diff options
| author | Roger Frank <rfrank@pglaf.org> | 2025-10-15 01:38:47 -0700 |
|---|---|---|
| committer | Roger Frank <rfrank@pglaf.org> | 2025-10-15 01:38:47 -0700 |
| commit | 521537a8932549a327e4fcb1966cf7a5d119ac99 (patch) | |
| tree | 40fe9d08ed1e2a249077ad4c2de4cc6225fcd8a3 /21353-h | |
Diffstat (limited to '21353-h')
| -rw-r--r-- | 21353-h/21353-h.htm | 16995 | ||||
| -rw-r--r-- | 21353-h/images/fig1.png | bin | 0 -> 72062 bytes | |||
| -rw-r--r-- | 21353-h/images/fig2.png | bin | 0 -> 44135 bytes | |||
| -rw-r--r-- | 21353-h/images/fig3.png | bin | 0 -> 25944 bytes | |||
| -rw-r--r-- | 21353-h/images/fig4.png | bin | 0 -> 54723 bytes | |||
| -rw-r--r-- | 21353-h/images/frontis.jpg | bin | 0 -> 106427 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep019.jpg | bin | 0 -> 132031 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep024.jpg | bin | 0 -> 118729 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep032.jpg | bin | 0 -> 91713 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep034.jpg | bin | 0 -> 93643 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep036.jpg | bin | 0 -> 91497 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep046.jpg | bin | 0 -> 96502 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep048.jpg | bin | 0 -> 106187 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep049.jpg | bin | 0 -> 92279 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep055.jpg | bin | 0 -> 85774 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep074.jpg | bin | 0 -> 139248 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep086.jpg | bin | 0 -> 57000 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep087.jpg | bin | 0 -> 89420 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep088.jpg | bin | 0 -> 63749 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep090.jpg | bin | 0 -> 109728 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep093.jpg | bin | 0 -> 88243 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep094.png | bin | 0 -> 84553 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep097.jpg | bin | 0 -> 69192 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep099.jpg | bin | 0 -> 99414 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep109.jpg | bin | 0 -> 118600 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep116.jpg | bin | 0 -> 110736 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep119.jpg | bin | 0 -> 116319 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep121.jpg | bin | 0 -> 123119 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep134.jpg | bin | 0 -> 100915 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep140.jpg | bin | 0 -> 96857 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep141.jpg | bin | 0 -> 74141 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep143.jpg | bin | 0 -> 127615 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep145.jpg | bin | 0 -> 124630 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep148.jpg | bin | 0 -> 125100 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep149.jpg | bin | 0 -> 99997 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep151.jpg | bin | 0 -> 33666 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep155.jpg | bin | 0 -> 118535 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep163.jpg | bin | 0 -> 71952 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep171.jpg | bin | 0 -> 81601 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep172.jpg | bin | 0 -> 121060 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep175.jpg | bin | 0 -> 110611 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep176.jpg | bin | 0 -> 83006 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep177.png | bin | 0 -> 50385 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep179.jpg | bin | 0 -> 141166 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep180.jpg | bin | 0 -> 122699 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep182.png | bin | 0 -> 44262 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep186.jpg | bin | 0 -> 133405 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep187.jpg | bin | 0 -> 138083 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep192.jpg | bin | 0 -> 96252 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep193.jpg | bin | 0 -> 111485 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep195.jpg | bin | 0 -> 110579 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep197.jpg | bin | 0 -> 67186 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep199.jpg | bin | 0 -> 107657 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep202.jpg | bin | 0 -> 111446 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep206.jpg | bin | 0 -> 101830 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep207.jpg | bin | 0 -> 138723 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep210.jpg | bin | 0 -> 117311 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep211.jpg | bin | 0 -> 126167 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep214.jpg | bin | 0 -> 105730 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep215.jpg | bin | 0 -> 148543 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep216.jpg | bin | 0 -> 112829 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep220.jpg | bin | 0 -> 113034 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep223.jpg | bin | 0 -> 161228 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep224.png | bin | 0 -> 88865 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep230.jpg | bin | 0 -> 69441 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep231.jpg | bin | 0 -> 129436 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep232.jpg | bin | 0 -> 97899 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep233.jpg | bin | 0 -> 153331 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep234.png | bin | 0 -> 45443 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep235.jpg | bin | 0 -> 159258 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep237.jpg | bin | 0 -> 93965 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep239.png | bin | 0 -> 96400 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep240.jpg | bin | 0 -> 99344 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep242.jpg | bin | 0 -> 112180 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep243.jpg | bin | 0 -> 116813 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep244.jpg | bin | 0 -> 96769 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep245.jpg | bin | 0 -> 129697 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep246.jpg | bin | 0 -> 93142 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep250.png | bin | 0 -> 68668 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep253.jpg | bin | 0 -> 184419 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep254.jpg | bin | 0 -> 104410 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep255.png | bin | 0 -> 61712 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep256.png | bin | 0 -> 115392 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep257.png | bin | 0 -> 128375 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep259.jpg | bin | 0 -> 133034 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep261.jpg | bin | 0 -> 132757 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep262.jpg | bin | 0 -> 186293 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep263.jpg | bin | 0 -> 83027 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep264.jpg | bin | 0 -> 379762 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep264_th.jpg | bin | 0 -> 110382 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep265.jpg | bin | 0 -> 147054 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep266.jpg | bin | 0 -> 147724 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep273.jpg | bin | 0 -> 132330 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep277.jpg | bin | 0 -> 160794 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep288.jpg | bin | 0 -> 402632 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep297.png | bin | 0 -> 65126 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep298.png | bin | 0 -> 66980 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep299.jpg | bin | 0 -> 105344 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep302.jpg | bin | 0 -> 235292 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep302_th.jpg | bin | 0 -> 125542 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep305.jpg | bin | 0 -> 133921 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep307.jpg | bin | 0 -> 127260 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep310.png | bin | 0 -> 49716 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep313.jpg | bin | 0 -> 168957 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep314.jpg | bin | 0 -> 190849 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep338.png | bin | 0 -> 28628 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep339.png | bin | 0 -> 140320 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep340.jpg | bin | 0 -> 138116 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep373.jpg | bin | 0 -> 115919 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep380.jpg | bin | 0 -> 181617 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep386.jpg | bin | 0 -> 119111 bytes | |||
| -rw-r--r-- | 21353-h/images/imagep387.jpg | bin | 0 -> 142108 bytes |
112 files changed, 16995 insertions, 0 deletions
diff --git a/21353-h/21353-h.htm b/21353-h/21353-h.htm new file mode 100644 index 0000000..efbc141 --- /dev/null +++ b/21353-h/21353-h.htm @@ -0,0 +1,16995 @@ +<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> +<html> + <head> + <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" /> + <title> + The Project Gutenberg eBook of Civics and Health, by William H. Allen. + </title> + <style type="text/css"> +/*<![CDATA[ XML blockout */ +<!-- + p { margin-top: .5em; + text-align: justify; + margin-bottom: .5em; + text-indent: 1em; + } + h1 { + text-align: center; font-family: garamond, serif; /* all headings centered */ + } + h5,h6 { + text-align: center; font-family: garamond, serif; /* all headings centered */ + } + h2 { + text-align: center; font-family: garamond, serif; /* centered and coloured */ + } + h3 { + text-align: center; font-family: garamond, serif; /* centered and coloured */ + } + h4 { + text-align: center; font-family: garamond, serif; /* all headings centered */ + } + hr { width: 33%; + margin-top: 1em; + margin-bottom: 1em; + } + body{margin-left: 10%; + margin-right: 10%; + } + + h2.wrap {margin-left: 25%; margin-right: 25%;} /* margins for wrapping wide titles */ + a {text-decoration: none} /* no lines under links */ + div.centered {text-align: center;} /* work around for IE centering with CSS problem part 1 */ + div.centered table {margin-left: auto; margin-right: auto; text-align: left;} /* work around for IE centering with CSS problem part 2 */ + ul {list-style-type: none;} /* no bullets on lists */ + ul.nest {margin-top: .15em; margin-bottom: .15em; text-indent: -1.5em;} /* spacing for nested list */ + ul.nest2 {margin-top: .15em; margin-bottom: .15em; text-indent: -3em;} /* spacing for 2nd nested list */ + li {margin-top: .15em; margin-bottom: .15em;} /* spacing for list */ + + .cen {text-align: center; text-indent: 0em;} /* centering paragraphs */ + .sc {font-variant: small-caps; font-size: 95%;} /* small caps, normal size */ + .sc2 {font-variant: small-caps;} /* small caps, normal size */ + .fakesc {font-size: 80%;} /* smaller font size, all caps */ + .noin {text-indent: 0em;} /* no indenting */ + .linenum {position: absolute; top: auto; left: 4%;} /* poetry number */ + .note {margin-left: 2em; margin-right: 2em; margin-bottom: 1em;} /* footnote */ + .block {margin-left: 5%; margin-right: 5%;} /* block indent */ + .block2 {margin-left: 10%; margin-right: 10%;} /* block indent */ + .block2p {margin-left: 10%; margin-right: 10%; padding-top: .15em; padding-bottom: .15em;} /* block indent */ + .block3 {margin-left: 15%; margin-right: 15%;} /* block indent */ + .ltext {width: 40%; text-align: left;} + .rtext {width: 40%; text-align: right; position: absolute; right: 0; padding-right: 30%;} + .hang {text-indent: -2em;} /* hanging indents */ + .hang2 {text-indent: -2%;} /* hanging indents */ + .right {text-align: right; padding-right: 2em;} /* right aligning paragraphs */ + .totoc {position: absolute; right: 2%; font-size: 75%; text-align: right;} /* Table of contents anchor */ + .totoi {position: absolute; right: 2%; font-size: 75%; text-align: right;} /* to Table of Illustrations link */ + .img {text-align: center; padding: 1em; margin-left: auto; margin-right: auto;} /* centering images */ + .imgl {float: left; padding: 1em; text-align: center;} /* floating image to the left of the paragraph */ + .imgr {float: right; padding: 1em; text-align: center;} /* floating image to the right of the paragraph */ + .sidenote {width: 20%; margin-bottom: 1em; margin-top: 1em; padding-left: 1em; font-size: smaller; float: right; clear: right;} + .tdr {text-align: right; padding-right: .5em;} /* right align cell */ + .tdr2 {text-align: right; padding-right: 1.5em;} /* right align cell */ + .tdrt {text-align: right; padding-right: .5em; vertical-align: top;} /* right align cell */ + .tdrb {text-align: right; padding-right: .5em; vertical-align: bottom;} /* right align cell */ + .tdc {text-align: center;} /* center align cell */ + .tdl {text-align: left; padding-left: .5em;} /* left align cell */ + .tdlhang {text-align: left; padding-right: .5em; padding-left: 2em; text-indent: -1.5em;} /* left align cell */ + .tdlsc {text-align: left; font-variant: small-caps;} /* aligning cell content and small caps */ + .tdrsc {text-align: right; font-variant: small-caps;} /* aligning cell content and small caps */ + .tdcsc {text-align: center; font-variant: small-caps;} /* aligning cell content and small caps */ + .vab {vertical-align: bottom;} /* vertical align bottom */ + .vat {vertical-align: top;} /* vertical align top */ + .vam {vertical-align: middle;} /* vertical align middle */ + +/* border classes */ + .tdctrb {text-align: center; border-top: 2px solid black; border-right: 1px solid black; border-bottom: 1px solid black; padding-top: .5em; padding-bottom: .5em;} /* center align, top, right and bottom border */ + .tdctrlb {text-align: center; border-top: 2px solid black; border-right: 1px solid black; border-left: 1px solid black; border-bottom: 1px solid black; padding-top: .5em; padding-bottom: .5em;} /* center align, top, right, left and bottom border */ + .tdctlb {text-align: center; border-top: 2px solid black; border-left: 1px solid black; border-bottom: 1px solid black; padding-top: .5em; padding-bottom: .5em;} /* center align, top, left and bottom border */ + .tdcrl {text-align: center; border-right: 1px solid black; border-left: 1px solid black;} /* center align, right and left border */ + .tdcrlt {text-align: center; border-right: 1px solid black; border-left: 1px solid black; border-top: 1px solid black; padding-top: .5em;} /* center align, right and left border */ + .tdcl {text-align: center; border-left: 1px solid black;} /* center align, left border */ + .tdcr {text-align: center; border-right: 1px solid black;} /* center align, right border */ + .tdrprl {text-align: right; padding-right: 5%; border-right: 1px solid black; border-left: 1px solid black;} /* center align, right and left border */ + .tdrpl {text-align: right; padding-right: 5%; border-left: 1px solid black;} /* center align, left border */ + .tdrprl2 {text-align: right; padding-right: 1%; border-right: 1px solid black; border-left: 1px solid black;} /* center align, right and left border */ + .tdlrl {text-align: left; padding-left: .5em; border-right: 1px solid black; border-left: 1px solid black;} /* left align, right and left border */ + .tdll {text-align: left; padding-left: .5em; border-left: 1px solid black;} /* left align, left border */ + .tdlr {text-align: left; padding-left: .5em; border-right: 1px solid black;} /* left align, right border */ + .tdlrlb {text-align: left; padding-left: .5em; padding-right: .5em; border-bottom: 1px solid black; border-right: 1px solid black; border-left: 1px solid black; padding-bottom: .5em;} /* left align, right and left border */ + .tdllb {text-align: left; padding-left: .5em; padding-right: .5em; border-bottom: 1px solid black; border-left: 1px solid black; padding-bottom: .5em;} /* left align, left border */ +/* end border classes */ + + .tr {margin-left: 15%; margin-right: 15%; margin-top: 5%; margin-bottom: 5%; padding: 1em; background-color: #f6f2f2; color: black; border: dotted black 1px;} /* transcriber's notes */ + + .pagenum { /* uncomment the next line for invisible page numbers */ + /* visibility: hidden; */ + position: absolute; right: 2%; + font-size: 75%; + color: silver; + background-color: inherit; + text-align: right; + text-indent: 0em; + font-style: normal; + font-weight: normal; + font-variant: normal;} /* page numbers */ + + .footnotes {border: dashed 1px;} + .footnote {margin-left: 10%; margin-right: 10%; font-size: 90%;} + .footnote .label {position: absolute; right: 84%; text-align: right;} + .fnanchor {vertical-align: text-top; font-size: .8em; text-decoration: none;} + + .poem {margin-left: 20%; margin-right: 15%; text-align: left;} + .poem br {display: none;} + .poem .stanza {margin: 1em 0em 1em 0em;} + .poem span {display: block; margin: 0; padding-left: 3em; text-indent: -3em;} + .poem span.i2 {display: block; margin-left: 2em;} + .poem span.i4 {display: block; margin-left: 4em;} + .poem span.i6 {display: block; margin-left: 6em; padding-left: 3em; text-indent: -3em;} + + .poem span.pn { /* uncomment the next line for invisible page numbers */ + /* visibility: hidden; */ + position: absolute; right: 2%; + font-size: 75%; + text-align: right; + text-indent: 0em; + font-style: normal; + font-weight: normal; + color: silver; background-color: inherit; + font-variant: normal;} /* page numbers in poems */ + + // --> + /* XML end ]]>*/ + </style> + </head> +<body> + + +<pre> + +The Project Gutenberg EBook of Civics and Health, by William H. Allen + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: Civics and Health + +Author: William H. Allen + +Contributor: William T. Sedgwick + +Release Date: May 8, 2007 [EBook #21353] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK CIVICS AND HEALTH *** + + + + +Produced by Jeannie Howse, Juliet Sutherland and the Online +Distributed Proofreading Team at https://www.pgdp.net + + + + + + +</pre> + + +<br /> +<hr /> +<br /> + +<div class="tr"> +<p class="cen" style="font-weight: bold;">Transcriber's Note:</p> +<br /> +<p class="noin">Inconsistent hyphenation in the original document has been preserved.</p> +<p class="noin">Some text in this document has been moved to avoid multi-page tables being inserted mid-paragraph.</p> +<p class="noin" style="text-align: left;">Obvious typographical errors have been corrected in this text. +For a complete list, please see the <span style="white-space: nowrap;"><a href="#TN">end of this document</a>.</span></p> +<p class="noin">Click on the images to see a larger version.</p> +</div> + +<br /> +<hr /> +<br /> + +<div class="img"> +<a href="images/frontis.jpg"> +<img border="0" src="images/frontis.jpg" width="50%" alt="Louis Agassiz" /></a><br /> +<p class="cen" style="margin-top: .2em;">LOUIS AGASSIZ <br />"A natural law is as sacred as a moral principle"</p> +</div> + +<br /> +<hr /> +<br /> + +<h1>CIVICS AND HEALTH</h1> + +<br /> +<br /> + +<h4>BY</h4> +<h2 style="margin-bottom: 2px;">WILLIAM H. ALLEN</h2> + +<h5 class="sc2" style="margin-top: 2px; margin-bottom: 2px;">Secretary, Bureau of Municipal Research</h5> + +<h5 class="sc2" style="margin-top: 6px;">Former Secretary of the New York Committee on Physical Welfare of<br /> +School Children, Author of "Efficient Democracy" and "Rural<br /> +Sanitary Administration in Pennsylvania," Joint Author<br /> +of "School Reports and School Efficiency"</h5> + +<br /> +<br /> +<br /> + +<h4>WITH AN INTRODUCTION</h4> + +<h4>BY</h4> + +<h3 style="margin-bottom: 2px;">WILLIAM T. SEDGWICK</h3> +<h5 class="sc2" style="margin-top: 6px;">Professor of Biology in the Massachusetts Institute of Technology</h5> + +<br /> +<br /> +<br /> + +<h5>GINN AND COMPANY<br /> +BOSTON · NEW YORK · CHICAGO · LONDON</h5> + +<br /> +<hr /> +<br /> +<br /> +<br /> +<br /> + +<h5><span class="sc2">Entered at Stationers' Hall</span><br /> +<br /> +<span class="sc2">Copyright, 1909</span><br /> +<span class="sc2">By</span> WILLIAM H. ALLEN</h5> +<br /> +<h5>ALL RIGHTS RESERVED</h5> +<h6>910.4</h6> +<br /> +<br /> +<br /> +<h5>The Athenæum Press<br /> +GINN AND COMPANY · PROPRIETORS · BOSTON · U.S.A.</h5> + +<br /> +<br /> +<br /> +<br /> +<hr /> +<span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span><br /> + +<h3>INTRODUCTION</h3> +<br /> + +<p>It is a common weakness of mankind to be caught by an idea and +captivated by a phrase. To rest therewith content and to neglect the +carrying of the idea into practice is a weakness still more common. It +is this frequent failure of reformers to reduce their theories to +practice, their tendency to dwell in the cloudland of the ideal rather +than to test it in action, that has often made them distrusted and +unpopular.</p> + +<p>With our forefathers the phrase <i>mens sana in corpore sano</i> was a high +favorite. It was constantly quoted with approval by writers on hygiene +and sanitation, and used as the text or the finale of hundreds of +popular lectures. And yet we shall seek in vain for any evidence of +its practical usefulness. Its words are good and true, but passive and +actionless, not of that dynamic type where words are "words indeed, +but words that draw armed men behind them."</p> + +<p>Our age is of another temper. It yearns for reality. It no longer +rests satisfied with mere ideas, or words, or phrases. The modern +Ulysses would drink life to the dregs. The present age is dissatisfied +with the vague assurance that the Lord will provide, and, rightly or +wrongly, is beginning to expect the state to provide. And while this +desire for reality has its drawbacks, it has also its advantages. Our +age doubts absolutely the virtues of blind submission and resignation, +and cries out instead for prevention and amelioration. Disease is no +longer regarded, as Cruden regarded <span class='pagenum'><a name="Page_vi" id="Page_vi">[vi]</a></span>it, as the penalty and the +consequence of sin. Nature herself is now perceived to be capable of +imperfect work. Time was when the human eye was referred to as a +perfect apparatus, but the number of young children wearing spectacles +renders that idea untenable to-day.</p> + +<p>Meanwhile the multiplication of state asylums and municipal hospitals, +and special schools for deaf or blind children and for cripples, +speaks eloquently and irresistibly of an intimate connection between +civics and health. There is a physical basis of citizenship, as there +is a physical basis of life and of health; and any one who will take +the trouble to read even the Table of Contents of this book will see +that for Dr. Allen prevention is a text and the making of sound +citizens a sermon. Given the sound body, we have nowadays small fear +for the sound mind. The rigid physiological dualism implied in the +phrase <i>mens sana in corpore sano</i> is no longer allowed. To-day the +sound body generally includes the sound mind, and vice versa. If +mental dullness be due to imperfect ears, the remedy lies in medical +treatment of those organs,—not in education of the brain. If lack of +initiative or energy proceeds from defective aëration of the blood due +to adenoids blocking the air tides in the windpipe, then the remedy +lies not in better teaching but in a simple surgical operation.</p> + +<p>Shakespeare, in his wildwood play, saw sermons in stones and books in +the running brooks. We moderns find a drama in the fateful lives of +ordinary mortals, sermons in their physical salvation from some of the +ills that flesh is heir to, and books—like this of Dr. Allen's—in +striving to teach mankind how to become happier, and healthier, and +more useful members of society.</p> + +<p>Dr. Allen is undoubtedly a reformer, but of the modern, not the +ancient, type. He is a prophet crying in our present <span class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></span>wilderness; but +he is more than a prophet, for he is always intensely practical, +insisting, as he does, on getting things done, and done soon, and done +right.</p> + +<p>No one can read this volume, or even its chapter-headings, without +surprise and rejoicing: surprise, that the physical basis of effective +citizenship has hitherto been so utterly neglected in America; +rejoicing, that so much in the way of the prevention of incapacity and +unhappiness can be so easily done, and is actually beginning to be +done.</p> + +<p>The gratitude of every lover of his country and his kind is due to the +author for his interesting and vivid presentation of the outlines of a +subject fundamental to the health, the happiness, and the well-being +of the people, and hence of the first importance to every American +community, every American citizen.</p> + +<p class="right">WILLIAM T. SEDGWICK</p> + +<p class="sc">Massachusetts Institute of Technology</p> + +<br /> +<br /> +<br /> +<span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span><br /> +<a name="toc" id="toc"></a><hr /> +<span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span><br /> + +<h3>CONTENTS</h3> +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="90%" summary="Table of Contents"> + <tr> + <td class="tdc" colspan="3"><a href="#PART_I_HEALTH_RIGHTS">PART I. HEALTH RIGHTS</a></td> + </tr> + <tr> + <td class="tdrt" width="10%"><span style="font-size: 80%;">CHAPTER</span></td> + <td class="tdl" width="70%"> </td> + <td class="tdrb" width="20%"><span style="font-size: 80%;">PAGE</span></td> + </tr> + <tr> + <td class="tdrt">I.</td> + <td class="tdlsc"><a href="#CHAPTER_I">Health a Civic Obligation</a></td> + <td class="tdrb">3</td> + </tr> + <tr> + <td class="tdrt">II.</td> + <td class="tdlsc"><a href="#CHAPTER_II">Seven Health Motives and Seven Catchwords</a></td> + <td class="tdrb">11</td> + </tr> + <tr> + <td class="tdrt">III.</td> + <td class="tdlsc"><a href="#CHAPTER_III">What Health Rights are not enforced in your Community?</a></td> + <td class="tdrb">23</td> + </tr> + <tr> + <td class="tdrt">IV.</td> + <td class="tdlsc"><a href="#CHAPTER_IV">The Best Index to Community Health is the Physical + Welfare of School Children</a></td> + <td class="tdrb">33</td> + </tr> + <tr> + <td class="tdc" colspan="3" style="padding-top: 1em; padding-bottom: 1em;"><a href="#PART_II_READING_THE_INDEX_TO_HEALTH_RIGHTS">PART II. READING THE INDEX TO HEALTH RIGHTS</a></td> + </tr> + <tr> + <td class="tdrt">V.</td> + <td class="tdlsc"><a href="#CHAPTER_V">Mouth Breathing</a></td> + <td class="tdrb">45</td> + </tr> + <tr> + <td class="tdrt">VI.</td> + <td class="tdlsc"><a href="#CHAPTER_VI">Catching Diseases, Colds, Diseased Glands</a></td> + <td class="tdrb">57</td> + </tr> + <tr> + <td class="tdrt">VII.</td> + <td class="tdlsc"><a href="#CHAPTER_VII">Eye Strain</a></td> + <td class="tdrb">72</td> + </tr> + <tr> + <td class="tdrt">VIII.</td> + <td class="tdlsc"><a href="#CHAPTER_VIII">Ear Trouble, Malnutrition, Deformities</a></td> + <td class="tdrb">83</td> + </tr> + <tr> + <td class="tdrt">IX.</td> + <td class="tdlsc"><a href="#CHAPTER_IX">Dental Sanitation</a></td> + <td class="tdrb">89</td> + </tr> + <tr> + <td class="tdrt">X.</td> + <td class="tdlsc"><a href="#CHAPTER_X">Abnormally Bright Children</a></td> + <td class="tdrb">104</td> + </tr> + <tr> + <td class="tdrt">XI.</td> + <td class="tdlsc"><a href="#CHAPTER_XI">Nervousness of Teacher and Pupil</a></td> + <td class="tdrb">107</td> + </tr> + <tr> + <td class="tdrt">XII.</td> + <td class="tdlsc"><a href="#CHAPTER_XII">Health Value of "Unbossed" Play and Physical Training</a></td> + <td class="tdrb">115</td> + </tr> + <tr> + <td class="tdrt">XIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XIII">Vitality Tests and Vital Statistics</a></td> + <td class="tdrb">124</td> + </tr> + <tr> + <td class="tdrt">XIV.</td> + <td class="tdlsc"><a href="#CHAPTER_XIV">Is your School Manufacturing Physical Defects?</a></td> + <td class="tdrb">139</td> + </tr> + <tr> + <td class="tdrt">XV.</td> + <td class="tdlsc"><a href="#CHAPTER_XV">The Teacher's Health</a></td> + <td class="tdrb">152</td> + </tr> + <tr> + <td class="tdc" colspan="3" style="padding-top: 1em; padding-bottom: 1em;"><a href="#PART_III_COOPERATION_IN_MEETING_HEALTH_OBLIGATIONS">PART III. COÖPERATION IN MEETING HEALTH OBLIGATIONS</a></td> + </tr> + <tr> + <td class="tdrt">XVI.</td> + <td class="tdlsc"><a href="#CHAPTER_XVI">European Remedies: Doing Things at School</a></td> + <td class="tdrb">159</td> + </tr> + <tr> + <td class="tdrt">XVII.</td> + <td class="tdlsc"><a href="#CHAPTER_XVII">American Remedies: Getting Things Done</a></td> + <td class="tdrb">166</td> + </tr> + <tr> + <td class="tdrt">XVIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XVIII">Coöperation with Dispensaries and Child-Saving Agencies</a></td> + <td class="tdrb">174</td> + </tr> + <tr> + <td class="tdrt">XIX.</td> + <td class="tdlsc"><a href="#CHAPTER_XIX">School Surgery and Relief Objectionable, if Avoidable</a></td> + <td class="tdrb">184<span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span></td> + </tr> + <tr> + <td class="tdrt">XX.</td> + <td class="tdlsc"><a href="#CHAPTER_XX">Physical Examination for Working Papers</a></td> + <td class="tdrb">190</td> + </tr> + <tr> + <td class="tdrt">XXI.</td> + <td class="tdlsc"><a href="#CHAPTER_XXI">Periodical Physical Examination after School Age</a></td> + <td class="tdrb">201</td> + </tr> + <tr> + <td class="tdrt">XXII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXII">Habits of Health promote Industrial Efficiency</a></td> + <td class="tdrb">208</td> + </tr> + <tr> + <td class="tdrt">XXIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXIII">Industrial Hygiene</a></td> + <td class="tdrb">218</td> + </tr> + <tr> + <td class="tdrt">XXIV.</td> + <td class="tdlsc"><a href="#CHAPTER_XXIV">The Last Days of Tuberculosis</a></td> + <td class="tdrb">229</td> + </tr> + <tr> + <td class="tdrt">XXV.</td> + <td class="tdlsc"><a href="#CHAPTER_XXV">The Fight for Clean Milk</a></td> + <td class="tdrb">252</td> + </tr> + <tr> + <td class="tdrt">XXVI.</td> + <td class="tdlsc"><a href="#CHAPTER_XXVI">Preventive "Humanized" Medicine: Physician and Teacher</a></td> + <td class="tdrb">268</td> + </tr> + <tr> + <td class="tdc" colspan="3" style="padding-top: 1em; padding-bottom: 1em;"><a href="#PART_IV_OFFICIAL_MACHINERY_FOR_ENFORCING_HEALTH_RIGHTS">PART IV. OFFICIAL MACHINERY FOR ENFORCING HEALTH RIGHTS</a></td> + </tr> + <tr> + <td class="tdrt">XXVII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXVII">Departments of School Hygiene</a></td> + <td class="tdrb">283</td> + </tr> + <tr> + <td class="tdrt">XXVIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXVIII">Present Organization of School Hygiene in New York City</a></td> + <td class="tdrb">296</td> + </tr> + <tr> + <td class="tdrt">XXIX.</td> + <td class="tdlsc"><a href="#CHAPTER_XXIX">Official Machinery for enforcing Health Rights</a></td> + <td class="tdrb">302</td> + </tr> + <tr> + <td class="tdrt">XXX.</td> + <td class="tdlsc"><a href="#CHAPTER_XXX">School and Health Reports</a></td> + <td class="tdrb">310</td> + </tr> + <tr> + <td class="tdrt">XXXI.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXI">The Press</a></td> + <td class="tdrb">322</td> + </tr> + <tr> + <td class="tdc" colspan="3" style="padding-top: 1em; padding-bottom: 1em;"><a href="#PART_V_ALLIANCE_OF_HYGIENE_PATRIOTISM_AND_RELIGION">PART V. ALLIANCE OF HYGIENE, PATRIOTISM, AND RELIGION</a></td> + </tr> + <tr> + <td class="tdrt">XXXII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXII">Do-Nothing Ailments</a></td> + <td class="tdrb">329</td> + </tr> + <tr> + <td class="tdrt">XXXIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXIII">Heredity Bugaboos and Heredity Truths</a></td> + <td class="tdrb">335</td> + </tr> + <tr> + <td class="tdrt">XXXIV.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXIV">Ineffective and Effective Ways of Combating Alcoholism</a></td> + <td class="tdrb">343</td> + </tr> + <tr> + <td class="tdrt">XXXV.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXV">Is it Practicable in presenting to Children the Evils of Alcoholism to tell the Truth, the Whole Truth, and Nothing but the Truth?</a></td> + <td class="tdrb">357</td> + </tr> + <tr> + <td class="tdrt">XXXVI.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXVI">Fighting Tobacco Evils</a></td> + <td class="tdrb">363</td> + </tr> + <tr> + <td class="tdrt">XXXVII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXVII">The Patent-Medicine Evil</a></td> + <td class="tdrb">369</td> + </tr> + <tr> + <td class="tdrt">XXXVIII.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXVIII">Health Advertisements that Promote Health</a></td> + <td class="tdrb">378<span class='pagenum'><a name="Page_xi" id="Page_xi">[xi]</a></span></td> + </tr> + <tr> + <td class="tdrt">XXXIX.</td> + <td class="tdlsc"><a href="#CHAPTER_XXXIX">Is Class Instruction in Sex Hygiene Practicable?</a></td> + <td class="tdrb">384</td> + </tr> + <tr> + <td class="tdrt">XL.</td> + <td class="tdlsc"><a href="#CHAPTER_XL">The Element of Truth in Quackery; Hygiene of the Mind</a></td> + <td class="tdrb">391</td> + </tr> + <tr> + <td class="tdrt">XLI.</td> + <td class="tdlsc"><a href="#CHAPTER_XLI">"A Natural Law is as Sacred as a Moral Principle"</a></td> + <td class="tdrb">398</td> + </tr> + <tr> + <td class="tdl"> </td> + <td class="tdl"><a href="#INDEX">INDEX</a></td> + <td class="tdrb">405</td> + </tr> +</table> +</div> + +<br /> +<br /> +<br /> +<br /> +<hr /> +<br /> +<br /> +<br /> +<br /> + +<h1>CIVICS AND HEALTH</h1> + +<br /> +<br /> +<br /> +<br /> +<a name="PART_I_HEALTH_RIGHTS" id="PART_I_HEALTH_RIGHTS"></a><a name="CHAPTER_I" id="CHAPTER_I"></a><hr /> +<span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span><br /> +<br /> +<br /> +<br /> + +<h2 class="wrap">PART I. HEALTH RIGHTS</h2> + +<br /> + +<h3>CHAPTER I<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>HEALTH A CIVIC OBLIGATION</h4> +<br /> + +<p>In forty-five states and territories the teaching of hygiene with +special reference to alcohol and tobacco is made compulsory. To +hygiene alone, of the score of subjects found in our modern +grammar-school curriculum, is given statutory right of way for so many +minutes per week, so many pages per text-book, or so many pages per +chapter. For the neglect of no other study may teachers be removed +from office and fined. Yet school garrets and closets are full of +hygiene text-books unopened or little used, while of all subjects +taught by five hundred thousand American teachers and studied by +twenty million American pupils the least interesting to both teacher +and pupil is that forced upon both by state legislation. To complete +the paradox, this least interesting subject happens also to be the +most vital to the child, to the home, to industry, to social welfare, +and to education itself.</p> + +<p>Whether the subject of hygiene is necessarily dull, whether the +statutes requiring regular instruction in the laws of health are +violated with impunity, whether health principles are flaunted by +health practice at school,—these are questions of immediate concern +to parents as a class, to employers as a class, to every pastor, every +civic leader, every health officer, every taxpayer.</p> + +<p>Interviews with teachers and principals regarding the present apathy +to formal hygiene instruction have brought <span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span>out the following points +that merit the serious consideration of those who are struggling for +higher health standards.</p> + +<p>1. <i>There is many a slip 'twixt the making of a law and its +enforcement.</i> If laws regarding hygiene instruction are not enforced, +we should not be surprised. It has been nobody's business to see +whether and how hygiene is being taught. The moral crusade spent +itself in forcing compulsory laws upon the statute books of every +state and territory. Making a fetish of <i>Legislation</i>, the advocates +of anti-alcohol and anti-tobacco instruction failed to see the truth +that experienced political reformers are but slowly coming to +see—<i>Legislation which does not provide machinery for its own +enforcement is apt to do little good and frequently will do much +harm.