Dental clinics will quickly follow the publication of facts that schools should gather. In some places these should be separate; but at first the best thing is to make every hospital, every children's home, every settlement a clinic, and every school an examining center. A skilled dentist informs me: "The demand that will follow examination of school children's teeth will make it profitable for young dentists to adopt a cooeperative scheme, where several young men hire a parlor in a cheap district, and, under the supervision of some experienced dentist, give good advice at reasonable rates. This is the best antidote to the dental parlor which exploits the public so shamelessly." Bellevue Hospital in New York is the first general hospital to establish regular dental examination; others will undoubtedly soon follow.

Dental education for profit rather than for instruction and for health has been the rule. Even where universities have put in dental courses, they have demanded a net profit from tuition. Instead of protecting society against men incapable of caring for teeth, the schools have marketed certificates to as large numbers as slowly enlightened self-interest would permit. Much progress has been made toward uniform standards of admission and graduation, but dental colleges sadly need the light and the inspiration of school facts about teeth.

Of fourteen dental journals in America, only one has the advancement of dental science as its first reason for existence. Thirteen are trade journals. Not one of these would print articles proving that the supplies advertised by their backers were inimical to dental hygiene. Many dental colleges still retain on their faculties agents or editors in the pay of supply houses, Harvard's new dental school being a notable exception. This trade motive tolerates and encourages the disreputable practices of existing dental parlors. Largely because of this prostitution of the dental profession, patients generally neglect the repairing and cleansing of the teeth and the sterilizing of the mouth from which germs are carried to all parts of the body. Dental journalism for the sale of supplies cannot outlive the dentist's reading of the school's index.

Many dentists will say that they must learn dentistry before they learn the economics and sociology of clean teeth. Being a young profession, it is natural that dentistry should first devote itself to learning its own mechanics,—the tricks of the trade—how to fill teeth. But the fact that it took the medical profession centuries to begin to feel responsibility for community health is no reason why the social sense of the dentist should be dormant for centuries or decades. We need training and exercise to determine what kind of filling will be most comfortable and most serviceable; whether the pulp of the teeth needs treating or removing before the filling is inserted; whether it is worth while to fill a deciduous or baby tooth. Sociology will never take the place of dental technic. The few dentists who have studied the social significance and social responsibility of their profession declare, however, that careless workmanship and indifferent education of patients continue chiefly because dentists themselves do not see the community's interest in dental hygiene. The school can socialize or humanize the dental profession if teachers themselves possess the social sense and make known the facts about the need for dental care among school children.

FOOTNOTES:

[5] The Teeth and Their Care, by Thaddeus P. Hyatt, D.D.S., is a short, concise treatment of the principles of dental sanitation.



CHAPTER X

ABNORMALLY BRIGHT CHILDREN

What is commonly considered abnormal brightness in a school child is often a tendency to live an abnormal physical life. Being a child bookworm means that time is spent indoors that should be spent playing games with one's fellows. Excellence in the activities of children, not ability to imitate the activities of adults, should be the test of child brightness. To be able to hit a bull's-eye, to throw a ball accurately, to calculate the swing of a curve or the bound of a "grounder," these are tests of brightness quite as indicative of mental power as the ability to win highest marks in school, while less injurious to physical power. The child who is abnormally bright requires special treatment just as much as the child who is abnormally dull. The former as well as the latter must have his abnormal condition corrected if he is to grow into a normally bright man.

The college man who sacrifices health to "marks" is thus described by the director of physical training at Harvard University:

A drooping head, a pale face, dull, sunken eyes, flat chest and rounded shoulders, with emaciated limbs, soft flabby muscles, and general lack of good physical, mental, and moral tone.

For the protection of these physical defective grinds it is suggested to put a physical qualification upon the candidates of Phi Beta Kappa and their awards of scholarship. If scholarship men cannot be induced to take time to improve their physique for fear of lowering their college standing, then give them credit for standing in physical work.

The abnormally bright, at whatever age, is as much a subject for examination and treatment as the child with adenoids and pulmonary tuberculosis. Such attention will increase the percentage of abnormally bright schoolmates who figure in active business in later life. Moreover, it will decrease the number of high school superintendents who declare that their honor pupils are physical wrecks.

There are children who develop very rapidly, both physically and mentally, and whose mental superiority is not at the expense of their bodies. Protection of such children requires that their minds be permitted to progress as rapidly as bodily health justifies. It is as cruel to keep back a physically and mentally superior child, as to push the physically or mentally defective beyond his powers. Worry and fatigue can be produced by lack of interest as well as by overwork. "Normal" should not be confused with "average." To keep a bright child back with the average child—marking time till the dull ones catch up—is to make him abnormal. The tests that we have employed for grading pupils are either the tests of age in years or of mental capacity. The first takes no account of slowness or rapidity of physiological development,—of physiological age. The second encourages mental activity at the expense of physique. The entrance of a child into school, the promotion from one class to another, the entrance into college, are thus determined either by the purely artificial test of age or by the individual teacher's discretion. There is nothing to prevent the ambitious teacher or the ambitious parent from pushing a child into kindergarten at four, high school at twelve, college at fifteen. If this cannot be done at the public school, a private school is resorted to. A community of college professors once started a school for faculty children. A tremendous pressure was put upon these scions of intellectual aristocracy to enter the high school at twelve. No thought was given to the ventilation of the school. The windows were so arranged that they could not be opened without the air blowing on some child's back. "You could cut the air with a knife" was a description given by one sensible professor who had taken his sturdy girl of seven away from the school, because he feared that in this environment she would become like the other little puny, pale, undersized children of that school.

The University of Pennsylvania has instituted a psychological clinic. Parents and teachers are invited to bring any deviation from the usual or the expected to the attention of this clinic. Every month a bulletin is published called the Psychological Clinic, which will be found of great service in dealing with the abnormally bright as well as with the abnormally dull. Naturally the well-to-do and the rich are the first to take advantage of these special facilities for ascertaining just what work should be done by a precocious child or by the mentally and morally retarded.

Abnormal brightness means power to be happy and to be serviceable that is above the average. Every school can be a miniature psychological clinic. While every teacher cannot be an expert, national and state superintendents can constantly remind teachers that the abnormally bright are also abnormally apt to neglect physical welfare and to endanger future mental power.



CHAPTER XI

NERVOUSNESS OF TEACHER AND PUPIL

Nervousness of teacher and pupil deserves special mention. So universal is this physical defect that we take it for granted, especially for teachers. Teachers themselves feel that they need not even apologize for nervousness, in fact they too frequently use it as an excuse for impatience, ugly temper, discourtesy, and unfairness. Children, slates, papers, parents, blackboards "get on their nerves." Nervousness of teacher causes nervousness of pupils and adds to the evil results of mouth breathing, bad teeth, eye strain, and malnutrition. These conditions, added to bad ventilation, bad light, and an overcrowded schoolroom, render the atmosphere thoroughly charged with electricity—nerves—toward the end of the day. Lack of oxygen to breathe as well as inability to breathe it; lack of well-printed books and good light, as well as lack of the power to use them; toothache, earache, headache, deplete the vitality of both teacher and pupil.

Most of the disturbances at school are but outward signs of unwholesome physical conditions. If the teacher attempts to treat these causes by crushing the child, she makes confession of her own nervousness and inadequacy and visits her own suffering upon her pupils. A transfixing glance prolonged into an overbearing stare, a loud, sharp voice, a rough manner, are successful only so far as they work on the nervousness of her pupil. She finds that it is temporarily effective, and so by her example and practice sets the child an example in losing control of himself. The position often assumed by school children when before authority, of hands held stiffly at the side, head drooped, and roving eye, does not mean control: it means a crushed spirit, hypocrisy, or brooding anarchy. The mother or teacher who obtains obedience by clapping her hands, pointing her finger, distorting her face, is copying in her own home the attitudes of caste in India, of serfdom in Russia, the discipline of the prison the world over, a modern reminder of the power of life and death or of physical torture.

A young college girl unfamiliar with the ways of the public school was substituting in the highest grammar grade. The time for civics arrived. Here, she thought, is a subject in which I can interest them. The boys showed a vast amount of press information, as well as decided opinions on the politics of the day. The candidates which they elected for the position of ideal American patriot were Rockefeller, Lincoln, and Sharkey the prize fighter. During the ensuing debate, which gave back to Lincoln his proper rank, the boys in the back of the room had moved forward and were sharing seats with the boys in the front. Every boy was engrossed in the discussion. The room was in perfect order,—not, however, according to the ideas of the principal, who entered at that moment to see how the new substitute was managing the class, famed for its bad boys. With the stern look of a Simon Legree she demanded, "How dare you leave your seats!" When one child started to explain she shouted: "How dare you speak without permission! Don't you know your teacher never permits it? Every boy take his own seat at his own desk." This principal was far more to be pitied than the boys, for they had before them the prospect of "work papers" and a grind less monotonous and more productive than the principal's discipline. She was a victim of a nerve-racking system, more sinned against than sinning.

