Staates exakte Versuche
vorgenommen hat iiber das Reinigungsbediirfnis in den Schulen und
das zweckmassigste Reinigungsverfahren, und es ist das Verdienst der
wissenschaftlichen Leiter dieses Instituts, des Prof. Dr. Dunbar und
seiner Mitarbeiter des Prof. Trautmann und Dr. Hanne, Methoden
angegeben zu haben, die eine relativ zuverlassige Feststellung und
Umgrenzung der Staubgefahr ermoglicht haben. Absolut unanfecht-
bare Versuche lassen sich nicht anstellen hier, wo soviel Zufalligkeiten
beim Verkehr in den Klassen, beim Schulbetriebe, bei der augenblick-

364 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

lichen Witterung kaum zuverlassig in Rechnung gestellt werden
konnen.

Was aber an Genauigkeit erreicht werden konnte, ist erreicht.

Vorweg geschickt mag werden, dass bei der Untersuchung der Zusam-
mensetzung des Staubes im Verhaltnis zu den sterilen Staubmengen
die Anzahl der entwicklungsfahigen Bakterienkeime gering befunden
worden ist, nur etwa ih bis y^ir der Staubteile. Dass aus diesem
Befunde freilich noch kein Grund zu mangelhafter Reinigung der Schul-
raume hergeleitet werden darf, ist klar.

Das Ergebnis der Versuche, soweit sie sich auf die Staubmengen und
deren Beseitigung ohne Unterschied bezogen haben, ist kurz folgendes:

Bei dem Vergleiche einer Schulreinigung

a) mittels zweimaligen wochentlichen Kehrens der Klassenboden
nach Wegriicken der Schultische, und taglichem trockenen Kehren unter
Verwendung von feuchten Sagespahnen (sog. Hamburger Verfahren)
mit einmaligem feuchten Wischen innerhalb 14 Tagen.

b) mittels taglichen nassen Wischens nach vorherigem trockenen
Kehren, sogar unter taglichem Wegriicken der Schultische, (sogenantes
Kopenhagener Verfahren) .

c) mittel Vacuumentstaubers, hat sich herausgestellt, dass der
schliessliche Effekt der vorgenommenen Reinigung bei alien drei, in
ihren Kosten natiirlich sehr verschiedenen Verfahren fast der gleiche
ist, d. h. alle drei sind imstande, die Klassen wirklich zu saubern in
einem solchen Masse, dass nach erfolgter Reinigung die Klasse als
rein angesehen werden kann. Beim Vacuumreiniger konnte dieses
Resultat nicht liberraschen, beim taglichen nassen Wischen nach
vorherigem Kehren (Kopenhagener Verfahren) ebensowenig. Erstaunlich
ist nur, dass auch ein tagliches Kehren und einmaliges Wischen
innerhalb von 14 Tagen Schon so gute Wirkungen hat. Es beweist
das, dass das nasse Auf wischen in seiner Wirkung dem'Staub gegeniiber
iiberschatzt wird, dass er mit trockenem Kehren unter Benutzung
von Sagespahnen bei entsprechender Sorgfalt ebenso gut beseitigt
werden kann. Dass auch die staubbindenden Ole, die in Deutschland
lange Jahre als Allheilmittel angesehen wurden gegen den Staub, die
Reinigungsfahigkeit der Klasse nicht wesntlich genug erhohen, um
ihre unangenehmen Seiten, die unertragliche Glatte, und das hassliche
Aussehen der mit ihnen behandelten Fussboden, die auf sie zuriickzu-
fiihrende Verschmutzung der Kleider vergessen zu machen, war ein
interessantes Nebenergebnis, so sehr man geneigt sein mochte, dem
Staubol mindestens die Wirkung zuzuschreiben, dass es die Boden
glatter, also reinigungsfahiger mache. Dass auch das Quantum des

DIE REINHALTUNG DER SCHULRAUME 365

beseitigten Staubes genau gemessen, annahernd das gleiche bei der
Reinigung nach den drei verschiedenen Verfahren ist und sogar unter
Hinzurechnung des Umstandes, dass die Boden mit Staubol behandelt
sind, ist mit ein wei teres Beweismittel fiir die These, dass alle drei Ver-
fahren gleich wirkungsvoU sind.

Die zweite Frage ist die: Wird die Staubentwicklung wahrend der
Unterrichtszeit von der Wahl des Reinigungsverfahrens wesentlich
beeinflusst. Auch hier zeigt sich, dass alle drei Verfahren ziemlich
gleich zu bewerten sind, was nach Feststellung der Tatsache, dass alle
drei zu einer wirklichen und vollstandigen Reinigung fuhren, eigentlich
selbstverstandlich ist. IJber das Ergebnis hinaus, dass die Klasse bei
Beginn des Unterrichts des Morgens rein ist, kann sich ein weiterer
Einfluss des Verfahrens nur in ganz beschranktem Masse erwarten
lassen, namlich insoweit, als die Annahme nicht ganz ausgeschlossen
war, dass durch die Art des Reinigungsverfahrens die gereinigten Flachen
entweder mehr geglattet oder mehr aufgerauht wiirden und somit
weiterem Reinigen weniger oder mehr Widerstand entgegensetzten.
Auch in der Beziehung haben sich die drei Verfahren als gleichwertig
erwiesen, was im Grunde auch durchaus einleuchtet, wenn man bedenkt,
dass beim Vacuumverfahren liberhaupt keine Reibung der gereinigten
Flachen erfolgt und dass das Kehren bei den beiden anderen, dem Ham-
burger und dem Kopenhagener Verfahren, doch zu wenig geeignet ist,
die gereinigten Flachen anzugreifen. Hochstens konnte man auf den
Gedanken kommen, dass das feuchte Aufwischen, den Fussboden mehr
aufrauhte, insofern es die angefeuchteten und spater wieder getrockneten
Teile von Holzfussboden quellen und damit rauher werden liesse, als
das Verfahren sie vorgefunden hatte. Auch das abei^ ist nicht in irgend-
wie messbarer Weise beobachtet worden.

Ist somit ohne Einfluss auf eine wirklich griindliche Sauberung in
ihrem Endresultat die Art der Reinigung der Klassen, kann also von
ihrdie Staubentwicklung wahrend des Unterrichtes nicht mehr beein-
flusst werden, so bleibt nur noch die Frage iibrig: Wovon hangt die
Staubentwicklung wahrend des Unterrichts ab.

Hier zeigt sich nun, dass das Mass der Staubentwicklung

a) selbstverstandlich abhangig ist von dem Mass des in die Klassen
eingeschleppten Schmutzes und

b) Von der Art des Schulbetriebes.

Um den letzeren Punkt zuerst zu erledigen, so hat sich gezeigt, dass
in einer Klasse mit strenger Disziplin, wo die Schuler ruhig sitzen, bei
den Fragen wenig aufstehen, sich uberhaupt gesittet und ordentlich
benehmen, wo der Lehrer selbst sich ruhig auf dem Katheder verhalt,
nicht in der Klasse hin- und hergeht, wie zu erwarten war, weniger

366 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Staub aufgewirbelt wird, als in einer Klasse, in der es sehr lebhaft zu-
geht. Eine strenge Schuldisziplin wird also nicht nur in geistiger
Beziehung auf die Schiiler wohltatig einwirken, sondern auch in rein
physischer Beziehung. Ihre Lungen werden unter Staubentwicklung
weniger zu leiden haben.

Die erste Frage, wie lassen sich die Staubentwicklungen be-
schranken, so weit sie abhangig sind von dem Mass des eingeschleppten
Schmutzes, eroffnet ein weites Untersuchungsfeld. Es ist klar, dass
hier die mannigfachsten Konstruktionsfragen mitsprechen. Dass die
Gestaltung der Decken eines Raumes vielleicht am wenigsten mit-
spricht, weil erfahrungsgemass an horizontalen Flachen von unten
der Staub am wenigsten haftet, ist auch durch besondere Versuche im
Hamburger Institut noch einmal einwandfrei festgestellt worden. Wei-
terhin aber ist die Gestaltung der Wande, besonders des unteren Teiles
derselben, zweifellos von Einfluss auf die Staubentwicklung. Eine
glatte Wand, eine besonders geglattete oder mit glattendem Anstrich
versehene, wird dem Staub weniger Gelegenheit geben, sich festzusetzen
und damit ihn zwingen, auf die Erde zu fallen, um hier am schnellsten
sich beseitigen zu lassen. Besondere desinfi^ierende Anstrichfarben,
wie sie Delius neuerdings als erprobt bezeichnet, werden etwa noch
an den Wanden hasstenden Staub unschadlich zu machen geeignet
sein. Auch die -Ausbildung aller Mobilien einschl. der beweglichen
Tiiren und ihrer feststehenden Putter, die Ausbildung des Katheders,
der Tafeln wird moglichst unter diesem Gesichtspunkte so erfolgen
miissen, dass recht glatte, unprofilierte Flachen hergestellt werden,
auf denen der Staub keine Gelegenheit findet, sich in Schlupfwinkeln
festzusetzen. Horizontale Flachen wird man tunlichst beschranken,
Fensterbretter wird man stark abschragen, die Schranke moglichst in
die Wande legen, damit auf jenen keine unkontrollierbaren Boden
entstehen. Endlich wird die wichtigste Rolle innerhalb der Klasse
der Fussboden selber spielen. Je leichter er federt, um so eher werden
Staubentwicklungen entstehen. Er soUte also eine gewisse Harte
haben, die allerdings auch nicht zu weit getrieben sein darf, aus Griinden
der leichten Verletzlichkeit der Schuler bei gelegenthchem Fallen und
weiter, um den Schall der sich bewegenden Menschen in der Klasse
nicht so unangenehm hervortreten zu lassen. In der Richtung dieses
Gedankenganges wird man unfehlbar dazu kommen, dem Linoleumbe-
lag ganz besondere Werte beizumessen, die, wie bekannt, noch dadurch
erheblich erhoht werden, dass die Fugenlosigkeit eines gut verlegten
Linoleums die Ansammlung von Staubmassen in verborgenen Schlupf-
winkeln von vorneherein unmoglich macht. Den Linoleumfussboden
in seiner Vorzugsstellung vor dem Holzfussboden gerade fiir Schul-
klassen zu untersuchen, ware eine weitere erspriessliche Aufgabe der

DIE REINHALTUNG DER SCHULRAUME 367

exakten Forschung. Der Holzfussboden, ganz besonders der stark
angegriffene fugenreiche, wird nach jeder Richtung bin als der ungun^
stigste in Bezug auf Staubansammlung und Staubaufwirbelung ange-
sehen werden diirfen.

Weiterhin wird man innerhalb der Klassen noch alle diejenigen Mass-

nahmen als forderlich gegen die Staubwirbelungen ansehen durfen,

welche geeignet sind, den an den Fussen der Schuler klebenden, ein-

geschleppten Staub von den Fussen abzustreifen und ihn dem Bereich

der ihn wieder aufwirbelnden Gliedmassen der Kinder zu entziehen.

Als solche Massnahme wird man die Fussroste unter den Sitzplatzen

der Kinder begriissen, an denen die Schuler den Staub abstreifen, ohne

ihn, wenn er einmal in die Vertiefungen hinuntergefallen ist, wieder in

Bewegung setzen zu konnen. Auch die feststehenden Pultflachen,

lie frei sind von alien beweglichen Teilen, wird man nunmehr wegen

ler geringeren gebotenen Gelegenheiten zur Staubansammlung und

(taubaufwirbelung den Subsellien mit beweglichen Teilen vorziehen. Pa-

>ierkorbe, Heizkorper usw. miissen weiterhin moglichst nur glatte und

:war vertikale Flachen haben, moglichst wenig horizontale Lagerflachen.

)s werden also in der Richtung die Rippenheiz Korpen und die

tngen horizontalen Heizrohre unter den Fenstern fiir die Staub-

msammlung und Aufwirbelung ungiinstiger sein, als die vertikal

itehenden Heizregister und was fast selbstverstandlich, jede Zentral-

leizung in Bezug auf die Staubfrage vorzuziehen den Ofenheizungen.

Am wichtigsten scheint es nunmehr aber den Schuler zu veranlassen,
loglichst wenig Schmutz in die Klassen mit hineinzubringen, also
^orkehrungen zu treffen, die

a) auf dem Wege zum Schulhaus, mindestens aber auf der letzten
►trecke desselben ihn moglichst wenig Schmutz an den Fussen mit
[orttragen lassen, den Weg also gut befestigt und stets gesaubert halten
iassen.

Schulen, die inmitten einer grossen unbefestigten Hof- oder Spiel-

lache liegen, und deren Zuwege aus Sparsamkeitsgrunden vielleicht

langere Zeit ungepflastert gelassen werden, bieten ganz besonders

relegenheit zur Staubeinschleppung und Staubaufwirbelung in ihren

Laumen. Eine in dieser Richtung sich bewegende Sparsamkeit ist

ilso sehr wenig am Platze. Dann muss noch ein grosses Augenmerk

-wie — immer deutlicher in die Erscheinung tritt — arauf gerichtet werden,

lass den Schiilern ausgibige Gelegenheit gegeben wird, ihre Fiisse vor

>etreten des Schulgebaudes zu reinigen. Blosse Fusskratzeisen von

[geringen Ausmessungen sind ganz vom Ubel. Grossere Gitter sind

)esser; am allerbesten werden solche sein, bei deren Uberschreitung

lie Schuler mehrere Schritte zu machen haben, innerhalb deren sie

368 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

also die Fiisse von anhaftendem Schmutz griindlich zu reinigen gerade
zu gezwungen sind selbst dann, wenn eigene Nachlassigkeit sie dazu
nicht anspornt. Eine besondere Aufsicht am Schuleingang, welche
die Kinder immer wieder anweist, die Fusse zu reinigen, selbst wenn
sie es vergessen soil ten, wird hier sehr segensreich wirken konnen. Aber
hinter dem Fusskratzgitter werden noch weiche Matten auszulegen
sein, iiber die hinwegschreitend die Schuler erneut ihr Schuhzeug sau-
bern. Es ist jedem Bewohner eines eleganten Hauses bekannt, wie
sehr er selbst ungewoUt sein Schuhzeug reinigt beim Begehen einer
mit Laufern belegten Treppe. Wenn es auch nicht moglich sein wird,
die Schultreppen mit Laufern zu belegen, so wird doch auf andere Weise
zunachst auf die angedeutete, auf moglichst ausgibige Sauberung des
Schiiler-schuhwerks hinzuwirken sein.

Endlich konnte die Beobachtung, dass die vom Eingange entfernter
liegenden Klassen erfahrungsgemass einen geringeren Schmutz auf-
weisen, eine Beobachtung, die der aus dem besseren Wohnhaus ent-
nommen durchaus parallel lauft, dazu verfiilifen, moglichst grossen
Schulsystemen das Wort zu reden. Solche Schlusse aber werden selbst-
verstandlich fehl gehen. Denn wenn auch die vom Eingange entfernter
liegenden Klassen in einer sehr grossen Schule geringere Schmutzmengen
aufweisen werden, so werden dafiir diejenigen, welche dem Eingang
zunachst liegen und ganz besonders auch die entsprechenden Korridor-
und Treppenteile, die von so vielen Schiilern gemeinsam benutzt werden,
um so mehr Schmutz zeigen. Die Beobachtung in den entfernter lie-
genden Klassen kann also nur die Notwendigkeit von Sauberungsvor-
richtungen, die auf dem Wege bis zur Klasse liegen, in ein noch helleres
Licht riicken. Es ist wohl denkbar, dass selbst grosse Aufwendungen
an dieser Stelle sich durchaus bezahlt machen, einerseits was die ge-
ringern Reinigungs kosten der Klasse angeht, andererseits vor allem
was die geringere Staubaufwirbelung und damit Beeintrachtigung der
Atmungsorgane der Kinder anbelangt.

Alles Vorhergesagte trifft nun nicht nur auf die Klassen zu, es ist
noch in viel hoherem Masse zu beherzigen hinsichtlich der Turnhallen.
Hier wo die lebhafte Bewegung der Schuler nicht nur nicht vermieden
werden kann, sondern sogar eine Aufgabe des Unterrichts ist, muss die
Einfiihrung von Schmutz auf das Sorgfaltigste hintan gehalten werden.
Daneben wird hier aber • eine erhohte und haufigere Sauberung ganz
besonders notwendig erscheinen. Die Einschleppung von Schmutz
zu vermeiden, dient in den Turnhallen kaum ein anderes Mittel besser,
als die Beschaffung von besonderen Turnschuhen fiir die Schuler. Ist
man sich des Wertes dieser glatten, mit dem Schmutz der Strasse nie
in Beriihrung kommenden Schuhe einmal bewusst, so wird man mogli-
cherweise den an manchen Stellen schon begangenen Weg, der Beschaffung

DIE REINHALTUNG DER SCHULRAUME 369

on Turnschuhen fiir die Schuler auf Kosten der Schulunterhaltungs-

pflichtigen, weiter zu gehen sich nicht mehr scheuen durfen. Daneben

tritt aber hier noch eine andere Beobachtung des Hamburger. Instituts

I bei seinen Reinigungsversuchen als wertvoU uns entgegen. Es ist die,

dass alle Staubaufwirbelungen schon sehr kurze Zeit nach Eintritt

volliger Ruhe im Raume zu Boden sinken und hier also zusammenge-

kehrt und weggebracht werden konnen. Die Hamburger haben festge-

stellt, dass schon nach 10 bis 12 Minuten fast aller Staub zu Boden

gesunken war, dass wenigstens erhebliche Staubmengen nach

dieser Zeit von dem einmal gesauberten Boden nicht mehr zusammen

gekehrt werden konnten. Diese Beobachtung selbst konnte den nicht

uberraschen, der die Beobachtungen des letzten Jahrzehnts auf einem

anderen verwandten Gebiet verfolgen musste, namHch auf dem der

^^bwasserklarung. Wie bei diesem in dem leicht beweglichen Fluidum,

^^em Wasser, die aufgewirbelten Schmutzteile zum grossen Teil in ganz

^kurzer Zeit bereits zu Boden sinken — man hat hier gefunden, dass in

^■0 bis 20 Minuten der grosste Teil der Klararbeit bereits vollendet ist —

^So konnte man annehmen, dass der Reinigungsvorgang in dem noch

so viel leichter beweglichen Fluidum, der Luft, sich so viel schneller

abspielen wiirde. Wenn auch nicht ganz allein der freie Fall im Wasser

einerseits, in der Luft andererseits den Massstab fiir die Schnelligkeit

der Wasser- bezw. Luftreinigung abgeben kann, weil auch die im

Wasser mitgefiihrten Schmutzteile wesentlich voluminoser sind als die

in der Luft mitgefiihrten, so werden doch sicherlich Beziehungen zwischen

dem freien Fall im Wasser, der Abwasserklarzeit, und dem freien Fall

in der Luft, der Luftklarzeit, bestehen, die genau zu untersuchen eine

ankbare Aufgabe der Zukunft noch ware. Jedenfalls werden das

rgebnis der Hamburger Versuche und die bisher in ihrer Exaktheit

h vereinzelt dastehende Feststellung, dass in 10 bis 12 Minuten die

uft bereits vom Staub gereinigt ist, durch die Beobachtung bei der

bwasserklarung in jeder Hinsicht bestatigt. Die Tatsache der schnel-

n SchuUuftreinigung wird ein haufigeres Auskehren des Turnsaales

ischen je 2 Turnstunden, als ebenso erfolgreich wie notwendig er-

heinen lassen. Auch hier wird die Frage der Fussbodengestaltung

hr mitsprechen, auch hier wird man zu der Uberzeugung kommen,

ss es kaum einen geeigneteren Bodenbelag als den des Linoleums geben

nn, wenn man Staubaufwirbelungen vermeiden, ein schnelles Saubern

s Raumes begiinstigen will.

Um die Frage der Schulreinigung ganz erschopfend zu behandeln,

darf es noch einer Untersuchung der verschiedenen Reinigungsver-

hren in ihrer Schadlichkeit auf das Reinigungspersonal., Ohne wei-

res ist klar, dass ein Kehren mit dem Besen wesentlich mehr Staub

ufwirbelt als eine Reinigung mit dem Vacuum-Apparat. Letzterer

370 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

ist hygienisch fiir das Reinigungspersonal am giinstigsten. Der Zusatz
von feuchten Sagespahnen beim Reinigen mittels Kehren wird fiir das
Personal als ebensowohl wertvoU bezeichnet werden diirfen.

Da das Reinigen mit dem Vacuum-Apparat in alien Schulen in
nachster Zeit sicherlich noch nicht wird erreicht werden konnen, da
also mit den Staubaufwirbelungen beim Kehren noch Jahrzehntelang
wird gerechnet werden miissen, muss jedenfalls eins gefordert werden:
Kinder selbst diirfen diese Reinigung unter keinen Umstanden vor-
nehmen. Ihr Ungeschick bei der Reinigungsarbeit einerseits wird die
Gefahr der Staubaufwirbelung noch mehr erhohen; ihre jungen Korper
aber werden unter dieser selbst geschaffenen Gefahr noch mehr zu
leiden haben, als die widerstandsfahigeren des erwachsenen Reinigungs
personals.

Den Stand unserer heutigen Erkenntnis auf diesem schulhygien
ischen Gebiet der Staubentwicklung und Staubbeseitigung in den Sch
len wird man zusammenfassend also dahin kennzeichnen miissen:

i) Eine sorgfaltige Reinigung der Schulraume, ganz besonde
der Turnsale, ist in jeder Beziehung notwendig, sie ist aber auch moglich
mit den verschiedensten Reinigungsverfahren, auch' dem altbewahrten
des blossen Kehrens in Verbindung mit feuchtem Abwischen aller
Tisch- und Bankfiachen pp., falls dabei die grosste Sorgfalt angewendet
wird und haufiger durch Wegrucken, Umlegen der Subsellien oder durch
geeignete Konstruktionen derselben Gelegenheit gegeben wird, auch
die Flachen unter den Tischen und Banken zu reinigen.

2) Ein gelegentliches einmaliges feuchtes Aufwischen der Schul-
raume wochentlich zur Befreiung des Fussbodens und der Mobilien
von festklebenden Schmutzteilen lasst sich nicht umgehen.

3) Die Staubaufwirbelung wahrend des Unterrichts ist abhangig
von der Schulzucht; sie ist nicht abhangig von dem vorher benutzten
Reinigungsverfahren, wenn bei den verschiedenen Verfahren gleiche
Vorsicht an den Tag gelegt wird. Am griindlichsten reinigend, fiir das
Personal am wenigsten belastigend, allerdings auch am teuersten in der
Anlage sowohl wie der Benutzung ist das Vacuum-Reinigungs-verfahren.

4) Die Staubaufwirbelung ist dagegen abhangig von der Staubein-
schleppung; diese wird am besten vermieden durch gute Befestigung
der Zuwege zur Schule, durch moglichst ausgibige Gelegenheit zur
Sauberung des Schuhmaterials gleich am Eingange zum Schulgebaude.

5) Die Fussbodengestaltung in den Klassen und der Turnhalle
ist von grossem Einfluss auf die Staubaufwirbelung. Zur Vermeidung
derselben wird Linoleumbelag ein wertvoUes Material sein.

SECTION TWO

The Hygiene of School Administration, Curriculum and Schedule
Room F. Monday, August 25th, 2:00 P.M.

SESSION FIVE

STATUS OF SCHOOL HYGIENE AND METHODS OF

INSTRUCTION IN CITY, VILLAGE AND COUNTRY

SCHOOLS (Part One)

Eugene H. Porter, M.A., M.D., D.P.H., Chairman
Henry P. Emerson, LL.D., Buffalo, N. Y ., Vice- Chairman

Program of Session Five

Eugene H. Porter, M.A., M.D., D.P.H., Commissioner of Health of
State of New York, Albany, N. Y. "What the State Shall Do
in the Care and Supervision of School Children,"

R. H. Crowley, M.D., Board of Education, Whitehall, England. "The
Present Position of the School Hygiene Movement in England."

R. L. Dixon, M.D., A.B., Secretary and Executive Officer, Michigan
State Board of Health, Lansing, Mich. "Relation of the State
Board of Health to the Rural School." (Manuscript not supplied.)

George A. Mirick, A.M., Assistant Commissioner of Education, De-
partment of PubHc Instruction, Trenton, N. J. "State Program
of Education in Hygiene in New Jersey."

William Hamilton, Ph.D., Acting Chief of the Alaska Division, U. S.
Bureau of Education. "Hygienic Conditions Among the Native
School Children of Alaska."

Burton S. Tefft, Commissioner of Schools, Saginaw, Mich. "Rural
School Hygiene in Michigan."

Felix Martel, General Inspector of Public Instruction, Paris, France.
"Legislation scolaire frangaise; Dispositions legales et reglemen-
taires relative aux mesures a prendre dans les ecoles en cas d 'epi-
demic."

Paper Presented in Absentia in Session Five
(Read by Title)
■. Heck, M.A., Professor of Education, University of Virginia,
Charlottesville, Va. "Parents' Part in School Hygiene."

372

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

WHAT THE STATE SHALL DO IN THE CARE AND
SUPERVISION OF SCHOOL CHILDREN

Eugene Hoffman Porter

The importance of this field of health work has long since been
admitted by those familiar with the problems presented b>^ the recent
developments in sanitary science. We are fully persuaded that the
best index of community health is the physical welfare of the school
children in that community. So far there is agreement, but when we
begin to consider methods of procedure differences of opinion appear.
It would seem very probable that any diversity of view regarding
plans to be adopted for the proper care and supervision of school children
would arise either from a lack of a comprehensive and firm grasp of the
question or a failure to clearly discern just what definite results are to
be accomplished. It would seem that it ought to be very clear to every-
one that if we effectively guard the physical well being of our school
children, teach them the fundamental laws of health and train them
in the observance of these laws, we have gone a very great ways in-
deed not only in protecting the health of the individual but in establish-
ing and confirming the health of communities and indeed of the State.

Such an advance as that in health work would be one of the great
foundation stones upon which might be successfully erected that ideal
structure of public health protection which would actively and visibly
promote and determine State and National efficiency and happiness.

But if we are to supervise and care for our school children we must
not only know what kind of care we are to give and what kind of super-
vision we are to exercise, but we must know something definitely and
accurately about the school children themselves.

There is only one way in which we can find out anything about the
children in our schools and that is to examine them and this examina-
tion must be made by those who have had some training in the work,
who understand the vital points at issue, and are competent to bring
out the facts that such an examination is searching for. Many examina-
tions of school children have been held and the results of such examina-
tions have been duly recorded on thousands and thousands of cards and
buried in as many forgotten reports. It is not the examinations that
do any good nor the tabulated results that are of any value, but the
use of these reports and their interpretation, and the intelligent work
based upon them. The proper care and supervision of school children

WHAT THE STATE SHALL DO IN THE CARE OF SCHOOL CHILDREN 373

is preventive medicine in the highest sense of the term, and preventive
medicine is the best and cheapest health insurance that a community
can take out.

Some time ago was begun the formation of hygienic committees
for universities.

These committees have employed an admirable scheme of investi-
gation, have adopted wise measures for bettering the hygienic condi-
tions of buildings and the health of the students. Such matters as
Ventilation, Humidity, Water, Sweeping, Toilets, Gymnasium, Lodg-
ing House Inspection, Medical Adviser, Emergency Cases, Health
Education, are given full consideration together with the various other
subjects which have to do with the health and habits or life of students.
Admirable as this scheme is and important as it is as an example of what
can and should be done, yet its greatest value lies in the illustration
given of the value and power of such close and critical examination of
the surroundings and physical condition of the students concerned.
Of necessity it reaches but an infinitesimal part of those attending the
schools and colleges in the Union. But what can be done for college
students should be done for every school child in the United States.

It is a curious fact, and by no means gratifying to our National
pride, that when we wish to strongly illustrate the value of modern
sanitary methods we draw our most striking illustrations from our
island and provincial possessions. Modern sanitary science, for example,
has abolished yellow fever in Cuba, discovered the cause and largely
controlled the ravages of hookworm senemia in Port Rico, barred yellow
fever and Chagres fever from the Canal Zone, and isolated leprosy in
Hawaii and the Philippines. Now this work has practically revolution-
ized conditions in our tropical possessions and enabled the President
to say in the short 12 years that we have been responsible for our people
in the tropics we have made more progress' in the discovery of methods
of prevention and cure of tropical diseases than all other countries
have made in the past two centuries. Now this advance has been
due to modern sanitary methods, backed up by intelligent and author-
itative administration. And the results show what intelligence and
authority can do when joined together. We have indeed intelligence
in modern sanitary methods in these, our United States, but it is not
always backed by authority, and we have in the same place authority
that is notably lacking in inteUigence.

Typhoid, pneumonia, tuberculosis, the black plague of venereal
infection, are still ravaging the land. If they were tropical diseases
how horrified we would be at their ravages and what active measures
would we take to control and extirpate them. And yet I think it may
be safely said that modern sanitation, if permitted, if we could unite

374 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

authority and intelligence in health matters as they should be united,
could effect as marvelous changes here as it has in the Canal Zone or
in Havana.

Herbert Spencer said a long time ago that "to be a good animal is
the first requisite to success in life, and to be a nation of good animals
is the first condition of national prosperity."

It is true that we protect our cattle. The great State of New York,
with nearly ten millions of people, spends many times more in looking
after the health of the cattle of the State than it does for the health
of its citizens. In 1909 the Health Department had $146,980, which
was less then one-half of one per cent, of the total expense of the
State ^poverament. At the same time was spent for the protection
of game,- ^§h and forests, $568,595.80.

We are all familiar with the wastes of life in our country, going on
day by day and year by year. Some of us know that much of this sick-
ness and death is absolutely preventable. We are aware that we do
not need to know more just now regarding the prevention of disease
but we do need to apply the knowledge that we have immediately and
without further delay. The attitude of the people is easily under-
standable. It is as Governor Hughes said a short time ago, "Only be-
cause we are accustomed to this waste of life and are prone to think
of it as one of the dispensations of Providence that we go on about our
business little thinking of the preventive measures that are possible."

The hog is fortunate in being an animal of commerce. If it were
not the waste of hog life would doubtless exceed that of human life.
We are a generous people. After every disaster money flows in to
relieve distress. A great epidemic occurs — towns, cities, states and even
the nation contribute liberally for the relief of the distressed community.
Now if it is right and proper for the State and the nation to appropri-
ate money for the relief of distress, it is certainly right and proper to
contribute money for the prevention of distress, which means in most
cases the prevention of disease.

Our system of philanthropy is essentially false. It has developed
naturally and in its early growth, animated by noble motives, sustained
by high ideals, it did a great and beneficent work. But increasing
knowledge has shown the futility of much of the misdirected philan-
thropy of to-day. If a child is threatened with illiteracy millions are
forthcoming for its education, but the child that is threatened with
preventable disease is told that just now nothing can be done; wait
until disease has attacked you and you are helpless. Then there is a
hospital provided for you and you will be taken there and an attempt
will be made to save your life. There are hospitals endowed for this
very purpose.

WHAT THE STATE SHALL DO IN THE CARE OF SCHOOL CHILDREN 375

And there you have the matter in a nut shell. It is not the curing
of disease that is important; it is the prevention of disease. Where
one life may be saved by appropriate treatment, a thousand lives may
be saved by timely preventive measures.

Now the problems of health have to do principally with environ-
ment— home, street, school, business. And it is because this is so
that it is worth trying to relate health instruction to industry and govern-
ment, to preach health from the standpoint of industrial and national
efficiency rather than of individual well-being. So that while the
State cares for the child and undertakes his examination and his general
health supervision, the real and important thing, the great result to be
attained, is not so much the health and efficiency of the one child as it
is the resulting increased efficiency in the community itself. The
supervision and care of the school child, his instruction in hygiene,
necessarily brings in all the persons in his home, takes in the groups
made up of friends and acquaintances, reaching out and eventually
embraces the entire community, and so lifts up and elevates the stand-
ards of living.

Now we must find some working program that will bring all these
members of the groups mentioned together and make it easy for them
to observe health standards, and we must remember that there is a great
gap between health laws and health law enforcement. We are con-
stantly making the mistake of concentrating our 'attentions upon the
morals and pretentions of candidates and officials instead of judging
^government by what government does. It makes no particular differ-
ence just how our officials are exercising authority, but it makes a tre-
mendous difference when what they do makes men freer in the enjoy-
ment of health and earning power. In protecting health as in reforming
government, as Allen says, "An ounce of efficient achievement is worth
infinitely more than a moral explosion."

Undoubtedly some legislation will be necessary if we are to make
the progress we desire in the care of the physical welfare of our school
children. Such legislation should be as brief, as simple, and as fitted
,to the place and the time and the people as possible. And it must be
remembered that the value and permanence of the results that are
sought for in any reform movement or in any type of governmental
action depend largely upon the adaptability of the movement under-
taken and of the principles on which it is based and the special condi-
tions of the time. If we wish, therefore, to improve the welfare of our
[schools we must study carefully the conditions of the State at this
particular time and see to it that our movement in advance is adapted
to these conditions.

An instructive illustration of the great advance made in another

376 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

field is shown by a proposed Children's Code of the State of New York,
compiled by Justice Deuel of the Court of Special Sessions of the City
of New York. He proposes to attain, among other things, the follow-
ing four purposes:

1. Indubitable protection of the child against all suggestion of
crime; hence the elimination of all objectionable references to him in
the penal law and the criminal code, and the specific definition of juve-
nile delinquency.

2. Extension of the Children's Court, without any increased expense,
to every city, town and hamlet in the State, at the same time giving to
each the home rule privilege of developing and utilizing to the utmost
the resources of the court.

3. The institution of uniform procedure and the acquisition of
uniform statistical data throughout the State.

4. The legal employment of scientific agencies in the detection ]
of mental or physical causes of waywardness which, uncorrected, pre-
disposingly lead to crime; and a procedure likewise legal compelling
curative treatment.

I cite these provisions of this proposed code simply to show what
progress the legal profession has made in dealing with what may be
called the criminal or perhaps rather the moral side of the child's nature.
Such a code as that proposed by Judge Deuel would have been impossible!
in this State ten years ago and unthinkable twenty-five years ago. Itj
will be noted that the underlying purpose of the judge is evidently the
prevention of crime rather than the punishment of crime.

In a paper so limited as this it is only possible to give a brief outline
as to what should be the duty of the State in its care of the school child.
I have already said that the best index to community health is the physi-
cal welfare of its school children. Now, if we can fix upon the test to:
be applied at school of home conditions affecting both the child's health
and his progress at school, it will be possible in the name of the school
to correct those conditions if necessary, just as it will be easy to read
the index, because the child is under study control for the greater part
of the year, from six to fourteen. This test should be the physical
record of the child obtained by the examination and re-examination
for the physical signs called for by the record card. This card, among
other things, should register the weight, height, age and other measure-'
ments. It should take note of the nutrition, of enlarged glands, of-
cardiac or pulmonary diseases, of defective spine, chest or extremities,
of defective vision or hearing, of the condition of the teeth, of the palate.

WHAT THE STATE SHALL DO IN THE CARE OF SCHOOL CHILDREN 377

of the tonsils, of post-nasal growths, of deficient and defective nasal
breathing, and of the mentality.

Now when such a card as this is filled out for every child in a class
in a school or city the story told points directly to physical health rights
neglected. In the examination of school children in New York City,
running from March, 1905, to January, 1908, 275,641 children were
examined and 198,139, or 71.9 per cent., were found to be defective.
If this percentage should obtain throughout the whole of the United
States then the army of children would be 7 out of 10 or over 14,000,000.
These figures have been vigorously attacked by those who do not believe
that such a percentage of the children in our public schools have any
serious defects. But it is really not material whether these figures
are exact or not. If they overstate the truth or understate the truth
the health authorities of the country should find out.

Now this record of physical examination is the only way in which
the existence in a community of conditions prejudicial to health that
particularly affect the child can be discovered. The card record will
show whether the child sleeps in a dark, ill-ventilated and crowded room,
if he has too little to eat or the wrong things to eat, and whether he has
eye trouble or adenoids or enlarged tonsils; whether he has defective
lung capacity, which may mean improper breathing or too little exercise
or too little food. Let me say again that it is the use of information
and no.t the measuring of information that improves the health. The
lere examination of school children does little good. The examination
tells what child should have special attention, what parents need to be
'■arned against as to the condition of the child, and what home con-
litions.need to be corrected.

Let us keep clearly in mind the distinction between medical school
inspection and medical school examination. Medical inspection is simply
the search for communicable diseases; medical examination is the search
for physical defects, many of which furnish the soil for contagion. Among
;he important defects which demand correction if the health and effi-
iency of the child are to be protected and his value as a future citizen
)f the commonwealth is to be preserved are mouth breathing; diseased
flands, which means adenoids and enlarged tonsils; ear troubles; eye
strain; malnutrition; diseases of the teeth, and contagious diseases.
It will be impossible in a brief paper of this character to discuss
iparately each of these defects, to attempt to point out their serious-
less, their frequently fatal results and the great importance of their
correction. Those who have given this subject any considerable atten-
:ion know full well that these conditions should be no longer neglected
)ut should be promptly, energetically afid wisely corrected.

For a working program for the supervision and care of school children,

378 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

that suggested by Mr. Allen will serve at least as an excellent basis for
discussion and future action.

First. A thorough physical examination of all candidates for teachers'
positions.

Second. A thorough physical examination of every single child in
every single school upon entering, and periodically during the school
life.

Third. Supervision by physicians of hygienic practices in school
rooms and upon playgrounds.

Fourth. Restrictions of study hours at school and at home to limits
compatible with health.

Fifth. Establishment of follow-up plan to ensure action by parents
to correct physical defects and to attend to physical needs.

Sixth. The teaching of hygiene so that children will cultivate
habits of health and see clearly the relation of health and vitality to
personal happiness and the future efficiency.

Seventh. Central supervision of school hygiene.

Eighth. Information gained at school regarding conditions prej-
udicial to community health should be published and made the basis
of an aggressive campaign for the enforcement of sanitary laws'.

This is by no means all that Mr. Allen suggested, or that has been
suggested by others, but it will serve excellently as an outline to guide
our advance in the betterment of conditions in our schools. I am
thoroughly convinced that this work should be in the hands of the
health authorities, and that all medical examinations of school children
should be made by competent physicians.

This work of school inspection and examination gives us a clear view
of some of the most important defects in the community health, and when
to this picture is added that given by a sanitary survey of the same
community, town or city, made by competent inspectors, which would
take in the questions of water supply, sewage disposal, tenement condi-
tions, clean streets, etc., we have a pretty definite and accurate picture of
the essential health conditions existent. Now with such sources of infor-
mation the annual report of the Board of Health should give as clear a
picture of a community's health for any past week or past quarter as an
accountant's books would give of the condition of any commercial busi-
ness. Furthermore such a Board of Health should not only keep track of
one community alone, but this community should be compared with
other communities of similar size and each community compared with

WHAT THE STATE SHALL DO IN THE CARE OF SCHOOL CHILDREN 379

itself year by year. Such comparisons as these have not often been
made and I do not know of a State where such records exist.

I beUeve thoroughly that it is the duty of health authorities to
compel all citizens under their jurisdiction to cultivate habits of health
and to punish all who persistently refuse to acquire those habits so far
as the evils of neglect are in any sense a danger and a menace to the
community. And one of the unlimited educational possibilities of health
boards consists in their privilege to point out repeatedly and cumula-
tively the industrial and community benefits which result from habits
of health, and the industrial and community losses which result from
habits of unhealthy living. And should it be thought that this health
program encroaches upon individual liberty we may recall what one
of the greatest of modern biologists has recently said: "As we march
onward toward the true goal of existence mankind will lose much of its
liberty but in return will gain a high measure of solidarity. The more
exact and precise a science becomes the less freedom we have to neglect
its lessons." These new duties are before us and it is only by organized,
enlightened and persistent effort that we may hope to. accomplish our ends.

I thoroughly appreciate the fact that what I am proposing is more
or less ideal, and yet I am as thoroughly convinced that within a few
short years it will be realized that the plan proposed is absolutely prac-
tical a^d sane. A public official said a little while ago: "I am fully
aware of how little I am doing and how little at best I shall have done
when my time is up. Corrections and improvements in government,
as in all things, may not be done at once, but only patiently and grad-
ually and, may I say, charitably; explaining and teaching as you go,
even as Isaiah says : ' Precept upon precept ; line upon line ; here a little
and there a little.'"

I think we may show that these words — modest, patient and chari-
table— could be hung over the desk of every ranting, denouncing re-
former who labors to make the people believe that he holds the remedy
for the complete and sudden reform of every existing abuse, health or
otherwise.

Realizing, then, the limitations of human power, the existence of
honest differences of opinion, the dependence of all true and lasting
education and reform on the people themselves, let us march steadily
onward and let us remember that the truest measure of civilization
and of intelligence in the government of a State is the support of its
institutions of science and of health. For the science of our time in its
truest sense is not the opinions or prejudice, the strength or weakness
of its votaries, it is the sum of our knowledge of nature with its infinite
applications to State welfare, to State health, to State progress, and to
the distribution of human happiness.

380 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE PRESENT POSITION OF THE SCHOOL HYGIENE
MOVEMENT IN ENGLAND

Ralph H. Crowley

The rapidity of the growth of the school hygiene movement has
been a remarkable phenomenon in nearly all countries. It is hardly
too much to say that where its significance has been appreciated it has
changed the center of gravity and profoundly affected the administra-
tion of the public health service. In England, some six years ago only,
a considerable controversy took place as to whether the school medical
service should be a separate ad hoc service or whether it should form a
branch of the existing public health administration. In the event of
the adoption of the latter course it was feared by some of the pioneers
of the new movement that this new branch of medical work which opened
out such great possibilities would tend to become side-tracked. It was
feared, if placed in the hands of men intent upon the more general
problems of public health and but little accustomed to deal with
those of the character which the new movement was bringing to light,
the development of school hygiene, and its peculiar problems* would
be seriously checked. The school medical service in England forms
an integral part of the public health administration of the country
and it is not too much to say that so far from this form of administra-
tion having led to the relegating of school hygiene to a subsidiary place,
the event has shown that the new service, coupled with that dealing
with the care of the infant, has become the pivot around which the
administration of public health tends more and more to revolve.

Administration. The responsibility for carrying out the work of
the school medical service is placed upon the 317 local education author-
ities of England and Wales. Upon each of these has been cast by Parlia-
ment in the Education (Administrative Provisions) Act 1907 the duty

"To provide for the medical inspection of children immediately
before or at the time of, or as soon as possible after their admission to
a public elementary school, and on such other occasion as the Board
of Education direct," and the power

"To make such arrangements as may be sanctioned by the Board
of Education for attending to the health and physical condition of the
children educated in Public Elementary Schools."

Upon the passing of the Act a n\edical department was inaugurated
at the Board of Education for England and Wales with" Sir George

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 38 1

Newman as Chief Medical Officer, and through this department the
general principles which should guide the local education authorities
in doing the work and the lines along which these should find expression
were laid down in a series of circulars, (i)

At the very output a broad and comprehensive view was taken of
the scope of the school medical service and of its relation on the one hand
to the existing general educational administration, and on the other
to the existing general public health service. As at present carried out
in England and Wales the work of the school medical service comprises
the following branches, viz:

Medical inspection of the child.

Following up and supervision of children found defective.

Treatment of defective children.

Special schools for physically and mentally defective children.

Provision of school meals.

Physical exercises and games.

School baths and bathing.

Supervision of school buildings.

The control of infectious disease.

Medical inspection in secondary schools.

The teaching of hygiene to teachers and scholars.

Employment of children.

Schools for mothers.

For the purpose of carrying out the work of the school medical
service a "school medical officer" has been appointed by the respective
local education authorities in each of the 317 areas. In 252 areas the
school medical officer is also the medical officer of health of the district.
In the remaining areas in which the School Medical Officer is not the
same officer as the Medical Officer of Health arrangements are made
in almost all instances to ensure close linking up of the general public
health and school medical services. There are throughout the country
597 assistant medical officers, 212 acting as whole-time and 385 as part-
time officers. The total number of medical officers is 943, of whom 74
are women medical officers.

The fundamental characteristic of the organization of Medical
Inspection in England and Wales is that it is compulsory and universal.
The systematic medical inspection of children has been assured through-
out the country, even in the most remote rural school, and while local
education authorities differ in the degree to which they carry the

(i) Circular 576. Memorandum on Medical Inspection of children in public
elementary schools, under section 13 of the Education (Administrative Provisions)
Act, 1907.

Circular 582 including a Schedule of Medical Inspection.

Circular 596 dealing in particular with the treatment of school children.

Code of Regulations for Public Elementary Schools.

382 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

efficiency of the work a minimum, and by no means a low standard of
minimum, is expected of ftnd obtained from all local education authori-
ties alike.

The Board keeps itself informed as to the extent, character and
efficiency of the work in each area by the payment of visits of inspec-
tion by medical officers of the Board and also by means of the Annual
Reports which the school medical officers present -to their respective
local education authorities and which are forwarded by them to the
Board.

Upon these reports are based the Annual Reports of the Board's
Chief Medical Officer, which will be found to contain full statements
as to the position of the school hygiene movement in England and Wales
from year to year.

Medical Inspection. Under the regulations of the Board of Educa-
tion for England and Wales arrangements are required to be made by
each local education authority for the medical examination of every
child in the country on the occasion of the first admission to school
and shortly before leaving school. From 1st April, 191 5, a third and
intermediate routine examination will be required at the age of eight
years. Already over one-third of the local education authorities have
arranged for this intermediate examination.

This routine examination includes a record of important points in
the family and personal history of the child, and while not professing
to be exhaustive is of a thorough character, involving an examination
of the height and weight, the special sense organs, the lymphatic system,
the heart and lungs, etc., and ensures that no pathological condition of
importance shall escape detection. The findings are recorded upon
a schedule prepared for each child. On the occasions of the visit of
the doctor to the school to carry out these routine examinations, children
of any age presented by the teacher as suffering from some particular
defect, or picked out by the school medical officer while making a
survey of the children in the classes, are also examined. The arrange-
ments for medical inspection form an organic part of the general educa-
tional system. Medical Inspection is upon school premises and during
school hours.

This systematic medical examination of the children forms the
foundation upon which is built the whole superstructure of school
hygiene.

Following Up and Supervision of Children Found Defective. It is
generally recognized that the medical examination of children in itself
would be of comparatively little value unless systematically followed
up. This branch of the work, technically known as "following up,"

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 383

embraces a definite range of activities, the object of which is to ensure
that the child shall receive appropriate treatment.

First and foremost among these agencies is the school nurse. In
the majority of cases she attends on the occasion of medical inspection
and subsequently visits in the home when necessary in order to encourage
the parent to obtain treatment, to advise how it may be obtained or to
show the parent how to apply such simple remedies as may have been
prescribed.

Repeated examinations for uncleanliness are made also on the occa-
sion of periodic visits to the schools when, in particular, the heads of
the girls are examined and warning notes sent to the parents if neces-
sary and the cases followed up till satisfactory action has been taken.
At the present time 632 school nurses or health visitors have been ap-
pointed by 212 local education authorities.

The school medical officer himself, on the occasion of subsequent
visits to the school, also "follows up" these children found defective,
reexamines them and notes what action, if any, has been taken towards
the relief or cure of the defect and what is the result of such action.

In some areas, particularly in country areas, a good deal of this work
oi following up is carried out by voluntary workers banded together to
form what is known as a "School Care Committee." Children re-
quiring attention are reported by the School Medical Officer to the
Committee whose members undertake to visit the homes where neces-
sary and endeavour to obtain on the part of the mother such attention
as has been recommended by the medical officer. There are upwards
of 1,000 such committees in London alone, and large numbers through-
out the country.

And lastly use is made in some districts, for the purposes of following
up, of the school attendance officers, but generally speaking their time is
already sufficiently occupied with purely school attendance problems.
Through the several agencies an endeavor is made to ensure that the.
school medical officer has cognizance of and supervision over all children
of school age found defective whether in attendance or not in attend-
ance at school.

Treatment. It has been the aim of the Board of Education for Eng-
land and Wales, in their circulars to local education authorities relating
to the school medical service, to emphasize the need for taking a broad
view of the meaning of treatment. Thus they have urged that the adap-
tation of school conditions and the school curriculum, establishment
of open-air recovery schools, the provision of school meals, arrange-
ments for physical exercises and school baths require to be viewed in
the light of treatment, as well as the more direct measures adopted for

384 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

the cure or relief of some specific defect, as for example the removal of
adenoids and enlarged tonsils by surgical operation, or the prescription
of glasses for defective eyesight.

The agencies available for treatment in its more restricted sense may
be summarized as follows:

1. The private practitioner.

2. The voluntary hospital and infirmary.

3. The poor law.

4. The school clinic.

Treatment under the English Poor Law, through the agency of the
local Boards of Guardians, is speaking generally, and for reasons into
which I need not enter, in practice not used.

For some children and for certain ailments the services of the private
practitioner are available. Due, however, in part to the fact that many
parents are unable to pay the cost of adequate treatment, in part too,
owing to the circumstance that many practitioners do not undertake
special forms of treatment, as for example the correction of defective
vision, the X-ray treatment of ringworm or the operative treatment
of adenoids, and in part again because associated with treatment by the
private practitioner there are usually no systematic arrangements for
obtaining the services of a nurse, it is found by experience that reliance
cannot be placed upon obtaining treatment from this source in a large
number, indeed in the majority, of cases.

Many children receive treatment through the agency of the volun-
tary hospital or infirmary. Speaking generally however these institu-
tions are suitable for the more serious cases of illness and especially for
cases requiring operative treatment.

Experience has shown, therefore, that in most areas there are diffi-
culties in the way of many children receiving prompt systematic and
adequate treatment for the ailments discovered, and the need has arisen
for further provision more intimately associated with the education
and school medical services. To meet this requirement the school
clinic has been instituted in a considerable number of areas.

The School Clinic. In England the school clinic has developed on
two lines. First it forms a centre for "following up" where the School
Medical Officer may examine more fully children referred by himself for
more detailed examination or sent by teachers, nurses, school attend-
ance officers or members of Care Committees or brought by the
parents themselves.