</i> Machinery, however admirably adapted to the work to be done, +will get out of order and become useless, or even harmful, unless +constantly watched and efficiently directed. Of what possible use is +it to say that state money may be withheld from any school board which +fails to enforce the law regarding instruction in hygiene, if state +officials never enforce the penalty? So long as the penalty is not +enforced for flagrant violation, what difference does it make whether +the reason is indifference, ignorance, or desire to thwart the law? +Fortunately, it is easy for each one of us to learn how often and in +what way the children in our community are being taught hygiene, and +how the schools of our state teach and practice the laws of health. If +either the spirit or the letter of the law regarding instruction in +hygiene is being violated, we can measure the penalty paid in health +and morals by our children and our community. We can learn whether +law, text-book, curriculum, or teacher should be changed. We can +insist upon discussion of the facts and upon remedies suggested by the +facts.</p> + +<p>2. <i>Teachers give as one reason for neglecting hygiene, that they are +often compelled to struggle with a curriculum which <span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span>requires more +than they are able to teach and more than pupils are able to learn in +the time allowed.</i> While an overcharged curriculum may explain, it +surely does not justify, the violation of law and the dropping of +hygiene from our school curriculum. If there is any class of citizen +who should teach and practice respect for law as law, it is the +teacher. Parents, school directors, county and state superintendents, +university presidents, social workers, owe it not only to themselves, +but to the American school-teacher, either to repeal the laws that +enjoin instruction in hygiene or else so to adjust the curriculum that +teachers can comply with those laws. The present situation that +discredits both law and hygiene is most demoralizing to teacher, +pupil, and community. Many of us might admire the man teacher who +frankly says he never explains the evils of cigarettes because he +himself is an inveterate smoker of cigarettes. But what must we think +of the school system that shifts to such a man the right and the +responsibility of deciding whether or not to explain to underfed and +overstimulated children of the slums the truth regarding cigarettes? +If practice and precept must be consistent, shall the man be removed, +shall he change his habits, shall the law regarding instruction in +hygiene be changed, or shall other provision be made for bringing +child and essential facts together in a way that will not dull the +child's receptivity?</p> + +<p>3. <i>Teachers are made to feel that while arithmetic and reading are +essential, hygiene is not essential.</i> Whatever may be the facts +regarding the relative value of arithmetic and hygiene, whether or not +our state legislators have made a mistake in declaring hygiene to be +essential, are questions altogether too important for child and state +to be left to the discretion of the individual teacher or +superintendent. It is fair to the teachers who say they cannot afford +to turn aside from the three R's to teach hygiene, to admit <span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span>that they +have not hitherto identified the teaching of hygiene with the +promotion of the physical welfare of children. Teachers awake to the +opportunity will sacrifice not only hygiene but any other subject for +the sake of promoting children's health. They do not really believe +that arithmetic is more important than health. What they mean to say +is that hygiene, as taught by them, has not heretofore had an +appreciable effect upon their pupils' health; that other agencies +exist, outside of the school, to teach the child how to avoid certain +diseases and how to observe the fundamental laws of health, whereas no +other agencies exist to give the child the essentials of arithmetic, +reading, and geography. "We teach (or try to teach) what our classes +are examined in. If you want a subject taught, you must test a class +in it and hold a teacher responsible for results, and examinations are +mercilessly unhygienic, you know."</p> + +<p>4. <i>Teachers believe that they get better results for their children +from teaching hygiene informally and indirectly than from stated +formal lessons.</i> Whether instruction should be informal or formal is +merely a question of method to be determined by results. What the +results are, can be determined by principals, superintendents, and +students of education. It is easy to understand how at the time of a +fever epidemic children could be taught as much in one week about +infection, disease germs, antiseptics, value of cleanliness, etc., as +in five or ten months when vivid illustration is lacking. Physicians +themselves learn more from one epidemic of smallpox than from four +years of book study. To make possible and to require a daily shower +bath will undoubtedly do more to inculcate habits of health than +repeated lessons about the skin, pores, evaporation, and discharge of +impurities.</p> + +<p>If one illustration is better than ten lessons, if an open window is +worth more than all that text-books have to say <span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span>about ventilation, if +a seat adjusted to the child is better than an anatomical chart, this +does not mean that instruction in hygiene should cease. On the +contrary, it means that provision should be made for every teacher to +open windows, to adjust desks, to use the experience of individual +children for the education of the class. If the rank and file of +teachers have not hitherto been sufficiently observant of +physiological and hygienic facts, if they are unprepared from their +own lives to detect or to furnish illustrations for the child, this +again does not mean that the child should be denied the illustrations, +but that the teacher should either have instruction and experience to +incite interest and to stimulate powers of observation, or else be +asked to give place to another teacher who is able to furnish such +qualifications.</p> + +<p>5. <i>Children, like adults, can be interested in other people, in rules +of conduct, in social conditions, in living and working relations more +easily than in their own bodies.</i> The normal, healthy child thinks +very little of himself apart from the other boys and girls, the games, +the studies, the animals, the nature wonders, the hardships that come +to him from the outside. So true is this that one of the best means of +mitigating or curing many ailments is to divert the child's attention +from himself to things outside of himself that he can look at, hear, +enjoy. The power to concentrate attention upon oneself is a sign +either of a diseased body, a diseased mind, or a highly trained mind. +To study others and to recognize the similarity between others and +oneself is as natural as the body itself. Teachers are consulting this +line of easiest access to children's attention when they honor +children according to cleanliness of hands, of teeth, of shoes. Human +interest attaches to what parks or excursions are doing for sickly +children, how welfare work is improving factory employees, how +smallpox is conquered by vaccination, how insurance companies <span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span>refuse +to take risks upon the lives of men or women addicted to the excessive +use of alcohol or tobacco.</p> + +<p>Other people's interests—tenement conditions, factory rules—can be +described in figures and actions that appeal to the imagination and +impress upon the mind pictures that are repeatedly reawakened by +experience and observation on the playground, at home, on the way to +school or to work. "Once upon a time—" will always arrest attention +more quickly than "The human frame consists—." What others think of +me helps me to obey law—statutory, moral, or hygienic—more than what +I know of law itself. How social instincts dominate may be illustrated +by an experience in advertising a public bath near a thoroughfare +traveled daily by thousands of working girls. I prepared a card to be +distributed among these girls that began: "A cool, refreshing bath, +etc." This card was criticised by one who knows the ways of girls and +women, as follows: "Of course you get no success when you have a man +stand on the street corner and pass out cards telling girls to get +clean. Every girl that is worth while is affronted by the +insinuation." Acting upon this expert advice, we then got out a neatly +printed card reading as follows: "For a clear complexion, sprightly +step, and bounding vitality, visit the Center Market Baths, open from +6 <span class="fakesc">A.M.</span> to 9 <span class="fakesc">P.M.</span> daily." The board of managers shook +their sage masculine heads and reluctantly gave permission to issue +these appeals. Woman's judgment was vindicated, however, and the +advantage was proved of urging health for "society's" sake rather than +for health's sake, when the patronage of the bath jumped at once to +considerable proportions.</p> + +<p>6. <i>Other people's habits of health influence our well-being quite as +much, if not more, than our own.</i> Because we are social beings, +ability to get along with our families, our friends, our employers, +is—at least so it seems to most of us—quite as important as +individual health. For too <span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span>many of us, living hygienically is +absolutely impossible without inconveniencing and bothering the +majority of persons with whom we live. I remember a girl in +college,—a fresh-air fiend,—who every morning, no matter how cold, +threw the windows wide open. Then, with forty others, I thought this +girl a nuisance as well as a menace to health, but now, twenty years +afterwards, I find myself wanting to do the same thing. Professor +Patten, the economist, whom I shall quote many times because he is +particularly interested in the purpose of this book, was recently +dining at my house and illustrated from his own health the importance +of teaching hygiene so as to affect social as well as personal +standards. "To be true to my own health needs, I ought to have +declined nearly everything that has been offered me for dinner, but in +the long run, if I am going to visit, my eating what is placed before +me is better for society than making those who entertain me feel +uncomfortable."</p> + +<p>Most of us know what uphill work it is to live hygienically in an +unhygienic environment. I remember how hard it was to eat happily when +sitting beside a college professor who took brown pills before each +meal, yellow pills between each course, and a dose of black medicine +after the meal was over. Mariano, an Italian lad cured of bone +tuberculosis by out-of-door salt air at Sea Breeze, returned to his +tenement home an ardent apostle of fresh air day and night, winter and +summer. His family allowed him to open the window before going to bed, +but closed it as soon as he was asleep. Lawrence Veiller, our greatest +expert on tenement conditions, says: "To bathe in a tenement where a +family of six occupy three rooms often involves the sacrifice of +privacy and decency, which are quite as important to social betterment +as cleanliness."</p> + +<p>To live unhygienically where others live hygienically is quite as +difficult. Witness the speedy improvement of dissipated men when +boarding with country friends who eat <span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span>rationally and retire early. It +must have been knowledge of this fact that prompted the tramways of +Belfast to post conspicuous notices: "Spitting is a vile and filthy +habit, and those who practice it subject themselves to the disgust and +loathing of their fellow-passengers." It is almost impossible to have +indigestion, blues, and headache when one is camping, particularly +where action and enjoyment fill the day. Our practical question is, +therefore, not "What shall I eat, how many hours shall I sleep, what +shall I wear," but "How can I manage to get into an environment among +living and working conditions where the people I live with and want to +please, those who influence me and are influenced by me, make healthy +living easy and natural?"</p> + +<p>7. <i>Because the problems of health have to do principally with +environment,—home, street, school, business,—it is worth while +trying to relate hygiene instruction to industry and government, to +preach health from the standpoint of industrial and national +efficiency rather than of individual well-being.</i> Since healthful +living requires the coöperation of all persons in a household, in a +group, or in a community, we must find some working programme that +will make it easy for all the members of the group to observe health +standards. A city government that spends taxes inefficiently can +produce more sickness, wretchedness, incapacity in one year than +pamphlets on health can offset in a generation. Failure to enforce +health laws is a more serious menace to health and morals than +drunkenness or tobacco cancer. Unclean streets, unclean dairies, +unclean, overcrowded tenements can do more harm than alcohol and +tobacco because they can breed an appetite that craves stimulants and +drugs. Others have taught how the body acts, what we ought to eat, how +we should live. We are concerned here not with repeating the laws of +health, but with a consideration of the mechanism that will make it +possible for us so to work together that we can observe those laws.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_II" id="CHAPTER_II"></a><hr /> +<span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span><br /> + +<h3>CHAPTER II<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>SEVEN HEALTH MOTIVES AND SEVEN CATCHWORDS</h4> +<br /> + +<p>In making a health programme as in making a boat, a garden, or a +baseball team, the first step is to look about and see what material +there is to work with. A baseball team will fail miserably unless the +captain places each man where he can play best. Gardening is +profitless when the gardener does not know the habits of plants and +the possibilities of different kinds of soil. So in planning a health +programme we must study our materials and use each where it will fit +best. The materials of first importance to a health programme in +civilized countries are men; for men working together can control +water sources, drainage, and ventilation, or else move away to +surroundings better suited to healthful living. Therefore the first +concern of the leader in a health crusade is the human kind he has to +work for and work with.</p> + +<p>Seven kinds of man are to be found in every community, seven different +points of view with regard to health administration. Each individual, +likewise, may have seven attitudes toward health laws, seven reasons +for demanding health protection. These seven points of view, seven +stages of development, are clearly marked in the evolution of sanitary +administration throughout the civilized world. With few exceptions, it +is possible, by examining ourselves, our friends, and our communities, +to see where one motive begins and leaves off, giving way to or mixing +with one or more other motives. A friend once asked me if I could keep +this number seven from growing to eight or nine. Perhaps not. Perhaps +there are more kinds of people, <span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span>more health motives, more stages in +health progress; but I am sure of these seven, and certain that they +have been of great help to me in planning health crusades for the +state of New Jersey and for New York City. The number seven was not +reached hit-or-miss fashion, nor was it chosen for its biblical +prestige. On the contrary, it came as the result of studying health +administration in twoscore British and American cities, and of reading +scores of books on sanitary evolution.</p> + +<p>Seven catchwords make it easy to remember the characteristics and the +source of every motive, every kind of person, and every stage in the +evolution of sanitary standards. These seven catchwords are: +<i>Instinct</i>, <i>Display</i>, <i>Commerce</i>, <i>Anti-nuisance</i>, <i>Anti-slum</i>, +<i>Pro-slum</i>, <i>Rights</i>. By the use of these catchwords any teacher, +parent, public official, educator, or social worker should be able to +size up the situation, the needs, and the opportunity of the +individuals or the communities for whom a health crusade is planned.</p> + +<p><i>Instinct</i> was the first health officer and made the first health +laws. Instinct warns us against unusual and offensive odors, sights, +and noises, just as it causes us to seek that which is agreeable. +Primitive man in common with other animals learned by sad experience +to avoid certain herbs as poisons; to bury or to move away from the +dead; to shun discolored drinking water. During the roaming period sun +and air and water acted as scavengers. When tribes settled down in one +spot for long periods, habits that had hitherto been inoffensive and +safe became noticeably injurious and unpleasant. Heads of tribes gave +orders prohibiting such habits and restricting disagreeable acts and +objects to certain portions of the camp. Instinct places outhouses on +our farms and then gradually removes them farther and farther from +dwellings. In many school yards, more particularly in country +districts and small towns, <span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span>outhouses are a crying offense against +animal instinct. In visiting slum districts in Irish and Scotch +cities, and in London, Paris, Berlin, and New York, I never found +conditions so offensive to crude animal instinct as those I knew when +a boy in Minnesota school yards, or those I have since seen in a Boy +Republic. But the evil is not corrected because it is not made +anybody's business to execute instinct's mandates. In the Boy Republic +the leaders were waiting for the children themselves to revolt, as +does primitive man.</p> + +<br /> + +<p class="cen sc">Table I</p> + +<p class="cen sc">Typhoid a Rural Disease<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a></p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="Table 1: Typhoid a Rural Disease"> + <tr> + <td width="70%" class="tdctrb"> </td> + <td width="15%" class="tdctrlb">Average Per Cent of Rural Population</td> + <td width="15%" class="tdctlb">Average Typhoid Fever Death Rate per 100,000</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;">Five states in which the urban population was more than 60% of the total</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">30</td> + <td class="tdcl" style="border-top: 1px solid black; padding-top: .5em;">25</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">Six states in which the urban population was between 40% and 60%</td> + <td class="tdcrl">49</td> + <td class="tdcl">42</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">Seven states in which the urban population was between 30% and 40%</td> + <td class="tdcrl">67</td> + <td class="tdcl">38</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">Eight states in which the urban population was between 20% and 30%</td> + <td class="tdcrl">75</td> + <td class="tdcl">46</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">Twelve states in which the urban population was between 10% and 20%</td> + <td class="tdcrl">87</td> + <td class="tdcl">62</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-bottom: 2pt solid black; padding-bottom: .5em;">Twelve states in which the urban population was between 0 and 10%</td> + <td class="tdcrl" style="border-bottom: 2pt solid black; padding-bottom: .5em;">95</td> + <td class="tdcl" style="border-bottom: 2pt solid black; padding-bottom: .5em;">67</td> + </tr> +</table> +</div> + +<br /> + +<p>Among large numbers of persons, in city as well as country, washing +the body is still a matter of instinct, a bath not being taken until +the body is offensive, the hands not being washed until their +condition interferes with the enjoyment of food or with one's +treatment by others. There is a point of neglect beyond which instinct +will not <span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>permit even a tramp to go. If cleanliness is next to +godliness, the average child is most ungodly by nature, for it loathes +the means of cleanliness and otherwise observes instinct's health +warnings only after experience has punished or after other motives +from the outside have prompted action. The chief form of legislation +of the instinct age is provision of penalties for those who poison +food, water, or fellow-man. There are districts in America where +hygiene is supposed to be taught to children that are conscious of no +other sanitary legislation but that which punishes the poisoner.</p> + +<p><i>Display</i> has always been an active health crusader. Professor Patten +says the best thing that could happen to the slums of every city would +be for every girl and woman to be given white slippers, white +stockings, a white dress, and white hat. Why? Because they would at +once notice and resent the dirt on the street, in their hallways, and +in their own homes. People that have nothing to "spoil" really do not +see dirt, for it interferes in no way with their comfort so far as +they can see. Their windows are crusted with dust, their babies' milk +bottles are yellow with germs. Who cares? Similar conditions exist +among well-to-do women who live on isolated farms with no one to +notice their personal appearance except others of the family who +prefer rest to cleanliness. But let the tenement mother or the +isolated farmer's wife entertain the minister or the school-teacher, +the candidate for sheriff or the ward boss, let her go to Coney Island +or to the county fair, and at once an outside standard is set up that +requires greater regard for personal appearance and leads to "cleaning +up."</p> + +<p>Elbow sleeves and light summer waists have led many a girl to daily +bathing of at least those parts of the body that other people see. +Entertainments and sociables, Saturday choir practice and church have +led many a young man to bathe for others' sake when quite satisfied +<span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span>to forego the ordeal so far as his own comfort and health were +concerned. Streets on which the well-to-do live are kept clean. Why? +Not because Madam Well-to-do cares so much for health, but because she +associates cleanliness with social prestige. It is necessary for the +display of her carriages and dresses, just as paved streets and a +plentiful supply of water for public baths and private homes were +essential to the display of Rome's luxury. Generally speaking, +residence streets are cleaned in small towns just as waterworks are +introduced, to gratify the display motive of those who have lawns to +water and clothes to show.</p> + +<p>Instinct strengthens the display motive. As every one can be +interested in instinct hygiene, so every one is capable of this +display motive to the extent that his position is affected by other +people's opinion. It was love of display quite as much as love of +beauty that gave Greece the goddess Hygeia, the worship of whom +expressed secondarily a desire for universal health, and primarily a +love of the beautiful among those who had leisure to enjoy it.</p> + +<p><i>Commerce</i> brooks no preventable interference with profits, whether by +disease, death, impassable streets, or disabled men. The age of +chivalry was also the age of indescribable filth, plague, Black Death, +and spotted fever that cost the lives of millions. It would be +impossible in the civilized world to duplicate the combination of +luxury and filthy, disease-breeding conditions in the midst of which +Queen Bess and her courtiers held their revels. The first protest was +made, not by the church, not by sanitarians, but by the great +merchants who were unable to insure against loss and ruin from the +plagues that thrived on filth and overcrowding. By an interesting +coincidence the first systematic street cleaning and the first +systematic ship cleaning—maritime quarantine—date from the same +year, 1348 <span class="sc">A.D.</span>; the former in the foremost German <span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span>trading +town, Cologne, and the latter in Venice, the foremost trading town of +Italy. The merchants of Philadelphia and New York started the first +boards of health in the United States. For what purpose? To prevent +business losses from yellow fever. Desire for passable streets, +drains, waterworks, and strong boards of health has generally started +with merchants. For commercial reasons many of our states vote more +money for the protection of cattle than for the protection of human +life, and the United States votes millions for the study of hog +cholera, chicken pip, and animal tuberculosis, while neglecting +communicable diseases of men. No class in a community will respond +more quickly to an appeal for the rigid enforcement of health laws +than the merchant class; none will oppose so bitterly as that which +makes profits out of the violation of health laws.</p> + +<br /> + +<p class="cen sc">Table II</p> + +<p class="cen sc">Cost in Life Capital of Preventable Diseases<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a></p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="Table 2: Cost in Life Capital of Preventable Diseases"> + <tr> + <td width="15%" class="tdctrb">Age</td> + <td width="15%" class="tdctrlb">Estimated Value of Human Life</td> + <td width="70%" class="tdctlb" style="padding-right: .5em; padding-left: .5em;">Multiply by the number of deaths for each age group to learn the cost in life + capital to your community in loss of life from one or all preventable diseases.</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;"> 0- 5 years</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">$1,500</td> + <td class="tdcl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"> 5-10 years</td> + <td class="tdcrl"> 2,300</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; white-space: nowrap;">10-15 years</td> + <td class="tdcrl"> 2,500</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">15-20 years</td> + <td class="tdcrl"> 3,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">20-25 years</td> + <td class="tdcrl"> 5,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">25-30 years</td> + <td class="tdcrl"> 7,500</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">30-35 years</td> + <td class="tdcrl"> 7,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">35-40 years</td> + <td class="tdcrl"> 6,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">40-45 years</td> + <td class="tdcrl"> 5,500</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">45-50 years</td> + <td class="tdcrl"> 5,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">50-55 years</td> + <td class="tdcrl"> 4,500</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">55-60 years</td> + <td class="tdcrl"> 4,500</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">60-65 years</td> + <td class="tdcrl"> 2,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">65-70 years</td> + <td class="tdcrl"> 1,000</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-bottom: 2pt solid black; padding-bottom: .5em; white-space: nowrap;">70- years</td> + <td class="tdcrl" style="border-bottom: 2pt solid black; padding-bottom: .5em;"> 1,000</td> + <td class="tdcl" style="border-bottom: 2pt solid black; padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + +<br /> + +<p><span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span><i>Anti-nuisance</i> motives do not affect health laws until people with +different incomes and different tastes try to live together. In a +small town where everybody keeps a cow and a pig, piggeries and +stables offend no one; but when the doctor, the preacher, the +dressmaker, the lawyer, and the leading merchant stop keeping pigs and +cows, they begin to find other people's stables and piggeries +offensive. The early laws against throwing garbage, fish heads, +household refuse, offal, etc., on the main street were made by kings +and princes offended by such practices. The word "nuisance" was coined +in days when neighbors lived the same kind of life and were not +sensitive to things like house slops, ash piles, etc. The first +nuisances were things that neighbors stumbled over or ran into while +using the public highway. Next, goats and other animals interfering +with safety were described as nuisances, and legal protection against +them was worked out. It has never been necessary to change the maxim +which originally defined a nuisance: "So use your own property that +you will not injure another in the use of his property." The thing +that has changed and grown has been society's knowledge of acts and +objects that prevent a man from enjoying his own property. To-day the +number of things that the law calls nuisances is so great that it +takes hundreds of pages to describe them. Stables and outhouses must +be set back from the street. Every man must dispose of garbage and +drainage on his own property. Stables and privies must be at least a +hundred feet from water reservoirs. Factories may not pollute streams +that furnish drinking water. Merchants may be punished if they put +banana skins in milk cans, or if they fail to scald and cleanse all +milk receptacles before returning them to wholesalers. Automobile +drivers may be punished for disturbing sleep. Anything that injures my +health will be declared a nuisance and abolished, if I can prove that +my health is being injured and that I am doing all I can to <span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span>avoid +that injury. No educational work will accomplish more for any +community than to make rich and poor alike conscious of nuisances that +are being committed against themselves and their neighbors. The rich +are able to run away from nuisances that they cannot have abated. If +proper publicity is given to living conditions among those who do not +resist nuisances, the presence of such conditions will itself become +offensive to the well-to-do, who will take steps to remove the +nuisance. Jacob Riis in this way made the slums a nuisance to rich +residents in New York City and stimulated tenement reform, building of +parks, etc.</p> + +<p><i>Anti-slum</i> motives originated in cities where there is a clear +dividing line between the clean and the unclean, the infected and the +uninfected, the orderly and the disorderly, high and low vitality. As +soon as one district becomes definitely known as a source of nuisance, +infection, and disease, better situated districts begin to make laws +to protect themselves. A great part of our existing health codes and a +very large part of the funds spent on health administration are +designed to protect those of high income against disease incident to +those of low income, high vitality against low vitality, houses with +rooms to spare against houses that are overcrowded. To the small town +and the country the slum means generally the near-by city whose papers +talk of epidemic scarlet fever, diphtheria, or smallpox. Cities have +only recently begun to experience anti-slum aversion to country +dairies whose uncleanliness brings infected milk to city babies, or to +filthy factories and farms that pollute water reservoirs and cause +typhoid. The last serious smallpox epidemic in the East came from the +South by way of rural districts that failed to notify the Pennsylvania +state board of health of the outbreak until the disease was scattered +broadcast. Every individual knows of some family or some district that +is immediately pictured when terms like "disease," "epidemic," "slum," +are <span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span>pronounced. The steps worked out by the anti-slum motive to +protect "those who have" from disease arising from "those who have +not" are given on page 31.</p> + +<div class="img"> +<a href="images/imagep019.jpg"> +<img border="0" src="images/imagep019.jpg" width="80%" alt="A Country Menace To City Health" /></a><br /> +<p class="cen" style="margin-top: .2em;">A COUNTRY MENACE TO CITY HEALTH</p> +</div> + +<p><i>Pro-slum</i> motives are not exactly born of anti-slum motives, but, +thanks to the instinctive kindness of the human heart, follow promptly +after the dangers of the slum have been described. You and I work +together to protect ourselves against neglect, nuisance, and disease. +In a district by which we must pass and with which we must deal, one +of us or a neighbor or friend will turn our attention from our danger +to the suffering of those against whom we wish to protect ourselves. +Charles Dickens so described Oliver Twist and David Copperfield that +Great Britain organized societies and secured legislation to improve +the almshouse, school, and working and living conditions. When health +reports, newspapers, and charitable societies <span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span>make us see that the +slum menaces our health and our happiness, we become interested in the +slum for its own sake. We then start children's aid societies, +consumer's leagues, sanitary and prison associations, child-labor +committees, and "efficient government" clubs.</p> + +<p><i>Rights</i> motives are the last to be evolved in individuals or +communities. The well-to-do protect their instinct, their comfort, +their commerce, but run away from the slums and build in the secluded +spots or on the well-policed and well-cleaned avenues and boulevards. +Uptown is often satisfied with putting health officials to work to +protect it against downtown. Pro-slum motives are shared by too few +and are expressed too irregularly to help all of those who suffer from +crowded tenements, impure milk, unclean streets, inadequate schooling. +So long as those who suffer have no other protection than the +self-interest or the benevolence of those better situated, disease and +hardship inevitably persist. Health administration is incomplete until +its blessings are given to men, women, and children as rights that can +be enforced through courts, as can the right to free speech, the +freedom of the press, and trial by jury. There is all the difference +in the world between having one's street clean because it is a danger +to some distant neighbor, or because that neighbor takes some +philanthropic interest in its residents, and because one has a right +to clean streets, regardless of the distant neighbor's welfare or +interest. When the right to health is granted health laws are made, +and all men within the jurisdiction of the lawmaking power own health +machinery that provides for the administration of those laws. A system +of public baths takes the place of a bathhouse supported by charity; a +law restricting the construction and management of all tenements takes +the place of a block of model tenements, financed by some wealthy man; +medical examination of all school children takes the place of a +private dispensary; <span class='pagenum'><a name="Page_21" id="Page_21">[21]</a></span>a probation law takes the place of the friendly +visitor to the county jail.</p> + +<p>Most of the rights we call inalienable are political rights no longer +questioned by anybody and no longer thought of in connection with our +everyday acts, pleasures, and necessities. When our political rights +were formulated in maxims, living was relatively simple. There was no +factory problem, no transportation problem, no exploitation of women +and children in industry. Our ancestors firmly believed that if the +strong could be prevented from interfering with the political rights +of the weak, all would have an equal chance. The reason that our +political maxims mean less to-day than two hundred years ago is that +nobody is challenging our right to move from place to place if we can +afford it, to trial by jury if charged with crime, to speak or print +the truth about men or governments. If, however, anybody should +interfere with our freedom in this respect, it would be of tremendous +help that everybody we know would resent such interference and would +point to maxims handed down by our ancestors and incorporated in our +national and state constitutions as formal expressions of unanimous +public opinion.