There is nothing in school life per se to cause nervousness. Given a well-aired, sunny room, where every child has enough fresh air to breathe, where he can see without strain, where he has a desk fitted to his body and work fitted to his maximum abilities, a teacher who is physically strong and mentally inspiring, and plenty of play space and play time, there will be no nervousness. One who visits vacation schools is struck with the difference in the atmosphere from that of the winter day schools. Here are the same rooms, the same children, and in many cases the same teachers, but different work. Each child is busy with a bright, interested, happy expression and easy attitude. Some are at nature study, some are weaving baskets, making dresses, trimming hats, knitting bright worsted sacks and mittens for the winter. Boys are at carpentering, raffia, or wrought-iron work. In none of the rooms is the absolute unity or the methodical order of the winter schoolroom, but rather the hum of the workroom and the order that comes from a roomful of children interested in the progress of their work. This condition only illustrates what a winter schoolroom might be were physical defects corrected or segregated, windows open, light good, and work adapted to the child.



Nervousness is not a monopoly of city teachers and city pupils. In country schools that I have happened to know, nervous children were the chief problem. Nervousness led in scholarship, in disorder, in absences, in truancy, and in backwardness. After reading MacDonald's Annals of a Quiet Neighborhood, I became interested in one or two particularly nervous children, just to see if I could overcome my strong dislike for them. To one boy I gave permission to leave the room or to go to the library whenever he began to lose his self-control. My predecessors had not been able to control him by the rod. A few weeks after Willie's emancipation from rules, the county superintendent was astonished to see that the county terror led my school in history, reading, and geography.

Had I known what every teacher should be taught in preparation,—the relation of eye strain, bad teeth, adenoids, "overattention," and malnutrition to nervousness and bad behavior,—I could have restored many "incorrigibles" to nerve control. Had I been led at college to study child psychology and child physiology, I should not have expected a control that was possible only in a normal adult.[6] In its primary aspect the question of nervousness in the schoolroom is purely physiological, and the majority of principals and teachers are not trained by professional schools how to deal with it. Normal schools should teach the physical laws which govern the child's development; should show that the pupil's mental, moral, and physical nature are one and inseparable; that children cannot at one time be docile, sickly, and intelligent,—perfect mentally and imperfect physically. Until teachers are so taught, the condition cannot be changed that makes of our schools manufactories of nervous teachers and pupils.

Country nervousness, like city nervousness, is of three kinds: (1) that caused by defective nervous systems; (2) that resulting from physical defects other than defects of the nervous system, but reacting upon it; (3) that due to habit or to lack of self-control. Children who suffer from a defective nervous system should, in city schools, be segregated where they can have special care under constant medical supervision. Such children in schools too small for special classes should be given special treatment. Their parents should know that they have chorea, which is the same trouble as St. Vitus's Dance, although often existing in a degree too mild to attract attention. Special treatment does not mean that such children should be permitted to interfere with the school progress of other children. In many rural schools, where special privileges cannot be given children suffering with chorea without injury to other children, it would be a kindness to the unfortunates, to their parents, and to all other children, were the parents requested to keep such children at home.

Nervousness that results from removable physical defects—eye strain, adenoids, indigestion, earache—will be easily detected by physical examination, and easily corrected by removing the physical defect.

Preventable nervousness due to "habit" can be quite as serious in its effects upon the mind and health as the other two forms of nervousness. Twitching the face, biting the nails, wetting the lips, blinking the eyelids, continually toying with something, being in perpetual motion and never relaxing, always changing from one thing to the next, being forever on the rush, never accomplishing anything, are common faults of both teacher and pupil. We call them mannerisms or tricks of personality. They are readily imitated by children. I once knew a young lawyer who had started life as an oyster dealer, whose power of imitation helped to make him responsive to both helpful and harmful influences. After being at the same table for two weeks with a talented man whom he admired, he acquired the latter's habit of constantly twitching his shoulder and making certain gestures. These habits in turn quickly produced a nervousness that interfered with his power to reason straight.

Nervousness is often confused with aggressiveness, initiative, confidence. "Think twice before you jump, and perhaps you won't want to jump" is a very difficult rule to follow for any one whose bodily movements are not under perfect control.

It is said that the confusion of city life causes habits of nervousness. Unfortunately no one knows whether the city children or the country children have the highest percentage of nervousness. There is a general feeling that city life causes an unwholesome degree of activity, yet one finds that those people in the city who least notice the elevated railway are those whose windows it passes. City noises irritate those who come from the country, or the city man on returning to the city from the country, but a similar irritation is felt by the city-bred man on coming to the country. Mr. Dooley's description of a night in the country with the crickets and the mosquitoes and the early birds shows that it is the unusual noise rather than the volume or variety of noises that wreck nerves. At the time of the opening of the New York schools in 1907 a newspaper published an editorial on "Where can the city child study?" showing that in New York the curriculum, the schoolhouse, and the tenements are so crowded and so noisy that study is practically impossible. Lack of sleep, lack of a quiet place in which to study at school and at home, are causes for nervousness, whether these conditions are in the city or in the country. What evidence is there that the country curriculum is less crowded or country work better adjusted to the psychological and physiological age of the country pupil? The index is there; it should be read.

In breaking habits of nervousness the first step is to explain how easily habits are formed, why their effects may be serious, and how a little attention will correct them. When a habit loses its mystery it becomes unattractive. Children will take an interest in cooeperating with each other and with the teacher in curing habits acquired either at home or at school. My pupils greatly enjoyed overcoming the habit of jumping or screaming after some sudden noise. I told them how, when a boy, my imagination had been very much impressed by one of Thackeray's characters, the last remnant of aristocratic traditions, almost a pauper, but possessing one attribute of nobility,—absolute self-control. When his house burned he stood with his ankles crossed, leaning on his cane, the only onlooker who was not excited. For months I imitated that pose, using sticks and rakes and fork handles. The result was that when I taught school, a scream, a broken desk, or unusual noise outside reminded me of my old aristocrat in time to prevent my muscles from jumping. In a very short time several fidgety and nervous girls and boys had learned to think twice and to relax before jumping.

One test of thorough relaxation in a dentist's chair proves the folly of tightening one's muscles. When in school or out the remedy for nervousness is relaxation. The discipline that prohibits a pupil from stretching or changing his posture or seat is as much to be condemned as that which flourishes the rod. It has been said of our schools that children are not worked to death but bored to death. Wherever a room must be stripped of all beauty and interest to induce concentration, wherever the greater part of the teacher's time must be spent in keeping order, there is confession either of inappropriateness of the present curriculum or of the failure of teacher and text-book to present subjects attractive to the pupils. Nervous habits will be inevitable until the pupil's attention is obtained through interest. Sustained interest will be impossible until teacher and pupil alike practice relaxation, not once a morning or twice a day, not during recess or lunch hour, but whenever relaxation is needed.

In overcoming nervousness of teacher and pupil, both must be interested in home causes as well as school causes of that nervousness. Time must be found to ask questions about those causes and to discuss means for removing them. Naturally it will be embarrassing for a very nervous teacher to discuss nervousness with children,—until after she has overcome her own lack of nerve stability. To help her or to compel her to learn the art of relaxation of bodily and of mental control is the duty and the privilege of the school physician, of her doctor, and of superintendent and trustees. The outside point of view is necessary, because of the peculiar fact that almost every nervous person believes that he has unusually good control over his nerves, just as a man in the midst of his anger will declare that he is cool and self-controlled. Had Robert Burns been thinking of the habit of nervousness he could not have thought of a better cure than when he wrote:

Oh wad some power the giftie gie us To see oursel's as ithers see us; It wad frae mony a blunder free us, And foolish notion.

FOOTNOTES:

[6] The Unconscious Mind by Schofield, The Study of Children and their School Training by Dr. Frances Warner, and The Development of the Child by Nathan Oppenheimer show clearly the physical and mental limitations and possibilities of children.



CHAPTER XII

HEALTH VALUE OF "UNBOSSED" PLAY AND PHYSICAL TRAINING

A boy without play means a father without a job. A boy without physical training means a father who drinks. When people have wholesome, well-disciplined bodies there will be less demand for narcotics as well as for medicines. On these three propositions enthusiasm has built arguments for city parks and playgrounds, for school gymnastics, and for temperance instruction. We have tried the remedies and now realize that too much was expected of them. Neither movement appreciated the mental and physical education of spontaneous games and play.

Like hygiene instruction, physical training was made compulsory by law in many states, and, like hygiene instruction, physical training had to yield to the pressure of subjects in which children are examined. At the outset both were based upon distorted psychology and physiology. Of late physical training has been revived "to correct defects of the school desk and to relieve the strain of too prolonged study periods." In New York grammar schools ten minutes a day for the lower grades, and thirty minutes a week for the higher grades, are set aside for physical training. With the exception of eighteen schools where apparatus is used, the exercise has been in the class rooms. It consists of what are known as "setting-up exercises,"—deep breathing and arm movements for two minutes between each study period, often forgotten until it is time to go home, when the children are tired and need it least. Many teachers so conduct these exercises that children keenly enjoy them.