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 385

But the clinic is used for the purposes of treatment also and in particu-
lar for the treatment of one or another or all of the following conditions,
viz:

1. Minor ailments, including the common and often contagious
affections of the skin of all kinds, such as impetigo and eczema and pus-
tular conditions generally, the lesions associated with pediculosis of the
body and head, scabies and ringworm, the simpler forms of external
eye disease such as blepharitis, hordoolum and conjunctivitis ;.otorrhoea.

2. Defective vision.

Defective hearing.
Ringworm by X-rays.
Adenoids and enlarged tonsils.
Dental defect and disease.

At the present time in a large number of education areas Inspection
Clinics have been arranged. Ninety-five Authorities have established
Treatment Clinics, 38 Authorities are treating ringworm by means of
X-rays and in 58 areas dental clinics have been established. Speaking
generally the operative treatment of adenoids and tonsils is carried out
at existing hospitals and infirmaries but a few authorities have themselves
established or are about to establish clinics for this work. In a few
centres there is being added also provision for treatment by means of
remedial exercises.

Experience has shown how great are the advantages if treatment
is to be promptly secured and effectively carried through, that it should
be, so far as possible, carried on as an integral part of the school medical
service. The conception taken of treatment in the past as a single
act with but little relation to subsequent action or to associated lines
of treatment has led to inefficiency and to ineffectiveness of result.
Thus the treatment of defective vision by means of glasses requires
the services of an oculist who is fully acquainted with school circumstan-
ces and requirements. The prescription of glasses for a child who
squints is of little value unless the interest and aid of the teacher is
invoked, in order that the instructions given in connection with the care
of the eye may be carefully carried out. The operation for the removal
of adenoids and enlarged tonsils again may be rendered largely nuga-
tory owing to failure to see that suitable breathing exercises are subse-
quently practised. Some children suffering in this way moreover

— require treatment along other lines, e. g. by the provision of meals or by

IB attendance at an open-air school.

386 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Special Schools for Physically and Mentally Defective Children. These
schools have been estabHshed under the Elementary Education (Blind
and Deaf Children) Act of 1893 and the Elementary Education (Defective
and Epileptic Children) Act of 1899 and include schools for the follow-
ing groups of children, viz: Blind, deaf, mentally defective, physically
defective (principally cripples), epileptics, tuberculous children, delicate
children of all types.

The Blind and Deaf Children Act makes it compulsory upon all
education* authorities to provide educational facilities for all blind and
deaf children in their area. The larger local education authorities
have established schools of their own; the smaller contribute for the
maintenance of their children to Institutions and Homes established by
the larger authorities or by private effort. There are in all 40 schools
for blind and 51 for deaf children throughout England and Wales,
providing accommodation for 2,400 and 4,300 children respectively.

As a result of medical inspection, more especially in the larger centres,
attention is being drawn by the school medical officers to the presence
in the schools of "partially-sighted" and " hard-of-hearing " children
who, though not considered bad enough in the past to justify attendance
at a special school are nevertheless unsuited for education given in an
ordinary elementary school. Special classes are now being formed
for these children in several centres or special provision is being made
for their accommodation in the existing schools for the blind and deaf.

Mentally defective children are provided for in both Day and Resi-
dential schools. The Act regulating the establishment of such schools
is, however, at present a permissive Act only and although action has
been taken under it by most of the larger towns there remains a large
number of children in the country for whom special provision is not at
present available. 52 Local Education Authorities have established
schools under the Act and 106 other Authorities contribute towards
the maintenance of their defective children in the schools provided by
the above-mentioned Authorities or in schools established by private
enterprise. There are in all 8 residential schools providing accommoda-
tion for approximately 600 children and there is further accommodation
for approximately 12,800 children in the 169 day schools.

The important group of children known as the dull and backward
is now receiving special attention as the result of medical inspection.
Children of this group, whether the cause of their retardation be in
heredity or associated with poor physical development, respond to
special training and to a curriculum adapted to their needs. Special
classes for such children have been started in a few towns and more-
over they form a considerable percentage of the children in attendance
at the open-air Recovery Schools.

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 387

Special schools for crippled children have been established under
the 1899 Act in several of the larger cities. There are at present in the
country 1 1 residential schools and 56 day schools, providing accommoda-
tion for approximately 800 and 4,400 children respectively. The fact
that so many of the children owe their condition to tuberculous disease
and the clearer appreciation accordingly of their requirements, is lead-
ing to a modification of this type of school, which it is now recognized
must take on, so far as possible, the form of the open-air school.

There are at present 11 day open-air Recovery Schools for delicate
children. These comprise children of the pretubercular type, children
suffering from debility associated with malnutrition, anaemia, lym-
phatic glandular enlargement, etc.; "nervous" children, including
those suffering from milder forms of chorea; children with chronic
bronchitis, heart disease, ricketts, etc.

Sanatorium schools for children suffering from pulmonary tuber-
culosis are being established in several parts of the country and in view
of the special government grants now available for such schools their
number is likely largely to increase in the near future.* A few local
education authorities have established also Day Open-Air Schools
exclusively for children in the early stages of pulmonary tuberculosis.

There are six Residential Schools reserved for the treatment of
epileptic children. They provide accommodation for 488 children, most
of whom suffer from epilepsy in its severer forms. The provision is at
present inadequate. Experience shows that for large numbers of these
children attendance at a special residential school, followed by colony
life, is required in the interest both of themselves and of the community.

Provision of Meals. The Provision of Meals Act, authorizing the
expenditure of public money an the provision of food to necessitous
children, was passed in 1906. The general administration of the Act,
as in the case of that regulating medical inspection, is entrusted to
the Board of Education for England and Wales, acting through the
medical department. The experience gained in the working of the Act
has shown the need for associating the administration of the Act as
closely as possible with the school medical service. An endeavour
is being made to bring the school medical officer into intimate relation
with the selection of the children, the dietary provided and the prepara-
tion and serving of the food.f

*A grant not exceeding £90 per bed or three-fifths of the cost, whichever is the
less, is payable towards the erection of sanatoria for children and a grant not exceeding
50% of the cost per child towards maintenance.

fThe total number of meals provided in 191 1 (the returns for 1912 being not yet com-
plete) was 16,100,000 at a cost of upwards of £157,000. Of this sum £151,000 was pro-
vided by Local Education Authorities and the remainder by voluntary and other means.

388 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Physical Exercises. The administration of this branch of educational
work is being steadily brought into closer connection with the school
medical service. The official syllabus of physical exercises now in use
throughout the country has been drawn up by the medical department
of the Board of Education for England and Wales which possesses a
staff of experts for purposes of inspection in schools and colleges of all
grades.

School Baths and Bathing. This branch of the School Medical Ser-
vice has not developed to such an extent as in several other countries.
Excellent use is, however, made of existing public baths in many towns
but the use of these baths is connected more particularly with the teach-
ing of the art of swimming and their use is in considerable measure
restricted to older children. It seems likely, however, that in the near
future there will be a fuller recognition of the physical and educational
value of school bathing.

In addition to the various towns in which use is made of the existing
public swimming baths, special spray bath installations have been
placed in schools by 20 local education authorities. Such baths form
also a feature of the open-air schools in the country and special provi-
sion is made for bathing children in most of the schools for mentally
and physically defective children.

School Buildings. The advent of the school medical service is
having a considerable influence on the hygiene of the school building.
The increased attention which has been drawn in particular to the need
for adequate ventilation has led to a reconsideration of the planning of
schools. The accepted type until recently has been the central hall
with class rooms leading out of it. This had avdantages from the point
of view of compactness and also in the case of a school heated and venti-
lated by some form of mechanical means. But such an arrangement
does not permit of adequate thorough ventilation of the class room and
moreover from the point of view of the use of the central hall for physical
exercises or for combined lessons such as singing, or for the purposes
of play and organized games the central hall is by no means as conve-
nient as a hall detached from the class rooms. Accordingly the type
of school building tends increasingly to the pavilion plan, the class room
opening on to a fresh-air corridor or on to a verandah. There is no
doubt but that the open-air school is reacting in many directions upon
the ordinary Elementary School and the buildings are tending to become
less formal and elaborate in structure.

Control of Infectious Disease. The School Medical Service is
furnishing a more precise weapon for dealing with the complex ques-

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 389

tions arising out of the administration of infectious disease than has
existed heretofore. Powers have, it is true, existed under the PubHc
Health Acts, but the School Medical Service has provided further oppor-
tunity for dealing more directly with the individual child whether
in the school or in the home. Accordingly earlier and more precise
knowledge is coming to hand, any steps required can be taken with more
prompitude and a fuller understanding of the part played by the School
in the spread of infectious disease is resulting. The utility of the service
is shown particularly in the case of measles, a disease for which apparently
so little can be done to lessen the incidence, but for which much can be
done through the agency of the school nurse and health visitor, by
calling at the homes of the children, to encourage the parents to seek
medical advice where necessary and to take ordinary hygienic pre-
cautions. Active measures of this kind are being taken now by many
school medical officers and there is every prospect that the mortality
and also the malign after-effects of measles will become materially
reduced.

Medical Inspection of Secondary Schools. The Act of 1907 made
medical inspection obligatory in primary or elementary schools only.
Nevertheless a considerable number of Authorities responsible for the
provision of secondary schools have made arrangements for the medical
inspection of the scholars. In some instances all the children, unless
any objection is raised by the parent, are examined on admission, those
with defects being subsequently followed up. In others, scholars are
examined who are presented by the head teacher as suffering from some
apparent defect.

The Teaching of Hygiene to Teachers and Scholars. Special sylla-
buses of instruction in Hygiene, Temperance and Infant Care have been
issued by the Board of Education for England and Wales and in 1908-9
Hygiene was introduced for the first time into the list of subjects which
students in Training Colleges are required to take for the final examination.

In 1910 the Board issued a Memorandum on the teaching of Infant
Care and Management for use in public elementary schools, and a number
of local education authorities are making a special feature of this branch
of hygiene training.

Employment of School Children. The compulsory medical examina-
tion of all children in the country shortly before the date upon which
they are expected to leave school links up very closely the work of the
school medical service' with the problems of juvenile employment.
Many school medical officers are now paying special attention to this
problem in its different aspects. Thus in some areas employed school

390 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

children are kept under supervision by the school medical officer, in
others the certifying factory surgeon is working in association with the
school medical officer and the findings of the latter are available for the
use of the former. Many school medical officers deal in their reports
with the extent to which children work out of school hours and with
the effects of such work on the physical and mental condition.*

Schools for Mothers. The establishment of the school medical
service has shown the need for further medical observation and care
of children below the age of compulsory school attendance which in
England and Wales is fixed at five years of age. The provision of
schools for mothers is at present in its infancy and their establishment
is beset with numerous practical difficulties. At the present time
there are approximately lOO properly organised schools of this kind
which include arrangements for infant consultations, home visiting and
educational classes towards the expenses of which the Board are in a
position to pay grant. In addition in a number of areas the nucleus
of such arrangements exists.

A large number of children are brought under observation in the
Babies' Department of the Infants' Schools, attendance in the Babies
class being optional between the ages of three and five. Comparatively
few children attend these classes at the age of three, but in the more
industrial centers about one-half of the children between the ages of
four and five attend. On the other hand much is being done in many
towns by infant care organisation under the medical officer of health,
to aid and guide parents during the first few months or year of the
infant's life. What is needed is some method of effectually bridging
the gap between infancy and the age of four and five. This matter is
now receiving careful attention and is likely to find solution along ex-
isting lines by extending the period of infant care as at present carried
out by Health Visitors under the Medical Officer of Health, by
developing the schools for mothers and by the establishment, more
particularly in the industrial centers, of suitable Nursery Schools.

Relation to Educational Methods. The establishment of the school
medical service is already exercising a considerable influence on educa-
tional methods and practice. It has emphasized the need, so far as prac-
ticable, of suiting the curriculum to the child, and the process of differ-
entiation begun by the Blind and Deaf Children Act of 1893 and the
Defective and Epileptic Children Act of 1899 is being carried still fur-
ther. The establishment of the open-air school of Recovery for deli-

The Acts specially affecting juvenile employment are the Factory Acts, the
Employment of Children Act, 1903, the Labor Exchanges Act, 1909, and the Education
(Choice of Employment) Act, 1910.

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 39 1

cate children, of classes for the dull and backward, for the partially
blind and the hard of hearing, for stammering children and children
with defective speech are evidences of the recognition of the needs of
certain well-defined groups of children. But further than this it is
becoming recognized that much that is faulty in current educational
method and practice is due to a lack of appreciation of the physiological
processes involved in the child's physical and mental development.
There is here an almost unlimited field for research, and for reform well
considered and wisely applied based on the results of such research.
A broad foundation is now laid, school medical officers in every part
of the country are becoming acquainted at first hand with the facts
bearing on the position. Special attention has necessarily and rightly
been concentrated on the problems of the physical condition and hygiene
of the child and its surroundings. All the time however the School
Doctor is becoming trained in the more subtle and the more purely
educational problems, and there can be but little doubt that the School
Medical Service, already bearing fruit in this direction, will in an im-
portant degree influence and modify existing educational practice.

Cost of the School Medical Service. The cost of the School Medical
Service has, up to approximately the last two years, been borne entirely
by the Local Education Authority for the County, Borough or Urban
District as the case may be. For the year ended 31st July, 191 2, a grant
was paid by the Board of Education for England and Wales out of
Imperial funds to Local Education Authorities in aid of expenditure
incurred upon following up and medical treatment. This grant has
now been further increased and for the year ended 31st July, 1913, agrant
will be paid by the Board to all local education authorities, amounting
approximately to one-half of the cost incurred in both medical inspec-
tion and medical treatment. In the case of some of the Special Schools
an additional grant in aid of treatment has recently been made by the
Board, and at the present time approximately one-half of the cost of
educating a child in a Day Open-air School and approximately one-
third of the cost of maintaining a child in a Residential Open-air School
is borne by the Imperial exchequer.

The foregoing sketch of the present position of the School Medical
Service in this country will show that an endeavour has been made to
lay broad the foundations. It has become evident that around the
child, from infancy upwards, must revolve the machinery for the admin-
istration of public health. With the adaptation of the conditions
of life and the environment generally to the healthful upbringing of the
child will be solved simultaneously many of the present-day problems
affecting the adult.

392 fourth international congress on school hygiene

Discussion of
R. H. Crowley's Paper

Herbert F. True, M. D.

Mr. Chairman: — By the way of comparison and since there has been
expressed a desire to learn of the methods used in Los Angeles City,
and as Professor Leslie, who is down for a paper at this session is not
here, I take this opportunity under the discussion of this most inte-
resting paper by Dr. Crowley, to briefly outline the methods followed
in our western city.

Under the California law, local boards of education may employ
persons who hold a certificate from the state board of education to do
health and development work; and the state board grants such certifi-
cates only to educators holding a California life diploma or to physicians
holding a California certificate to practice, and only to such persons
when additional evidence as to their particular fitness for this class of
work is produced. In the city of Los Angeles, the Board of Education
has employed ten such certified examiners — nine physicians and one
educator. In addition they have also employed one dentist and nine
nurses.

Our plan of work is as follows: Each physician has a given district
and one of the nurses assigned to him. Preliminary notices are sent
to the home notifying the parents of the date of the examination so that
that they may be present if they so desire. When the parent is not
present the nurse or a teacher is always present during the examination.
Some parents desire their children excused from our examination on
account of religious belief or preferring that their own physician do the
examining ; blanks are provided for these which they sign and file with the
principal at any date prior to the examination. The examination itself
is essentially the same as elsewhere ; record cards are kept, and notices
sent to the parents of any unusual condition that might require atten-
tion. It then becomes the nurse's duty to see how much of this atten-
tion is given and to record the same. A second notice may be sent
out by the nurse or she may make a visit. to the home, where she explains
the condition to the parents and requests that the family practitioner
be consulted and his decision be followed. Special attention is given
the cases in families unable to pay the ordinary fees. If the parents
are unable to employ a medical practitioner, purchase glasses, etc.,
and wish the work done or glasses supplied by our clinic, which is sup-
ported by the Board of Education and voluntary subscriptions and is

PRESENT POSITION OF SCHOOL HYGIENE MOVEMENT IN ENGLAND 393

under the control and management of the City Parent-Teachers* Asso-
ciation, then such parents must sign a request for such work and the
principal must certify to their inability to pay the fees. The work at
the clinic is carried out by paid dentists, volunteer physicians and the
nurses of our department. The sum total of the work done by the
family physicians and the clinic bring a large percentage of results,
and the results are what we are working for.

The schools of Los Angeles are of the highest standard in the United
States, and Superintendent J. H. Francis was one of the first to put into
operation the intermediate schools. In these schools, as in the high
schools, gymnastics are given especial attention; so in the intermediate
and high schools the examiner, assisted by the gymnasium instructors
takes many physical measurements and prescribes special forms of
corrective work for selected cases. In addition, Los Angeles is one of
the few cities having a clinical-psychologist. Professor George L. Leslie,
who was to have read the paper this morning, holds this office. Thus
it may be seen that we have ample provision for the examination into
the physical and mental condition of the children, and means for associ-
ating the two ; and for providing the proper amount of work for the supra-
normal, the normal and the sub-normal child; and for improving the
condition of the physically and mentally sub-normal child whenever
possible.

394 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

STATE PROGRAM OF EDUCATION IN HYGIENE IN

NEW JERSEY

George A. Mirick

In presenting this condensed statement of the State plan for educa-
tion in hygiene, I wish to say that I am not speaking for myself but am
representing the State Board of Education, whose chairman. Dr. William
G. Schauffler, is a positive force in promoting hygiene education in the
State, and the Commissioner of Education, Dr. C. N. Kendall, whose
assistant it is my privilege to be. Two other members of the Board
of Education have rendered signal service to the State in the field of
school hygiene. To John P. Murray, Esq., is due the law for the school
segregation of mental defectives, a law which in a practical, positive way
is effecting the betterment of mental school conditions. To Mr. Melvin
A. Rice is due the demonstration of the practicability of a free oral
clinic for all children in a semi-rural school district.

The need of a plan of education in hygiene that would comprehend
all the adult population of the State and not simply the school children
has been made evident in several ways.

1st. The efforts of the State Board of Education and of the Com-
missioner to improve the sanitary conditions of school life met and are
still meeting with popular indifference in many quarters.

2nd. The school medical inspection in the State as a whole is very
unsatisfactory. In cities, like Newark, Jersey City and Camden, the
Department of Medical Inspection is a model of efficiency. In some
smaller places also, like Leonardo, fine dental care is given; and in
Cranford the attendance supervision has been socialized, but it cannot
as yet be said that the law requiring medical inspection in every school
in the State has universal approval, or is generally effective in its work-
ing. The people are too generally uninformed and too many physicians
accept the pay for school inspections without accepting the professional
responsibilities that should go with it.

3rd. The Department of Public Instruction is now at work on a
pamphlet on the Teaching of Hygiene for the elementary schools.

The plan covers the entire field of hygiene — personal and community ;
physical and mental; preservation of health and prevention of disease
and disability — and involves not only the giving of information but
the formation of habits of conduct, including social conduct, in the hope
that life itself may be bettered.

STATE PROGRAM OF EDUCATION IN HYGIENE IN NEW JERSEY 395

Public Opinion and conviction are factors that cannot be ignored
in dealing with this subject in school, and at present, in many places
where the hygiene need is greatest, public opinion and conviction are
at variance with the teachings and practices that will be proposed for
the schools.

4th. It appears also that there is a growing conviction that the time
has come for the State Department of Education to assume responsi-
bility for the systematic education of those not connected with schools,
who cannot therefore be reached directly through the schools. The
theory that the conduct of adults cannot be affected by education is not
sound and should not blind us to our educational duty and opportunity.

What this view of the larger educational responsibility of the State
Department of Education may in the future develop is not now evident
but it seems to be clear that, to accomplish the desired purposes of edu-
cation in hygiene in the schools, there must be a systematic dissemina-
tion of information regarding health matters and a systematic develop-
ment of public conviction and approval of hygiene practices.

These are the reasons for the formulation of a plan of education
in matters pertaining to health that shall reach not only the most remote
school but also every community consciousness no matter how remotely
located.

The question at once arises, "What agencies are available for carry-
ing out any such State program of education?"

The following table will indicate these agencies. They are sur-
prisingly numerous and powerful in their possible influence.

Tabulated Statement of the Agencies and Means Available in the State for Purposes of

Education in Hygiene

*State Organization for the Control and Promotion of Public Education.

State Board of Education — Department of Public Instruction:
Commissioner of Education
, Assistant Commissioners of Education
State Inspector of School Buildings
County Superintendents
State Normal Schools
State Summer Schools
*Extension Normal School Courses

State School Agencies:

State Home for Boys (delinquents) Under Special Board
State Home for Girls (delinquents) Under Special Board
State School for the Deaf (Under State Board of Education)
State Industrial School for Colored Boys and Girls (Under State Board of
Education)
Note — *These items are contemplated or are in process of making.

396 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

County School Agencies:

County Schools of Detention

Local School Agencies:

Boards of Education

City Superintendents

School Supervisors

Teachers

School Medical Inspectors and Nurses

Teachers of Mentally Defective Children

Agencies in the State Interested in the Promotion of Health:

State Board of Health

State Lecturer on Hygiene

State Lecturer on Tuberculosis

State Medical Society

State Sanitary Association

State Dental Association

State Board of Architects

Commissioner of Charities and Corrections

State Granges

New Jersey Congress of Mothers

Woman's Christian Temperance Union

New Jersey State Federation of Women's Clubs

New Jersey Sons of Temperance

Local Boards of Health

Local Playground Associations

Local Civic Organizations

State Agricultural Experiment Station

Princeton University — Department of Hygiene

State Hospitals for the Insane

State Sanatorium for Tuberculosis Diseases

State Home for Epileptics

Training School at Vineland (Feeble- Minded Children)

United Junior Order of American Mechanics

Patriotic Order Sons of America

State Agencies That Should Be Created to Direct Educational Effort
in Hygiene:

*State Director of Medical Inspection and Educational Hygiene
*State Director of School Attendance

Means for Education in Hygiene in the Public Schools :

*State Courses of Study in Hygiene
*Special State Bulletins on Hygiene
Newspaper and Magazine Articles
*Traveling Educational Exhibits

Note — *These items are contemplated or are in process of making.

STATE PROGRAM OF EDUCATION IN HYGIENE IN NEW JERSEY 397

Before discussing the plans, still tentative, for utilizing these various
agencies and means in a systematic way for general education in hy-
giene, it may not be out of place to refer briefly to three laws that have
recently been put in force in the State:

I. Medical Inspection is required in every school in the State,
and its regulation is in the control of the State Board of Education.

II. Children mentally unfit are by law required to be removed
from the regular school and placed in classes of not more than fifteen
pupils in charge of a teacher specially trained for work with these children.
Under this law about 150 classes of this character have been formed,
affecting from 1,500 to 2,000 children. The reports fbr last year are
not yet compiled and these figures are conservatively estimated.

III. No school house can be built or repaired in the State except
on approval of the State Department and in conformity with a State
Building Code. Modifications in existing buildings must be made to
bring them to the standard of this Code.

The State, it will thus be seen, has already adopted in its legislation
a liberal and enlightened policy in regard to the physical and mental
well-being of the school children. I have not the time here, nor is this
the place, to discuss the health policy of the State in other fields,

The definite problems of the Department of Education are to make
effective those laws relating to hygiene that are already in its hands
to administer, and to recommend such other legislation as may appear
necessary. Perhaps the most important phase of the general problem
relates to the medical inspection of schools. "How shall it be made
worth while in every school district in the State?"

I believe the suggestion of Dr. Joseph E. Raycroft, head of the De-
partment of Hygiene, Princeton University, will lead in the right direcr
tion. He proposes that the various medical and hygiene State asso-
ciations, the health departments of the two universities in the State,
the State Board of Health and the Department of Public Education
arrange a program of conferences with the school medical inspectors.
For these conferences the State is to be divided into medical inspection
districts. The conferences should result in the extension of better
medical inspection practices, a more sensitive professional conscience
in some of the inspectors, the general recognition of this as a legitimate
specialized department of medical practice. These conferences may
also have some value in forcing upon medical colleges the realization
of the duty of giving some attention to this specialized form of medical
practice which all now practically ignore, as revealed by correspondence

Ke leading medical schools of this country.

398 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

This problem of school medical inspection is peculiarly one for the
medical and health organizations to work out. It may be said that
the State Medical Society has a committee of ten working upon this
problem.

The problems of personal, school and community hygiene, and the
development of means for the special treatment of the physical defects
of school children are problems that can be solved only by sound educa-
tion in hygiene through the schools, an education that, both in its con-
tent and in its method, shall have the endorsement of the various branches
of the medical and sanitary professions and also be supported and
reinforced by an approving public sentiment.

To secure the support of the former it is proposed to submit to them
the manuscript of the Course of Study in Hygiene for criticism and
suggestions. They have shown themselves more than willing to co-
operate in this.

To secure the approval of public sentiment it is proposed to follow
the plan mentioned before, of dividing the State into districts, possibly
using the same districts that are used for the medical inspection con-
ferences. The various women's organizations and other civic associa-
tions will be affiliated with the Department of Education in some system-
atic way, so that through them in each district an enlightened, civic,
hygienic conscience may be created. It is hoped by this plan to have
in each school district a movement from within in support of desirable
health practices.

It is evident that to carry out this State plan of education in hygiene
there should be a "State Director of Medical Inspection and Educa-
tion in Hygiene," whose duties would include the direction of the activ-
ities of the various civic forces referred to, as well as the direction of
health education and training in the schools, and of medical inspection.
Dr. Louis W. Rapeer, the well-known authority in this field, would
name the one holding this position a "physician-physical-educator."
It is agreed that such a position requires one who has had training and
experience as a physician and as a teacher, who also is competent in the
field of sanitation, physical training and mental hygiene. It is prob-
able that the legislature will be asked to create this position.

There is also needed a better training opportunity for teachers.
This the State should give free. In addition to the excellent work of
the Normal Schools, and of the new State Summer Schools, extension
courses should be offered during the year. It may be said that Rut-
gers College is seriously considering plans for such courses.

Moreover, the truant officer should be replaced by an attendance
officer. Habitual unnecessary absence from school is a sign of social
maladjustment. The difficulty is one in mental and social hygiene.

STATE PROGRAM OF EDUCATION IN HYGIENE IN NEW JERSEY 399

It should be so treated. It is being so treated in an increasing number
of places, but there should be an immediate reorganization in New Jer-
sey of the entire attendance business from the social viewpoint. There
appears, however, to be no prospect that this reorganization will be made
immediately.

In brief, the State Plan for Education in Hygiene consists in:

I. Increasing the efficiency of the education through the schools
by the adoption of State Courses of Study and by the opening of addi-
tional opportunities for the training of teachers.

II. Increasing the efficiency of medical inspection by the appoint-
ment of a State Director of Medical Inspection and Education in Hy-
giene and by district conferences, in which medical and sanitary asso-
ciations and boards of health will come together.

III. A union of all civic forces with the State Board of Health
and the State Department of Education, for the promotion of intelli-
gence and conviction in matters pertaining to health in every com-
munity in the State.

400 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

HYGIENIC CONDITIONS AMONG THE NATIVE SCHOOL
CHILDREN OF ALASKA

William Hamilton

Alaska is a continent. Its southern coast is washed by the mild
waters of the North Pacific Ocean, ice-free the year round; its barren
northern shores touch the eternally frozen Polar Sea ; its eastern boundry
faces the Dominion of Canada; its western-most extremity is within
sight of Russia's remotest hinterland. Within its vast area there are con-
tinental varieties of climate and conditions. In July while the dwellers on
the shores of the Arctic Ocean watch the whales spouting among the ice
floes, in the gardens of Sitka the humming birds flit from flower to
flower. During the summer the great rivers of Alaska are flowing
highways for white men and natives, its forests are vocal with the song
of birds, its plains are carpeted with flowers, and among its mountains
is the sound of falling water. Throughout the long winter months Alaska,
with the exception of its southern coast, is a mute land, locked in ice-
bound silence. Those compelled to travel follow the snow-covered
trails and frozen rivers.

In this unique land there are, approximately, 25,000 natives, belong-
ing to 4 distinct races — the Eskimos on the shores of the Arctic Ocean
and Bering Sea; the Aleuts on the Aleutian Islands, and on the adjacent
peninsula the Athabascans in the valleys of the interior, and the Thlin-
gets along the southern coast. The native villages, ranging from 30
or 40 up to 300 or 400 persons, are scattered, usually at long intervals,
along thousands of miles of coast line and on the great rivers. Some
of the villages on remote islands or on the frozen ocean are brought
into touch with the outside world only once or twice a year when visited
by the revenue cutter on its annual cruise, or by the supply vessel sent
by the Bureau of Education.

In spite of the inherent difflculties of the problem, a United States
Public School has been established in each of 76 villages; every school
is a center from which proceed earnest efforts for the uplift of the
native races, intellectually, morally, and physically.

The efforts of the Bureau of Education to safeguard the health of
the Alaskan natives include (i) the maintenance of 4 small hospitals
in important centers of native population, (2) contracts with 3 hospitals
for the treatment of diseased natives, (3) the employment of traveling
physicians who devote their entire time to the medical and sanitary

HYGIENIC CONDITIONS NATIVE SCHOOL CHILDREN OF ALASKA 4OI

work among the' natives in their districts, (4) the employment of nurses
who assist the physicians and do exceedingly valuable work for the
children in the school rooms, and (5) the providing of medical supplies
and textbooks to the teachers of the schools throughout Alaska to enable
them to treat minor ailments, and intelligently to supervise hygienic
measures. The entire medical and sanitary work of the Bureau of
Education in Alaska is under the immediate supervision of an officer
of the Public Health Service, on special detail. During the fiscal year
ended June 30, 1913, the working force of the Bureau of Education in
Alaska, including superintendents, physicians, nurses, and teachers,
numbered 132, a force inadequate to accomplish the Augean task of
cleaning up Alaska.

The Bureau of Education recognizes the vital importance of check-
ing the diseases which prevail among the natives of Alaska to an alarm-
ing extent, and which are largely due to the unhygienic conditions pre-
vailing in many of the native villages. Accordingly, without neglect-
ing the scholastic work in the school rooms, special emphasis is given
to medical and sanitary work in the villages and to hygienic work among
the children.

In the native villages the teachers and nurses endeavor to establish
proper sanitary conditions by inspecting the houses, by insisting upon
the proper disposal of garbage, and by giving instruction in sanitary
methods of living. Natives are encouraged to replace their filthy huts
by neat, well-ventilated houses. Many of the school buildings contain
bath tubs and facilities for the proper washing of clothing. In many
schools sputum cups and individual drinking cups and towels are pro-
vided. The bathing and laundry facilities furnished are usually greatly
appreciated. The teacher at Sitka thus describes this part of the
work:

"On the first floor of our building we have a laundry which was used
three days during the week, many women bringing their tubs and wash-
boards to make use of the hot water. I consider this our best settle-
ment wedge, for thus the mothers become co-workers with the children.
I secured the services of an experienced laundress to give us instruction
in starching and ironing the different kinds of garments. The class
was popular, so much so that some of the white ladies suggested that
they might come too. The baths have grown in popularity ever since
their opening last year. The young men of my evening class were the first
to try it frequently, but a few times we had a whole household come.
Conservative, older women were slow to adopt the plan, but now we have
a number who come regularly. It is now quite the fashion when guests
arrive from another town to bring them to the school house for a bath.
Thursdays are bathing days for the men, Friday for the women and small

402 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

children, Saturday mornings for the school girls, Saturday afternoons
for the school boys."

In some of the native villages the results of the efforts of the teachers
and missionaries are evident in the orderly streets and well-built houses
containing all the necessary articles of furniture, pictures, and books.
The natives in places such as these are self-respecting, thrifty people,
and their children are as clean as those in the average village in the
States.

In other settlements not reached by civilizing influences the con-
ditions are such as to appall the most enthusiastic social worker. The
houses are wretched hovels constructed of driftwood, crowded together
on an ill-smelling beach covered with garbage of all kinds, including
discarded articles of clothing, old tin cans, and putrefying offal pol-
luting the air with its horrible odors. In such a village the houses
contain but a single room, very dirty and without ventilation, into which
men, women, and children are herded, a stove and a bed being the only
articles of furniture. The bed is usually used as a "catch-all" for a
great assortment of articles, the natives preferring to sit, eat, and
sleep on the floor.

The establishing of a United States Public School in such a village
and the advent of a teacher mark the inauguration of a crusade against
filth and conditions which foster disease. The methods used in order
to establish hygienic conditions among the school children coming from
homes such as those just described can best be told in the words of one
of the enthusiastic workers :

"The clinic work of the school usually commenced with a talk on
parasites and the necessity for cleanliness, and this was followed by an
inspection of the entire class. Two and sometimes three of the older
pupils were selected as assistants. The boys were taken to the clinic
room, and after I had clipped each boy's hair my assistants gave him
a shampoo with antiseptic soap, dressed his hair with a fine comb and
anointed it with coal oil. Talks upon hygiene were given each day
and the worst cases used as illustrations. After the talk, my assistants
examined the heads of all the children and when necessary gave the above-
described treatment. The assistants soon learned to do their work
quickly and well and seemed much interested in it.

"My principal rules were: Keep clean. Wash your face. Wash
your hands. Wash your neck. Wash your ears. Wash your teeth
every day. Bathe your whole body with soap and warm water at least
once a week. After these rules were well understood any child who
came to school with a dirty face was brought before the class for con-
sideration. The usual verdict was 'Scrub 'em good with soap and warm
water.' After the assistants were through with him, the subject was

HYGIENIC CONDITIONS NATIVE SCHOOL CHILDREN OF ALASKA 4O3

usually a shining example of cleanliness. It was most encouraging to
see the results of a little teaching, for after four or five weeks it was a
rare occurrence to have a child come to school with dirty hands or face.
They soon developed pride in their personal appearance and would
strive to have their few torn clothes at least clean.

"The crusade was extended to the homes, and the father or older
brother sometimes brought to the schoolhouse and clipped. With the
mothers it was a different proposition, for they would not allow anyone
to look at their hair, but kept it well covered with a cap or handkerchief,
saying that they would comb their own hair.

"It takes time to change their old customs for new ones, and I can-
not say that the root of this evil has been destroyed, but much has been
accomplished, for the school children have learned that it is indecent
to be filthy."

Especially do the native mothers require instruction in the care of
infants. The teacher of the school at Wainwright, among the Eskimos
dwelling beside the frozen ocean, far beyond Bering Strait, thus tells
how he made one baby an object lesson to the entire village:

"A baby suffering from some form of skin disease proved a useful
object lesson. The baby came from a dirty home of the old type, and
its mother was of the old regime that knew not the virtues of soap and
water. It is difficult to imagine a rnore distressing object than that
baby was when its mother brought it to me for treatment. Its arms,
legs, and body were covered with immense scabs, and when the mother
removed its little fur bonnet, its head was seen to be in a similar condition.
It was given a thorough bath in warm water and hydrogen peroxide.
The mother thought the hydrogen peroxide was 'plenty strong medi-
cine' when she saw the white fuzz spout up wherever it touched the
t child's body. We impressed very strongly upon the mother that the
H filthy rags that clothed the baby must not be put on again. As the
mother could not provide suitable clothing, my wife made some under-
Ji clothes and a bonnet, while the baby's older sister made the dress for it
l^p in the sewing period in the school. This baby was inspected thoroughly
r and washed every day, and we saw to it that the clothes were kept
1 ^ clean. After repeated applications of hydrogen peroxide, blue ointment,
IB and soap and water, the baby became well. Whereas formerly she had
" been a sickly, crying baby, to-day the child is well, strong, and happy,
and, above all, clean. That the mother was sufficiently impressed
with the importance of cleanliness was shown in the fact that her only
subsequent request was for soap to keep the baby and its clothes clean,
so it would be 'no sick.' This case made quite a stir in the village,
and mothers kept the babies much cleaner than they had done before.

404 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The children would come to me with cuts and ask for the 'clean medi-
cine.' "

It is by radical, effective measures such as those described that the
self-denying force of workers in the native villages throughout Alaska
is striving to build up a healthy race of young Alaskans.

Tuberculosis, syphilis, and diseases of the eye are rife among the
natives of Alaska. According to the investigations of the Public Health
Service, 15 per cent, of the native population is infected with tubercu-
losis. If the native races of Alaska are to survive, the children must
be saved.

RURAL SCHOOL HYGIENE IN MICHIGAN 405

RURAL SCHOOL HYGIENE IN MICHIGAN

Burton S. Tefft

It is said that in one of the campaigns of the Revolutionary war
an important victory for the Americans was gained by a clever strategem
on the part of the general in command. A half-witted Tory boy who
had been taken prisoner was promised his freedom, if he would go into
the enemy's camp and declare that a very large body of American sol-
diers was close at hand. He did this and more, for he cut holes in his
clothes to represent bullet holes and pointed upward to the leaves on
the trees, when asked the number of men. The British fled in confusion,
I am not here as the main body of the American Rural Schools with
its 17,000,000 soldiers, but to point upward to the leaves on the trees.

I am not a pessimist, but, on the contrary, I have the profoundest
faith in mankind and their desire to do the best and to provide the best
for those depending upon them. These depend upon knowledge, judg-
ment and ability. I shall give my experiences and observations only.
My interest and my effort are for the rural schools. I was born and
raised in a rural community, all of my preliminary education was acquired
in a one-room country school; I taught in this kind of schools and in
village schools, and my work as commissioner and superintendent has
been among this class of schools only. I have had every opportunity
to become familiar with rural school conditions and needs, and if I do
not know them it is very largely my own fault. I shall give some spe-
cific cases that have come under my observation as types of conditions
to be found in not a few communities in my own county and state,
as well as in other counties and states. These are bona fide cases, not
imaginary ones.

My home is in a city having schools that rank second to none in the
state; and I say this with pride, not with boasting. In one portion
of the city is a splendid Manual Training School, equipped for the best
service and highest efficiency. The teachers in this school, as well as
the teachers in the high school and grade schools, are the best a splen-
didly trained superintendent can procure. Nearly all the school build-
ings are modern and constructed on the most recent scientific plans.
Heating, lighting, ventilating, interior decoration, blackboards, etc.,
are well nigh perfect. Many rooms have adjustable single seats and
desks. Windows are provided with proper shades. There are drink-
ing fountains or individual drinking cups and filtration plants to insure

406 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

pure drinking water. Warm breakfasts and noon lunches in some parts
of the city for needy pupils. Well kept and closely observed toilet
rooms and lavatories. Sanitary towels or well laundered ones, etc.,
etc., through the long list of needed and convenient apparatus and ap-
pendages, besides school gardens and recreation grounds, splendidly
supervised.

Another portion of the city has in course of construction and nearly
completed a magnificent Trade School and has all the other accessories
just named, excepting the recreation grounds with their supervised
games. But roomy, well kept parks containing swings, slides, teeters,
etc., are available to the children of that district. In fact, almost
everything that the human mind can conceive, and the human hand
can make and money can buy is placed at the command of the proper
school authorities to be used in the education of the children of these
districts.

I contend the greatest problem which the American people have to
solve in the school system of our country is not the city school problem,
but the question of the rural and small village school, the question of
properly educating the rural child, academically, vocationally, socially
and religiously. The fact that many children of rural communities
achieve success in the world is not because of the little "red school,"
but in spite of it ; and by the training in industry, economy and responsi-
bility which their environment gave to them.

In one rural school in which I taught there were four brothers attend-
ing. Their ages at that time were six, eight, ten and twelve years
respectively, or thereabout. They brought their dinners, or lunches,
in one basket. But the older brothers made complaint that the younger
ones ate all the food before the noon hour and left them with nothing
to eat, when the proper time came for eating. I sent word to the mother,
a stepmother, to put the boys' dinners into separate baskets, thinking
it would prevent them from eating one another's lunches and getting
into trouble over their noon meal. The mother did as I suggested,
but the complaints did not cease coming in from the larger brothers
and from other pupils, too. I investigated further and I found that
each boy had in his pail for his dinner; dinner for a hungry, growing,
poorly clothed boy, one single biscuit, a cross between poor bread and
hardtack. This was divided into two pieces and had some meat grease
or some meat between the pieces, and that was all they did have. Do
you wonder that other pupils missed food from their lunch baskets?

A teacher made this report to me: She had a pupil, a boy ten or
twelve years of age, who went home from school at noon for his dinners.
On several occasions he failed to appear in the afternoon sessions of the
school. The teacher told him he must not stay out of school in that way

RURAL SCHOOL HYGIENE IN MICHIGAN

407

or she would be compelled to refuse him the privilege of going home at
noon. He promised to do better, but almost the very next day he was
absent from school in the afternoon. The following morning he appeared
with no dinner and was allowed to go home only after he had agreed to
come back as soon as he had eaten his dinner. The afternoon came,
but no boy appeared according to the terms of the agreement. Can
you imagine the thoughts that invaded the mind of that teacher at
this stage of the game? The next morning the boy was at school again
as usual, and you may be assured that the teacher met him when he came
in, too. She reminded him of his promise and demanded of him the
reason he had for not living up to his part of the agreement, and the
demand had some force behind it I want to say to you. The answer
came; for the boy, half ashamed, half frightened and half sobbing con-
fessed, "I didn't have no dinner, teacher, and so I couldn't come," and
the worst part of the answer was he told the truth.

I have had several cases in schools where I taught, and several cases
reported to me by my teachers, of pupils coming to school actually
filthy, and repulsive from this cause. Cases of children having com-
paratively good clothing and shoes on entering school in the fall, but
who apparently did not change clothes till they were completely worn
out and unwearable, and who showed no evidence of any kind of having
had a bath from summer to summer. I recall the story of two boys
who went on an outing to a lake, given by the philanthropic people
of the city to children unable to take an outing by any other means.
The boys hurried down to the lake and made preparation to take a plunge
at once. When they began to divest themselves of their scanty cloth-
ing, one of the boys eyed his companion quite closely and exclaimed,
"Gee, Jim, but you are awful dirty." His chum replied, "Yes, I know,
but you see, last year I missed the train."

I visited one of the schools of my county several years ago and found
this condition: On observing the personal appearance of pupils I
noticed that nearly every pupil, if not every one, was sitting with eyes
somewhat closed and squinting. I noticed, also that many seemed to
have some trouble with their eyes. They were wiping them frequently
and their eyes looked inflamed and bad. I went into the rear of the room
and sat down, wondering what could cause such a generally bad condi-
tion of the pupils' eyes. I think the causes were evident; for the pupils
sat facing two large, unshaded windows and were compelled to look
in that direction most of the day during school hours. The black-
boards were fully three feet from the floor and had a poor but reflecting
surface. The windows where on the right-hand side and in the front
of the room. The walls had been a shade of pink, but. were very dark
at that time. The teacher's desk was on a platform by the two front

408 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

windows, which compelled the children to look upward when in the class
as well as to look directly into the light. I believe it was the worst
condition I have ever met in school room lighting. The heating and
ventilating were about the same. I asked the Board to change the
seating in order to change the light effect, and they did as I suggested.
There is but little eye trouble to be found in the school now. There
were other factors that contributed to the bad eye condition, no doubt,
but I am certain the elements I have just named did a large part in making
this condition.

I found in another school room that had been recently redecorated
by order of the district voters and board that the colors used were
cream color and bright red. The body of the walls and ceiling was
tinted with the cream color and the trimming was of the red. I felt
as though a thousand spears had been thrust into my eyes, when I
first entered the room. The contrast was too sharp. Of course one
would get accustomed to the colors, after being in the room for a time.
But the point I wish to make is the utter disregard of harmony and ap-
propriateness in colors, when the matter of decorating the interior of
a school room is being considered. This is a prime factor in school
room conditions, I am sure.

We still have in my county school buildings with windows on four
sides, or three sides, instead of on but one side or two at the most; and
having no provision for any kind of ventilation except doors and win-
dows. School rooms that receive a thorough cleaning but once in a
year, and some that "miss the train" occasionally. Not all are like
these, for we have some buildings which are the reverse, being modern
buildings and well kept and furnished. Practically up-to-date school
buildings in every respect. But these extreme cases are the ones first
to attest our attention. The pupils in the unfavorable districts are
entitled to as good school opportunities as any other children, if they
are to become a part of the state and nation and intelligently perform
their duty to them. It was the needs of the poor and oppressed in
Europe that contributed largely to the settlements in America and the
founding of a free government. It was the needs of the poor and un-
fortunate in America that developed our free school system ,^ and I
contend we must administer still further to the needs of our less fort-
unate children, our rural pupils and pupils of the small villages.

The curse of many schools is found in their outbuildings. Abso-
lutely unfit for use and so situated they are an actual menace to morals
and to health. Another source of danger is the disregard of the danger
of disease and the means of dissemination of diseases. The following
case was reported to me by an observing teacher: A boy "came down"
with measles in her school and was sent home. He was taken care of

RURAL SCHOOL HYGIENE IN MICHIGAN 409

according to instructions of the family physician and his woolen jacket
removed and hung away until he might need it again. When school
began in the fall, the boy entered for work and wearing the same jacket
he had worn at the time he was taken ill with measles. Have you any
doubt that any cases of measles appeared in that school again? Well,
they surely did, and within two weeks from the time the jacket entered
school in the fall. That teacher told me she had every reason to believe
the source of the new outbreak was traceable to the infected jacket,
for it never had been disinfected. I have had numerous cases of par-
ents who refused to keep children out of school when they were ill
with a communicable disease, because they did not think it necessary
to protect the health of other pupils. "Children will get the diseases
whether they are exposed or not," they said.

The most perplexing duty which the truant officer of my county
is called upon to perform is that of compelling pupils to attend school,
when they have poor shoes and poor clothing — and this duty comes
often. It is a mighty embarrassing situation for a child to attend school,
when his shoes are in shreds and his clothes are in rags. It is no less
embarrassing for the truant officer when confronted by this situation,
and told by the parents of the child that they will gladly send, if their
children can be provided with suitable shoes or clothing or both; if he
has no means at his command to provide these needs, but must enforce
the compulsory education law instead.

The district board of education may furnish the child with food
and clothing, if needed, but are not compelled to do so; which means
the district board does not do it.

Another condition with which the county commissioner and truant
officer have to contend is that of compelling attendance at all times of
the year. I called at a school one morning in the spring of the year.
On my way to the school I overtook and passed children going to school.
The snow had melted and gone, leaving lakes and rivers of water and
mud. Here and there were island, cape, isthmus and peninsula, and
upon these latter the children were endeavoring to find a route to school.
It was a good lesson in geography, but a mighty poor one in hygiene.
I reached the landing ahead of them and watched them come in. Many
of them had wet feet, in fact, nearly all of them had, and softie of them
were wet to the knees. In that condition those pupils sat in their seats
all of that day; for there was no effort made to dry them, save the act
of standing by the stove a few minutes before school "called." I
inquired of the teacher what she did in such cases. She told me there
was nothing she could do, for they came to school in that condition
almost every morning during the wet weather. There were girls ten,
eleven, twelve years of age and older; besides younger ones and boys

410 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

of every school age, walking as far as two miles to school. This is not
true everywhere nor of all children, but because these conditions do
exist in some places is why I mention this one incident.

There are other conditions to be found in my county equally as
unhygienic and equally as unnecessary, but I do not wish to make this
paper over gloomy or morose. I should like as much to speak of the
favorably hygienic conditions, of school room conditions which approach
perfection in many respects. School houses which have basement
playrooms, furnaces, warm and well ventilated rooms for wraps and
lunches ; correctly lighted and decorated study rooms with proper shades,
usable blackboards, clean ventilation, etc., for we have them. But I
will forbear speaking on this side of the question.

I wish to give some suggestions of remedies that may alleviate very
largely, if not remove entirely, the unsanitary, unhygienic and unde-
sirable conditions I have just recited. Michigan has a law, passed in
1911, which gives to district boards of education the right to supply
needy pupils with necessary clothing and food in order to enable them
to attend school as required by the compulsory education law. But
this law does not compel these boards to give aid, only confers upon
them the power to do so and leaves them free to take negative action
in every case. I do not say that this is unwise, for in many cases aid
is most needed where it is least available. I am sure that aid should
be given and that a larger taxing unit should be called upon to give
support to this class of indigent persons, say the county or state, and the
law should be mandatory.

You will pardon me, I trust, for referring to my home city once more,
but it is for the purpose of illustration and suggestion. The truant
officer of one district of the city conceived a plan of giving relief to
needy children, when out of school because of lack of clothing or shoes,
or both. He has what he terms a ''shoe fund" upon which he can draw
in needy cases. This fund is made up by contributions from individuals
and from fraternal bodies, cash and interest bearing securities, the latter
serving as an endowment. When he finds a case of need and out of
school,* he immediately provides the necessary things, giving an order
on his "shoe fund," and gets the child into school at once. The amount
of money expended annually is not large, so the officer tells me, but the
benefit is immeasurable.

There are buildings being constructed every year which have many
of the defects known to architects and to sanitary engineers; defects
which contribute to physical ailments and intellectual retardation of
the pupils who will be compelled to occupy them. I firmly believe no
building should be erected in my state, or in any state, unless the plan
of the proposed structure shall have been approved by a board of com-

RURAL SCHOOL HYGIENE IN MICHIGAN 4 II

petent engineers, to insure proper sanitary features as well as physical
safety and hygienic properties. There should be a standard of floor
space, air space, lighting area and relative position, ventilation, color
scheme, seating, and many other factors which make up a perfect setting.
I took a survey of seventy school rooms in my county during the past
year to learn more specifically of the constituents just named and was
astonished at the great variety to be found. Floor space per pupil,
varying from lo square feet to fifty-three square feet; air space, 136
cubic feet to 731 cubic feet; lighting area, 11% to. 34% of the floor area,
and coming- from all directions. Defects of vision, teeth, breathing
and vitality and mentality were everywhere found and reported. The
picture was a revelation to me. There is absolutely no uniformity in
the plans of rural school buildings, except the old style of school building.
They should be uniform and meet the standard. For the privilege of
requiring this to be done the state should pay a portion of the cost of
construction, say ten per cent, or twenty-five per cent., or more. This
plan would insure greater uniformity in school buildings, a higher stand-
ard and modern construction. It would not occasion so much oppo-
sition from school boards and voters of local communities, who might
otherwise feel that their rights were being invaded by higher authority.