</p> + +<p>The time is past when any one seriously believes that political +freedom or personal liberty will be universal, just because everybody +has a right to talk, to move from place to place, to print stories in +the newspapers. The relation of man to man to-day requires that we +formulate rules of action that prevent one man's taking from another +those rights, economic and industrial, that are as essential to +twentieth-century happiness as were political rights to +eighteenth-century happiness. Political maxims showed how, through +common desire and common action, steps could be taken by the +individual and by the whole of society for the protection of all. +Health rights, likewise, are to be obtained through common action. A +modern city must <span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span>know who is accountable when an automobile runs over +a pedestrian, when a train load of passengers lose their lives because +of an engineer's carelessness, when an employee is incapacitated for +work by an accident for which he is not responsible, or when fever +epidemics threaten life and liberty without check. How can a child who +is prevented by removable physical defects from breathing through his +nose be enthusiastic over free speech? Of what use is freedom of the +press to those who find reading harder than factory toil? How futile +the right to trial by jury if removable physical defects make children +unable to do what the law expects! Who would not exchange rights of +petition for ability to earn a living? Children permanently +incapacitated to share the law's benefits cannot appreciate the +privilege of pursuing happiness.</p> + +<p>Succeeding chapters will enumerate a number of health rights and will +show through what means we can work together to guarantee that we +shall not injure the health of our neighbor and that our neighbor +shall not injure our health. The truest index to economic status and +to standards of living is health environment. The best criterion of +opportunity for industrial and political efficiency is the conditions +affecting health. The seven catchwords that describe seven motives to +health legislation and health administration, seven ways of +approaching health needs, and seven reasons for meeting them, should +be found helpful in analyzing the problem confronting the individual +leader. Generally speaking, we cannot watch political rights grow, but +health rights are evolved before our eyes all the time. If we wish, we +can see in our own city or township the steps taken, one by one, that +have slowly led to granting a large number of health rights to every +American.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> Prepared by Dr. John S. Fulton, secretary of the state +board of health, Maryland, and quoted by Dr. George C. Whipple in +<i>Typhoid Fever</i>.</p></div> + +<div class="footnote"><p class="noin"><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Marshall O. Leighton, quoted in Whipple's <i>Typhoid +Fever</i>.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_III" id="CHAPTER_III"></a><hr /> +<span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span><br /> + +<h3>CHAPTER III<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>WHAT HEALTH RIGHTS ARE NOT ENFORCED IN YOUR COMMUNITY?</h4> +<br /> + +<p>Laws define rights. Men enforce them. For definitions we go to books. +For record of enforcement we go to acts and to conditions.<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a> What +health rights a community pretends to enforce will, as a rule, be +found in its health code. What health rights are actually enforced can +be learned only by studying both the people who are to be protected +and the conditions in which these people live. A street, a cellar, a +milk shop, a sick baby, or an adult consumptive tells more honestly +the story of health rights enforced and health rights unenforced than +either sanitary code or sanitary squad. Not until we turn our +attention from definition and official to things done and dangers +remaining can we learn the health progress and health needs of any +city or state.</p> + +<p>The health code of one city looks very much like the health code of +every other city. This is natural because those who write health codes +generally copy other codes. Even small cities are given complicated +sanitary legislative powers by state legislatures. Therefore those who +judge a community's health rights by its health laws will get as +erroneous an impression as those who judge hygiene instruction in our +public schools from printed statements about the frequency and +character of such instruction. Advocates of health codes have thought +the battle won when boards of health were given almost unlimited power +to abate nuisances and told how to exercise those powers.</p> + +<div class="img"><span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span> +<a href="images/imagep024.jpg"> +<img border="0" src="images/imagep024.jpg" width="80%" alt="A Dairy Inspector's Outfit" /></a><br /> +<p class="cen" style="margin-top: .2em;">A DAIRY INSPECTOR'S OUTFIT</p> +</div> + +<p>The slip 'twixt law making and law enforcement is everywhere found. In +1864 New York state prohibited the sale of adulterated milk. Law after +law has been made since that time, giving health officials power to +revoke licenses of milk dealers and to send men to jail who violated +milk laws. We now know that no law will ever stop the present +frightful waste of infant lives, counted in thousands annually, unless +dairies are frequently inspected and forced to be clean; unless milk +is kept at a temperature of about fifty degrees on the train, in the +creamery, at the receiving station, and in the milk shop; unless +dealers scald and thoroughly cleanse cans in which milk is shipped; +unless licenses are taken from farmers, creameries, and retailers who +violate the law; unless magistrates use their power to fine or +imprison those who poison helpless babies by violating milk laws; and +unless mothers are taught to scald <span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span>and thoroughly cleanse bottles, +nipples, cups, and dishes from which milk is fed to the baby. We know +that these things are not being done except where men or women make it +their business to see that they are done. Experience tells us that +inspectors will not consistently do their duty unless those who direct +them have regular records of their inspections, study those records, +find out work not done properly or promptly, and insist upon thorough +inspection.</p> + +<p>Whether work is done right, whether inspectors do their full duty, +whether babies are protected, can be learned only from statements in +black and white that show accurately the conditions of dairies and +milk shops, the character of milk found and tested by inspectors, and +the number of babies known to have been sick or known to have died +from intestinal diseases chiefly due to unsafe milk. Any teacher or +parent can learn for himself, or can teach children to learn, what +steps are taken to guarantee the right to pure milk by using a table +such as Table III. Whether conditions at the dairy make pure milk +impossible can be told by any one who can read the score card used by +New York City (Table IV).</p> + + +<br /> + +<p class="cen sc">Table III<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span></p> + +<p class="cen fakesc">MILK INSPECTION WITHIN NEW YORK CITY, 1906</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="0" cellspacing="0" width="80%" summary="Table 3: Milk Inspection within New York City, 1906"> + <tr> + <td width="60%" class="tdctrb" rowspan="2"> </td> + <td colspan="2" class="tdctrlb">New York</td> + <td colspan="2" class="tdctlb">Each borough</td> + </tr> + <tr> + <td width="10%" class="tdctrlb" style="border-top: 1px solid black;">Stores</td> + <td width="10%" class="tdctrlb" style="border-top: 1px solid black;">Wagons</td> + <td width="10%" class="tdctrlb" style="border-top: 1px solid black;">Stores</td> + <td width="10%" class="tdctlb" style="border-top: 1px solid black;">Wagons</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;">FIELD</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + <td class="tdcl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Permits issued during 1906</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Permits revoked during 1906</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">For discontinuance of selling</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">For violation of law</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Average permits in force in 1906</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: 1em;">INSPECTION</td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcl" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Regular inspections</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Inspections at receiving stations</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Total</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; font-weight: bold; padding-left: 1.5em;">Average inspections per permit per year</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Specimens examined</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Samples taken</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: 1em;">CONDITIONS FOUND</td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcl" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; font-weight: bold; padding-left: 1.5em;">Inspections finding milk above 50°</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; font-weight: bold; padding-left: 1.5em;">% of such discoveries to total inspections</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; font-weight: bold; padding-left: 1.5em;">Inspections finding adulteration</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Warning given</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Prosecuted</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; font-weight: bold; padding-left: 1.5em;">% of adulterations found to inspections</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: .25em; padding-left: 1.5em;">Rooms connected contrary to sanitary code</td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcl" style="padding-top: .25em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Ice box badly drained</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Ice box unclean</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Store unclean</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Utensils unclean</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Milk not properly cooled</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Infectious disease</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: .25em; padding-left: 1.5em;">Persons found selling without permit</td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcrl" style="padding-top: .25em;"> </td> + <td class="tdcl" style="padding-top: .25em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: 1em;">ACTION TAKEN</td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcrl" style="padding-top: 1em;"> </td> + <td class="tdcl" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: .5em; font-size: 80%; padding-left: 1em;">DESTRUCTION OF MILK</td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcl" style="padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Lots of milk destroyed for being over 50°</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Quarts so destroyed</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em; font-weight: bold;">Lots of milk destroyed for being sour</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Quarts so destroyed</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em; font-weight: bold;">Lots of milk destroyed for being otherwise adulterated</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Quarts so destroyed</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Total quarts destroyed</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: .5em; font-size: 80%; padding-left: 1em;">NOTICES ISSUED</td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcl" style="padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">To drain and clean ice box</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">To clean store</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-top: .5em; font-size: 80%; padding-left: 1em;">CRIMINAL ACTIONS BEGUN</td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcrl" style="padding-top: .5em;"> </td> + <td class="tdcl" style="padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">For selling adulterated milk</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">For selling without permit</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">For interference with inspector</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-bottom: 2px solid black; padding-bottom: .5em; padding-left: 1.5em;">Total</td> + <td class="tdcrl" style="border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + <td class="tdcl" style="border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + +<br /> +<span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span><br /> + +<p class="cen sc">Table IV</p> + +<br /> + +<div class="block2"> + +<p class="right">Perfect Score 100%<br /> +Score allowed ...%</p> + +<p class="noin">File No............</p> + +<h2>DEPARTMENT OF HEALTH</h2> +<h5>(Thirteen items are here omitted)</h5> + +<p><span class="ltext"><b>Dairy Inspection</b></span> <span class="rtext"><b>Division of Inspections</b></span></p> + +<div class="block"> +<p class="hang">1 Inspection No. <span style="white-space: nowrap;">.........</span> Time <span style="white-space: nowrap;">.........</span> A. P. M. Date <span style="white-space: nowrap;">......</span> 190</p> +<p class="hang">2 All persons in the households of those engaged in producing or handling + milk are <span style="white-space: nowrap;">.........</span> free from all infectious disease <span style="white-space: nowrap;">.........</span></p> +<p class="hang">3 Date and nature of last case on farm <span style="white-space: nowrap;">.........</span></p> +<p class="hang">4 A sample of the water supply on this farm taken for analysis <span style="white-space: nowrap;">.........</span> + 190... and found to be <span style="white-space: nowrap;">.........</span></p> +</div> +</div> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="90%" summary="Table 4: Dairy Inspection Tally card"> + <tr> + <td width="80%" class="tdctrb" style="font-size: 110%; font-weight: bold;">STABLE</td> + <td width="10%" class="tdctrlb">Perfect</td> + <td width="10%" class="tdctlb">Allow</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;"> 5 + <span style="font-weight: bold;">COW STABLE</span> is <span style="white-space: nowrap;">......</span> located on + elevated ground with no stagnant water, hog pen, or privy within 100 feet</td> + <td class="tdcrl vab" style="border-top: 1px solid black; padding-top: .5em;">1</td> + <td class="tdcl vab" style="border-top: 1px solid black; padding-top: .5em;">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;"> 6 <span style="font-weight: bold;">FLOORS</span> + are <span style="white-space: nowrap;">......</span> constructed of concrete or some nonabsorbent material</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;"> 7 Floors are + <span style="white-space: nowrap;">......</span> properly graded and water-tight</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;"> 8 + <span style="font-weight: bold;">DROPS</span> are <span style="white-space: nowrap;">......</span> + constructed of concrete, stone, or some nonabsorbent material</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;"> 9 Drops are + <span style="white-space: nowrap;">......</span> water-tight</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">10 + <span style="font-weight: bold;">FEEDING TROUGHS</span>, platforms, or cribs are ... + well lighted and clean</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">11 + <span style="font-weight: bold;">CEILING</span> is constructed of + <span style="white-space: nowrap;">......</span> and is <span style="white-space: nowrap;">......</span> + tight and dust proof</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">12 Ceiling is + <span style="white-space: nowrap;">......</span> free from hanging straw, dirt, or cobwebs</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">13 + <span style="font-weight: bold;">NUMBER OF WINDOWS</span> + <span style="white-space: nowrap;">......</span> total square feet ... which is + <span style="white-space: nowrap;">......</span> sufficient</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">14 Window panes are + <span style="white-space: nowrap;">......</span> washed and kept clean</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">15 + <span style="font-weight: bold;">VENTILATION</span> consists of + <span style="white-space: nowrap;">......</span> which is sufficient 3, fair 1, insufficient 0</td> + <td class="tdcrl vab">3</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">16 + <span style="font-weight: bold;">AIR SPACE</span> is + <span style="white-space: nowrap;">......</span> cubic feet per cow which is + <span style="white-space: nowrap;">......</span> sufficient (600 and over—3) (500 to + 600—2) (400 to 500—1) (under 400—0)</td> + <td class="tdcrl vab">3</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">17 + <span style="font-weight: bold;">INTERIOR</span> of stable painted or whitewashed on + <span style="white-space: nowrap;">......</span> which is satisfactory 2, fair 1, never 0</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">18 <span style="font-weight: bold;">WALLS + AND LEDGES</span> are <span style="white-space: nowrap;">......</span> free from dirt, dust, manure, or cobwebs</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">19 <span style="font-weight: bold;">FLOORS + AND PREMISES</span> are <span style="white-space: nowrap;">......</span> free from dirt, + rubbish, or decayed animal or vegetable matter</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">20 <span style="font-weight: bold;">COW BEDS</span> are + <span style="white-space: nowrap;">......</span> clean</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">21 <span style="font-weight: bold;">LIVE + STOCK</span>, other than cows, are <span style="white-space: nowrap;">......</span> excluded + from rooms in which milch cows are kept</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">22 There is + <span style="white-space: nowrap;">......</span> direct opening from barn into + silo or grain pit</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">23 + <span style="font-weight: bold;">BEDDING</span> used is + <span style="white-space: nowrap;">......</span> clean, dry, and absorbent</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">24 <span style="font-weight: bold;">SEPARATE BUILDING</span> is <span style="white-space: nowrap;">......</span> provided for cows + when sick</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">25 Separate quarters are <span style="white-space: nowrap;">......</span> provided for cows + when calving</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">26 <span style="font-weight: bold;">MANURE</span> is <span style="white-space: nowrap;">......</span> removed daily to at least 200 + feet from the barn ( ... ft.)</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">27 Manure pile is <span style="white-space: nowrap;">......</span> so located that the cows + cannot get at it</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">28 <span style="font-weight: bold;">LIQUID MATTER</span> is <span style="white-space: nowrap;">......</span> absorbed and removed + daily and <span style="white-space: nowrap;">......</span> allowed to overflow and saturate ground under or around cow barn</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">29 <span style="font-weight: bold;">RUNNING WATER</span> supply for washing stables is + <span style="white-space: nowrap;">......</span> located within building</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">30 <span style="font-weight: bold;">DAIRY RULES</span> of the Department of Health are + <span style="white-space: nowrap;">......</span> posted</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;">COW YARD</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">31 <span style="font-weight: bold;">COW YARD</span> is <span style="white-space: nowrap;">......</span> properly graded and drained</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">32 Cow yard is <span style="white-space: nowrap;">......</span> clean, dry, and free from + manure</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;"><span class='pagenum'><a name="Page_28" id="Page_28">[28]</a></span>COWS</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">33 <span style="font-weight: bold;">COWS</span> have <span style="white-space: nowrap;">......</span> been examined by veterinarian ... + Date <span style="white-space: nowrap;">......</span> 190 Report was</td> + <td class="tdcrl vab">3</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">34 Cows have <span style="white-space: nowrap;">......</span> been tested by tuberculin, and + all tuberculous cows removed</td> + <td class="tdcrl vab">5</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">35 Cows are <span style="white-space: nowrap;">......</span> all in good flesh and condition + at time of inspection</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">36 Cows are <span style="white-space: nowrap;">......</span> all free from clinging manure and + dirt. (No. dirty ... )</td> + <td class="tdcrl vab">4</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">37 <span style="font-weight: bold;">LONG HAIRS</span> are <span style="white-space: nowrap;">......</span> kept short on belly, flanks, + udder, and tail</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">38 <span style="font-weight: bold;">UDDER AND TEATS</span> of cows are <span style="white-space: nowrap;">......</span> thoroughly + cleaned before milking</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">39 <span style="font-weight: bold;">ALL FEED</span> is <span style="white-space: nowrap;">......</span> of good quality and all grain + and coarse fodders are <span style="white-space: nowrap;">......</span> free from dirt and mold</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">40 <span style="font-weight: bold;">DISTILLERY</span> waste or any substance in a state + of fermentation or putrefaction is <span style="white-space: nowrap;">......</span> fed</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">41 <span style="font-weight: bold;">WATER SUPPLY</span> for cows is <span style="white-space: nowrap;">......</span> unpolluted and + plentiful</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;">MILKERS AND MILKING</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">42 <span style="font-weight: bold;">ATTENDANTS</span> are <span style="white-space: nowrap;">......</span> in good physical condition</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">43 Special Milking Suits are <span style="white-space: nowrap;">......</span> used</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">44 Clothing of milkers is <span style="white-space: nowrap;">......</span> clean</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">45 Hands of milkers are <span style="white-space: nowrap;">......</span> washed clean before + milking</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">46 <span style="font-weight: bold;">MILKING</span> is <span style="white-space: nowrap;">......</span> done with dry hands</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">47 <span style="font-weight: bold;">FORE MILK</span> or first few streams from each teat + is <span style="white-space: nowrap;">......</span> discarded</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">48 Milk is strained at <span style="white-space: nowrap;">......</span> and <span style="white-space: nowrap;">......</span> in clean + atmosphere</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">49 Milk strainer is <span style="white-space: nowrap;">......</span> clean</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">50 <span style="font-weight: bold;">MILK</span> is <span style="white-space: nowrap;">......</span> cooled to below 50° F. within two + hours after milking and kept below 50° F. until delivered to the creamery <span style="white-space: nowrap;">......</span> °</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">51 Milk from cows within 15 days before or 5 days + after parturition is <span style="white-space: nowrap;">......</span> discarded</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;">UTENSILS</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">52 <span style="font-weight: bold;">MILK PAILS</span> have <span style="white-space: nowrap;">......</span> all seams soldered flush</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">53 Milk pails are <span style="white-space: nowrap;">......</span> of the small-mouthed design, + top opening not exceeding 8 inches in diameter. Diameter <span style="white-space: nowrap;">......</span> </td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">54 Milk pails are <span style="white-space: nowrap;">......</span> rinsed with cold water + immediately after using and washed clean with hot water and washing solution</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">55 Drying racks are <span style="white-space: nowrap;">......</span> provided to expose milk + pails to the sun</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;">MILK HOUSE</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">56 <span style="font-weight: bold;">MILK HOUSE</span> is <span style="white-space: nowrap;">......</span> located on elevated ground + with no hog pen, manure pile, or privy within 100 feet</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">57 Milk house has <span style="white-space: nowrap;">......</span> direct communication with + <span style="white-space: nowrap;">......</span> building</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">58 Milk house has <span style="white-space: nowrap;">......</span> sufficient light and + ventilation</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">59 Floor is <span style="white-space: nowrap;">......</span> properly graded and water-tight</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">60 Milk house is <span style="white-space: nowrap;">......</span> free from dirt, rubbish, and all material not used in the handling and storage of milk</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">61 Milk house has <span style="white-space: nowrap;">......</span> running or still supply of + pure clean water</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">62 Ice is <span style="white-space: nowrap;">......</span> used for cooling milk and is cut from ...</td> + <td class="tdcrl vab">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px solid black; padding-top: 1em; font-size: 110%; font-weight: bold;">WATER</td> + <td class="tdcrl vab" style="padding-top: 1em;"> </td> + <td class="tdcl vab" style="padding-top: 1em;"> </td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">63 <span style="font-weight: bold;">WATER SUPPLY</span> for utensils is from a <span style="white-space: nowrap;">......</span> located + <span style="white-space: nowrap;">......</span> feet deep and apparently is <span style="white-space: nowrap;">......</span> pure, wholesome, and uncontaminated</td> + <td class="tdcrl vab">5</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">64 Is <span style="white-space: nowrap;">......</span> protected against flood or surface + drainage</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">65 There is <span style="white-space: nowrap;">......</span> privy or cesspool within 250 feet + ( ... feet) of source of water supply</td> + <td class="tdcrl vab">2</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black;">66 There is <span style="white-space: nowrap;">......</span> stable, barnyard, or pile of + manure or other source of contamination within 200 feet <span style="white-space: nowrap;">( ... feet)</span> of source of water supply</td> + <td class="tdcrl vab" style="border-bottom: 1px black solid;">1</td> + <td class="tdcl vab">...</td> + </tr> + <tr> + <td class="tdlhang" style="border-right: 1px solid black; border-bottom: 2px black solid;"> </td> + <td class="tdcrl vab" style="border-bottom: 2px black solid;">100</td> + <td class="tdcl vab" style="border-bottom: 2px black solid;"> </td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p><span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span>It is a great pity that we Americans have taken so long to learn that +laws do not enforce themselves, that even good motives and good +intentions in the best of officials do not insure good deeds. Thousands +of lives are being lost every year, millions of days taken from +industry and wasted by unnecessary sickness, millions of dollars spent +on curing disease, the working life of the nation shortened, the hours +of enjoyment curtailed, because we have not seen the great gap between +health laws and health-law enforcement. In our municipal, state, and +national politics we have made the same mistake of concentrating our +attention upon the morals and pretensions of candidates and officials +instead of judging government by what government does. Gains of men and +progress of law are useful to mankind only when converted into deeds +that make men freer in the enjoyment of health and earning power. In +protecting health, as in reforming government, an ounce of efficient +achievement is worth infinitely more than a moral explosion. One month +of routine—unpicturesque, unexciting efficiency—will accomplish more +than a scandal or catastrophe. Such routine is possible only when +special machinery is constantly at work, comparing work done with work +expected, health practice with health ideals. Where such machinery does +not yet exist, volunteers, civic leagues, boys' brigades, etc., can +easily prove the need for it by filling out an improvised score card +for the school building, railroad station, business streets, +"well-to-do" and poor resident streets, such as follows:</p> + +<br /> + +<p class="cen sc">Table V</p> + +<p class="cen sc">Score Card for Citizen Use</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="1" cellspacing="0" width="70%" summary="Table 5: Score Card for Citizen Use"> + <tr> + <td width="80%" class="tdctrb"> </td> + <td width="10%" class="tdctrlb">Perfect</td> + <td width="10%" class="tdctlb">Allow</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;"><i>Schoolhouse</i></td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + <td class="tdcl" style="border-top: 1px solid black; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Well ventilated, 20; badly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Cleaned regularly, 20; irregularly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Feather duster prohibited, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">No dry sweeping, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Has adequate play space, 10; inadequate, 0-5</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Has clean drinking water, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Has clean outbuildings and toilet, 20: unclean, 0-10</td> + <td class="tdcrl" style="border-bottom: 1px solid black;"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;"> </td> + <td class="tdcrl">100</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"><i>Church and Sunday School</i></td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Well ventilated, 20; badly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Heat evenly distributed, 20; unevenly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Cleaned regularly, 20; irregularly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Without carpets, 20</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Without plush seats, 20</td> + <td class="tdcrl" style="border-bottom: 1px solid black;"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;"> </td> + <td class="tdcrl">100</td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"><i>Streets</i></td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Sewerage underground, 20; surface, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">No pools neglected, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">No garbage piled up, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Swept regularly, 20; irregularly, 0-10</td> + <td class="tdcrl"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Sprinkled and flushed, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Has baskets for refuse, 10</td> + <td class="tdcrl"> 10</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">All districts equally cleaned, 20; unequally, 0-10</td> + <td class="tdcrl" style="border-bottom: 1px solid black;"> 20</td> + <td class="tdcl">...</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em; border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px solid black; padding-bottom: .5em;">100</td> + <td class="tdcl" style="border-bottom: 2px solid black; padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p><span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span>Until recently the most reliable test of health rights not enforced +was the number of cases of preventable, communicable, contagious, +infectious, transmissible diseases, such as smallpox, typhoid fever, +yellow fever, scarlet fever, diphtheria, measles, whooping cough. By +noticing streets and houses where these diseases occurred, students +learned a century ago that the darker and more congested the street +the greater the prevalence of fevers and the greater the chance that +one attacked would die. The well-to-do remove from their houses and +their streets the dirt, the decomposed garbage, and stagnant pools +from which fevers seem to spring. It was because fevers and congestion +go together that laws were made to protect the well-to-do, the +comfortable, and the clean against the slum. It is true to-day that if +you study your city and stick a pin in the map, street for street, +where infection is known to exist, you will find the number steadily +increase as you go from uncongested to congested streets and houses, +from districts of high rent to districts of low rent. Because it is +easier to learn the number of persons who have measles and diphtheria +and smallpox than it is to learn the incomes and living conditions +prejudicial to health, and because our laws grant protection against +communicable diseases to a child in whatever district he may be born, +the record of cases of communicable diseases has heretofore been the +best test of health rights unenforced. Even in country schools it +would make a good lesson in hygiene and civics to have the children +keep a record of absences on account of transmissible disease, and +then follow up the record with a search for conditions that gave the +disease a good chance.</p> + +<p>But to wait for contagion before taking action has been found an +expensive way of learning where health protection is needed. Even when +infected persons and physicians are prompt in reporting the presence +of disease it is often <span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span>found that conditions that produced the +disease have been overlooked and neglected.</p> + +<p>For example, smallpox comes very rarely to our cities to-day. Wherever +boards of health are not worried by "children's diseases," as is often +the case, and wait for some more fearful disease such as smallpox, +there you will find that garbage in the streets, accumulated filth, +surface sewers, congested houses, badly ventilated, unsanitary school +buildings and churches are furnishing a soil to breed an epidemic in a +surprisingly short time. Where, on the other hand, boards of health +regard every communicable disease as a menace to health rights, you +will find that health officials take certain steps in a certain order +to remove the soil in which preventable diseases grow. These steps, +worked out by the sanitarians of Europe and America after a century of +experiment, are seen to be very simple and are applicable by the +average layman and average physician to the simplest village or rural +community. How many of these steps are taken by your city? by your +county? by your state?</p> + +<br /> + +<div class="block"><p>1. Notification of danger when it is first recognized.</p> + +<p>2. Registration at a central office of facts as to each dangerous +thing or person.</p> + +<p>3. Examination of the seat of danger to discover its extent, its +cost, and new seats of danger created by it.</p> + +<p>4. Isolation of the dangerous thing or person.</p> + +<p>5. Constant attention to prevent extension to other persons or +things.</p> + +<p>6. Destruction or removal of disease germs or other causes of +danger.