Like hygiene instruction, physical training preceded physical examination. Generally speaking, it has not yet, either in schools or in colleges, been related to physical needs of the individual pupil. In fact, there is no guarantee that it is not in many schools working a positive injury on defective children or imposing a defective environment on healthy children. Formal exercises in cramped space, in ill-ventilated rooms, with tight belts and heavy shoes, are conceded to be pernicious. Formal exercises should never be given to any child without examination and prescription by a physician. Children with heart weakness, enlarged tonsils, adenoid growths, spinal curvature, uneven shoulders, are frequently seen doing exercises for which they are physically unfit, and which but serve to deplete further their already low vitality. Attention might be called to many a class engaged in breathing exercises when by actual count over half the boys were holding their mouths open. Special exercises are needed by children who show some marked defect like flat foot, flat chest, weak abdominal muscles, habitual constipation, uneven shoulders, spinal trouble, etc.

That no physical training should be provided for normal children is the belief of many leading trainers. This special training is useful to develop athletes or to correct defects. Like massage, osteopathy, or medicine, it should follow careful diagnosis. The time is coming when formal indoor gymnasium exercises for normal pupils or normal students will be considered an anomaly. There is all the difference in the world between physical development and what is called physical training. The test of physical development is not the hours spent upon a prescribed course of training, but the physical condition determined by examination. To be refused permission to substitute an hour's walk for an hour's indoor apparatus work is often an outrage upon health laws. Given a normal healthy body, plenty of space, and plenty of playtime, the spontaneous exercise which a child naturally chooses is what is really health sustaining and health giving.

Mere muscular development artificially obtained through the devices of a gymnasium is inferior to the mental and moral development produced by games and play in the open air. Eustace Miles, M.D., amateur tennis player of England, says:

I do not consider a mere athlete to be a really healthy man. He has no more right to be called a really healthy man than the foundations or scaffolding of a house have a right to be called a house. They become a good house, and, indeed, they are indispensable to a good house, but at present the good house exists only in potentiality.

The "healthy-mindedness" and "physical morality" which play and games foster rarely result from physical training as a business, at stated times, indoors, under class direction. It is too much like taking medicine. A certain breakfast food is said to have lost much of its popularity since advertised as a health food. When the National Playground Association was organized President Roosevelt cautioned its officers against too frequent use of the word "supervision" on the ground that supervision and direction were apt to defeat the very purpose of games and to stultify the play spirit. Is the little girl on the street who springs into a hornpipe or a jig to the tune of a hurdy-gurdy, or even the boy who runs before automobiles or trolley cars or under horses' noses, getting less physical education than those who play a round game in silence under the supervision of a teacher in the school basement, or who stretch their arms up and down to the tune of one, two, three, four, five, six? Who can doubt that the much-pitied child of the tenement playing with the contents of the ash can in the clothes yard or with baby brother on the fire escape is developing more originality, more lung power, and better arteries than the child of fortune who is led by the hand of a governess up and down Fifth Avenue.

Children have not forgotten how to play, but adults have forgotten to leave space in cities, and time out of school, home work, and factory work in which children may play. Again, the child—whether a city child or a country child—rarely needs to be taught how to play. Teaching him games will not produce vitality. Games are the spontaneous product of a healthy body, active mind, and a joy in living. Give the children parks and piers, roof gardens and playgrounds in which they may play, and leave the rest to them. Give them time away from school and housework, and leave the rest to them. Instead of lamenting the necessity for playing in the streets, let us reserve more streets for children's play. There are too many students of child welfare whose reasoning about play and games is like that of a lady of Cincinnati, who, upon reading the notice of a child-labor meeting, said: "Well, I am glad to see there is going to be a meeting here for child labor. It is high time some measure was taken to keep the children off the streets." Physical examinations would prove that streets are safer and better than indoor gymnasiums for growing children. Intelligent physical training will train children to go out of doors during recess; will train pupils and teachers not to use recess for study, discipline, or eating lunch.



"After-school" conditions are quite as important as physical training and gymnastics at school. Not long ago a nurse was visiting a sick tenement mother with a young baby. She found a little girl of twelve standing on a stool over a washtub. This child did all the housework, took care of the mother and two younger children, got all the meals except supper, which her father got on his return from work. As the nurse removed the infant's clothes to give it a bath, the little girl seized them and dashed them into the tub. "Yes, I am pretty tired when night comes," she confessed. This child has prototypes in the country as well as the city, and she did not need physical training. She did not lack initiative or originality. She did need playmates, open air, a run in the park, and "fun."

The educational value of games and outdoor play should be weighed against the advantages of lowering the compulsory school age, and of bridging over the period from four to seven with indoor kindergarten training. Neither physical training nor education is synonymous with confinement in school. The whole tendency of Nature's processes in children is nutritional; it is not until adolescence that she makes much effort to develop the brain. Overuse of the young mind results, therefore, in diverting natural energy from nutritive processes to hurried growth of the overstimulated brain. The result is a type of child with a puny body and an excitable brain,—the neurotic. The young eye, for example, is too flat (hypermetropic)—made to focus only on objects at a distance. Close application to print, or even to weaving mats or folding bits of paper accurately, causes an overstrain on the eye, which not only results in the chronic condition known as myopia,—short-sightedness,—so common to school children, but which acts unfavorably on the constitution and on the whole development of the child. At the recent International Congress of School Hygiene in London, Dr. Arthur Newsholme, medical officer of health of Brighton, made a plea for the exclusion of children under five years of age from schools. "During the time the child is in the infant department it has chiefly to grow. Nutrition and sleep are its chief functions. Paints, pencils, paper, pins, and needles should not be handled in school by children below six." Luther Burbank, in an article on "The Training of the Human Plant," says:

The curse of modern child life in America is overeducation, overconfinement, overrestraint. The injury wrought to the race by keeping too young children in school is beyond the power of any one to estimate. The work of breaking down the nervous systems of the children of the United States is now well under way. Every child should have mud pies, grasshoppers, and tad-poles, wild strawberries, acorns, and pine cones, trees to climb and brooks to wade in, sand, snakes, huckleberries, and hornets, and any child who has been deprived of these has been deprived of the best part of his education.

Not every child can have these blessings of the country, but every child can be protected from the stifling of the nature instinct of play by formal indoor "bossed" exercises, whether called games, physical training, gymnastics, or Delsarte.



The answer to the protest against too early and too constant confinement in school has always been: "Where will the child be if out of school? Will its environment at home not work a worse injury to its health? Will not the street injure its morals?" Because we have not yet worked out a method of supervising the health of those children who are not in school, it does not follow that such supervision is impossible. Perhaps the time will come when there will be state supervision over the health of children from birth, parents being expected to present them once a year at school for examination by the school physician. In this way defects can be corrected and health measures devised to build up a physique that should not break down under the strain of school life. For children whose mothers work during the day, and for those whose home environment is worse than school, it might be cheaper in the long run to assign teachers to protect them from injury while they play in a park, roof garden, or out-of-door gymnasium. If parks and playgrounds come too slowly, why not adopt the plan advocated by Alida S. Williams, a New York principal, of reserving certain streets for children between the hours of three and five, and of diverting traffic to other streets less suitable for children's play? So great is the value—mentally, morally, and physically—of out-of-door play that it has even been suggested that the substitution of such play for school for all children up to the age of ten would insure better minds and sounder physiques at fifteen. It is generally admitted that the child who enters school at eight rather than at six will be the gainer at twelve. What a travesty upon education to insist upon schooling for children because they are apt to be run over on the street, or to be neglected at home, to shoot craps, or belong to a gang and develop bad morals.

Educators will some day be ashamed to have made the schools the catch-all or the court-plaster for the evils of modern industry. Instead of pupils and mothers going to the school, enough hygiene teachers, and play teachers, and district physicians could be employed with the money now spent on indoor instruction to do the house-to-house visiting urged in many chapters of this book. Such a course of action would have an incalculable effect on the reduction of tuberculosis, not only in making healthier physiques but by inculcating habits of outdoor life and love of fresh air. The danger of those contagious diseases which ravish childhood would be greatly reduced. An ambition for physical integrity would make unnatural living unpopular. Competition in games with children of the same physical class develops accuracy, concentration, dispatch, resourcefulness, as much as does instruction in arithmetic. Smoking can easily be discredited among boys trying to hit the bull's-eye. A boy would sooner give up a glass of beer than the championship in rifle shooting or a "home run."

The influence of the "spirit of the game" on practical life has been described thus by New York's director of physical training, Dr. Luther H. Gulick:

Play is the spontaneous enlistment of the entire personality in the pursuit of some coveted end. We do not have to pursue the goal; we wish to—it is our main desire. This is the way in which greatest discoveries, fortunes, and poems are made. It is the way in which we take the responsibilities and problems of life that makes it either a deadly bore—a mere dull round of routine and drudgery—or the most interesting and absorbing game, capable of enlisting all the energy and enthusiasm we have to put into it. The people who accomplish things are the people who play the game. They let themselves go; they are not afraid. Under the stimulus and enthusiasm of play muscles contract more powerfully and longer than under other conditions. Blood pressure is higher in play. It is far more interesting to play the game than to work at it. When you work you are being driven, when you play you are doing the driving yourself. We play not by jumping the traces of life's responsibilities, but by going so far beyond life's compulsions as to lose sight of the compulsion element. Play up, play up, and play the game.