There is in my state a law, enacted in 191 1, which gives to the truant
officer the right, and makes it a part of his official duty, to inspect the
outhouses of the schools of the county, and to require the district
board to put them in order when found out of fit condition for use. He
determines their fitness, also. Upon the failure of the board of educa-
tion to perform this office when so directed, the truant officer shall
cause it to be done and at the expense of the district. There have been but
few cases in Saginaw County where the truant officer has been called upon
to exercise the last named power and actually hire this work done. I
fully believe there is an improvement of fifty per cent, in the actual
condition of these buildings since the law went into operation.

Most cities now have free, or nearly free, medical inspection in schools.
Defects of vision, of teeth, of hearing and other physical defects are
carefully looked after and every precaution taken to preserve and con-
serve the child. The rural school pupil needs these services and should
receive them.

In fact I believe the state should have more authority over the child,
should contribute more to his welfare and development, should exercise
a greater vigilance over him, and should give him more complete pro-
tection from his enemies; whether they be parent, teacher, school board,
employer, neighbor or associate. Will not a greater service to the child
warrant the demand from the state of greater efficiency from him as a
citizen? If we give him five talents, may we not expect ten in return?

412

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

In this age of our Republic, when every man and every woman may exer-
cise the powers of a sovereign, can we fit them too well for this duty? My
answer is no, if we incorporate into his training some of the philosophy
of the Son of God. Teach him to be clean in body and mind; to respect
the rights of others, and to earn honestly those things which he desires
to possess.

When we have done all of these for him, may it not be possible, as
he stands upon the threshold of life, young, hopeful, expectant, virile
and zealous to achieve success, to say of his native state, cheerfully,
honestly, gratefully, "I was naked and they clothed me; I was hungry
and they gave me bread ; I was thirsty and they gave me to drink of the
waters of life." "And now, by virtue of these services, I am rich in
possibilities ; I have found that for which men in all ages have diligently
sought; I am in possession of the Holy Grail."

LEGISLATION SCOLAIRE FRANCAISE 413

LEGISLATION SCOLAIRE FRANCAISE

Dispositions legales et reglementaires relatives aux mesures
a prendre dans les ecoles en cas d'epidemie

PAR

Felix Martel

(i) Quand une epidemic se declare dans un etablissement d 'instruc-
tion, c'est le maire de la commune et le ^refet du departement qui ont
qualite pour prendre les mesures n^cessaires dans Tintdr^t de la sa-
lubrity publique et de la sante des Aleves.

(2) Pouvoirs et attributions du maire. C'est tout d'abord au maire
qu'il appartient d'agir. La loi municipale du 5 avril 1884 lui confie "le
soin de prevenir par des precautions convenables et celui de faire cesser
les fleaux calamiteux, tels que les maladies ^pidemiques ou contagieuses,
en provoquant, s'il y a lieu, I'intervention de I'administration
superieure."

Aux termes de la loi du 15 fevrier 1902 sur la sante publique, il est
tenu "de determiner, apres avis du conseil municipal et sous forme
d'arret^s municipaux portant reglement sanitaire les precau-
tions destinees a assurer la salubrite des maisons, de leurs dependances
et des autres agglomerations, quelle qu'en soit la nature." Enfin le
maire tient, de la loi organique de I'enseignement primaire (loi du 30
octobre 1886, art. 9), le droit d'inspection dans les ecoles, et cette inspec-
tion (Decret organique du 18 Janvier 1887, art. 140), porte particu-
lierement sur I'hygiene. C'est en vertii de ce droit qu'il peut, en cas
d 'epidemic, prescrire, tant dans les ecoles publiques que dans les ecoles
privees, les mesures reconnues necessaires.

(3) Pouvoirs et attributions du Prefet. II pourrait arriver que, par
negligence ou pour toute autre cause, le maire d'une commune, une
epidemic s'etant declaree, n'us^t point de ses pouvoirs et ne rempltt
pas son devoir. C'est alors au Prefet, representant de I'administration

up6rieure, qu'il appartient d'intervenir. On lit dans la loi municipale,
a I'article 99, que "les pouvoirs qui appartiennent au maire ne font
pas obstacle au droit du Prefet de prendre, pour toutes les communes
du departement ou pour plusieurs d'entre elles, et dans tous les cas ou
il n'y aurait pas ete pourvu par les autorites municipales toutes mes-
ures relatives au maintien de la salubrite publique. Ce droit ne pourra
Ietre exerce par le Prefet a I'egard d'une seule commune qu'apres une

414 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Le Pr6fet, informe de Tepideinie, doit dans telle ou telle commune
determln^e, demander I'avis du maire, puis saisir, dans le plus bref
delai, le conseil d 'hygiene qui existe dans chaque departement; puis il
applique sans retard, pour les ecoles privies comme pour les ecoles
publiques, les mesures sanitaires que ce conseil a propos6es.

(4) Qu'arriverait-il, si un directeur d'ecole privee se refusait a se
conformer aux prescriptions de I'autorite competente? Le chef du
service de I'lnstruction publique dans le departement,. c'est-a-dire
rinspecteur d' Academic, aurait alors le devoir de rappeler a cet
instituteur quelles sont les dispositions de la loi (loi du 30 octobre 1886,
art. 41), et de lui faire observer qu'apres constatation de I'infraction aux
reglements par lui commise, il s'expose, pour faute grave dans I'exercice
de ses fonctions, a etre defere au conseil departemental qui prononcerait
suivant la gravite de la faute, les peines ou de la censure ou de I'inter-
diction (id., art. 41).

(5) Fermeture des ecoles et licenciement des Sieves. L'autorit6 compe-
tente pour prononcer la fermeture d'un etablissement d'instruction,
en cas d 'epidemic, est I'autorite municipale ou I'autorite prefectorale,
suivant la distinction ci-apres. S'agit-il des ecoles privees, c'est-a-dire
fondles et entretenues par des particuliers ou des associations, le maire
a le droit de faire fermer I'^cole contamin6e, s'il le juge indispensable
(circulaire minist6rielle du 13 mars 1893). Pour les ecoles publiques,
c'est-a-dire fondees et entretenues par I'etat, les departements ou les
communes (loi du 30 octobre 1886, art. 2), le maire a pour devoir d'aviser
le Prefet et il lui proposera, s'il croit devoir le faire, de fermer I'^tablis-
sement ou I'epidemie s'est declar^e. Le Prefet, sur la proposition de
rinspecteur d'Acad^mie, apres avis du maire et du comite departe-
mental d'hygiene, prononce, s'il y a lieu, la fermeture temporaire.

(6) II importe de remarquer que la fermeture d'une ecole, en. cas
d'epidemie, est une mesure toute facultative. II est m^me recommand6
aux autorit^s competentes de n'en user qu'avec une certaine prudence,
car elle pent offrir plus d'inconvenients que d'avantages. Le Comite
consultatif d' Hygiene publique de France s'est nettement prononce sur
le danger que le licenciement de I'ecole pent presenter dans certains cas.
On lit a ce propos dans la circulaire precitee du 13 mars 1893: "En
I'absence des parents retenus k leur travail, les enfants sont confies
aux soins et a la surveillance d'une voisine, laquelle sera souvent la mere
d'un enfant malade, que cette circonstance seule oblige a garder le logis.
Le licenciement de I'ecole pent done favoriser la contagion, au lieu d'y
remedier. Aussi serait-il preferable alors de recourir a la disinfection
du local, toutes les fois que cette operation sera jugee possible."

LEGISLATION SCOLAIRE FRANCAISE 415

(7) Ces indications generates sont compl^t^es par les dispositions
d'un reglement modele, en date du 18 aoOt 1893, "relatif aux prescrip-
tions hygieniques k prendre dans les ecoies primaires pour prevenir et
combattre les epidemics." Ces prescriptions pour les 6coles publiques
sont fixees dans tous les departements par arretes du Prefet. Aux
termes des articles 7 et 74 de ce reglement, le licenciement ne doit avoir
lieu que dans les deux cas ci-apres: (a) en cas de scarlatine, si plusieurs
cas se produisent en quelques jours malgre toutes les precautions prises;
(b) en cas de rougeole: le licenciement n'est alors present que pour les
enfants au dessous de six ans, et m^me alors on devra auparavant recou-
rir aux evictions successives des eleves atteints par la maladie et
employer les moyens de desinfection.

(8) Dans le cas ou le licenciement est reconnu necessaire, il est
envoys a chaque famille, au moment du licenciement, un exemplaire
d'une instruction officielle relative a la maladie epidemique qui I'aura
n^cessite (Reglement modele precite, art. 13).

(9) Lorsqu'une ecole recevant des eleves pensionnaires doit etre
fermee, notamment en cas d'epidemie, le Prefet, I'lnspecteur d'Academie,
et le Procureur de la Republique doivent se concerter pour que les parents
ou tuteurs des eleves soient avertis sans retard et pour que les Aleves
pensionnaires, dont les parents ne resident pas dans la localite, soient
provisoirement -recueillis dans une maison convenable, jusqu'a ce qu'il
ait ete possible de les rendre a leurs families.

(10) Les prescriptions reglementaires edictees pour les Ecoies pu-
bliques sont egalement applicables aux ecoies privees, et il ne saurait en
etre autrement sans que la sante publique soit serieusement menac6e.
Comme le remarque le Ministre, dans la circulaire du 13 mars 1893,

Texperience," en effet, "a demontre que trop souvent I'ecole priv^e
recueillait les enfants renvoyes momentan6ment de I'^cole publique
licenciee et que, par suite, le danger que courait la sant6 publique avait
€t€ simplement deplace."

41 6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

PARENTS' PART IN SCHOOL HYGIENE

W. H. Heck

For several years the author of this paper has been making an effort
in the State of Virginia to increase the interest of school officials, teachers,
and parents in the school child's health. During the session I9i2-'i3
the movement was systematized into a State School Hygiene Campaign,
which will be continued through the session I9i3-'i4. The campaign
included inspection of schools, health conferences with parents and teach-
ers, round-table discussions at teachers' institutes, hygiene talks to older
pupils, and lectures at the State Normal Schools. This experience
is the basis of the following suggestions, a brief discussion of which
will not give time for description of similar work that is being done
elsewhere.

The main purpose of this campaign fuses into the larger purpose of
bringing the home directly into relation with school problems. The
natural evolution of the school out of the home has resulted in an evo-
lution out of relation to the home, both school and home suffering greatly
thereby in not understanding, learning from and cooperating with each
other. The school needs, far more than teachers realize, such a view
of the individual results of school management and methods as the
home, sometimes even an uneducated home, can give. On the other
hand, the home needs, far more than parents realize, such an interpre-
tation of child development as the school, sometimes even an uneducated
school, can give. The deficiencies of home and school cannot be over-
come by mutual isolation, criticism, or defensiveness but by considerate
consultation, where each can help the other. Such a give-and-take
consultation is seldom seen. The usual school reports, notices, and
functions may inform parents but are too one-sided and formal. Most
patrons' meetings include entirely too few of those that ought to be
concerned and consulted, and they are not really conferences where
parents and teachers can frequently question each other and give sugges-
tions.

In the health conferences of parents and teachers in Virginia,
the leader would begin the discussion of each subject and then ask for
opinions, questions, etc., from both the home and the school, empha-
sizing the value of "getting together and talking things out." The
attendance and the response varied with the community leadership
of the school and the intelligent interest in education. The local news-

PARENTS PART IN SCHOOL HYGIENE 417

papers gave accounts of the conferences and this increased the demand
for further discussions.

School hygiene is decidedly the most serviceable phase of education
for consultation between home and school. It is of basic importance;
almost all parents can be interested in some of it; all teachers should
be forced to study it ; it can never be considered properly out of its rela-
tion to home hygiene; its principles can be concretely explained, pro
and con, by reference to the equipment and management of the homes
and the school concerned; its practical application can be put within
reach of ordinary intelligence and finances; and, above all, the home has
a legal and moral right to know under what hygienic advantages and dis-
advantages its children are being schooled by the state and local government.
Cooperation is here not only an opportunity but also a necessity, because
a child cannot be made healthy by life and instruction during a few
hours at school if the many hours at home do not cooperate, or vice
versa. The unhygienic influence of either one may obstruct the hy-
gienic influence of the other. You cannot create health in fractions
of a day. Furthermore, the school can never get an all-round view of
a child's health without the more inclusive view of the home.

The following are some of the subjects in which cooperation is now
being sought in Virginia, those for a single conference being chosen to
meet local interest and need.

Parents and teachers must be taught the meaning of vitality. A
great many of them consider health simply the absence of illness; there-
fore, as long as the child is not ill, they classify it as well and then let
the matter drop. Until this laissez-faire notion of health is eradicated,
most of the aims of the school hygienist will be regarded as doctrinaire
and secondary. Without, and even with, medical inspection for dis-
eases and defects, interest is difficult to awaken in regard to the less
evident but very important phases of school hygiene, such as the proper
use of window shades, the minus distance between seats and desks, the
prevention of the common cold, the postures of children, the care of the
teeth, the open-air sleeping rooms, and a score of other problems. "If
the child is not made ill by present conditions, why worry?" This
attitude is the worst foe of school hygiene.

Vitality must be preached as the aim of growth, the basis of happi-
ness, the secret of success. School hygiene works for the buoyant,
complete child, for physical force expressing itself in mental and moral
force, for physical power trained to efficiency. Diseases are treated
and defects corrected as obstructions to vitality; school equipment
and management are reorganized so as to avoid limitations to vitality.
But these considerations are negative and preliminary, and hygiene
is more positive than negative. The main emphasis should be upon

41 8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

hygienic activity as the means of developing vital efficiency. If parents
can be made hungry for their children's vitality, the battle of school
hygiene is half won, only the proper information being needed to effect
the desired changes. Without this hunger the information will be
little heeded.

Illustrations can be given by a summary of typical stages of growth
in childhood and youth, showing that the child organism is not an adult
in miniature, simply enlarging year by year, but a different organism
with varying rates of growth in different organs. Emphasis should be
put upon the disharmonies due to these variations. The danger of
not meeting the vital demands of the growing organism at any stage,
through unhygienic action or environment, arises from the probability
of limiting for life the vitality of those organs growing most at that
time. This danger is greater during the prepubertal increase in height
and weight and the pubertal development of primary and secondary
sex characters, when the cooperation of home and school ought to be
very close in protecting boys and especially girls from overstrain. At
every stage school demands are secondary to growth demands, and any
strain is harmful if it Hmits the nutrition, physical activity, and rest
required for growth.

The value of medical inspection is an attractive subject for meeting
of parents and teachers. If such inspection does not exist in a school
or exists only in part, the need for it can be well discussed in relation
to many problems of home and school. If such inspection does exist
the opportunities thus offered can be emphasized in such a way as to
make their good results far more extensive. For instance, a brief account
of the injury caused by adenoids or eye strain will often open the eyes
of parents and teachers to the serious significance of defects which they
have been disregarding. The best influence, however, that medical
inspection can make upon the home is by inviting, even requiring, as
in some German cities, the attendance of one parent or guardian at
the inspection of every child. The meaning of each phase of the inspec-
tion can then be explained, the parent can give the child's past history
in so far as it bears upon the inspection, and the advice concerning each
defect noted can be discussed immediately. This education of the
parent will take time and money, but it will well pay the school and the
community. The usual notices to parents regarding the results of
medical inspection are too brief for proper explanation, and the very
valuable visits of trained nurses can include only a small portion of the
homes represented by the school and can ordinarily deal with only a
small part of the inspection. It is becoming more and more evident
that the home must be brought into closer and more inclusive knowl-
edge of the aims, methods, and results of medical inspection.

PAREN.TS PART IN SCHOOL HYGIENE 419

Parents should be informed of the hygienic condition and care of the
building and equipment used by their children. They cannot be ex-
pected to learn standards from printed discussions or lectures on general
principles; they must be shown the actual school plant and have prin-
ciples interpreted in relation thereto. Their questions should be frankly
answered and their reports as to the effect of the school upon their chil-
dren should be carefully considered, although most buildings, even
new ones, will not meet all standard requirements, and school officials
may be sensitive about criticism. Principals and teachers are not
really equipped for their positions unless they understand and can
explain to parents the hygienic merits and demerits of their school
plant and the daily use of it.

The same right of parents must be recognized in regard to the hygiene
of school management and methods. Unfortunately, there are few
principles to guide us here, as these matters are closely connected with
the elusive problems of fatigue and interest. In most schools tradi-
tion regulates the length of the school day, the amount and use of recess
periods, the requirements for home-study, the number of recitations
per day, the nature of examinations, the forms of discipline, etc. Never-
theless, an intelligent conference between parents and teachers is the
best way at present to improve conditions.

The prevalent practice of keeping-in at recess has nothing to justify
it. If the recess has any significance, that significance is its effect
upon health; therefore, to keep a child in at recess is to punish him
at the expense of his health. A few such punishments may not injure
one individual, but a school that practices such a form of discipline
is to that extent an inconsiderate and unhealthy school. Furthermore,
the windows of most classrooms ought to be opened at recess so that
the rooms can be flushed with pure air; and, if the children are kept
or even allowed in the rooms, this needed flushing cannot be thoroughly
done. Thus the punishment of one individual may not only injure
his health but also that of the entire class.

Home-study is first and foremost a home problem. It is surprising
that parents have so long submitted to this intrusion of school require-
ments into home management without claiming the right to be con-
sulted. Of all conference subjects I have found home-study the most
interesting to parents and teachers. This fall a detailed plan for co-
operative study of this problem will be worked out in several communi-
ties.

Parents can easily be interested in school instruction and training
in hygiene. The formation of health habits, rightly the chief aim of
hygiene instruction, can only be successful when both sfchool and home
insist together on the desired habits. It is strange that schools have

420 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

blundered along without seeking the cooperation of those responsible
for the health conditions of most of the pupils' time and environment.
The home is the most important teacher of hygiene, for good or ill ; and
the school that fails to learn from and give advice to this teacher as a
co-partner is failing through its own indifference or foolishness.

This subject naturally includes that of sex instruction. The public
schools certainly ought to undertake this responsibility, if the home
cannot be made to do so. The many difficulties involved in mass in-
struction, selection of teachers, gradation of subject-matter, combina-
tion of scientific fact with proper emotion, etc. will have to be solved
by extended trials, cost what they may. But have the parents refused
to bear this responsibility? It is one thing to say that the home is not
now doing its duty ; it is a far different thing to say that the home cannot
or will not do its duty. Wait until the parents have been shown by
educational and medical experts, as is now being done in a few places
through the schools, just what that duty is, the serious results of neglect-
ing it, and the proper methods of fulfilling it. Parents will welcome
and make good use of such instruction, mock modesty here being a sign
of pruriency. If, however, they show no inclination or success in meet-
ing this problem, then the school must grapple with it. But let the school
work through the parents first, especially in regard to elementary chil-
dren, assisting the home, if necessary, in some of the instruction of
high-school students.

Other subjects for discussion at these conferences have been the
length of the school day by grades, the midday meal of school children,
the afternoon play and social life, the systematic regulation of the time
and environment of sleep, etc. The subjects briefly outlined in this
paper and the methods of treatment given in these conferences may
not be just those most suitable for other states and educational needs.
They are mentioned here to emphasize the ideal of bringing school
and home together in consultation regarding the health problems in
education.

SESSION SIX

Room F. Tuesday, August 26th, 9:00 A.M.

STATUS OF SCHOOL HYGIENE AND METHODS OF

INSTRUCTION IN CITY, VILLAGE AND COUNTRY

SCHOOLS (Part Two)

Samuel G. Dixon, M.D., LL.D., Chairman
Dr. Francis E. Fronczak, Buffalo, N. Y., Vice-Chairman

Program of Session Six
Allen W. Freeman, M.D., Assistant Commissioner and Director of
Rural Sanitation, Richmond, Va. "A Study of Sanitary Con-
ditions in the Rural Schools of Virginia." (Manuscript not
supplied).

George Starr Lasher, A.B., Department of Public Instruction, Lan-
sing, Mich. "Safe-Guarding Rural Children."

Walter E. Larson, State Rural School Inspector, Madison, Wis.
"Improvements in the Sanitary Conditions of the Rural Schools
of Wisconsin."

N. K. Foster, M.D., Director of Department of Health and Sanitation,
Oakland, Cal. "Oakland System of Health Inspection."

Otis B. Nesbit, M.D., Ph.G., School Physician, Valparaiso, Ind.
"Medical Inspection in Valparaiso, Indiana, Public Schools."

Papers Presented in Absentia in Session Six
(Read by Title)
Samuel G. Dixon, M.D., LL.D., Commissioner of Health, State of
Pennsylvania. "Sanitary Inspection of the Rural Schools of
Pennsylvania."

Samuel G. Dixon, M.D., LL.D., Commissioner of Health, State of
Pennsylvania. "School Medical Inspection in Rural Districts
of Pennsylvania."

A. J. McLaughlin, M.D., Surgeon, U.S.P.H.S. "Hygiene in the
Philippine Schools. ' '

Dr. Clemente Ferriera, Sao Paulo, Brazil. " L' Organisation de
inspection medicale des ecoles au Bresil."

422 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SAFEGUARDING RURAL CHILDREN

G. S. Lasher

The rural one-room school is here; it has persisted despite all its
limitations for years; it will remain for many years to come. It is well
enough to hold the ideal of the consolidated school with its splendid
possibilities but why not face the issue squarely, recognize that the
ideal belongs to the future as far as the majority of rural districts are
concerned and bend our energies toward making the present country
school as healthful, as attractive, as efficient as possible?

Michigan is one of the richest states in the nation, its natural re-
sources are superb, its population ranks high in intelligence and culture.
There is no reason why its schools should not be among the very best
yet the Russell Sage Foundation investigation resulted in a ranking of
seventeenth. Even this indicates that the state is considerably above
the average so there is a basis for the belief that the conditions to be
found in Michigan among the rural schools are better than in many
states that have equal advantages, still a survey of the situation reveals
the appalling fact that the vast majority of boys and girls in rural
districts are spending from four to six hours every school day in build-
ings which are a menace to their health.

In 82 of the 83 counties in Michigan, there are 7,234 rural one and
two room schools. Of this number, 2,075 possess heating and venti-
lating systems; 499, basement furnaces and 888, jacketed stoves. The
children in 3,772 schools or more than fifty per cent, suffer from stove-
heated rooms which are inadequately ventilated. Only 1,260 or approx-
imately eighteen per cent, have drinking fountains, while but 3,606
or less than one-half even boast the makeshift individual cups. But
151 safeguard the children from the dangers of the common roller towel
by the use of paper towels and 140 by the use of individual towels.

Comparatively little attention is paid to correct seating of children.
In only 435 schools or less than six per cent are found adjustable seats
and desks. But 1709 schools or about twenty- three per cent, have
the seats and desks properly arranged, the same sized seats and desks
in the same rows from front to back. In 3,959 schools there are not
a sufficient number of small-sized seats and desks so that thousands
of youngsters have to sit all day with their feet swinging in the air and
must distort their backs in order to write or figure because the desks
are too high. Small chairs and tables are provided for the little ones
in only 782 schools.

SAFEGUARDING RURAL CHILDREN 423

The lighting of the schoolrooms is causing children and teachers to
become spectacle wearers by the hundred. In 887 rooms children are
forced to face open windows while a similar fate falls to the teachers
in 2,575 schools. The eyesight of the vast majority of children and
teachers is impaired by cross lights because in 6,457 schools, or eighty-
nine per cent., there are windows on both sides of the room. Schools,
which have the lighting entirely from the left side, are limited to 242^
while 360 light from the left and rear.

These injurious lighting conditions are modified in only 993 schools
by the hanging of window shades at the bottom so that they can be
pulled up rather than down. Correct decoration of the walls is found
in 2,072 schools.

That the outhouse problem is serious is shown by the fact that but
4,052 schools have well-built, widely separated outhouses, while only
123 have inside toilets. Ample playgrounds are scarce. School
grounds containing at least two acres are found in only 170 districts,
while those possessing at least one acre number 2,526. No fewer than
4,060, or over fifty per cent., have one-half an acre or less. The schools
possessing satisfactory water supply total 4,463. The information
for this survey was furnished by the county commissioners and while
not minutely accurate, is conservatively true. At least the conditions
are not exaggerated. I am not inclined to be pessimistic, despite this
adverse showing, as practically all the improvements noted have been
made in the past few years and the number of progressive districts is
growing.

I So much for the actual situation; now what is to be done about it?
Fortunately, manufacturers with foresight have been studying the prob-
lems so that it is to-day possible to make the country schoolhouse as
healthful, sanitary and comfortable as the city schoolroom at a decidedly
moderate cost. There is not a one-room building in the state but that
can be remodeled and improved to meet the demands for health and
comfort at a cost of less than $500, while the great majority can be
brought up to standard for much smaller amounts. Districts that
cannot afford to give their children decent and healthful conditions

■ are so few that consideration is not necessary.
Systems, which thoroughly ventilate the schoolroom and warm it
evenly without the direct rays striking any child, can be purchased for
'' from $95 to $125 or be made for less. Sanitary bubbling drinking foun-

» tains for districts where there is no water system do away entirely with the
use of cups and cost from $13.25 to $20. Indoor chemical closets, which
are sanitary and odorless and require neither sewerage nor water under
pressure, solve the outdoor outhouse problem at a cost of from $20 to
$40 each. Adjustable seats and desks that can be made to fit the

424 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

individual boy or girl vary from $2.10 to $3.50. Paper towels, costing
about 10 cents a hundred, eliminate the source of nearly every skin
disease epidemic, the common roller towel. Proper window shades,
correctly installed so that they may be pulled up rather than down,
are not expensive, neither are floor brushes and dustless cloths to replace
brooms and feather dusters. The cost of remodeling the building to
f)ermit adequate and correct lighting would probably vary from $25
to $75, while the expense of decorating the interior to aid in the light-
ing is trivial. It is not necessary to argue that such an expenditure
by a school district would be the best possible investment, as it would
be insurance against doctors' bills and epidemics; would permit the
teacher and the children to do efficient work every hour of the school
day; would be the most effective advertising a community could pre-
sent to farm purchasers.

No one can question that rural districts need improved conditions
while the cost is not so excessive as to be prohibitive for any district
or a heavy burden for the majority. The situation now resolves itself
into the question, what can be done to bring about the desired changes.
The answer, in my judgment, lies in the general education of the people
as to existing conditions and needs; in the intensive education of teachers
and county superintendents; in legislation regulating the construction
of new buildings and the remodeling and equipping of old structures.

In Michigan we have begun the work of general education through
the department of public instruction. Press sheets are sent out every
few weeks to each newspaper in the state. They are prepared by an
experienced newspaper man so editors use the articles freely as they are
written in a concise, direct style and, varying from the short paragraph
to a half column, make most desirable "time copy." No more effective
w-ay has been used to bring about a general understanding of school
laws, conditions and needs throughout the state.

Michigan has adopted a system of standardization which is arousing
wide interest in the state. A certain minimum standard is fixed and any
school reaching that requirement will be given a framed diploma des-
ignating it as a "Standard School" while a metal plate, bearing the
same inscription, will be placed on the school building. When district
No. 4 is so honored, it can well be anticipated that the residents of
District No. 5 will wonder why their school is not also recognized.

The qualifications which concern the health of the children are:
ample school grounds of at least one acre ; two well kept, widely separated
outhouses or inside toilets; schoolhouse well built and in good repair,
lighted with some attention to correct lighting; good blackboards, some
suitable for small children; heating and ventilating system; sanitary
bubbling drinking fountain; hardwood floor; seats and desks properly

SAFEGUARDING RURAL CHILDREN 425

placed so that the same sized are in the same rows from front to back,
and a sufficient number of small sized seats provided.

The department of public instruction has in preparation a manual
of schoolhouse construction and improvement which will give a number
of detailed plans for the erection and improvement of one and two room
buildings. The plans will be accompanied by complete specifications
and estimates and adapted to varying needs. Illustrations or proper
equipment with prices charged will be given, together with many helpful
suggestions. In addition, the department is requesting all districts
that are planning to build to submit their plans for expert criticism as
to heating, ventilating, lighting arrangement, toilet accommodations,
etc. In this way, it is expected many mistakes due to unwise archi-
tects will be avoided.

That visual impression is most effective was strongly emphasized
upon my mind during the past few weeks while making a tour of Michi-
gan with the state health train. I had charge of an exhibit of sanitary
school equipment, which was a feature of the train, arousing great
interest among general visitors as well as school officers and teachers.
Comparatively few had ever seen an adjustable seat and desk, an indoor
chemical closet, window shades hung at the bottom of the window
instead of at the top or a sanitary drinking fountain for rural schools.
Many had never seen paper towels or heard that a schoolroom could
be properly heated and ventilated by a room furnace, while to still more,
lighting entirely from the left side of the pupil was a new idea.

Included in the exhibit was a display of jaw casts showing the result
of lack of attention to children's teeth and the effect of adenoids. The
interest in this was noteworthy as it seemed new to the majority of
parents, many of whom realized for the first time the cause of their
children's mouth-breathing, deafness, and associated afflictions. The
number of children in the crowds visiting the cars who were obviously
affected by the throat growths was surprisingly large and their presence
emphasized my statements.

The exhibit train will reach probably fifty thousand people before
the tour is completed and will undoubtedly prove a great missionary
agency for better school conditions. The thing that impressed me
deeply was the seeming ignorance of the general public in regard to
the needs of school children and the possibility of meeting those needs.
To most live educators all that is somewhat of an old story but to the
general public it is new gospel and thoroughly appreciated.

Another great agency for this wider enlightenment is the annual
school officers' meeting held in every county in Michigan. A repre-
sentative of each school board is expected to attend and' as he or she is

426 FOURTH- INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

most boards are represented. Some member of the department con-
ducts the sessions. These meetings were started six years ago and at
first school law absorbed the interest and the entire time, but more
recently, general educational problems have predominated and the
questions of school hygiene and sanitation are most strongly empha-
sized. The Michigan law gives the district officers almost complete
taxing power, making the board of education the court of last resort
in the proper remodeling and furnishing of the school buildings. The
result of the agitation in the officers' meetings for better conditions
is shown by the decided advancement in the state during the past two
years.

No more powerful stimulus toward this same end can be given than
by intelligent and efficient teachers and county superintendents, but
both are in need of an intensive education along these lines. In visit-
ing schools, the thing that has impressed me most decidedly is the
pathetic ignorance of the great number of teachers in the most common
sense principles of hygiene and sanitation, and that statement applies
to city and village superintendents and teachers as well as to those in I
rural districts, to so-called trained teachers as well as untrained.

It is a curious paradox that the university, state normal schools
and colleges require a somewhat extensive course in history of educa-
tion, yet none of them demand a knowledge of school hygiene and san-
itation. There is no question but that an individual can become a
splendid teacher without knowing who devised the kindergarten or how
the various theories of education originated, but no one can do his duty
by the boys and girls under his supervision unless he understands that|
children must be seated so that they can rest their feet firmly on the
floor and use the desk in front of them without distorting their backs.

Comfort is essential to good work and the first thing that a really;
successful teacher must do in order to develop efficiency among his pupils j
is to see that the schoolroom conditions make for comfort and health.
The superintendent who does not thoroughly understand the heating
and ventilating system of his school so that he can be sure that the
janitor is not saving coal at a sacrifice of children's health, is not fit to
be a superintendent. The sooner the dry rot in so many courses in
higher institutions of learning is replaced by live subjects that will make
it possible for the teachers to teach correctly the fundamentals of right
living, the more hope there will be for the coming generation of men
and women. The institution which does not train its product in the
principles of school hygiene and sanitation and how to apply those
principles cannot but fail in its real object, the development of the right
kind of teachers.

The most effective way to do away with the dangers of the common

SAFEGUARDING RURAL CHILDREN 427

drinking cup, the common roller towel and other insanitary articles
of use is to teach children the actual dangers of those things. People
have at last discovered that it is possible to know how to live correctly
without knowing the anatomy of the human body. It is vastly more
important that the child shall know how to clean his teeth than to know
just how those teeth are constructed. Teachers must be trained in
health knowledge and be made to appreciate that the health of the
child is of much greater importance than the elements of arithmetic,
geography and all other academic subjects combined.

The course of study, which under the present law must be followed
in all Michigan schools, except city districts, outlines work in everyday
hygiene. This is supplemented by helpful bulletins on various health
questions issued by the department of public instruction and the state
board of health. Last' year eye- testing charts were sent out for use
in every school room and the number of children found to be suffering
from defective eyesight was overwhelmingly large. Teachers were
urged to report the condition to the parents and in many cases dull
children were transformed into bright students because with the aid
of glasses they could see with some degree of correctness. The devoting
of eight out of ten physiology questions to hygiene and sanitation in
the state teachers' examinations is also proving effective in training
teachers.

Education of the general public and of the teachers is a somewhat
slow process, so if any sweeping reform is brought about in school con-
ditions, it must come through mandatory legislation. If the state
demands compulsory education, as practically every progressive state
does, it most emphatically should demand compulsory health condi-
tions in every school district. It is an absolute injustice to force par-
ents to send children to school during the formative years when con-
ditions are a menace to the health of the children. Neither is it fair
to coop children up from four to six hours a day in a room that is un-
comfortable, unattractive and unhealthful.

In order to prevent districts from reproducing the same mistakes
in new buildings that are so glaringly conspicuous in the, vast majority
of old buildings, laws should be enacted to require boards of education
to submit their plans to competent state authorities so that the details
of lighting, heating, ventilating, arrangement, toilet accommodations
might be corrected. No district should be permitted to expend any
money unless the requirements of such board are complied with.

The state officials should also have authority to condemn buildings
that are insanitary or unsafe and to require certain improvements
and equipment that make for health. Unless the board of education
acts under the instructions of the officials, then the latter should have

428 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

authority to make such changes as are necessary in their judgment
and assess the cost of the same against the district. Michigan has a
law that makes it possible for the truant officer under direction of the
county commissioner to require districts to meet any qualifications
in regard to outhouses that he demands and, for the first time, many
districts are getting outhouses that are decent, healthful and free from
moral filth. The law works exceptionally well in this one respect and
would do the same in regard to general conditions of the school.

Too long have law makers, educators and people in general enter-
tained the silly fallacy of "ruddy cheek and glowing health" of the coun-
try lad and lass. As a matter of statistics, the death rate among children
of the country is as great as that in congested cities. If many rural
children are healthy youngsters it is in spite of the conditions under
which they live in school and often at home, rather than because of
them.

The country school children need proper health conditions as much
as their city cousins; it is possible to secure such conditions at moderate
expense. The members of the communities and the teachers must
be brought to an appreciation of these facts. Even with that, manda-
tory legislation will be essential to safeguard the rural children in every
community. If this country is to possess the quality of citizenship
which will guarantee its supremacy intellectually, commercially, artisti-
cally, physically and morally, it must require not only compulsory
education but compulsory health conditions under which to gain such
education.

SANITARY CONDITIONS OF RURAL SCHOOLS OF WISCONSIN 429

IMPROVEMENTS IN THE SANITARY CONDITIONS OF
THE RURAL SCHOOLS OF WISCONSIN

Walter E. Larson

In 1905 two important laws were enacted. The first provided for
annual school board conventions to be held in every county of the state,
and the second provided for the appointment of a rural school inspec-
tor, one of whose duties is to attend, and with the county superintendent
direct, these conventions. As a result of these laws school board con-
ventions have been held for the past eight years. The school officers of
the various counties have met from year to year and learned about the
best methods of school management. A considerable portion of the
discussions have related to school sanitation.

These two laws have brought about a close relationship and coopera-
tion between the state department of education and the local school
boards, that has resulted in much improvement in the country schools.
From seventy-five to ninety meetings have been held each year and the
aggregate attendance during the last few years has been approximately
10,000 school officers each year, or nearly one-half of the total number of
school officers in the state. At these school board conventions certain
definite topics have been taken up each year and discussed by the repre-
sentative of the state department. The first year the special topic was
sanitation and the special feature of this topic was schoolhouse ventila-
tion.

In 1907 a law was enacted, grouping the country one-room schools
into two classes — first and second. Certain standards were prescribed
for schools of the first class. Among the requirements made were first,
that the school room should be kept in good condition and free from any
unsanitary features; second, that it should have an adequate system of
heating and ventilation; third, that the desks should be arranged prop-
erly; and fourth, that the outbuildings conform to the law. Schools
that came up to this standard were to receive a special state aid of fifty
dollars per year for three years. As a result of this law about four-
fifths of the country schools in Wisconsin have installed heating and
ventilating systems and provided the other equipment required to meet
that standard prescribed by the state superintendent. Many of the
first heating systems, it is true, were of a somewhat inferior kind and
were not always properly installed. The result, however, has been
exceedingly beneficial, as the people have been brought to see the neces-

430

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

sity of having schoolhouses ventilated. It is the exception now to enter
one of the rural schools and not find a ventilation system installed.
The practice has even had a wholesome effect upon many of the village
schools, which did not have the best of ventilation before.

The question of outbuildings has always been a difficult one in con-
nection with the country school. In order to remedy this matter a law
was enacted in 1907, providing that it shall be "the duty of each school
board to provide at least two suitable and convenient outhouses for each
of the schoolhouses under its control. Said outhouses shall be entirely
separated each from the other and shall have separate means of access."
Some other specifications are also made in the law. As a result of this
law the outbuildings have been largely improved, although they are not
yet what they should be in some places, but in counties where the cam-
paign for better outbuildings has been taken up in a systematic way
almost perfect conditions prevail. The problem of securing proper out-
buildings and keeping them in proper condition is one that cannot be
solved by mere enactment of a law. There must be developed in the
children themselves and even in the people of the community a right
attitude toward public property, and one of the difficulties in securing
this is that many of our teachers are young and inexperienced and do
not look after this matter in the proper way. We have been impressing
upon school boards and teachers alike that they are in duty bound to

The Old Schoolhouse in District No. 2, Beetown, Grant County

SANITARY CONDITIONS OF RURAL SCHOOLS OF WISCONSIN

431

see that these buildings are kept in good condition, inasmuch as a filthy
outbuilding is not only detrimental to the children's health, but it is
also detrimental to their morals.

Another law that has had good effect upon the sanitary condition of
school buildings was passed in 1907, authorizing the state superintendent
to procure plans and specifications for rural schools and loan these plans
to school districts. This law also provides that "Where the plans and
specifications prepared by the state superintendent are not used, in order
that the health, sight and comfort of pupils may be properly protected,

The Old Schoolhouse in District No. i, Beetown, Grant County

all schools board of districts in which new schoolhouses of not to exceed
1 four rooms are to be erected shall make suitable provision for the heat-
IB ing, lighting and ventilating:, and hygienic conditions of such buildings,
« and all plans and specifications for any such proposed school building shall

(^ be submitted to and approved by the county superintendent of schools
B in whose jurisdiction the building is located, before it shall be accepted
by the school district board of the district in which it is proposed to erect
h such building."

IB In accordance with this law the state superintendent has secured
" plans for five different one-room school buildings. In these plans the
t sanitary features, such as proper heating and ventilation, proper lighting,

432

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

was uaed in the construction of a model rural school building which is
found on the state fair gounds at Milwaukee.

In order to enable the people to get rid of old schoolhouses in bad
condition, a law was passed in 1909 providing a means whereby they
could be readily condemned. A condemnation law that had been on
the statute books for some time was a dead letter, inasmuch as it required
the joint action of the town chairman and the county superintendent.
The law of 1909 provides that any voter in the school district, any county
or city superintendent, or any school officer may make application to the

Consolidated School, Beetown, District No. 1 1 , Grant County
(Formed by the Union of Districts i and 2)

State superintendent to have the schoolhouse inspected, with the view of
condemnation or securing order for repair. Four of the inspectors of
the department are authorized to examine school buildings with the view
of condemnation. If the schoolhouse is found to be unsatisfactory it
may be ordered repaired or remodeled. If it is in such condition that it
is unfit to be repaired the inspector may order it discontinued and that
a new one be built by a specified time. Under this law over two hundred
buildings have been inspected and in every case improvements have
resulted. In the majority of cases new school buildings have been erected
while in others the old buildings have been remodeled or repaired. This

SANITARY CONDITIONS OF RURAL SCHOOLS OF WISCONSIN 433

One of the Buildings Condemned

Another Schoolhouse That Has Been Condemned

434 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

law has also had an indirect effect upon conditions throughout the state
in that many districts have improved their school properties knowing
that the state inspector might be sent into the community to condemn the
school.

Many of the new buildings that have been erected in rural commu-
nities are first class in every way. One county especially has done
much in this respect. During the last ten years fifty-three departments
have had new school rooms provided and nine others have been re-
modeled. Every county has now some good, up-to-date school build-
ings and these serve as an ideal and a stimulus for other districts that con-
template building. Whenever a district builds a schoolhouse now the
officers or the building committee usually inspect some of the newly-con-
structed, up-to-date buildings.

Some reference has already been made to the ventilation of the one-
room school building. Although perfect ventilation has not been
secured, yet the progress made has been great. The attitude of the
people has in general been changed and school officers especially are now
convinced of the need of ventilation and it is becoming simply a question
of the best method. Many of the new buildings have basements with
furnaces and these are all constructed so that fresh air is provided for
the school room. The principal drawbacks to the proper ventilation
of the schools are the following:

First, some of our teachers are untrained and unfamiliar with the
method of properly running the plants. In such cases the results ob-
tained are not what they should be.

Second, in some instances the school buildings are poor. The hot
air agent succeeded in getting the district to buy the outfit notwith-
standing the unsatisfactory condition of the building.

Third, in some instances the chimneys are not adequate to handle
the system.

Every year, however, we find better conditions. The school officers
are taking greater interest in school affairs and they are becoming more
intelligent in the discharge of their duties. The teachers are learning
more and more about the operation of the plants, the regulation of heat
and fresh air supply, the regulation of light and the need of proper
physical exercise and direction. The plants themselves are also much
improved over those that were first placed upon the market.

About four years ago the state board of health made a ruling that the
common drinking cup should be no longer used on trains and in other
public places, including schools. As a result of this ruling, the water
pails have almost entirely disappeared from the schoolhouses of the state.
Some years ago it was common to find the water pail and general dipper;

SANITARY CONDITIONS OF RURAL SCHOOLS OF WISCONSIN 435

now it is the exception. A covered jar or a covered tank is now used
and as a rule children have their individual cups. In some cases these
cups are not used in the best way possible, but still the improvement is
great. The attitude of the children themselves has also greatly changed.
In many instances the pupils are able to tell why this order was made,
and they are rather proud of the fact that they have their own indi-
vidual cups. In some of the schoolhouses sanitary cabinets have been
installed so that each child has a place for his cup.

In many instances the old schoolhouses are inadequately lighted.
In our investigations we find the window surface to be from one-twelfth
to one-sixth that of the floor space ; the usual ratio being about one-ninth
or one-tenth. The arrangement of the windows is also on the old style,
three or four windows being placed on each side of the school room. In
the new buildings the lighting is according to the. approved methods.
In the new school buildings not only is the lighting surface adequate,
but the windows are properly arranged. I think there will be little
trouble after this in having the proper kind of schoolhouses built. Not
only does the law require the approval of the plans by the county super-
intendent, but the people themselves, after seeing the new schoolhouses
readily note their superiority over the old.

One of the subjects required to be taught in the schools of the state is
physiology and hygiene with special reference to the effect of stimulants
and narcotics upon the human body. Some stringent laws relating to
the use of tobacco in any form have also been placed on our statutes.
This subject was introduced into the schools many years ago, but during
the last few years special effort has been made to make this subject of
practical value to the people. Instead of giving the major portion of
the time to the teaching of anatomy and physiology, as was the custom
following the early text books, we now are emphasizing the hygienic
side of the subject. The last revised common school course of study
lays special stress upon the health phase of the subject. The following
are some of the topics that are given special emphasis: The care of the
teeth, prevention of tuberculosis, the danger from flies and mosquitoes,
quarantine and disinfection. The course of study also emphasizes the
importance of right living in the school room as well as in the home.
In fact, the teacher is given to understand that the proper observation
of hygienic principles in the school room is really the most important
part of the course of study. On this subject the course of study says
"We teach by precept and by example. The first amounts to but little
unless it is reinforced by the second. The best way to make teaching
practical is to put the facts taught into actual practice. The first thing
to consider in the teaching of physiology and hygiene is the sanitary con-
dition of the school room and surroundings. Teaching the children a

436 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

few facts in the physiology class is time wasted unless these facts are
made real in the daily conduct of the school."

It may also be mentioned in this connection that there is in every
country school in the state of Wisconsin a library containing on the
average one hundred books. In most of these libraries are some recent
books on hygiene and sanitation. The influence that reading these
books has upon the health of these children cannot be over-emphasized.
An excellent pamphlet on "The Great White Plague" was prepared last
year for the department by Prof. W. D. Frost and Prof. M. V. O'Shea,
of the University of Wisconsin, and published and distributed by the
state superintendent. A copy of this pamphlet has been placed in every
school to be used by the teachers in connection with the teaching of
hygiene.

In one of the ceunties a unique campaign was carried on during the
past year. It was a campaign for clean teeth. Under the leadership
of the county superintendent the teachers took this matter up and made
a special effort to have the children realize the importance of preserving
their teeth. Another county superintendent has made a special cam-
paign during the past year against the house fly. At the school board
convention a year ago he announced his policy to have every school-
house properly screened, and to wage a campaign against the fly in every
possible way.

Much of the success in the improvement of rural school sanitation
is due to the county training schools in which the young people are trained
for their country school work. In these schools a special effort is made
to emphasize the hygienic side of physiology teaching and as a result
the work done is much more effective. The training of the teacher is
shown in the way she teaches hygiene as well as in the teaching of the
other subjects. County superintendents also make special efforts to
secure from their teachers more efficient work in hygiene instruction.

Time and space prevent us from discussing some other phases of the
work, and all that can be done is to refer to them. An effort has been
made to increase the educational value of the playground activities by
having the teachers supervise them to some extent. The state depart-
ment has published and widely distributed a bulletin entitled "Plays
and Games," to aid the teachers in this work. Special effort has also
been made to secure desks of proper size for the children and to have
the children properly seated. As a rule the desks are fairly well ar-
ranged, although in many instances this matter can be improved upon,
as some little children still sit in desks that are too large for them. We
hope, however, to quickly remedy this condition. The law now requires
the schoolhouse to be cleaned at least three times during the year. In
many of the schools it is done every month. A law recently enacted

SANITARY CONDITIONS OF RURAL SCHOOLS OF WISCONSIN 437

makes it compulsory to teach prevention of accidents one hour each
month and the state superintendent is required to prepare a booklet
containing information for instruction on this subject. Some of the
teachers have introduced the practice of giving school credit for home
work, and in this way they have included the care of the- teeth, sleeping
with open windows, etc. As a rule, greater precautions are taken when
an epidemic breaks out in the community. The law requires that the
schoolhouse be fumigated by the local health officer immediately after
the prevalence of an epidemic disease. In some of the schools the teach-
ers have introduced the practice of preparing warm lunches for the
children. The introduction of the oil stove makes this feasible. This
is by no means a general practice, however.

It is impossible in this short article to include all the phases of the
subject under discussion. There has been notable progress in Wiscon-
sin during the last eight years in particular. The cause of this im-
provement is largely due to the laws mentioned at the beginning of the
article. These laws provided machinery by which the people could
come together and get ideas. When the people are once convinced
that a certain policy is right, the policy will be carried out. Like all
great movements, this movement is slow but it gains momentum each
year. The most gratifying factor is the attitude of the people. As a
rule, the people want to have the best living conditions possible not only
in the schools but in the home, and these conditions when secured are
mutually helpful, but in many instances they do not know what these
conditions are. It is the duty of those of us who are leaders in the edu-
cational movements to bring these ideas to the people and show them
in a business-like way their importance. Wisconsin now allows the
teachers to attend the school board conventions. During the coming

son it is our plan to have the teachers attend these conventions and

this way the state plans to give suggestions and helps to both the
school officers and teachers in such a way that better results will be

ured because of better mutual understanding.

discussion of
Walter E. Larson's Paper

J. George Becht

It is scarcely possible to add anything illuminating to the very clear,
scriminating and comprehensive survey of rural school conditions as
jsented in the papers of the representatives of Michigan and Wis-

438 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

consin. It may not be unprofitable, however, to speak briefly of what
Pennsylvania has done during the past two years to secure better school-
house conditions.

The School Code, enacted in 191 1, provided that thereafter the plans
and specifications for every new construction and every reconstruction
of schoolhouse should be submitted to the State Board of Education for
examination. Expert architects are employed to examine these plans,
and, if the plans conform to the standard requirements for light, air
space, floor area, heating and ventilating appliances, they are approved,
and the Boards of Directors may proceed to. give contracts. No contract
can be entered into by any Board of School Directors unless the plans
for construction or reconstruction have been first submitted to the State
Board of Education, and its suggestions, if any are made, considered.
During the past two years more than 600 plans have been passed upon
and approved by authority of the State Board of Education. A study
of these plans by the architects and other officers of the Board has given
opportunity for helpful service in the suggestions that were made relative
to the planning of buildings. Frequently architects and builders who
draw the plans are not familiar with the varied schoolhouse conditions.
Structurally and architecturally the building may be well conceived but
lacking in adaptability and adjustability to school activities. To bring
about the best results, the architect must study special schoolhouse con-
ditions.

The State Board of Education has been able to give help to the rural
districts where one-room school buildings are the prevalent type. Stand-
ard plans for one, two, and three-room buildings have been prepared
for free distribution. Detailed drawings and specifications from which
any builder may build are sent to districts making application. These
plans may be adjusted to meet particular needs.

The State Board of Education is insistent that every one-room build-
ing shall have as its minimum requirements:

15 square feet of floor space.

200 cubic feet of air space.

20% net of floor space in lighting area.

A heating and ventilating stove.

Cloak rooms for boys and for girls.

A vestibule.

It also insists that more attention shall be paid to the construction
of outside sanitaries and to the proper care of the same.

OAKLAND SYSTEM OF HEALTH INSPECTION 439

OAKLAND SYSTEM OF HEALTH INSPECTION

N. K. Foster

Medical, or as I prefer to say health inspection, is among the
youngest offsprings of our school department. It was small at birth
and in its early infancy gave no promise of the rapid strides it made
in early childhood. Its present lusty youth is evidence that it has come
to stay and that it will be a mighty force in the upbuilding of a strong
man and womanhood.