</p> + +<p>7. Analysis and record, for future use, of lessons learned by +experience.</p> + +<p>8. Education of the public to understand its relation to danger +checked or removed, its responsibility for preventing a recurrence +of the same danger, and the importance of promptly recognizing and +checking similar danger elsewhere.</p></div> + +<br /> + +<p><span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span>With a chart showing what districts have the greatest number of +children and adults suffering from measles, typhoid fever, scarlet +fever, consumption, one can go within his own city or to a strange +city and in a surprisingly short time locate the nuisances, the +dangerous buildings, the open sewers, the cesspools, the houses +without bathing facilities, the dark rooms, the narrow streets, the +houses without play space and breathing space, the districts without +parks, the polluted water sources, the unsanitary groceries and milk +shops. In country districts a comparison of town with town as to the +prevalence of infection will enable one easily to learn where slop +water is thrown from the back stoop, whether the well, the barn, and +the privy are near together.</p> + +<div class="img"> +<a href="images/imagep032.jpg"> +<img border="0" src="images/imagep032.jpg" width="80%" alt="The Baby, Not The Law, Is The Test Of Infant Protection In Country And In City" /></a><br /> +<p class="cen" style="margin-top: .2em;">THE BABY, NOT THE LAW, IS THE TEST OF INFANT PROTECTION IN COUNTRY AND IN CITY</p> +</div> + +<p>Testing health rights requires not only that there be a board of +health keeping track of and publishing every case of infection, but it +requires further that one community be compared with other communities +of similar size, and that each community be compared with itself year +for year. These comparisons have not been made and records do not +exist in many states.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> A striking demonstration of law enforcement that followed +lawmaking is given in <i>The Real Triumph of Japan</i>, L.L. Seaman, M.D.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_IV" id="CHAPTER_IV"></a><hr /> +<span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span><br /> + +<h3>CHAPTER IV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE BEST INDEX TO COMMUNITY HEALTH IS THE PHYSICAL WELFARE OF SCHOOL CHILDREN</h4> +<br /> + +<p>Compulsory education laws, the gregarious instinct of children, the +ambition of parents, their self-interest, and the activities of +child-labor committees combine to-day to insure that one or more +representatives of practically every family in the United States will +be in public, parochial, or private schools for some part of the year. +The purpose of having these families represented in school is not only +to give the children themselves the education which is regarded as a +fundamental right of the American child, but to protect the community +against the social and industrial evils and the dangers that result +from ignorance. Great sacrifices are made by state, individual +taxpayer, and individual parent in order that children and state may +be benefited by education. Almost no resistance is found to any demand +made upon parent or taxpayer, if it can be shown that compliance will +remove obstructions to school progress. If, therefore, by any chance, +we can find at school a test of home conditions affecting both the +child's health and his progress at school, it will be easy, in the +name of the school, to correct those conditions, just as it will be +easy to read the index, because the child is under state control for +six hours a day for the greater part of the years from six to +fourteen.<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a></p> + +<div class="img"><span class='pagenum'><a name="Page_34" id="Page_34">[34]</a></span> +<a href="images/imagep034.jpg"> +<img style="border: 1px black solid;" src="images/imagep034.jpg" width="80%" alt="(Facsimile) PHYSICAL RECORD." /></a><br /> +</div> + +<p>What, then, is this test of home conditions prejudicial to health that +will register the fact as a thermometer tells us the temperature, or +as a barometer shows moisture and air pressure? The house address +alone is not enough, for many children surrounded by wealth are denied +health rights, such as the right to play, to breathe pure air, to eat +wholesome food, to live sanely. Scholarship will not help, because the +frailest child is often the most proficient. Manners mislead, for, +like dress, they are but externals, the product of emulation, of other +people's influence upon us rather than of our living conditions. +Nationality is an index to nothing significant in America, where all +race and nationality differences melt into Americanisms, all +responding in about the same way to American opportunity. No, our test +must be something that cannot be put on and off, cannot be left at +home, cannot be concealed or pretended, something inseparable from the +child and beyond his control. This test it has been conclusively +proved in Chicago, Boston, Brookline, Philadelphia, and particularly +in New York City, is the physical condition of the school child. To +learn this condition the child must be examined and reëxamined for +<span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span>the physical signs called for by the card on page 34. Weight, height, +and measurements are needed to tell the whole story.</p> + +<p>When this card is filled out for every child in a class or school or +city, the story told points directly to physical, mental, or health +rights neglected. If for every child there is begun a special card, +that will tell his story over and over again during his school life, +noting every time he is sick and every time he is examined, the +progress of the community as well as of the child will be clearly +shown. Such a history card (p. 314) is now in use in certain New York +schools, as well as in several private schools and colleges.</p> + +<p>Have you ever watched such an examination? By copying this card your +family physician can give you a demonstration in a very short time as +to the method and advantage of examination at school. The school +physician goes at nine o'clock to the doctor's room in the public +school, or, if there is no doctor's room, to that portion of the hall +or principal's office where the doctor does his work. The teacher or +the nurse stands near to write the physician's decision. The doctor +looks the child over, glances at his eyes, his color, the fullness of +his cheeks, the soundness of his flesh, etc. If the physician says +"B," the principal or nurse marks out the other letter opposite to +number 1, so that the card shows that there is bad nutrition.</p> + +<p>In looking at the teeth and throat a little wooden stick is used to +push down the tongue. There should be a stick for every child, so that +infection cannot possibly be carried from one to the other. If this is +impossible, the stick should be dipped in an antiseptic such as boric +acid or listerine. If, because of swollen tonsils, there is but a +little slit open in the throat, or if teeth are decayed, the mark is Y +or B. The whole examination takes only a couple of minutes, but the +physician often finds out in this short time facts that will save a +boy and his parents a great deal of trouble. Very often this +examination tells a story that overworked <span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span>mothers have studiously +concealed by bright ribbons and clean clothes. I remember one little +girl of fourteen who looked very prosperous, but the physician found +her so thin that he was sure that for some time she had eaten too +little, and called her anæmic. He later found that the mother had +seven children whom she was trying to clothe and shelter and feed with +only ten dollars a week. A way was found to increase her earnings and +to give all the children better living conditions,—all because of the +short story told by the examination card. In another instance the +card's story led to the discovery of recent immigrant parents earning +enough, but, because unacquainted with American ways and with their +new home, unable to give their children proper care.</p> + +<div class="img"> +<a href="images/imagep036.jpg"> +<img border="0" src="images/imagep036.jpg" width="80%" alt="Looking for Enlarged Tonsils and Bad Teeth" /></a><br /> +<p class="cen" style="margin-top: .2em;">LOOKING FOR ENLARGED TONSILS AND BAD TEETH<br />Note the mouth breather waiting</p> +</div> + +<p>The most extensive inquiry yet made in the United States as to the +physical condition of school children is that conducted by the board +of health in New York City since 1905. From March, 1905, to January 1, +1908, 275,641 children have been examined, and 198,139 or 71.9 per +cent have been found to have defects, as shown in Table VI.</p> + +<br /> + +<p class="cen sc">Table VI<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span></p> + +<p class="cen sc">Physical Examination of School Children—performed by the<br /> +Department of Health in the Borough of Manhattan, 1905-1907</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="1" cellspacing="0" width="70%" summary="Table 6: Physical Examination of School Children"> + <tr> + <td width="70%" class="tdctrb"> </td> + <td width="15%" class="tdctrlb">Total</td> + <td width="15%" class="tdctlb">Percentage</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;">Number of children examined</td> + <td class="tdrprl" style="border-top: 1px solid black; padding-top: .5em;">275,641</td> + <td class="tdrpl" style="border-top: 1px solid black; padding-top: .5em;">100</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;">Number of children needing treatment</td> + <td class="tdrprl">198,139</td> + <td class="tdrpl">71.9</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;"><i>Defects found:</i></td> + <td class="tdrprl"> </td> + <td class="tdrpl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Malnutrition</td> + <td class="tdrprl">16,021</td> + <td class="tdrpl">5.8</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Diseased anterior or posterior cervical + glands</td> + <td class="tdrprl">125,555</td> + <td class="tdrpl">45.5</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Chorea</td> + <td class="tdrprl">3,776</td> + <td class="tdrpl">1.3</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Cardiac disease</td> + <td class="tdrprl">3,385</td> + <td class="tdrpl">1.2</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Pulmonary disease</td> + <td class="tdrprl">2,841</td> + <td class="tdrpl">1.0</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Skin disease</td> + <td class="tdrprl">4,557</td> + <td class="tdrpl">1.6</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Deformity of spine, chest, or extremities</td> + <td class="tdrprl">4,892</td> + <td class="tdrpl">1.7</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Defective vision</td> + <td class="tdrprl">58,494</td> + <td class="tdrpl">21.2</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Defective hearing</td> + <td class="tdrprl">3,540</td> + <td class="tdrpl">1.2</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Obstructed nasal breathing</td> + <td class="tdrprl">43,613</td> + <td class="tdrpl">15.8</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Defective teeth</td> + <td class="tdrprl">136,146</td> + <td class="tdrpl">49.0</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Deformed palate</td> + <td class="tdrprl">3,625</td> + <td class="tdrpl">1.3</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Hypertrophied tonsils</td> + <td class="tdrprl">75,431</td> + <td class="tdrpl">27.4</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 2em;">Posterior nasal growths</td> + <td class="tdrprl">46,631</td> + <td class="tdrpl">16.9</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-bottom: 2px solid black; padding-bottom: .5em; padding-left: 2em;">Defective mentality</td> + <td class="tdrprl" style="border-bottom: 2px solid black; padding-bottom: .5em;">7,090</td> + <td class="tdrpl" style="border-bottom: 2px solid black; padding-bottom: .5em;">2.5</td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p>It is generally believed that New York children must have more defects +than children elsewhere. If this assumption is wrong, if children in +other parts of the United States are as apt to have eye defects, +enlarged tonsils, and bad teeth as the children of the great +metropolis, then the army of children needing attention would be seven +out of ten, or over 14,000,000.</p> + +<p>Whether these figures overstate or understate the truth, the school +authorities of the country should find out. The chances are that the +school in which you are particularly interested is no exception. To +learn what the probable number needing attention is, divide your total +by ten and multiply the result by seven.</p> + +<p><span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span>The seriousness of every trouble and its particular relation to school +progress and to the general public health will be explained in +succeeding chapters. The point to be made here is that the examination +of the school child discloses in advance of epidemics and breakdowns +the children whose physical condition makes them most likely to "come +down" with "catching diseases," least able to withstand an attack, +less fitted to profit fully from educational and industrial +opportunity.</p> + +<p>The only index to community conditions prejudicial to health that will +make known the child of the well-to-do who needs attention is the +record of physical examination. No other means to-day exists by which +the state can, in a recognized and acceptable way, discover the +failure of these well-to-do parents to protect their children's health +and take steps to teach and, if necessary, to compel the parents to +substitute living conditions that benefit for conditions that injure +the child.</p> + +<p>Among the important health rights that deserve more emphasis is the +right to be healthy though not "poor." A child's lungs may be weak, +breathing capacity one third below normal, weight and nutrition +deficient, and yet that child cannot contract tuberculosis unless +directly exposed to the germs of that disease. But such a child can +contract chronic hunger, can in a hundred ways pay the penalty for +being pampered or otherwise neglected. Physical examination is needed +to find every child that has too little vitality, no zest for play, +little resistance, even though sent to a private school and kept away +from dirt and contagion.</p> + +<p>The New York Committee on the Physical Welfare of School Children +visited fourteen hundred homes of children found to have one or more +of the physical defects shown on the above card. While they found that +low incomes have more than their proper share of defects and of +unsanitary living conditions, yet they saw emphatically <span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span>also that low +incomes do not monopolize physical defects and unsanitary living +conditions. Many families having $20, $30, $40 a week gave their +children neither medical nor dental care. The share each income had in +unfavorable conditions is shown by the summary in the following table.</p> + +<br /> + +<p class="cen sc">Table VII</p> + +<p class="cen sc">Showing Per Cent Share of Physical Defects of Children,<br /> +Unfavorable Housing Conditions, and Child Mortality<br /> +found among each Family-income Group</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="95%" summary="Table 7: Showing Per Cent Share of Physical Defects of Children"> + <tr> + <td width="44%" rowspan="3" class="tdctrb"> </td> + <td class="tdctlb" colspan="7"><span class="sc">Weekly Family Income</span></td> + </tr> + <tr> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$0-10</td> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$10-15</td> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$16-19</td> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$20-25</td> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$25-29</td> + <td width="8%" class="tdctrlb" style="border-top: 1px black solid;">$30 and over</td> + <td width="8%" class="tdctlb" style="border-top: 1px black solid;">$100</td> + </tr> + <tr> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctrlb" style="border-top: 1px black solid;">%</td> + <td class="tdctlb" style="border-top: 1px black solid;">%</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-top: 1px solid black; padding-top: .5em;">Proportion to total families</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> 8.4</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">32.7</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">15.2</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">23.8</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;"> 3.9</td> + <td class="tdcrl" style="border-top: 1px solid black; padding-top: .5em;">15.6</td> + <td class="tdcl" style="border-top: 1px solid black; padding-top: .5em;">100</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"><i>Physical defects</i>:</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Malnutrition</td> + <td class="tdcrl">13.8</td> + <td class="tdcrl">43.4</td> + <td class="tdcrl">12.4</td> + <td class="tdcrl">17.9</td> + <td class="tdcrl"> 3.4</td> + <td class="tdcrl"> 9. </td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Enlarged glands</td> + <td class="tdcrl"> 8.6</td> + <td class="tdcrl">37.4</td> + <td class="tdcrl">14.6</td> + <td class="tdcrl">22.6</td> + <td class="tdcrl"> 3.6</td> + <td class="tdcrl">13.2</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Defective breathing</td> + <td class="tdcrl"> 9.6</td> + <td class="tdcrl">32.3</td> + <td class="tdcrl">15.5</td> + <td class="tdcrl">24.4</td> + <td class="tdcrl"> 2.8</td> + <td class="tdcrl">15.4</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Bad teeth</td> + <td class="tdcrl"> 8.1</td> + <td class="tdcrl">32.2</td> + <td class="tdcrl">15.3</td> + <td class="tdcrl">24.5</td> + <td class="tdcrl"> 4.8</td> + <td class="tdcrl">15.1</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Defective vision</td> + <td class="tdcrl"> 8.2</td> + <td class="tdcrl">34.6</td> + <td class="tdcrl">16.5</td> + <td class="tdcrl">22.1</td> + <td class="tdcrl"> 1.4</td> + <td class="tdcrl">17.3</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"><i>Unfavorable housing conditions</i>:</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Dark rooms</td> + <td class="tdcrl"> 8.2</td> + <td class="tdcrl">35.4</td> + <td class="tdcrl">18.1</td> + <td class="tdcrl">18.4</td> + <td class="tdcrl"> 3.8</td> + <td class="tdcrl">15.9</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Closed air shaft</td> + <td class="tdcrl"> 6.9</td> + <td class="tdcrl">30.2</td> + <td class="tdcrl">18.9</td> + <td class="tdcrl">26.4</td> + <td class="tdcrl"> 3.2</td> + <td class="tdcrl">19.6</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">No baths</td> + <td class="tdcrl">10.1</td> + <td class="tdcrl">38.5</td> + <td class="tdcrl">16.5</td> + <td class="tdcrl">19.7</td> + <td class="tdcrl"> 4.4</td> + <td class="tdcrl">10.8</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Paying over 25% rent</td> + <td class="tdcrl"> 8.6</td> + <td class="tdcrl">27.6</td> + <td class="tdcrl">21.7</td> + <td class="tdcrl">14.7</td> + <td class="tdcrl">...</td> + <td class="tdcrl">27.6</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black;"><i>Child Mortality</i>:</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Families losing children</td> + <td class="tdcrl">10.3</td> + <td class="tdcrl">35.5</td> + <td class="tdcrl">14.7</td> + <td class="tdcrl">20.5</td> + <td class="tdcrl"> 5.4</td> + <td class="tdcrl">13.6</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Families losing no children</td> + <td class="tdcrl"> 6.4</td> + <td class="tdcrl">30.1</td> + <td class="tdcrl">15.7</td> + <td class="tdcrl">26.9</td> + <td class="tdcrl"> 2.4</td> + <td class="tdcrl">18.6</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Children dead</td> + <td class="tdcrl">11.7</td> + <td class="tdcrl">36.2</td> + <td class="tdcrl">13.1</td> + <td class="tdcrl">20.8</td> + <td class="tdcrl"> 6.1</td> + <td class="tdcrl">12.1</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; padding-left: 1.5em;">Infants dying from intestinal diseases</td> + <td class="tdcrl"> 8.9</td> + <td class="tdcrl">37.6</td> + <td class="tdcrl">18.3</td> + <td class="tdcrl">18.8</td> + <td class="tdcrl"> 4. </td> + <td class="tdcrl">12.4</td> + <td class="tdcl">"</td> + </tr> + <tr> + <td class="tdl" style="border-right: 1px solid black; border-bottom: 2px black solid; padding-bottom: .5em; padding-left: 1.5em;">Children working</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> 4.2</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">19.5</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">13.2</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">30.3</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">11.5</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">21.3</td> + <td class="tdcl" style="border-bottom: 2px black solid; padding-bottom: .5em;">"</td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p>The index should be read in all grades from kindergarten to high +school and college.</p> + +<p><span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span>Last winter the chairman of the Committee on the Physical Welfare of +School Children was invited to speak of physical examination before an +association of high-school principals. He began by saying, "This +question does not concern you as directly as it does the +grammar-school principals, but you can help secure funds to help their +pupils." One after another the high-school principals present +told—one of his own daughter, another of his honor girls, a third of +his honor boys—the same story of neglected headaches due to eye +strain, breakdowns due to undiscovered underfeeding, underexercise, or +overwork. Are we coming to the time when the state will step in to +prevent any boy or girl in high school, college, or professional +school from earning academic honors at the expense of health? Harmful +conditions within schoolrooms and on school grounds will not be +neglected where pupils, teachers, school and family physicians, and +parents set about to find and to remove the causes of physical +defects.</p> + +<p>Disease centers outside of school buildings quickly register +themselves in the schoolroom and in the person of a child who is +paying the penalty for living in contact with a disease center. If a +child sleeps in a dark, ill-ventilated, crowded room, the result will +show in his eyes and complexion; if he has too little to eat or the +wrong thing to eat, he will be underweight and undersized; if his +nutrition is inadequate and his food improper, he is apt to have eye +trouble, adenoids, and enlarged tonsils. He may have defective lung +capacity, due to improper breathing, too little exercise in the fresh +air, too little food. Existence of physical defects throws little +light on income at home, but conclusively shows lack of attention or +of understanding. Several days' absence of a child from school leads, +in every well-regulated school, to a visit to the child's home or to a +letter or card asking that the absence be explained. Even newly +arrived immigrants have learned the necessity and <span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span>the advantage of +writing the teacher an "excuse" when their children are absent. +Furthermore, neighbors' children are apt to learn by friendly inquiry +what the teacher may not have learned by official inquiry, why their +playmate is no longer on the street or at the school desk. While +physicians are sometimes willing to violate the law that compels +notification of infection, rarely would a physician fail to caution an +infected family against an indiscriminate mingling with neighbors. +Whether the family physician is careless or not, the explanation of +the absence which is demanded by the school would give also +announcement of any danger that might exist in the home where the +child is ill.</p> + +<p>If it be said that in hundreds of thousands of cases the child labor +law is violated and that therefore school examination is not an index +to the poverty or neglect occasioning such child labor, it should be +remembered that the best physical test is the child's presence at +school. The first step in thorough physical examination is a thorough +school census,—the counting of every child of school age. Moreover, a +relatively small number of children who violate the child labor law +are the only members of the family who ought to be in school. Younger +children furnish the index and occasion the visit that should discover +the violation of law.</p> + +<p>Appreciation of health, as well as its neglect, is indexed by the +physical condition of school children. Habits of health are the other +side of the shield of health rights unprotected. Physical examination +will discover what parents are trying to do as well as what they fail +to do because of their ignorance, indifference, or poverty. In so far +as parents are alive to the importance of health, the school +examination furnishes the occasion of enlisting them in crusades to +protect the public health and to enforce health rights. The Committee +on the Physical Welfare of School Children found many parents +unwilling to answer <span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span>questions as to their own living conditions until +told that the answers would make it easier to get better health +environment not only for their own children but for their neighbors' +children. Generally speaking, fathers and mothers can easily be +interested in any kind of campaign in the name of health and in behalf +of children. The advantage of starting this health crusade from the +most popular American institution, the public school,—the advantage +of instituting corrective work through democratic machinery such as +the public school,—is incalculable. To any teacher, pastor, civic +leader, health official, or taxpayer wanting to take the necessary +steps for the removal of conditions prejudicial to health and for the +enforcement of health rights of child and adult, the best possible +advice is to learn the facts disclosed by the physical examination of +your school children. See that those facts are used first for the +benefit of the children themselves, secondly for the benefit of the +community as a whole. If your school has not yet introduced the +thorough physical examination of school children, take steps at once +to secure such examination. If necessary, volunteer to test the eyes +and the breathing of one class, persuade one or two physicians to +coöperate until you have proved to parent, taxpayer, health official, +and teacher that such an examination is both a money-saving, +energy-saving step and an act of justice.</p> + +<p>We shall have occasion to emphasize over and over again the fact that +it is the use of information and not the gathering of information that +improves the health. The United States Weather Bureau saves millions +of dollars annually, not because flags are raised and bulletins issued +foretelling the weather, but because shipowners, sailors, farmers, and +fruit growers obey the warnings. Mere examination of school children +does little good. The child does not breathe better or see better +because the school physician fills out a card stating that there is +<span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span>something wrong with his eyes, nose, and tonsils. The examination +tells where the need is, what children should have special attention, +what parents need to be warned as to the condition of the child, what +home conditions need to be corrected. If the facts are not used, that +is an argument not against obtaining facts but against disregarding +them.</p> + +<p>In understanding medical examination we should keep clearly in mind +the distinction between medical school inspection, medical school +examination, and medical treatment at school. Medical inspection is +the search for communicable disease. The results of medical +inspection, therefore, furnish an index to the presence of +communicable diseases in the community. Medical examination is the +search for physical defects, some of which furnish the soil for +contagion. Its results are an index not only to contagion but to +conditions that favor contagion by producing or aggravating physical +defects and by reducing vitality. Medical treatment at school refers +to steps taken under the school roof, or by school funds, to remove +the defects or check the infection brought to light by medical +inspection and medical examination. Treatment is not an index. In +separate chapters are given the reasons for and against trying to +treat at school symptoms of causes that exist outside of school. When, +how often, and by whom inspection and examination should be made is +also discussed later. The one point of this chapter is this: if we +really want to know where in our community health rights are +endangered, the shortest cut to the largest number of dangers is the +physical examination of children at school,—private, parochial, +reformatory, public, high, college.</p> + +<p>Apart from the advantage to the community of locating its health +problems, physical examination is due every child. No matter where his +schooling or at whose expense, every child has the right to advance as +fast as his own powers <span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span>will permit without hindrance from his own or +his playmates' removable defects. He has the right to learn that +simplified breathing is more necessary than simplified spelling, that +nose plus adenoids makes backwardness, that a decayed tooth multiplied +by ten gives malnutrition, and that hypertrophied tonsils are even +more menacing than hypertrophied playfulness. He has the right to +learn that his own mother in his own home, with the aid of his own +family physician, can remove his physical defects so that it will be +unnecessary for outsiders to give him a palliative free lunch at +school, thus neglecting the cause of his defects and those of +fellow-pupils.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Sir John E. Gorst in <i>The Children of the Nation</i> reads +the index of the health of school children in the United Kingdom; John +Spargo, in <i>The Bitter Cry of the Children</i>, and Simon N. Patten in +<i>The New Basis of Civilization</i>, suggest the necessity for reading the +index in the United States and for heeding it.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="PART_II_READING_THE_INDEX_TO_HEALTH_RIGHTS" id="PART_II_READING_THE_INDEX_TO_HEALTH_RIGHTS"></a><a name="CHAPTER_V" id="CHAPTER_V"></a><hr /> +<span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span><br /> +<br /> +<br /> +<br /> + +<h2 class="wrap">PART II. READING THE INDEX TO HEALTH RIGHTS</h2> + +<br /> + +<h3>CHAPTER V<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>MOUTH BREATHING</h4> +<br /> + +<p>If the physical condition of school children is our best index to +community health, who is to read the index? Unless the story is told +in a language that does not require a secret code or cipher, unless +some one besides the physician can read it, we shall be a very long +time learning the health needs of even our largest cities, and until +doomsday learning the health needs of small towns and rural districts. +Fortunately the more important signs can be easily read by the average +parent or teacher. Fortunately, too, it is easy to persuade mothers +and teachers that they can lighten their own labors, add to their +efficiency, and help their children by being on the watch for mouth +breathing, for strained, crossed, or inflamed eyes, for decaying +teeth, for nervousness and sluggishness. Years ago, when I taught +school in a Minnesota village, I had never heard of adenoids, +hypertrophied tonsils, myopia, hypermetropia, or the relation of these +defects and of neglected teeth to malnutrition, truancy, sickness, and +dullness. I now see how I could have saved myself several failures, +the taxpayers a great deal of money, the parents a great deal of +disappointment, and many children a life of inefficiency, had I known +what it is easy for all teachers and parents to learn to-day.</p> + +<div class="img"><span class='pagenum'><a name="Page_46" id="Page_46">[46]</a></span> +<a href="images/imagep046.jpg"> +<img border="0" src="images/imagep046.jpg" width="80%" alt="Mouth Breathers Before "Adenoid Party"" /></a><br /> +<p class="cen" style="margin-top: .2em;">MOUTH BREATHERS BEFORE "ADENOID PARTY"</p> +</div> + +<p>The features in the following cut are familiar to teachers the world +over. Parents may reconcile themselves to such lips, eyes, and mouths, +but seldom do even neglectful parents fail to notice "mouth +breathing." Children afflicted by such features suffer torment from +playfellows whose scornful epithets are echoed by the looking-glass. +No fashion plate ever portrays such faces. No athlete, thinker, or +hero looks out from printed page with such clouded, listless eyes. The +more wonder, therefore, that the meaning of these outward signs has +not been appreciated and their causes removed; conclusive reason, +also, for not being misled by recent talk of mouth breathing, +adenoids, and enlarged tonsils, into the belief that the race is +physically deteriorating. Three generations ago Charles Dickens in his +<i>Uncommercial Traveller</i> pointed out a relation between open mouths +and backwardness and delinquency that would have saved millions of +dollars and millions of life failures had the civilized world +listened. He was speaking of delinquent girls from seventeen to twenty +years old in Wapping Workhouse: "I have never <span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span>yet ascertained why a +refractory habit should affect the tonsils and the uvula; but I have +always observed that refractories of both sexes and every grade, +between a Ragged School and the Old Bailey, have one voice, in which +the tonsils and uvula gain a diseased ascendency."</p> + +<p>To-day we are just beginning to see over again the connection between +inability to breathe through the nose and inability to see clearly +right from wrong and inability to want to do what teachers and parents +wish. Physical examinations show now, and might just as well have +shown fifty years ago, that the great majority of truants and juvenile +offenders have adenoids and enlarged tonsils. A recent examination +made by the New York board of health on 150 children in one school +made up from the truant school, the juvenile court, and Randall's +Island, showed that only three were without some physical defect and +that 137 had adenoids and large tonsils. Dickens wrote his +observations in 1860; in 1854 the New York Juvenile Asylum was +started, and up to 1908 cared for 40,000 children; in 1860 William +Meyer pointed out, so that no one need misunderstand, the harmful +effects of adenoids. What would have been the story of juvenile +waywardness, of sickness, of educational advancement, had examinations +for defective breathing been started in 1853 or 1860 instead of 1905; +if one per cent of the attention that has been given to teaching mouth +breathers the ten commandments had been spent on removing the nasal +obstructions to intelligence?</p> + +<div class="img"> +<a href="images/imagep048.jpg"> +<img border="0" src="images/imagep048.jpg" width="80%" alt="A "Degenerate" Made Normal By Removal Of Adenoids" /></a><br /> +<p class="cen" style="margin-top: .2em;">A "DEGENERATE" MADE NORMAL BY REMOVAL OF ADENOIDS</p> +</div> + +<p>William Hegel, who is pictured on page 48, before his tonsils and +adenoids were removed was described by his father in this way: "When +playing with other boys on the street he seems dazed, and sluggish to +grasp the various situations occurring in the course of the game. When +he decides to do something he runs in a heedless, senseless way, as if +running away,—will bump against something, <span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span>pedestrian or building, +before he comes to himself; seems dazed all the time. When told +something by his mother he giggles in the most exasperating way, for +which he receives a whipping quite often." The father said the +whipping was of no avail. The child was restless, talkative, and +snored during sleep. He had an insatiable appetite. He was removed or +transferred from five different schools in New York City. To get +redress the father took him to the board of education, whence he was +referred to the assistant chief medical inspector of the department of +health, whose examination revealed immensely large fungous-looking +tonsils and excessive pharyngeal granulations (adenoids). He was +operated on at a clinic. The tonsils and adenoids removed are pictured +on the opposite page, reduced one third. After the operation the child +was visited by the assistant medical inspector. There was a marked +improvement in his facial expression,—he looked intelligent, was +alert and interested. When <span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span>asked how he felt, he answered, "I feel +fine now." It required about fifteen minutes to get his history, +during all of which time he was responsive and interested, constantly +correcting statements of his father and volunteering other +information. Eleven days after the operation he was reported to have +had no more epileptic seizures. "Doesn't talk in sleep. Doesn't snore. +Doesn't toss about the bed. Has more self-control. Tries to read the +paper. His immoderate appetite is not present."