CHAPTER XIII

VITALITY TESTS AND VITAL STATISTICS

Two things will disclose the strength or weakness of a bank and the soundness or unsoundness of a nation's banking policy, namely, a financial crisis or an expert audit. A searching audit that analyzes each debit and each credit frequently shows that a bank is solvent only because it is not asked to pay its debts. It continues to do business so long as no obvious weaknesses appear, analogous to measles, adenoids, or paralysis. A frequent disorder of banking results from doing too big a business on too little capital, in making too many loans for the amount of cash held ready to pay depositors upon demand. This disorder always comes to light in a crisis—too late. It can be discovered if looked for in advance of a crisis. Many individuals and communities are likewise physically solvent only because their physical resources are not put to the test. Weaknesses that lie near the surface can be discovered before a crisis by physical examination for individuals and sanitary supervision for communities. Whether individuals or communities are trying to do too much business for their health capital, whether the health reserves will pay debts that arise in a crisis, whether we are ill or well prepared to stand a run on our vitality, can be learned only by carefully analyzing our health reserves. Health debits are compared with health credits for individuals by vitality tests, for communities by vital statistics.

Of the many vitality tests none is practicable for use in the ordinary class room. Scientific training is just as necessary for such tests as for discovering the quality of the blood, the presence or absence of tubercle bacilli in the sputum, diphtheria germs in throat mucus, or typhoid germs in milk. But scientific truth, the results of scientific tests, can be made of everyday use in all class rooms. State and national headquarters for educators, and all large cities, can afford to engage scientists to apply vitality tests to school children for the sake of discovering, in advance of physical breakdown and before outward symptoms are obvious, what curriculum, what exercise, what study, recreation, and play periods are best suited to child development. It will cost infinitely less to proceed this way than to neglect children or to fit school methods to the loudest, most persistent theory.

The ergograph is an interesting strength tester. It takes a picture (1) of the energy exerted, and (2) of the regularity or fitfulness of the manner in which energy is exerted. Perhaps the time will come when science and commerce will supply every tintype photographer with an ergograph and the knowledge to use it. Then we shall hear at summer resorts and fairs, "Your ergograph on a postal card, three for a quarter." We can step inside, harness our middle finger to the ergograph, lift it up and down forty-five times in ninety seconds, and lo! a photograph of our vitality! If we have strong muscles or good control, the picture will be like this:



If weak and nervous, we shall look like this before taking exercise:



And like this after gymnasium exercise:



In Chicago, two of whose girls are above photographed, the physician was surprised to have four pupils show more strength late in the day than in the morning. "Upon investigation it was found that the teacher of the four pupils had been called from school, and that they had no regular work, but had been sent to another room and employed themselves, as they said, in having a good time." The chart on page 127 shows the effect of the noon recess and of the good time after three o'clock.

Chicago's child-study experts concluded after examining a large number of children:

1. In general there is a distinct relationship in children between physical condition and intellectual capacity, the latter varying directly as the former.

2. The endurance (ergographic work) of boys is greater than that of girls at all ages, and the difference seems to increase after the age of nine.

3. There are certain anthropometric (body measurements) indications which warrant a careful and thorough investigation into the subject of coeducation in the upper grammar grades.

4. Physical condition should be made a factor in the grading of children for school work, and especially for entrance into the first grade.

5. The great extremes in the physical condition of pupils in the upper grammar grades make it desirable to introduce great elasticity into the work of these grades.

6. The classes in physical culture should be graded on a physical instead of an intellectual basis.



To these conclusions certain others should be added, not as settled beyond any possibility of modification, but as being fairly indicated by these tests.

1. The pubescent period is characterized by great and rapid changes in height, weight, strength of grip, vital capacity, and endurance. There seems to accompany this physical activity a corresponding intellectual and emotional activity. It therefore is a period when broad educational influences are most needed. From the pedagogic standpoint it is preeminently a time for character building.

2. The pubescent period is characterized by extensive range of all physical features of the individuals in it. Hence, although a period fit for great activity of the mass of children, it is also one of numerous individual exceptions to this general law. During this period a greater per cent of individuals than usual pass beyond the range of normal limits set by the mass. It is a time, therefore, when the weak fail and the able forge to the front, and hence calls for a higher degree than usual of individualization of educational work and influence.

3. Unidexterity is a normal condition. Rapid and marked accentuation of unidexterity is a pubescent change. On the whole, there is a direct relationship between the degree of unidexterity and the intellectual progress of the pupil. At any given age of school life bright or advanced pupils tend toward accentuated unidexterity, and dull or backward pupils tend toward ambidexterity.... Training in ambidexterity is training contrary to a law of child life.

4. Boys of school age at the Bridewell (reform school) are inferior in all physical measurements to boys in the ordinary schools, and this inferiority seems to increase with age.

5. Defects of sight and hearing are more numerous among the dull and backward pupils. These defects should be taken into consideration in the seating of pupils. Only by removing the defects can the best advancement be secured.

6. The number of eye and ear defects increases during the first years of school life. The causes of this increase should be investigated, and, as far as possible, removed.

7. There are certain parts of the school day when pupils, on the average, have a higher storage of energy than at other periods. These periods should be utilized for the highest forms of educational work.

8. The stature of boys is greater than that of girls up to the age of eleven, when the girls surpass the boys and remain greater in stature up to the age of fourteen. After fourteen, girls increase in stature very slowly and very slightly, while boys continue to increase rapidly until eighteen.

9. The weight of the girl surpasses that of the boy about a year later than her stature surpasses his, and she maintains her superiority in weight to a later period of time than she maintains her superiority in height.

10. In height, sitting, girls surpass boys at the same age as in stature, namely, eleven years, but they maintain their superiority in this measurement for one year longer than they do in stature, which indicates that the more rapid growth of the boy at this age is in the lower extremities rather than in the trunk.

11. Commencing at the age of thirteen, strength of grip in boys shows a marked accentuation in its rate of increase, and this increase continues as far as our observations extend, namely, to the age of twenty. In girls no such great acceleration in muscular strength at puberty occurs, and after sixteen there is little increase in strength of grip. The well-known muscular differentiation of the sexes practically begins at thirteen.

12. As with strength of grip, so with endurance as measured by the ergograph; boys surpass girls at all ages, and this differentiation becomes very marked after the age of fourteen, after which age girls increase in strength and endurance but very slightly, while after fourteen boys acquire almost exactly half of the total power in these two features which they acquire in the first twenty years of life.

13. The development of vital capacity bears a striking resemblance to that of endurance, the curves representing the two being almost identical.

Physiological age, according to studies made in New York City, should be considered in grading, not only for physical culture classes but for all high school or continuation classes. Dr. C. Ward Crampton, assistant physical director, while examining boys in the first grade of the High School of Commerce, noticed a greater variation in physical advancement than in years. He kept careful watch of the educational progress and discovered three clear divisions: (1) boys arrived at puberty,—postpubescent; (2) boys approaching maturity,—pubescent; (3) boys not yet approaching maturity,—prepubescent.

The work in lower grades they had all passed satisfactorily, but in high school only the most advanced class did well. Practically none of the not-yet-maturing boys survived and few of the almost mature. In other words, the high school course was fitted to only one of the three classes of boys turned out of the grammar schools. The others succumbed like hothouse azaleas at Christmas time, forced beyond their season. Physiological age, not calendar years or grammar school months, should determine the studies and the companions of children after the tenth year. Physiological strength and vitality, not ability to spell or to remember dates, should be the basis of grading for play and study and companionship among younger children. Vitality, power to endure physically, should be the test of work and recreation for adults. Physicians may be so trained to follow directions issued by experts that physical examinations will disclose the chief enemies of vitality and the approximate limits of endurance.

Teachers may train themselves to recognize signs of fatigue in school children and to adapt each day's, each hour's work to the endurance of each pupil. One woman principal has written:

School programmes, after they have been based upon the laws of a child's development, should provide for frequent change of subject, alternating studies requiring mental concentration with studies permitting motor activity, and arranging for very short periods of the former. Anaemic children should be relieved of all anxiety as to the results of their efforts, and only short hours of daylight work required of them. The disastrous consequences of eye strain should be understood by all in charge of children who are naturally hypermetropic. The ventilation of a class room is far more important than its decoration or even than a high average percentage in mathematics, and the lack of pure air is one of the auxiliary causes of nervous exhaustion in both pupils and teachers. Deficient motor control is a most trustworthy indication of fatigue in children, and teachers may safely use it as a rough index of the amount of effort to be reasonably expected of their pupils. Facial pallor or feverish flushes are both evidences of overtasking, and either hints that fatigue has already begun. As to unfavorable atmospheric conditions, the teacher herself will undoubtedly realize them as soon as the children, but she should remember that effort carried to the point of exhaustion, injurious as it is in an adult, is yet less harmful than it is to the developing nerve centers of the child.