Like every other advance step in civilization, experiments have been
tried and failures made. It could not be otherwise, and that the work
has grown despite discouragements is proof that it has a strong hold
on the public. It is only by comparing our failures and successes and
winnowing out the chaff that we can build up the most effective system,
and this is the excuse I have for speaking of Oakland's system of health
inspection. I designate it Oakland's system because at the time it
was instituted, July, 1909, there was, as far as I could learn no other
city working along the same lines nor do I know at present bf any other
large city that has adopted it. It is an entirely paid and whole time
department. No volunteer work and no one with divided interests,
everyone connected with the department giving full time to the work.
At present the department consists of a Director, who is a physician
and seven graduate nurses. The work attempted by the department
in common with all systems is educational, reparative, attention to
sanitation of school buildings and grounds and the eradication of in-
fectious diseases.

The distinctive feature of this system is that the work is largely done
by nurses. They are trained to the work and receive a gradually in-
creasing salary, beginning at $75.00 per month and increasing $5.00
per month each year until $100.00 per month is reached. They are
also paid $2.50 per month for extra car fare. The Director is the man
of all work and upon his tact and ability to handle people will depend,
as in all systems, its success. He must train his nurses, be ever ready
to answer questions of any and- all kind, meet irate parents and con-
vince them that the work is for their good, enlist the active support
of physicians, see to the sanitary conditions of schools and be at all times
ready to answer the call of teachers, even if it is sometimes useless.
Only in a slightly less degree does success depend upon the nurse. They

440 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

are constantly with the children and the parents, and their personality
and ability to meet and kindly conquer is a strong factor of success.

Method of Work. Our schools are divided among the nurses, each
one keeping as nearly as possible the same schools year after year. She
visits them at least every two weeks to look after any particular case
or give any aid or advice that may be needed. Once each year she
examines systematically each child in her schools and carefully records
results. The child is taken into the room set aside for this purpose
and examined for vision, hearing, throat or mouth trouble, condition of
breathing, general nutrition, etc. The child is not disrobed, but any
malformation that can be detected is noted. An effort is made to get
the confidence of the child and excite an interest in health. For this
purpose a mental picture of the ideal man or woman is kept before the
child and the means of attaining that ideal, rather than the defects
found are dwelt upon. The defects are, however, carefully noted and
after school hours the nurse sends to the parent, in a sealed envelope,
the result of the examination, if anything needing care is found. This
notice will have some effect, a small percentage will respond at once
and this percentage is increasing each year. While the parent may
forget or neglect, the nurse does not, but she visits the home and explains
the need of attention, and these visits are repeated as needs demand.
Our notice to the parents does not state a definite diagnosis, but says
the examinations "seems to show" a given condition and asks that the
family physician or specialist be consulted. The reasons for this are
apparent: First, we do not think it well for the nurse to try to make
a diagnosis, although in a large majority of cases she could do so. Second,
the loss of time required to niake a careful diagnosis and frequently
the impossibility of making one with the appliances at hand. Third,
there are still some doctors who feel that it raises them in the estimation
of a patron if they dispute another's diagnosis.

The nurse after a few days follows the notice to the house and shows
the mother the needs of the case and the benefits to be expected if the
proper work is done. No compulsion, but strong persuasion is used.
Conditions at the home are studied and whenever it will be received,
advice as to proper food, bathing, ventilation, etc., are given. Among
a very large class, inattention to these things are responsible for much
physical and mental weakness and their correction will wonderfully
improve conditions. In every city there are many who cannot pay
the price for proper medical or surgical attention and it is among this
class that our work is most needed. Frequently we find whole families
having physical defects that are slowly and surely sapping their vitality.
A few dollars expended on each member in remedying these defects would

OAKLAND SYSTEM OF HEALTH INSPECTION 44 1

make the difference between success and failure in life, but the few
dollars is not theirs and unless the city conies to their aid it will later
have to support many of them as indigents or criminals. No city can
afford not to have facilities for the repair of physical defects of the
children of the poor.

Practically the only criticism that I meet to this system comes from
those who think that a nurse cannot or should not examine the children.
They seem to think that a nurse cannot tell trouble when she sees it.
A moment's reflection will answer this criticism. They can certainly
tell a decayed tooth, a mouth breather, defective vision, impaired
posture or malnutrition. They may not be able always to tell the
cause, but what of it, neither can any of us always, and some of us not
at all. It makes no difference, the defect is there and the family doctor
or specialist is anxious to find the exact condition and cause. If treat-
ment is to be given he would examine for himself and arrive at his own
conclusion and the time given by the school examiner to make an exact
diagnosis would be wasted and if it did not agree with the conclusions
of the latter examiner, discredit would be cast on the department.

The nurse is patient, painstaking and diplomatic. She can get
nearer to the children than a man and excite more interest in themselves
and her "seems to show" is for all practical purposes as good as a careful
diagnosis. A divided interest is not conducive to the best work and it is
difficult to get a doctor to give his full time to routine examinations of
school children, unless he is a failure in his profession, in which case we
do not want him. Young physicians or old ones who have lost their
grip can be secured for part time, both making the school work secondary
to their private. It is seldom that one of this class will do the best
public work, for it is nearly impossible for one not to have an eye on
their private business. Even if the position is not used to get private
practice, work is liable to come to them during hours that should be
.devoted to the schools, and the private work gets the preference. While
[the doctor may work honestly and faithfully for the public, the public,
)r some of it, will accuse him of using his position for private gains. It
jis as important to avoid the appearance of evil as the evil itself. For
the whisperings of wrong will wreck the harmonious workings of a
lepartment as quickly as it will a private character.

Results. There is no absolute standard of results by which we can
measure our work, it is not spectacular and results will frequently
develop only after months of waiting and one should not be discouraged
if a child, after operative work has been done, does not, immediately
improve. The removal of diseased tojisils, for instance, is generally
. in a child followed quickly by good results, but sometimes the patient

442 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

fails to show improvement for a long time, and it is the same with other
operations. There are so many complicated conditions entering into
our cases that no one can tell exactly from whence the good comes or
why results are not what we hoped. Again we have to depend upon
whoever the parents select to do the work; the selection is often bad
and poor results follow. We will never be independent of this draw-
back until the city has a hospital of its own where the best skill is em-
ployed and where the poor and those in moderate circumstances can
have the work done free or at a moderate expense.

The usual way to measure results is the number who attempt to
follow suggestions. While this does not give the final result in units
of improved physical or mental force, it does show the effectiveness of
the department. Until we can control the reparative work some of it
will be unsatisfactory and we will get the minimum of good results.
In the Oakland Department we do not try to get reports from parents
or teachers as to whether or not our requests for treatment have been
followed. We tried it the first year and the results were useless. We
mark as corrected one year those who do not show the same defect as
was recorded against them the year before, and seek the cause of cure.
This is the basis of our report of results. A mere visit to a doctor or
dentist is not accepted, actual improvement in conditions or the removal
of the defect must be in evidence. Statistics of results for comparison
based upon physical or mental improvement must always be unsatis-
factory until we have a standard of examination and results. One
city will mark every decayed, decidious tooth as a defect, thereby in-
creasing the percentage of defects. Another will mark none of this
class and have a small percentage. The small defect did no particular
harm to the health of the child nor will its repair increase its vitality;
looking forward the benefit is great, but for classification on a basis
of immediate physical or mental improvement it cannot compare with
a city which records only more serious defects. We have made no
classification as to benefit except the general one that almost all cases,
at least 98% of tonsilar and adenoid cases have been decidedly bene-
ficial. An equal percentage have been benefited by glasses. For dental
work the percentage is much less, this is what would be expected, as
very many of the dental cases show no ill effects on health. The danger
is for the future.

The other defects vary in benefits received. Just as in all medical
and surgical practice, the removal of a defect or diseased condition
will prevent more extensive trouble while always not immediately
improving the general health.

The 6 per cent, decrease of retarded^children in our schools during

■ ■ Ma

OAKLAND SYSTEM OF HEALTH INSPECTION 443

the school year of 1911-12 is, no doubt, largely the result of our health
inspection.

We examined, in the school year of 1911-12, 17,326 pupils. Of these
12,343 or 71% were more or less defective. In the examination in 1912-
13, we found 8,666 of the defective children still in school. The others
having passed to higher schools or left school entirely. Of these 8,666,
4,271 or 49.4% had received beneficial attention. We have recorded
508 cases as receiving hygienic treatment. These are cases which
were influenced to better methods of life by the school nurses and the
defects were thereby removed. If these be taken from the 4,271 receiv-
ing beneficial treatment there would be 43.6% receiving professional
treatment. As these 508 are marked defective and charged as such,
I see no reason why they should not be credited to the other side of the
account since they received benefit by following special directions of
the nurse by sleeping out of doors, giving up drinking of wine, coffee
and tea, breathing properly and bathing frequently.

Among the parents there is almost no complaint and frequently
they send for the school nurse to get advice on questions pertaining
to health matters. The principals and teachers are coming to rely on
the department and refer to it questions of the relation of health to
work. Infectious diseases have materially lessened, and the appear-
ance and cleanliness of the children has very much improved.

Grand Total, Term of 191 i- 12

Age 10 Yrs., 6 Mos.

Grade

Defect of Vision 3.572 20.6 %

Defect of Hearing 1,198 6.6 "

Defect of Nasal Br 1,815 10.4 "

Defect of Tonsils 5.189 29.9 "

Adenoids 1,112 6.6 "

Enlarged Glands 1,312 7-5 "

Decayed Teeth 7,343 42-3 "

Disease of Nerves 40 -2

Disease of Skin 61 .3

Disease of Lungs 2 . 01 "

Disease of Heart 14 -08 "

Defect Orthopedic 75 -4

Defect of Palate 29 .1 "

Malnutrition 54^ 3-1

444 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Pupils with I defect 6,104

2 " 3,670

3 " ' 1.716

4 " ••• 634

5 " 168

6 " 45

12,343
Pupils defective I2,343 7i%

" non-defective 4,983 29 "

examined 17,^26

Corrections of Defects, Term of 1911-12

Pupils reported for one or more defects 8,666

No response 4,395 50-6%

Responded 4,271 49 • 4%

Glasses fitted 385

Eyes treated 127

Throat or nose operation 572

Throat or nose treatment 245

Other operations 51

Skin treatment 137

Medical treatment 525

Hygienic treatment 508

Dental work 1,691

Christian Science treatment 30

Total 4,271

DISCUSSION OF

N. K. FosTEji's Paper

B. Franklin Royer

I am not inclined to agree with the preceding speakers concerning
the advisability of doing the work of medical inspection by means of
nurses. It seems to me to be very much better to use the physician
for this work and the nurse or, better still, the sociological worker to
follow up cases requiring treatment where the teacher fails to secure

OAKLAND SYSTEM OF HEALTH INSPECTION

445

e cooperation of the parents. We have not reached the ideal in
medical inspection; it is only when we include many things not now
included in the inspection that we can hope to approach the ideal and to
do the things the nurse's training does not fit her t6 do. Further med-
ical inspection is very much more likely to meet with the approval of
the medical profession and with school authorities, largely influenced
by the profession, if done by medical men; and the opinion given the
parents relative to defects in the child, probably remediable, is very much
more apt to be heeded when based upon a physician's opinion than when
based upon the opinion of nurse or teacher.

There should be no question of conflict of authority concerning the
sanitary procedure incident to the presence of communicable disease
in the school room. In these matters the authority of the health officials
I always takes precedence, so that in schools, as in this building, if infec-
tious disease developed the health officer's order must be obeyed. For
example, in this particular room, if smallpox, scarlet fever or diphtheria
were present. Dr. Fronczak, the health officer of the city, would order
the room closed until disinfected and no matter what other authority
might disagree with him his order would always be respected and obeyed,
and so with school work, the supreme authority is always the health
authority and must necessarily remain so. With inspection under
health authorities no conflict arises; with inspection under school author-
ities occasional friction may occur.

446 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

MEDICAL INSPECTION IN VALPARAISO (INDIANA)
PUBLIC SCHOOLS

Otis B. Nesbit

School inspection in Valparaiso, Indiana, was established in March,
1910, to assist in controlling an epidemic of scarlet fever which had per-
sisted in the city for two and one-half years. Two physicians without
compensation carried on the work with the essayist, the balance of the
school year, there being three school buildings known as the Central,
the Columbia, and the Gardner Schools. The last case of scarlet fever
in 191 1 occurred in June. The city went until April, 1912, when three
cases appeared about the same time, two beinig school children, telling
us some mild case was at large. It was not found in school.

Our schools opened September 3rd, 1912, and the inspection failed
to find a case of quarantinable disease. No case of scarlet fever was
known to exist in the city. The second week of school passed with no
cases. On Sept. 24th a girl in the Fourth Grade, Central Building, was
taken sick with scarlet fever. The case was not diagnosed until Friday.
On Friday night another case developed from this room. Monday all
pupils were in attendance except these two. An inspection failed to
reveal any pupil with, the disease but a pupil was found with a muco-
purulent discharge from the nose, with enlarged tonsils, several decaying
teeth, and adenoids, who was the last known case of scarlet fever in the
city, having taken sick June i, 1912, and released from quarantine July
15th. This pupil was regarded as a probable carrier and was excluded
from school until her nose was dry. She was re-admitted. After eight
weeks the two cases returned and no further trouble occurred in that
building during that semester. January 20th the new semester opened,
the probable carrier was promoted to Room Five. On January 22nd
and 23rd she was out of school with a cold, returned the 24th, and on
the 27th a pupil in the room was stricken with scarlet fever. On this
date the inspection failed to find any one in the room or school except
this probable carrier, whose nose and throat presented about the same
appearance as before. She was again excluded and after re-entering
no further trouble occurred in the room or building until a boy who had
been ill was permitted to re-enter school without seeing the physician.
He was in one day and was found the next morning, with a profuse skin
desquamation and a history of illness that made the diagnosis of scarlet
fever easy. His brother had come home from an adjoining city sick

MEDICAL INSPECTION IN VALPARAISO (iND.) PUBLIC SCHOOLS 447

with quinsy and his sickness, with that of a brother under school age,
followed. This pupil was in the Sixth Grade. When found the nose
and throat were free from abnormal discharges, he being one of the type
that do not freely distribute discharges and infections. He was excluded
from school and the home quarantined. An inspection of all pupils
found no suspects. The inspector explained the situation to the pupils
and told them how scarlet fever was spread, advised all to return at every
session of the school unless ill and to stay from school and see a physician
for any mild case of sore throat or ill feeling and explained its importance.
The method of school room cleaning was explained to them. The pupils
were excUvsed until the afternoon session. The room was disinfected.
The pupils' books were disinfected by the Beebe Method. School resumed
at I P.M., all pupils were back except two, both returning the next morn-
ing. The pupils were inspected every day for four days and not a case
developed nor did any other case occur in pupils attending the building
during the school year.

In the Columbia building we had only two cases of the disease, one
source not being determined except that it certainly did not occur from
a school exposure. The other case went to Chicago to spend Christmas
with a bachelor lady physician. The physician had a dear friend who
had two children. One had scarlet fever. The physician took the other
child to her home to keep until after the quarantine was lifted. On
Monday following the Valparaiso girl went to visit the doctor. She
played with the doctor's other guest, returned home Friday, developing
scarlet fever that night. This occurs so frequently and so little notice
taken of it, is why I recite it. The Chicago doctor was afraid the child
she took home with her was coming ^down with scarlet fever but decided
it was not, being as she said a very mild sore throat. Children taken
from where scarlet fever is known to exist, with red throats, nasal dis-
charge and the mildest symptoms are frequent carriers and distributors.

Scarlet fever did not occur in the Gardner School until in the second
semester, when three cases from three different rooms developed the
same day. Nothing was found in school but all gave a history of having
been with a girl whose sister had the disease and this girl had not been
quarantined and was living away from home. She gave a history of
having had a sore throat, and was probably the source of these cases as
well as three cases outside of school.

A teacher in this building developed the disease on Thursday who had
been visited by a young man from a near-by city on Sunday. The young
man had suffered from a very severe sore throat ten days before. He
came from a city which had much scarlet fever. This teacher was re-
leased from quarantine on the 42nd day and returned to- school on the
43rd day after the beginning of illness without the permission of the

448 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

school physician and remained that day. She was excluded the following
morning under the rule of two weeks' exclusion from school after release
from quarantine. The following Sunday a case developed in one of her

pupils.

The week following the release of the three cases occurring the same
day a boy in the neighborhood developed the disease. The children had
not returned to school.

In 1 9 10 there were 51 cases of scarlet fever among pupils who lost
1,526 days in attendance. In 191 1 only two cases losing 80 days. In
1 9 12, ID cases compelling them to be absent 272 days.

The number of cases attributed to school exposure in 19 10 was 31;
in 1911, o; in 1912, 3.

In nearly every case of scarlet fever in this city since September,
1910, we have been able to trace an exposure of the patient within four
days. First, to some person known to have the disease. Second, a
person who had previously, even months before, had scarlet fever and
having a diseased condition of the nose, throat or teeth ever since. Third,
to persons who had recently been with known cases and gave history or
evidence of a mild infection.

We have had no cases that pointed to infection from things.

Some of the other infections in the schools in 19 12 were:

Diphtheria Carriers. Four diphtheria carriers were found in the
school during this year but no cases developed.

Septic Sore Throat. We had at the opening of school thirty cases.
None in acute stages. All were admitted with only six cases developing
after, among the pupils, and all these had intimate playmates or mem-
bers of the family at home with the disease, which leads us to regard
the disease as but mildly contagious in school.

Measles. Thirty-seven cases of measles occurred during this year.
In view of the disease starting outside of school and being well dis-
tributed, this was considered not bad. The plan proposed by E. C.
Levy, Richmond, Va., of closing the room from nine to fourteen days,
was considered but was not practical in all cases. It is a splendid ob-
servation and would be useful at times. The inspection of the pupils
in a room where measles has developed from the ninth to the fourteenth
day and exclusion of all cases with slightest catarrhal symptoms was
probably of some service in lessening the spread.

We do not disinfect for measles as a rule. Would do so if the first
case in a city was a school case.

Chicken-pox. Occurred in only three families and were easily con-
trolled.

MEDICAL INSPECTION IN VALPARAISO (iND.) PUBLIC SCHOOLS 449

Impetigo^ Itch and Vermin. Caused a much greater loss than would
have been necessary had a school nurse been employed. 26 cases lost
126 days.

Mumps. Mumps occurred in 35 pupils from 25 families and was
spread through inability to recognize a probable carrier which produced
10 cases, and possibly other carriers, and too short an exclusion of the
first case— three weeks.

Whooping Cough. Only four cases of this disease was found. This
disease will be easier controlled in the future in places where laboratories
are accessible, as the taking of cultures will enable the authorities to
recognize this as easily as diphtheria. It has been the unrecognized case
that has been the principle distributor.

Oral Hygiene. Mouth conditions attracted the attention of the
Medical Department of the school in 1910 when 190 examinations were
made by the local dentists without expense to the school. In 1911-1912
records were made of 976 mouths which included practically the entire
school membership from the kindergarten up — public school pupils and
three country schools. In 1912-1913 records were made of 1,013 i^ the
Public Schools, 24 in the German, and 86 in the Parochial. A decrease
of one cavity per pupil and the increase of the number with no cavities
in permanent teeth from 22% to 36%, the saving of 186 permanent
molars, and 50% receiving fair dental attention are some of the things
shown by the following table that seems encouraging:

H Comparison of Mouth
■ Examinations
H Valparaiso Schools

Public

Schools

May

1910

Public
Schools

Sept.

1911

Public
Schools

Jan.

1913

German

School

1913

St. Paul

School

1913

Three

Rural

Schools

1912

^ Total No. Examined

190

976

1013

H Total No. Cavities

937

4796

3996

582

403

■ ""''*''""• ^<*^»^^^

^S Total No. Cavities in Temp.

482

2197

1905

205

148

H Total No. Cavities in Perm.
■ Teeth

454

2599

2091

277

275

I Total No. Pupils with No

116

179

^p Total No. Pupils with None
^" in Perm. Teeth

246

369

Total No. Perm. Teeth Ex-
B trartH

178

H Total No. Pupils. Having
■ Lost Perm. Teeth

116

450 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Comparison of Mouth

Examinations

Valparaiso Schools

Public

Schools

May

1910

Public
Schools

Sept.

1911

Public
Schools

Jan.

1913

German

School

1913

St. Paul

School

1913

Three

Rural

Schools

1912

100

Total No. with No Fillings

No. Not Using Brush

238

No. Not Having Brush

119

No. Pupils' Teeth Need

722

Total No. Perm. Teeth to
be Extracted

No. Pupils Having Had Den-
tal Attention

521

Average No. Cavities

4.98

4-9

3-99

312

6.76

5-9

Average No. Cavities in
Temo. Teeth

2.52

2.25

1.88

1.58

2.38

Average No. Cavities in
Perm. Teeth

2.38

2.2

2.06

1-54

3-22

3-6

Per Cent, of Pupils with
None

7.8

II. 8

16.6

16.

6.97

Per Cent, of Pupils with
None in Per . . .

22.1

25.

36.

50.

22.

18.

Per Cent, of Pupils with
Diseased Teeth

92.2

88.2

834

84.

93 03

96.

No. of First Molars Diseased

1389

1203

187

151

Disinfection, For disinfection material a mixture of the Cresols, the
Phenal coefficient being known, is used.

The one used last year had a Phenal coefficiency of 3.92 and was used
one part to 80 parts of water.

Method. A one to eighty solution was used daily on the banisters
or stair hand, railings. When scarlet fever occurred in a pupil while at
school the books were removed from the sick pupil's desk and disinfected.
The seats, wainscoting, lower window casings, the chalk troughs, door,
including knob, and the interior of the clothes closets were washed with
the disinfectant. The floors of the room and cloak room were mopped
with the same. As soon as the floors and seats were dry school would
resume if desired. Erasers are fumigated by putting in closed chamber
using formalin.

MEDICAL INSPECTION IN VALPARAISO (iND.) PUBLIC SCHOOLS 45 1

Disinfection of Books. When books were fumigated the Beebe Method
of immersing the books in a solution of 2% Phenal crystals in gas-ma-
chine gasoline for 20 minutes was used. Then allow the books to stand
on ends for several days in the store room.

The mortality record during the school year of 1911-1912 was one
pupil, age eight years, dying of acute dilation of the heart due to em-
physema.

During the school year 1912-1913 it was three, one age 10 of tetanus,
one age 11 of septicemia due to acute endocarditis, and one age 16 due
to pneumonia. No deaths occurring during the vacations directly
attributed to acute conditions arising during the school year. The school
enumeration in the city in 1912 was 1,735 with two deaths of school age.

Other activities of the department has been the making of a physical
record of the pupil, a limited study of some of the mentally deficient, and
the establishing of a manual training class for them.

Free operations, dental and surgical, have been provided for some.

Ventilation and heating have been studied sufficiently to know our
plants are inadequate and the opening of windows during exercise period
is the rule.

The teaching of hygiene and sanitation has been emphasized by a
School Health Exhibit. Talks have been carried on before the physiology
classes in the grades and high school with microscopic demonstrations,
and the cultivation of bacteria from water, milk, air, and from mouth
discharges and fingers.

Public health lectures under the auspices of the County Medical
Society have been well patronized and it will furnish two lectures a
month during the coming winter.

452 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SANITARY INSPECTION OF THE RURAL SCHOOLS
OF PENNSYLVANIA

Samuel G. Dixon

In making provision for sanitary inspection of the school grounds
and buildings, the School Code continued a custom that had been in
force in the rural districts of the Commonwealth since 1907, the specific
provision in the Code reading as follows:

"The medical inspector shall, at least once each year, and as early
in the school term as possible, make a careful examination of all privies,
water-closets, urinals, cellars, the water supply, and drinking vessels
and utensils, and shall make such additional examinations of the sani-
tary conditions of the school buildings and grounds as he deems neces-
sary, or as the regulations of the State Department of Health, or the
rules of the board of school directors or of the local board of health
require. He shall see that the laws of the Commonwealth relating to
the health and sanitation of the public schools and the requirements of
the public schools and the requirements of the local board of health
are complied with."

In compliance with this provision of the Code, a sanitary survey
form was designed that combined the best features of former blanks,
some features of forms used in other communities and some of the
features of the Sanitary Index, designed by Dr. Hoag of Berkley, Cali-
fornia. (The particular form in use at the present time in our schools
is available at the Department's Exhibit.) The form in use at the
present time requires the Inspectors to make particular notes in regard
to the air space; floor space; lighting surface; cleanliness and methods
of cleaning of all rooms in the building; special notes relative to the
ventilating system, whether by mechanical apparatus or by means of
windowfe; window shades; the heating and operating of the heating
devices; condition of the basement; most careful inquiry into the water
supply of the school, including the handling of the water in the room
itself; use of drinking cups, fountains, etc.; the condition of the grounds
in the vicinity of the school buildings; and careful examination of the
school water closets and the disposition of waste from them.

A surprisingly large number of the schools of Pennsylvania, I regret
to say, are not in a sanitary condition. In fact, only about one-half the
country schools have a suitable amount of air space and floor surface.
About 14 per cent, of these schools have deficient lighting surface; that

SANITARY INSPECTION OF RURAL SCHOOLS OF PENNSYLVANIA 453

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SANITARY INSPECTION - OF RURAL SCHOOLS OF PENNSYLVANIA 455

is, less than 20 per cent, of the floor space. The majority of them
admit light from both sides of the room and in front of all pupils seated
in the rear of the room. Sixty per cent.. of these schools use no prepara-
tion on the floors to prevent dust arising while cleansing the rooms,
the majority of them using dry sweeping and dry dusting. In about
thirty per cent, of the schools heated by stoves the jackets are not in
use. In about one-third of the rural schools without ventilating appa-
ratus rational flushing was used during recess. In a majority of the
single room buildings dark green shades were used to exclude the light,
meaning of course too much exclusion or too much light. In not quite
one-fourth of the rooms heated by stoves was the air admitted at or near
the stove. In about one-half of the schools using towels the roller
towel was found in use. One-half of the schools have their doors
opening inward instead of outward. The majority of the schools have
their own water supply, usually wells or springs, and in more than ninety
per cent, of the schools a fair degree of protection of the source of supply
is maintained, although in nearly half the cases a dangerous menace
existed in the form of a neighboring privy or in the waste disposal from
the school itself, the human filth accumulating in dry wall closets within
less than a hundred feet of the source of water supply, either on the
school premises or on neighboring premises. In from seventy-five to
eighty per cent, of the rural schools drinking water was found in con-
tainers without covers and in a very large percentage of the schools the
public drinking cup is still in use. In a vast majority of the schools
of Pennsylvania separate privies are provided for both sexes, but in
five per cent, of the schools these privies are in bad repair and in more
than ten per cent, of the schools, are not kept in a clean and sanitary
condition; that is, in a decent condition for the use of pupils.

Probably at times the fault lies with the teacher, at other times
with the directors in not providing locks on the doors so that the public
tramps, vagabonds or anyone may use the closets that the pupils are
required to use at school. In less than twenty-five per cent, of the
schools did we find lime or other antiseptic used to disinfect and deodor-
ize the contents of privy vaults.

Some amusing things occurred in connection with the sanitary
inspection of the rural schools. It may surprise you to know that in
one district where the parents complained to us that no privies or out-
buildings were provided, the secretary of the School Board admitted
to us in writing that they had not provided such a building, explaining
that the school house was new and as there were several acres of timber
land nearby, they thought the children could get along very well by using
the woods. I am sure this Congress would expect a pretty sharp repri-
mand from the health authorities when a school director showed such

456 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

little decency as to allow his own child, along with his neighbors to
expose themselves in the woods with perhaps other pupils gaping at him
while attending to nature's needs. We not only reprimanded the
Director, but urged the parents to seek a remedy at law by appealing
to the Court and proceeding against the Board for malfeasance in office.
Some of the school boards felt that our standards were too high and
objected to medical inspection because of standards implied in the sur-
vey form and made mandatory by the School Code. In the Act, pro-
vision is made for the light area to equal 20 per cent, of the floor area,
and for each pupil to have 15 sq. ft. of floor surface and 200 cu. ft. of air
space, the provision of course referring to new buildings or those that
are about to be remodeled. , In our communication to the Board after
the inspection was made we forwarded a letter calling particular atten-
tion to all unsanitary conditions found, pointing out the specific defects
in groups and sent a complete copy of the sanitary inspection with the
letter, the letter reading as follows and bearing on the back of it the
particular extracts from the vSchool law :

DEPARTMENT OF HEALTH
Harrisburg, Pa.

191..

Secretary School Board,
District.

Dear Sir: The water supply, the lighting facilities, the methods of cleaning, the
methods of heating and ventilating in school buildings and the conditions of the water-
closets, privies and the grounds, are made the subject of sanitary inspection by the
State Department of Health.

The water supply for your schools should be free from any possible surface pollution,

and from menaces located on a higher level, such as privies and barnyards. In

of your schools a safer supply should be provided. Individual drinking cups should
be provided for the pupils in all schools not having a public water supply and the drink-
ing supply should be kept in a covered vessel, preferably with spigot at the bottom,
and the vessel should be scalded every day and a fresh water supply eecured for every

session. These precautions are not being observed in of your schools.

Where public water supplies are available bubbling fountains should be installed.

Dry cleaning should never be practiced in any school room. This custom is being
followed in of your schools.

Article VI, Section 618 of the new School Code provides that the lighting surface
should be at least 20% of the floor surface, and that light shall not be admitted in front

of the seated pupil. In of your schools the lighting surface is less than

20% of the floor space, and in of your schools light is admitted in front

of the seated pupils.

Article VI, Section 619 of the School Code requires that where a common heat-
ing stove is used, it shall be incased with a shield or jacket. The stoves in use in

of your schools are not so incased.

SANITARY INSPECTION OF RURAL SCHOOLS OF PENNSYLVANIA 457

Article VI, Section 632 provides that not less than two water-closets shall be pro-
vided for each school building where both sexes are in attendance. Where such closets
are detached from the school building, entrances shall be screened; if situated near
each other the approaches shall be screened by a partition, wall or fence not less than
7 feet high. This section is being violated in of your schools.

Article VI, Section 633 provides that water-closets shall be kept in a clean and

sanitary condition and dry slaked lime or other disinfectant shall be used. In

of your schools the water-closets are not in a sanitary condition.

In of your schools the grounds show evidence of pollution from

human waste. Your attention is called to this condition because of the opportunity
for children to carry such filth into school rooms on their shoes.

Yours respectfully,

SAMUEL G. DIXON.
N.B. — Enclosure — Copy of Inspector's report of the schools in your district.

EXTRACTS FROM SCHOOL CODE.

Article VI. Section 601. The board of school directors of each district shall
provide the necessary grounds and suitable school buildings to accommodate all the
children between the ages of six and twenty-one years, in said district, who attend school.
Such buildings shall be constructed, furnished, equipped, and maintained in a proper
manner as herein provided, suitable provisions being made for the heating, ventilating,
and sanitary conditions thereof, so that every pupil in any such building may have
proper and healthful accommodations.

Article VI. Section 618. All school buildings hereafter built or rebuilt shall
comply with the following conditions:

In every school room the total light area must be equal at least twenty per centum
of the floor space, and the light shall not be admitted thereto from the front of seated
pupils.

Every school room shall have not less than fifteen square feet of floor space, and
not less than two hundred cubic feet of air space per pupil.

Article VI. Section 619, No board of school directors in this Commonwealth
shall use a common heating stove for the purpose of heating any school room, unless
such stove is in part enclosed within a shield or jacket made of galvanized iron, or other
suitable material, and of sufficient height, and so placed, as to protect all pupils while
seated at their desks from direct rays of heat.

Article VI. Section 620. No school room or recitation room shall be used in
any public school which is not provided with ample means of ventilation, and whose
windows, when they are the only means of ventilation, shall not admit of ready adjust-
ment both at the top and bottom, and which does not have some device to protect
pupils from currents of cold air. Every school room or recitation room shall be fur-
nished with a thermometer.

Article VI. Section 621. Every school building hereafter erected or recon-
structed, whose cost shall exceed four thousand dollars ($4,000.00), or which is more
than one story high, shall be so heated and ventilated that each school room and reci-
tation room shall be supplied with fresh air at the rate of not less .than thirty cubic
feet per minute for each pupil, and which air may be heated to an average temperature
of seventy degrees Fahrenheit during zero weather.

458 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Article VI. Section 622. All school buildings, two or more stories high, here-
after erected or leased in any school district of the first class in this Commonwealth
shall be of fireproof construction; and in any school district of the second, third, or fourth
class, every building more than two stories high, hereafter built or leased for school
purposes, shall be of fireproof construction.

Article VI. Section 623. All doors of entrance into any building more than one
story high, used for a public school building in this Commonwealth, shall be made to
open outward, and the board of school directors of every district in this Commonwealth
shall, before the opening of the school term next following the approval of this act,
change the entrance doors of every such school building so that they shall all open
outward.

Article VI. Section 624. In all school buildings more than one story high,
hereafter erected, all entrance doors, as well as all doors from class rooms, school rooms,
cloak rooms, or other rooms into halls, shall open outward.

Article VI. Section 625. Every school building shall be provided with neces-
sary fire-escapes and safety-appliances as required by law.

'Article VI. Section 626. The board of school directors in each school district
shall put the grounds about every school building in a neat, proper, and sanitary condi-
tion, and so maintain the same, and shall provide and maintain a proper number of
shade-trees.

Article VI. Section 632. The board of school directors in every district shall, with
every building used for school purposes, provide and maintain in a proper manner, a
suitable number of water-closets or outhouses, not less than two for each building,
where both sexes are 'in attendance. ^ Such water-closets or outhouses shall be suitably
constructed for, and used separately by, the sexes. When any water-closets or out-
houses are outside and detached from the school building, the entrances thereto shall
be properly screened, and they shall, unless constructed at a remote distance from each
other, have separate means of access thereto, and, if possible, for not less than twenty-
five feet from such water-closets or outhouses, such means of access or walks leading
thereto shall be separated by a closed partition, wall, or fence, not less than seven
feet high.

Article VI. Section 633. The board of school directors shall keep all water-
closets or oujhouses, used in connection with any school building, in a clean and sani-
tary condition, and shall, not less than ten days prior to the opening of any term of school,
and oftener if necessary, have them properly cleaned and disinfected by the use of
fresh dry-slaked lime, or other proper disinfecting material.

It was encouraging in some districts to find that the school author-
ities agreed with the framers of the law that what is required for new
buildings and reconstructed^ buildings is also good for old buildings
so that in one district in Warren County our Inspector reported after
his first examination and our letter that all buildings had been changed
throughout the district, his letter to us reading as follows:

SANITARY INSPECTION OF RURAL SCHOOLS OF PENNSYLVANIA 459

**Dear Sir:

As school inspector for Pine Grove Township (Warren County), I would like to
make a, special report in regard to the improvement made by the Pine Grove School
Board since the inspection last year. These improvements are:

1. Use of * no dust ' sweeping,

2. Abolishment of dry dusting,

3. The placing of additional windows in each schoolhouse to comply with 20%

law,

4. Window boards,

5. Jackets around stoves,

6. Pan water on each stove,

7. Placing stools in each room as necessary,

8. Two new ventilation stoves,

9. Paper towels in all rooms,

10. Changing doors to open outwards,

11. Installation of stand water-crocks with spigot at bottom — covered,

12. Individual drinking cups,

13. Screening and repairing closets,

14. Liming closets,

15. Cleaning closets and grounds.
Involving in all about $500 expenditure.

I believe that a good strong letter of recommendation to Mr. Chas. A. Clark,
Secretary School Board, Pine Grove Township, Russell, Pa., would help much in show-
ing the community just what has been done and the value thereof."

In another community the sanitary inspection was delayed a little
while until the Directors could meet the modern requirements of the
Code and make changes that were held under advisement for several
years previously. A letter from the Examiner in this school district
is also worth reproducing:

Sir:

I am forwarding reports of the medical inspection of the (-

-) Schools

under separate cover. The delay in sending in these reports was occasioned by the
request of the Board of Education desiring time to study them and meet the advanced
requirements of modern hygiene.

Paper towels have this day been installed, dry dusting has been abolished, and
contracts let for the sanitary drinking fountains.

These essentials it was impossible to get until confronted by this Sanitary Survey
of the Schools.

Respectfully submitted.
November 22, 1912."

Even in some of our Normal schools were found lacking in certain
sanitary particulars, one school, I will not mention it by name, made
a hurry-up contract with a plumber and installed drinking fountains
during the few days that the Inspector was examining the pupils so that
in this requirement they might get a hundred per cent.

460 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

With results before us such as have been accumulated it is certainly
encouraging to health authorities and school authorities to fix high
sanitary standards and to make inspections from time to time to see
that they are being carried out. It is just as essential that the country
boy and country girl be given healthful sanitary surroundings in school
as it is for the city boy and city girl. It is just as essential that they
be taught obedience to law as that they should be taught to read and
write and be given a knowledge of arithmetic, etc. In sanitary matters
in rural schools we are greatly handicapped by the lack of sanitary
information on the part of the School Directors and it is only by faithful
attempts to educate the Directors and parents that we can hope to
secure for the pupils all of that protection which the framers of the school
laws of the country hope to secure for them.

MEDICAL INSPECTION IN RURAL DISTRICTS OF PENNSYLVANIA 46I

SCHOOL MEDICAL INSPECTION IN RURAL DISTRICTS
OF PENNSYLVANIA

Samuel G. Dixon

Medical inspection of rural school children was first undertaken by
the State Department of Health of Pennsylvania during the spring of
1910, trial inspection being made in 657 rural schools located in the
second-class townships of Cumberland, Dauphin and Lancaster Counties
reaching 14,434 students. State-wide inspection of rural school children
was not undertaken, however, until the fall of 191 1 and was done in com-
pliance with Article 15 of the new School Code of Pennsylvania, adopted
on the 1 8th of May of the same year.

The School Code provides for compulsory medical inspection of all
pupils attending the public schools at least once each year, except in
districts of the third and fourth-class where the School Directors may
elect to have no such inspection. In third-class districts such resolution
must be adopted before August ist, and in fourth-class districts the reso-
lution must be adopted and the Commissioner of Health notified prior to
July 1st, in order to be effective for the ensuing year. Further, the
expense of inspection in a first, second and third-class district is to be
borne by the district itself and in a fourth-class district by the State
Department of Health. I may say incidentally that first-class districts
include cities having a population greater than 500,000. There are two
such districts in the state. Second-class districts include municipalities
having more than 30,000 and less than 500,000 population. There are
fourteen such districts in the Commonwealth. The third-class districts
include boroughs and cities of the third-class and densely populated
townships having a population of from 5,000 to 30,000. There are
188 of these districts. Districts of the fourth-class include all townships
and organized boroughs having a population less than 5,000. These
districts total 2,366.

In the districts of the first and second-class where medical inspection
is mandatory or in third-class districts where it is optional and resolu-
tions are not passed against it prior to the time fixed by the Code — and
an Inspector is not appointed within thirty days after the beginning of
the school term — the Commissioner of Health is required after written
^—^ notice to appoint qualified Inspectors, fix their compensation, the ex-
IB pense of which must be paid by the school district.

462 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

defective sight, to defective hearing and other disabilities to be deter-
mined by the Commissioner; and also provides that written reports
shall be sent to the parents through the teacher concerning all pupils
found to need medical or surgical attention. The Medical Inspector is
also required by law to make a careful sanitary inspection of all privies,
water closets, urinals, cellars, water supplies, drinking vessels and uten-
sils, and to make any such additional examinations of the sanitary con-
dition of the school buildings and grounds as he deems necessary or as
the regulations of the State Department of Health or the rules of the
Board of School Directors or of the local Board of Health require.

School Medical Inspectors are required by law to have had two years'
experience in the practice of medicine.

In order to comply with the provisions of the School Code it was
necessary to appoint a large staff of medical men (for the term of 19 12-13,
871), to instruct them in the work, and to design special forms for use
in noting their findings while examining pupils and in making the sani- tt
tary survey of the school grounds and school buildings. The whole
scheme of work had to be planned with due regard to thoroughness and
to the varying needs of school districts located entirely within small
towns and to others located entirely in the country. We had also to
keep in mind that in these districts the public were not yet fully edu-
cated concerning medical inspection and that we could go just a little
way in advance of public education without meeting antagonism that
might cripple the work. In our examinations for the sessions of 191 1 -12
and 1 91 2-1 3, a blank form was used, which is here reproduced.

You will note that" provision was made for certain identification
records relating to the school itself, teacher, district, etc. ; and for listing
the name of the pupil, the name of the parent or guardian, the age, sex,
color and the nativity of the pupil ; and in columns space was provided
for recording the vision of each eye separately after testing with Snellen's
card ; for noting any defects or scars on the cornea or inflammatory con-
ditions about the lids; provision was made for recording the hearing of
each ear after they were separately tested. In testing hearing we pre-
ferred to use a whisper at a distance of twenty feet. We purposely
avoided the greater refinement of noting the tick of a watch or the sound
from a tuning fork because we felt that the defective pupil who fails to
appreciate what is said by the teacher or by the reciting pupil is the one
that we first want to reach and correct and that this test is more certain
in locating the defects noted by teacher and pupil than are the more
refined tests. If any otorrhoea was present it was noted. A note was
riiade as to the method of breathing, whether there was slight impair-
ment of nasal breathing, serious impairment or whether mouth breathing
was noted and if in addition to any obstruction to breathing a catarrhal

MEDICAL INSPECTION IN RURAL DISTRICTS OF PENNSYLVANIA 463

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464 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

discharge or adenoid fades was found a probable diagnosis of adenoids
was given. The teeth were carefully examined and a note was made
whether they were dirty, decayed or whether the gums were diseased.
Tonsils were examined and if enlarged or inflamed a record was made of
it, a similar record was made for the condition of the cervical glands and
for any evidence of tuberculosis of the lungs, glands, bones or joints.
In nervous diseases we only noted the presence of chorea or epilepsy,
any one of the various skin diseases that are remedial or communicable
were recorded and if communicable, provision was made for school ex-
clusion. A careful examination was made of the hair of all pupils and if
lice or nits were present those with infected heads were excluded until
treatment was given, and finally notes were made concerning the presence
of deformities and the general nutrition of the child.

It requires a great deal of tact on the part of an examiner to work
successfully in many of the fourth-class districts, especially if the teacher
is not thoroughly in accord with the work or if the pupils are a little
nervous and excited and not quite willing to give hearty cooperation
and to have the examiner succeed in locating all defects that should be
noted. It is altogether probable that at times errors occurred.

As rapidly as these reports reached the Department letters were
sent in duplicate to the teacher. The letters were for the most part
printed in blank, worded about as follows:

''Dear

You are hereby notified that -the examination of

made by the Department of Health's Medical Inspector of Schools, apparently shows

that has some affection of the and we

would advise you, for the good of the child, to consult your family doctor relative to
treatment.

Yours very truly,

SAMUEL G. DIXON,

Commissioner of Health."

The letters relating to remedial defects were all in duplicate, the
teacher's copy containing a note asking her to return it to us at the end
of the session with a report of treatments if any were given and her
impression of the results.

In sending letters to the parents we were careful to call attention to
every defect found, even though it were not more serious than dirty teeth.
Our object in going so far in communicating with parents was that we
preferred to arouse just a little agitation in the school district and a good
deal of discussion as to the reasons for cleansing the teeth and for atten-
tion to small matters in personal hygiene. We believed that if in each
school district the children, as well as the parents were somewhat aroused

MEDICAL INSPECTION IN RURAL DISTRICTS OF PENNSYLVANIA 465

by these letters that not only the parents and pupils, but the teachers
themselves would be more likely to take an active interest in oral hygiene.

At the end of the session when the teachers forwarded their reports
it was not an uncommon thing to find notes that every pupil in their
school now used a tooth brush at least once a day, that a very large per-
centage of the pupils having defective vision were now wearing lenses,
that a number of those having enlarged tonsils or adenoids had been
improved by operation, that the general health of the pupils had im-
proved and that infested heads were rapidly becoming a thing of the past.

The School Code was not in general circulation among the School
Boards of Pennsylvania until the middle of the summer of 191 1. A
number of the fourth-class district Boards were not fully advised as to
who would bear the burden of expense of inspection and unfortunately
the League of Medical Freedom, an organization largely responsible for
the optional clause in the Code giving third and fourth-class district
boards the right to reject inspection, were very active so that out of the
2,366 districts some 1,500 elected the first year to have no inspection.
In the 750 districts inspected in 191 1, however, we reached a total of
3,572 school buildings and examined 145,500 pupils.

A year later when the school authorities were more fully acquainted
with the provisions of the Code the same agitation on the part of the
League of Medical Freedom having been kept up, twice this number of
districts, about 1,500, were convinced that school inspection was worth
having and passed no resolutions against it. More than 300,000 pupils
were examined. For the coming school year 1,831 out of the 2,366 dis-
tricts will receive medical inspection and in all of the remaining districts
a sanitary inspection will be made by the Department's Health Officers.

To do this work in the rural districts of Pennsylvania will require
one thousand doctors at an estimated cost of $100,000 a year. The
entire organization is being handled by the Division of Medical Inspec-
tion of the Department and a corps of clerks.

The writing of letters to parents and the tabulation of the statistics
of such a large piece of work is in itself a heavy task. In tabulating the
statistics we adopted the United States Census office system of tabula-
tion using a punch card together with the automatic counter and tabu-
lator.

Some of you will be sufficiently interested in this rnethod of tabula-
tion to inspect the forms and see the tabulated data displayed in the
Department's Exhibit. I may say in passing that this method of tabu-
lation is the only one with which we are familiar that makes it practicable
to show the relation or the association of defects in groups, as for instance

Ecentage of children having adenoids in association with defective
, the percentage having enlarged tonsils or decayed teeth with

466

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

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MEDICAL INSPECTION IN RURAL DISTRICTS OF PENNSYLVANIA 467

enlarged cervical lymphatic glands or bad teeth with defective nutri-
tion, etc. ■*"

We are so well pleased with the punch card system of tabulation that
we have concluded to adopt triplicate punch cards to be used in the
school room by the examiner. The object in trying to plan a triplicate
card is that the one copy may become the permanent copy of the school,
this card to follow the child from year to year through school life ; the
duplicate to remain in the possession of the teacher until the end of the
year, when it is to be forwarded to the Department with her notes as to
results of treatment ; the third copy to come to this Department for our
alphabetical files as soon as the inspection is made. Subsequent inspec-
tions would provide for the same system with a matching of the cards
both in the hands of the teacher and in the Department. In this way
we could follow each individual pupil throughout his school course At
the present time, these cards are not completed, although we had hoped
to have them here for your inspection. They are so nearly completed
that with the consent of the Secretary of the Congress I will have them
reproduced with this paper.

School medical inspection in the rural districts of Pennsylvania
has not shown the rural children to be any freer of the weaknesses and
frailties incident to school children than is noted in the larger cities.
In fact, the percentage of visual defects, defects of hearing, defects noted
about the nose and throat and cervical glands are just about as common
in the country as in the city. A detailed study of the statistics of Penn-
sylvania's rural children will be presented in another session of this
Congress, hence I need not dwell upon it here.

In addition to the routine Medical Inspection as outlined in this dis-
cussion and in the forms used, a complete sanitary survey was made
of each school premises, a report of these sanitary investigations being
the subject of another paper to be read by title only.

Section 1413 of the School Code, reading as follows:

"It shall be the duty of the county or district superintendent, attendance officer,
or secretary of the board of school directors, in every school district in this Common-
wealth, to report to the medical inspector of the school district every blind, deaf, or
mentally deficient child in the district, between the ages of eight (8) and sixteen (16)
years, who is not being properly educated and trained. The medical inspector of the
school district shall examine such child, and report to the board of school directors
whether it is a fit subject for education and training, If the child is reported to be a
fit subject for education and training, but cannot be properly educated and trained in
the public schools of the district, the board of school directors shall secure for it proper
education and training: Provided, That when it is necessary to educate or train such
children outside of the public schools, their parents or guardians shall, if able to do so,
pay to the district the expense necessarily incurred by it in educating and training the

468 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

PHYSICAIy INSPECTION

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MEDICAL INSPECTION IN RURAL DISTRICTS OF PENNSYLVANIA 469

same: And provided further, That any child who is reported by the medical inspector
of the school district not to be a fit subject for education and training shall be exempt
from the provisions of this act."

places upon the Department additional duties. We have not found it
advisable at the present time to plan for expert opinion as to mental
defect, being guided by the general family practitioner in his opinion
as to the desirability of special education. In comparatively few in-
stances has this provision of the Code been put in force; the school
authorities seemingly overlooking its provision but we hope later to have
valuable statistics, both as to number and location of the feeble-minded
through its better enforcement.

We are not yet satisfied that we have reached the ideal Medical
Inspection but from this beginning in a common-sense and practical
way we hope gradually to convince the public of its usefulness and
efficiency and lead on to a more complete system and to develop through
the present Medical Inspector's corps a very much higher type of organ-
ized work than is now practicable or desirable.

A great deal more will eventually be done in the diagnosis of early
deformities due to defective posture and advice will likely be given as to
methods of correction. Much future work of the inspection will deal
with mental and physical fatigue and methods of overcoming both by
recreation and change of program.

The future inspector will eventually deal with the kinds and size of
type used in text books; he will deal in a more extensive way with ven-
tilation and scientific problems of lighting than is now done and, through
his cooperation with the health authorities, deal more extensively with
the contact infection and carrier cases in schools and through the assist-
ance of school nurses will secure satisfactory follow-up reports.

Probably the present type of inspection will be received so kindly
that at some future time the inspector will deal with all forms of school
recreation and with the teaching of hygiene and preventive medicine
in the school and in a supervisory way deal with the school lunch prob-
lem. These higher ideals in Medical Inspection of rural schools of course
will not be reached until long after they have been adopted in large
municipalities but they are bound to come at some time in the future.

470 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

discussion of
Samuel G. Dixon's Paper

Alexander C. Abbott, M.D.