</p> + +<div class="img"> +<a href="images/imagep049.jpg"> +<img border="0" src="images/imagep049.jpg" width="80%" alt="Reason Enough for Mouth Breathing: Adenoid and tonsils reduced one third" /></a><br /> +<p class="cen" style="margin-top: .2em;">REASON ENOUGH FOR MOUTH BREATHING<br />Adenoid and tonsils reduced one third</p> +</div> + +<p>While the open mouth is a sure sign of defects of breathing, it is not +true that the closed mouth, when awake and with other people, is proof +that there are no such defects. Children breathe through the mouth not +because they like to, not because they have drifted into bad habits, +not <span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span>because their parents did, not because the human race is +deteriorating, but because their noses are stopped up,—because they +must. A mouth breather is not only always taking unfiltered dirt germs +into his system but is always in the condition of a person who has +slept in a stuffy room. What extra effort adenoids mean can be +ascertained by closing the nostrils for a forenoon.</p> + +<p>For many reasons it is perhaps unfortunate that we can breathe at all +when the nose is stopped up. If we could see with our ears as well as +with our eyes, we should probably not take as good care of our eyes. +In this respect the whole race has experienced the misfortune of the +man of whom the coroner reported, "Killed by falling too short a +distance." Because we can breathe through the mouth we have neglected +for centuries the nasal passages. When a cold stops the nose we +necessarily breathe through the mouth. Unfortunately children make the +necessary effort required to breathe through the nose long before +other people notice the lines along the nose and the slow mind. Mouth +breathing will show with the child asleep, before the child awake +loses power to accommodate his effort to the task. Therefore the +importance of a physical test at school to detect the beginnings of +adenoids and large tonsils before these symptoms become obvious to +others.</p> + +<p>No child should be exempted from this examination because of +apocryphal theories that only the poor, the slum child, the +refractory, or the unclean have defects in breathing. This very +afternoon a friend has told me of her year abroad with a girl of nine, +whose parents are very wealthy. The girl is anæmic. Her backwardness +humiliates her parents, especially because she gave great promise +until two years ago. High-priced physicians have prescribed for her. +It happens that they are too eminent to give attention to such simple +troubles as adenoids that <span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span>can be felt and seen. They are looking for +complications of the liver or inflammation of muscles at the base of +the brain. One celebrated French savant found the adenoids, assured +the mother that the child would outgrow them, and advised merely that +she be compelled to breathe through the nose. The mother and +nursemaids nag the child all day. The poor unwise mother sits up +nights to hold the child's jaws tight in the hope that air coming +through the nose will absorb the adenoids. The mother is made nervous. +Of course this makes the child more nervous and adds to the evil +effects of adenoids. If the mother had the good fortune to be very +poor, she could not sit up nights, and would long ago have decided +either to let the child alone or else to have the trouble removed.</p> + +<p>Adenoids are not a city specialty. Country earache is largely due to +adenoids or to inflammation that quickly leads to adenoids. In 415 +villages of New York state twelve per cent were found to be mouth +breathers. For two summers I have known a lad named Fred. He lives at +the seashore. Throughout his twelve years he has lived in a veritable +El Dorado of health and nature beauty. Groves and dunes and flora vie +with the blues of ocean and sky in resting the eye and in filling the +soul with that harmony which is said to make for sound living. Yet to +a child, Fred's schoolmates are experts on patent medicines and on the +heredity that is alleged to be responsible for bad temper, running +sores, tuberculosis, anæmia, and weak eyes. Freddie is particularly +favored. His well-to-do parents have supplied him with ponies, games, +and bicycles. Nothing prevents his breathing salt air fresh from the +north pole but hermetically sealed windows. The father thinks it +absurd to make a fuss over adenoids. Didn't he have them when a boy, +and doesn't he weigh two hundred pounds and "make good money"? The +mother never knew of operations for such trifles when <span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span>she taught +school; she supposes her boy needs an operation, but "just can't bear +to see the dear child hurt." As for Fred, he breathes through his +mouth, talks through his nose, grows indifferent to boy's fun, fails +to earn promotion at school, and fears that "I won't be strong in +spite of all the patent medicine I've taken." Father, mother, and Fred +feel profound pity for the city child living so far from nature.</p> + +<p>Adenoids are not monopolized by children whose parents are ignorant of +the importance of them and of physical examination. Last summer I was +asked by a small boy to buy some chocolate. A glance at his cigar box +with its two or three uninviting things for sale showed that the boy +was really begging. He had thick lips, open mouth, "misty" eyes, and a +nasal twang. I asked him if his teacher had not told him he had lumps +back of his nose and could not breathe right. He said, "No." I +explained then that he could make a great deal more money if he talked +like other boys, stepped livelier, and breathed as other people +breathe. He said he had "been by a doctor onct but didn't want to be +op'rated." I turned to my companion and asked, "Have you never noted +those same lines on your boy's face?" Although he had been lecturing +on mouth breathers, he had never noticed his own boy's trouble. He +hastened home and found the infallible signs. The mother declared it +could not be true of her boy. About five months before, their family +physician had said of the child's earache, "The same inflammation of +the nasal passages that causes earache causes adenoids; you must be on +the lookout." Although in the country, the boy's appetite was not good +and his zest for play had flagged. They had looked for the trouble to +back generations and in psychology books,—everywhere but at the boy's +face, in his mouth, and in his nose. After the operation, which took +less than two minutes, the appetite was <span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span>ravenous, the eyes cleared, +and the spirit rebounded to its old buoyancy that craved worlds to +conquer.</p> + +<p>The new personal experience made a deep impression upon my friend's +mind. He wanted everybody to know how easy it was to overlook a +child's distress. One person after another had a story to tell him; +even the janitor said: "You'd ought to have seen our John at sixteen. +He spent a week by the hospital." The only people who do not seem to +know more than the new convert are the mouth breathers whom he +religiously stops on the street.</p> + +<p>The indexes to adenoids and large tonsils for the teacher to read at +school are:</p> + +<br /> + +<div class="block"><p>1. Inability to breathe through the nose.</p> + +<p>2. A chronically running nose, accompanied by frequent nose-bleeds +and a cough to clear the throat.</p> + +<p>3. Stuffy speech and delayed learning to talk. "Common" is +pronounced "cobbéd"; "nose," "dose"; and "song," "sogg."</p> + +<p>4. A narrow upper jaw and irregular crowding of the teeth.</p> + +<p>5. Deafness.</p> + +<p>6. Chorea or nervousness.</p> + +<p>7. Inflamed eyes and conjunctivitis.</p></div> + +<br /> + +<p>The adenoids and large tonsils discovered at school are an index:</p> + +<br /> + +<div class="block"><p>1. To children needlessly handicapped in school work.</p> + +<p>2. To teachers needlessly burdened.</p> + +<p>3. To whole classes held back by afflicted children.</p> + +<p>4. To breeding grounds for disease.</p> + +<p>5. To homes where children's diseases and tuberculosis are most +likely to break out and flourish.</p> + +<p>6. To parents who need instruction in their duty to their +children, to themselves, and to their neighbors, and who are +ignorant of the way in which "catching" diseases originate and +spread.</p></div> + +<br /> + +<p>The riot that occurred when the adenoids of children in a school on +the "East Side" in New York City were <span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span>removed without the preliminary +of convincing the parents as to the advantages of the operation was +merely a demand for the "right to knowledge," which is never +overlooked with impunity. Reluctance to permit operation on a young +child, and the natural shrinking of a parent at seeing a child under +the surgeon's knife, require the teacher or school physician or nurse +to answer fully the usual questions of the hesitant mother and father.</p> + +<p>1. Is the operation necessary? Will the child not outgrow its +adenoids? Usually the adenoid growths atrophy or dry up after the age +of puberty. Adenoids are not uncommon in adults, however. The surgeon +general of the army reports that during the year 1905, out of 3004 +operations on officers and enlisted men in service, there were 225 +operations on the nose, mouth, and pharynx, 103 of which were +operations for adenoids and enlarged or hypertrophied tonsils. +Allowing the child to "outgrow" adenoids may mean not only that he is +being subjected to infection chronically but that his body is allowed +to be permanently deformed and his health endangered. Beginning at the +age of the second dentition, the bones of jaw, nose, throat, and chest +are undergoing important changes—nasal occlusion. Adenoids left to +atrophy—if large enough to cause mouth breathing—may mean atrophy of +this developing process, permanent disfiguration of face, and +permanent deformity of chest and lungs.</p> + +<p>2. Will the growth recur? In a few cases it does recur; frequently +either because it was not desirable to make a complete removal of the +adenoid tissue or because the surgeon was careless. If the growths do +recur, then they must be removed again.</p> + +<p>3. Is the operation a dangerous one?</p> + +<p>4. Is an anæsthetic necessary?</p> + +<p>5. Will the operation cure the child of all its troubles? These +questions are best answered by the process and <span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span>results of an "adenoid +party," which was given especially for the benefit of this book, every +step and symptom of which were carefully studied.</p> + +<p>The seven children pictured here were discovered by their school +physician to have moderately large adenoid growths,—one boy having +enlarged tonsils also.</p> + +<div class="img"> +<a href="images/imagep055.jpg"> +<img border="0" src="images/imagep055.jpg" width="80%" alt="Mouth Breathers Immediately After "Adenoid Party"" /></a><br /> +<p class="cen" style="margin-top: .2em;">MOUTH BREATHERS IMMEDIATELY AFTER "ADENOID PARTY"</p> +</div> + +<p>The picture on page 46 was taken by flash light at 2.30 <span class="fakesc">P.M.</span>, +January 15, 1908. At 3 <span class="fakesc">P.M.</span> the principal escorted these +children into the operating room at Vanderbilt Clinic. The doctor +examined the throat and nose of each child, entered the name and age +of each, together with his diagnosis, on a clinic card, sending each +child into the next room after examination. He then called the first +boy and explained that it would hurt, but that it would be over in a +minute. The principal stood by and told him to be brave and remember +the five cents he could have for ice cream afterwards. The clinic +nurse tied a large towel about him and put him in her lap; with one +hand she held his clasped hands, while the other held his head back. +The doctor then took the little instrument—the curette—and pushed it +up back of the soft palate, and with one twist <span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span>brought out the +offending spongy lump. The boy's head was immediately held over a +basin of running water. He was so occupied with spitting out the blood +that rushed down to choke him that he hadn't time to cry before the +acute pain had ceased. The rush of cool air through his nostrils was +such a pleasurable sensation that he smiled as the school nurse +escorted him out into the hall to wait for his companions. At 3.30 +<span class="fakesc">P.M.</span> all seven children were out in the hall, all seven +mouths were closed, and all seven faces were clothed with the sleepy, +peaceful expression that comes with rest from the prolonged labor of +trying to get enough air. At 3.45 <span class="fakesc">P.M.</span> they had been all +reëxamined by the doctor, and a few tag ends were picked out of the +nasopharynx of one child. At 4 <span class="fakesc">P.M.</span> the "party" had returned +to the Children's Aid Society's school and to the ice cream that +follows each adenoid party.</p> + +<p>It is worth while to tell mothers stories of the "marvelous +improvement in school progress of those children whose brains have +been poisoned and starved by the accursed adenoid growths, and how +their bodies fairly bloom when the mysterious and awful incubus is +removed," to use the words of one school principal. It is worth while +to show them "before" and "after" pictures, and "before" and "after" +children, and "before" and "after" school marks.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_VI" id="CHAPTER_VI"></a><hr /> +<span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span><br /> + +<h3>CHAPTER VI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>CATCHING DISEASES, COLDS, DISEASED GLANDS</h4> +<br /> + +<p>Deadly fevers, the plague, black death, cholera, malaria, smallpox, +taught mankind invaluable lessons. Millions of human beings died +before the mind of man devoted itself to preventing the diseases for +which no sure cure had been found. Efforts to conquer these diseases +were tardy because men were taught that some unseen power was +punishing men and governments for their sins. The difference between +the old and the new way is shown powerfully by a painting in the +Liverpool Gallery entitled "The Plague." A mediæval village is strewn +with the dead and dying. Bloated, spotted faces look into the eyes of +ghouls as laces and jewelry are torn from bodies not yet cold. In the +foreground a muscular giant, paragon of conscious virtue, clad like +John the Baptist and Bible in hand, finds his way among his +plague-stricken fellow-townsmen, urging them to turn from their sins. +Modern efficiency learns of the first outbreak of the plague, isolates +the patient, kills rats and their fleas which spread the disease, +thoroughly cleanses or destroys, if necessary, all infected clothing, +bedding, floors, and walls, and makes it possible for us to go on +living for each other with a better chance of "bringing forth fruits +worthy for repentance."</p> + +<p>Where boards of health make it compulsory to report cases of sickness +due to contagion, health records are a reliable index to "catching" +diseases. But now that the chief infection is the kind that afflicts +children, we can read the index before the outbreak that calls in a +physician to diagnose the case. School examination shows which +<span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span>children have defects that welcome and encourage disease germs. It +points to homes that cultivate germs, and consequently menace other +homes. To locate children who have enlarged tonsils may prevent a +diphtheria epidemic. To detect in September those who are +undernourished, who have bad teeth, and who breathe through the mouth +will help forecast winter's outbreaks of scarlet fever and measles. +One dollar spent at this season in examination for soil hospitable to +disease germs may save fifty dollars otherwise necessary for +inspection and cure of contagious diseases.</p> + +<p>It is harder at first to interest a community in medical examination +than in medical inspection, because we are all afraid of "catching" +diseases, while few of us know how they originate and how they can be +prevented by correcting the unfavorable conditions which physical +examination of school children will bring to light.</p> + +<p>Courses in germ sociology are therefore of prime necessity. How do +germs act? On what do they live? Why do they move from place to place? +What causes them to become extinct? With few exceptions, germs migrate +for the same reason as man,—search for food, love of conquest, and +love of adventure. When there is plenty of food they multiply rapidly. +Full of life, overflowing with vitality, they move out for new worlds +to conquer. Like human beings, they will do their best to get away +from a country that provides a scanty food supply. Like men and women, +they starve if they cannot eat. Like boys and girls, they avoid +enemies; the weak give way to the strong, the slow to the swift, the +devitalized to the vitalized.</p> + +<p>Human sociology imprisons, puts to death, deprives of opportunity to +do evil, or reforms those who murder, steal, or slander. Germ +sociology teaches us to do the same with injurious germs. We imprison +them, we take away their food supply, we kill them outright, or we +starve them slowly. They have a peculiar diet, being especially +<span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span>partial to decomposing vegetable and animal matter and to what human +beings call dirt. By putting this diet out of their reach we make it +impossible for them to propagate their kind. By placing poison within +their reach or by forcing it upon them we can successfully eliminate +them as enemies. As the president of Mexico restored order "by setting +a thief to catch a thief," so modern science is setting germs to kill +germs that harm crops and human stock. Of utmost consequence is it +that the body's germ consumer—its pretorian guard—be always armed +with vitality ready to vanquish every intruding hostile germ. If we +are false to our guard, it will turn traitor and join invaders in +attacking us. But here, as in dealing with evils that originate with +human beings, an ounce of prevention is worth a ton of cure. The most +effectual way to eliminate germ diseases is to remove the cause—the +food supply of disease germs. The fact that many germs are plants, not +animals, does not weaken the analogy, for weeds do not get a chance in +well-tilled soil.</p> + +<p>Perhaps the most notable recent example of government germ +extermination is the triumph over the yellow-fever and malaria +mosquito in Panama. When the French started to build a canal in +Panama, the first thing they did was to build a hospital. The hospital +was always full and the canal was given up. At the time the United +States proposed to re-attempt the work, it was thought that it could +not be done without great loss of life and without great labor +difficulties. Instead of taking the sickness for granted and enlarging +the French hospital, the chief medical inspector, Gorgas, took for +granted that there need be no unusual sickness if proper preventive +measures were taken. He knew what the French had not known, that the +yellow-fever scourge depends for its terrors upon mosquitoes. +Accordingly, with the aid of six thousand men and five million dollars +he set about to starve <span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span>out the few infected and infectious kinds of +mosquito,—the yellow-fever or house mosquito and the malaria or +meadow mosquito. He introduced waterworks and hydrants, paved the +streets, drained the swamps and pools in which they breed, and +instituted a weekly house-to-house inspection to prevent even so much +as a pail of stagnant water offering harbor to these enemies. The +grass of the meadows where the malaria mosquito breeds was cut short +and kept short within three hundred feet of dwellers,—as far as the +mosquito can fly. All ditches were disinfected with paraffin, and the +natives were forced to observe sanitary laws. President Roosevelt, in +his special message to Congress on the Panama Canal in 1906, stated +that in the weekly house-to-house visit of the inspectors at the time +he was in Panama but two mosquitoes were found. These were not of the +dangerous type. As a consequence of this sanitary engineering there is +very little sickness in Panama, the hospital is seldom one third full, +and the canal is progressing very much faster than was expected. +Panama, like Havana, is now safer than many American cities, because +cleaner and less hospitable to disease germs.</p> + +<p>Any place where numbers of people are accustomed to assemble favors +the propagation of germs,—whether it be the meetinghouse, the +townhall, the theater, or the school. Every teacher can be the +sanitary engineer of her own schoolroom, school, or community by +coöperating with the school doctor, the town board of health, family +physicians, and mothers. Every teacher can exterminate disease by +applying the very same principles to her schoolroom as Chief Medical +Inspector Gorgas applied to Panama. Knowledge, disinfection, absolute +cleanliness, education, and inspection are the essential steps. First +she must know that "children's diseases" are not necessary. She should +discountenance the old superstition that every child <span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span>must run the +gamut of children's diseases, that every child must sooner or later +have whooping cough, measles, chicken pox, mumps, scarlet fever, just +as they used to think yellow fever and cholera inevitable. The price +of this terrible ignorance has been not only expense, loss of time, +acquisition of permanent physical defects, and loss of vitality, but, +for the majority of children, death before reaching five years of age. +All these "catching" diseases are germ diseases, which disinfection +can eliminate. The free use of strong yellow soap and disinfectants on +the school floor, windows, benches, desks, blackboards, pencils, in +the coat closets and toilets, plus the natural disinfectants, hot sun +and oxygen, will prevent the schoolroom from being a source of danger. +One or more of these germ-killing remedies must be constantly applied; +cleansing deserves a larger part in every school budget.</p> + +<p>Often country towns are as ignorant of the existence of germs and of +the means of preventing the spread of disease as the woman in a small +country town who used daily to astound the neighbors by the "shower of +snow" she produced by shaking the bedding of her sick child out of the +window. Their astonishment was soon changed to panic when that shower +of snow resulted in a deadly epidemic of scarlet fever. Medical +inspection of New York City's schools was begun after an epidemic of +scarlet fever was traced to a popular boy who passed around among his +schoolmates long rolls of skin from his fingers.</p> + +<p>Much of the care exercised at school to prevent children's diseases is +counteracted because children are exposed at home and in public places +to contagion, where ignorance more often than carelessness is the +cause of uncleanliness. By hygiene lessons, illustrating practically +the proper methods of cleaning a room, much may be done to enlist +school children in the battle against germs. Through the enthusiasm of +the children as well as through <span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span>visits to the homes parents may be +instructed as to the danger of letting well children sleep with sick +children; the wisdom of vaccination to prevent smallpox, of antitoxin +to prevent serious diphtheria, of tuberculin tests to settle the +question whether tuberculosis is present; why anything that gathers +dust is dangerous unless cleansed and aired properly; and why bedding, +furniture, floor coverings, and curtains that can be cleansed and +aired are more beautiful and more safe than carpets, feather beds, +upholstery, and curtains that are spoiled by water and sunshine; how +to care for the tuberculous member of the family, etc. Anti-social +acts may be prevented, such as carrying an infected child to the +doctor in a public conveyance, thereby infecting numberless other +people; sending infected linen to a common laundry; mailing a letter +written by an infected person without first disinfecting it; sending a +child with diphtheria to the store; returning to the dairy unscalded +milk bottles from a sick room.</p> + +<p>The daily inspection of school children for contagious diseases by the +school physician has, where tried, been found to reduce considerably +the amount of sickness in a town. Such inspection should be +universally adopted. Moreover, the teacher should be conversant with +the early symptoms of these diseases so that on the slightest +suspicion the child may be sent home without waiting for the +physician's call. Like the little girl who never stuttered except when +she talked, school children and school-teachers are rarely frightened +until too late to prevent trouble. The "easy" diseases such as +measles, whooping cough, etc., cost our communities more than the more +terrible diseases like typhoid and smallpox. During one typical week +ending May 18, 630 new cases of measles were reported to one +department of health. Obviously the nineteen deaths reported give no +conception of the suffering, the cost, the anxiety caused by this +preventable disease. The same <span class='pagenum'><a name="Page_63" id="Page_63">[63]</a></span>may be said of diphtheria and croup, of +which only thirty-two deaths are reported, but 306 cases of sickness. +Yet no one to-day will send a child to sleep with a playmate so as to +catch diphtheria and "be done with it."</p> + +<p>The most strategic point of attack is almost universally unrecognized. +That is the child's mouth. Here the germs find lodgment, here they +find a culture medium—at the gateway of the human system. The mouth +is never out of service and is almost never in a state of true +cleanliness. Solid particles from the breath, saliva, food between the +teeth, and other débris form a deposit on the teeth and decompose in a +constant temperature of ninety-eight degrees Fahrenheit. In the normal +mouth from eight to twenty years of age the teeth present from twenty +to thirty square inches of dentate surface, constantly exposed to +ever-changing, often inimical, conditions. This bacterially infected +surface makes a fairly large garden plot. Every cavity adds to the +germ-nourishing soil. Dental caries—tooth decay—is a disease +hitherto almost universal from birth to death. Thus the air taken in +through the mouth becomes a purveyor of its poisonous emanations and +affects the lung tissues and the blood. Food and water carry hostile +germs down into the stomach. Thence they may be carried into any organ +or tissue, just as nourishment or poison is carried.</p> + +<p>Moreover, the child with an unclean mouth not only infects and +reinfects himself but scatters germs in the air whenever he sneezes or +coughs. In a cold apartment where there is no appreciable current of +air a person can scatter germs for a distance of more than twenty-two +feet. Germs are also scattered through the air by means of salivary or +mucous droplets. It is this fact that makes colds so dangerous.</p> + +<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span><br /> + +<p class="cen sc">Table VIII</p> + +<p class="cen"><b>City of Manchester Education Committee</b></p> + +<h3>INFECTIOUS OR CONTAGIOUS DISEASES IN SCHOOLS INFORMATION FOR +TEACHERS</h3> + +<div class="block"><p>Four columns are omitted: (1) Interval between Exposure to +Infection and the First Signs of the Disease; (2) Day from Onset +of Illness on which Rash appears; (3) Period of Exclusion from +School after Exposure to Infection; (4) Period of Exclusion from +School of Person suffering from the Disease</p></div> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="95%" summary="Table 8: Infectious or Contagious Diseases in Schools Information For Teachers"> + <tr> + <td width="10%" class="tdctrb"><i>DISEASE</i></td> + <td width="35%" class="tdctrlb"><i>PRINCIPAL SIGNS AND SYMPTOMS</i></td> + <td width="20%" class="tdctrlb"><i>Method of Infection</i></td> + <td width="35%" class="tdctlb"><i>REMARKS</i></td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Measles</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;"><i>Begins like cold in the head</i>, with + <i>feverishness, running nose, inflamed and watery eyes, and sneezing</i>; small crescentic groups of + <i>mulberry-tinted spots</i> appear about the third day; <i>rash first seen on forehead and face</i>. + The rash varies with heat; may almost disappear if the air is cold, and come out again with warmth.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges from nose and mouth.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">After effects often severe. Period of greatest + risk of infection first three or four days, before the rash appears. May have repeated attacks. Great + variation in type of disease.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">German Measles</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Illness usually slight. Onset + sudden. <i>Rash often first thing noticed;</i> no cold in head. Usually have <i>feverishness</i> and + <i>sore throat</i>, and the <i>eyes may be inflamed. Rash</i> something between Measles and Scarlet + Fever, variable.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges from nose + and mouth</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">After effects slight.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Chicken Pox</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Sometimes begins with feverishness, + but is <i>usually very mild</i> and without sign of fever. <i>Rash</i> appears on second day as <i>small pimples</i>, + which in about a day become filled with <i>clear fluid</i>. This fluid then becomes <i>matter</i>, and then the <i>spot + dries up</i>and <i>the crust falls off</i>.<br /><br /> + May have <i>successive crops of of rash</i> until tenth day.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and crust of spots.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">When children return, examine head for + overlooked spots. All spots should have disappeared before child returns. A mild disease and seldom any after + effects.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Whooping Cough</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;"><i>Begins like cold in the + head</i>, with <i>bronchitis</i> and <i>sore throat</i>, and a <i>cough</i> which is <i>worse at night</i>. + Symptoms may at first be very mild. Characteristic <i>"whooping" cough</i> develops in about a fortnight, + and the spasm of coughing often ends with <i>vomiting</i>.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges + from nose and mouth.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">After effects often very severe + and the disease causes great debility. Relapses are apt to occur. Second attack rare. Specially infectious for + first week or two. If a child is sick after a bout of coughing, it is most probably suffering from whooping cough. + <br /><br />Great variation in type of disease.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Mumps</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Onset may be sudden, beginning + with sickness and fever, and <i>pain about the angle of the jaw</i>. The <i>glands become swollen and + tender</i>, and the <i>jaws stiff</i>, and the <i>saliva sticky</i>.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges from nose + and mouth.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">Seldom leaves after effects. + Very infectious.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Scarlet + Fever or Scarlatina<span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span></td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">The <i>onset is usually + sudden</i>, with <i>headache, languor, feverishness, sore throat</i>, and often the child is <i>sick</i>. + Usually within twenty-four hours the <i>rash</i> appears, and is <i>finely spotted, evenly diffused</i>, + and <i>bright red</i>. The <i>rash</i> is seen first on the <i>neck and upper part of chest</i>, and + lasts three to ten days, when it fades and the <i>skin peels in scales, flakes</i>, or even <i>large + pieces</i>. The <i>tongue</i> becomes whitish, with bright red spots. The eyes are not watery or congested.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath, discharges from nose + and mouth, particles of skin, and discharges from suppuratory glands or ears. Milk specially apt to + convey infection.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">Dangerous both during attack + and from after effects. Great variation in type of disease. Slight attacks as infectious as severe ones. + Many mild cases not diagnosed and many concealed. The peeling may last six to eight weeks. A second attack + is rare. When scarlet fever is occurring in a school, all cases of sore throat should be sent home.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Diphtheria</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Onset insidious, may be rapid + or gradual. Typically <i>sore throat</i>, great weakness, and swelling of glands in the neck, about the + angle of the jaw. The back of the throat, tonsils, or palate may show <i>patches</i> like pieces of + yellowish-white kid. The most pronounced symptom is great debility and lassitude, and there may be little + else noticeable. There may be hardly any symptoms at all.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges + from nose, mouth, and ears.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">Very dangerous both during + attack and from after effects. When diphtheria is occurring in a school all children suffering from sore + throat should be excluded. There is great variation of type, and mild cases are often not recognized + but are as infectious as severe cases. There is no immunity from further attacks. Fact of existence + of disease sometimes concealed.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em;">Influenza</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;"><i>Begins with feverishness, + pain in head, back</i>, and <i>limbs</i>, and usually <i>cold in the head</i>.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em;">Breath and discharges + from nose and mouth.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em;">Excessively infectious. After + effects often very serious and accompanied with great prostration and nervous debility.</td> + </tr> + <tr> + <td class="tdl vat" style="border-right: 1px solid black; border-top: 1px solid black; border-bottom: 1px solid black; padding: .5em; border-bottom: 2px solid black;">Smallpox</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em; border-bottom: 2px solid black;">The illness is usually well + marked and the onset rather sudden, with <i>feverishness, severe backache, and sickness</i>. About third + day a <i>red rash</i> of <i>shotlike pimples</i>, felt below the skin, and seen first about the <i>face</i> + and <i>wrists. Spots develop</i> in <i>two days</i>, then form <i>little blisters</i>, and in other two + days become <i>yellowish</i> and filled with matter. <i>Scabs</i> then form, and these fall off about + the fourteenth day.