Because adults at work and at play reluctantly submit themselves to vitality tests, because few scientists are beseeching individuals to be tested, because almost no one yearns to be tested, the promotion of adult vitality and of community vitality can best be hastened by demanding complete vital statistics. Industrial insurance companies and mutual benefit societies are doing much to educate laborers regarding the effect upon vitality of certain dangerous and unsanitary trades, and of certain unhygienic habits, such as alcoholism and nicotinism. Progress is slower than it need be because state boards of health are not gathering sufficiently complete information about causes of sickness and death. American health and factory inspection is not even profiting, as it should, from British, German, and French statistics. Statistics are in ill repute because the truth is not generally known that our boasted sanitary improvements are due chiefly to the efficient use of vital statistics by statesmen sanitarians.[7]

The vital statistics of greatest consequence are not the number of deaths or the number of births, not even the number of deaths from preventable diseases, but rather the number of cases of sickness from transmissible diseases. The cost and danger to society from preventable diseases, such as typhoid, diphtheria, scarlet fever, measles, are imperfectly represented by the number of deaths. Medical skill could gradually reduce death rates in the face of increasing prevalence of infectious disease. With few exceptions, only those patients who refuse to follow instructions will die of measles, diphtheria, or smallpox. The scarlet-fever patient who recovers and goes to church or school while "peeling" can cause vastly more sickness from scarlet fever than a patient who dies. Dr. W. Leslie Mackenzie, who has recently written The Health of the School Child, said ten years ago, while health officer of Leith:

Death is the ultimate and most severe injury that any disease can inflict, but short of death there may be disablement, permanent or temporary, loss of wages, loss of employment, loss of education, increase of home labor, increase of sickness outlays, increase of worry, anxiety and annoyance, disorganization of the household, general impairment of social efficiency.

The best guarantee against such loss, the best protection of health, and the most essential element of vital statistics is prompt, complete record of cases of sickness. Statistics of sickness are confined to sickness from transmissible diseases, because we have not yet arrived at the point where we recognize the state's right to require information, except when the sick person is a menace to the health of other persons.

The annual report of a board of health should give as clear a picture of a community's health during the past week or past quarter as the ergograph gives of the pupils mentioned on page 126. As ragged, rapidly shortening lines show nervousness and depleted vitality, so charts and diagrams can be made to show the needless waste of infant life during the summer months, the price paid for bad ventilation in winter time, when closed windows cause the sickness-and-death line from diphtheria and scarlet fever to shoot up from the summer level. In cities it is now customary for health boards to report weekly the number of deaths from transmissible diseases. Health officers will gladly furnish facts as to cases of sickness, if citizens request them. Newspapers will gladly publish such information if any one will take the pains to supply it. Wherever newspapers have published this information, it quickly takes its place with the weather reports among the news necessities. Marked changes are commented on editorially. Children can easily be interested, as can adults, in filling out week by week a table that will show increases and decreases in preventable sickness due to transmissible diseases.

TABLE X

CASES OF INFECTIOUS AND CONTAGIOUS DISEASES REPORTED

================+=============================================== WEEK ENDING + + + + + + + Oct. Nov. Nov. Nov. Nov. Nov. Dec. 26 2 9 16 23 30 7 -+ + + + + + + Tuberculosis pulmonalis 350 350 317 364 345 337 422 Diphtheria and croup 313 264 283 331 282 343 326 Measles 142 212 203 261 293 323 472 Scarlet fever 208 228 231 252 278 323 372 Smallpox 1 1 2 Varicella 40 83 91 162 136 115 167 Typhoid fever 106 105 107 123 86 77 71 Whooping cough 6 13 15 14 27 9 8 Cerebro-spinal meningitis 6 11 3 4 4 8 15 -+ + + + + + + Total 1171 1267 1250 1512 1451 1535 1855 =================+======+======+======+======+======+======+======

=================+========================================= WEEK ENDING + + + + + + Dec. Dec. Dec. Jan. Jan. Jan. 14 21 28 4 11 18 -+ + + + + + Tuberculosis pulmonalis 360 354 308 344 432 402 Diphtheria and croup 369 338 347 308 370 406 Measles 471 517 346 581 691 803 Scarlet fever 397 417 426 478 562 585 Smallpox 4 3 2 2 Varicella 160 198 123 98 199 169 Typhoid fever 62 35 42 37 55 36 Whooping cough 12 19 3 25 24 14 Cerebro-spinal meningitis 13 7 6 11 16 13 -+ + + + + + Total 1844 1888 1603 1882 2351 2428 =================+====+====+====+====+====+====

In cities where physicians are not compelled to notify the health board of danger centers,—that is, of patients sick from measles, smallpox, or diphtheria,—and in smaller communities where notices are sent only to state boards of health, parents will find it difficult to take a keen interest in vital statistics. But if teachers would start at the beginning of the year to record in such a table the days of absence from school because of transmissible disease, both they and their pupils would discover a new interest in efficient health administration. After a national board of health is organized we may reasonably expect that either state boards of education or state boards of health will regularly supply teachers with reports that will lead them to compare the vitality photographs of their own schools and communities with the vitality photographs of other schools and other communities working under similar conditions. Then children old enough to study physiology and hygiene will be made to see the happiness-giving possibilities of vitality tests and vital statistics.



Instead of discussing the theory of vital statistics, or the extent to which statistics are now satisfactory, it would be better for us at this point to make clear the significance of the movement for a national fact center for matters pertaining to personal, industrial, and community vitality. Five economic reasons are assigned for establishing a national department of health:

1. To enable society to increase the percentage of exceptional men of each degree, many of whom are now lost through preventable accidents, and also to increase the total population.

2. To lessen the burden of unproductive years by increasing the average age at death.

3. To decrease the burden of death on the productive years by increasing the age at death.

4. To lessen the cost of sickness. It is estimated that if illness in the United States could be reduced one third, nearly $500,000,000 would be saved annually.

5. To decrease the amounts spent on criminality that can be traced to overcrowded, unwholesome, and unhygienic environment.

In addition to the economic gain, the establishment of a national department of health would gradually but surely diminish much of the misery and suffering that cannot be measured by statistics. Sickness is a radiating center of anxiety; and often death in the prime of life closes the gates of happiness on more than one life. Let us not forget that the "bitter cry of the children" still goes up to heaven, and that civilization must hear, until at last it heeds, the imprecations of forever wasted years of millions of lives.

If progress is to be real and lasting, it must provide whatever bulwarks it can against death, sickness, misery, and ignorance; and in an organization such as a national department of health, adequately equipped,—a vast preventive machine working ceaselessly,—an attempt at least would be made to stanch those prodigal wastes of an old yet wastrel world.

Among the branches of the work proposed for the national bureau are the following: infant hygiene; health education in schools; sanitation; pure food; registration of physicians and surgeons; registration of drugs, druggists, and drug manufacturers; registration of institutions of public and private relief, correction, detention and residence; organic diseases; quarantine; immigration; labor conditions; disseminating health information; research libraries and equipment; statistical clearing house for information.

Given such a national center for health facts or vital statistics, there will be a continuing pressure upon state, county, and city health officers, upon physicians, hospitals, schools, and industries to report promptly facts of birth, sickness, and death to national and state centers able and eager to interpret the meaning of these facts in such simple language, and with such convincing illustrations, that the reading public will demand the prompt correction of preventable evils.

Our tardiness in establishing a national board of health that shall do this great educational work is due in part to the fact that American sanitarians have frequently chosen to do things when they should have chosen to get things done. Almost every state has its board of health, with authority to require registration of births, deaths, and sickness due to transmissible disease; with few exceptions the heads of these state boards have spent their energies in abating nuisances. In a short time they have degenerated into local scavengers, because they have shown the public neither the meaning of the vital statistics gathered nor its duty to support efficient health administration.

The state reports of vital statistics have not been accurate; therefore in many states we have the anomalous situation of an aggressive veterinary board arousing the farmer and the consumer of milk to the necessity of protecting the health of cattle, and an inactive, uninformed state board of health failing to protect the health of the farmer and the consumer.

Vital statistics presume efficient health administration. An inefficient health officer will not take the initiative in gathering health statistics. If some one else compels him to collect vital statistics, or furnishes him with statistics, they are as a lantern to a blind man. Unless some one also compels him to make use of them, unless we remove the causes of transmissible or infectious diseases and check an epidemic when we first hear of it, the collection of information is of little social value. "Statistics" is of the same derivation as "states" and "statesmen." Statistics have always been distinguished from mere facts, in that statistics are instruments in the hands of the statesman. Wherever the term "statistics" is applied to social facts it suggests action, social control of future contingencies, mastery of the facts whose action they chronicle. The object of gathering social facts for analysis is not to furnish material for future historians. They are to be used in shaping future history. They are facts collected with a view to improving social vitality, to raising the standard of life, and to eliminating permanently those forces known to be destructive to health. Unless they are to be used this way, they are of interest only to the historical grub. No city or state can afford to erect a statistical office to serve as a curiosity shop. Unless something is to be done to prevent the recurrence of preventable diseases annually experienced by your community or your school, it is not reasonable to ask the public printer to make tables which indicate the great cost of this preventable sickness. A tax collector cannot discharge his duties unless he knows the address of every debtor. The police bureau cannot protect society unless it knows the character and haunts of offenders. A health officer cannot execute the law for the protection of society's health unless he knows the haunts and habits of diseases. For this he must look to vital statistics.