The system of medical inspection throughout the rural districts of
Pennsylvania, as outlined in the paper we have just heard, is cause for
pride on the part of the citizens of that State. It was made possible
through a change in the administration of State health matters author-
ized by act of Assembly in 1905.

Previous to that time there was a State Board of Health and num-
erous town and borough Boards having no affiliation one with another,
and no fixed responsibility to a central controlling and directing power.
The result was as might have been expected: in some districts school
inspection and other measures for safeguarding the public health were
in satisfactory operation; in others such was not the case.

Systematic school inspection throughout the rural districts of the
State developed as part of the regular functions of the newly created
Health Department of the State Government.

That which has been accomplished in Pennsylvania we believe to be
worth while. We also know that it could not have been done under the
former methods of administering public health affairs.

I am of the opinion that it can be done in any other State that will
centralize authority and responsibility and not depend upon the whims
of loosely affiliated city, town and borough Boards of Health.

HYGIENE IN THE PHILIPPINE SCHOOLS 47 1

HYGIENE IN THE PHILIPPINE SCHOOLS

Allan J. McLaughlin

Practical hygiene is taught in the Philippine schools even in the lower
grades. In this country we are prone to overlook the enormous influence
of school children upon the hygiene of the home. The children of poor,
ill-educated parents are often the intermediary through which the
simple gospel of hygiene and disease prevention reaches the parents.
In the Philippines this is even more true, and in many instances it is
only because of the children that the parents carry out the instructions
of the health officer.

In combating cholera we were not slow to take advantage of the
schools. A cholera circular containing the simple facts of the spread
and prevention of cholera was used as a catechism even in the elementary
grades. The children recited the answers daily, and in times of actual
epidemic this teaching took precedence over all other studies and was
supplemented by actual demonstration of hand cleansing and disin-
fection.

With an epidemic of contagious disease existing, there is a tendency
in most communities to close the schools. In the Philippines on the
contrary, it is the policy of the Bureau of Health to keep the schools
open because of their extraordinary value in teaching the precepts of
disease prevention. They were used in cholera epidemics as demon-
strating stations where the children were taught how to protect them-
selves and their parents against cholera. The same principle is used
in combating tuberculosis, hookworm, dysentery, and beri-beri. The
children are taught how these diseases are contracted and how they
may be prevented.

The modern Philippine school building is a model of construction,
adapted to the tropics. There is no heating problem in the Philippines
and as a consequence ventilation is very much simplified. Water supply
and sewage disposal are directly under the control of the Bureau of
Health. The pupils are specially trained in the necessity of thorough
hand cleansing after using the toilet and before eating. The children
have been used also to eliminate the time honored Filipino custom of
eating with the fingers out of one common family dish.

The dense ignorance of sanitary principles and the ^Oriental fatalism
of the older generation could not be successfully combated without
the aid of the school children. With their aid a very great improve-
ment has been effected.

472 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

There is now in Manila a very efficient medical inspection of schools.
This is particularly effective because of the splendid facilities of the
Bureau of Health for giving medical treatment. The city is divided
into health districts with free dispensaries and hospitals where the
school children are treated. In this country the health department
can often do no more than recommend treatment. In Manila the child
is reported to the Bureau of Health and the powers and organization
are such that control is easily maintained until the child is returned
to school cured. Special attention is paid to the teeth of children and
these are treated in the free dental clinics of the Philippine General
Hospital. During the school year ended March 29, 1912, in Manila
over 2,400 children were referred to the hospitals and dispensaries
of the Bureau of Health for treatment.

The effect of the teaching and practice of hygiene in the Philippine
schools is not only manifest in the improved physical condition of the
pupils but is a powerful instrument in the sanitary regeneration of the
Filipino people.

l'inspection MEDICALE DES ECOLES AU BRESIL 473

L'ORGANISATION DE L'INSPECTION MEDICALE
DES ECOLES AU BRESIL

PAR

Clemente Ferreira

L'important service d 'inspection medicale des ecoles et des ^coliers,
qui fonctionne avec tant d 'eclat dans la plupart des pays de haute civili-
sation, n'a commence que tout recemment au Br6sil.

Ce complement indispensable de I'appareil scolaire n'existe chez
nous que dans les departements plus avances de notre patrie — aux
Etats de Sao Paulo et Minas Geraes et dans la capitale de I'Union — Rio
Janeiro.

A Rio Janeiro remonte a la fin de 1909 la premiere 6tape dans
I'organisation de l'inspection medicale des ecoles, et c'est au Pr^fet
municipal, M. le dr. Serzedello Correia, que Ton doit cette utile initia-
tive. En Septembre 1909 il a envoy e au Conseil municipal un message
dans lequel il accentuait I'avantage d'etre inaugure le service d 'inspec-
tion sanitaire scolaire, et le 6 Octobre de la meme annee il nommait
une commission de medecins, pediatres, pedagogues et hygi^nistes, en
les chargeant d'6tudier la question et de presenter un rapport complet
et bien fait pour I'orienter dans I'organisation de 1 'important service.

Cette commission s'est reunie a plusieurs reprises et a 61abor6 un
projet de loi, qui a 6te soumis a une large discussion au sein de ses mem-
bres. La redaction finale a ete la suivante :

Art. I. II est cree le service d'inspection sanitaire scolaire, sub-
ordonn^ a la direction generale d'hygiene et d'Assistance Publique.

Art. 2. L'inspection sanitaire scolaire a pour but:

a) la surveillance hygienique des ecoles et du mobilier scolaire;
h) la prophylaxie des maladies transmissibles et evi tables;

c) l'inspection medicale des ecoliers et du personnel ;

d) I'education sanitaire des ecoliers et des maitres;

e) la systematisation et le contr61e de I'education physique scolaire.

Art. 3. La surveillance hygienique des b^timents et du mobilier
scolaire sera faite au moyen de visites periodiques, portant sur les con-
ditions hygi6niques des locaux et des batiments, dans le but de solliciter
des autorites competentes les mesures necessaires.

474 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Art. 4. L'inspection sanitaire des eleves et de tout le personnel
scolaire sera faite au moyen de visites periodiques aux ecoles, avec
I'examen de I'etat de sante general des ecoliers et du personnel scolaire,
en soumettant a I'exploration clinique ceux qui paraitront suspects ou
seront separes comme tels par le directeur ou instituteur.

§1° Quand dans cet examen il sera verifie un cas de maladie trans-
missible chez un ecolier ou chez le personnel scolaire, on en defendra la
permanence a I'ecole ou dans I'lnstitut et il ne lui sera permis de re-
venir avant qu'un nouvel examen aura demontre sa 'guerison com-
plete.

§2° Lorsque cet examen decelera une maladie transmissible. Tad-
ministration de I'etablissement en donnera avis aux parents, gardiens
ou interesses, afin que les ecoliers atteints soient convenablement
soignes.

§3° Le directeur de I'enseignement recevra tou jours un avis preal-
able de ces visites.

Art. 5. La prophylaxie des maladies transmissibles et evitables
aura lieu au moyen de l'inspection medicale des eleves suspects; on
adoptera les mesures prophylactiques necessaires d'accord avec les
lois et reglements en vigueur.

Art. 6. Les providences auxquelles ont trait les articles 3, 4 et 5
s'etendent a toutes les personnes qui demeurent ou restent a I'etablisse-
ment.

Art. 7. L'inspection sanitaire scolaire prendra les mesures qui
deviendront necessaires en vue de favoriser la divulgation des precepts
et notions d'hygiene 61ementaire, sp^cialement en ce qui concerne la
prophylaxie des maladies transmissibles et evitables.

Art. 8. L'inspection sanitaire scolaire s'efforcera pour que dans
les ecoles et Instituts municipaux I'education physique soit effective
et obeisse a une orientation scientifique, en la systematisant dans le
sens de favoriser le developpement physique et psychic^ue des ecoliers.

Art. 9. II est cree le carnet sanitaire obligatoire pour les ecoliers
des ecoles et instituts municipaux.

§1° La fiche de sante sera constitute par un livre ou seront inscrits
le nom, I'age, filiation, naturalite, adresses, renseignements sur les
vaccinations et revaccinations ; mensurations anthropometriques, les
resultats de I'examen physio-pathologiques et psychiques et d'autres
donnees utiles, qui seront consignees dans le reglement.

l'inspection medicale des ecoles au bresil 475

§2° La fiche sanitaire constituera un document qui servira k que
Ton juge du developpement physique de I'^colier.

§3° Les renseignements de la fiche seront revus tous les six mois.

§4° Les notations generates de la fiche sanitaire seront faites par
I'instituteur ou le directeur a I'occasion de rimmatriculation ; on r^ser-
vera au medecin scolaire celles d'ordre technique.

Art. 10. Sur la fiche sanitaire de chaque 61^ve I'inspecteur sanitaire
scolaire inscrira ce qu'il remarquera d'anormal toutes les fois que I'^col-

ier sera examine.

Art. II. Les fiches sanitaires seront conserv^es dans Tdcole ou
I'institut pour Tusage exclusif de T Administration, elles devront suivre
I'eleve lorsqu'il sera transfere dans un autre etablissement municipal.

Art. 12. Les directeurs des instituts d'enseignement et les institu-
teurs des ecoles devront aider a l'inspection scolaire dans tout ce qui sera
a leur portee.

Art. 13. Le service d'inspection sanitaire scolaire restera a la charge
d'un inspecteur en chef, medecin d'evidente competence et de libre choix
du Prefet, aide par dix medecins scolaires et plus 4 specialistes, dont
deux seront ophtalmologistes, I'oto-rhino-laryngologiste et I psychiatre,
tous recrutes par vois de concours, et en outre par le personnel compris
dans la table annexee.

Art. 14. Les ecoliers deja immatricules seront soumis ^l'inspec-
tion sanitaire et on dressera leurs fiches, dont s'agit la loi presente.

Art. 15. Aucun permis ne sera accorde pour I'ouverture d'ecoles
priv6es d'un genre quelconque sans I'avis prealable de l'inspection sani-
taire.

Art. 16. Tous les b^timents et les adaptations des b^timents des-
tinees a ecoles ou asiles de mineurs ne seront pas autorises sans I'avis
prealable de l'inspection sanitaire.

Art. 17. Le Prefet demeure autorise a expedier les reglements pour
la mise en vigueur de la loi presente, lesquels en detailleront toutes les
mesures necessaires a la bonne execution et delimiteront les attribu-
tions des differents fonctionnaires.

t. 18. Les appointements de personnel du service de l'inspection
i sont ceux consignes dans la table annexee.

476 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Ce projet de loi fut envoye au Prefet, qui a son tour I'adressa, en le
faisant accompagner d'un message, au Conseil municipal du district
federal, en date du 20 Octobre 1909.

Ayant expire le mandat du Conseil municipal, un arrete du Prefet,
sous le num^ro 778, en date du 9 Mai 1910, a cr6e le corps medical scolaire
compose de 20 cliniciens et hygienistes et de 4 specialistes et a fait expe-
dier le reglement du service d'inspection medicale des ecoles, d'apres
les lignes principales du projet de loi elabore par la commission, dont
nous avons fait mention precedemment.

Le 16 Mai a ete mis en vigueur le service, qui a recontre peu d'embar-
ras de la part du public, deja bien renseigne sur les avantages de cette
importante piece de I'appareil scolaire, grace a la propagande bien
conduite due a la grande presse et a quelques mMecins tres au courant
de cette branche de I'hygiene infantile.

Malheureusement, avec le changement du prefet, ce service a cesse
de fonctionner, le nouveau chef de Tadministration municipale I'ayant
suspendu sous le pretexte de manque de resources budgetaires.

Au commencement de cette ann^e le Prefet, sous la soUicitation
de la presse et de I'opinion de distingu6s hygienistes, a decide de retablir
cet important service. On va organiser incessamment le corps de
m6decins inspecteurs, qui seront au nombre de 28, ils seront recrut^s
par voie de concours.

A Sao Paulo la reorganisation des services sanitaires en 1911 a cr66
I'inspection m^dico-sanitaire des Ecoles, comme une section du depart-
ement d 'hygiene. Voici le texte des articles du nouveau reglement
sanitaire, qui ont trait k ce pr^cieux service:

TITRE I.

Chapitre VII.

Inspection m^dico-sanitaire des ecoles.

Art. 66. L'inspection medico-sanitaire des ecoles sera exerc^
dans la capitale par 4 inspecteurs sanitaires sp6cialement design^s pai
la Direction generate du service sanitaire.

Art. 67. Le service est organist de fagon a comprerendre les Ecoles.
publiques et privies d'enseignement primaire, secondaire et professionel,
et il aura pour but :

1. L'indication des mesures hygieniques et administratives con-j
cernant Templacement et la construction des b^timents scolaires.

2. Le choix, d'accord avec la direction de TEnseignement Public,,
du mobilier scolaire, des m6thodes et procedes d'enseignement, des:

l'inspection MEDICALE DES ECOLES AU BRESIL 477

attitudes des ecoliers, aussi bien que la distribution des mati^res en-
seign6es, la repartition des heures de travail, de repos et d'exercices
physiques.

3. La prophylaxie des maladies transmissibles.

4. L'examen individuel du corps enseignant, des ^l^ves et des
employes.

5. La vaccination et la revaccination du personnel des 6coles.

TITRE II

Chapitre VI.

Art. 135. Les b^timents scolaires devront etre construits sur des
terrains assainis, d'apres les regies qui sont en vigueur pour les habita-
tions collectives.

Art. 136. Les b^timents scolaires ne devront ^tre assombris par
d'autres Edifices ou par des arbres, et seront k I'abri des vents nuisibles.

Art. 137. Toujours qu'il sera possible les ecoles ne comprendront
qu'un etage avec une cave haute d'un metre au minimum, suffisamment
expose et aere.

Art. 138. Les escaliers seront droits ou tourn^s en angle droit et
les marches n'auront plus de 6 centimetres de hauteur.

Art. 139. Les salles des classes auront des dimensions en rapport
avec le nombre d 'ecoliers, qui sera au maximum de 50, chaque 61eve
disposera d'un metre et 25 centimetres de superficie au minimum.

Art. 140. La hauteur des salles sera au minimum de 4 metres demi.

Art. 141. La ventilation des salles devra etre la plus parfaite pos-
sible, sans des courants d'air qui puissent nuire k la sante des Ecoliers.

Art. 142. L'eclairage des classes doit etre unilateral avec lumi^re
venant de la gauche, l'eclairage bilateral sera tolere, une fois que la
lumiere provienne de surfaces non paralleles.

Art. 143. L'eclairage electrique est l'eclairage artificiel preferable.
L'eclairage au gaz ou I'alcool sera tolere une fois qu'il soit convenable-
ment etabli.

Art. 144. Les fenetres des classes devront commencer a 0°^ 90-
I metre du sol et se rapprocheront le plus possible du plafond.

Art. 145. La superficie utile des fenetres des classes devra ^tre
au moins egale au cinquieme de la superficie du plancher.

478 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Art. 146. Les salles des classes rev^tiront de preference la forme
rectangulaire et la largeur du rectangle sera calculee de fagon que I'eclair-
age ramplisse les exigences hygieniques.

Art. 147. Les classes auront les angles arrondis et la surface d€-
pourvue de moulures et de saillances et depressions.

Art. 148. Les murs des ecoles seront revetus de materiel aisement
lavable, on pref^rera les couleurs grise, bleu^tre ou verditre.

Art. 149. II y aura un water closet pour chaque groupe de 40 eleves
dans les sections masculines et de 20 dans les sections feminines.

Art. 150. Le mobilier soclaire devra etre soigneusement choisi
si et aura la grandeur proportionnee a la grandeur des 6coliers.

Art. 151. La gymnastique 6ducative sera obligatoire, d'apr^s la
methode plus avantageuse.

Art. 152. On interdira les exercices gymnastiques apres les repas.

Art. 153. Les ecoles disposeront de locaux abrites afifectes aux
jeux.

Art. 154. On interdira la frequence scolaire aux ecoliers atteints de
maladies transmissibles.

Art. 155. Aux internats on observera les dispositions concernant
les habitations collectives.

Art. 156. Les ecoles publiques ou privees ne pourront fonctionner
que dans des b^timents consideres appropries par les autorites sani-
taires.

Art. 157. Les ecoles superieures demeurent assujeties k ces pre-
scriptions dans tout ce qui leur sera applicable.

A I'interieur de I'Etat de Sao Paulo I'inspection m^dico-sanitaire
des ecoles est realisee par 16 medecins inspecteurs.

Le Dr. Vieira de Mello, qui a ete charge de 1 'organisation du service
d 'inspection m6dicale des Ecoles de la capitale, a adopte un cosier sani-
taire des ecoles calqu6 sur le modele etabli par le dr. Christiani, de Berne,
a dresse une fiche sanitaire individuelle, d 'apres les modeles les plus
modernes et trois modeles de bulletins sanitaires, Tun pour ^tre remis
aux parents ou tuteurs des Aleves s'il s'agit d'une affection ou deformite,
constat^es lors de I'examen, et qui reclament des soins et des corrections,
I'autre pour etre adresse au directeur de I'^cole ou au professeur s'il
s'agit d'une maladie qui exige I'eviction de I'ecolier et un troisieme pour

l'inspection M^DICALE DES ECOLES AU BRESIL 479

etre rempli par le medecin traitant, une fois I'enfant gueri et n'offrant
plusde danger de contagion.

Sous I'initiative de la Section d 'inspection medicale des ^coles de
Sao Paulo, a €t6 organisee une association privee ayant pour but la crea-
tion de cliniques dentaires scolaires pour les soins des Aleves des ^coles
publiques, tres eprouves par la carie dentaire; on a deja installe 4 cabinets
tres bien outilles et diriges par des dentistes competents, ou Ton procede
^ l'inspection systematique des bouches et des dents des enfants des
6coles et on surveille I'hygiene buccale. Les services rendus par ces
dispensaires d 'assistance dentaire sont deja des plus precieux et ce
serai t un inestimable avantage que d'elargir leur programme pour les
soins des maladies de la gorge, des yeux, du nez et des oreilles, en con-
stituant de veritables cliniques scolaires, pareilles a celles qui ont 6te
6tablies en Angleterre et qui sont si pronees par I'eminent dr. Hogarth,
qui affirme la necessite de la creation de ces centres de traitement et
assistance pour certaines maladies et affections de I'^ge scolaire chez
les 6coliers pauvres. "Without the school clinic the whole system of
medical inspection becomes practically fruitless," dit Hogarth. Les
cliniques scolaires municipales en Angleterre rendent de notoires ser-
vices.

A I'Etat de Minas Geraes c'est tout r^cemment, le 10 Avril de I'annde
courante, qui Ton a commence le service d'inspection medicale des ecoles,
on a I'intention de suivre les principes adoptes en Allemagne. Ce sont
les medecins de la Ligue contre la tuberculose qui ont 6te charges de
remplir les fonctions de medecins inspecteurs.

SESSION SEVEN

Room F. Wednesday, August 27th, 9:00 A.M.

STATUS OF SCHOOL HYGIENE AND METHODS OF
INSTRUCTION IN CITY, VILLAGE AND COUNTRY
SCHOOLS (Part Three)

H. M. Bracken, M.D., Chairman
Dr. H. U. Williams, Buffalo, N. Y., Vice-Chairman

Program of Session Seven

Thomas E. Finegan, M.A., Pd.D., LL.D., Third Assistant Commis-
sioner for Elementary Education, State of New York. "The
Medical Inspection of Public Schools in New York State."

James H. Morrison, A.M., M.D., Health Commissioner, Hartsville,
Ind. "The Evolution of Hawcreek Township."

John T. Calhoun, B.A., County Superintendent of Education, Collins,
Miss. "Opportunity of County Superintendent in Fight Against
Hookworms." (Manuscript not supplied.)

Clinton P. McCord, M.D., Medical Inspector of Schools, Board of
Education, Albany, N. Y. "Health Direction in the Public
Schools."

MosBY G. Perrow, A.m., Ph.D., Health Officer, Lynchburg, Va.
"Two years' Work in the Schools of Lynchburg."

James A. Nydegger, A.M., M.D., Sc.D., U. S. P. H. Service. "Hygiene
of the Rural Schools."

B. Franklin Royer, M.D., Chief Medical. Inspector, Department of
Health, Commonwealth of Pennsylvania. "A Statistical Study
of the Physical Defects of Three Hundred Thousand Rural
School Children."

Papers Presented in Absentia in Session Seven
(Read by Title)

^J. L. Ludlow, C.E., M.S., President Winston-Salem Board of Trade,
Member and Consulting Engineer, State Board of Health, Wins-
ton-Salem, N. C. "A Practical Method of Promoting School
Hygiene in Small Cities."

I Alice Florer, County Superintendent of Schools, York County, Ne-
braska. "Status of Hygiene in the Schools of York County,
Nebraska."

482 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE MEDICAL INSPECTION OF PUBLIC SCHOOLS IN

NEW YORK STATE

Thomas E. Finegan

For several years the local health laws of certain cities in the State
of New York have been interpreted to confer upon municipal health
officers the authority to make medical inspections in the public schools.
Under this legal power, the health authorities of the city of New York
organized a system of medical inspection in the public schools of that
city in the year 1897. It was not, however, until the year 1910 that
a provision relating to the medical inspection of public schools was in-
corporated into the education law of this State. In that year the school
authorities of certain cities and of union free school districts — districts
including villages which usually maintain high schools — were author-
ized, within certain limitations of expenditures, to provide for medical
inspection of public schools. The provisions of these statutes, either
the local health laws or the education law, were simply permissive
and yet under them various cities in the State have from time to time,
in response to public sentiment organized systems of medical inspection
in their public schools until fifteen of the leading cities "in the State
are now conducting systems of medical school inspection. In addition
to the work accomplished under these statutes, the State Education
Department and the State Health Department have cooperated for
several years in an effort to induce local school authorities to adopt
a voluntary system of medical inspection in all the schools of the State.

The whole plan of medical inspection of public schools in New York
State, up to the present time, has been not only under statutes which
were simply permissive but which were even so inadequate and cumber-
some in their provisions as to render satisfactory results impossible.
The achievements attained, however, even under the unfavorable con-
ditions under which medical inspection in the public schools of the State
has been operated, were sufficient not only to show the results which
might be accomplished under a law mandatory in its provisions, state-
wide in its application and based upon sound principles of public school
administration, but the results secured were a potent factor in develop-
ing public sentiment which sustained the enactment of a general statute
on the subject, by the Legislature of 1913. The law of 1913 went into
effect on the first day of this month. This paper therefore will not
review what has been accomplished under previous statutes but will

MEDICAL INSPECTION OF PUBLIC SCHOOLS IN NEW YORK STATE 483

consider briefly the broad features of the new act and point out how
it is expected to be administered and what may be accompUshed under
its proper enforcement. It is a comprehensive law and confers very
broad powers upon those charged with its enforcement. It is also
mandatory in its provisions and applies to the entire State except the
cities of the first class. These cities are Rochester, Buffalo and New
York. Frankly, these cities were exempted from the provisions of
this law to insure its passage in the Legislature and for the further
reason that these cities were maintaining reasonably effective systems
under their local laws.

The enactment of this law was based upon the broad ground that,
when the State makes the attendance of a child upon instruction com-
pulsory, it is the duty of the State to protect the life and health of such
child, not only by requiring sanitary buildings in which he receives
such instruction, but by protecting such child from the liability of having
a disease communicated to him by another pupil. Four fundamental
principles which are vital to the most effective and satisfactory opera-
tion of a system of medical inspection in public schools were incorporated
in this law. These principles are :

1. That the medical inspection of the children in a public school
system is a purely school question and a law requiring such inspection
should be administered by the school authorities.

2. That a parent possesses the legal right to have such examination
of his children as the law may demand made by a physician whom
such parent selects.

3. That local school authorities should possess the same power
and obligations in relation to the employment of physicians, nurses,
etc., in providing for the physical necessities of school children that
they possess in relation to the employment of teachers, supervisors,
superintendents, etc., in providing for the intellectual needs of such
children.

4. That penalties should be imposed upon cities and school dis-
tricts for failure to enforce a medical inspection law on the same bases
that penalties for failure to enforce the compulsory attendance laws,
fire laws or other statutes affecting the schools are imposed.

The status of the public school has undergone a marvelous change
within a generation. It no longer stands as an institution whose sole
function is to give instruction to children in the usual elementary and
academic subjects found in the public school curricula. It is now
universally recognized as an institution which is to so train and develop
boys and girls that, when they enter into the activities of the social,

484 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

commercial and industrial life of the nation, they shall possess the best
equipment possible for efficient service in their own behalf and in behalf
of society in general. One of the greatest assets which a girl or boy
may possess when leaving school to become a worker and earner is a
sound, healthy body. It is as much the function of the school to teach
a boy how to care for his body and to see that proper treatment is pro-
vided for physical defects which interfere with his normal growth and
development or with his progress in school work as it is to teach such
boy how to read and to cultivate in him a desire for wholesome literature.
The only agency for the accomplishment of this is a thorough system
of medical inspection. Medical inspection is therefore a school question,
and the responsibility for the administration of any school proposition
should be placed upon the school authorities. Experience has also
demonstrated that the administration of a system of medical inspection:
by any other agency will result in a waste of funds, in the loss of time]
and energy on the part of the pupils and teachers, in the usual embar-
rassments and conflict of authority incident to a division of responsi-
bility in the general direction of any one proposition and will therefore'
result in great inefficiency.

Compulsory attendance laws universally recognize the right of a
parent to provide in his own way the minimum amount of instruction
which the State decrees each child shall receive. A parent cannot be
compelled to send his child to the public school. He may send him to
a private school. He may employ a private teacher and educate his
child at home. He may be required to send his child to a public school
only when he fails to provide such child with instruction elsewhere
which is equivalent to that given in the public schools. The same
principle upon which such laws are based must be applied to the enact-
ment of medical inspection laws. The State may properly require
evidence of a child's freedom from disease and his physical fitness to
attend school. Neither the authority nor the policy of the state to
protect a child in his right to receive treatment for defects which are
impediments to his proper physical and mental development will be
questioned. The parent must first be given the opportunity to provide
any required examination and treatment and willful negligence on the
part of the parent to furnish the same affords sufficient ground for the.
State to supply it.

Under the law of 1913 the board of education of each city must]
appoint a medical inspector and as many additional inspectors and asi
many school nurses as may be required to properly inspect the pupils j
in attendance upon the schools of such city. The board of education
m a union free school district possesses similar power except that in a
district having a population of five thousand or less but one medical

MEDICAL INSPECTION OF PUBLIC SCHOOLS IN NEW YORK STATE 485

inspector may be appointed. Provision is also made for adequate
inspection of the rural districts. The trustees of a rural district may
employ a medical inspector and a school nurse and two or more of such
districts may unite in the employment of the same inspector and the
same nurse. The action of these several boards in the employment
of medical inspectors and school nurses does not depend upon the direc-
tion or ratification of any other municipal board or body. The law
confers upon these school boards the absolute power not only to appoint
such inspectors and nurses but to determine the number to be appointed
with the exception stated, and to fix their compensation. The educa-
tion law further provides that, when the statutes make it the duty of
school boards to perform specific functions, such boards shall have power
to include in the school budgets and raise by tax upon the districts or
to pay from unexpended moneys in the treasuries, without vote of the
districts, the amounts necessary to meet the expenditure incurred in
the performance of such duties. These local medical inspectors must
be physicians licensed to practice in the State and must have had at
least two years' experience. Although not required under the law,
they should possess a thorough knowledge of physical training and of
school hygiene and sanitation. The school nurses must be registered
trained nurses. Neither inspectors nor nurses are employees of the
municipal government but are employees of the public school system
and are not therefore subject to local civil service requirements. The
clear intent and purpose of this law is to create within the organization
of the school system the necessary machinery to give intelligent, scien-
tific direction to all the health agencies of the schools, to correlate all
of this work and to cooperate with all school forces to the end that all
the health needs of a great school system, giving instruction to one
and one-half million children shall be wisely, economically and scien-
tifically supplied. For the accomplishment of this purpose, local school
authorities possess the same independent powers to organize, manage
and direct this special work which they possess in the organization
and direction of the teaching and supervisory forces of their schools.
One of the medical inspectors should be designated as the chief Medical
Inspector or Director of Hygiene or some similar title and the other
inspectors as assistant inspectors and these and the school nurses should
be under the general direction of this principal officer. The principal
officer and nurses should be employed for full time but assistant inspec-
tors may sometimes be employed to good advantage on part time.
Each pupil is required on entering a public school at its opening
in the beginning of each year to present a health certificate signed by
a physician licensed to practice medicine in this State. - The Commis-
sioner of Education prescribes the form of the certificate after con-

486 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

sultation with the State Commissioner of Health. This certificate
must set forth in such detail as may be required the physical condition
of the pupil. The examination on which such certificate is based must
have been within thirty days prior to the application of the holder
thereof for admission to school. Parents are allowed thirty days within
which to furnish such certificate. Notice is then forwarded to those
parents whose children have not furnished the required certificates,
that if such certificates are not presented within the next thirty days,
examinations will be made by the school inspectors. Parents may
waive their right to furnish such certificates and request the school
inspectors to make the examination at any time. The school inspectors
may take up for immediate consideration at their discretion such emer-
gency cases as appear, from their observation or from information
obtained through teachers, to demand prompt attention. School
inspectors must make separate and individual examinations and tests
of each pupil who has not furnished a health certificate, to ascertain
if any of such pupils are suffering from physical disabilities tending to
interfere with their normal development or with the progress of their
school work. In cases where such disability exists, full notice thereof
must be given the parent. If the parent is unable or if he refuses to
provide the necessary relief and treatment, it then becomes the duty
of the school authorities to provide it. These cases are to be followed
up by inspectors from time to time as their necessities demand. When-
ever a case of contagious disease is discovered, the affected pupil must
be excluded from the school and the health authorities notified. Such
pupil may not be admitted to school again until the health officer of the
city or district, the family physician who treated him or the medical
inspector shall certify to his physical fitness to associate with other
pupils. Medical inspectors are also required to inspect the school
building to see that they are properly lighted, heated, ventilated and
cleaned. They are also required to make medical examinations of all
teachers and janitors.

The State Commissioner of Education is charged with the duty of
supervising the enforcement of this law. Such officer may, after con-
sultation with the State Commissioner of Health, prescribe regulations
to supplement the provisions of the law for its better enforcement.
The Commissioner of Education is also authorized to appoint a State
Medical Inspector of Schools, who will have the immediate supervision
of the enforcement of this law. This inspector must be a licensed
physician and must have had at least five years' experience in the actual
practice of his profession. Other qualifications are quite as essential
as this professional training and experience. He should also possess
a thorough knowledge of physical education and of educational hygiene

MEDICAL INSPECTION OF PUBLIC SCHOOLS IN NEW YORK STATE 487

and sanitation. The statutes place in the hands of the Commissioner
of Education an effective power for the proper enforcement of this
law. The law authorizes him in his discretion to withold from a city
or district its share of the public moneys appropriated by the State
for the support of schools, whenever such city or district has willfully
refused or failed to enforce this law. The education law further pro-
vides that when a city or district is subjected to the penalty of a loss
of its funds through the willful failure or refusal of a school officer to
perform any duty imposed upon him, such officer shall be personally
liable to the city or district for the amount of such loss. This whole-
some provision of the law is generally a sufficient stimulus to induce
school officers to perform their duties.

The proper enforcement of this law will result in the segregation of
all pupils afflicted with infectious or contagious diseases, in showing the
necessity of making special provision for the education of the mentally
defective, in the establishment of open-air schools for the treatment
and training of thousands of anemic ghildren and for those having a
predisposition to tubercular troubles, ten thousand of whom now in
attendance upon the schools of this State will die before they become
eighteen years of age if this treatment is not provided for them, in the
correction of physical defects in thousands of children who would other-
wise become permanently disabled or diseased, in providing cleaner and
more sanitary school buildings and surroundings, in teaching the future
generations how to take proper care of their bodies and thus make them
better citizens, in providing more effective instruction in the schools,
and in changing the schoolroom from a place which often breeds and
disseminates disease and immorality to an institution which will be the
most powerful and effective agency of modern times in promoting the

E^^'^^th. interests of the Empire State.
The Board of Education should be the supreme authority in the
^^..jol. It is impossible to obtain efficient service and the best results
when two supreme directing and governing authorities are controlling
different parts of the same work. A house divided against itself must

discussion of
Thomas E. Finegan's Paper

W. E. Struthers

488 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

fall. For dealing with disease or control of contagious disease, although
an important part, is a small part of medical inspection of schools.
The aim of medical inspection of schools is to obtain the very best
physical development of school children, not merely the treatment of
those having disease, or even physical defects. The teaching of hygiene,
personal cleanliness, the laws of health, right habits of life, the relation
of health conditions to physical efficiency, mental development, and
school progress, physical training, culture, drills, games, etc., and the
many other things that make up the school child's daily life, are the
things that are of essential interest to the Board of Education if they
have a broad conception of their duties to the children under their care.
In all these matters the school teacher, the school nurse, the school
medical officer, and the parent are the vital factors, and the best work-
ing cooperation of these factors is obtained through the Board of Educa-
tion. To argue that the health officer should control medical inspec-
tion of schools because it involves the supervision of contagious disease
among school children is to hark back to the old idea that the Board
of Education has discharged its full duties when it sees that school
children have obtained a full knowledge of the three R's. The school
teacher, the school nurse, the school medical inspector, and the parent,
have a common interest in the best development of the child. The
fundamental work of medical inspection is preventive medicine, and
is, therefore, educational. There is no reason in smaller municipal-
ities why the health officer should not also be the school medical inspector,
but as school medical inspector he should be appointed and controlled
by the Board of Education. The viewpoint of the health officer is not
that of the school medical inspector, and the work of the school is, and
always will be, best carried out by the school medical official. The vital
interests of the child should always be the first consideration, but it
appeals to me that these supreme interests of the child, its best physical,
mental and moral development are best secured under one directing
and supervising authority. This can only be done under the Board of
Education — and that should not mean overlapping of work. The Board
of Education should have the child under its care from birth until the
close of its school life. This is shown at present by the decided and
democratic forward step being taken in the establishment of nursery
schools. This is true, of course, only in large centers where so-called
slum areas exist. Here some systematic effort must be made to care
for young children, and the Board of Education is the proper body
to undertake that responsibility. Practically all the health officer
does for the prenatal life of a child is to improve the home conditions
or environments of the mother. Such improvements would continue,
and would undoubtedly benefit the life of the child. But this would

MEDICAL INSPECTION OF PUBLIC SCHOOLS IN NEW YORK STATE 489

not be overlapping work. The only way for the Board of Health to
do the work of medical inspection of schools is to take over the whole
of the school work and abolish the Board of Education. You cannot
separate the school work in this way — placing part of it under one
authority, and part of it under another authority. School medical
officers should be given the same authority as health officers to enter
a home where contagious disease is suspected to exist. This is for dis-
covery only, the medical officer then reporting such cases to the Board
of Health.

Hills Cole, M.D.: Will Dr. Finegan please explain the relation
between the educational authorities and the health officer as provided
in the law which he has summarized?

Dr. Finegan: The law requiring medical inspection in the schools
of New York provides that trustees of rural schools and the board of
education of a village of five thousand people employing a superintendent
of schools may, in their discretion, appoint the health officer of the town
or village to make the medical inspections required in the schools. The
recent health law has endeavored to increase the professional standing
of the local town and village health officer. It is desirous of utilizing
the service of such officer so far as may be to the advantage of the school
and wherever it is feasible to arrange with the health officer for this
work, it should be done.

490 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

THE EVOLUTION OF HAWCREEK TOWNSHIP

James H. Morrison

'Round my Indiana homestead wave the cornfields,
In the distance loom the woodlands clear and cool,

Oftentimes my tho'ts revert to scenes of childhood,
Where I first received my lessons — nature's school.

The poet, Paul Dresser, had in mind no lovelier spot than Hawcreek
township when he wrote our Indiana song, "On the Banks of the
Wabash," and well might he have received equal inspiration from a visit
to this place.

This township has some history and some surroundings that show
characteristics and conditions peculiar to its people and to describe
these may require this paper to be somewhat local in character yet it
serves to represent rural conditions in many Indiana schools and in fact
in many of the States of the Union.

It is a congressional township. Because of the average intelligence
of its inhabitants, the distribution of its population, its roads and its
geographical location Hawcreek township was chosen as the first place
in the United States in which rural free delivery of mail was tried and one
of the original routes established is still in existence. Hawcreek Township
has the largest pQultry farm in the world devoted to one breed, the corn
king of Indiana resides within its borders, and the people are very tem-
perate, not a saloon being within its thirty-six square miles of territory.

I mention a few facts such as the foregoing to show the enterprise
of its citizens in secular and moral affairs and when energy is manifest
along these lines we might expect to find equal improvement in educa-
tional matters, although financial prosperity is not always a key to
educational success for the reason that minds and means are not always
diverted to channels productive of the most good, and no doubt this
township could have been further advanced educationally had more
of its trustees been given a vision of its financial possibilities.

The early inhabitants received their education in primitive log
schoolhouses characteristic of the forest days in Indiana. These in
time were supplanted by more substantial frame buildings and later by
brick structures each in a school district of its own, there finally being
twelve such districts. The slab seat with its four pins for legs and the
slab writing desk extending along the entire side of the room of the log
houses were superseded by carpenter-made desks in the frame school-

THE EVOLUTION OF HAWCREEK TOWNSHIP 49 1

houses and later modern desks of various sizes were installed in the brick
houses. In the pioneer schoolhouse little thought was given to the
amount of light necessary and the heating apparatus consisted of a huge
fireplace in one end of the room in which logs were piled and which
crackled with pleasure and laughed for joy along with the merriment of
the buxom girls and boys. Needless to say the great throat of the
chimney was a deadly enemy of carbon dioxide and any other noxious
gases. This valuable means of heating and ventilating was supplanted
in the frame and brick schoolhouses by the more unsanitary stove still
in use in most rural districts of Indiana.

The most perceptible evolution in rural hygiene began with the
establishment within the township of Hope Female Seminary in which
many of the grandmothers and mothers of the present generation of
school children received their education and which accounts for the high
character of the motherhood of the township. None the less potent for
the cause of sanitation and hygiene was the establishment of Hartsville
College which contributed more perhaps than any one factor to advancing
education of parents of both sexes of the last two or threie generations.
This college, now extinct, was the alma mater of many men of note
and it was in this township in old Hartsville College that Wilbur and
Orville Wright, of aviation fame, received their early college training.

The author of the poem "Indiana" had this period of time and per-
haps this township of Hawcreek in mind when he wrote :

Though many laud Italia's clime,
And call Helvetia's land sublime,
Tell Gallia's praise in prose and rhyme,

And worship old Hispania;
The winds of heaven never fanned,
The circling sunlight never spanned.
The borders of a better land

Than our own Indiana.

Where late the birchen wigwam stood,
Or Indian braves their game pursued,
And Indian maids were won and wooed,

By light of soft Diana;
Fair cities, as by magic, rise.
With church towers pointing to the skies,
And schools that charm the world's wide eyes

To fair young Indiana.

Her gentle mothers, pure and good,
In stately home or cabin rude.
Are types of noble womanhood;
Her girls are sweet and cannie ;

492 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Her sons among the bravest, brave,
Call no man master, no man slave —
Holding the heritage God gave
In fee in Indiana.

People of this class can not be satisfied with the ordinary. School
hygiene had not kept pace with hygienic conditions in the majority of
homes. The health of the child was being discovered as the greatest
asset of the township. To conserve the child's development along
nature's own lines to promote mental attainment without sacrificing his
physical being, to inspire the development of both mind and body
without unnecessary waste of energy, to solve the many health prob-
lems in education, began to confront the parents and a demand was
begun to mitigate conditions. Overheating of rooms by unmanageable
stoves, poor ventilation and improper light by misplaced immovable
windows, and misfit school furniture were found to retard mentally, to
render physically unfit and make nervously unstable the children of the
township. The old schoolhouses produced and harbored too many
school diseases. A demand was made and heartily supported by the
trustees to build a sanitary, up-to-date consolidated building. Of course
kickers sprang up. Nearly always it is the man who gets value received
and who gets justice who kicks. Walt Mason describes this freak of the
genus homo in his jocose way, by saying :

In every town and city the kicker wields his jaw;
It seems a frightful pity he's not suppressed by law,
That people can not rally around the croaking Jake
And take him to an alley and burn him at the stake.
One kicker in a village, who kicks with might and main,
Is worse than pest or pillage or suffragette campaign,
And yet we only snicker or spring a feeble sneer,
When we behold the kicker do deadly damage here.

In the evolution of things some of the opposition to building was
withdrawn, and some of the kickers died.

Personally, when one of these kickers had kicked away a life that
might have been otherwise useful, and the time comes to cover him with
the clods of the valley, I am not going to take any chances by standing
at the wrong end of the grave.

Fortunately this class is very much like the screech owl valued more
for the noise they make than for their size, and so in Hawcreek Township
in spite of their looks of wisdom and their words of censure a contract
was let by a trustee who had learned that the way to become popular is
to let other people impose on you, so, a substantial brick building with
stone trimmings, was erected, properly lighted, heated and sanitary in
every respect.

THE EVOLUTION OF HAWCREEK TOWNSHIP

493

This building is located near the geographical center of the township
and the pupils are gathered from all parts of the urban territory and trans-
ferred to the school in eleven hacks which are owned by the township.
These hacks, well ventilated and properly warmed in cold weather,
convey about 200 pupils to school, daily. These pupils, since consoli-
dation, are quite as properly graded as a city school, a condition that
would be impossible without consolidation. A marked decrease in sick-
ness is noticeable, so with compulsory education in Indiana the per cent,
of attendance runs high. There has never been an epidemic of sickness
in the school during the five years since consolidation. The various
hygienic improvements in the present building conforming to Indiana
State Board of Health requirements, is a great improvement over old
style architecture, and does much to conserve the health of the children.
Medical inspection thus far has been conducted by the teachers and has
shown numerous defects of both eyes and ears. Some of these defects
are caused, or at least aggravated, no doubt by the use of automobiles,
many of which are used in the township, and which are causing enough
injury, because of the rapidity with which objects pass before the eyes,
to be recognized as the "automobile eye."

Table No. i.
Showing Number of Pupils with Defective Sight and Hearing.

Year

No. Pupils
Examined

Defective
Sight

Defective
Hfearing

1911-12

197

120

1912-13

186 60

Snellin's charts were used in making eye tests and the watch and
whisper tests were used in ear tests.

A comparison will show that in 1 911 -12 sixty per cent, had defective
sight and thirteen per cent, had defective hearing while in 1912-13
thirty-three per cent, had defective sight and ten per cent, defective
hearing.

I attribute the higher per cent, of defective eyes in 1911-12 over
191 2- 1 3 to the better understanding on the part of the teachers in the
use of the chart in making the tests. Some slight errors of vision will be
overlooked and others magnified unless the ophthalmoscope is used or
the eyes influenced by the use of local application of medicines, thus
while the eye tests may not be as accurate as seat measurements, they
prove to be of vast benefit to both teacher and pupil.

494

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Measurements of pupils, seats and desks are made annually, and many
misfits are apparent as shown by

Table No. 2.

Year

Number
Examined

Seats
High Low

Desks
High Low

1911-12

197

12 80

144 I

1912-13

186

19 38

139 0

Every seat if but one-half inch too high was recorded as such but
only seats that were three inches or more lower than leg measurement
and desks that were three inches or more higher than elbow measure-
ment were recorded.

Table No. 3.
Showing Measurements by>Grades, 1912-13.

Grades

Number
Examined

Seats
High Low

Desks
High Low

I & 2

14 0

6 0

2&3 •

2 8

40 0

3&4

2 6

29 0

5&6

0 13

37 0

7&8

I II

6 0

The rules for making the measurements were (i) the length of the leg.
This is secured by seating the pupil upon a flat top table. A book is
held under the foot of the pupil and the measurement of the leg is taken
from the sole of the foot (i. e. from the top of the book) to the underside
of the thigh (i. e. to the top of the table). Then (2) the height of the
elbow is measured from the top of the table to the underside of the
horizontal forearm, the upper arm being held closely to the side of the
body, the forearm being flexed at right angle. Next (3) measure from
the floor to the top of the seat used by the pupil, and (4) measure from
the floor to the top of the desk. Measure the seat and desk at that
point which would be an average height from the floor.

THE EVOLUTION OF HAWCREEK TOWNSHIP

495

Most remarkable strides are shown in the evolution from district
schools to consolidated by the following table for fifteen years, in periods
of five years each, making comparisons, and showing gains in number of
graduates, the younger age at which they graduate under consoHdation,
higher general average in grades attained, increase in per cent, of gradu-
ates to total enumeration and the remarkable economic gain to the town-
ship, the low estimate of $300 being used as the value of a child's educa-
tion at the time of graduation from the public schools.

Tables for fifteen years in periods of five years each, making compari-
sons and showing gains of graduates.

Table No. 4.
Period Ten Years Prior to Consolidation.

Year

Num-
ber of
Grad-
uates

Ave-
rage
Age

Average
Grade

No. 13
Yrs. Old

No. 12
Yrs. Old

Enumer-
ation

Per
Cent, of
Enumer-
ation

Econom-
ic Value
to Town-
ship

Value
for 5
Years

1899

No
Record

247

.008

$600.00

1900

77-5

242

.008

600.00

1901

15.2

77.2

239

•037

2,700.00

1902

214

.005

300.00

1903

155

77-4

209

.047

3,000.00

Totals

77.5

230

.021

$7,200

. Table No. 5.
Period Five Years Prior to Consolidation.

r
1904

15-3

194

.036

$2,100.00

1905

155

.02

900.00

1906

84.2

160

•05

2,400.00

1907

15.7

150

.02

'900.00

1908

143

77.6

160

.056

2,700.00

Totals

> 30

151

81.3

164

.036

$9,000

496 FOURTH INTERNATIONAL COf<TGRESS ON SCHOOL HYGIENE

Table No. 6.
Five Years Since Consolidation.

1909

84.8

202

.074

$4,500.00

I9IO

80.4

198

.085

5,100.00

I9II

87.2

• '''

.07

4,500.00

I9I2

13.7

94-7

205

•053

3,300.00

I9I3

14.2

90.3

289

.042

3,600.00

Totals

14-3

87.5

221

.065

$21,000

A gain of % year on each of 70 graduates at $300.00 per year $14,000

Total gain in five years. *. .$35,000

Out of the fourteen townships of Bartholomew County, Hawcreek
Township graduating classes for the years 1912 and 1913 averaged the
youngest in years and highest in grades of any in the county.

Evolution has taken place in Hawcreek Township, not only in matters
of sanitation and hygiene but in parents, teachers, more regular attend-
ance, punctuality and grading, so we may not attribute all the gains
shown, to better health conditions, but surely a well lighted, well heated,
well ventilated building, with its properly located blackboards and seats,
its soft colored walls, its splendid hallways and roomy basement, with all
general conditions catering not only to the mind but to the aesthetic
nature of the child, all this, together with a large playground certainly
is conducive to scholarship and is an admirable contrast to the condi-
tions under the old district system about which the Hoosier poet said :

Catchin* cold an' gettin' well;
'Twas 'bout all they had to tell
Of this life, it seemed to me,
All the way from A to Z.
Some one asked them, "How d'ye do?"
And they'd only got jes two
Answers, if the truth was told —
"Gettin' well" or "catchin' cold."

When their throat wAs feelin' sore,
An' their head began to roar,
Then they knew that if they'd wait
Patiently, they'd feel first rate.
An' they knew, when free from pain
They'd be catchin' cold again.
'Twas 'bout all there was to tell —
Catchin' cold and gettin' well.

HEALTH DIRECTION IN THE PUBLIC SCHOOLS 497

HEALTH DIRECTION IN THE PUBLIC SCHOOLS

Clinton P. McCord

We are living in the renaissance of science as applied to society.
The last five years have given us as great advances along lines of public
health as the last twenty-five years have brought us progress along
linical channels. We are in the midst of a great movement toward the
improvement of physical conditions, which movement has as its real
purpose the prolongation of human life. At work, in some measure,
are forces that will make for better living and improved social conditions.
Welfare work embraces lines of investigation and activities that have
ome to have their expression in organized departments in many of our
large industrial concerns, in probation officers in connection with our
Juvenile Courts, in our various Cooperated Charities and in our institu-
tions for the segregation and proper care of a certain number of our
criminals and mental defectives. Lines of research have revealed the
dangers that threaten our social body through disregard of laws of
heredity of almost mathematical precision.

The day has passed when we can truthfully say that the child owes
a debt of gratitude to parents for the privilege of having been born,
unless he reach maturity, sound in body and with a fair degree of training.
The day is here when no Board of Education can shut its eyes to the great
need of proper physical care of the community's future men and women
during the years when these little ones are so largely within the keeping
of the schools. It is no longer enough to supply buildings and books and
teachers; there must also be the certainty that attendance upon this
training, which law has in so many states made compulsory, shall not
mean "compulsory disease," to use another's apt phrase.

The explanation of the whole movement for better health conditions
may rest on the possible psychology of altruistic moral emotion, namely,
on the selfishness of self-preservation, but no matter, the fact remains
that we are looking after our less well-informed neighbor and are trying
to give him a better chance for freedom from suffering and a wider share
in real happiness.

Emerson said: "The greatest wealth is health," and yet few be-
lieved this to the extent of seriously governing their actions and life
along health lines, until the past few years. To-day the wisest of our
people, no matter how important is their work or how wide the range of
their responsibilities, are finding time to think of their physical well-

498 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

being, realizing that without the physical basis real mental efficiency
is never attained.

Along with all this has come the interest in the growing child. This
has developed the laws concerning child labor, the infant welfare work,
the various lines of social research, and medical inspection and the school
nurse. Compulsory education in this country placed approximately
20,000,000 children under a daily routine which often was far from being
conducive to good health and normal development. Modern medical
inspection arose in this country some nineteen years ago to combat
some of these physical evils and to point the way to better health as the
first essential to school progress. It in turn has grown to assume a scope
which makes it more properly health direction, and I wish to propose a
more general adoption of the term. Health Director, as more accurately
designating the functions of the officer who is to play a part constantly
increasing in importance in our educational systems.