</td> + <td class="tdlrlb vat" style="border-top: 1px solid black; padding-top: .5em; border-bottom: 2px solid black;">Breath, all discharges, + and particles of skin or scabs.</td> + <td class="tdllb vat" style="border-top: 1px solid black; padding-top: .5em; border-bottom: 2px solid black;">Peculiarly infectious. When + smallpox occurs in connection with a school or with any of the children's homes, an endeavor + should be made to have all persons over seven years of age revaccinated. <br /><br /> Cases of modified + smallpox—in vaccinated persons—may be, and often are, so slight as to escape detection. + Fact of existence of disease may be concealed. Mild or modified infectious as severe type.</td> + </tr> +</table> +</div> + +<h4>In the following diseases only the affected child is excluded</h4> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="In the following diseases only the affected child is excluded"> + <tr> + <td width="50%" class="tdlr"><b>Erysipelas.</b> Child should not return till all swelling and + peeling of skin has disappeared.</td> + <td width="50%" class="tdll" style="padding-left: 1em;"><b>Ringworm on Scalp.</b> Child should be excluded till cured. Very + difficult to cure and often takes a very long time.</td> + </tr> + <tr> + <td class="tdlr"><b>Ophthalmia.</b> Child should not return till all traces have disappeared.</td> + <td class="tdll" rowspan="2" style="padding-left: 1em;"><b>Phthisis</b> (<b>Consumption</b>). If in advanced stage and coughing much + <i>or spitting</i>, child should be excluded. (Infection from breath and dried spit floating in the + air as dust.)</td> + </tr> + <tr> + <td class="tdlr"><b>Scabies or Itch.</b> Child should be excluded until cured.</td> + </tr> + <tr> + <td class="tdlr"><b>Ringworm on Skin.</b> Child should be excluded till cured. This takes + only a few days if properly treated.</td> + <td class="tdll" style="padding-left: 1em;"><b>Impetigo</b> (<b>Contagious Sore</b>). Child should be excluded until + cured. A week or ten days should suffice.</td> + </tr> + <tr> + <td colspan="2" class="tdr" style="padding-top: 1em;"><b>A. BROWN RITCHIE</b>, <i>Medical Officer to Education Committee</i>.</td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p><span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span>Most people still think that colds are due to cold air or draughts +rather than to a cold germ, which finds a body unequipped with +resisting power, with its germ police off guard, exhausted from +overwork, or disaffected and ready to turn traitor if the enemy seems +stronger than our vitality. Sometimes it seems as if we contracted it +from a sneezing fellow-passenger, sometimes from a draught from an +open car window. An uninformed opponent of the theory that colds are a +germ disease wrote the following letter last winter to a New York +newspaper:</p> + +<div class="block"><p>In addition to the Society for the Suppression of Noises there +should be in this town a Society for the Suppression of +"Fresh-Air" Fiends. The newspapers report an epidemic of +pneumonia, grippe, and colds. It is almost entirely due to the +fact that the average New Yorker is compelled to live, move, and +have his being from daylight to midnight in a succession of +draughts of cold air caused by the insanity of overfed male and +female hogs, who, with blood almost bursting through their skins, +demand "fresh air" in order to keep from suffocating. Everywhere a +man goes, day or night, he is in a draught caused by the crazy +ideas about fresh air.</p> + +<p>Our wise ancestors, who as a rule lived much longer than we do, +and had much better health, said:</p></div> + +<div class="poem"><div class="stanza"> +<span class="i0">"If the wind should blow through a hole,<br /></span> +<span class="i0">God have mercy on your soul."<br /></span> +</div></div> + +<p>After the correspondent has learned that our ancestors had more colds +than we, had poorer health, and died twenty years younger, perhaps he +will listen to proof that his unclean warm air weakens the body and +makes it an easy prey to cold germs.</p> + +<p>Many physicians preach and practice this fallacy as to fresh air and +colds, but few physicians now deny that influenza is a germ disease or +that a nose so irritated and so neglected as to secrete large +quantities of mucus is a better place for breeding disease germs than +a nose whose membranes are clean and not thus irritated.</p> + +<p><span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span>Until medical specialists are agreed, and until they have definitely +located the cold germ, we laymen must choose for ourselves a working +theory. The weight of opinion at the present time declares that colds +are due to germs. Strong membranes with good circulation and drainage +provide poor food for germs. Congested membranes furnish proper +conditions for propagation. The germ theory explains the spread of +germs from the nose to the passages of the head, and from head to +arteries and lungs.</p> + +<p>A cold can always be charged to some one else. How many can be laid to +our account? There is one right that is universally not recognized, +and that is the right of protection from the germs showered in the air +we breathe, over the food we eat, by the sneezes of our unfortunate +neighbor at school, in the street car, at the restaurant. The chief +danger of a cold is to our neighbor, not to ourselves. A cold which a +strong person may throw off in a day or two may mean death to his +tuberculous neighbor. Though for our own health "lying up for a mere +cold" is an unnecessary bore, the failure to do so may deprive our +neighbor of a right greater than the right to protection against +scarlet fever or smallpox. Though formerly this statement would <span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span>not +have been true, rights change with conditions, and the fact that +to-day the three most deadly diseases are pneumonia, tuberculosis, and +diphtheria,—all diseases of the respiratory organs,—justifies the +assertion that we have a right to protection against colds. The +prevalence of colds, sore throats, irritated vocal cords, bad voices, +catarrh, bronchitis, laryngitis, and asthma in America to-day demands +summary measures. One can learn to sneeze into a handkerchief, not +into a companion's face or into a room. School children can be taught +to avoid handkerchiefs on which mucus has dried. In the far distant +future we may be willing to use cheesecloth, and boil it or throw it +away, or, like the Japanese, use soft paper handkerchiefs and burn +them after using.</p> + +<br /> + +<p class="cen sc">Table IX</p> + +<p class="cen sc">Death Rate per 10,000 Population, Pneumonia and Bronchitis<br /> +Five-Year Period, 1896-1900</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="50%" summary="Death Rate per 10,000 Population"> + <tr> + <td width="50%" class="tdl">England and Wales</td> + <td width="50%" class="tdr">22.70</td> + </tr> + <tr> + <td class="tdl">Scotland</td> + <td class="tdr">27.40</td> + </tr> + <tr> + <td class="tdl">Stockholm</td> + <td class="tdr">26.70</td> + </tr> + <tr> + <td class="tdl">London</td> + <td class="tdr">31.20</td> + </tr> + <tr> + <td class="tdl">Berlin</td> + <td class="tdr">16.10</td> + </tr> + <tr> + <td class="tdl">Vienna</td> + <td class="tdr">39.70</td> + </tr> + <tr> + <td class="tdl">Christiania</td> + <td class="tdr">21.30</td> + </tr> + <tr> + <td class="tdl">Boston</td> + <td class="tdr">30.60</td> + </tr> + <tr> + <td class="tdl">Chicago</td> + <td class="tdr">24.20</td> + </tr> + <tr> + <td class="tdl">Philadelphia</td> + <td class="tdr">25.10</td> + </tr> + <tr> + <td class="tdl">New York City</td> + <td class="tdr">36.60</td> + </tr> +</table> +</div> + +<br /> +<br /> + +<p>One child with a cold can infect a whole class or family, thus +depriving the class and family of the top of their vitality and +efficiency without their consent. Because a person is thought a +weakling who lies up for a "mere cold," one is inclined to wish that +colds were as prostrating as typhoid, in which case there would be +some hope of their extermination.</p> + +<p>The exclusion of children with colds from school deserves trial as a +check to children's diseases. Many of these "catching" diseases start +with a cold in the head, as, for instance, measles, influenza, and +whooping cough. The first symptom of mumps, diphtheria, and scarlet +fever is a sore throat or swollen glands, which, because they commonly +accompany a cold, are not at first distinguished from it.</p> + +<p>The first step for the teacher or mother in reading the index for +colds is to look into the coat closet for evidence of warm clothing +and overshoes, then to note whether the children put them on when they +go out for lunch or recess. Whether "cold" settles in the nasal +passages, ear, or stomach depends upon which is the weak spot. +Draughts, <span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span>thin soles, wet soles, exposure when perspiring, may be the +immediate cause of the nutritional or respiratory disturbances that +give cold germs a foothold. Adenoids, diseased teeth, inflamed ears, +may furnish the food supply. "There is no use treating children and +sending them on fresh-air trips as long as they have nutritional and +digestive disturbances due to bad teeth, or colds due to adenoids," +said a physician when examining a party of children for a summer +outing. The great preventive measure to be taken for catching +diseases, colds, diseased glands,—in fact all germ diseases,—is the +repeated cleansing of those portions of the human body in which germs +may find lodgment,—the mouth, the nose, the eyes, and the ears.</p> + +<p>In caring for young infants great pains is taken to cleanse all the +orifices daily, but as soon as the child washes himself this practice +is usually abandoned. Washing these gateways is far more important +than washing the surface of the body through which germs could not +possibly gain entrance into the system except through wounds. +Oftentimes the douching of the nostrils with salt water will stop a +cold at once. The mouth is the most important place of all, and the +teacher should take care of her pupils' mouths first and foremost. As +bad teeth, enlarged tonsils, and adenoids harbor germs and putrescent +matter that vitiate every incoming and outgoing breath, these defects +should be immediately corrected. Are we coming to a time when a +thorough house-cleaning in the mouth of every child will take place +before he enters the schoolroom, preferably in the presence of the +teacher?</p> + +<p>Two other "catching" diseases cause city schools a great deal of +trouble,—trachoma and pediculosis (head lice). There are probably no +two diseases more quickly transmitted from one person to another. +Almost before their presence is known, all children of a school or +all <span class='pagenum'><a name="Page_70" id="Page_70">[70]</a></span>persons of a group have contracted them. When at college twenty +men of my fraternity discovered almost at the same time that they had +an infectious eye trouble; yet we thought we were using different +towels and otherwise taking sanitary precautions. Last summer a Vassar +graduate took a party of tenement children for a country picnic. She +returned with head lice that required constant attention for weeks. +What then may we expect of children who live in homes where there is +neither water, time, nor privacy for bathing, where one towel must +serve a family of six, where mothers work for wages away from home and +see their children only before seven and after six?</p> + +<p>Unfortunately for thousands of children, many parents still believe +these troubles will be outgrown. Last summer a fresh-air agency in New +York City arranged for several hundred school girls to go to a certain +camp for ten days each. The only condition was that the heads should +be free from lice and nits (eggs). From the list furnished by +school-teachers—girls supposed to have been cured by school +nurses—not one in five was accepted. A baby two weeks old, brought to +Caroline Rest, had already begun to suffer from this easily +preventable scourge. Of 1219 children examined in Edinburgh, Scotland, +909, or 69 per cent, had some skin disease, and 60 per cent had sores +due to head lice. Even when neglect has caused the loss of hair and +ugly sores on the head, mothers deceive themselves into believing that +some other cause is responsible.</p> + +<p>Trachoma, if neglected, not only impairs the health of the eye, but +may cause blindness. Tears carry the germs from the eye to the face, +where they are taken up on handkerchiefs, towels, and fingers and +infect other eyes. Of late, thanks to school nurses and physicians and +hygiene instruction, American cities have found relatively little +trachoma except among recent immigrants. So dangerous is the germ and +so insidious its methods of propagation, <span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span>that a physician should be +summoned at once at the first sign of inflammation. Conjunctivitis is +due to a germ, and will spread unless checked. Since the board of +health of New York City has instituted the systematic examination of +the eyes of the children in the public schools, it has found fully one +third affected with some form of conjunctivitis. Many of these cases +are out-and-out trachoma, others acute conjunctivitis, and a larger +proportion are "mild trachoma." This last form of the disease is found +to a great extent among children who have adenoids. The adenoids +should be regarded as a predisposing factor rather than a direct +cause. Therefore sore eyes are given as one of the indexes of +adenoids. When we consider that adenoids are made up of lymphoid +material, and that trachoma follicles are made up of the same sort of +tissue, it is not surprising that the two conditions are found in the +same child. The catarrhal inflammation produced by adenoids in the +nasal mucous membrane travels up the lachrymal duct and thus infects +the conjunctiva by contiguity.</p> + +<p>In preventing pediculosis and infection of the eye vigilance and +cleanliness are indispensable. After the diseases are advanced, after +the germ colonies have taken title, some antiseptic or germ killer +more violent than water is needed,—kerosene for the hair or strong +green oil soap; for the eye, only what a physician prescribes.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_VII" id="CHAPTER_VII"></a><hr /> +<span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span><br /> + +<h3>CHAPTER VII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>EYE STRAIN</h4> +<br /> + +<p>Wherever school children's eyes have been examined, from six to nine +out of thirty are found to be nearsighted, farsighted, or otherwise in +need of attention. A child is dismissed from school for obstinately +declaring that the letter between <i>c</i> and <i>t</i> in "cat" is an <i>o</i>; "a +pupil in her fourth school year was recently brought to me by her +teacher with the statement that she did unreasonably poor work in +reading for an intelligent and willing child;" a boy is punished for +being backward. These three cases are typical. Examinations showed +that the first child was astigmatic and not obstinate; the boy had run +a pin into one eye ten years before and destroyed its sight; while the +second girl was found to be afflicted with diplopia, and in a friendly +chat told the following story: "I very often see two words where there +is only one. When I was a very little girl I used to write every word +twice. Then I was scolded for being careless. <i>So I learned that I +must not say two words even when I saw them.</i>" As Miss Alida S. +Williams, principal of Public School 33 in New York City, has in many +articles and addresses freely illustrated from school experience, the +art of seeing is acquired, not congenital, and every human being who +possesses it has learned it.</p> + +<p>The large proportion of children suffering more or less seriously from +eye trouble has led many persons to suggest physical deterioration as +the cause. Eye specialists, however, assure us that eye troubles are +probably as old as man. Our tardiness in learning the facts regarding +these <span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span>troubles is due in part to the lack, until recently, of +instruments for examining the eye and for manufacturing glasses to +correct eye defects; in part, also, to the tendency of the medical +profession, which I shall repeatedly mention, to explain disorders by +causes remote and hard to find rather than by those near at hand.</p> + +<p>About 1870 Dr. S. Weir Mitchell's attention was called "to the marked +relief of headache, insomnia, and other reflex symptoms following the +correction of optical defects by glasses." In 1874 and 1876 he wrote +two articles that "impressed upon the general profession the grave +significance of eye strain." Since that time, "in Philadelphia at +least, no study of the rebellious cause of headache or of the obscure +nervous diseases has ever been considered complete until a careful +examination of the eyes has included them as a possible cause of the +disturbance."</p> + +<p>The new fact, therefore, is not weak eyes or strained eyes, but rather +(1) an increase in the regular misuse of eyes by school children, +seamstresses, stenographers, lawyers, etc.; and (2) the incipient +propaganda growing out of school tests that show the relation of eye +strain to headache, nervous diseases, stomach disorder, truancy, +backwardness.</p> + +<p>Every school, private and parochial as well as public, should supply +itself with the Snellen card for testing eyes. Employers would do well +to have these cards in evidence also, for they may greatly increase +profits by decreasing inefficiency and risks. If there is no expert +optician near, apply for cards to your health board or school board; +failing there, write to your state health and school boards. In many +states rural teachers are already supplied with these cards by state +boards. In October, 1907, the New York state board of health sent out +cards, with instructions for their use, to 446 incorporated towns. The +state commissioner of education also sent a letter giving school +reasons for using the cards. Results from 415 schools having <span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span>shown +that nearly half the children had optical defects, it is proposed to +secure state legislation that will make eye tests obligatory in all +schools. Such a test in Massachusetts recently discovered twenty-two +per cent of the school children with defective vision, and from forty +to fifty thousand in need of immediate care by specialists.</p> + +<div class="img"> +<a href="images/imagep074.jpg"> +<img border="0" src="images/imagep074.jpg" width="75%" alt="Positions Often Suggest Eye Strain" /></a><br /> +<p class="cen" style="margin-top: .2em;">POSITIONS OFTEN SUGGEST EYE STRAIN</p> +</div> + +<p>Of course eye specialists,—oculists,—if skillful, know more about +eyes and eye troubles than general medical practitioners or teachers. +Preliminary eye tests, however, may be made by any accurate person who +can read. The Massachusetts state board of health reports that tests +made by teachers were "not less efficient" than tests made by +specialists. In June, 1907, a group of eminent oculists recommended to +the school board of New York <span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span>City that teachers make this first test +after being instructed by oculists. Persons interested in the schools +nearest them can quickly interest teachers and pupils by starting +tests with this card. In cities oculists can be found who will be glad +to explain to teachers, individually or in groups, how the cards +should be used and what dangers to avoid.</p> + +<p>Nature intended the human eye to read the last line of this card at a +distance of ten feet. This conclusion is not a guess, but is based +upon the examination of thousands of eyes. In making the test, the +number of feet the eye ought to see is written as the denominator of +the fraction; the distance the eye can see clearly is the numerator. +If the child's card reads, "Right eye 10/10, left eye 10/20," it means +that the right eye sees without conscious strain the distance it is +intended to see, while the left eye must be within ten feet to see +what it ought to see twenty feet away.</p> + +<p>The practical steps for a teacher to take in making eye tests are:</p> + +<div class="block"><p>1. Scrutinize the faces for a strained or worried expression while +reading or writing, for squint eyes, for unnatural positions, and +for improper distances (more or less than nine inches) from eye to +book.</p> + +<p>2. Select for first tests the children who obviously need +attention and will be obviously benefited. Use the eye test to +help trace the cause of headaches, nervousness, inattention.</p> + +<p>3. Let the children mark off the distances with a foot rule and +chalk, going as high as twenty. Be sure to get the best light in +the room.</p> + +<p>4. Start all children on the ten-foot line. If a child cannot read +at ten feet the letter which should be seen at that distance, move +the child forward, have it step forward and backward, and note the +result carefully. It is better to have ten separate letters of +exactly the right size and the same size than a row of letters on +one card, as in the Snellen test, otherwise memory will aid the +eye, or, as happened recently, a whole class may agree to feign +remarkable <span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span>nearsightedness or farsightedness by confusing letters +learned in advance from the card. If the Snellen card is used, and +if it is more convenient to have both child and card stationary, +satisfactory results will be obtained by having the child read +from large letters down as far as he can see.</p> + +<p>5. Have the child read from right to left, from left to right, or +skip about so that memory cannot aid the eye.</p> + +<p>6. Test each eye separately. I was twenty-five years old before I +learned that my left eye did practically all of the close sight +work. A grown woman discovered just a few days ago that she was +almost blind in the left eye; when she rubbed the right one while +reading she was shocked to find that she could see nothing with +the left eye.</p> + +<p>7. If the card is stationary and the child moved, and if only one +size of the letter is used, put in the denominator the number of +feet at which the normal eye should see clearly, and in the +numerator the distance at which each eye and both together can +easily see. If the regular Snellen card is used containing letters +of different size, place in the denominator the number of the +lowest line each eye and both eyes together can read easily, and +in the numerator the number of feet from card to eye.</p> + +<p>8. Explain the result to the child, to his fellows, to his +parents. If the left eye reads 10/20 and the right eye 10/30, it +means that neither eye is normal, and that reading small type is a +constant strain, even though unnoticed. The right eye must be +within ten feet to read what it should read at twenty feet. The +left eye must be within ten feet to read what it should read at +thirty feet. If the two eyes read at ten, it means that in working +together they successfully strain for a result that is not worth +what it is costing. When eyes thus unconsciously see what they are +not intended to see, it is only a matter of time when stomach and +nervous system will announce that the strain can no longer be +borne. Indigestion, dislike of study, restlessness follow. If, +however, the eyes are so near the normal that their story reads +12/10 or 8/10, the strain will be negligible <i>for the present</i>. +If, on the other hand, the only difficulty is a confusion of <i>x</i> +and <i>z</i> with <i>c</i> and <i>g</i>, it means that there is a strain due to +astigmatism, and that the child should be sent to an oculist.</p> + +<p><span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span>9. Teach children and parents (and practice what you preach) the +urgent importance of periodic reëxamination, just as you would +teach them to visit a dentist twice a year. This is needed by +those who wear eyeglasses, and more particularly by those who have +recently put them on. Moreover, as shown below, it is needed by +children able to pass satisfactorily the Snellen test.</p> + +<p>10. Acquire the habit of reading the eye for evidence of temperate +or intemperate living, sleeping, eating, dancing, drinking, and +smoking. Inflamed eyes are <i>results</i>,—signals of danger. "The +organ may be faultless in construction and in its work poor, +because of nerve exhaustion, or, in a less and more easily +recoverable degree, nerve fatigue." If unusual eye conditions are +not readily explained by mode of living or by eye tests, an +oculist should be consulted.</p></div> + +<p>The limits of the card test must be constantly kept in mind: (1) it +does not register eye sickness due to dust, smoke, or disease germs; +(2) it does not show unconscious eye strain due to successful +accommodation. But it will discover a great part of the children who +most need care. Sooner or later, too, inflammation of the eyelids, due +to external causes, will affect the nerves of the eye and their power +to conceal by accommodation the eye's defects. Just as we +unconsciously open the mouth when a cold stops up the nose, the eye +adapts itself to our needs without our realizing it. We expect it to +see. It sees. If our eyes are not made alike, they do their best to +work together. Like a good team of horses, the slow one hurries, the +fast one holds back a little. But if one eye is 10/15 and the other +10/10, they will both be unnatural and strained if both read the same +type. The effects of this strain frequently upset the stomach before +the eyes rebel. I learned that I needed eyeglasses after a case of +protracted indigestion, first diagnosed as "nervous" and later traced +to eyes. Thousands of upper-grade children and college students are +dieting for stomach trouble that will last until the eyes are relieved +of the undue and unrecognized strain. <span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span>To prove the influence of eye +strain on indigestion, persuade some obstinate parent to wear +improperly focused glasses for a day; she will then be willing to have +her child's eyes attended to.</p> + +<p>It is unfortunate that the eyes will overwork without protesting. For +years many persons suffer without learning that their eyes are unlike, +or, as often happens, that one eye does all the close range work. Even +when being tested, eyes will seem to see easily what requires a great +effort of "accommodation." To prevent this self-deception skilled +oculists do not trust the eye card, but put a drug in the eye that +benumbs the muscles of accommodation. They cannot contract or expand +if they want to. The oculist then studies the length of the eye and +the muscle of accommodation. With this absolute knowledge of how each +eye is made he knows what is wrong, exactly at what angle light enters +the eye, whether objects are focused too soon or too late, exactly +what kind of eyeglasses or what operation upon the eye is needed to +enable it to do its work without undue straining or accommodation. So +unconsciously do the eyes accommodate themselves to the work expected +of them that not infrequently a child with seemingly perfect sight may +be more in need of glasses than the child with imperfect sight. +Practically, however, it is out of the question at the present time to +have the majority of children given a more thorough test than that +provided by the Snellen card. Where eye strains escape this test +teachers will find evidence in complaints of headache, nervousness, +sick stomach, chorea, or even epilepsy. The constant strain may also +cause red or inflamed lids. Parents and teachers must be on the +constant lookout for these symptoms of good sight persisting in spite +of imperfect eyes.</p> + +<p>An epidemic of eyeglasses is usually the consequence of eye tests. So +naturally do we associate eyeglasses with <span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span>eye defects that some +people assert that the eye tests at school originate with opticians +more intent upon selling spectacles than upon helping children. In +fact, even among educators who proclaim the need for eye tests there +has been far more talk of eyeglasses than of removable conditions that +cause eye strain. The women principals of New York City have sounded +an alarm, and urge more attention to light and to reading position, +more rest, more play, more hand work, less home study and less eye +work at school, rather than more eyeglasses to conceal temporarily the +effect of abusing children's eyes. Putting glasses on children without +changing causal conditions is like giving alcohol to consumptives. The +feeling of relief is deceptive. The trouble grows worse.</p> + +<p>For some time to come eye tests will find eye troubles by the +wholesale in every industrial and social class, in country as well as +city schools. In 415 New York villages 48.7 per cent of school +children had defects of vision,—this without testing children under +seven,—while 11.3 per cent had sore eyes.</p> + +<p>There are three possible ways of remedying defects: (1) changing the +eye by operation; (2) changing the light as it enters the eye by +eyeglasses; (3) decreasing the demands made upon the eye. To change +eyes or light requires a technical skill which few physicians as yet +possess. It will be remembered that it is but thirty years since the +medical profession in America first began to understand the relation +of eye defects to other defects. Until a generation of physicians has +been trained by medical colleges to learn the facts about the eye and +to apply scientific remedies, it is especially necessary that teachers +and parents reduce the demands made upon children's eyes; oral can be +substituted for written work, manual for optical work, relaxed and +natural movement for discipline, outdoor exercise for less home study. +Other requirements are <span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span>suitable light and proper position, and +abolition of shiny paper, shiny blackboard, and fine print. Even after +it is easy to obtain the correction of eye defects it will still be +necessary to adapt the demands upon children's eyes to the strength +and shape of those eyes. Because we are born farsighted, nearsighted, +and astigmatic, we must be watchful to eradicate conditions that +aggravate these troubles. Finally, there is no excuse whatever for +permitting the parent of any school child in the United States to +remain ignorant of the fact that it is just as absurd to go to the +druggist or jeweler for eyeglasses as to the hardware store for false +teeth.</p> + +<p>The education of physician, oculist, and optician can be expedited by +eye tests in school and by the follow-up work of schools in removing +the prejudice of parents against glasses when needed. Because +knowledge of chemistry preceded knowledge of the human body, the +teaching of medicine still shows the effect of predilection for the +remote, the problematical, the impossible. This predilection has +influenced many specialists as well as many general practitioners, +both overlooking too frequently obvious causes that even intelligent +laymen can be taught to detect. Very naturally the man who makes money +out of attention to simple troubles has stepped into the field not as +yet occupied by the general practitioner and the specialist. Thus we +have the optician, the painless tooth extractor, and quack cures for +consumption. Opticians are placing before hundreds of thousands simple +truths about the eye not otherwise taught as yet. Because they make +their money by selling eyeglasses and because their special knowledge +pertains to glasses rather than to eyes they frequently fail to +recognize their limitations.</p> + +<p>Physicians feel very strongly that it is as unethical for an optician +to fit eyeglasses without a physician's prescription as for a +pharmacist to give drugs without a physician's <span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span>prescription. The +justification for this feeling should be based not upon the commercial +motive of the optician but upon his ignorance. A physician uninformed +as to eye troubles is just as unsafe as an optician determined to sell +glasses. It must be made unethical and unprofessional for physician +and optician alike to prescribe in the dark. Laymen and physicians +must be taught that it is just as unethical and unprofessional for +oculists and physicians to fail to bring their knowledge within the +practical reach of the masses as for the optician to advertise his +wares. School tests will not have been used to their utmost +possibilities until optician and physician alike take the ethical +position that the first consideration is the patient's welfare, not +their own profits. It must soon be recognized as unethical and +unprofessional for an optician who is also a skilled physician to +refer patients to a medical practitioner ignorant as to optical +science.</p> + +<p>Whether opticians and physicians are unprofessional or unethical may +be told by reëxamination if the <i>examiner</i> is himself competent and +ethical. There is no better judge of their efficiency than the patient +himself, who can tell whether the results promised have been effected. +Whether the work of a country oculist is efficient and ethical can be +learned: (1) by teaching country school children to recognize eye +strain; (2) by comparing his results with those of other physicians. +As soon as one or two states have tested eyes, we shall have an +average by which to compare each class, school, and city with others +of their size under similar conditions. If a particular physician +finds half as many more or only half the average number, the +presumption will be that his results are inaccurate and warrant an +investigation. The interested teacher or parent can render an +inestimable service to her local school and to the children of her +state by taking steps to secure state laws compelling eye tests in all +schools.</p> + +<p><span class='pagenum'><a name="Page_82" id="Page_82">[82]</a></span>Finally, it must be remembered by teachers, employers, parents, and +all eye users that eyes are constantly changing; that eyes may need +glasses six months after they are examined and found sound; that +glasses change or develop the eye, so that they may be unnecessary and +harmful six months after they are prescribed, or the eye may require a +stronger glass; that eyeglasses become bent and scratched, so that +they worry and strain the eye; that a periodic examination is +essential to the health of the eye.</p> + +<p>In caring for the health of the eye, we should also remember that our +eyes are our chief interpreters of the world that gives us problems, +profits, and pleasures. Out of gratitude, if not out of enlightened +self-interest, we owe our eyes protection, attention, and training, so +that without straining we shall always be able to see truth and +beauty.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_VIII" id="CHAPTER_VIII"></a><hr /> +<span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span><br /> + +<h3>CHAPTER VIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>EAR TROUBLE, MALNUTRITION, DEFORMITIES</h4> +<br /> + +<p>The presence of adenoids is a frequent cause of both slight and +aggravated deafness. Of 156 deaf mutes examined 59 per cent had +adenoids, while only 6 per cent of the general run of the children in +the neighborhood had this trouble. In mouth breathing, the current of +air entering the mouth draws out some of the air from the Eustachian +tube which ventilates the middle ear and unequalizes the atmospheric +pressure on the eardrum, causing it to sink in and to blunt the +hearing. An examination of the eardrums of school children in New York +who are mouth breathers showed a high percentage of deafness, +incipient or pronounced, accompanying adenoids. For example, of 9 +mouth breathers selected from one class (average age 7-8 years), 6 +were well-marked cases of deafness. Of 8 mouth breathers (average age +8-9 years), and of 5 mouth breathers (average age 5-6 years), all had +noticeable defects of hearing. Many adults that suffer from deafness +maintain that they never had any trouble in childhood. Yet the +evidences of nose and throat trouble in childhood persist and disprove +such statements. <i>The foundations of deafness in later life are, in +most instances, laid in childhood.