But the greatest service of vital statistics is the educational influence. Health administration cannot rise far above the hygienic standards of those who provide the means for administering sanitary law. The taxpaying public must believe in the economy, utility, and necessity of efficient health administration. Power and funds come from town councils and state legislatures. To convince and move these keepers of the purse, trustworthy vital statistics are indispensable. Information will be used for the benefit of all as soon as it is possessed by all.

Fortunately the gathering of vital statistics is not beyond the power of the kind of health officer that is found in small cities and in rural communities. If years of study of mathematics and of the statistical method were required, we should despair of obtaining light within a century. But the facts we want are, for the most part, common, everyday facts, easily recognizable even by laymen; for example, births, deaths, age at death, causes of death, cases of transmissible diseases, conditions found upon examination of children applying for work certificates, etc. Where expert skill is required, as at state and national headquarters, it can be found. Every layman can train himself to use skillfully the seven ingredients of the statistical method which it is his duty to employ, and to know when to pay for expert analysis and advice. We can all learn to base judgment of health needs upon the seven pillars,—desire to know, unit of inquiry, count, comparison, percentages, classification, and summary.

FOOTNOTES:

[7] Dr. Arthur Newsholme's Vital Statistics should be in public libraries and on the shelves of health officers, public-spirited physicians, and school superintendents.



CHAPTER XIV

IS YOUR SCHOOL MANUFACTURING PHYSICAL DEFECTS?

Last year a conference on the physical welfare of school children was told by a woman principal: "Of course we need physicians to examine our children and to teach the parents, but many of us principals believe that our school curriculum and our school environment manufacture more physical defects in a month than all your physicians and nurses will correct in a year." At the same meeting the physical director of schools of New York City appealed eloquently for "biological engineers" at school, who would test the child's strength as building engineers are employed to test the strength of beams and foundations.[8] As explanation for the need of the then recently organized National School Hygiene Association, he elaborated the proposition that school requirements and school environment damage child health. "Ocular defects are in direct ratio to the length of time the pupil has attended school.... A desk that is too high may easily be the indirect agent for causing scoliosis, producing myopia or astigmatism.... Physically examine school children by all means, but do not fail to examine school desks."

Fifty schools in different parts of New York City were examined last year with especial reference to the factors likely to cause or to aggravate physical defects.[9] The results, tabulated and analyzed, prove that the woman principal was right; many schools are so built or so conducted, many school courses are so devised or so executed, that children are inevitably injured by the environment in which the compulsory education law forces them to spend their formative years.



Recently I noticed that our little office girl, so anaemic and nervous when she left school that we hesitated to employ her, was becoming rosy and spirited. The child herself explained the change: "I like it better. I have more money to spend. I get more outdoor exercise, and then, oh, the room is so much sunnier and there is more air and the people are all so nice!" And these were just the necessities which were lacking in the school from which she came. Moreover, it is a fair commentary on the school work and the school hygiene in too many of our towns and cities to-day. "I like it better" means that school work is not adapted to the dominant interests of the child, that the curriculum includes subjects remote from the needs and ambitions of the modern school child, and fails to include certain other subjects which it recognizes as useful and necessary, and therefore finds interesting. "I have more money to spend" means that this little girl was able to have certain things, like a warm, pretty dress, rubbers, or an occasional trolley ride, which she longed for and needed. "I get more outdoor exercise" means that there was no open-air playground for her school, that "setting up" exercises were forgotten, that recess was taken up in rushing home, eating lunch, and rushing back again, and that "after school" was filled up with "helping mother with the housework." "The office is so much sunnier and I get more air" accounts for the increase in vitality; and "the people are all so nice," for the happy expression and initiative which the undiscriminating discipline at school had crushed out.



For such unsanitary conditions crowded sections of great cities have no apologies to make to rural districts. A wealthy suburb recently learned that there was overcrowding in every class room, and that one school building was so unsanitary as to be a menace to the community. Unadjustable desks, dry sweeping, feather dusters, shiny blackboards, harassing discipline that wrecks nerves, excessive home study and subjects that bore, are not peculiar to great cities. In a little western town a competition between two self-governing brigades for merit points was determined by the amount of home study; looking back fifteen years, I can see that I was encouraging anaemic and overambitious children to rob themselves of play, sleep, and vitality. Many a rural school violates with impunity more laws of health than city factories are now permitted to transgress.

After child labor is stopped, national and state child labor committees will learn that their real interest all the time has been child welfare, not child age, and will be able to use much of the old literature, simply substituting for "factory" the word "school" when condemning "hazardous occupations likely to sap [children's] nervous energy, stunt their physical growth, blight their minds, destroy their moral fiber, and fit them for the moral scrap heap."

Many of the evils of school environment the teacher can avert, others the school trustee should be expected to correct. So far as unsanitary conditions are permitted, the school accentuates home evils, whereas it should counteract them by instilling proper health habits that will be taken home and practiced. Questions such as were asked in Miss North's study will prove serviceable to any one desiring to know the probable effect of a particular school environment upon children subject to it. Especially should principals, superintendents, directors, and volunteer committeemen apply such tests to the public, parochial, or private school, orphanage or reformatory for which they may be responsible.

I. NEIGHBORHOOD HEALTH RESOURCES

1. Is the district congested?

2. Is congestion growing?

3. How far away is the nearest public park?

a. Is it large enough? b. Has it a playground or beauty spot? c. Has it swings and games? d. Is play supervised? e. Have children of different ages equal opportunities, or do the large children monopolize the ground? f. Are children encouraged by teachers and parents to use this park?

4. Are the streets suitable for play?

a. Does the sun reach them? b. Are they broad? c. Are they crowded with traffic?

5. How far away is the nearest public bath?

a. Has it a swimming pool? b. Has it showers? c. Is it used as an annex to the school?



II. EFFECT OF SCHOOL EQUIPMENT UPON HEALTH

1. Is there an indoor yard?

a. Is the area adequate or inadequate? b. Is the floor wood, cement, or dirt? c. Is the heat adequate or deficient? d. Is the ventilation adequate or deficient? e. Is the daylight adequate, deficient, or almost lacking? f. Is there equipment for light gymnastics and games? g. Is it used out of school hours; by special classes, athletic teams, etc., or by pupils generally?

2. Is there an outdoor yard?

a. Is the area ample or inadequate? b. Is the area mainly occupied by toilets? c. Is the daylight sufficient or deficient? d. For how many hours does the sun reach it? e. Is it equipped for games? f. How much larger ought it to be? g. Is it used out of school hours; by special classes, athletic teams, etc., or by pupils generally?

3. Is there a gymnasium?

a. Is it large enough? b. Is it used for a gymnasium? c. Is it cut up into class rooms? d. Is it used out of school hours; by special classes, athletic teams, etc., or by pupils generally?

4. Is there a roof playground?

a. Is there open ventilation? b. Is it used in the daytime? c. Is it used at night? d. Is it used during the summer? e. Is it monopolized by the larger children? f. Is it used out of school hours; by special classes, athletic teams, etc., or by pupils generally?

5. Are washing facilities adequate?

a. How many pupils per washbasin? b. Are there individual towels? c. Have eye troubles been spread by roller towels? d. Are only clean towels permitted? e. Are there bathing facilities; are these adequate? f. Are swimming pools used for games, contests, etc.? g. Are bathing facilities used out of school hours? h. Who is responsible for cleanliness of towels, washbasins, and swimming pools? i. How often is water changed in swimming pool, or is it constantly changing?

6. Is adequate provision made for clean drinking water?

a. Are sanitary fountains used that prevent contamination of faucet or water? b. How often are cups or faucets cleaned?

7. Is provision made for airing outer clothing?

a. Are children permitted to pile their clothing in the class room? b. Are there hooks for each child? c. Are lockers provided with wire netting to permit ventilation? d. Are lockers or hooks in the halls or in the basement? e. Have you ever thought of the disciplinary and social value of cheap coat hangers to prevent wrinkling and tearing?



III. THE CLASS ROOM AS A PLACE OF CONFINEMENT

1. How many sittings are provided?

a. How many pupils are there?

2. What is the total floor area?

a. What proportion is not occupied by desks?

3. Are the seats adjustable?

a. Are the seats adjusted to pupils? b. Where desks are adjustable, are short children seated in low desks, or are children seated according to class or according to discipline exigencies without regard to size of desk? c. Are seats placed properly with reference to light?

4. Is the light ample and proper?

a. For how many hours must artificial light be used in the daytime? b. Is artificial light adequate for night work? c. Does the reflection of light from blackboard and walls injure the eye? d. Are the blackboards black enough? e. Are the walls too dark? f. Is the woodwork too dark? g. Are window panes kept clean?

5. Is the air always fresh?

a. Is ventilation by open windows? b. Is ventilation artificial? c. Does the ventilating apparatus work satisfactorily? d. Are the windows thrown open during recess, and after and before school? e. Do unclean clothes vitiate the atmosphere? f. Do unclean persons vitiate the atmosphere? g. Does bad breath vitiate the atmosphere? h. Are pupils and parents taught that unclean clothes, unclean persons, and bad breath may decrease the benefits of otherwise adequate ventilation and seriously aggravate the evils of inadequate ventilation?