I hope to convey in this paper what I believe should be the scope that
health direction may properly assume in the Public Schools of cities of
100,000 or less (the cities which in greatest numbers will introduce the
work within the next few years) with reference to some of the details
of initiation of such a system so far as we have realized our ideals in the
capital of this state. Since in most of the smaller cities persist remains
of the "village spirit" which must be combatted in the introduction of
a new institution, I have felt that a brief description of conservative
methods of establishing the work might be welcomed by executives
who are contemplating such innovation in their cities. In a paper,
limited as is this one, it will be impossible to amplify any statements.
I hope therefore, simply to present a bare outline and trust that this will
invite inquiry which it is our hope to satisfy in subsequent publications
or in exhibits of the actual workings of our system at Albany, N. Y., as
the months bring a realization of ideals and an enlargement of the scope
of the work. I direct your attention to our small chart exhibit as a
unit of the New York State Education Exhibit at this Congress, not as
presenting a startling array of figures, equipment or paraphernalia of
medical inspection, but as setting forth what we believe to be the best
plan of organization in cities of 100,000 or less, with the chief features
of our system together with the lines along which we hope to develop.

Allow me to deal briefly with the initiation of such a system, touching
on the things of special interest to executives contemplating medical
inspection, and then pass on to a consideration of such a system when
extended to embrace the wider idea of health direction.

The "full-time" man selected preferably should have had some
experience as an executive in school work. This, with a first-class medi-
cal training, including a knowledge of the elements of the specialties,

HEALTH DIRECTION IN THE PUBLIC SCHOOLS 499

makes a happy combination. He should have a fair outlook upon
pedagogical and sociological problems. He should know the "special
case" child. The salary should be somewhere between $2,000 and
$3,000 a year. There should be a sufficient number of nurses to assure
a daily visit to every school (approximately one nurse to every 1,500
children). The Inspector should have an office adjoining that of the
Superintendent of Schools. Provision should be made for a system of
adequate records if the work is to be placed from the start upon a scien-
tific basis.

The appropriation for the first year of such a system in a city of
100,000 should be at least $5,000, and this amount will furnish only
the minimum number of nurses. It will be necessary to increase this
sum from year to year as the number of nurses for the most efficient
conduct of the work is approximated, and also to provide for any addi-
tional salaries, equipment, attendance upon conventions, etc., such as
may be indicated under a system of health direction as outlined farther
on in this paper. The Board of Education should secure the cooperation
of the medical profession in any city in the matter of the selection of an
Inspector, and because of the local jealousies, or often because of the
lack of a specially trained man or a high-grade man who is willing to
give up his practice for new work, it is often wiser to import a man who
will be free from the local prejudices and will be ready to deal fairly
with everyone. It is true that the nature of the defects discovered by
medical inspection will mean more work for men who are in the special-
ties, but well-trained family physicians see this and will do only what
they would have done had the cases come to them direct from the parent
— namely, send the patient to a reputable oculist, rhinologist, etc., if
the condition be not within the scope of general practice.

Fortunately there are in every community cultured, well-trained
ethical physicians, who, as soon as they see that the Inspector in no way
trespasses upon their rights as family physicians, are ready to examine the
workings of the system, and in many cases come to be the Inspector's
most helpful counselors. These are the real "pillars" of the profession,
and if the Inspector and the educational authorities under whom he
works are sincere, and show this sincerity by a strict adherence to the
highest type of professional ethics, the cooperation of these men is assured,
as is their approval of any public work which has for its object the better-
ment of health conditions and the advancement of health standards.

The policies involved in the initial plan, the analysis of a local situa-
tion, the avenues of appeal to the parents, principals, teachers, etc., are
matters of detail, depending upon the city, the type of people, the per-
sonality of the Inspector and those with whom he is most closely asso-
ciated. When medical inspection is a part of the educational system

500 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

COOPEr RATION

The riAcic Circle.

as in the plan here discussed, the question of its relation to the local
Board of Health arises. The most courteous relations should of course
exist although they "touch hands" in comparatively few cases. The
acute contagious diseases are the only cases occurring among school
children which fall under the authority of the Board of Health.

By a most satisfactory arrangement effected with the Board of Health
in our particular field, all cases of the "so-called" reportable diseases
discovered by the Inspector are reported by telephone to the Board of
Health, and in turn, each morning, the office of the Medical Inspector
receives a report of all such cases known to the Board of Health. Here
these cases are tabulated in relation to the different schools, and where
any school is affected the Inspector and the Principal concerned have
prompt knowledge of the fact. When speaking of contagious diseases I
feel that one is always moved to criticism of the existing inefficient
methods of quarantine observed in many of our second-class cities.
In view of recent researches on measles and scarlet fever the question
arises as to whether or not the period of exclusion for these diseases, or
at least for measles, might not be materially shortened in some cases with
a great saving in school time to the child. In the matter of diphtheria,
the question forces itself as to whether or not a more careful quarantine,

HEALTH DIRECTION IN THE PUBLIC SCHOOLS

501

the proper enforcement of the rule requiring two negative "cultures"
on two successive days for release (which is seldom enforced in smaller
cities) might not greatly decrease the number of cases of this disease
which every winter takes its "toll" from the ranks of the school children.

From the point of view of the Medical Inspector there is one avenue
open, which involves considerable work but which offers greatly to lessen
the spread of this disease in the schools, namely — to make "cultures"
of every sore throat, and where a case of diphtheria develops to culture
at once the throat of every child in the class and exclude the "carriers."

You will notice that I seek to suggest a wider range of activity for
the Health Director than the field commonly assigned to a Medical
Inspector.

What is the scope that this direction, as part of the educational sys-
tem, should assume?

There are five chief highways to health in the public schools. Health
direction should in a large measure take cognizance of them all. The
accompanying chart perhaps best presents the details.

5CH NURSEB-

HotttWiTiHe

CHILT STOPt
Z^YCHOIOGIgT.

QoNTA-CT-WlTtt

jTIVIlpLECirJtT

i:d6e.nic&~

•puJe«T.•^^cHz^^b

^ OT-

TsoTtt3mimKi-
LiCHTrHG -
ventilation-
Heating -
furwttuke •

Tl^CHEK.*'
ZLmKS£ncv

CmKlCULUJl
JftlRhSwW'ou'T

OPE.H AW *CJ)o«I

giUffiTSwHwiR

BA.TH-ms-

roop-

Z.3tE5CI?=E.
CI.OTHIW&
(vvy»TT«Ta-

rioSEJ^TllHay:
rWEECTroN ►
iMtfuwirY-

Habit
Znmznct-

REGVJ-ATi

Cfe\J-T»TlBeWlt*

gaWtrta-fwci.

-<<VrHl^TlC'S-

gfUNlfiKltE-*.-
IrtePcnKI Clinio

Wide/- ufcc of

YioTV.x.vQ
■^ Hotkehv

SiAtjojis
Ton CKIL-D-

-TRe-

ThdJ- me ipEAL sha.ll be I^Ei^L to thee'L

502 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

It is very plain that such a system cannot be adopted outright at the
start of the work in any given city. Perhaps the first step usually will
be the initiation of a system of medical inspection with one "full time"
physician and four or five nurse assistants, and only those record cards,
equipment, etc., absolutely essential for careful and scientific work.
As the need for additions to such a system becomes evident (which is
usually when a year of good work has demonstrated the great value of
the venture to the city) it may well be expanded along the lines indicated.
Eventually such a system would include, beside the Health Director, a
"full-time" physician, devoting his energy to the medical inspection
phase of the system, a psychologist or at least a person skilled in the use
of the Binet Tests, with a child study laboratory, and a sufficient number
of nurses to assure a visit to each school every day (approximately one
nurse to every 1,500 children).

With such a working force the Health Director would be in a posi-
tion to make exhaustive studies of the various health problems, to keep
the needs of the child before the public and the educational authorities,
to confer to some purpose with the Superintendent of Schools upon
medico-pedagogical questions, to supervise the conduct of the various
school plants from a health standpoint, to give expert advice to the
Board of Education upon matters of school hygiene, furniture, physical
fitness of candidates for the teaching force, ietc, to act as consultant
to the Director of Physical Training, to act as adviser to the Director
of School Lunches, to supervise the work of the child study laboratory
and consult with the Superintendent of Schools in regard to the training
of the "special" child — all these things in addition to the supervision of
the actual work of medical examination of children by the "full-time"
examiner and nurse assistants. The open-air school may well be visited
by a special physician and nurse whose reports should be filed with the
Health Director. The question of the work in the child study laboratory
perhaps requires more careful amplification. We have in our schools
some 10% of children suffering from poor nutrition, some 20% of nerv-
ous cases, some 2% with speech defects, some 2% of those mentally
deficient. All the above are "special case" children. The Director's
Office might well be made a "clearing house" for the worst of these cases.
Here, with proper equipment, a more careful study could be conducted
than is possible at the schools, and proper disposition of the cases could
then be made. The cases of speech defect would be assigned to special
teachers for varying periods of training, the poor nutrition cases to the-
open-air schools or the open- window class-rooms and the care of the
Director of School Lunches, the nervous and "backward" cases to the^
child study laboratory, where special apparatus is available and where
the Binet Tests could be applied by a person skilled in the use of these.

HEALTH DIRECTION IN THE PUBLIC SCHOOLS 503

valuable diagnostic aids. The children found mentally deficient could
then be assigned to the "special schools." Let me emphasize the fact
that there are in the public schools certain mentally deficient children
that are detectable only by the specially trained examiner, and upon
whom positive diagnosis should be made only after a careful psycholog-
ical examination. Is the system I have pictured possible?

I do not say that in Albany to-day we have even the beginnings of
some of these lines of good, hut I am confident that we have the right
start. For the benefit of cities contemplating a system, formulated
along scientific lines, I would say, that the first requisites for the realiza-
tion of such a system are: (i) men on the Board of Education who are
broad-minded and far-seeing, fearless in their manhood and dignified
in their citizenship, and with hearts warm for human sufifering, and (2)
a Superintendent of Schools who is an educator and scholar in the true
sense of those words — a man who can see beyond the present system
of desk and book and blackboard, and can appreciate the real end of
education — ^human happiness. These chief requisites our city possesses,
and I can predict, that, with Commissioners of Education and a Super-
intendent who are alive to the wisdom of prevention as well as the good
of cure, and with letters from leading physicians of the city approving
of any plan which means more careful supervision of children of school
age from the standpoint of health, in a couple of years you can visit
Albany and see such a system in practice, working untold good to 12,000
future men and women. If the profession as a whole awoke to the wis-
dom of such supervision prior to school age, the cooperation which they
would then measure to the school and child hygienist would more than
double the results of present methods, raising the health standard
among school children and fulfilling one of the vital objects of school
training — to bring the child to maturity with his powers so developed
[and Ris energies so conserved that the richest return may accrue to the
state in its vigorous, aggressive, progressive men and women.

DISCUSSION OF

Clinton P. McCord's Paper

Dr. C. Edward Jones

I am pleased to hear that there is a tendency to substitute "health
direction" for "medical inspection." The work under its proper con-
ception has to do with hygiene rather than with medicine, and it calls

504 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

for careful and definite direction rather than for mere inspection. With
this understanding there can be no conflict with the Board of Health.
The Health Director barely touches hands with the city Board of Health,
but he is a vital factor in the school system, and as such his work be-
longs under the Board of Education as much as does that of the director
of drawing, music, physical education or even that of the superin-
tendent himself.

At present the work of the Health Director has not been clearly
defined. He is looked upon by some as a physician, by others as a com-
piler of statistics. When he comes to his own he will be recognized as
belonging to a new profession. He needs to know hygiene, anatomy
and medicine, he needs to know psychology, he needs also to know
school administration. Out of the demand for better health conditions
this profession will be created and the sooner it is, the better will we be
able to cope with health problems as they relate to schools.

DISCUSSION OF

Clinton P. McCord's Paper

Dr. Frederick E. Downes

Mr. Chairman: I have noted with interest that a considerable por-
tion of the time of each session of this department has been taken up
with discussions as to conflict of authority between Boards of Health
and Boards of Education. I cannot full appreciate arguments along
this line for the reason that in the city which I have the honor of repre-
senting no such conflict exists or is likely to exist. I am inclined to the
belief that most of the fears along this line have nothing more or less
than imaginary grounds for arising.

In Pennsylvania the law provides for Boards of Health and prescribes
their authority. It also provides for school medical inspection and
prescribes the authority of medical inspectors. The former bodies,
generally speaking, have to do with contagious diseases, the vaccination
of school children, community sanitation, etc. School medical inspec-
tion has to do very largely with a field of service which Boards of Health
do not and cannot enter, such as the general inspection and examination
of school children and teachers, home visitation for instruction and
guidance, special schools for the mentally backward and tubercular,
the common or specific hygienic needs of the child, etc. In our state
the law makes it the duty of both Boards of Health and Medical In-
spectors to look into the sanitation of school buildings, but on this point

HEALTH DIRECTION IN THE PUBLIC SCHOOLS 505

there has never been an instance of conflict of authority in Harrisburg,
for the reason that it has always been conceded that the authority of
the Board of Health supersedes that of the school medical department,
or any other department, for that matter, of the city government.

In the five years that medical inspection has been in practice in our
city, there has never been a conflict of authority, and I do not believe
that there is any reason for any such conflict.

DISCUSSION OF

Clinton P. McCord's Paper

Dr. Albert VanderVeer

Dr. McCord, from the standpoint of history and experience has given
us a very wholesome paper. He gives us a firm foundation upon which
to build, and has presented a whole lot of material from which to select.
He has combined, in his valuable paper, a statement of facts commanding
our entire confidence. He has correlated these facts in such a manner
as to impress one with the necessity of an analysis of conditions pre-

H senting in connection with school hygiene, and of organization and
methods in a most charming manner. He has given us, in clean clear
language the clinical conditions he has observed from time to time, has

H shown how this sort of information can be applied, and has held up, in
a very interesting manner the subjects that call for action, along his
line in school inspection. That he has thoroughly in hand the medical

B side of the work, and how to approach it, there can be no doubt. His
careful study of conditions in the latter, of which I am personally cog-
nizant, regarding the public schools in Albany, leaves little opportunity

Bfor argument against the introduction of the methods he advocates.-
His whole paper is full of the germ of active work. There is no hesi-
tancy on his part in presenting the practical points we are so much in

H need of at this time. He has clearly shown how that action may be
taken after his careful discussion of the important work he has been

^ doing for the past year. He has not left us ignorant of what to do but

H proceeds in a clear, judicial manner to tell us how to accomplish these
results. He has given us a complete resume of the situation, in cities
of one hundred thousand inhabitants.

|H The conditions, and the methods of organization, lead to simplifica-
tion of the entire work, in fact his paper is one manifesting great general-
ship, and must result in much good in the better understanding of this
branch of eugenic work.

506 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

TWO YEARS' WORK IN THE SCHOOLS OF
LYNCHBURG

MosBY G. Perrow

When the Health Department, somewhat over two years ago, under-
took an inspection of the school buildings and grounds of the city, it
was probably the first time a real sanitary survey of them was ever
made. The public schools had for years been classed by the State
educational authorities as the best in Virginia, and had ranked as up-
excelled by none in the entire South. The classification of course was
based on the curriculum, and the scholastic efficiency of the pupils.
The schools had enjoyed the continued supervision of a man, highly
competent and enthusiastic in the usually recognized educational lines,
and what is said here is intended as no reflection on him, or for that
matter, on anyone. The facts simply illustrate that one may be very
diligent in certain departments of activity, and yet allow other and even
more important work to go neglected.

The inspection showed that many of the rooms were overcrowded.
The State law required 200 cubic feet of air space per pupil. The
measurements of one room were taken and found to give not quite
118 feet per pupil. The law exacted a minimum of 15 square feet of
floor space per pupil. The measurements showed 13 feet. , The law
also stated that the ceiling should be at least 12 feet high. This room
had only 9 feet and to make matters worse, there was no way to get
sufficient ventilation, although the law required that there must be
30 cubic feet of air per pupil every minute.

A regulation of the State Board of Health also read: "Every room
used for school purposes, whether public or private, shall be furnished
at all times, when in use, with an adequate supply of drinking water
of good sanitary quality. This shall be running water whenever same
is available. If running water is not available, a tank or cooler shall
be supplied, furnished with a spigot; or a dipper shall be supplied, which
shall be used only for dipping the water from such tank or cooler.

*'In addition to the dipper there shall be furnished a cup or glass to
be used only for drinking, and which shall not be used for dipping water
from the tank or bucket, or for any other purpose. The contents of
every receptacle for drinking water must be renewed fresh every morn-
ing, and every receptacle, dipper, cup, or glass shall be well washed
every morning, and scalded with boiling water at least once a week."

TWO years' work in the schools of LYNCHBURG 507

As a matter of fact in only one building were drinking fountains
found, and in this building but two. Open buckets were forbidden
by law, and yet half the schools had open buckets, and in many instances
the drinking vessel was without a handle so that the fingers dipped
with the glass beneath the water. Some schools, however, were fur-
nished with coolers having closed tops, but these coolers seemed unac-
quainted with cleaning, and in the bottom of one was a very heavy
deposit of dirt. Regular scalding of the coolers appeared unknown
although a plain legal requirement. The law also stated, "That where
sewerage is available, proper water closets must be installed." In the
face of this a number of the schools not only had no water closets, but
the worst form of unprotected and unsanitary privies.

Methods of heating and ventilation, while in some cases commend-
able, in others were very bad. The ordinary un jacketed coal stove
was in frequent use, with the consequent vitiated air, and no systematic
method of securing fresh air. In many of the rooms the desks were
ludicrously small, making a condition ruinous to health, and in itself
absolutely intolerable.

Below is given the detailed description of each building sent to the
School Superintendent, and Chairman of the School Board. Along
with this description went a letter urging immediate action.

Building No. i. Two modern drinking fountains. Closets new.
First-class condition. Plaster along stairway on boys' side needs re-
pairing. Floor rough and defective in several places. Weeds in yard
need cutting.

Building No. 2. Water coolers greatly in need of cleaning. In
four rooms there was no glass dipper for the pupils to drink out of, and
in one room a very rusty tin cup. A layer of dust over the water in each
cooler. There was a heavy deposit of dirt in one cooler under the
water. Two hydrants, neither of these having the drain required by
law. Only two rooms with slop buckets and one of these extremely
dirty. In one room a large puddle of water was on the floor where it
had been apparently thrown by the pupils. No slop bucket in some
of the rooms. Plaster broken in several places, and paper peeling in
two or three places. Plaster in upper hall apparently dangerous.

Building No. 3. Seats in boys' closet strongly in need of cleaning.
Sanitary conditions generally good.

Building No. 4. All walls with the exception of one room glaringly
white, which is very injurious to the eyes. These walls should be
tinted. Walkways to buildings of plank in which several of the planks
are broken, making the walks dangerous. Heating and ventilation

508 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

of this building the best in the city, however the intake of fresh air is
too near the ground, and it would seem that a large quantity of dust
is sucked up. Measures should be taken to prevent this.

Building No. 5. Two tower rooms on third story have very narrow
steps, and are consequently very dangerous in case of fire. Coolers
in all the rooms kept unusually clean. In one room was a rusty tin
dipper. General condition good.

Building No. 6. Insufficient supply of water. Intake for ventila-
tion too low thereby causing dust. General conditions good.

Building No. 7. Conditions intolerable. Stove heat. No jackets.
On east side of building, within 20 feet of school, two privies and one
cow stable. On west side boys' privy was within 20 feet. Girls' privy
within 10 feet. Girls' privy owned and used by a colored family, who
extend the use of same to girls as a courtesy. Odor in schoolroom
unbearable. No water on lot. Open bucket for water. Desks obsolete.
(This building was summarily closed by the Health Department in ten
days from the inspection after due notice to the School Board.)

Building No. 8. Spot of plaster off in one room. Floor in two rooms
not stained. Only one cooler with glass. No slop bucket. Old-
fashioned earth closet. Stove heat and no jacket on stove.

Building No. 9 (colored). Filthy old-fashioned earth closets. Ven-
tilation bad and paper scattered all over the grounds. Undesirable
conditions.

Building No. 10 (colored). Open buckets in five rooms, but the
Principal had secured old coolers from another building to replace
these. Wall chipping in spots. Plaster in one place and downstairs
hall broken. Both plank walkways to closets from buildings broken
and dangerous. Building three stories high with narrow stairway.
No fire-escape, making the building almost a fire-trap. Over 650
pupils in attendance. Two hydrants neither having drain in accord-
ance with law, and making a mess all over the back yard.

Building No. 11 (colored). In all the rooms an open water bucket,
and a glass for each bucket, without handle, making it not only neces-
sary to put the glass into the bucket, but to dip the fingers into the bucket
as well. Walls chipping in places. Closets directly • over sewer with
apparently no trap. Boys' closet very dirty.

Building No. 12 (colored). Low pitched. Boards broken. Heated
with stoves without jackets. Open buckets and plaster broken in spots.

TWO YEARS WORK IN THE SCHOOLS OF LYNCHBURG 509

Water closets, but these were old fashioned, and have bad odor. Needs
hinged door in front. Gutter opens on yard, making wash.

Building No. 13 (colored). Open buckets. Broken plaster in two
places. Desks very low. Stove heat, no jackets. Old-fashioned
unsanitary earth closets.

When this report reached the School Board, the Board was astounded.
No one had ever thought that conditions could be so bad, and yet when
attention was called to the facts they were seen to be too true. Action
was taken at once, and the results will here be stated. Every building
in the city is in excellent repair and repeated inspection sees that it is
kept so. All buildings are equipped with drinking fountains, and noth-
ing like a common drinking cup can be found. The privies have been
abolished and modern plumbing installed. Obsolete desks have given
place to those of proper size and pattern; adjusted to individual pupils.
Old buildings have been torn down and in their stead have been erected
new ones, with the best heating, lighting and ventilation that science
in its present stage could suggest. One building for colored children,
although the Health Department passed over the plumbing in its original
report, the plumbing being excellent compared with that in some other
buildings at that time, the School Board this summer decided should
be better and more amply equipped, and is now spending $2,500 to put
the water closets in the best of shape.

So much then for the buildings themselves. Two years ago no
medical inspection of children was in existence. Now we have exami-
nation of eyes and ears, and a good control of contagious diseases. The
medical inspection is inadequate, but adequate inspection is coming,
and coming fast. We hope soon to have school nurses, and the exami-
nation of nose, teeth and throat. At a recent meeting the Board created
the position of Playgrounds Director, whose duty it will be to develop
the school yards as playgrounds, and to further generally the outdoor
activities of the children.

The object of this paper is to suggest that executives are as much
needed as investigators. Oftentimes we have the law, but it is null
and void because no one pays any attention to it. School Boards and
Superintendents are usually not only willing but anxious to comply
with hygienic requirements, if only their attention is called to the re-
quirements, and they are told definitely what to do. School officials
should work in close harmony with health departments. Neither
school board nor health board can meet with the fullest success without
the aid of the other.

510 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

HYGIENE OF THE RURAL SCHOOLS

James A. Nydegger

Sanitary laws in great numbers have been enacted and enforced
for the betterment of the complex health conditions of our cities. Ex-
tensive public health educational campaigns have been carried on in
all that pertains to health and hygiene; and in the onward movement
which at the present time is being agitated more than in any former
period, in behalf of better methods of living, physically, mentally and
morally, with the great advances made in hygienics, eugenics and eu-
thenics, the rural and urban districts, which now offer the most fruitful
fields for the promotion of hygiene, in all the term implies, seem in a
great measure to have been overlooked, and practically passed by,
and up to the present time, almost forgotten. This has been due in
a measure to the engrossing attention paid to improving health condi-
tions in the cities and large towns, while the rural areas have been
sadly neglected.

Other factors of importance in this connection are the remoteness
of some of the sections from the more populous cities and environs, and
partly through lack of knowledge and ignorance of the existing injurious
environment, insofar that the rules for correct living and good health
have been almost completely ignored.

In further explanation of the backwardness in the rural hygienic
movement, it might be said that the non-investigation into the true
status of health conditions in rural areas more thoroughly, has not
been intentional on the part of the sanitary and health officials of any
state, but partly follows as a result of the lack of interest and knowledge
concerning these matters, of the inhabitants themselves. What will
apply as a whole to the tardiness in advancing better hygienic and
health conditions in the rural communities, of the majority of our states,
will likewise apply to any particular environment in which the popula-
tion inr these areas might happen to be placed.

How frequently do we hear the assertion made by statesmen and
others, that the country district school is the foundation of the republic,
the bulwark of the nation, and yet how little has the nation apparently
done for the public schools of the rural communities. In the cities
and larger towns the schools are as a rule, fairly well administered;
and the buildings fairly well constructed and equipped, in accordance
with hygienic measures, but how about the sadly neglected rural

HYGIENE OF THE RURAL SCHOOLS 5II

schools? Whenr.we come to consider the subject of school hygiene, this
is one of the supreme questions of the hour, as I take it.

When we fail to respond to the call for more modern school houses
in the rural areas, and better equipped and better paid teachers, we
fail in a great public duty.

The claim that the children in the country districts are entitled to
just as well lighted and heated buildings, to just as habitable, modern
and sanitary schools, as are the children of the cities and towns, is a just
one, and the demand must be met if we would heed the call of progress
and justice.

Every American child is entitled to a free common school educa-
tion, and where the rural communities cannot properly provide and sup-
port their schools, the State and Federal Governments should see to it
that better provisions for the rural schools are provided.

It is highly important for us to understand that schools are provided
for that part of our population which is peculiarly susceptible to the
influences of bad hygienic surroundings. It is now a well recognized
fact that the hygiene of school life is of paramount importance in con-
nection with the subject of political economy and the prosperity of a
nation.

.It is also highly important that those who are in any way connected
with the education of the young should have uppermost in mind that
the greatest asset or resource of a nation is its healthy citizen ; and that
unless we do provide better and more modern and sanitary schools
in the rural districts, we cannot expect the children of these communities
to grow up into healthy citizens, and a citizen without good health is
a non-valuable quantity when resources are being considered. As a
people we spend comparatively little money on the conservation of
health, our greatest national resource, while vast sums are expended
for other public purposes of lesser importance.

In the little white, one-roomed, country school house, many of our
greatest men began and completed their school education, yet there
can be no doubt that there were others who would have been great but
for the undesirable environment and limitations of the country school.

It is a sad fact that the school houses in many of our rural communi-
ties are far from sanitary, and that the work imposed upon the teachers,
who are chiefly women, is greater than they can perform without en-
dangering their health.

The majority of the rural school children spend from twenty to
thirty hours weekly in the school room for a period of several months
each year, for eight or ten years. Such being the case the need of hy-
gienic schools and environs, and a good personal hygiene must be ad-
mitted by all.

512

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Formerly we were taught that the country is mor» healthful than
the city, and we accepted this without comment, but recently the sani-
tarians have called attention to the fact that the death rate in the cities
is falling more rapidly than in the rural districts. The cause of this
is simply a matter of sanitation. While sanitary and hygienic pro-
visions have been made for the cities, the urban and rural areas have
been sadly neglected. When the country was first settled the popula-
tion was scattered, and the virgin soil was not polluted, the waters
were pure, and many of the contagious diseases which now claim thou-
sands were practically unknown.

If we but compare the existing unhygienic condition of the average
rural school with that of the schools of the cities, the contrast will be
shown to be all the greater. How often do we see — especially those of
us who are somewhat more familiar with rural life and rural conditions —
the district school located at some one or other extreme limit of the
school district, placed there doubtless more to please some influential
trustee, or patron, or because of a stronger local faction, rather than
being placed centrally, where it would be equally distant and accessible
to all, thereby lessening the hardships, fatigue, and exposure in inclement
weather, imposed on the children who attend from the more distant
parts. Again on the aforesaid grounds, as also by reason of ignorance
of the laws of hygiene, how frequently do we see the rural school house
located at some unhygienic or badly oriented spot. Occasionally do
we see the school placed on low ground where drainage is poor or where
the ground water is near the surface, or perhaps it is seen surrounding
and overhung by trees, which are conducive to moisture and insufficient
sunlight, or it is situated at the base of a hill or eminence, thereby de-
priving the building of the proper amount of light, as also affording an
ill-pleasing view from the windows.

The filth and foul air of the toilet rooms of many schools in decent
urban and town communities is unspeakable, but if we venture into
the more remote rural districts, we are wont to observe the total absence
of this important sanitary accommodation of the school; and the scholars,
responding to the daily calls of nature, must make use of the privacy
afforded by natural objects, and otherwise, in the vicinity of the build-
ing, with necessarily resulting soil pollution and the liability of the dis-
semination of disease germs contained in the excreta, deposited on the
ground. In this manner pathogenic germs may easily gain access to
the source of supply of drinking water for the school. The dangers
of the drinking water are thus two-fold: From the impure water, and
from the common drinking cup, in transmitting disease, still in common
use in the rural school.

The water supply of the rural school generally comes from a surface

HYGIENE OF THE RURAL SCHOOLS

513

spring or shallow well. The former, if free from pollution, is frequently
made inaccessible by reason of the distance necessary to transport the
water, with a resulting deprivation in the amount supplied for drink
and purposes of cleanliness in the personnel of the school, their effects,
and the building itself. Drinking water coming from a shallow well
is more dangerous than from a spring, as it is located near the school
and is more liable to receive surface drainage from the vicinity of the
building, and therefore is more likely to be polluted and its use a greater
risk to health.

When we come to consider the rural school itself, the lack of clean-
liness is perhaps the most glaring and universal defect, being worse
frequently in this respect than the school in the city, while also it is
generally found to be poorly constructed, and imperfectly heated, venti-
lated and lighted. The average country school house is usually a one-
room affair, with thin walls and thin floors, with cloak-room, wash-
room and school-room combined in one, with emanations from unwashed
bodies and soiled clothing and collected gases tainting the atmosphere.
No vestibule or ante-room is provided, and the single door opening
directly without assists in making the heating of the country school a
question. This is generally done by stoves, and in cold climates is as
unsatisfactory a method as possibly can be imagined. The floors are
always cold and the children suffer cruelly from chilblains and colds.
While the upper part of the room is too warm, the outer row of seats
is in an icy atmosphere, and the whole room suffers from bad air. How
many of us here recall the cold and cheerless mornings of our early
school days, when the wood stove failed to draw, and smoked, and the
frequent sorties of the scholars in search of better fuel to make it burn.

The floors in rural schools are covered with dust, as are also the walls
and furnishings, and while the floors are scrubbed once or oftener a year,
were it not for the vacation interim, doubtless a number of pupils would
not escape serious illness thereby, though perhaps the country school's
lack of cleanliness is less harmful on account of the presence of better
air and more sunlight than in the cities; but the cold floors, poor venti-
lation and lighting and absence of all toilet conveniences make them
extremely uncomfortable and often unsanitary. The improper venti-
lation and lighting of these schools frequently justly call for words of
extreme criticism on»the part of the hygienist. What provisions do we
see made for the proper ventilation of the school rooms of the rural
communities? To nature is entrusted this all-important function.
Foul air must find its egress from the room per via naturalis, as also
must fresh air gain access in the same manner. To supply these de-
fects in construction, windows must frequently be raised or lowered and
doors thrown open, when the air becomes overcharged with accumulated

514 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

gases, or the room overheated, as frequently happens, thereby resulting
in exposure of the scholars to cold drafts, with consequent detrimental
effects on health. Also do we see many rural schools where the lighting
is totally inadequate. Either the building is not properly oriented, so
as to receive the maximum amount of sunlight throughout the day, or
the windows are improperly placed or insufficient in number and size,
with the resultant detrimental effects on the eyes of the scholars, lead-
ing to eye strain, headaches, and other discomforts, and eventually
impairing visual acuity.

The lack of systematic medical inspection of rural schools is also a
matter of crying need. While this excellent method of eliminating the
danger of transmitting contagious diseases from among school children
in our cities and some of the larger towns is being extended and improved,
as also the relief of faulty health conditions in the children themselves
which would interfere with their progress, physically and mentally,
and frequently would eventually lead to serious disorders, the rural
and urban schools are practically totally deprived of this valuable ser-
vice. The recent wonderful awakening on the part of the State Boards
of Health and the State Boards of Education, and the Federal authori-
ties, in respect to this point in certain sections of our country, cannot
be praised too highly. The initiative in solving this particular phase
of rural school needs seems therefore to have been taken, but time will
be required for the development of public sentiment along this line
among the rural people, and for the passage and enforcement of state
and local laws providing for this much needed inspection.

The common drinking cup, the common towel, the badly constructed,
placed and kept blackboard, and the common tin wash basin, all will
be found still to fill a prominent part in the equipment of the rural schools
in many communities, and two of these at least play well their part in
the spread of disease among the school children.

Many other subjects which have an important bearing on the pro-
motion of hygiene of the rural school, such as providing proper and sani-
tary playgrounds, proper toilet rooms, the proper care of school rooms,
equipment with proper furniture, providing baths, lunch rooms, short-
ening of the long school hours, the color of the walls with respect to
light, the prevention of certain games played by children with the view
of preventing the spread of disease through osculation, and others,
might well here be discussed, but time will not permit.

Having dwelt upon the unsanitary and unhygienic condition of the
rural schools, naturally the question is asked what is the solution of
this whole problem. The answer is, education in public health matters,
and the adoption of a state-wide policy of improved health and hygienic
measures. The splendid health organizations in force in some states.

HYGIENE OF THE RURAL SCHOOLS

515

cities and large towns only need extension and increased scope of action
to include the rural districts in all their beneficial operations, while
others need to have health departments organized and put on a proper
footing of efficiency. Many of our rural public school hygienic problems
are difficult of solution, and will require the outlay of much time, talent
and money. The latter is not always forthcoming from the State Leg-
islatures, but with it in hand the other two can be obtained.

If the rural communities cannot properly support their schools it
would seem but proper to maintain that the State or Federal Govern-
ment should do so. We know the states are limited to the amount of
money they can raise by direct tax, while the Federal Government,
by indirect taxation, can provide, without in any way embarrassing
its efficiency ; and the farmers who hold the balance of power should see
that they are made, and the funds thus released used for the better-
ment of the country schools.

As has been said, what is most needed to improve and promote the
hygiene of the rural schools is the arousing of public interest in all mat-
ters pertaining to hygiene and health in these communities. This can
be accomplished effectively in one way, and that is, by education of the
public, by lecture campaigns, talks, traveling exhibits, by State Boards
of Health, and Education, by the school teachers, trained in detecting
the contagious diseases in school children, and other interested organi-
zations and individuals, and the district school nurse.

Under this head, the Federal Government, working in conjunction
with State health and education officials in establishing model school-
houses, with model equipment, playgrounds and toilet rooms, etc.,
adapted to the needs of the several rural communities, these to be used
as standard types of buildings for similar purposes in the future, would
find a field of great usefulness and great public benefit, thereby making
good the oft-quoted statement, that the rural school is truly the founda-
tion of the republic, and that it aims to conserve the health of our school
children, our greatest national resource; by improving the sanitary
conditions surrounding the country school to a point where it will not
form, as it forms to-day, the great disease-spreading center for rural
and semi-rural communities.

By these methods, it is believed, modern school houses, as well
lighted and heated and as habitable and well equipped as those in the
cities, can be provided in the rural communities, at no great increase
in cost; and in this manner it is believed that all residents of such dis-
tricts can be reached and interested and instructed, and be brought to
realize that life can be conserved and prolonged, by observing certain and
not difficult hygienic rules for the schools, thus insuring increase of health
and happiness, and in the end greater prosperity in any community.

5l6 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

DISCUSSION OF

James A. Nydegger's Paper

Himself

The object in presenting the paper on Hygiene of the Rural Schools
was to emphasize the importance of turning our eyes on the rural schools
of our country. The inhabitants of our rural communities have to pay
taxes on their property the same as the city dwellers, and why should
they not be entitled to just as habitable and comfortable and well adapted
school buildings as the people of the city? I do not mean to minimize
the importance of attention to the hygiene of the city schools, but the
rural schools are the ones most lacking in it. If we expect to have the
children of the rural communities grow up into healthy citizens we must
provide them better schools.

The photographs which are being handed around do not exaggerate
the unhygienic rural schools and their unhealthy environments. They
speak for themselves stronger than words.

DISCUSSION OF

James A. Nydegger's Paper

John A. Ferrell

We do not always understand each other in these discussions because
the remarks of one are directed to city problems where there is great
wealth, a dense population, and specialization in public work is neces-
sary; whereas the remarks of others are directed to the solution of rural
problems where funds are scarce and the creation of a new office calls
for an appreciable contribution from each of the comparatively few
property holders.

My interest in the main is in the rural problems such as have been
described by Dr. Nydegger in his excellent paper on "Hygiene of the
Rural Schools." We must have a whole-time health officer to begin
with in every county in inaugurating proper medical supervision of
the schools and children. He should be a physician representing the
Board of Health and the Board of Education conjointly. His duties

HYGIENE OF THE RURAL SCHOOLS 517

should embrace an inspection of school premises relative to the sanitary
conditions of the school property and the vicinity immediately surround-
ing it; the school children for the identification of all those requiring
medical care; the exclusion of those suffering from communicable dis-
eases; the detection of ailments, defects or diseases other than communi-
cable diseases, the examination of the drinking water, the inspection
of privies and other school facilities necessary to the protection of the
health and vitality of those attending school.

It is the work of the health department in that it aids to prevent or
eradicate disease, to protect health, and to teach our children how to live
to be useful citizens. It is the work of the educational department in
that it saves and preserves the child for the school, a healthy, educatable
child, one whose heart and mind is receptive to training, one whose
life will bless the State with the highest type of citizenship. Both de-
partments in endeavoring to meet what may have seemed emergen-
cies have been giving their efforts primarily to other lines of work, and
only secondary consideration has been given to the line of activity
fundamentally essential to placing the work of either department on a
firm foundation.

The conducting of medical inspection is so essential to both depart-
ments and so inseparable, at this time, from either, that the inspector
should be a representative of both acting conjointly. With any other
arrangement there might arise a conflict of authority. If there is to be
any separation of the respective departments in the work the authority
for its conduction should be logically vested in the educational depart-
ment, with power when conditions warrant it to delegate the authority
to the health department.

As the medical inspection among our rural schools represents some-
thing of a pioneer work its success or failure will be governed very largely
by the man selected as inspector. He should be a physician well equipped
with tollegiate and professional training. He should possess discretion,
tact, patience, enthusiasm for the work, and the power to inspire
enthusiasm in others. Previous experience in school and health work
is a very desirable requisite. Possessed of these qualifications the man
needed will always command an adequate income. It need not be
expected, therefore, that he can be had without his being compensated
on a basis commensurate with what he would receive in private practice.
To let out work of such vital importance to the lowest bidder, to one
perhaps who needs the salary because in private practice he is so seldom
sought, would be fatal to the work, and should be regarded as criminal.

I The man chosen should be the fittest physician obtainable, without
regard to county or state boundaries.
The county commissioners now pay a county superintendent of health
I

5l8 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

to care, as a rule, for those who, often perhaps through medical neglect,
have become paupers or criminals, and to fight disease usually after it
has become epidemic. It is the exception to find applied the principle
of "a stitch in time saves nine." The toll paid directly and indirectly
as a result of such a system is appalling. The jails are filled ; the county
homes are crowded; the dependents are numerous; schools are poorly
attended ; many children are backward and require two years to complete
what should be accomplished in one ; frequently on account of epidemics
schools are actually closed for weeks and months, quarantines are
established, business suffers, and there is general stagnation.

The county cannot afford to longer tolerate this poor business policy.
It must invest in the best talent obtainable, regardless of price, to pro-
tect it from such conditions. The "stitch in time" principle must be
applied.

To take the entire amount needed from either the general county
fund or from the school fund in a small county might cause some slight
inconvenience, but if both funds will support the inspector who is mu-
tually the choice of the Board of Health and the Board of Education,
the expense will not be heavy on the Commissioners nor on the Board
of Education. As a matter of fact, it should make little difference which
tax money is used to provide for medical inspection, as it affords pro-
tection to all the people and may well be regarded as either regular
health or regular school work.

STATISTICS OF 300,000 RURAL SCHOOL CHILDREN 519

A STATISTICAL STUDY OF THE PHYSICAL DEFECTS

OF THREE HUNDRED THOUSAND RURAL

SCHOOL CHILDREN

B. Franklin Royer

Medical Inspection of schools in Pennsylvania has been conducted
in a more extensive way among the rural children than has been common

I in other sections of the country. Probably the statistics of Pennsyl-
vania now show a greater number of visual tests, tests of hearing,
records of the condition of breathing, of the condition of their teeth
and tonsils and of certain other defects and deformities than have been
accumulated elsewhere for this class of children.
The object in preparing this paper is to present the statistics with a
brief analysis and give an opportunity for the Congress to discuss them
and to contrast them with statistics in municipalities where figures
, have been accumulated for years. The statistics upon which this analysis
is based deal with a total of 305,372 rural school children, none of whom
reside in settlements having over 5,000 population and in fact quite ninety
per cent, of them are children living in the country districts on farms or
in little villages. My first thought was to include the children from the
third-class districts with these in the fourth-class districts, but on further
consideration determined that it would make the study more interest-
ing to limit it to the purely rural child.*

Out of the 305,000 odd children examined, more than 210,000 of
them were found to have some defect, that is, upward of seventy-four
per cent, of the children were defective.

COMMONWEALTH OF PENNSYLVANIA— DEPARTMENT OF HEA'lTH

School Medical Inspection — Fourth Class Districts
School Year 191 2 and 19 13

No. Schools Inspected 7.375

No. School Rooms Inspected 1 1,684

No. Pupils Inspected • 305.372

No. Pupils Defective 228,693 74-9%

No. Pupils Not Defective 76,679 25.1%

No. Single Defects 91,408

No. Multiple Defects 187,285

Total No. Defects - 599.272

*In Pennsylvania a school district of the third class is one having a population of
not less than 5,000, nor more than 30,000; a district having a population of less than
5,000 is of the fourth class.

520 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Eyes

Pupils Having Defective Vision 82,454 27.0%

Defective Vision, Right Eye Only 12,190

Defective Vision, Left Eye Only 13,515

Defective Vision, Both Eyes 56,749 18.6%

Total No. Corneal Defects 2,293

Corneal Defects, Right Eye Only 658

Corneal Defects, Left Eye Only 825

Both Cornea 810

Blepharitis 1,183

Conjunctivitis 1,031

C. simplex . 1,009

C. foUicularis 22

Iritis 27

Trachoma 18

Hearing

Pupils Having Defective Hearing 8,818 2,9%

Defective Hearing, Right Ear Only 3,487

Defective Hearing, Left Ear Only 2,970

Defective Hearing, Both Ears , 2,361

Total No. Having Otorrhea 2,724

Right Otorrhea 858

Left Otorrhea . . : 943

Otorrhea Both Sides i»923

Breathing

Slight Impairment 6,845

Serious Impairment 2,117

Mouth Breathing 1,617

Adenoids 4,454

Teeth

Unclean - 27,685 9.1%

Decayed 91,561 30.0%

Gums Diseased 928

Tonsils

Slightly Enlarged 60,846

Greatly Enlarged 26,356

Acutely Inflamed 1,126

Enlarged Cervical Glands 19,650 6.4%

Tuberculosis

Lungs ; 192

Glands. 367

Bones , 33

Joints,

STATISTICS OF 300,000 RURAL SCHOOL CHILDREN

Nervous Disease

Chorea 291

Epilepsy 82

Skin Disease

Scabies 88

Impetigo Contagiosa 260

Favus I

Ring Worm 58

Nits in Hair 3.657

Head Lice 1 1

Body Lice 6

Deformities

Hunchback 40

Clubfoot 50

Curved Spine 59

Ankylosed Joint 13

Hair Lip 29

Cleft Palate 95

Goitre 347

Miscellaneous.' 896

Nutrition

Fair I1463

Poor 2,155

Quarantinable Disease

Chicken-pox , 27

Whooping Cough 24

Measles 5

Diphtheria I

521

The following tables and diagrams shov^ the number and percentage
of children defective at each age period from 6 to 16 inclusive:*

Age

Normals

Percentage

Defectives

Percentage

9,028

2.9

24,957

8.2

7,057

2.3

26,122

8.6

6,591

2.2

27,764

6,329

2.1

27,477

9.0

6.866

2.2

25,860

8.5

7,126

2.4

22,058

7.2

7,975

2.6

22,089

7.2

7,285

2.4

17,602

5.8

6,412

2.1

13,814

4-5

4,741

1.5

8,795

2.9

3,233

1. 1

5,247

1.7

♦Children under 6 (Kindergarten and others), those past 16 and with ages not
recorded, are omitted from this tabular and diagrammatic analysis.

522 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

305.572 RURAL SCHOOL CHILDREN CLASSIFIED BY AGE, SEX,

COLOR AND NATIVITV
GROUPED AS NORMALS AND DEFECTIVES

ATHFPrmnffS

_afl_28

302 8
8S5-
4 £9

rJORMAU?

9A\
6»5

PERCENTAGE GROUPING OF 305372 RURAL SCHOOL

CHILDREN. Percentages arranged by age sex, color

AND NATIVITY GROUPED AS NORMALS t DEFECTIVES

Total.

ToTAu 4-^ Class
Districts

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Total

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STATISTICS OF 300,000 RURAL SCHOOL CHILDREN

523

Of the total number examined, just twenty-seven per cent, showed
defective vision; that is, by the use of Snellen's Chart twenty-seven per
cent, of all of these children failed to read the line at a distance of twenty
feet that the normal children should read, which means that they were
either nearsighted or had some serious refractive error or some obstruc-
tion to the admission of light to the retina. This percentage takes no
account of children whose vision has been corrected by lenses.

Two and nine-tenths, or almost three per cent, of all pupils examined
showed defective hearing ; that is, a defect of sufficient moment to seriously
impair the progress of the child in school and probably not only to impair
the progress of the child, but to seriously affect the progress of the class.

Commonwealth of Pennsylvania
Department or Health

305.372 RUF?AL SCHOOL CHILDREN CLASSIFIED
BYA3E, AND GRAPHICALLY GROUPED AS
NORMALS AND DEFECTIVES

Not far from five per cent, of all of these children show some
defect of nasal breathing; that is, there was enough obstruction some-
where in the nasal orifices or naso-pharynx to prevent breathing through
the nose. In this group of course is included adenoids, growths, hyper-
trophied turbinate bones, deflected nasal septa and other deformities.
Nearly twenty-nine per cent, of all children examined show enlarged
tonsils; in about ten per cent, the enlargement was enough to affect
the pupils' health and general nutrition. The teeth required attention
in nearly forty per cent, of the children. One quarter of these have un-

524

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Commonwealth of Pennsylvania
department of health
Percentage: grouping or 305^372 rural school children

PERCENTAGES ARRANGED BY ASE AND GRAPMICALLV
GROUPED AS NORMALS AND DEFECTIVES

■■^^■l EB

HII^S^H ^

jH^BHH ^

^^^Bl m

^lEBH ^

m^^B ^

^^^^^^^^1 f7^

^^^^^H ^

^QB m

NORMALS

mnii

II^B o

Defect

-|\/PC..

clean teeth ; that is, teeth darkened in color by collection of bacterial
debris and other evidence of beginning disease that might be averted
by discreet use of the toothbrush; and the other, three-quarter also show
actual decay of the teeth ; that is, cavities were noted by the examiner
or diseased gums were found resulting from decayed teeth and neglect
of the proper hygiene of the mouth.

As a result of the impaired nasal breathing, unclean and decayed teeth
and diseased tonsils, a goodly percentage of the pupils — between six and
six and one-half per cent. — show enlargement of the lymphatic glands in
the neck; the superficial glands in the vicinity of the tonsils and lower jaw.

Everyone of these pupils, with the exception of a few first term
children in kindergarten and regular schools, was examined in the same
routine way and for each pupil examined a complete record was made on
Form 51 reproduced in this volume, in a paper by Dr. Samuel G. Dixon.

In order to tabulate these records and secure complete statistics, a
punch card system was adopted, the card being ingeniously arranged to
record the data in fields for mechanical tabulation, the official method
of statistical compilation adopted some years ago in the United States
Census office, this card being made up as follows :

STATISTICS OF 300,000 RURAL SCHOOL CHILDREN

525

PHYSICAL INSPECTION

O rt

^ -a
Ij ->,

a; Pli

■*-» ^<

.s 1

|o
a a
cu o

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o a,

(X)

^—

r>.

(»

^J-

C>«

c/2

r>-

>
^

««

^c^

05.

'vj-

5-^

»5

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CilO

r--

x«

Suo

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2 ^-

; -

PP CM

gco

'^t

3 *-

tH CM

-r

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r~-

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V-

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526 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The method was adopted with a two-fold object in view; first, that
it would give us the statistics more accurately and in a less expensive
way than could be secured by the ordinary hand methods of tabulation
and second, in that it lent itself to a system of grouping of defects and
association of ailments not possible except at an enormous cost by any
other method with which we were familiar. In designing the punch
card form and statistical tables we took advantage of the expert knowledge
of Dr. Wilmer R. Batt, State Registrar of Vital Statistics, in these par-
ticulars and with his aid believe we succeeded in compiling statistics
that when entirely complete will be unique in school medical inspection
work. In pupils having defective vision it is interesting to know how
many of them may have associated with defective vision other ailments
that might tend to impair sight, as for instance a child having defective
hearing on one side such as to cause the head to be held in an abnormal
position in school work, thus giving faulty position of the eye; or in hear-
ing defects what percentage of pupils having impaired hearing have
associated with this defect impaired nasal breathing, adenoid growths,
etc. Or with children having defective teeth what percentage of them
show in association hypertrophied tonsils, palpable cervical lymph
glands.

This association of defects naturally brings up the query : How far
do defective teeth impair the usefulness of the cervical lymph glands
and thus lessen the pupil's resistance to disease, interfere with nutrition
or impair his progress in school work?

In those having defects of vision it is interesting to know that but
sixteen per cent, of them have visual defects alone. About two per
cent, of the total number have associated with the visual error defects of
hearing, about one per cent, have associated errors of breathing, about
twelve per cent, have defective teeth, about nine per cent, have diseased
tonsils and less than one per cent, have curvature of the spine.

Of those having defective hearing, about five per cent, have impaired
breathing, about ten per cent, have defective teeth, about twelve per
cent, have diseased tonsils and a like number have adenoids.