</i> Since the majority of cases of ear +trouble occurring in school children accompany diseased conditions of +the nose and throat, the proper care of nose and throat will, in large +measure, balance the shortcomings of the aural examinations. Since the +examination of the drum itself is not practicable, especial care +should be given to the examination of the nose and throat.</p> + +<p><span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span>The figures published by New York City's department of health show +that of 274,641 children examined from March, 1905, to January, 1908, +3540, or 1.2 per cent, gave evidence of defective hearing. Ear +specialists suggest that this small percentage results from employing +the whisper test at twenty feet. The whisper test at sixty feet has +been set by experts as a test of normal hearing. But preciseness with +this test is well-nigh impossible when we consider that the acoustics, +the quality of the examiner's voice, the weather, the vowel or +consonant sounds, all are variable quantities. The watch test is +frequently used, but since a young teacher in her enthusiasm used an +alarm clock to make the test, specialists have decided that the volume +of sound differs in watches to such a degree as to make the watch test +unreliable. The examination of the eye has been reduced to +mathematical precision, due altogether to the anatomy of that organ. +As yet there is no instrument for the ear comparable to the +ophthalmoscope. The acoumeter is largely used by aurists and can be +obtained from the optician. This instrument has an advantage over the +whisper or watch tests in that its tick is uniform.</p> + +<p>Each ear should be tested separately. Let the child place his finger +against the flap of one ear while the other is being tested. Then +compare the farthest distance from the ear at which the tick can be +heard with the normal, standard distance. During the test all sound +should be eliminated as far as possible and the eyes should be closed. +At a demonstration of ear testing at Teachers College, one student +stated that she could not hear the tick of the watch at a distance +greater than twenty inches. Then the tester walked noisily toward her, +leaving the watch on the desk, five feet away from the patient. She +heard it now. When the class burst out laughing she opened her eyes, +and, seeing the watch so far away, exclaimed, "Why, <span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span>I thought I +imagined it." Be careful in testing a child to distinguish between +what he "thinks he imagines" and what he really hears. Because of the +difficulties of this test a doubt should be sufficient to warn the +teacher to send the child to be tested by an expert. Detection of +slight deafness may lead to the discovery of serious defects of nose +or throat. Inflammation from cold or catarrh may cause deafness, which +if neglected may permanently injure the ear. Often deafness is due to +an accumulation of wax. A running ear should receive immediate +attention, as it is an indication of inflammation which may imperil +the integrity of the eardrum, and, if neglected, may eat its way +through the thin partition between the ear and the brain and cause +death.</p> + +<p>It should never be assumed that deafness is incurable. Stupidity, +inattention, and slowness to grasp a situation accompany difficulty of +hearing and should cause the teacher to examine the ears. No ear +trouble is negligible. Children and parents should be taught that the +normal ear is intended to hear for us, not to divert our attention to +itself. When the ear aches or "runs" or rumbles there is something +wrong, and it should be examined together with the throat and nose.</p> + +<br /> + +<h4 class="sc">Nervousness</h4> + +<p>In New York City one child in ninety-one already examined has had the +form of nervous disease known as St. Vitus's Dance, or chorea. So +prone are we to overlook moderate evils and moderate needs that the +child with aggravated St. Vitus's Dance is apt to be cured sooner than +the child who is just "nervous." Teachers cannot know whether +twitching eyes, emotional storms, constant motion of the fingers or +feet are due to chorea, to malnutrition, to eye strain, or to habits +acquired in babyhood or early childhood and continued for the +advantage that <span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span>accrues when discipline impends. Many a child +treasures as his chief asset in time of trouble the ability to lose +his temper, to have a "fit," to exhibit nervousness that frightens +parent, teacher, or playmate, incites their pity, and wards off +punishment. The school examination will settle once for all whether +the trouble can be cured. The family physician will explain what steps +to take.</p> + +<br /> + +<h4 class="sc">Tests of Malnutrition</h4> + +<p>We Americans were first interested in the physical examination of +school children by exaggerated estimates of the number of children who +are underfed. As fast as figures were obtained for eye defects, +breathing defects, bad teeth, some one was ready to declare that these +were results of underfeeding. Hence the conclusion: give children at +least one meal a day at school. Scientific men began to set us +straight and to give undernourishment a technical meaning,—soft +bones, flabby tissue, under size, anæmia. While too little food might +cause this condition, it was also explained that too much food of the +wrong sort, or even food of the right sort eaten irregularly or +hurriedly or poisoned by bad teeth, might also cause undernourishment, +including the extreme type known as malnutrition. In extreme instances +the symptoms enable an observant teacher who has learned to +distinguish between the pretty hair ribbon and clean collar and the +sunken, pale, or hectic cheek and lusterless eyes to detect the cause. +But as with eyes and nose, an unhealthy condition <span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span>of nourishment may +exist long before outward symptoms are noticeable. Therefore the value +of the periodic searching examination by the school physician.</p> + +<div class="img"> +<a href="images/imagep086.jpg"> +<img border="0" src="images/imagep086.jpg" width="50%" alt="Same Age, Same School, Different Nutrition" /></a><br /> +<p class="cen" style="margin-top: .2em;">SAME AGE, SAME SCHOOL, DIFFERENT NUTRITION</p> +</div> + + +<br /> + +<h4 class="sc">Bone Tuberculosis; Orthopedic Tests</h4> + +<p>Only recently have we laymen learned that knee trouble, clubfoot, +ankle sores, spine and hip troubles, scrofula, running sores at +joints, etc., are not hereditary and inevitable, but are rather the +direct result of carelessness on the part of adult consumptives. These +conditions in school are indices of homes and houses where +tuberculosis is or has been active, and of health boards that are or +have been inactive in checking the white plague. Early examination may +disclose the small lump on the child's spine,—which one mother +diagnosed as inherited "round shoulders,"—and save a child from being +a humpback for life. Moreover, the examination of the crippled child's +brothers and sisters will often show the beginnings of pulmonary +tuberculosis.</p> + +<div class="img"> +<a href="images/imagep087.jpg"> +<img border="0" src="images/imagep087.jpg" width="80%" alt="A Grievous Penalty For Neglect By Adult Consumptives" /></a><br /> +<p class="cen" style="margin-top: .2em;">A GRIEVOUS PENALTY FOR NEGLECT BY ADULT CONSUMPTIVES</p> +</div> + +<span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span><br /> + +<h4 class="sc">Enlarged Glands—Tuberculosis</h4> + +<p>In almost every class are one or more children who are proud of small +or big lumps under one or more jaws. Only physicians can find very +small lumps. Many family doctors will say, "Oh, he will outgrow +those," or "Those lumps will be absorbed." Like most other evils that +we "outgrow" or that pass away, these lumps shriek not to be +neglected. They mean interference with nourishment and prevent proper +action of the lymphatic system, as adenoids prevent free breathing. +Even when not actually infected with tubercle bacilli, they are +fertile soil for the production of these germs. If detected early, +they point to home conditions and personal habits that can be easily +corrected. In New York one child in four has these enlarged glands. If +the same proportion prevails in other parts of the United States, +there are 5,400,000 children whose strength is being needlessly +drained, many of whom, if neglected, will need repeated operations.</p> + +<div class="img"> +<a href="images/imagep088.jpg"> +<img border="0" src="images/imagep088.jpg" width="80%" alt="Model Of America's First Hospital For Seashore Fresh-air Treatment of Nonpulmonary Tuberculosis in Children" /></a><br /> +<p class="cen" style="margin-top: .2em;">MODEL OF AMERICA'S FIRST HOSPITAL FOR SEASHORE FRESH-AIR<br /> TREATMENT OF NONPULMONARY TUBERCULOSIS IN CHILDREN<br /> +To be erected at Rockaway Beach, New York City</p> +</div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_IX" id="CHAPTER_IX"></a><hr /> +<span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span><br /> + +<h3>CHAPTER IX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>DENTAL SANITATION</h4> +<br /> + +<p>"Have their teeth attended to first, and many of the eye defects will +disappear." This was an unexpected contribution to the debate upon +free eyeglasses for the school children of New York City. So little do +most of us realize the importance of sound, clean teeth, and the +interrelation of stomach and sense nerves, that even the school +principals thought the eye specialist was exaggerating when he +declared that bad teeth cause indigestion and indigestion causes eye +strain.</p> + +<p>"Bad" teeth mean to most people dirty teeth and offensive odors, +loose, crooked, or isolated teeth, or black stumps. Even among +dentists a great many, probably the majority, do not appreciate that +"bad" teeth mean indigestion, lowered vitality, plague spots for +contaminating sound teeth and for breeding disease germs. Until +recently the only rule about the teeth of new recruits in the United +States army was: "There must be two opposing molars on each side of +the mouth. It doesn't matter how rotten these molars may be." The +surgeon general was persuaded to change to "four opposing molars on +each side"; still nothing as to the condition of the two additional +molars! In the German army there is a regular morning inspection of +teeth and toothbrushes. Several German insurance companies give free +dental treatment to policy holders, not to bestow charity but to +increase profits.</p> + +<p>Neglecting "baby teeth" and adenoids may mean crooked second teeth +that will cause: (1) hundreds of dollars for straightening; (2) +permanent business handicap because crooked teeth are disagreeable to +others, because mastication <span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>is less perfect, and because a disfigured +mouth means dis-arranged nerves; or perhaps (3) large dental bills +because it is difficult to clean between cramped, crooked teeth.</p> + +<p>Unfortunately the great majority of parents rarely think of their +children's teeth until too late to preserve them intact. Even among +families where the rule of brushing the teeth twice daily prevails, +regular dental examination is often not required. Doctors and dentists +themselves have not been trained to realize that the teeth are a most +dangerous source of infection when unclean. Does your dentist insist +upon removing tartar and food particles beyond your reach, upon +polishing and cleansing, or does he regard these as vanity touches, to +be omitted if you are in a hurry?</p> + +<div class="img"> +<a href="images/imagep090.jpg"> +<img border="0" src="images/imagep090.jpg" width="80%" alt="Industrial Handicaps Discovered At School" /></a><br /> +<p class="cen" style="margin-top: .2em;">INDUSTRIAL HANDICAPS DISCOVERED AT SCHOOL</p> +</div> + +<p>Physicians send tuberculosis patients to hospitals or camps without +correcting the mouth conditions that make it impossible for the +patient to eat or swallow without infecting <span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span>himself. Tonics are given +to women whose teeth are breeding and harboring disease germs that +tear down vitality. Nurses watch their suffering patients and do the +heavier tasks heroically, but are not trained to teach the simple +truths about dental hygiene. The far-reaching results of neglect of +teeth will not be understood until greater emphasis is placed on the +bacteriology, the economics, the sociology, and the æsthetics of +clean, sound teeth. Whether or not there is at present a tendency to +exaggerate the importance of sound teeth, there is no difference of +opinion as to the fact that the teeth harbor virulent germs, that the +high temperature of the mouth favors germ propagation, that the twenty +to thirty square inches of surface constantly open to bacterial +infection offer an extensive breeding ground, and that the formation +of the teeth invites the lodgment of germs and of particles of food +injurious both to teeth and to other organs.</p> + +<p>By scraping the teeth with the finger nail and noticing the odor you +can convince yourself of the presence of decomposing organic matter +not healthful to be carried into the stomach. By applying a little +iodine and then washing it off with water, your teeth may show stains. +These stains are called gelatinous plaques, which are transparent and +invisible to the naked eye except when colored by iodine. These +plaques protect the germs, which ferment and create the acid which +destroys tooth structure. Their formation can be prevented by vigorous +brushing and by eating hard food.</p> + +<p>The individual with decayed teeth, even with unclean teeth, is open to +infection of the lungs, tonsils, stomach, glands, ears, nose, and +adenoid tissues. Every time food is taken, and at every act of +swallowing, germs flow over the tonsils into the stomach. Mouth +breathers with teeth in this condition cannot get one breath of +uncontaminated air, for every breath becomes infected with poisonous +emanations from the teeth. Bad teeth are frequently the sole <span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span>cause of +bad breath and dyspepsia, and can convey to the system tuberculosis of +the lungs, glands, stomach, or nose, and many other transmissible +diseases. They may also cause enlarged tonsils and ear trouble.</p> + +<p>Apart from decomposing food and stagnant septic matter from saliva +injured by indigestion, and by sputum which collects in the healthy +mouth, there are in many infected mouths pus, exudations from the +irritated and inflamed gum margins, gaseous emanations from decaying +teeth, putrescent pulp tissue, tartar, and chemical poisons. Every +spray from such a mouth in coughing, sneezing, or even talking or +reading, is laden with microbes which vitiate the air to be breathed +by others. Indigestion from imperfect mastication and imperfect +salivation (themselves often due solely to bad teeth) is far less +serious than indigestion from germ infection. Germs taken into the +stomach can so change the composition of saliva (a natural +disinfectant when healthy) as to render it no longer able to kill +germs. Indigestion may result in excess of uric acid and toxic +material, so that the individual becomes subject to gout and +rheumatism, which in turn frequently destroy the bony support of the +teeth and bring about Riggs's Disease. The last named is a prevalent +and disfiguring disease, whose symptom is receding gums. The +irritating toxins deposited on the teeth cause inflammation of the +tissues at the gum margins. The gums withdraw more and more from +sections of the teeth; the poisons get underneath and work back toward +the roots; the infection increases and hastens the loosening of the +teeth. I know of a man who had all of his teeth extracted at +twenty-one years of age, because he was told that this was the only +treatment for this disease, which was formerly thought to be +incurable. Yet thorough cleansing and removal of this matter from +under the edges of the gums, disinfection, a few visits to the +dentist, will stop the recession but cannot regain lost ground.</p> + +<p><span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span>Among those who regularly use the toothbrush, instinct, comfort, or +display is the ruling motive, while a small percentage have evolved to +the anti-nuisance stage, where the æsthetic standard of their group +forbids any member to neglect his teeth. The anti-slum and pro-slum +motives for mouth cleanliness and dental sanitation have been awakened +in but one or two places. A significant pro-slum activity is the +dental clinic organized by forty volunteer dentists, acting for an +industrial school maintained by the New York Children's Aid Society.</p> + +<div class="img"> +<a href="images/imagep093.jpg"> +<img border="0" src="images/imagep093.jpg" width="80%" alt="New York Children's Aid Society's Dental Clinic For School Children" /></a><br /> +<p class="cen" style="margin-top: .2em;">NEW YORK CHILDREN'S AID SOCIETY'S DENTAL CLINIC FOR SCHOOL CHILDREN</p> +</div> + +<p>Here 550 children have been examined, 447 teeth extracted, 284 teeth +filled, 200 teeth treated for diseased pulp (and only 24 sets +cleaned), 40 dentists taking turns in giving time to this work. The +equipment cost but $239; cards and stationery, $72; incidentals, $33. +The principal attends the clinic, because in her presence no child is +willing to confess fear or unwillingness. To supplement this work, the +dentists have prepared for free distribution a leaflet which tells in +short, clear sentences how to care for the teeth.</p> + +<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span><br /> + +<div class="img"> +<a href="images/imagep094.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep094.png" width="60%" alt="(leaflet) A DENTAL CATECHISM" /></a><br /> +</div> + +<p>Such a leaflet should be given out at dispensaries, hospitals, dental +offices, schools, and from many Sunday schools and missions.<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a></p> + +<p><span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span>The time for the schools to begin is when the child is first +registered. Examination and reëxamination must be accompanied by +explanation of the serious disadvantages of neglected teeth, and the +physical, social, and economic advantages of clean, sound teeth. +Instruction at school must be followed by education of parents. The +school or health authorities should examine the teeth of all children +before issuing work certificates. Finally, the dental, medical, and +nursing professions and the press must be enlisted in the school's +campaign for dental hygiene. The Dental Hygiene Council of +Massachusetts should be copied in all states.</p> + +<p>A preliminary examination of teeth can be made by parent or teacher. +Crooked, loose, dirty, or black teeth or receding gums can be detected +by a layman's naked eye. In fact, children can be interested in +finding the most obvious defects in their own or their brothers' +teeth. There could be no better first lesson than to ask each pupil to +look in a hand mirror and to count each tooth obviously needing a +cleaning or a filling. The most urgent need can thus be ascertained +without expert aid. But because parent, teacher, or child cannot +discover defects does not prove that dental care is not imperative; +hence the importance of examination by a dentist or by a physician +competent to discover dental needs. If a private, public, or parochial +school has no paid visiting dentist, a zealous school officer can, at +least in large towns, persuade one or more dentists or physicians to +make a few first tests to confirm the teacher's findings, and to +persuade the community that regular examination and reëxamination are +necessary and a saving of pain, beauty, and money.</p> + +<p>Reëxamination is necessary because decay <i>may</i> start the day after a +dentist has pronounced a tooth sound. For most of us twice a year is +often enough. A reëxamination should be made upon the slightest +suspicion of decay, breaking, or loosening.</p> + +<p><span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span>Educational use should be made by the teacher of the results of school +examination. Children cannot be made self-conscious and cleanly by +telling them that their teeth will ache three or five years from now. +They can be made to brush or wash their teeth every morning and every +night if they once realize that cavities can be caused only by <i>mouth +garbage</i>. All decay of human teeth starts from the outside through the +enamel that covers the soft bone of the tooth. This enamel can be +destroyed by accidentally cracking or breaking it, or by acids eating +into it. These acids come from (1) particles of food allowed to remain +in the teeth; (2) tartar, etc., that adheres to the teeth and can be +removed only by a dentist; (3) saliva brought up from an +ill-conditioned stomach. Even where the enamel is destroyed, absolute +cleanliness will prevent serious decay of the tooth. A perfectly clean +tooth will not decay. Generally speaking, unless particles of food or +removable acids remain on or between the teeth long enough to +decompose, teeth cannot decay. Decay always means, therefore, +uncleanliness. To unclean teeth is due in large part the offensive +odor of many schoolrooms.</p> + +<div class="imgr" style="width: 30%;"> +<a href="images/imagep097.jpg"> +<img border="0" src="images/imagep097.jpg" width="90%" alt="An Armenian School Girl" /></a><br /> +<p class="cen" style="margin-top: .2em; font-size: 80%;">AN ARMENIAN SCHOOL GIRL</p> +</div> + +<p>Uncleanliness becomes noticeable to our neighbors sooner or later. +There is no offense we are so reluctant to commit as that of having +uncleanliness of our bodies disagreeable to those about us. Very young +children will make every effort in their power to live up to the +school's standard of cleanliness. The other side to this reason for +having clean teeth is vanity. Because all cleanliness is beautiful to +us, clean teeth are one attribute of beauty that all of us can +possess.</p> + +<p>Habits of cleanliness are easily fixed. In the most crowded, most +overworked section of large cities visitors from "uptown" are +surprised by the children's bright hair ribbons, clean aprons, clean +faces, and smoothly combed hair. It will be easy to add clean teeth to +the list of things necessary to personal and family standing. Armenian +children <span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span>are taught to clean their teeth after eating, even if only +an apple between meals. They covet "beautiful teeth." American +standards will soon prevent these Armenians from cleaning their teeth +in public, but desire for beautiful teeth will stay, and will remind +them to care for their teeth in private. As coarse food gives way to +sugars and soft foods, stiff toothbrushes must supplement tongue and +toothpicks.</p> + +<p>Strong as are the instinct and display motives in cleaning teeth, both +parents and children need to be reached through the commerce motive. +Instinct makes children afraid of the dentist, or content when the +tooth stops aching. Display may be satisfied with cleaning the front +teeth, as many boys comb only the front hair or as girls hide dirty +scalps under pompadours and pretty ribbons. Desire to save money may +give stronger reasons for not going to the dentist than instinct and +comfort can urge for going. But parents can be made to see, as can +children after they begin to picture themselves as wage earners, that +a dentist in time saves nine, and that no regular family investment +will earn more money than the price of prompt and regular dental care. +A problem in arithmetic would be convincing, if, by questions such as +those on page 98, we could compare the family cost of neglecting teeth +with the cost of toothbrushes, bicarbonate of soda, pulverized chalk +or tooth powder, early and repeated examination by a dentist, and +treatment when needed.</p> + +<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span><br /> + +<div class="centered" style="clear: both;"> +<table border="0" cellpadding="2" cellspacing="0" width="75%" summary="questions about cost of neglected teeth vs. regular teeth care"> + <tr> + <td width="50%" class="tdl vat" style="padding-left: 4%;"><p class="hang2">How many members in your family?</p> + <p class="hang2">How many teeth have they?</p> + <p class="hang2">How many teeth have they lost?</p> + <p class="hang2">How many false teeth have they?</p> + <p class="hang2">How many teeth have been filled?</p> + <p class="hang2">What is the total cost to date?</p> + <p class="hang2">How many days have been lost from work because of toothache?</p> + <p class="hang2">How many teeth are now decayed?</p> + <p class="hang2">What will it cost to have them attended to?</p></td> + <td width="5%"> </td> + <td width="45%" class="tdl vat" style="padding-left: 4%;"><p class="hang2">What does a toothbrush cost?</p> + <p class="hang2">How many do you need in one year?</p> + <p class="hang2">How much does tooth powder cost?</p> + <p class="hang2">How much is needed for one year?</p> + <p class="hang2">How much would two examinations a year by a dentist cost?</p></td> + </tr> +</table> +</div> + +<p>The result will show that the money spent for one good "house +cleaning" of one child at fourteen or eighteen exceeds the cost of +keeping clean and in repair the teeth of the entire family. How +effective and economical is thorough cleaning is confessed by an +eminent dentist, who taught an assistant to clean his patients' teeth. +"Do you know," he said, "I had to stop it, so perceptibly did my work +decrease." The total time required to examine school children for +teeth needing attention is much less than the time now lost by absence +from school or wasted at school on account of toothache.</p> + +<div class="imgr" style="width: 30%;"> +<a href="images/imagep099.jpg"> +<img border="0" src="images/imagep099.jpg" width="90%" alt="Won By The Economic Argument" /></a><br /> +<p class="cen" style="margin-top: .2em; font-size: 80%;">WON BY THE ECONOMIC ARGUMENT</p> +</div> + +<p>To remind school children regularly of dental hygiene is not more +important than for the school to remind parents repeatedly of the many +reasons for attending to their children's teeth. It is not enough, +however, to send one message to parents. Illustrated lectures, +mothers' meetings, demonstrations at hospitals and fresh-air homes are +all very serviceable, but listening is a poor substitute for +understanding. Schools should see that parents understand the +æsthetics, the economics, the humanity of dental hygiene. <span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span>The best +test of whether the parent has understood is the child's tooth.</p> + +<p>Dental examination of children applying for work certificates gives +the health and school authorities a means of enforcing their precepts. +When no child is allowed to go to work whose teeth cause malnutrition +or disgust, the news will spread, and both child and parent will see +clearly the grave need for dental care.</p> + +<p>Finally, local papers can be interested. They will print almost +anything the teacher sends about the need for dental care. They like +particularly facts about the number of cavities found, the number of +children needing care, efforts made to procure care, and new facts +about diseases that can be caused by bad teeth or about diseases that +can injure teeth. Teachers can persuade dentists and physicians to +write stories. No newspaper will refuse to print such statements as +this: "A tuberculous patient in six weeks lost ground steadily. I +persuaded him to go to a dentist to clean the vestibule to his +digestive system, and to have a set of false teeth. He enjoys his +meals, and has gained twelve pounds in six weeks." Popular magazines +and newspapers mention teeth seldom, because those who best know the +interesting vital things are making money, not writing articles or +otherwise concerning themselves with dental education. It is said that +of forty thousand American dentists not over eleven thousand are +readers of dental journals, and probably not three hundred contribute +to professional <span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span>literature. One dentist who is working for the +children's clinic described above, when asked by the board of +education to lecture to the people on the care of the teeth and to +recommend simple, readable books, told me that he knew no good books +to suggest.</p> + +<p style="clear: both;">Five obstacles exist to practicing what is here preached:</p> + +<div class="block"><p>1. The expensiveness of proper dentistry.</p> + +<p>2. The untrustworthiness of cheap dental service and "painless" +dental parlors; the domination of the supply houses wishing to +sell instruments and other supplies.</p> + +<p>3. The ethical objection to any kind of advertising or to work by +wholesale.</p> + +<p>4. The lack of dispensaries.</p> + +<p>5. The profit-making basis of dental education.</p></div> + +<p>Additional reasons these for cleanliness that will make the dentist +serviceable for his knowledge rather than for his time and gold.</p> + +<p>Good dentists really "come too high" for both the poor and the +comfortably situated. Families in New York City that have four or five +thousand dollars a year hesitate to go to a dentist whom they +thoroughly trust, because his time is worth more than they feel they +can afford to pay.</p> + +<p>The "free-extraction" dental parlors undoubtedly are doing a vast +amount of harm. In every city are dental quacks that injure +wage-earning adults as much as soothing-sirup quacks injure babies. +Instead of teaching people to preserve their teeth, they extract, and +then, by dint of overpersuading by a pretty cashier hired for the +purpose, make a contract for a gold crown or a false set at an +exorbitant price. A reputable dentist has said that a dental parlor +can do more damage to the welfare of the race in a few months than a +well-intentioned man in the profession can repair in a lifetime. Its +question is not, What can I do for this patient? but What is there in +this mouth for me? Many "parlors" never expect to see the same <span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span>person +twice, because they do not make him comfortable or gain his +confidence; they put a filling in on top of decayed matter or even +diseased pulp; put in plates and bridges that do not fit; charge more +than the examination at first leads one to expect; refuse to correct +mistakes; deny having ever seen the patient before. Yet true and +severe as this arraignment is, many of these parlors, with their +liveried "runners in," are doing an educational service not otherwise +provided; it is conceivable that in many cities they are doing less +harm by their malpractice than well-intentioned men in the profession +by neglect of public needs or by failure to organize facilities for +meeting those needs.</p> + +<p>I realize that advertising is "unethical" among dentists as among +physicians. Humbug and imposition are supposed to go inevitably with +self-advertising by the methods used in selling shoes or automobiles. +Therefore such advertising is prohibited. But what seems to be +forgotten in this definition of ethics is that the need and the +opportunity for dental care must be advertised in some way, if we are +ever to control diseases and evils due to bad teeth. The rich that one +dentist can help are able to pay for his good taste, his neat +attendants, his automobile, his club dues, his vacations at +fashionable resorts, his hours without work, his standard of living. +All of these things advertise him, just as hospital appointments and +social position may and do advertise successful physicians. The +patients of moderate means that one dentist can treat cannot afford to +pay for rent, time disengaged, and indirect advertising. Either they +must have free treatment, must go without treatment, or must go to a +dental parlor where dental needs are organized so that a very large +number will contribute to rent and display. It is out of the question +to have both dentists and patients so distributed and prices so +adjusted that dentists can make a good living by charging what the +patient can afford, and at the same time admit of every <span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span>patient being +properly treated when necessary. Judging from every other branch of +work, the solution of the problem lies partly in free care for those +who can pay nothing or very little, and partly in coöperative +treatment through the heretofore objectionable dental parlors. If +instead of inveighing against advertisers, honorable and capable +dentists worked through dental and medical societies to secure +adequate public supervision of dental practice, more progress would be +made against dental malpractice.</p> + +<p>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 coöperative 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.</p> + +<p>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.</p> + +<p>Of fourteen dental journals in America, only one has the advancement +of dental science as its first reason for <span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span>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.</p> + +<p>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.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> <i>The Teeth and Their Care</i>, by Thaddeus P. Hyatt, D.D.S., +is a short, concise treatment of the principles of dental +sanitation.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_X" id="CHAPTER_X"></a><hr /> +<span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span><br /> + +<h3>CHAPTER X<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>ABNORMALLY BRIGHT CHILDREN</h4> +<br /> + +<p>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.</p> + +<p>The college man who sacrifices health to "marks" is thus described by +the director of physical training at Harvard University:</p> + +<div class="block2p"><p class="noin">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.</p></div> + +<p>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.</p> + +<p><span class='pagenum'><a name="Page_105" id="Page_105">[105]</a></span>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.</p> + +<p>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 <span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span>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.</p> + +<p>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 <i>Psychological Clinic</i>, 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.</p> + +<p>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.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XI" id="CHAPTER_XI"></a><hr /> +<span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span><br /> + +<h3>CHAPTER XI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>NERVOUSNESS OF TEACHER AND PUPIL</h4> +<br /> + +<p>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.</p> + +<p>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, <span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span>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.</p> + +<p>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.</p> + +<p>There is nothing in school life <i>per se</i> to cause nervousness. Given a +well-aired, sunny room, where every child <span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep109.jpg"> +<img border="0" src="images/imagep109.jpg" width="80%" alt="Vacation School Interest: An Antidote To Nervousness" /></a><br /> +<p class="cen" style="margin-top: .2em;">VACATION SCHOOL INTEREST: AN ANTIDOTE TO NERVOUSNESS</p> +</div> + +<p><span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span>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 +<i>Annals of a Quiet Neighborhood</i>, 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.</p> + +<p>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.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a> 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.</p> + +<p><span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span>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.</p> + +<p>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.</p> + +<p>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 <span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span>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 coöperating +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.