6. Is the temperature properly regulated?

a. Has every class room a thermometer? b. Are teachers required to record the thermometer's story three or more times daily? c. Is excess or deficiency at once reported to the janitor?

7. Are the floors, walls, desks, and windows always clean?

a. How often are they washed? b. Is twice a year often enough? c. Do the floors and walls contain the dust of years? d. Is dry sweeping prohibited? e. Has wet sawdust or even wet sand been tried? f. Has oil ever been used to keep down surface dust on floors? g. Are feather dusters prohibited? h. Are dust rags moist or dry? i. Is an odorless disinfectant used?

8. Does overheating prevail?

a. Do you know teachers and principals who protest against insufficient ventilation, particularly against mechanical ventilation, while they themselves are "in heavy winter clothing in a small room closely sealed, the thermometer at 80 degrees"?

IV. EXERCISE AND RECREATION

1. How much time and at what periods is exercise provided for in the school schedule?

a. Indoors? b. Outdoors?

2. How much exercise indoors and outdoors is actually given?

3. Are the windows open during exercise?

4. Is exercise suited to each child by the school physician after physical examination, or are all children compelled to take the same exercise?

5. Whose business is it to see that rules regarding exercise are strictly enforced?

6. Do clouds of dust rise from the floor during exercise and play?

7. Are children deprived of exercise as a penalty?

8. Should hygiene talks be considered as exercise?



V. THE SCHOOL JANITOR AND CLEANERS

1. Do they understand the relation of cleanliness to vitality?

2. Is their aim to do the least possible amount of work, or to attain the highest possible standard of cleanliness?

3. Will the teacher's complaint of uncleanliness be heeded by trustees? If so, is the teacher not responsible for uncleanliness?

4. Have you ever tried to stimulate the pride of janitors and cleaners for social service?

a. Have you ever tried to show them how much work they save themselves by thorough cleansing? b. Have you ever shown them the danger, to their own health, of dust and dirt that may harbor infection and reduce their own vitality?

5. What effort is made to instruct janitors and cleaners by your school trustees or by your community?

6. Have you explained to pupils the important responsibility of janitors for the health of those in the tenements, office buildings, or schools?

a. Do you see in this an opportunity to emphasize indirectly the mother's responsibility for cleanliness of home?



VI. REQUIREMENTS OF CURRICULUM

1. How much home study is there?

a. How much is required? b. What steps are taken to prevent excessive home study? c. Are light and ventilation conditions at home considered when deciding upon amount of home study?

2. Is the child fitted to the curriculum, or is the curriculum fitted to the child?

a. Does failure or backwardness in studies lead to additional study hours or to regrading? b. Are there too many subjects? c. Are the recitation periods too long? d. Are the exercise periods too short and too few? e. Is there too much close-range work? f. Is it possible to give individual attention to individual needs so as to awaken individual interest?

3. Is follow-up work organized to enlist interest of parents, or, if necessary, of outside agencies in fitting a child to do that for which, if normal, he would be physically adapted?

By reducing the harm done by old buildings and by the traditions of curriculum and discipline, teachers can do a great deal. Perhaps they cannot move the windows or the desks, but they can move the children. If they cannot insure sanitary conditions for home study, they can cut down the home study. If the directors do not provide proper blackboards, they can do less blackboard work. They can make children as conscious, as afraid, and as resentful of dirty air as of dirty teeth. They can make janitors believe that "dry sweeping" or "feather dusting" may give them consumption, and leave most of the dirt in the room to make work for the next day; that adjustable desks are made to fit the child's legs and back, not the monkey wrench; that the thermometer in the schoolroom is a safer guide to heat needed than a boiler gauge in the basement; that fresh air heated by coal is cheaper for the school fund than stale air heated by bodies and by bad breath. Finally, they can make known to pupils, to parents, to principals and superintendents, to health officials and to the public, the extent to which school environment violates the precepts of school hygiene.

If the state requires the attendance of all children between the ages of five and fourteen at school for five hours a day, for five days in the week, for ten months in the year, then it should undertake to see that the machinery it provides for the education of those children for the greater part of the time for nine years of their lives—the formative years of their lives—is neither injuring their health nor retarding their full development.

If the amount of "close-range" work is rapidly manufacturing myopic eyes; if bad ventilation, whether due to faulty construction or to faulty management, is preparing soil for the tubercle bacillus; if children with contagious diseases are not found and segregated; if desks are so ill adapted to children's sizes and physical needs that they are forming crooked spines; if too many children are crowded into one room; if lack of air and light is producing strained eyes and malnutrition; if neither open air, space, nor time is provided for exercise, games, and physical training; if school discipline is adapted neither to the psychology nor the physiology of child or teacher, then the state is depriving the child of a greater right than the compulsory education law forces it to endure. Not only is the right to health sacrificed to the right to education, but education and health are both sacrificed.

In undertaking to enforce the compulsory education law, to put all truants and child laborers in school, the state should be very sure for its own sake that it is not depriving the child of the health on which depends his future usefulness to the state as well as to himself.

TABLE XI

EFFECTS OF A CHILD LABOR LAW

Increase in Chicago Attendance

Grades 4-9

## 1901-1902

### 1902-1903

######### 1903-1904

Grades 9-15

##### 1901-1902

#### 1902-1903

######### 1903-1904

FOOTNOTES:

[8] The Sanitation of Public Buildings, by William Paul Gerhard, contains a valuable discussion of how the school may avoid manufacturing physical defects.

[9] By Professor Lila V. North, Baltimore College for Women, for the New York Committee on the Physical Welfare of School Children, 105 East 22d Street, New York City.



CHAPTER XV

THE TEACHER'S HEALTH

"Teachers, gentlemen, no less than pupils, have a heaven-ordained right to work so adjusted that the highest possible physical condition shall be maintained automatically." This declaration thundered out by an indignant physician startled a well-meaning board of school directors. The teacher's right to health was, of course, obvious when once mentioned, and the directors concluded:

1. School conditions that injure child health also injure teacher health.

2. Poor health of teacher causes poor health of pupil.

3. Poor health of pupil often causes poor health of teacher.

4. Adequate protection of children requires adequate protection of their teachers.

5. Teachers have a right to health protection for their own sake as well as for their children's sake.

Too little concern has hitherto been shown for the vitality of teachers in private or public schools and colleges. Without protest, and without notice until too late, teachers often neglect their own health at home and at school,—recklessly overwork, undersleep, and undernourish; ruin their eyes, their digestion, and their nerves. School-teachers are frequently "sweated" as mercilessly as factory operatives. The time has come to admit that a school environment which destroys the health of the teacher is as unnecessary and reprehensible as an army camp that spreads typhoid among a nation's defenders. A school curriculum or a college tradition that breaks down teachers is as inexcusable as a gun that kills the gunner when discharged. Experience everywhere else proves that periodic physical examinations and health precautions, not essays about "happy teachers—happy pupils," are indispensable if teachers' health rights are to be protected.

Physical tests are imposed upon applicants for teachers' licenses by many boards of education. In New York City about three per cent of those examined are excluded for defects of vision, of hearing, of probable endurance. Once a teacher, however, there is no further physical examination,—no way of discovering physical incapacity, nothing to prevent a teacher from exposing class after class to pulmonary tuberculosis contracted because of overwork and underventilation. The certainty of salary increase year by year and of a pension after the twentieth year will bribe many a teacher to overtax her own strength and to jeopardize her pupils' health.

Seldom do training schools apply physical tests to students who intend to become teachers. One young girl says that before starting her normal course she is going to the physician of the board of education for examination, so as to avoid the experience of one of her friends, who, after preparing to be a teacher, was rejected because of pulmonary tuberculosis. During her normal course no examination will be necessary. Overwork during the first year may cause pulmonary tuberculosis, and in spite of her foresight she, too, may be rejected four years hence.

The advantages of physical examination upon beginning and during the courses that prepare one for a teacher are so obvious that but little opposition will be given by prospective teachers. The disadvantages to teacher and pupil alike of suffering from physical defects are so obvious that every school which prepares men and women for teachers should make registration and certification dependent upon passing a satisfactory physical test. No school should engage a teacher who has not good proof that she can do the required work without injury to her own or her pupils' health. Long before physicians can discover pulmonary tuberculosis they can find depleted vitality which invites this disease. Headaches due to eye trouble, undernourishment due to mouth breathing, preventable indigestion, are insidious enemies that cannot escape the physical test.

Three objections to physical tests for teachers will be urged, but each loses its force when considered in the light of general experience.

1. A sickly teacher is often the most efficient teacher in a school or a county. It is true that some sickly teachers exert a powerful influence over their pupils, but in most instances their influence and their efficiency are due to powers that exist in spite of devitalizing elements. Rarely does sickness itself bring power. It must be admitted that many a man is teaching who would be practicing law had his health permitted it. Many a woman's soul is shorn of its self-consciousness by suffering. But even in these exceptional instances it is probable that children are paying too dearly for benefits directly or indirectly traceable to defects that physical tests would exclude.