From what we know of the causes of impaired hearing, we believe
that the abnormal conditions in the nose and naso-pharynx and in the
vicinity of the tonsils, that is, the bad hygienic condition of the nasal
and oral cavities, are directly responsible in most instances for the ear
conditions.

The unhealthy condition of the mucous membranes, especially in the
naso-pharynx and vicinity of the tonsils where the lymphatic circulation
is wonderfully rich, readily presents opportunity for bacterial in-
vasion and dissemination both to the organs of hearing and to the glands
near by.

STATISTICS OF 300,000 RURAL SCHOOL CHILDREN 527

Possibly greater difficulty is met with in encouraging the toilet of the
mouth, especially about the teeth, than in any other portion of children's
bodies and it is doubtful if parents can for some time be made to appre-
ciate fully that unclean teeth are factors in impaired health of children.
They are not apt to believe that what appears to them as discoloration of
teeth and dirt actually means germ life and that this germ life gains en-
trance to the alimentary canal, disordering digestion, to the circulatory
system, impairing nutrition or to the nervous system, making the child
irritable and of bad disposition.

So, too, with decayed teeth. Parents are apt to feel that decay,
especially of the deciduous or baby teeth, is a natural process and that
it does no harm to the health of the child, when as a matter of fact there
is very great probability of neglect of this sort seriously impairing the
health of the individual pupil both by affecting the lymphatic glands in
the vicinity of the jaw by affording opportunity for germs to gain en-
trance to the body through the circulation and by preparing the soil for
prompt decay of the permanent teeth; and there is no way to estimate
the wear and tear on a child's nervous system caused by exposure of
nerves in teeth that have not actually ached.

Probably a thousand pupils in all the rural schools of Pennsyl-
vania show some form of tuberculosis, a very small percentage of them
showing tuberculosis of the lungs and this percentage is decreasing be-
cause of the provisions of the School Code for excluding those having
tuberculosis disease of the lungs except in schools prepared for the pur-
pose. At the present time but few of these schools are established in
the fourth-class districts.

DISCUSSION OF

B. Franklin Rover's Paper

Dr. Harold B. Wood

The old belief that rural school children are in better physical condi-
[tion than city school children has been proven to be erroneous. In some
work in the west, I found that there is little difference, except the rural child
has somewhat better teeth. The reliability of the Pennsylvania records
I show that these percentages of defects may be accepted as representative
of rural conditions. That they are reliable is shown by the exact method
of scoring adopted. The examinations were made by 821 physicians,
and show surprisingly uniform results. Exactitude in making and

528 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

recording examinations results when the method of scoring does not
leave room for variations due to the difference of opinion or judgment
of the different examiners. Score cards, for whatever use, whether for
scoring dairies, food supply houses, hotels or schools, should be made so
definite and in such detail that the recorder himself does not determine
percentages to be allowed, nor use his own judgment of the degree of
defect present. In reporting that a certain percentage of children have
defective vision, writers should state what is their selected evidence of
normal vision. In the Pennsylvania work if a child in reading the Snellen
test card missed two letters on the 20-30 lines, he was recorded as de-
fective.

DISCUSSION OF

B. Franklin Royer's Paper

Dr. B. Franklin Royer

I agree with Dr. Ball in good part and have some quarrel with statis-
tics that give only a gross percentage of defects, and for that very reason
read carefully from the paper the percentage of total defects, the per-
centage of defects of vision and hearing, of enlarged cervical glaiids and
each of the other principal defects, separately tabulated so that those
who want to know the percentage of the serious defects may easily find
them. The Department works with considerable handicap in using busy
physicians who run the whole gamut of medical practice in the country
districts and in being forced to give them their instruction largely by
correspondence, yet very much to our satisfaction, when comparing the
statistics presented this morning with similar statistics presented from
Boston, New York, Philadelphia and Jacksonville, Fla. (some of which
will be found displayed in the Exhibit at the Auditorium) less than two
per cent, variation is found between the combined findings of the 871
country doctors doing these inspections and that done in the large cities
where a corps has been doing the work for years and where the work
has been done by men presumably well trained for it. Indeed, these
statistics speak volumes for the country doctor and his adaptability to
this work.

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 529

A PRACTICAL METHOD OF PROMOTING SCHOOL
HYGIENE IN SMALL CITIES

J. L. Ludlow

Two factors are essential to the problem of promoting school hygiene.
First, there must be created a public sentiment that recognizes the value
and importance of medical inspection of the students in the public
schools as a community function, and, second, there must be a practical
plan by which this inspection can be properly financed.

In the larger cities of accumulated wealth and other taxable property
financing this element of public education is not difficult, but in towns
and smaller cities it becomes quite a problem to be reckoned with, along
with the development of a sustaining public sentiment.

It is believed by the writer that a fully organized department for the
medical inspection of schools, and Other study and practice of school
hygiene, cannot be secured, in many of the smaller cities at least, except
at a minimum cost through a maximum of volunteer cooperative service
on the part of the local physicians and dentists,. and particularly of the
officers and teachers in the schools. Such a plan has been in operation
in the public schools of Winston-Salem, North Carolina, during the past
two years, more particularly in the feature of cooperation on the part of
the school officers and teachers.

This plan had its birth in a civic conscience aroused to the appre-
[ciation of public health, brought about through a local public health
propaganda conducted by the Winston-Salem Anti-Tuberculosis Com-
mittee of One Hundred, which the writer had the privilege of directing.
Beginning with the lessons taught through the exhibition of the National
Association for the Study and Prevention of Tuberculosis, an intensive
public health crusade was conducted by the organization referred to.
It soon became manifest that the subject of school hygiene had per-
meated the public mind with a favorable response, and that a workable
plan to pursue it, in harmony with local conditions, would be more than
[acceptable to the school authorities and to a large part of the public.
But to have all the students examined by physicians and dentists in-
(volved more of financial support than was readily forthcoming, so it
became necessary that some more economic plan should be devised.

From its inception, this public health movement had the hearty and
active cooperation of most of the teachers, and of the Superintendent of
[Schools, Mr. R. H. Latham, who diligently gave his time and energies
to evolving the plan which is herewith presented.

530 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

In general the plan provides a means by which a minimum of strictly
professional work is required. It is predicated on two other ideas,
namely, that the teachers themselves should have a greater knowledge
of the symptoms of good health — or the lack of it — than is usually the
case, and that they should be prepared to make a sufficiently compre-
hensive physical examination to be able to select, with a reasonable
degree of certainty, the healthy students, as well as to detect the symp-
toms of minor defects in others. With such knowledge properly utilized
the teachers can largely reduce the number of students to be examined
and treated by the physician or specialist.

The plan was fully outlined in detail by the Superintendent to all the
teachers and the working plan was comprehensively set forth in the
printed pamphlet, a copy of which makes the body of this paper. The
teachers were required by the Superintendent to study the pamphlet of
instruction and pass an examination thereon. They cheerfully complied
with the requirements of preparation and, by putting the plan into
effective practice, the financial difficulties involved in medical inspection
of schools have been very largely overcome. With such interest and
activity on the part of the public school teachers, much general advance-
ment to the cause of public health has been incidentally accomplished.
But the specific results have been very effective work in promoting the
general health of the students, and substantially accentuating in the
public mind the importance to community life of sanitary environment
and hygienic living conditions.

The Pamphlet of Instruction, etc., embraced the following matter:

To the Teacher:

The laws of the State of Massachusetts relating to Medical Inspection
contain this clause:

"The school committee of every city and town shall cause every child in the public
schools to be separately and carefully tested and examined at least once in every school
year, to ascertain whether he is suffering from defective sight or from any other dis-
ability or defect tending to prevent his receiving the full benefit of his school work, or
requiring a modification of the school work in order to prevent injury to the child or
to secure the best educational results."

The examination of school children with reference to the relation of
the condition of their eyes, ears, throat, etc., to their mental efficiency
has now proceeded far enough to justify the following conclusion:

First: A considerable part of the dullness, truancy, and backward-
ness of childhood, and the nervous breakdowns occurring in later life,
preceded or not preceded by the above defects of childhood, are due not
to defective minds, but to the existence of some easily detected disease
of the eyes, ears, throat, etc.

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 53 1

Second: That many children have their dispositions ruined by
being scowled at and punished by parents and teachers, and ridiculed
by schoolmates, when their only trouble is some removable physical
defect.

Third: That the test necessary for the detection of these defects
may be made by any accurate person who can read. The Massachusetts
State Board of Health, after two years' application of these tests by the
public school teachers of this State, say that the tests made by the
teachers were not less efficient than those made by the specialists.

Fourth : That it is the duty of teachers to apply these simple tests,
before some serious injury to the child's disposition or nervous system
results.

Along with the pamphlet, we are handing you the following:

1. "Eyes and Ears," Public School Health Bulletin No. i.

2. ''Tuberculosis and Its Prevention," issued by the Anti-Tuber-
culosis Committee of One Hundred of Winston-Salem, N. C.

3. Hookworm Edition (December, 1910) of Bulletin of North Caro-
lina Board of Health.

Every teacher ought to get and study carefully Richie's Primer of
Sanitation (60c.). With this book and the pamphlets and your own
common sense you can do more for your pupils than you ever dreamed of.
If you need help on doubtful points, every doctor in Winston stands
ready to come to your assistance.

Teachers will call pupils' attention to the following Rules of the School
Board :

"No pupil suffering from an infectious of contagious disease, or
coming from a family where such disease exists, shall be allowed to re-
main or return to school without the certificate of the attending physi-
cian, or the city health officer."

"No pupil shall be admitted into the City Public Schools who cannot
show a certificate of successful vaccination within the past three years,
or of immunity."

The following described children should be sent to the principal's
office for inspection :

1. Every child returning to school without a certificate from the
family physician after absence on account of illness, or from unknown
cause.

2. Every child who shows signs of being in ill health, or suffering
from infectious or contagious disease.

532 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

3. Every child returning to school after previous exclusion.

4. Children previously ordered under treatment.

5. Children examined by teachers for non-contagious affections
that seem to interfere with the work of the children in school, but upon
which teachers are unable to pass judgment.

Let me urge upon every teacher the importance of the work you are
about to undertake. Do not regard it as one more burden added to
your many school duties. You can do nothing that will bring greater
returns to you and your pupils than .to be the means of helping them to
take care of the physical body which "is the temple of the Holy Ghost."
Only exercise good judgment and tact in what you say to or about pupils
who need medical attention.

Very respectfully,

R. H. Latham, Superintendent.

Infectious Diseases.

Diphtheria. It is a well-recognized fact that nasal diphtheria of a
mild type without constitutional disturbance is one of the most important
factors in causing the spread of the disease, and also that children very
frequently have profuse discharges from the nose. It therefore follows
that, in order properly to inspect the public schools, it is important
that cultures should be taken from the nose in every case where there is a
persistent discharge, particularly if there is any excoriation about the
nostrils.

The throat should be examined at varying intervals, depending upon
the physical condition of the children. Any hoarseness or any thickness
of the voice should cause an examination of the throat. If the tonsils
are enlarged, if the mucous membrane is congested, if there is swelling
of the palate, a culture should be taken. These symptoms precede
diphtheria.

A child with positive cultures should be excluded from school^ until
two consecutive negative cultures at an interval of forty-eight hours
have been obtained.

Scarlet Fever. If there is a sudden attack of vomiting, if there is
any redness of the throat, if the child complains of headache, if there is
an unexplained rise in temperature, the child should be isolated at once.
Any desquamation (peeHng of the skin) should be looked upon with
suspicion. If there are any breaks at the finger tips, if on pressing the
pulp of the finger there is a white lining at the juncture of the nail with
the pulp of the finger, particularly if this occurs in the majority of the
finger tips, the child should be excluded from school.

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 533

A child who has had scarlet fever should not return to school until
the process of desquamation has been entirely completed and all dis-
charge from the nose and ears has ceased.

Measles. Running from the nose and slight intolerance of light may
call for an examination of the mucous membrane of the mouth for
Koplik's sign. Koplik's sign, so called, is the presence on the lining
membrane of the mouth, near the molar teeth of minute pearly white
blisters, without any inflammation around them. There may be only
two or three of these blisters, and they may easily escape detection if
the patient is not carefully, examined in a good light. These blisters are
certain forerunners of an attack of measles.

No child should return to school after an attack of measles until the
desquamation is entirely completed, and the child has recovered from
the incurrent bronchitis.

Mumps. Any swelling of tenderness in the region of the parotid
glands (situated behind the angle of the jaw) should be looked upon with
suspicion. It is important to notice any enlargement or swelling about
Steno's duct (inside the mouth, opposite the second upper molar teeth)
as this is a very frequent symptom of mumps.

A child should be excluded from school until one week has elapsed
after the disappearance of all swelling and tenderness in the region of the
parotid glands.

Whooping Cough. A persistent paroxysmal cough, frequently accom-
panied with vomiting, no matter whether there is any distinct whoop or
not, is indicative of whooping-cough.

In. cases of whooping-cough of long standing, even if there has been no
distinct whoop, an ulcer on the band connecting the lower surface of
the tongue with the floor of the mouth is found in a certain number of
cases. If there is no distinct ulceration, there may be a marked con-
gestion of the band.

As long as there is any cough, the child who has had whooping-cough
should be looked upon with suspicion.

Varicella {Chicken Pox). A few black crusts scattered over the body
are evidence of an attack of chicken pox. The crusting seen in impetigo
must be differentiated from that of chicken pox. (See diseases of the
skin.)

No child should return to school until all crusts have diasppeared
from the body, particularly from the scalp, for in this region the crusts
remain longer than elsewhere.

The Eyes. There are certain children who show normal vision by
ordinary tests, yet whose parents should be notified to have the eyes

534 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

examined. These are: (i) children who habitually hold the head too
near the book (less than twelve or fourteen inches) ; (2) children who fre-
quently complain of headache, especially in the latter portion of the school
hours; (3) children in whom one eye deviates even temporarily from the
normal position.

The Ears. See directions for testing eyes and ears in "Eyes and
Ears," Public School Health Bulletin, No. i.

The Throat and Nose. In all cases of acute illness, the throat should
be examined for the presence of the eruption of scarlet fever and measles
and for the exudation or membrane of tonsilitis and diphtheria, and a
culture taken in any suspected case of the latter.

The presence of discharge from the nose should be noted, and if it is
thick and creamy, a culture should always be taken. In all cases of
severe hoarseness, with difficult breathing, diphtheria should be sus-
pected. If the discharge from the nose is only from one nostril, a foreign
body in the nose should be looked for.

In cases of chronic nasal obstruction, as evidenced by mouth-breath-
ing, snoring, continual post-nasal catarrh or recurring ear trouble, the
presence of an adenoid growth (third tonsil) should be suspected, and
the child referred for special examination and treatment. As a rule,
digital examination for adenoids should be made only by the operating
surgeon. Obviously large tonsils, recurring tonsilitis and enlargement
of the glands of the neck, suggest the advisability of referring the child
to the family physician as to the propriety of removing the tonsils.

Recurring nose-bleed should be referred for special treatment.

In eases of eczema about the nostrils, a cause may be sought in pediculi
capitis (head lice).

In referring cases for treatment, school physicians, in addition to
the diagnosis, should state the symptoms upon which the diagnosis is
based for the benefit of the family physician or specialist.

Diseases of the Skin.

Scabies {The Itch). A contagious skin disease, due to an animal
parasite which burrows in the skin, causing intense itching and scratching.
The disease usually begins upon the hands and arms, spreading over the
whole body, but does not affect the face and scalp. Between the fingers,
on the front of the wrist, at the bend of the elbows and near the arm pits
are favorable locations for the disease; but in persons of cleanly habits
the disease may not show at all upon the hands, and its real nature is
determined only after a most thorough and careful examination. There
is a great variation in the extent and severity of the disease, lack of

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 535

personal care and cleanliness always favoring its development. Scratch-
ing soon brings about an infection of the skin with some of the pus-pro-
ducing germs, and the disease is then accompanied by impetigo, or a
pus infection of the skin.

At the present time itch is very common and widespread, and, be-
cause of the great variation in its severity, mild cases have been mis-
taken for hives, eczema, etc., the real condition not being recognized,
and the disease spread in consequence. All children who are scratching
or have an irritation upon the skin should be examined for scabies.

It is very important that all infected members of a family be treated
till cured, else the disease is passed back and forth from one to another.
It is also important that all under-clothing, bedding, towels, etc., things
that come in contact with the body, be boiled when washed.

All cases of scabies should be excluded from school until cured.

Pediculi Capitis {Head Lice). An extremely common accident
among children, either from wearing each others' hats and caps, or
hanging them on each other's pegs, or from combs and brushes. No
person should be blamed for having lice — only for keeping them.

The irritation caused by vermin in the scalp leads to scratching
which in turn causes an inflammation of the skin of the neck and scalp.
The skin then easily becomes infected with some of the pus-producing
germs, and large or small scabs and crusts are formed from the dried
matter and blood. Along with this condition the glands back of the
ears and in the neck become swollen, and may be very painful and tender.

The condition of pediculosis is most easily detected by looking for
the eggs (nits), which are always stuck onto the hair, and are not readily
brushed off. The condition is best treated by killing the living parasites
with crude petroleum, and then getting rid of the nits. With boys, this
is easy — a close hair cut is all that is needed ; with girls, by using a fine-
toothed comb wet with alcohol or vinegar, which dissolves the attach-
ments of the eggs to the hair. All combs and brushes should be carefully
cleansed.

Children with pediculosis should be excluded from school until their
heads are clean.

Ringworm. A vegetable parasite disease of the skin and scalp.
When it occurs upon the skin, it yields readily to treatment; but upon
the scalp it is extremely chronic. Ringworm of the skin usually appears
on the face, hands, or arms — rarely upon the body — in varying sized
more or less perfect circles. One or more, usually not widely separated,
may be present at the same time. All ringed eruptions upon the skin
should be examined for ringworm. When the disease attacks the scalp,
the hairs fall or break off near the scalp, leaving dime to dollar sized

536 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

areas nearly bald. The scalp in these areas is usually dry and somewhat
scaly, but may be swollen and crusted. The disease spreads at the cir-
cumference of the area, and new areas arise from scratching, etc.

Another disease somewhat like ringworm of the scalp, is known as
favus — a disease much more common in Europe than in America. In
this disease quite abundant crusts of a yellowish color are present where
the process is active, so that the loss of hair from this disease is permanent,
a scar remaining when the condition is cured.

Care must be taken to see that all combs and brushes are thoroughly
cleansed, and to prevent children wearing each other's hats, caps, etc.

Children with ringworm should not be allowed to attend school.

Impetigo. A disease characterized by few or many large or small
flat or elevated pustules or festers upon the skin. The condition is often
secondary to irritation or itching diseases of the skin (hives, lice, itch),
and scratching starts up a pus infection.

The disease most often appears upon the face, neck, and hands; less
often upon the body or scalp. The size of the spots varies very much,
and they often run together to form on the face large superficial sores,
covered with thick, dirty, yellowish or brownish crusts.

The disease is contagious, and often spread by towels and things
handled.

Children having impetigo should not be allowed to attend school until
all sores are healed and the skin is smooth.

Diseases of the Bones and Joints.

All noticeable lameness, whether sudden or continued, may indicate
serious joint trouble, or may be due to improper shoes. These cases
as well as curvatures of the spine, as indicated by habitual faulty postures
at the desk or in walking, should be referred for medical inspection.

Spinal curvature should be suspected when one shoulder is habitually
raised or drooped, or when the child leans to the side, or shows persistent
round shoulders.

Complaints of persistent "growing pains" or "rheumatism" may be
the earliest signs of serious disease of the joints.

Some General Symptoms of Disease in Children Which Teachers
Should Notice, and on Account of Which the Children
Should be Referred to the School Physician.

Emaciation. This is a manifestation of many chronic diseases, and
may point especially to tuberculosis.

Pallor. Pallor usually indicates anaemia. Pallor in young girls usu-
ally means chlorosis — a form of anaemia peculiar to girls at about the age

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 537

of puberty. It is usually associated with shortness of breath ; the general
condition otherwise usually appears good. Pallor may also be mani-
festation of disease of the kidneys; this is almost invariably the cas.e if
it is associated with puffiness of the face.

Puffiness of the Face. This, especially if it is about the eyes, points
to disease of the kidneys; it may, however, merely indicate nasal ob-
struction.

Shortness of Breath. Shortness of breath usually indicates disease of
the heart or lungs. If it is associated with blueness, the trouble is usually
in the heart. If it is associated with cough, the trouble is more likely to
be in the lungs.

Swelling in the Neck. These may be due to mumps or enlargement
of the glands. The swelling of mumps comes on acutely, and is located
just behind, just in front, and below the ear. Swollen glands are situa-
ted lower in the neck, or about the angle of the jaw. They may come on
either acutely or slowly. If acutely, they mean some acute condition
of the throat. If slowly, they are most often tubercular. They may
also be the result of irritation of the scalp, or lice in the hair.

General Lassitude, and Other Evidences of Sickness. These hardly
need description, but may, of course, mean the presence or onset of any
of the acute diseases.

Flushing of the Face. This is very often indicative of fever, and on
this account should be reported.

Eruptions of Any Sort. All eruptions should be called to the atten-
tion of the physician. It is especially important to notice eruptions,
because they may be manifestations of some of the contagious diseases.
The eruption of scarlet fever is of a bright scarlet color, and usually
appears first on the neck and chest, spreading thence to the face. There
is often a pale ring about the mouth in scarlet fever, which is very char-
acteristic. There is usually a sore throat in connection with the erup-
tion. The eruption of measles is a rose or purplish red, and is in blotches
about the size of a pea. It appears first on the face, and is usually asso-
ciated with running of the nose and eyes. The eruption of chicken pox
appears first as small red pimples, with quickly become blisters.

A Cold in the Head, with Running Eyes. This should be noticed, be-
cause it may indicate the onset of measles.

Irritating Discharge From the Nose. A thin, nasal discharge, which
irritates the nostrils and the upper lip, should always be regarded with
suspicion. It may mean nothing more than a cold in the head, but not
infrequently indicates diphtheria.

538 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Evidences of Sore Throat. Evidences of sore throat, such as sweUing
of the neck and difficulty in swallowing, are of importance. They may
mean nothing but tonsilitis, but are not infrequently manifestations of
diphtheria or scarlet fever.

Coughs. It is very important to notice whether children are coughing
or not, and what is the character of the cough. In most cases, of course,
the cough merely means a simple cold or slight bronchitis. A spas-
modic cough, that is, a cough which occurs in paroxysms and is uncon-
trollable, very frequently indicates whooping-cough. A croupy cough,
that is, a cough which is harsh and ringing, may indicate the disease
diphtheria. A painful cough may indicate diseases of the lungs, espe-
cially pleurisy or pneumonia. A long continued cough may mean
tuberculosis of the lungs.

Vomiting. Vomiting, usually of course, merely means some digestive
upset. It may, however, be the initial symptom of many of the acute
diseases, and is therefore of considerable importance.

Frequent Requests to Go Out. Teachers are too much inclined to think
that frequent requests to go out merely indicate restlessness or perversity
They often, however, indicate trouble of some sort, which may be in
the bowels, kidneys, or bladder; therefore, they should always be reported
to the physician.

The Teeth.

Unclean mouths promote the growth of disease germs, and cavities
in the teeth are centers of infection. Pus from diseased teeth seriously
interferes with digestion, and poisons the system. It causes a lowering
of vitality, and renders mental effort difficult. Diseased teeth, tem-
porary as well as permanent, are frequently the causes of abscesses,
and should be carefully watched and treated.

Irregularities of the teeth, especially those which make it impossible
to close the teeth properly, lead to faulty digestion, to mouth-breathing,
and to other diseases and evils which an insufficient supply of oxygen
produces.

The first permanent molars are perhaps the most important teeth
in the mouth, and are the most frequently neglected, because they are
so often mistaken for temporary teeth. (It should be remembered that
there are twenty temporary teeth, ten in each jaw, and that the teeth
that come at about the sixth year immediately behind each last tem-
porary tooth — four in all — are the first permanent molars.)

The teacher should be on the lookout for pain or swelling in the face.
When the child keeps the mouth constantly open, an examination of

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 539

the teeth should be made. When symptoms of indigestion occur, or
physical weakness or mental dullness are observed, the teeth should be
inspected. It should be remembered that diseases of the ears, disturb-
ance of vision and swelling of the glands of the neck may be caused by
diseased teeth.

It should be shown that decay of the teeth is caused primarily by the
fermentation of starchy foods and sugars, and that the greater factor
in preventing dental caries is the removal of food particles by frequent
brushing. Children should be prevented from eating crackers and candy
between meals, and when possible the teeth should be cleaned after eating.
Inspection of the teeth by a dentist should be made once in six months
at least.

Nervous Troubles and Mental Defects.

Teachers and medical inspectors of the schools should investigate
children who show certain physical and mental symptoms. Especially
should they take notice of the presence of these symptoms in a child
who did not formerly show them. The most important of these are the
following :

1. Restlessness and inability to stand or sit quietly in a previously
quiet child, especially if to this is added irritability of temper and loss
of self-control, as shown by crying for trifles, or inability to keep the
attention fixed.

There may also be present quick, twitching movements of the muscles
of the trunk, face, and especially of the hands, fingers, arms, or legs. If
severe, these may cause the child to drop things, render its work awkward,
or interfere with buttoning the clothes, writing or drawing. Such chil-
dren are often scolded for being inattentive or careless.

These symptoms are the slighter one of chorea (St. Vitus' Dance).
With these should not be confounded other forms of twitching of muscles,
such as the blinking of the eyelids, the slower twisting movements of
the face or shoulders, or other parts of the body, often called habit
spasms, which may be due to effects of vision, adenoid growths or other
reflex causes.

These latter cases do not usually need to be withdrawn from school
work, though often requiring treatment; while the former class should
be removed from school at once, both for the child's sake, and to prevent
an epidemic of imitative movements, such as sometimes occurs.

2. Another class of symptoms requiring investigation are repeated
faintings, especially if the child's lips become blue; attacks, often only
momentary, in which the child stares fixedly and does not reply to ques-
tions, or in which he suddenly stops speaking or whatever he is doing,

540 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

and is unaware of what is going on about him. These lapses of con-
sciousness may be accompanied also by rolling up of the eyes, drool-
ing, or unusual movements of the lips, and often appear like a
"choking" attack.

Sudden attacks of senseless movements of various sorts, such as twist-
ing and pulling at the clothes or handkerchief, fumbling aimlessly at
the desk, especially if there is no recollection afterwards of what was
done, are often another expression of the same conditions.

Such attacks, particularly if repeated at varying intervals, even when
not accompanied by complete loss of consciousness, are frequently as
characteristic of epilepsy as the severe convulsions.

Epileptic convulsions usually involve the entire body in sharp jerking
movements, with blueness of the face or lips, complete loss of conscious-
ness, and are usually followed by a period of sleep or drowsiness, and
occasionally by wetting or soiling of the clothes.

Another class of convulsions is the hysterical, which are often difficult
to distinguish. The hysterical convulsions, however, differ from epi-
leptic in the following respects. The hysterical patient often shouts,
cries, or raves, not only previous to but frequently throughout the
attack, and is often able to reply to questions during the convulsions.
The epileptic gives a single cry, immediately followed by unconsciousness
and the spasm. The movements in the hysterical convulsions are often
accompanied by bowing of the body backwards, and very frequently
simulate intentional or voluntary movements, such as tearing the hair,
pulling at the clothes, and such things; while the epileptic movements
are characterized by their jerking or twisting character. The hysterical
patient, also, in place of a convulsion, may strike an attitude, such as of
fear or entreaty, often accompanied by raving or singing. This again
may follow the convulsion, taking the place of, and strikingly contrasted
with, the almost invariable sleep of the epileptic, which is almost never
seen in hysteria. Hysterical patients if they fall seldom injure them-
selves by the fall, as epileptic frequently do. Biting the tongue almost
invariably indicates an epileptic seizure, as does wetting or soiling the
clothes when it occurs.

Cases of epilepsy, whether mild or severe, require treatment, and
advice as to whether they should be removed from school. Many
cases do not require to be withdrawn from school, and are benefited by
its discipline.

3. Excessive nerve fatigue, which is shown by irritability or sleep-
lessness, may indicate a neurasthenic condition, that is, a threatened
nervous breakdown. Such symptoms may be due to irregular habits,
want of proper sleep, lack of suitable food, poor hygienic conditions, or

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 54 1

simply from the child being pushed in school beyond its physical or mental
capacity.

Excessive fear or morbid ideas, bashfulness, undue sensitiveness,
causeless fits of crying, morbid introspection and suspiciousness may
also be symptoms of a neurasthenic condition, and call for investigation,
and for the teacher's sympathy and winning of the child's confidence to
prevent developments of a more serious nature.

This nerve fatigue may result in a child being unable for the time
being to keep up in its work in school.

Forgetful ness, loss of interest in work and play, desire for solitude,
untidiness in dress or person, and like changes of character, are sometimes
incidental to the period of puberty.

4. Mentally defective children in the public schools exhibit certain
common characteristics. The essential evidence of mental defect is
that the child is persistently unable to profit by the ordinary methods
of instruction, as shown by lack of progress or failure of promotion
through lack of capacity. After one, two or three years in school, they
are either not able to read at all, or they have a very small and scanty
vocabulary. One of the most constant and striking peculiarities is the
feebleness of the power of voluntary attention. The child is unable
to fix his attention upon any exercise or subject for any length of
time. The moment his teacher's direction is withdrawn, his attention
ceases.

These children are easily fatigued, by mental effort, and lose interest
quickly. They are not observant. They are often markedly backward
in number work. They are especially backward in any school exercise
requiring judgment and reasoning power. They may excel in memory
exercises. They usually associate and play with children younger than
themselves. They have weak will-power. They are easily influenced
and led by their associates. These children may be dull and lifeless,
and restless and excitable. They are often willful and disobedient, and
liable to attacks of stubbornness and bad temper. The typical "in-
corrigible" of the primary grades is often a mentally defective child of
the excitable type. They are often destructive. They may be cruel to
smaller children. They are often precocious sexually. They may have
untidy personal habits. Certain cases with only slight intellectual
defects show marked moral deficiency.

The physical inferiority of these defective children is often plainly
shown by the general appearance. There is generally some evidence
of defect in the figure, face, attitude, or movements. They seldom show
the physical grace and charm of normal childhood. The teeth are apt
to be discolored and to decay early.

542 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

It is a most delicate and painful task to tell a parent that his child
is mentally deficient. This duty should be performed with the greatest
tact, kindness and sympathy. It would be a great misfortune for the
school physician and teachers, as well as for the child, to designate a
pupil as feeble-minded who was only temporarily backward.

Temporary backwardness in school work may be due to removable
causes, such as defective vision, impaired hearing, adenoid growths in
nose or throat, or as the result of unhappy home conditions, irregular
habits, want of proper sleep, lack of suitable food, bad hygienic condi-
tions, etc. Great care must always be used in order not to confound
cases of permanent mental deficiency with cases of temporary backward-
ness in school work, due to the causes mentioned above, or those de-
scribed under the head of excessive nervous fatigue.

In some cases, where the existence of mental defect is in doubt,
accurate information is usually obtained in the early history of the child.
The time of first "taking notice," the time of recognition of Ihe mother,
that of beginning to sit up, to creep, to stand, to walk and to talk should
be learned. Marked delay in development in these respects is usually
found in all pronounced cases of mental deficiency.

It may be found useful to require teachers to refer at stated intervals
to the medical inspectors for examination all children who, without
obvious cause, such as absence of ill health, show themselves unable to
keep up in their school work, who are unable to fix their attention, or are
incorrigible — though it does not follow that all such cases have either
physical or mental defects.

Tuberculosis.

It is important that we should realize that the earliest sign
of consumption is not necessarily the so-called hacking cough,
hemorrhage from the lungs, or the presence of night sweats and fever.
These frequently do not appear until comparatively late in the disease.
The earliest signs, in children especially, are those of failing health,
from whatever cause. Loss of appetite, weakness, languor, listlessness,
are among the early signs. Pallor, marked anemia, loss of weight,
excessive emaciation, the presence of enlarged glands in the neck, are
indications that there is something wrong. If, in addition to this, there
is a cough, with or without any sputum, the child should most certainly
be examined by a physician.

Teachers and pupils should study carefully the pamphlet on "Tuber-
culosis and Its Prevention," issued by the Anti-Tuberculosis Committee
of One Hundred.

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 543

Hookworm.

Hookworm disease is infectious, and is caused by hookworms
which, in the mature stage of their development, are about one-half
an inch long, are round and about the thickness of an ordinary pin, or
a course sewing thread. They live in the small intestine, usually the
upper portion, that is, the portion next to the stomach, and there firmly
hold on with their teeth to the flesh lining the intestine, sucking blood
from it, making wounds from which much slow bleeding occurs into the
intestine, secrete and inject a poison into the flesh and so damage the
intestine that a chronic inflammation is set up which hinders digestion.

The great loss of blood, the damage done to the intestine and the
poison combined, soon sap the vitality of infected persons so that they
become thin, pale, weakly, and are easily tired, have queer appetites
and are unable to accomplish as much work as healthy and strong
people. In very mild cases and in cases where the disease is just begin-
ning, no great change in the appearance of a person may be. noticed.
But in severe cases, as those of long standing, the tallow-like skin, the
pale lips, the listless dull eyes, the dry hair, the prominent shoulder-
blades and abdomen are all features which lead one to suspect the disease.

Moreover, if the disease begins, as is usually the case, during the grow-
ing age of a person, the development is likely to be either checked or at
least delayed. Oftentimes boys and girls are no larger at 15 years than
they should be when 12, and are slow at work and in school. In such
cases hookworm disease should be suspected. Especially is this so if
such a child has ever had ground-itch, which is usually the first step to
be noticed in the beginning of the disease.

Sometimes victims of hookworm disease have their face, especially
under the eyes, and their legs to puff or swell. Again they seem to have
sores which do not heal rapidly. They suffer at times with headaches
and dizziness, may have some tenderness in the upper part of the abdo-
men, indigestion, and are often feverish. In severe cases the infected
person is so frail, so thin-blooded, so dwarfed in body and mind, that any
one who has read of the disease will recognize it.

544 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

WINSTON-SALEM PUBLIC SCHOOLS
Daily Report to Principal

School Grade. Date ,

Teacher.

GIRLS

TOTAL

Total Enrollment,
Left by Transfer.

( Building.
Entered by Transfer <

( Grade. . .

Left

Restored

New Pupils.

Present Enrollment.

Absent

Daily Attendance. .
Tardy

NAMES

Left by Transfer

Entered by Transfer i ^ ,
Left

Restored .

New Pupils . . .
Absent Pupils.
Tardy Pupils.

Pupils Falling Behind in Their Work

Names Subject

School Physician Should See the Following:

No.

METHOD OF PROMOTING SCHOOL HYGIENE IN SMALL CITIES 545
WINSTON-SALEM PUBLIC SCHOOLS

I Notice to Parents or Guardians:

Teacher j

School I has re-
Pupil i ceived a physical examination and is

Age Grade Date ; found to be in need of immediate medical

Parent ; or dental attention. Please see your

Address j physician or dentist at once. Take this

Inspector's Diagnosis and Advice i notice with you. The child

M.D.

No.

WINSTON-SALEM PUBLIC SCHOOLS

Name of Teacher *

Name of Pupil Age

Name of Parent

Address

The Medical Inspector will please examine this child for

School

Grade ,

Inspector's Diagnosis and Advice

Signed M.D.

546

FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

, Grade .

Name . .
Age...

Date

School

Gums: Good. Fair

Bad

Mouth: Good. ..

Fair Bad

Tooth Brush . . . .
Yes No.

Malocclusion:. ..
Yes No.

No. Fillings

No. Cavities

No. Extractions . .
No. Teeth Out...

No. Abscesses

Urgent Attention
Yes No.

Examined by
Treated by . . .
Results:

WINSTON-SALEM PUBLIC SCHOOLS

Dental Examination Under the Direction of the Superin-

intendent of Schools by the Winston-Salem Dental

Society.

Name Age .

Address

Grade Date School

Condition of Gums Good Fair.

Condition of Mouth Good. .... .Fair.

Use Tooth Brush Yes No. . . .

Malocclusion Yes No

No. of Fillings

No. of Cavities

No. of Extractions

No. of Teeth Out

No. of Abscesses

Urgent Attention .... Yes .... No

(Hand) Cross out words that do not
apply

Bad
Bad

(
(

Dentist's

Diagram

Mouth.

Examined by DDS.

Teeth Marked o Out
" " X Cavities

" " V Fillings

To Parent or Guardian:

This report is sent for your careful consideration. The
examination has been made without cost to you. Of
course you do not have to pay any attention to the condi-
tions here stated, but we believe that you will not, after
receiving this notice, allow your child to suffer the conse-
quences of further neglect. We feel that we have dis-
charged our duty in going this far, and it now rests with you
to do your part. This examination places you under no
obligation whatsoever to the examining dentist. You can
have the work done by any dentist you may see fit to em-
ploy. When the child is sent to the dentist, kindly send
this blank. To do so will help matters very much.

To the Dentist Consulted:

We ask that you keep this blank that we may know how
many of the pupils examined have taken advantage of the
examination. We will be glad to send for the blanks at
any time that will suit your convenience.
Very respectfully,

R. H. Latham, Superintendent.

STATUS OF HYGIENE IN SCHOOLS OF YORK COUNTY, NEBRASKA 547

THE STATUS OF HYGIENE IN THE SCHOOLS OF
YORK COUNTY, NEBRASKA

Alice Florer

For years, for many years, children went to school to study the three
R's — Readin', Ritin', 'Rithmetic. During these years teachers were
contented with having taught these three subjects; parents were per-
fectly satisfied, and the children were apparently happy. But times
have changed. Brain development has advanced materially. Edu-
cators have discovered that in order for a child's brain to develop prop-
erly it must necessarily live in a clean, healthy body.

City schools are putting in equipment for serving hot lunches to the
children for the noon-day meal and have demonstrated that such children
do better work and are healthier than when they go home long distances
on- cold or excessively warm days and perhaps have improper food when
they get there. In many places, breakfasts are served by the school
authorities as many children would have no breakfast if they did not
get it at school.

Why this change? A few years ago, this was an unheard of idea.
It is because the people have awakened to the fact that the child must
have good health in order to do good work and that good, clean, whole-
some food is necessary in order to have good health.
• No other educational movement has made such rapid progress in
absolutely securing results as has that which contributes to the health.
Generally, throughout the country, this agitation has resulted in an
unrest which will not be satisfied until some systematic plan has been
[established, moderately uniform, to promote the health of our children.

All of this chafige in "Public Opinion" has practically been brought
ibout by educators. All over this "great country of ours," at every
[educational gathering, the subject of "Hygiene and Health" is right-
ffully given an important place on the program. Men and women of
jprominence, ability, good judgment and influence are everywhere
to-day making individual and united efforts to influence teachers, parents,
[pupils and school officers to regard the laws of health.

Upon the health of our people depend, in a great measure, the
[efficiency of our schools, the efficiency of our professional people, the
^efficiency of the individual American citizen.

Great and noble men and women are making research daily to dis-
cover causes for ill health and also to discover how to remove such causes.

548 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

The old, old maxim, "An ounce of prevention is worth a pound of cure,"
may very appropriately be applied to the health question or condition
which is before us to-day.

We shall no longer say as was formerly said, "It is the duty of the
parents and not that of the teacher, to look after the health of the
pupils." Since this question of public health has been agitated, people i
begin to realize that parents who have never, as children, received any • ]
training along the lines of sanitation and health, are really not capable
of teaching it to their children. Then, if the schools do nothing toward
the education of the children in this respect, many children of the present
generation will grow to be men and women with families of their own
with no more knowledge of sanitation and health than had their parents
before them. Thus it might have gone on forever, had the educators
of this country not realized the situation, looked the matter squarely
in the face and sought to meet the proposition and to remedy conditions
as rapidly as possible.

All this discussion has been brought about and public opinion is
being molded along these channels from no selfish motives. "The
world is growing better" and there exists a keener sympathy between
individuals. People, as a rule, dislike to see others suffer and if they
can do anything to alleviate such suffering they rejoice in doing it.

A renaissance in health is at hand. The people realize the possi-
bilities in prolonging life. The time has come when all forces should
and must unite and work together for a common cause.

"To have a perfect body, crowned by a perfect brain is the grandest
hope of the race to-day." To be strong and healthy, the pupils must
have nourishing food and plenty of it; they must have pure, fresh air*;
they must have the proper clothing and they must have sanitary school
houses which include proper architecture, heating, lighting, seating
and ventilation. They must be free from the use of narcotics.

That this great International Congress on Hygiene has convened
with a view to bettering conditions along these lines is an indication
that better conditions will prevail in this country in the future than
in the past.

This Congress is dealing with the basic, the fundamental problem
of citizenship. It is important, yes necessary, that all forces join in
promoting the health, not only of the individual, but of the nation.

Sanitary laws and the laws of public health can only be promoted
when they are supported by the general public. When the people are
educated to the fact that such laws should and of necessity must be
passed, then will such laws easily be secured. This Congress will do
much to bring the proposition "squarely" before the people of the
country.

STATUS OF HYGIENE IN SCHOOLS OF YORK COUNTY, NEBRASKA 549

Grover Cleveland once said, "The health condition that confronts
us to-day is one of ignorance, — ignorance on the part of the individual,
state and nation and the. only hope of amelioration is by educating our
boys and girls in sanitary science and public health conditions."

This statement is true. We must educate our boys and girls to be
able to throw off diseases, to regard the laws of health. Infectious
diseases are all parasitic in nature, that is, are due to some form of
plant or animal life and the pupils must be taught how best to resist
these parasites.

The application of such principles makes for right living, morality,
temperance, cleanliness and an understanding of the necessity of the
individual, the state and the nation joining forces and working as a unit,
thus bringing home to consciousness, a keener sense of civic obligation.

Some illustrations of what has been done and what is being worked
out in rural communities in York County, Nebraska, along the line of
health and sanitary conditions might be of interest.

For several years we have been working along a few lines, the essen-
tial one being a systematic study of the subject of physiology and hy-
giene from the third grade up. For such study we have used Blais-
dell's Child's Book of Health, How to Keep Well and Our Bodies. For
two years we have been having in many of the schools, the "Gulick
Series" as supplementary texts. This study has been systematic,
grade by grade, and the children, in order to make certain grades were
required to complete a certain amount of work and pass the examina-
tion.

We have now on our list the following points that are observed
almost without exception yet there is much to be done along some of
these lines before perfection is reached.

1. Dispensing with the open water pail and common drinking cup.

2. Quarantining for contagious diseases.

3. Fumigating the homes and school rooms for contagious diseases.

4. Sterilization of lead pencils.

5. Proper construction of new buildings and the proper heating,
lighting, ventilating and seating of the same.

6. Requiring sweeping compound in every school room to take
up the dust.

7. Establishing the proper playground apparatus.

8. Abolishing the narcotic habit.

550 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

^ Now we have not accomplished nearly all of these points but I shall
indicate what we have done and the progress we have made thus far
in what we have undertaken.

Open Water Pail. Six years ago, the old fashioned water pail and the
common drinking cup were found in every rural school in the county, one
hundred and three districts. It was my privilege to visit a rural school
that first year of my administration, about sixteen miles in the country.
At the noon hour, the children on the playground kept expressing their
desire from time to time for Catherine to come. Upon making inquiry,
I discovered that Catherine was one of their schoolmates; she had
gone on an errand for her mother and the children feared she would
not be back by one o'clock. To my delight, I observed that they had
had a perfect record that week and if this little girl should have been
tardy, their record would have been broken. However, Catherine
came. I noticed that she was tired and dusty and warm. Her face
was very much afflicted with sores about her mouth, nose and chin.
She was brought into the house where the teacher washed her face in
a common pan, dried it on a common towel, gave her a drink from a
common cup. This concerned me very much and I talked with the
teacher about it. She had never thought of it before. Right there,
I said in my own mind, "If this condition exists in many places it must
be stopped and it must cease here." I talked with the school officers
and insisted upon a change. They asked, "What can we do?" Then
I advised first, that they ask the parents to keep the child out of school
and consult a physician; second, that they- get a sanitary drinking
fountain and individual drinking cups. This was done at once and
the parents in that district were thankful. They had been uneasy but
had feared causing hard feelings if they said anything and ''the parents
of that child were their neighbors ^ No one was more thankful than
those parents after a while, but at the time they thought it rather a
hardship. When the physician told them it would have resulted seri-
ously had they not attended to it, w^hen they did, the parents were
satisfied.

The results were that the child's face was cured, the district owned
a sanitary water fountain and individual drinking cups. With this
as an example, a general campaign was started throughout the county
and to-day every district in the county has a sanitary drinking fountain
of some kind and individual drinking cups. The pupils, young and old,
are particular about using their own cups and realize the importance
of it.

Quarantining. When we first attempted to enforce the quarantine
law, the people exhibited about the same attitude toward it as they did

STATUS OF HYGIENE IN SCHOOLS OF YORK COUNTY, NEBRASKA 55 1

at first toward the open water pail. They refused to be quarantined
or in other words, were free to break the quarantine if they wished.
However, a county physician was appointed by the County Board of
Supervisors to act m conjunction with the County Superintendent in
quarantining all homes where contagious diseases were discovered.
After some discord and many heated discussions, the people have prac-
tically become convinced that it is the only thing to do. The teachers
now understand that it is their duty to report cases of contagious diseases
either to the County Superintendent or the County Physician. The
County Physician proceeds at once to quarantine. The pupils in such
homes are not permitted to return to school until the physician has
fumigated the clothing, rooms, etc. In case the pupil has taken ill
during school hours or at school, the school room, books, etc., etc., are
fumigated. Pencils are sterilized with formaldehyde frequently.

Architecture. We have not constructed many new buildings re-
cently but several will be constructed next year. A special architect
will be employed to see that they are sanitary in the way of lighting,
ventilating, heating, seating, etc.

Heating and Ventilating. One great problem has been how to equip
rural schools with some kind of heating apparatus that would ventilate
at the same time. This year, however, all former agitation seems
to have begun to bring results. Twenty such heaters have been installed
within the year and orders for something like forty more have been given
and the plants will be installed in time for the winter school. The schools
where the heaters have been in use a year have been a great help to us
in securing new ones as the people in those districts are so delighted
with the results. It has been the means, the parents think, of the chil-
dren being free from coughs and colds that they formerly have had and
school boards and parents have unconsciously disseminated the infor-
mation regarding the good results brought about by installing the heater
and ventilator.

Sweeping Compound. One of the most unwholesome, unhealthful
practices in school rooms is that of sprinkling the floor with water, to
sweep, or that of leaving it dry and allowing the dust to fly. We have
succeeded in securing a good sweeping compound in the school houses of
the county which leaves the floors in an oily condition and takes up
all dust, germs, etc. It is inexpensive and is one of the essentials that
every school district should furnish, as dust particles not only irritate
the delicate membranes causing sore throat and other diseases, but
dust is a carrier of contagion and should be kept out of -the school room
as much as possible.

552 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Medical Inspection. We have no medical inspection in the county.
However, we have succeeded in agitating the question of sanitation as
cases have arisen until the people generally are discussing the health
problem of school children and they are looking at that side of the ques-
tion more favorably than at the financial side entirely as they formerly
did. While it seems there is an organization at work to try to defeat
the medical inspection movement in this country, it is surging forward
rapidly. It will eventually be the means of eliminating the spread of
contagious diseases in our schools and is bound to be the means of pro-;
longing life.

Playground Apparatus. In many districts we have playground-
apparatus. We believe that while good food is essential to good health,
plenty of the right kind of exercise is also essential. The playground
movement is spreading rapidly. Last year was the first time we have
agitated the question and about one-fourth of the districts have pro-
vided their schools with either swings, teeter-boards, giant-strides, or
other apparatus, and a great many more will furnish them this year.

Formerly, it was considered that only city schools needed the play-
ground apparatus but this idea has vanished and our people are inter-
esting themselves in not only playground apparatus, but in many
things that were formerly thought to be appropriate only for city
schools.

Cleanliness. After all, the teacher has a responsibility aside from
teaching the contents of the text book, that is even more important
to the health of the pupils. . Each teacher is requested to look after the
general appearance of the pupils. They must appear with clean hands
and clean faces. If they do not, they must go through the process of
a good "scrubbing" before beginning their work. Teachers are also
requested to urge the importance of clean clothing. Children are not
expected to have expensive clothing but ''it must be clean." Sometimes
this has been difficult to accomplish and sometimes the teacher has not
been strong enough, shall I say, has not had the "nerve" to ask parents
to dress children in clean clothes but " the campaign " is on in York County
and very much has been accomplished and more will be as the campaign
proceeds, along the line of "Cleanliness in the Schoolroom."

Nothing Too Good For The Rural Child. It has been my custom
and is my custom to insist at all times and in all places where oppor-
tunity offers, that the best the city can afford to offer their city children
is none too good for the rural child. They* must give up the idea that
"anything" is good enough in a country school. Experience has proven
that our strongest citizens, nationally and otherwise, were born and

STATUS OF HYGIENE IN SCHOOLS OF YORK COUNTY, NEBRASKA 553

reared in the country, educated in the country schools. Horace Mann
once said, "There is nothing too good for the child — if it is my child,"
and this is a pretty good motto for each parent to put into practice.

This International Congress of School Hygiene is one of the grandest
conservation gatherings ever assembled in America or any other country
because "the greatest of all natural resources is human life." It is
important to conserve our national forests, our supply of water and soil,
but far more important to- this country to-day is "the conservation
of human life," the ability to make it superior in efficiency. That the
people of this Congress have assembled for this purpose, that of advising
with one another and using united resources for making a more healthy
efficient humanity, is evidence that results are not far distant and that
our future citizens will have superior knowledge and privileges for
developing healthy bodies which mean healthy minds and superior
citizenship.

SESSION EIGHT

Room F. Wednesday, August 27th, 2:00 P.M.

STATUS OF SCHOOL HYGIENE AND METHODS OF

INSTRUCTION IN CITY, VILLAGE AND COUNTRY

SCHOOLS (Part Four)

(Special Group on Women's Colleges)

President Anna J. McKeag, Chairman
Mrs. Dexter P. Rumsey, Buffalo, N. Y., Vice-Chairman

Program of Session Eight

Anna Jane McKeag, Ph.D., LL.D., President Wilson College, Cham-
bersburg. Pa. "Methods in Use in Colleges for Women for the
Maintenance and Advancement of the Health of Students."