2. There are not enough healthy candidates to supply our schools. This is begging the question. In fact, no one knows it is true. On the contrary, it is probable that the teacher's opportunity will make even a stronger appeal to competent men and women after physical soundness and vitality are made conditions of teaching,—after we all believe what leading educators now believe, that the highest fulfillment of human possibilities requires a normal, sound body, abounding in vitality.

3. Examination by a physician, especially if a social acquaintance, is an unnecessary embarrassment. The false modesty that makes physical examination unwelcome to many adults, men as well as women, is easily overcome when the advantages of such examination are understood. It is likewise easy to prove to a teacher that the loss of time required in having the examination is infinitesimal compared with the loss of time due to ignoring physical needs. The programme for school hygiene outlined in Chapter XXVII, Part IV, assumes that state and county superintendents will provide for the examination of teachers as well as of pupils.



Because the health of others furnishes a stronger motive for preventive hygiene than our own health, it is probable that the general examination of teachers will come first as the result of a general conviction that unhealthy teachers positively injure the health of pupils and retard their mental development. Children at school age are so susceptible and imitative that their future habits of body and mind, their dispositions, their very voices and expressions, are influenced by those of their teachers. Experts in child study say that a child's vocal chords respond to the voices and noise about him before he is able to speak, so that the tones of his voice are determined before he is able to express them. This influence is also marked when the child begins to talk. Babies and young children instinctively do what adults learn not to do only by study,—follow the pitch of others' voices. Can we then overestimate the effect upon pupils' character of teachers who radiate vitality?

The character and fitness, aside from scholarship, of applicants for teachers' licenses are now subjected by the board of examiners of New York City to the following tests:

1. Moral character as indicated in the record of the applicant as a student or teacher or in other occupation, or as a participant in an examination.

2. Physical fitness for the position sought, reference being had here to all questions of physical fitness other than those covered in a physician's report as to "sound health."

3. Satisfactory quality and use of voice.

4. Personal bearing, cleanliness, appearance, manners.

5. Self-command and power to win and hold the respect of teachers, school authorities, and the community.

6. Capacity for school discipline, power to maintain order and to secure the willing obedience and the friendship of pupils.

7. Business or executive ability,—power to comprehend and carry out and to accomplish prescribed work, school management as relating to adjustment of desks, lighting, heating, ventilation, cleanliness, and attractiveness of schoolroom.

8. Capacity for supervision, for organization and administration of a school, and for the instructing, assisting, and inspiring of teachers.

These tests probably exclude few applicants who should be admitted. Experience proves that they include many who, for their own sake and for children's sake, should be rejected. The moral character, physical fitness, quality of voice, personal bearing, self-command, executive ability, capacity for supervision, are qualities that are modified by conditions. The voice that is satisfactory in conference with an examiner may be strident and irritating when the teacher is impatient or is trying to overcome street noises. On parade applicants are equally cleanly; this cannot be said of teachers in the service, coming from different home environments. Self-command is much easier in one school than in another. Physical fitness in a girl of twenty may, during one short year of teaching, give way to physical unfitness. Therefore the need for periodic tests by principal, superintendent, and school board, to determine the continuing fitness of a teacher to do the special task assigned to her, based upon physical evidence of her own vitality and of her favorable influence upon her pupils' health and enjoyment of school life. Shattered nerves due to overwork may explain a teacher's shouting: "You are a dirty boy. Your mother is a dirty woman and keeps a dirty store where no decent people will go to buy." A physical examination of that unfortunate teacher would probably show that she ought to be on leave of absence, rather than, by her overwork and loss of control, to cause the boys of her class to feel what one of them expressed: "Grandmother, if she spoke so of my mother I would strike her."

Just as there should be a central bureau to count and correct the open mouths and closed minds that clog the little old red schoolhouse of the country, so a central bureau should discover in the city teacher as well as in the country teacher the ailments more serious than tuberculosis that pass from teacher to pupil; slovenliness, ugly temper, frowning, crossness, lack of ambition, cynicism,—these should be blackballed as well as consumption, contagious morphine habit, and contagious skin disease. Crooked thinking by teacher leads to crooked thinking by pupil. Disregard of health laws by teacher encourages unhygienic living by pupils. A man whose fingers are yellow, nerves shaky, eyes unsteady, and mind alternately sleepy and hilarious from cigarettes, cannot convey pictures of normal, healthy physical living, nor can he successfully teach the moral and social evils of nicotinism. Both teacher and pupil have a right to the periodic physical examination of teachers that will give timely warning of attention needed. Until there is some system for giving this right to all teachers in private, parochial, charitable, and public schools, we shall produce many nervous, acrid, and physically threadbare teachers, where we should have only teachers who inspire their pupils with a passion for health by the example of a good complexion, sprightly step, bounding vitality, and forceful personality born of hygienic living.



PART III. COOePERATION IN MEETING HEALTH OBLIGATIONS



CHAPTER XVI

EUROPEAN REMEDIES: DOING THINGS AT SCHOOL

Recently I traveled five hundred miles to address an audience on methods of fitting health remedies to local health needs. I told of certain dangers to be avoided, of results that had always followed certain remedies, of motives to be sought and used, of community ends to seek. Not knowing the local situation, I could not tell them exactly what to do next, or how or with whom to do it; not seeing the patient or his symptoms, I did not diagnose the disease or prescribe medicine. Several members of the audience who were particularly anxious to start a new organization on a metropolitan model were disappointed because they were told, not just how to organize, but rather how to find out what sort of organization their town needed. They were right in believing that it was easier to copy on paper a plan tried somewhere else, than to think out a plan for themselves. They had forgotten for the time being their many previous disappointments due to copying without question some plan of social work, just as they copy Paris or New York fashions. They had not expected to leave this meeting with the conviction that while the ends of sanitary administration may be the same in ten communities, health machinery should fit a particular community like a tailor-made suit.

American-like, they had a mania for organization. I once heard an aged kindergartner—the savant of an isolated German village—describe my fellow-Americans as follows: "Every American belongs to some organization. The total abstainers are organized, the brewers are organized, the teachers are organized, the parents are organized, the young people and even the juniors are organized. Finally, those who belong to no organization go off by themselves and organize a society of the unorganized." Love of organization and love of copying have given us Americans a feverish desire for what we see or read about in Europe. When we talk about our European remedies we try to make ourselves believe that we are broad-minded and want to learn from others' experience. In a large number of cases our impatient demand for European remedies is similar to the schoolboy's desire to show off the manners, the slang, or the clothes picked up on his first visit away from home. With many travelers and readers European remedies or European ways are souvenirs of a pleasant visit, to be described like a collection of postal cards, a curious umbrella, a cane associated with Alpine climbing, or a stolen hymnal from an historic cathedral.

Experience proves, however, that just as Roman walls and Norman castles look out of place in New York and Kansas, so European laws and European remedies are too frequently misfits when tried by American schools, hospitals, or city governments. Yesterday a Canadian clergyman, after preaching an eloquent sermon, met a professional beggar on the street in New York City and emptied his purse—of Canadian money! Quite like this is the enthusiastic demand of the tourist who has seen or read about "the way it's done in Germany." The trouble is that European remedies are valued like ruins, by their power to interest, by their antiquity or picturesqueness, or, like the beggar, by their power to stimulate temporary emotion. But we do not sleep in ruins, go to church regularly in thirteenth-century abbeys, or live under the remedies that fire our imagination. We do not therefore see their everyday, practical-result side.

The souvenir value of European remedies is due to the assumption that no better way was open to the European, and that the remedy actually does what it is intended to do. Because free meals are given at school to cure and prevent undernourishment, it is taken for granted that undernourishment stops when free meals are introduced; therefore America must have free meals. Because it is made compulsory in a charming Italian village for every child to eat the free school meal, it is taken for granted that the children of that village have no physical defects; therefore let Kansas City, Seattle, and Boston introduce compulsory free meals. But when one goes to Europe to see exactly how those much-advertised, eulogized remedies operate from day to day, it is often necessary to write, as did a great American sanitarian recently, of health administration in foreign cities continually held up as models to American cities: "In spite of the rules and theories over here, the patient has better care in New York City."

We have been asked of late to copy several very attractive European remedies for the physiological ills of school children, and for the physical deficiencies of the next generation of adults: breakfasts or lunches, or both, at school for all children, rich as well as poor, whether they want school nourishment or not; school meals for the poor only; school meals to be given the poor, but to be bought by those who can afford the small sum required; free eyeglasses for the poor, for poor and well-to-do, for those who wish them, for those who need them whether they want to wear eyeglasses or not; free dental care; free surgical treatment; free rides and outings during summer and winter; country children to visit the metropolis, city children to visit country and village; free treatment in the country of all children whose parents are consumptives; free rides on street cars to and from school; city-owned street railways that will prevent congestion by making the country accessible; city-built tenements to prevent overcrowding, dark rooms, insufficient air and light; free coal, free clothes, free rent for those whose parents are unable to protect them properly against hunger and cold. Every one of these remedies is attractive. Every one is being tried somewhere, and can be justified on emotional, economic, and educational grounds, if we think only of its purpose. Let us view them with the eyes of their advocates.