Amy Morris Romans, M.A., Director of Hygiene and Physical
Education, Wellesley College, Wellesley, Mass. "Some Problems
in the Administration of a Department of Hygiene and Physical
Education in a Woman's College."

[Elizabeth Leiper Martin, M.D., Adviser of Women and Medical
Examiner in the University of Pittsburgh, Pa. "The Import-
ance of Teaching the Conservation of Nervous Energy to Our
Advanced Women Students."

Mrs. Frank DeGarmo, B.S.D., One-time Chairman Country Life De-
partment, National Congress Mothers; Collaborator U. S. Office
Public Roatis. "Good Roads and Good Health."

Paper Presented in Absentia in Session Eight
(Read by Title)

Margaret C. Beer, Principal Gardner School, Valparaiso, Ind. "Hy-
giene Instruction in the Gardner School, Valparaiso."

556 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

METHODS IN USE IN COLLEGES FOR WOMEN FOR
THE MAINTENANCE AND ADVANCEMENT

OF THE HEALTH OF STUDENTS P

Anna J. McKeag

The separate college for women, unconnected with any of the great
universities, is peculiarly an American institution. It finds its highest
development in the eastern part of our country, as co-education pre-
vails in most of the western colleges and universities. The colleges
which I have chosen for special consideration are eight institutions
in the New England and Middle States: Bryn Mawr, Elmira, Mount
Holyoke, Smith, Vassar, Wellesley, Wells and Wilson. Four of these
colleges are of more than five hundred students: Mount Holyoke (754),
Smith (1,617), Vassar (1,658) and Wellesley (1,378). The remaining four
have fewer than five hundred: Bryn Mawr (426), Elmira (175), Wells
(189) and Wilson (362). The statistics are taken from the latest Report
of the Commissioner of Education (191 1, Volume II).

While each of these institutions has a few day students, almost the
entire student body is njade up of residential students lodged in build-
ings under the full control of the college authorities. This residential
character of the typical American college for women makes possible a
more minute supervision and regulation of matters of health than would
be found in an institution where students are lodged in private boarding-
houses.

The colleges in the group under consideration, it may be added,
are similar in their academic purposes, being primarily institutions
of the "liberal culture" type, and offering courses leading to the degree
of Bachelor of Arts, though some offer courses also for the Master's
degree and Bryn Mawr gives the Doctorate. There is therefore a greater
degree of homogeneousness in the student body than would be found
in a professional institution or in a university.

The student who desires to enter one of these institutions must
present, among her credentials for admission, a certificate of health
from her physician. Unfortunately, standards differ so greatly among
physicians that the presentation of such a certificate is not always
indisputable evidence of the candidate's physical fitness for college
work, but the colleges themselves conduct a physical examination of
new students which gives the necessary additional and more detailed

METHODS IN USE IN COLLEGES FOR WOMEN 557

information. At Bryn Mawr, this examination is made by the Resident
Physician; at Wells and Wellesley by the Department of Physical Edu-
cation; and at Vassar and Mount Holyoke by the two departments
in cooperation. In some of the colleges — ^Wells and Bryn Mawr, for
instance — the examination is repeated annually for each student.

All of the eight colleges have courses of lectures, required of all
freshmen, on the application of physiology and hygiene. These courses
are of an extremely practical and simple nature, and are intended to
give to the new student the fundamental rules of personal hygiene.
In Wellesley the course lasts throughout the freshman year; in Vassar
it consists of six lectures. A few of the colleges have introduced lectures
(optional) for seniors on subjects connected with social hygiene.

Physical training, both in the gymnasium and in outdoor athletics,
is given in all of these colleges. The requirements are as follows:

Bryn Mawr: 2 hours per week in the freshman, sophomore, junior

and senior years.
Elmira :
Mount Holyoke: 3 hours in the freshman, sophomore and junior

years.
Smith: 4 half-hours from November i to Easter in the freshman

and sophomore years.
Vassar: 3 hours in the freshman and sophomore years.,
Wellesley: 2 hours in the freshman and sophomore years.
Wells: 2 hours in the freshman and sophomore years.
Wilson: 3 hours in the freshman, sophomore and senior years.

The outdoor sports include archery, basketball, baseball, rowing,
running, field hockey, golf, tennis, swimming and riding. Most of the
colleges impose a scholarship requirement upon candidates for teams
in athletics, consisting usually in the exclusion of conditioned students
from the teams.

In most of the colleges the work in physical culture counts toward
the degree in the sense that a student may not be graduated until she
has completed it, but, except at Wellesley, it is usually not reckoned
in the 120 semester hours for the B.A. degree.

Before leaving this matter of physical training, attention should
be called to the unique service which is being rendered by Wellesley
College to the cause of physical education in the department specially
established there for the training of teachers of physical education.
The greatest hindrance to the progress of physical education has here-
tofore been the scarcity of properly trained women. Wellesley is
attempting to remedy this defect, though the graduates of the course
are not numerous enough to fill the positions that await them.

558 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

All of the colleges mentioned have their own infirmaries, nurses
and, usually, resident women physicians. The isolation of patients
in the case of infectious and contagious diseases is provided for, and
there is almost no danger of epidemics, so carefully are all matters of
sanitation safeguarded and supervised.

The heads of college houses of residence are usually women of a high
degree of general intelligence, with special training in domestic science.
The table is necessarily simple, as the prices paid for board are moderate
but in general the food is wholesome and the menu well-balanced from
a dietetic standpoint.

It may be asked, however, whether, in spite of all these admirable
administrative arrangements for the conservation of the health of
young women, there is not some truth in the popular theory that a col-
lege education is detrimental to the health of young women. After
all, do not the strenuous academic demands upon students and the
intense nervous strain of living in a college community tend inevitably
to lower the vitality of students and perhaps to produce specific physical
injury? In particular, is not the practice of the colleges in requiring
examinations or final papers in all subjects in February and June in
itself a menace to health?

After twenty years of experience in large and small residential col-
leges, I have to say that I have never seen any evidence that college life
per se is detrimental to the health of young women. I have known
cases of breakdown in college, some of which were traceable to pre-
collegiate causes, some to non-academic pursuits in college, and some
to unwise methods of work, but I do not now recall a single instance
in which a young woman who entered college in good health and with
fair academic preparation and carried her work sanely was broken
in health thereby. A more vigorous and active body of women than
those of our colleges it would be hard to find anywhere.

A few years ago a faculty committee, on which I served as chairman,
made an investigation in a large college for women, of the matter of the
relation of semi-annual examinations to the health of students. Our
data were secured from students, from members of the faculty, from the
resident physician, from the heads of houses of residence, and from
administrative officers of other colleges for women. The evidence
gathered from these sources was overwhelmingly convincing that
most of the talk about the detrimental effects of examinations is not
based on fact. We learned for instance, to our surprise, I confess, that
the majority of the members of our senior class had never at any time
during the college course, studied during the greater part of the night.
In a student body of over 1,300, we could find the names of only nine
persons who seemed to have felt in any detrimental way the strain

METHODS IN USE IN COLLEGES FOR WOMEN

559

of examinations, and on further investigation we found that these were
cases in which the vitality of the student had been low before the exami-
nation period; there were, for instance, several cases of grippe among
these students shortly before the examination period. The admin-
istrative offices of other colleges stated that there was little, if any,
abnormal tension during examination time.

So far as my personal observation extends, the methods in use in
the colleges for women for the maintenance and advancement of the
health of students have already resulted in the attaining of an unusually
high standard of health in women college students. I think it may
be seriously questioned whether there can be found, anywhere, condi-
tions more favorable to the maintenance of health than those which
prevail in colleges of the type we have considered.

560 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SOME PROBLEMS IN THE ADMINISTRATION OF A

DEPARTMENT OF HYGIENE AND PHYSICAL

EDUCATION IN A WOMAN'S COLLEGE

Amy Morris Homans

The Department of Hygiene and Physical Education of Wellesley
College was organized four years ago. Previous to this athletics and
sports had been carried on, chiefly by student initiative and under
student management. The facilities for systematic training were very
inadequate as there was only a small, poorly equipped gymnasium,
without baths or dressing rooms, in one of the college buildings; never-
theless much was accomplished. Since that time there has been steady
progress in the effectiveness and scope of the Department's work and
responsibility, so that now it embraces not only the supervision of the
physical activities, but all phases of the lives of the students which in
any way are related to their health. While there is thus much reason
for satisfaction and encouragement, conditions are by no means per-
fect, and much remains to be done.

The functions of the Department in relation to the health of the
student body may be considered under the following general heads:

1 . Preventive and corrective measures.

2. Constructive and educational measures.

Preventive and Corrective Work.

Medical and Physical Examinations. There is scarcely a woman's
college in the country of which it is not said that many of the students
are broken down in health because of the exacting demands of the
curriculum. This is not true. It is true, however, that a large number
of students are permitted to enter college whose health does not warrant
the undertaking of an academic course of study with its attendant
papers, reports, tests, and final examinations. In view of this, Wellesley
College has introduced preventive measures that shall keep out those
applicants (pathological cases) who should seek health and endurance
before undertaking serious academic work. The college has also adopted
measures intended to help those who are well, but who lack endurance
and robust strength, not only to conserve energy but to gradually
increase their vitality. To this end the college requires that applicants

SOME PROBLEMS IN ADMINISTRATION OF A WOMAN'S COLLEGE 561

for admission shall be organically sound and in good health; that they
shall present a physician's certificate to this effect. Upon entranceja
thorough medical examination is made (experience has shown that
not one in ten has been properly examined before entrance), and upon
the advice of the Medical Staff the College reserves the right to reject
the applicant altogether, or to require her to take the course in five
years instead of four. If a student be registered after having presented
a certificate of organic soundness and good health, the physician who
signed her certificate must bear the onus of the applicant's rejection
and her disappointment in consequence.

Students admitted to take the course in five years have their work
distributed accordingly, and under the direction of the Department
of Hygiene are required to devote much time to the acquirement of
good habits of living, such as right feeding, bathing, clothing, rest, sys-
tematic exercise, regular habits, etc. Special stress is laid upon posture
in its relation to efficiency and upon proper footwear in the same relation.

Beginning with 1 913- 14 the medical and physical examinations
begin, and will be finished before the formal opening of College, in
order that registrations may be complete at that time. In this connec-
tion it has been found desirable to have the clinical, personal and family
history blank filled out at home, so that the applicant may have the
advantage of her parents' help and knowledge. The filled-out blanks
are sent in to the College in June with other documents. This arrange-
ment saves much time and confusion at the medical examination and
in the filing of records.

The medical staff consists of the Resident Physician and six Assistant
Physicians. Besides, the physician belonging to the Department
Staff, with special training in orthopedics, aided by two assistants,
likewise trained, makes a detailed examination of backs and feet. In
this part of the examination the students are shown, by the aid of mir-
rors and drawings of the torso, the need (if such need exists) of special
posture work and also of immediate attention to the feet. (In this
connection it would not be extravagant to say that the percentage of
correct posture and of perfect feet is found to be less than ten per cent.)

A full staff of trained assistants makes the drawings of the torso
(using the Demeny thoracimeter) , the anthropometric measurements
and the strength tests. While the collection of this data is desirable
for statistical purposes, the College acquires all this information pri-
marily that it may help the individual student.

Grading and Assignment. After the examinations are completed and
the unfit are rejected, the students are graded according to the showing
made in the examinations. Doubtful cases are placed upon probation

562 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

for three months and followed up. Those who are sound but weak
are put upon a five years' schedule. Those who are sound and vigorous,
but show marked defects of posture or have weak feet are given special
individual corrective work in the required periods. The Department
is well equipped for this kind of work, both as regards facilities and per-
sonnel. Special work, in small groups or individually, is also given to
students who have some temporary or permanent disability, as weak-
ness due to recent operations, permanent lameness, weak heart, etc.
Students who are, or become, run down for one reason or another may
even be required to take absolute rest during the required periods.
The College has set aside a large room with capacity for between 75
and 100 wicker cots, where students will be taught to relax, and where
they must rest, if so advised, under supervision, during the required
periods as well as at other times. American women need to learn how-
to relax and to form habits of regular periods of rest. The bulk of the
students who are sound and vigorous and reasonably normal in all
respects are assigned to the regular classes and given graded, progres-
sive work in gymnastics, dancing, games and athletics.

The object of the medical and physical examinations is then two-
fold: Serving the purpose of excluding applicants whose condition
and care would involve too great responsibility, .and serving as a basis
for advice of a preventive, as well as positive character.

Construction Work

Personal Hygiene. One of the main objects of the Department is
to train students in the knowledge and practice of right habits of living.
Instruction and advice to this end are given: (i) At the time of the
physical and medical examination; (2) in a formal course of lectures
on personal hygiene, one lecture a week throughout the freshman year
(with examinations); (3) and in personal conferences. Through the
latter much of the follow-up work is done.

While instruction and advice are fairly adequately provided, to
insure the following out and application of such advice and instruction
is a more difficult matter. In the first place, the living conditions of
the students must be such as to encourage and facilitate hygienic habits.
The Department is gradually extending its influence in this direction,
cooperating with those officers who have supervision of the housing
and feeding of students, as well as with the Student Government Board,
which is vitally interested in all that pertains to the uplift of the student
body.

Regular Habits. One of the problems especially relating to the
freshman students who, on account of insufficient dormitories on the

SOME PROBLEMS IN ADMINISTRATION OF A WOMAN' S COLLEGE 563

campus are still obliged to live in the village, is being gradually solved.
The College has assumed control of a number of large houses in the
village where about two-thirds of the class live, the remaining third
live in village homes, in which, through the urgent request of the College
authorities, additional bath rooms, shower baths and separate closets
are gradually being provided. The large houses are moderately well
equipped. In this way one of the most imperative needs is being met
and regular habits are made possible. The habit of constipation, formed
largely because of lack of adequate facilities, is easily the cause of half
the ills of women college students. The advantage of the shower bath
over the tub is obvious; as a time-saver, and in its tonic effects. Many
students find the shower invigorating who get no reaction from immer-
sion, and who must, therefore, avoid it. The habit of the daily bath,
in some form, is not so common as one would expect. I shall speak
later of other means provided to encourage this most desirable habit.

Diet and Feeding. Another problem which confronts the Depart-
ment, and one most difficult of solution, is the matter of diet and habits
of eating. The students are, on the whole, given a good wholesome
diet, but whether always sufficient and suited to their individual needs
is questionable.

As regards the eating habits of the students, "promiscuous" eating
between meals is one of the evils which the Department is trying to
combat. The village lunch and tea rooms and confectionery shops
do an entirely too flourishing business. Many students are addicted
to eating at all hours for the mere gratification of the palate. How to
remedy this evil is not clear. Efforts are being made to impress the
students with the value and dignity of self-restraint and its result in
influence, power, and physical efficiency. Another most powerful
appeal is the relation of regular and reasonable habits of eating to good
appearance. College authorities must be made to recognize their respon-
sibility and provide an abundant and balanced diet, appealingly served.
However that may be the necessity for increased self-control and self-
respect still remains and is constantly kept before the students. The
growing interest in organized games and sports and the keen zest with
which the students enter into them, is perhaps the most promising and
effective avenue of appeal in this matter. All members of crews and
teams, as well as all aspirants, must give up all such irregular eating
when they are "in training."

School Hygiene. The Department is constantly looking into the
hygienic conditions under which the academic work is carried on, making
suggestions and bringing about improvements in class room and labor-
atory furniture, in heating, lighting, ventilation, sanitation, etc.

564 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Exercise. The Department believes that habits of exercise that
shall last through life should be formed in college, if not previously
formed. Aside from the required bodily activities — organized games,
sports, gymnastics and dancing — it tries to encourage more and more
such forms of exercise as may be done alone, such as walking, running,
rowing, paddling, swimming, cycling, skating, snowshoeing, skiing,
coasting, etc. The student, like the average person, is too dependent
upon the company of others, in the matter of exercise as well as in other
respects. She seeks solitude too little. She does not think, she knows
not how to meditate. She wants to talk and she must have someone
to talk to, and generally prefers to talk to many. She lives in a crowd.
This is not conducive to a contented frame of mind after leaving college,
especially for those not required to enter upon some occupation.

Required Work. At present all freshmen and sophomores are re-
quired to take two periods a week of practical work in the Department
of Hygiene and Physical Education. The freshmen, as has been already
stated, take in addition a course of weekly lectures. Both the practical
and the theoretical work receive academic credit counting towards
the degree of B.A. The practical work prescribed by the Department
to meet individual needs may be regular graded class work in the gym-
nasium, in the posture room in a special class; or outdoors in the Spring
and Fall, or it may be absolute rest. The bodily activities comprise:

1. Unorganized games on the general playground for freshmen;
crew rowing, hockey, basketball, tennis, golf, archery, field and track
sports (of a modified character) for sophomores, juniors and seniors.
Each student participates in one of these sports at least three times a
week during the first five weeks in the Fall and the last six weeks in the
Spring.

2. During the Winter two hours a week of gymnastics are required
of freshmen and sophomores. For the upper classes gymnastic work
is optional. Dancing, aesthetic and folk, is also optional.

Indoor baseball is also practised by about fifty students once a week
during the Winter.

These activities aim to secure: (i) Organic development and training
as a necessary basis for health and vitality.

The majority of the young women, while not ill, fall far short of
that degree of organic efficiency which shows itself in robust health
and abounding vital energy. Many are "delicate," cannot stand much
exertion — mental or physical — and so are subject to many (unnecessary)
limitations. Again, the sedentary life most women lead, from high
school age on, entails various functional irregularities (such as consti-
pation and menstrual disturbances) which in turn react unfavorably

SOME PROBLEMS IN ADMINISTRATION OF A WOMAN'S COLLEGE 565

on the wholes bodily economy and cause temporary or periodic incapa-
city for work. Through abundant and varied muscular exercise, fur-
nished both by the outdoor and gymnastic work, the functions of all
the organs are stimulated, become more regular and the whole organic
system gains power, better adjustment and greater efficiency. The
motor organs too, are strengthened and toned up. A moderate and
harmonious muscular development is one of the necessary "tools" for
complete and efficient living. The majority of incoming students
are conspicuously lacking in this respect. While muscular development
is not a prime object of the work, it almost invariably results, to a
moderate extent, from the regular and vigorous exercise each student
is required to take. The bodily activities are of such a character
that they cultivate the right kind of motor and posture habits. There is
a great deal of unnecessary "breaking down," partial or complete,
among people of sedentary occupation, and especially among women,
which may be traced to wrong use of the body. Good posture and
efficient economical motor habits bear an important relation to health
and vitality insofar as they eliminate unnecessary strain and waste of
nervous energy, and insure better working conditions for the vital
organs as regards space, support and circulation. In the gymnastic
work the students are trained to move all parts of the body with pre-
cision and power ; to perform with promptness, accuracy and vigor those
elementary movements of which all skilled actions are made up. Through-
out all gymnastic work the training of good posture, erect carriage and
ease of bearing are especially emphasized. This subjective motor train-
ing furnished by gymnastics is thus closely related to the purely hygienic
phase of the work. But it is something more than that — it has a dis-
tinct and positive educational aspect. It means the development of
latent powers of coordination, the increase of motor adaptability; it
makes for physical efficiency and the self-reliance which is always asso-
ciated with it. It gives the student both the idea and the means to
live a fuller, freer, healthier and more efficient physical life. All this
as well as the direct training of attention and will, the habit of coopera-
tion and unison of action in the gymnastic work; the unquestioning
obedience to leaders, the observance of rules, the team work, spirit of
sportsmanship and applied ethics in games and sports, cannot fail to
have a pronounced and permanent effect on mentality and character
and to bring the student to a fuller realization of the meaning of educa-
tion— health — or wholeness, which is the harmonious development
of the body, the mind and the spirit.

Medical Care. The physical care of the students is under the imme-
diate supervision of the Resident Physician. By the terms of admis-

566 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

sion the student may have two weeks care per year in the infirmary,
and all necessary medical care at all times. She may, of course, consult
any outside physician if she wishes to do so. There should be complete
cooperation between the Department and Resident Physician. In
Wellesley College I am happy to say that this is the case.

The Plant. The plant consists of a large building in T shape. The
gymnasium is lOO x 70. Beneath it, and entirely above ground, are
two large dressing rooms with 120 alcoves and a bath room with 60
alcoves. There is also a locker and drying room. The students are
given their baths in groups, whole classes at one time, the showers
being under control of the bath matron. It is possible to give a
full tonic bath to classes of sixty every ten minutes in the day, with
absolute individual privacy. Bath sheets and towels are furnished by
the Department and sent daily to the college laundry. A required
gymnasium fee covers all expense of dressing room, locker and bath.
No gymnastic lesson is complete that does not include the bath.
Students unaccustomed to it soon acquire a liking for the shower bath,
which often results in the habit of a daily bath. After constant use
for nearly four years, we are satisfied that our bathing facilities cannot
be improved. The arrangement saves time, water and possibility of
accident. It is to be regretted that we have no swimming pool, how-
ever we hope to have one in the near future. In the main part of the
building are located the offices of administration; a suite of four large
rooms for medical and physical examinations, and for remedial work.
A beautiful well equipped department library is on the second floor, as
well as two large lecture rooms. On the third floor may be found the ana-
tomical and histological laboratories ; the physiological and bacteriological
laboratories. Surrounding the building on three sides are fourteen tennis
courts, a fine archery court, four courts for basket ball, and two courts for
hockey. There is also a running track and a large field for group games.
Further development of the grounds for additional sports is in progress.

It must be remembered that the hygienic care of the student body
is but one part of the work of this Department, which includes, as well,
a training school for teachers. The Department of Hygiene and Phys-
ical Education in Wellesley College has equal rank with all other depart-
ments, and numbers virtually the entire student body. It has also
charge of the physical education in the public schools of the town of
Wellesley, acting in conjunction with the school officials, and it is plan-
ning to do further extension work in this and other towns in the imme-
diate future. It is a debt that the College owes to the town and to
the Commonwealth in return for exemption from taxation — a debt
that it is a privilege to try to pay.

IMPORTANCE OF TEACHING CONSERVATION OF NERVOUS ENERGY 567

THE IMPORTANCE OF TEACHING THE CONSER-
VATION OF NERVOUS ENERGY TO OUR
ADVANCED WOMEN STUDENTS

Elizabeth Leiper Martin

In presenting this paper before the body of experts who are present
at this Congress I feel that I can add nothing to the facts already familiar
to you all.

Physiology and Psychology are so universally required subjects in
the curriculum of our normal schools and colleges that it would seem
that all our advanced students would consider the conservation of their
nervous energy of paramount importance. Indeed, did we practice
what we all know so well theoretically such a paper as this would be
distinctly unnecessary. Unfortunately my five years' experience as
Medical Examiner and Adviser in institutions that are training young
women for various kinds of professional work, and my association with
graduates of many colleges, has convinced me that we are still far from
the ideal system which prepares the. greatest number of individuals
for the greatest personal efficiency. Strangely enough it is usually
the more brilliant students who fail to realize the physical basis of ner-
vous energy and the methods of its conservation and who often there-
fore fail to reach the goal to which their ambitious and natural ability
would otherwise lead them. That this attitude of mind is found among
men, as well as women students, is illustrated by the following anecdote:
A student in one of our large eastern universities was sent by an instructor
to a prominent psychiatrist for a medical examination with the state-
ment that he was decidedly the most brilliant student in the University
and had the best mind. After the examination the physician reported .
that though he might be the most brilliant in some lines he was woefully
lacking in common sense and that in knowledge of his own body he was
about three years old.* Probably every school and college physician
here has had similar experiences. The recent movement for. the pre-
vention of nervous diseases and the advancement of mental hygiene
shows that great need for practical work along this line. It is a sad
reflection on our educational system that while factories and all business
concerns are considering every means for increased efficiency of their
employees that many of "our higher educational institutions are apply-
ing so little of the knowledge that they have.

*Related by Dr. Paton in another session.

568 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

For the woman of intellectual ability this subject is of importance
from three viewpoints. First, that of the individual, for this is the
type of woman who, if she breaks down, is liable to have the most severe
exhaustion, and unless very judiciously managed, to become one of the
chronic nervous invalids who fill our sanitariums and whose lives are
a burden to themselves and their friends. It was my experience with
these patients in sanitarium practice which aroused my interest in the
prevention of these conditions and made me feel the burning necessity
for early training in mental hygiene. Although under proper care
many of these patients recover and become most useful members of
society and from their hard experiences learn how to conserve their
energy, they probably are rarely able for what they should be had they
learned the lesson earlier. But who can say how many never are able
for the ordinary duties of life. So many of those who suffer from over-
strain drop out of high school and college before they have been properly
tested.

We are in danger of thinking that those who thus fail are hopelessly
defective and so far below the normal physically as to be hardly worth
any effort. Of course this is true in some cases, but my experience
makes me sure that many cases are the result of lack of knowledge of
hygiene, which may be defined as the art of living according to biological
laws. Many of these girls are refined and ambitious and have will
power and ideals much above the ordinary, but they fail because they
attempt the impossible, believing that mental work depends solely
upon the will and apparently unconscious of its physical basis. Their
ideas are indeed those of the ancient spiritualistic philosophers and seems
to be a remnant of the superstitions which dominated our ancestors
through the ages.

We must not unduly blame the girl for this, for how many of her
teachers and her still more ignorant family are responsible for this atti-
tude and often put on her burdens that are too grevious to be borne.

If from the standpoint of the individual we are doing the woman a
grave wrong by giving her a training for life which in any way handicaps
her for her highest and happiest function, that of wifehood and mother-
hood, from a eugenic standpoint we are doing no less a wrong to society.
While we must admit that brilliancy of intellect is often associated with
an instability of the nervous system which makes parenthood undesirable
for some of these women, still there are many others who with a proper train-
ing in hygiene are needed to be the mothers of future generations. It is
certainly of great importance for the intellectual development of the race
that the women of highest intellectual ability should not be rendered
unfit for motherhood by undue mental strain during adolescence and
early adult life; while by our laws for the protection of women in industry

IMPORTANCE OF TEACHING CONSERVATION OF NERVOUS ENERGY 569

we are endeavoring to conserve their ability for maternity. While
we care for the one, let us not forget the other. It is a well recognized
fact by all physicians that upon the women of our upper and more intel-
ligent classes the physical burden of maternity falls the heaviest. I
do not believe that this is the result of hard mental work, but because
she has not the knowledge, and does not realize the absolute importance
of a conservation of nervous energy, and because the educational and
social world conspire to stimulate her beyond human powers. Were
she properly educated she would recognize that her highest and most
solemn moral responsibility is her physical well being. Just so far as
she is below normal, so far is she unable for the duties and pleasures of
life. As the largest proportion of our highly educated women enter
the teaching profession it is surely of importance to society that they
enter upon their life work so trained that they will not only be more
efficient themselves, but also properly prepared to care for and set
correct standards and ideals for those under their influence. How can
a woman whose highest ambition has been to obtain honors in some
purely intellectual line, no matter what the cost to her own health, be
expected to take a rational and sympathetic view of what is of the greatest
importance to her pupils. Nor, when she begins to suffer from the
results of her own physical extravagance is she fit to have charge of
impressionable children. No matter how brilliant intellectually, a neu-
rasthenic mother or teacher is unfit to guide children of any age. Pro-
fessor Terman in his excellent monograph entitled "The Teachers'
Health" has collected a number of statistics that show that while the
mortality among teachers is low, the morbidity is very high; a large
proportion of the illness being caused' by nervous affections. The fact
that the members of few professions are subjected to the nervous strain
which teachers undergo makes it most essential that they should be
especially trained to withstand conditions which are apparently inevit-
able. Professor Terman states "that the belief that the fatigue co-
efficient of teaching is about twice that of other kinds of mental work
is probably nearer the truth than the common assumption that an hour
always equals an hour." In answering a questionnaire issued by Dr.
Burnham to 569 normal school students 20% name conditions of school
life as responsible for their ill health. No doubt the increased teaching
of practical hygiene in our schools and the medical examinations and
vocational guidance of our students will tremendously raise our health
standards, and thus contribute to a better mental hygiene, but we must
also reckon with the factor of increased stimulation to work, which
affects us all in these days of increased opportunities which are such a
great temptation to those who see the great amount to be done. How
many of our tired teachers and students are entering upon summer

570 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

courses of study, when above all the need is to let the mind li^ fallow
in preparation for the work of the next regular session.

One of the early symptoms of neurasthenia is increased impulse to
work beyond the reasonable amount, and in many nervous individuals
this is especially marked whenever they are tired. Dr. Mosso says that
"in proportion as the energy of the brain is consumed and our organism
weakened, the excitability of the nervous system increases. Here we
have an automatic means of defense of great efficacy which nature has
provided to counteract enfeeblement. The senses become more acute
and the nervous system more excitable, when in consequence of fasting
or fatigue an animal becomes less fit for the struggle." Many illnesses
would be avoided if this fact were more often recognized. To my mind
the most important facts that we must emphasize in our teaching of
Physiology and Hygiene is the physical basis of nervous energy and the
chemical changes in fatigue. While different individuals have vary-
ing capacities for work, all work consumes a certain amount of living
material as truly as fuel is consumed by an engine in producing energy
with a corresponding production of waste products. As in an engine,
there may be great loss of power on account of. defective construction
or faulty management including the provision of unsuitable fuel, so in
our bodies there is an even greater opportunity for the products of
faulty metabolism and insufficient nourishment or hereditary weakness
to prevent accomplishment of the work of which we should be capable.
Probably the different capacities of different individuals for work
depends upon the amount of latent energy available depending in turn
largely upon their habits of personal hygiene, affecting constructive
metabolism, oxidation and the removal of waste, and also upon their
methods of work. Indeed, the question is largely an economic one,
and we must decide how we are to spend the latent energy or, in other
words, the available materials with which we have to work. Some
very interesting observations on fish have been reported showing the
relationship between the metabolism of the different tissues during times
of special stress and also studies in starvation which demonstrate how the
tissues are sacrificed in the order of their importance, to the heart and
brain, which are essential to the life of the organism and are the last
to suffer loss of substance. These studies all demonstrate the need for
proper regulation of the various bodily activities and that strain on
one part affects, more or less, other important functions. We often
forget that all the physiological functions require expenditure of ner-
vous energy and that probably only one-tenth of our necessary nervous
expenditure is controlled by the will. By training children to do the
routine work of life automatically energy would be saved for conscious
efforts. If one has not acquired such habits it is worth the effort and

IMPORTANCE OF TEACHING CONSERVATION OF NERVOUS ENERGY 57 1

time necessary to learn to make such acts automatic. When by forcing
ourselves to do more than is normal in certain directions we first rob
other organs of what is needed for their work and finally we reduce our
total store of energy to the point of physical bankruptcy. The person
who does not retain a "margin of safety" in health expenditure is much
more foolish than he who lives entirely up to his financial income. For
health is our capital in more ways than we realize. Women must realize
that upon the female in all higher organisms falls the burden or privilege,
according to point of view, of storing latent energy for future genera-
tions, and no matter what the individual wishes, nature has provided
certain physiological processes and laid down certain laws which cannot
be broken without entailing suffering for the individual and injury and
loss to society. In the normal metabolism of women, provision is made
for a periodic loss of latent energy which, in health, the woman can
easily meet. Much of the mental sluggishness during the menstrual
period is due to the local pelvic congestion. Another factor on the
economical side is that of improper methods of work, and the lack of
efficiency caused by fatigue. "It has been estimated that not less than
25-50% of the entire possible output has been wasted by lack of knowl-
edge of the most economical ways of running the psychological machine."
Dr. Mosso's studies on fatigue show that only one-fourth of the time
necessary for restoration of the muscle is required when one-half the
amount of work necessary for complete exhaustion is done. I find
we must constantly emphasize this to our students who work late at
night when they are fatigued and remind them of the time that would
be saved if they rested then and worked when they were rested. So
much time is lost by working when we should rest. It is interesting to
note that the tremendous work done by Charles Darwin was the result
of only three hours of concentrated work daily and many others who
have influenced the intellectual life of the world could spend little more
time. This should be considered in arranging students' schedules.
We need quality so much more than quantity.

Mosso's experiment also shows that muscular fatigue follows mental
work to such a marked degree that we must be more careful how we recom-
mend physical exercise to our students who are under great mental strain.
Much nervous exhaustion is no doubt caused by our theories that change
of occupation is rest. This is partially true and occurs when one part
of the nervous system is fatigued and when the total amount of waste
products in the body is well below what is tolerated by the individual.
By muscular exercise after an ordinary amount of mental work the
circulation is so modified that a fresh blood supply is brought to the
fatigued cells, and waste products are more quickly removed and as
we all know the proper proportion between mental and muscular work

572 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

is very important. We should, however, consider carefully the nature
of the exercise and select that which makes the least strain on the ner-
vous system, those exercises being selected that are largely automatic
in character. Much of our physical training consists of complicated
dances and difficult gymnasium feats, not to mention competitive
games, which instead of relieving the over-taxed nervous system adds
directly to the strain. One important factor in conserving nervous
energy is the training in proper posture and correct poise of the body.
Many symptoms of nervous strain are those resulting from incorrect
sitting and standing posture with the increased muscle strain which is
required for ordinary movements, as well as interference with the cir-
culation. So often our gymnasium instructors are teaching highly
coordinated movements when the students have not learned the rudi-
ments of muscular training. I have been amazed in some cases at the
improvement in health which has followed instruction in methods of
correcting faulty posture with a consequent saving of energy.

In teaching of physiology and hygiene we must dignify and idealize
all the physical functions by teaching that our bodies are the instruments
by which we are enabled to fulfill our highest responsibilities and that
our mental efficiency depends upon the application of biological laws.
This dignified attitude is especially important in the teaching of sexual
hygiene and I believe that we should avoid in our talks with students
the emphasis that is so often laid upon the pathological and the dese-
crated sexual functions. It is impossible to calculate how much harm
has been done to sensitive individuals by taking a morbid attitude
concerning this subject and by creating a disgust for the most sacred
human functions. That a proper teaching of the facts concerning sex
is a factor in mental hygiene I have no doubt, for anything that causes
a false view of, or a morbid curiosity concerning the great facts of life
must cause psychic injury. Upon many of us lies the responsibility
of helping the student to decide what her life work is to be and we must
be very careful in our study of the individual. Dr. Stewart Paton
in his work on Psychiatry states that one of the common causes of in-
sanity is over-education of certain people who are unable for the strain
of mental work. I believe we must learn to give credit and honor to
all useful work and make our students realize that to do well what they
can is much more creditable than to attempt lines of intellectual en-
deavor in which they will never excel on account of the tax on the
nervous system for which they are not fitted. The present movement
for vocational training will help us solve the problem, but we must
avoid the danger for some students of loading vocational courses with
theoretical work which puts a strain on the nervous system plus that
of the muscular work inherent to the course. It has only been possible

IMPORTANCE OF TEACHING CONSERVATION OF NERVOUS ENERGY 573

to-day to touch on the necessity for the teaching of the conservation
of nervous energy from the physical side and to mention a few of the
points I have found helpful in dealing with a very interesting class of
girls so full of enthusiasm and anxious to make the most of their lives,
but in their zeal and ignorance so often courting disaster and failure
forgetting that what they need most is rational consideration of physical
ability and a sensible attitude toward life.
To summarize these points :

1. The necessity for a hygienic regime to insure proper nutritive
processes and the elimination of waste.

2. The formation of correct habits that much work may be done
automatically.

3. The economic loss of time and energy from working until ex-
hausted.

4. The importance of training in correct posture to prevent mechan-
ical waste of energy and consequent strain of nerve and muscle.

5. The necessity that more honor and dignity be given to good
work outside the purely mental field.

References:

"The Teachers' Health," Lewis M. Terman, Houghton, Mifflin Co.,
Boston, New York and Chicago.

"Fatigue," A. Mosso, G. P. Putnam Co., New York.

"Psychiatry," Stewart Paton.

574 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

GOOD ROADS AND GOOD HEALTH

Mrs. F. De Garmo

To combine the subject of good health with good roads, may
seem a little "queer" for an International Congress on School Hygiene.
But all health is so essential, so meritorious, so compelling and so vital
to the growth and stability of nations that any worthy element that
enters into child hygiene, which is the world's hygiene, should be
regarded with thoughtfulness, even though it be the conservation of the
public roads.

What is a Road? A road is a path or highway for the people.

Use of Roads. Good roads are the milestones that mark the progress
of all humanity "up to ampler destinies."

Kinds of Roads. There are physical, mental and moral paths, or
highways.

Mental roads are the highways of immortal mind, over which high-
power thought-motors are acting as pathfinders for the highest type of
modern race development.

Moral highways are the "Old Trails Road" of the Decalogue, whose
ten guide-posts have stood throughout the ages — at the cross-roads of
life — to point out the right of way to good earthly citizenship and
eternal hope and happiness.

Physical highways are the basic element in the rise or fall of humanity
and are largely responsible for the mental and moral conditions of man-
kind.

Kinds of Health. The wider use of the word health, like that of
highways, naturally divides itself into physical, mental and moral
conditions of the body, mind and soul.

Values of Health. Improved health, in this larger sense, will bring
a new race with infinite possibilities for good.

Value of Roads. Improved roads will bring, among other things:
Better farms and more cultivated land, better cities and more

civic pride ;

Better crops and cheaper transportation, better economic conditions

and more products;

GOOD ROADS AND GOOD HEALTH

575

Better church attendance, better citizens;

Better social conditions, less isolation and selfishness and more
refinement ;

Better neighborhood understanding, and less community antagonism;

Better schools and greater attendance, better health and quicker
medical attention ;

Better home economics and less drudgery and insanity.

These reasons alone for public road improvement should be suffi-
cient to create a public sentiment for better highways, and a greater
interest in arousing all thinking people to study the awful condition of
the roads in America.

It is gratifying to know that there is a national awakening as to the
economic values of good roads, and we are grateful to the automobile
and all other agencies, whatever their motive, for the increased activities
in road improvement; but it remains for the future to make known in
a scientific manner and from scientific investigations the greatest
menace of bad roads to the development of the human family — that is
the danger to health.

Bad roads are hard to define, because they differ in their kind of
"badness," according to their location, and the climate and topography
of the country.

But any road that is impassable, for any period of the year, for
travel, traffic, pleasure or profit, by children or adults, is bad for the
physical, mental and moral welfare of the people.

Bad roads are easily distinguishable by mud-holes, frog ponds,
choked-up culverts, soggy, stagnant pools, and hog-wallows. Bad
liighways may also be rocky, rutty, washed-out and impassable hill
roads; but, in either case, bad roads always mean bad drainage.

Bad drainage means breeding places for the filthy fly, and the
deadly mosquito.

Bad drainage and the flies and mosquitoes mean yellow, typhoid,
malarial and other fatal fever diseases. Muddy roads mean tuber-
culosis, croup, pneumonia, catarrh and rheumatism.

If for no other reason than to exterminate the mosquito and fly, by
draining their breeding places, the medical world and all other students
of health agencies should advocate the immediate improvement of the
public roads, by expert highway builders. Thinking people should
wage a campaign of education to teach the taxpayers that good roads
are not a tax, but an investment in health, wealth and happiness.

Boards of Health should have legal powers to close bad roads against
traffic and travel just as they now have against unsanitary Produce
Markets, or epidemic breeding schoolhouses.

576 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

Good Roads Make Possible Pure Milk and Pure Food. " Pure Food,"
the slogan of "The Consumer," is almost impossible to obtain even
under the most stringent laws by National and State Boards of Health,
unless the roads to market are good, throughout the year, so that pure
milk, pure eggs, pure meat, and pure vegetables can be rushed to the
consumer in a very short time.

Dr. Dowling, President of the State Board of Health of Louisiana, is
concentrating on the "better drainage of roads to destroy the breeding
places of mosquitoes and flies" and also to urge the value of good roads
as a "pure food measure."

Dr. John J. Sippy, Assistant in the State Board of Health of Kansas,
under the heading, "Good Roads Prevent Disease," gives the following
reasons for a health campaign for good roads.

I. By Reason of the Removal of All Weeds and Trash.

Weeds and trash prevent the prompt evaporation of moisture, and
promote retention of the ground water. This makes ideal breeding
spots for mosquitoes, flies and other insects which are known as disease
carriers, not to mention chinch bugs, hoppers and other insects which
are crop damagers. Furthermore, an undergrowth of weeds invites
the dumping of garbage, manure and excrement by offering conceal-
ment, of which fact careless and thoughtless people are prone to take
advantage, thus increasing the facility of insect breeding and at once
providing these insect carriers with proper material for disease trans-
mission.

n. By Providing Good Drainage. ^ •

Many farms have no means of drainage except by ditches along
roadways. Open ditches, clear of brush and debris with hardened sur-
face and proper fall, aff^ord these farms the opportunity of ridding them-
selves of many a stagnant pool. The removal of weeds, together with
proper road grading, surface hardening and oiling, insures prompt
drainage of all pool, ditch and surface water, at once removing the
possibility of insect breeders, for none can multiply without moisture.
Road oiling, in itself, is destructive of insect larvae, especially mosquitoes
— a well known fact.

Dry roads offer pedestrians, and notably children, who are compelled
to walk to and from school, dry shoes and feet; while colds are undoubt-
edly due to specific germ origin, more or less, it is a well-known fact that
cold, wet feet and chilling limbs lower the resistance of individuals and
make them favorable subjects for infections of the respiratory passages,
including pneumonia and tuberculosis. ^

GOOD ROADS AND GOOD HEALTH 577

III. By Example to Adjoining Farm Premises.

Good roads promote travel on those highways and in themselves they
set examples to the farmer whose premises are bordered by them. The
comparison of a well graded, clean highway with an unkept and trashy
barnyard adjoining is sufficient to stimulate every land owner to a clean-
up. Pride compels him to offer to passers-by a neat appearing and
attractive house and barnyard. Results are only too obvious — Q. E. D.
Thus, good roads are active disease prevention agencies aside from their
financial and commercial value.

The "Saint Louis Republic," which has waged a popular good
roads campaign recently, and one which will have far reaching results,
says of good roads and good highways:

"Good Roads and Good Health.

"Good roads are inseparably connected with good health." When
the average indoor worker is out of doors, in two hours out of three he
is on the road, or immediately adjacent to it. He is breathing the air
of the road, such as it is. If this air is full of germs or of mosquitoes
obligingly acting as common carriers of germs, or if it is full of dust
or foul odors, it will surely exert its maximum effect upon just those mem-
bers of the community whose exclusion from spn and air during work-
ing hours makes them most susceptible to unfavorable influences.

When an invalid goes for his first drive, he goes out on the road.
[W^hen a baby goes for a walk, he is taken along the highway. The aged
and infirm, called forth by necessity, or desire, for the rest that comes
from change, breathe the air of the road. It ought to be good air. It
[cannot be if the road is diversified by mosquito breeding pools, carpeted
clean up to the roadway with dank and matted weeds, littered with
filth, or permitted to become knee deep with dust.

It is vastly important to the public health, that users of the roads
should be able to go where they want, when they want to, and arrive
there on time. The baby that died in the midst of the rigors of winter
on a farm because the doctor could not be gotten in time, is only one of
the victims. Many a life has paid the penalty of over exposure on account
of bad roads, and it chances that the roads are worst just when the
weather is worst. Bad roads, too, prevent the conservation of human
energy by making "going to town" so hard that the delicate person in
the country gives up the medical treatment that would restore health
and strength, because the exertion of a long drive through bog and mud-
:hole more than counterbalances the benefit of the treatment.

But, perhaps, the most marked effect of good roads on health comes
by way of the mind and soul. Shut up to itself, fresh water stagnates,

578 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

SO does human life. The very word "pagan" originally meant the vil-
lager, who, remote from the great currents of life and thought of his
time, remained untouched by the Christianity that had leavened the
cities. The secret of rural civilization is the preservation of the link
which unites the men and women of the far-off hamlet with the great
world outside.

Wherever good roads go, the vital energy of the world flows along the
highway. And the building of a good road is a challenge to which
national manhood responds.

The slums of big cities are on bad streets. Many a neighborhood
has been lifted out of a slough of vice and poverty by the process of im-
proving its streets. Well curbed, neatly paved streets have induced
the property owner to improve his house and his lot ; the lessons in neat-
ness given by street cleaning have been an object lesson in good house-
keeping; the good highway has helped to transform the people's lives by
bracing their self-respect. And the building of a good road into a back-
ward country district has often lifted the whole life of the people and
given children a better chance for health of body, mind and soul.

The civilization of a country may justly be gauged by the healthful-
ness of the life lived in the open on its roads.

Bad roads cause the churches to be neglected and deserted, and their
decay and dissolution follows. Along with the use of the churches for
corn cribs instead of spiritual evangelization, the moral health of a com-
munity vanishes.

Are not the conditions of the roads of a nation the measure of the
efficiency of its health authorities, as well as the test of the efficiency
of the highway engineer, or the public spirit of its citizens?

May we not measure the health and efficiency of the schools of our
nation by the efficiency of its transportation facilities to the educational
centers?

Is it not time for the humanitarian doctor to join with the highway
engineer in an irresistible and remedial team-work slogan for better
homes, better schools and better sanitary environments?

Dr. Robert M. Funkhouser, President of the Missouri State Medical
Association, has furnished a remarkable ocular demonstration of the
danger to travelers along bad, swampy, fly-breeding roads. A few weeks
ago a man living in the country near St. Louis, came to the distinguished
doctor's office complaining of a headache. The doctor examined his
nose, and found that the eggs of a fly had been deposited far up in one
of the nostrils.

The patient, when questioned, remembered that while he was walk-
ing along the road, some days before, an insect flew into his nose. He
immediately forced it out, and forgot all about it.

GOOD ROADS AND GOOD HEALTH 579

On the day he visited the doctor, suffering from severe pains in his
head, the doctor extracted five green fly pupae from his nose by chloro-
form. These five pupae were deposited, by the doctor, in a paper box.
All five of the units developed, although very little air could have reached
them in the box. This illustrates not only the persistence of life, but
the danger from the common fly. Yellow fever which has claimed its
victims by the thousands and tens of thousands is directly traceable
to the mosquito, known as the Sty gomia fas data.

Any breeding spot for mosquitoes is a deadly menace to the health
of humanity.

Innumerable examples could be cited to prove the origin of fatal
diseases from bad roads and bad streets, directly and indirectly.

Good roads make possible so many opportunities for prosperity,
for health, for education, for culture, for music, for art, for amusement
and for recreation, that their value might be expressed in general terms
as the antitoxins for the physical, mental and moral ailments of mankind.

When every road leading to every home and every school is a clean,
modern highway, and when every agency is utilized to preserve the per-
fect health of all the children in every home and every school, all nations
will boast a perfect child, from whom will spring the perfect race, and
thus mankind will fulfill the prophecy of the poet:

The brute man of the planet, he will pass,
Blown out like forms of vapor on a glass,
And from this quaking pulse of life will rise,
The Superman-child of the higher skies.
Immortal, he will break the ancient bars,
Laugh and reach out his hands among the stars.

580 FOURTH INTERNATIONAL CONGRESS ON SCHOOL HYGIENE

HYGIENE INSTRUCTION IN THE GARDNER
SCHOOL OF VALPARAISO

Margaret C. Beer

Instruction in hygiene in the Gardner School has been reduced to
a system and is taught regularly in all of the grades. The work is oral
and written.

For the oral work the teachers use Health Hints. These have been
classified as follows: Sunshine, Air, Personal Cleanliness, Care of the
Eyes, Care of the Teeth, and Flies. There is also a miscellaneous list.
Each morning the teacher writes upon the board a health hint. A few
comments are made. Care is taken to make these comments as con-
crete and practical as possible. Sometimes a story is told by way of
illustration. The health hint is left upon the board during the day.
Every Friday boys and girls give a health hint. It may be one they
have learned or an original one. A girl of seven years gave this, "Air
beds at least two times every day." This was at the completion of the
instruction on air.

The written work begins in the second grade. It takes the form
of stories and compositions. The subject is sometimes assigned by the
teacher. At other times the pupils choose their own subjects. The
aim in the written work is to make the expression free and spontaneous,
not laying too much stress upon form.

This work has been carried on for three years. Neither teachers nor
pupils have tired of it. Its success is shown in the interest which the
pupils take in the instruction and in their application of it in their homes.
The parents are in sympathy with the work and many expressions of
gratitude have come from them which show that they appreciate the
work which is being done.

AIR

Night air is purer and more wholesome than day air.

Night air is charged with health and strength.

Let night air into your bedroom abundantly.

Night air contains less smoke, less dirt and fewer microbes than day air.

Night air is cooler than day air.

Night air is a good tonic.

Night air is the only air we have to breathe in the night time.

Live all you can in the open air.

Foul air is full of disease and death.

HYGIENE INSTRUCTION IN THE GARDNER SCHOOL

581

Pure air is full of health and life.

Do not live, study or sleep in rooms where there is no fresh air.

Do not live in dusty air. Keep your rooms clean.

Get rid of dust by cleaning with damp cloths. Do not sweep with a dry broom.

AIR

The air is nice.

There is no thing better than air.

Air is good for you.

The air is fresh.

Air your lungs.

Play in the air.

Air makes us happy.

We love the air.

There is no thing better than air.

Air your beds.

The air is good for you.

The air helps to make us grow.

The air makes things smell fresh.

You must air your beds.

Air your homes.

You must air your clothes.

You must love the air.

Second Grade, Gardner School.

Ella May Vevia.

SUNSHINE

We love the sunshine.

Sunshine is good for us.

Keep on the sunny side.

Let the sunshine shine in on the beds.

We could not live without sunshine.

The woman said pull down the shade the sun is fading the wallpaper.

O, put it up said the little girl let the beautiful sunshine shine in.

Florence May Stansell.

Second Grade, Gardner School.

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3403

1913

V.2

International Congress on
School Hygiene. 4th, Buff a]
1913

Fotirth International
Congress

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Full text of "Fourth International congress on school hygiene, Buffalo, New York, U.S.A., August 25-30, 1913. Transactions. Edited by Thomas A. Storey with the assistance of Frederic A. Woll and Julian Park"

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