</p> + +<p>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. +<span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span>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.</p> + +<p>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:</p> + +<div class="poem"><div class="stanza"> +<span class="i0">Oh wad some power the giftie gie us<br /></span> +<span class="i0">To see oursel's as ithers see us;<br /></span> +<span class="i0">It wad frae mony a blunder free us,<br /></span> +<span class="i2">And foolish notion.<br /></span> +</div></div> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> <i>The Unconscious Mind</i> by Schofield, <i>The Study of +Children and their School Training</i> by Dr. Frances Warner, and <i>The +Development of the Child</i> by Nathan Oppenheimer show clearly the +physical and mental limitations and possibilities of children.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XII" id="CHAPTER_XII"></a><hr /> +<span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span><br /> + +<h3>CHAPTER XII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>HEALTH VALUE OF "UNBOSSED" PLAY AND PHYSICAL TRAINING</h4> +<br /> + +<p><i>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.</i> 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.</p> + +<p>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.</p> + +<div class="img"><span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span> +<a href="images/imagep116.jpg"> +<img border="0" src="images/imagep116.jpg" width="80%" alt="Serviceable Relief From School Strain, But A Poor Substitute For Outdoor Play" /></a><br /> +<p class="cen" style="margin-top: .2em;">SERVICEABLE RELIEF FROM SCHOOL STRAIN, BUT A POOR SUBSTITUTE FOR OUTDOOR PLAY</p> +</div> + +<p>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 <span class='pagenum'><a name="Page_117" id="Page_117">[117]</a></span>defect like flat foot, flat chest, weak +abdominal muscles, habitual constipation, uneven shoulders, spinal +trouble, etc.</p> + +<p>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.</p> + +<p>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:</p> + +<div class="block2p"><p class="noin">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.</p></div> + +<p>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 +<span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span>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.</p> + +<p>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 <span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep119.jpg"> +<img border="0" src="images/imagep119.jpg" width="80%" alt="Spontaneous Play On One Of New York City's School Roof Playgrounds" /></a><br /> +<p class="cen" style="margin-top: .2em;">SPONTANEOUS PLAY ON ONE OF NEW YORK CITY'S SCHOOL ROOF PLAYGROUNDS</p> +</div> + +<p>"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."</p> + +<p><span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span>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:</p> + +<div class="block2p"><p class="noin">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 <span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span>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.</p></div> + +<p>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.</p> + +<div class="img"> +<a href="images/imagep121.jpg"> +<img border="0" src="images/imagep121.jpg" width="80%" alt="New York City's School Farm Does Not Stifle Nature Instinct" /></a><br /> +<p class="cen" style="margin-top: .2em;">NEW YORK CITY'S SCHOOL FARM DOES NOT STIFLE NATURE INSTINCT</p> +</div> + +<p>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 <span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span>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.</p> + +<p>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 <i>of the same +<span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span>physical class</i> 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."</p> + +<p>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:</p> + +<div class="block2"><p>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.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XIII" id="CHAPTER_XIII"></a><hr /> +<span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span><br /> + +<h3>CHAPTER XIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>VITALITY TESTS AND VITAL STATISTICS</h4> +<br /> + +<p>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.</p> + +<p>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 <span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span>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.</p> + +<p>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:</p> + +<div class="img"> +<a href="images/fig1.png"> +<img border="0" src="images/fig1.png" width="80%" alt="Fig. 1: Ergogram of T.R., a strong, healthy girl, before taking 40 minutes' work in the gymnasium" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;"><span class="sc">Fig.</span> 1. Ergogram of T.R., a strong, healthy +girl, before taking 40 minutes' work in the gymnasium. Weight used, +3.5 kg. Distance lifted, 151 cm. Work done, 528.5 kg.-cm.</p> +</div> + +<p><span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span>If weak and nervous, we shall look like this before taking exercise:</p> + +<div class="img"> +<a href="images/fig2.png"> +<img border="0" src="images/fig2.png" width="80%" alt="Fig. 2: Ergogram of C.E., a weak and somewhat nervous girl, before taking 40 minutes' work in the gymnasium" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;"><span class="sc">Fig.</span> 2. Ergogram of C.E., a weak and somewhat nervous girl, before taking +40 minutes' work in the gymnasium. Weight used, 3.5 kg. Distance lifted, 89 cm. Work done, 311.5 kg.-cm.</p> +</div> + +<p>And like this after gymnasium exercise:</p> + +<div class="img"> +<a href="images/fig3.png"> +<img border="0" src="images/fig3.png" width="80%" alt="Fig. 3: Ergogram of C.E. after taking 40 minutes' work in the gymnasium, showing that the exercise proved very exhausting." /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;"><span class="sc">Fig.</span> 3. Ergogram of C.E. after taking 40 +minutes' work in the gymnasium, showing that the exercise proved very +exhausting. Weight used, 3.5 kg. Distance lifted, 55 cm.</p> +</div> + +<p>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.</p> + +<p>Chicago's child-study experts concluded after examining a large number +of children:</p> + +<div class="block"><p>1. In general there is a distinct relationship in children between +physical condition and intellectual capacity, the latter varying +directly as the former.</p> + +<p><span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span>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.</p> + +<p>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.</p> + +<p>4. Physical condition should be made a factor in the grading of +children for school work, and especially for entrance into the +first grade.</p> + +<p>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.</p> + +<p>6. The classes in physical culture should be graded on a physical +instead of an intellectual basis.</p></div> + +<div class="img"> +<a href="images/fig4.png"> +<img border="0" src="images/fig4.png" width="80%" alt="Fig. 4: the effect of the noon recess and of the good time after three o'clock." /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;"><span class="sc">Fig.</span> 4.</p> +</div> + +<p>To these conclusions certain others should be added, not as settled +beyond any possibility of modification, but as being fairly indicated +by these tests.</p> + +<div class="block"><p>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 preëminently a time for character +building.</p> + +<p><span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>9. The weight of the girl surpasses that of the boy about a year +later than her stature surpasses his, and she maintains her +<span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span>superiority in weight to a later period of time than she maintains +her superiority in height.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>13. The development of vital capacity bears a striking resemblance +to that of endurance, the curves representing the two being almost +identical.</p></div> + +<p>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.</p> + +<p>The work in lower grades they had all passed satisfactorily, but in +high school only the most advanced class <span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span>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.</p> + +<p>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:</p> + +<div class="block"><p>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. Anæmic 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 <span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span>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.</p></div> + +<p>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.<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a></p> + +<p>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 <span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span>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 <i>The Health of the School Child</i>, +said ten years ago, while health officer of Leith:</p> + +<div class="block"><p>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.</p></div> + +<p>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.</p> + +<p>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 +<span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span>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.</p> + +<br /> + +<p class="cen sc">Table X</p> + +<p class="cen sc">Cases of Infectious and Contagious Diseases Reported</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="95%" summary="Table 10: Cases of Infectious and Contagious Diseases Reported" style="border: 1px black solid;"> + <tr> + <td width="22%" rowspan="2" class="tdctrlb" style="border-top: 1px black solid;"> </td> + <td colspan="13" class="tdctrlb" style="border-top: 1px black solid;">WEEK ENDING</td> + </tr> + <tr> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Oct. <br />26</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Nov. <br />2</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Nov. <br />9</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Nov. <br />16</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Nov. <br />23</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Nov. <br />30</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Dec. <br />7</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Dec. <br />14</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Dec. <br />21</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Dec. <br />28</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Jan. <br />4</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Jan. <br />11</td> + <td width="6%" class="tdctrlb" style="border-top: 1px black solid;">Jan. <br />18</td> + </tr> + <tr> + <td class="tdlrl" style="border-top: 1px black solid; padding-top: .5em;">Tuberculosis pulmonalis</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">350</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">350</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">317</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">364</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">345</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">337</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">422</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">360</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">354</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">308</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">344</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">432</td> + <td class="tdrprl2" style="border-top: 1px black solid; padding-top: .5em;">402</td> + </tr> + <tr> + <td class="tdlrl">Diphtheria and croup</td> + <td class="tdrprl2">313</td> + <td class="tdrprl2">264</td> + <td class="tdrprl2">283</td> + <td class="tdrprl2">331</td> + <td class="tdrprl2">282</td> + <td class="tdrprl2">343</td> + <td class="tdrprl2">326</td> + <td class="tdrprl2">369</td> + <td class="tdrprl2">338</td> + <td class="tdrprl2">347</td> + <td class="tdrprl2">308</td> + <td class="tdrprl2">370</td> + <td class="tdrprl2">406</td> + </tr> + <tr> + <td class="tdlrl">Measles</td> + <td class="tdrprl2">142</td> + <td class="tdrprl2">212</td> + <td class="tdrprl2">203</td> + <td class="tdrprl2">261</td> + <td class="tdrprl2">293</td> + <td class="tdrprl2">323</td> + <td class="tdrprl2">472</td> + <td class="tdrprl2">471</td> + <td class="tdrprl2">517</td> + <td class="tdrprl2">346</td> + <td class="tdrprl2">581</td> + <td class="tdrprl2">691</td> + <td class="tdrprl2">803</td> + </tr> + <tr> + <td class="tdlrl">Scarlet fever</td> + <td class="tdrprl2">208</td> + <td class="tdrprl2">228</td> + <td class="tdrprl2">231</td> + <td class="tdrprl2">252</td> + <td class="tdrprl2">278</td> + <td class="tdrprl2">323</td> + <td class="tdrprl2">372</td> + <td class="tdrprl2">397</td> + <td class="tdrprl2">417</td> + <td class="tdrprl2">426</td> + <td class="tdrprl2">478</td> + <td class="tdrprl2">562</td> + <td class="tdrprl2">585</td> + </tr> + <tr> + <td class="tdlrl">Smallpox</td> + <td class="tdrprl2">—</td> + <td class="tdrprl2">1</td> + <td class="tdrprl2">—</td> + <td class="tdrprl2">1</td> + <td class="tdrprl2">—</td> + <td class="tdrprl2">—</td> + <td class="tdrprl2">2</td> + <td class="tdrprl2">4</td> + <td class="tdrprl2">3</td> + <td class="tdrprl2">2</td> + <td class="tdrprl2">—</td> + <td class="tdrprl2">2</td> + <td class="tdrprl2">—</td> + </tr> + <tr> + <td class="tdlrl">Varicella</td> + <td class="tdrprl2">40</td> + <td class="tdrprl2">83</td> + <td class="tdrprl2">91</td> + <td class="tdrprl2">162</td> + <td class="tdrprl2">136</td> + <td class="tdrprl2">115</td> + <td class="tdrprl2">167</td> + <td class="tdrprl2">160</td> + <td class="tdrprl2">198</td> + <td class="tdrprl2">123</td> + <td class="tdrprl2">98</td> + <td class="tdrprl2">199</td> + <td class="tdrprl2">169</td> + </tr> + <tr> + <td class="tdlrl">Typhoid fever</td> + <td class="tdrprl2">106</td> + <td class="tdrprl2">105</td> + <td class="tdrprl2">107</td> + <td class="tdrprl2">123</td> + <td class="tdrprl2">86</td> + <td class="tdrprl2">77</td> + <td class="tdrprl2">71</td> + <td class="tdrprl2">62</td> + <td class="tdrprl2">35</td> + <td class="tdrprl2">42</td> + <td class="tdrprl2">37</td> + <td class="tdrprl2">55</td> + <td class="tdrprl2">36</td> + </tr> + <tr> + <td class="tdlrl">Whooping cough</td> + <td class="tdrprl2">6</td> + <td class="tdrprl2">13</td> + <td class="tdrprl2">15</td> + <td class="tdrprl2">14</td> + <td class="tdrprl2">27</td> + <td class="tdrprl2">9</td> + <td class="tdrprl2">8</td> + <td class="tdrprl2">12</td> + <td class="tdrprl2">19</td> + <td class="tdrprl2">3</td> + <td class="tdrprl2">25</td> + <td class="tdrprl2">24</td> + <td class="tdrprl2">14</td> + </tr> + <tr> + <td class="tdlrl" style="border-bottom: 1px black solid; padding-bottom: .5em;">Cerebro-spinal meningitis</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">6</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">11</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">3</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">4</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">4</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">8</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">15</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">13</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">7</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">6 </td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">11</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">16</td> + <td class="tdrprl2" style="border-bottom: 1px black solid; padding-bottom: .5em;">13</td> + </tr> + <tr> + <td class="tdlrl" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">Total</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1171</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1267</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1250</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1512</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1451</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1535</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1855</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1844</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1888</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">1603</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em; padding-top: .5em;">1882</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">2351</td> + <td class="tdrprl2" style="border-top: 1px black solid; border-bottom: 1px black solid; padding-bottom: .5em; padding-top: .5em;">2428</td> + </tr> +</table> +</div> + +<br /> + +<p>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 <span class='pagenum'><a name="Page_134" id="Page_134">[134]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep134.jpg"> +<img border="0" src="images/imagep134.jpg" width="80%" alt="Vital Statistics Can Make Disease Centers As Obvious And As Offensive As The Smoke Nuisance" /></a><br /> +<p class="cen" style="margin-top: .2em;">VITAL STATISTICS CAN MAKE DISEASE CENTERS AS OBVIOUS AND AS OFFENSIVE AS THE SMOKE NUISANCE</p> +</div> + +<p>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. <span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span>Five economic reasons are assigned for +establishing a national department of health:</p> + +<div class="block"><p>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.</p> + +<p>2. To lessen the burden of unproductive years by increasing the +average age at death.</p> + +<p>3. To decrease the burden of death on the productive years by +increasing the age at death.</p> + +<p>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.</p> + +<p>5. To decrease the amounts spent on criminality that can be traced +to overcrowded, unwholesome, and unhygienic environment.</p> + +<p>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.</p> + +<p>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.</p></div> + +<p>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; <span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span>disseminating health information; research libraries and +equipment; statistical clearing house for information.</p> + +<p>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.</p> + +<p>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 <i>do things</i> when they should +have chosen to <i>get things done</i>. 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.</p> + +<p>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.</p> + +<p>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 <span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span>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.</p> + +<p>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 +<span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span>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.</p> + +<p>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.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Dr. Arthur Newsholme's <i>Vital Statistics</i> should be in +public libraries and on the shelves of health officers, +public-spirited physicians, and school superintendents.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XIV" id="CHAPTER_XIV"></a><hr /> +<span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span><br /> + +<h3>CHAPTER XIV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>IS YOUR SCHOOL MANUFACTURING PHYSICAL DEFECTS?</h4> +<br /> + +<p>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.<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a> 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."</p> + +<p>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.<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a> The results, <span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep140.jpg"> +<img border="0" src="images/imagep140.jpg" width="80%" alt="One Of New York City's Roof Playgrounds" /></a><br /> +<p class="cen" style="margin-top: .2em;">ONE OF NEW YORK CITY'S ROOF PLAYGROUNDS</p> +</div> + +<p>Recently I noticed that our little office girl, so anæmic 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 <span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep141.jpg"> +<img border="0" src="images/imagep141.jpg" width="80%" alt="Bone Tuberculosis Is One Of The Penalties For Dry Sweeping And Feather Dusters" /></a><br /> +<p class="cen" style="margin-top: .2em;">BONE TUBERCULOSIS IS ONE OF THE PENALTIES FOR DRY SWEEPING AND FEATHER DUSTERS</p> +</div> + +<p>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 <span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span>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 anæmic 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.</p> + +<p>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."</p> + +<p>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.</p> + +<br /> + +<p class="cen sc">I. Neighborhood Health Resources</p> + +<div class="block"> +<p>1. Is the district congested?</p> + +<p>2. Is congestion growing?</p> + +<p>3. How far away is the nearest public park?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is it large enough?<br /> + <i>b.</i> Has it a playground or beauty spot?<br /> + <i>c.</i> Has it swings and games?<br /> + <span class='pagenum'><a name="Page_143" id="Page_143">[143]</a></span><i>d.</i> Is play supervised?<br /> + <i>e.</i> Have children of different ages equal opportunities, or do + the large children monopolize the ground?<br /> + <i>f.</i> Are children encouraged by teachers and parents to use this + park?</p> + </div> + +<p>4. Are the streets suitable for play?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Does the sun reach them?<br /> + <i>b.</i> Are they broad?<br /> + <i>c.</i> Are they crowded with traffic?</p> + </div> + +<p>5. How far away is the nearest public bath?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Has it a swimming pool?<br /> + <i>b.</i> Has it showers?<br /> + <i>c.</i> Is it used as an annex to the school?</p> + </div> +</div> + +<div class="img"> +<a href="images/imagep143.jpg"> +<img border="0" src="images/imagep143.jpg" width="80%" alt="Vacation-school Play Clinic On A "Vacant" City Lot Owned By The Rockefeller Institute For Medical Research" /></a><br /> +<p class="cen" style="margin-top: .2em;">VACATION-SCHOOL PLAY CLINIC ON A "VACANT" CITY LOT <br />OWNED BY THE ROCKEFELLER INSTITUTE FOR MEDICAL RESEARCH</p> +</div> + + +<p class="cen sc">II. Effect of School Equipment upon Health</p> + +<div class="block"> + <p>1. Is there an indoor yard?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is the area adequate or inadequate?<br /> + <i>b.</i> Is the floor wood, cement, or dirt?<br /> + <span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span><i>c.</i> Is the heat adequate or deficient?<br /> + <i>d.</i> Is the ventilation adequate or deficient?<br /> + <i>e.</i> Is the daylight adequate, deficient, or almost lacking?<br /> + <i>f.</i> Is there equipment for light gymnastics and games?<br /> + <i>g.</i> Is it used out of school hours; by special classes, athletic + teams, etc., or by pupils generally?</p> + </div> + +<p>2. Is there an outdoor yard?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is the area ample or inadequate?<br /> + <i>b.</i> Is the area mainly occupied by toilets?<br /> + <i>c.</i> Is the daylight sufficient or deficient?<br /> + <i>d.</i> For how many hours does the sun reach it?<br /> + <i>e.</i> Is it equipped for games?<br /> + <i>f.</i> How much larger ought it to be?<br /> + <i>g.</i> Is it used out of school hours; by special classes, athletic + teams, etc., or by pupils generally?</p> + </div> + +<p>3. Is there a gymnasium?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is it large enough?<br /> + <i>b.</i> Is it used for a gymnasium?<br /> + <i>c.</i> Is it cut up into class rooms?<br /> + <i>d.</i> Is it used out of school hours; by special classes, athletic + teams, etc., or by pupils generally?</p> + </div> + +<p>4. Is there a roof playground?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is there open ventilation?<br /> + <i>b.</i> Is it used in the daytime?<br /> + <i>c.</i> Is it used at night?<br /> + <i>d.</i> Is it used during the summer?<br /> + <i>e.</i> Is it monopolized by the larger children?<br /> + <i>f.</i> Is it used out of school hours; by special classes, athletic + teams, etc., or by pupils generally?</p> + </div> + +<p>5. Are washing facilities adequate?</p> + + <div class="block"> + <p class="noin"><i>a.</i> How many pupils per washbasin?<br /> + <i>b.</i> Are there individual towels?<br /> + <i>c.</i> Have eye troubles been spread by roller towels?<br /> + <i>d.</i> Are only clean towels permitted?<br /> + <i>e.</i> Are there bathing facilities; are these adequate?<br /> + <i>f.</i> Are swimming pools used for games, contests, etc.?<br /> + <span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span><i>g.</i> Are bathing facilities used out of school hours?<br /> + <i>h.</i> Who is responsible for cleanliness of towels, washbasins, + and swimming pools?<br /> + <i>i.</i> How often is water changed in swimming pool, or is it + constantly changing?</p> + </div> + +<p>6. Is adequate provision made for clean drinking water?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Are sanitary fountains used that prevent contamination of + faucet or water?<br /> + <i>b.</i> How often are cups or faucets cleaned?</p> + </div> + +<p>7. Is provision made for airing outer clothing?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Are children permitted to pile their clothing in the class + room?<br /> + <i>b.</i> Are there hooks for each child?<br /> + <i>c.</i> Are lockers provided with wire netting to permit + ventilation?<br /> + <i>d.</i> Are lockers or hooks in the halls or in the basement?<br /> + <i>e.</i> Have you ever thought of the disciplinary and social value + of cheap coat hangers to prevent wrinkling and tearing?</p> + </div> +</div> + +<div class="img"> +<a href="images/imagep145.jpg"> +<img border="0" src="images/imagep145.jpg" width="80%" alt="An Attempt To Overcome The Disadvantages Of Congestion--A Boys' High School, New York City" /></a><br /> +<p class="cen" style="margin-top: .2em;">AN ATTEMPT TO OVERCOME THE DISADVANTAGES OF CONGESTION—A BOYS' HIGH SCHOOL, NEW YORK CITY</p> +</div> + + +<p class="cen sc"><span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span>III. The Class Room as a Place of Confinement</p> + +<div class="block"> +<p>1. How many sittings are provided?</p> + + <div class="block"> + <i>a.</i> How many pupils are there? + </div> + +<p>2. What is the total floor area?</p> + + <div class="block"> + <p class="noin"><i>a.</i> What proportion is not occupied by desks?</p> + </div> + +<p>3. Are the seats adjustable?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Are the seats adjusted to pupils?<br /> + <i>b.</i> 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?<br /> + <i>c.</i> Are seats placed properly with reference to light?</p> + </div> + +<p>4. Is the light ample and proper?</p> + + <div class="block"> + <p class="noin"><i>a.</i> For how many hours must artificial light be used in the + daytime?<br /> + <i>b.</i> Is artificial light adequate for night work?<br /> + <i>c.</i> Does the reflection of light from blackboard and walls + injure the eye?<br /> + <i>d.</i> Are the blackboards black enough?<br /> + <i>e.</i> Are the walls too dark?<br /> + <i>f.</i> Is the woodwork too dark?<br /> + <i>g.</i> Are window panes kept clean?</p> + </div> + +<p>5. Is the air always fresh?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Is ventilation by open windows?<br /> + <i>b.</i> Is ventilation artificial?<br /> + <i>c.</i> Does the ventilating apparatus work satisfactorily?<br /> + <i>d.</i> Are the windows thrown open during recess, and after and + before school?<br /> + <i>e.</i> Do unclean clothes vitiate the atmosphere?<br /> + <i>f.</i> Do unclean persons vitiate the atmosphere?<br /> + <i>g.</i> Does bad breath vitiate the atmosphere?<br /> + <i>h.</i> 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?</p> + </div> + +<p><span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span>6. Is the temperature properly regulated?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Has every class room a thermometer?<br /> + <i>b.</i> Are teachers required to record the thermometer's story + three or more times daily?<br /> + <i>c.</i> Is excess or deficiency at once reported to the janitor?</p> + </div> + +<p>7. Are the floors, walls, desks, and windows always clean?</p> + + <div class="block"> + <p class="noin"><i>a.</i> How often are they washed?<br /> + <i>b.</i> Is twice a year often enough?<br /> + <i>c.</i> Do the floors and walls contain the dust of years?<br /> + <i>d.</i> Is dry sweeping prohibited?<br /> + <i>e.</i> Has wet sawdust or even wet sand been tried?<br /> + <i>f.</i> Has oil ever been used to keep down surface dust on floors?<br /> + <i>g.</i> Are feather dusters prohibited?<br /> + <i>h.</i> Are dust rags moist or dry?<br /> + <i>i.</i> Is an odorless disinfectant used?</p> + </div> + +<p>8. Does overheating prevail?</p> + + <div class="block"> + <p class="noin"><i>a.</i> 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"?</p> + </div> +</div> + +<br /> + +<p class="cen sc">IV. Exercise and Recreation</p> + +<div class="block"> +<p>1. How much time and at what periods is exercise provided for in the + school schedule?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Indoors?<br /> + <i>b.</i> Outdoors?</p> + </div> + +<p>2. How much exercise indoors and outdoors is actually given?</p> + +<p>3. Are the windows open during exercise?</p> + +<p>4. Is exercise suited to each child by the school physician after + physical examination, or are all children compelled to take the + same exercise?</p> + +<p>5. Whose business is it to see that rules regarding exercise are + strictly enforced?</p> + +<p><span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span>6. Do clouds of dust rise from the floor during exercise and play?</p> + +<p>7. Are children deprived of exercise as a penalty?</p> + +<p>8. Should hygiene talks be considered as exercise?</p> +</div> + +<div class="img"> +<a href="images/imagep148.jpg"> +<img border="0" src="images/imagep148.jpg" width="80%" alt="Home Workshops Need Fresh Air" /></a><br /> +<p class="cen" style="margin-top: .2em;">HOME WORKSHOPS NEED FRESH AIR</p> +</div> + +<p class="cen sc">V. The School Janitor and Cleaners</p> + +<div class="block"> +<p>1. Do they understand the relation of cleanliness to vitality?</p> + +<p>2. Is their aim to do the least possible amount of work, or to attain + the highest possible standard of cleanliness?</p> + +<p>3. Will the teacher's complaint of uncleanliness be heeded by + trustees? If so, is the teacher not responsible for uncleanliness?</p> + +<p>4. Have you ever tried to stimulate the pride of janitors and + cleaners for social service?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Have you ever tried to show them how much work they save + themselves by thorough cleansing?<br /> + <i>b.</i> Have you ever shown them the danger, to their own health, of + dust and dirt that may harbor infection and reduce their own + vitality?</p> + </div> + +<p><span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span>5. What effort is made to instruct janitors and cleaners by your + school trustees or by your community?</p> + +<p>6. Have you explained to pupils the important responsibility of + janitors for the health of those in the tenements, office + buildings, or schools?</p> + + <div class="block"> + <i>a.</i> Do you see in this an opportunity to emphasize indirectly + the mother's responsibility for cleanliness of home? + </div> +</div> + +<div class="img"> +<a href="images/imagep149.jpg"> +<img border="0" src="images/imagep149.jpg" width="80%" alt="School Workshops Also Need Fresh Air" /></a><br /> +<p class="cen" style="margin-top: .2em;">SCHOOL WORKSHOPS ALSO NEED FRESH AIR</p> +</div> + + +<p class="cen sc">VI. Requirements of Curriculum</p> + +<div class="block"> +<p>1. How much home study is there?</p> + + <div class="block"> + <p class="noin"><i>a.</i> How much is required?<br /> + <i>b.</i> What steps are taken to prevent excessive home study?<br /> + <i>c.</i> Are light and ventilation conditions at home considered when + deciding upon amount of home study?</p> + </div> + +<p>2. Is the child fitted to the curriculum, or is the curriculum + fitted to the child?</p> + + <div class="block"> + <p class="noin"><i>a.</i> Does failure or backwardness in studies lead to additional + study hours or to regrading?<br /> + <i>b.</i> Are there too many subjects?<br /> + <i>c.</i> Are the recitation periods too long?<br /> + <i>d.</i> Are the exercise periods too short and too few?<br /> + <i>e.</i> Is there too much close-range work?<br /> + <span class='pagenum'><a name="Page_150" id="Page_150">[150]</a></span><i>f.</i> Is it possible to give individual attention to individual + needs so as to awaken individual interest?</p> + </div> + +<p>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?</p> +</div> + +<p>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.</p> + +<p>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.</p> + +<p>If the amount of "close-range" work is rapidly manufacturing myopic +eyes; if bad ventilation, whether due to <span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span>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.</p> + +<p>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.</p> + +<br /> + +<p class="cen sc">Table XI</p> + +<p class="cen sc">Effects of a Child Labor Law</p> + +<p class="cen">Increase in Chicago Attendance</p> + +<div class="img"> +<img border="0" src="images/imagep151.jpg" width="80%" alt="Table XI: Effects of a Child Labor Law" /><br /> +</div> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> <i>The Sanitation of Public Buildings</i>, by William Paul +Gerhard, contains a valuable discussion of how the school may avoid +manufacturing physical defects.</p></div> + +<div class="footnote"><p class="noin"><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> 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.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XV" id="CHAPTER_XV"></a><hr /> +<span class='pagenum'><a name="Page_152" id="Page_152">[152]</a></span><br /> + +<h3>CHAPTER XV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE TEACHER'S HEALTH</h4> +<br /> + +<p>"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:</p> + +<div class="block"><p>1. School conditions that injure child health also injure teacher +health.</p> + +<p>2. Poor health of teacher causes poor health of pupil.</p> + +<p>3. Poor health of pupil often causes poor health of teacher.</p> + +<p>4. Adequate protection of children requires adequate protection of +their teachers.</p> + +<p>5. Teachers have a right to health protection for their own sake +as well as for their children's sake.</p></div> + +<p>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. +<span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 <span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span>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.</p> + +<p>Three objections to physical tests for teachers will be urged, but +each loses its force when considered in the light of general +experience.</p> + +<p>1. <i>A sickly teacher is often the most efficient teacher in a school +or a county.</i> 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.</p> + +<p>2. <i>There are not enough healthy candidates to supply our schools.</i> +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.</p> + +<p>3. <i>Examination by a physician, especially if a social acquaintance, +is an unnecessary embarrassment.</i> 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. <span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span>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.</p> + +<div class="img"> +<a href="images/imagep155.jpg"> +<img border="0" src="images/imagep155.jpg" width="80%" alt="Teachers will Prefer Physical Examinations to Forced Vacations" /></a><br /> +<p class="cen" style="margin-top: .2em;">TEACHERS WILL PREFER PHYSICAL EXAMINATIONS TO FORCED VACATIONS<br /> +Boston Society for Relief and Study of Tuberculosis</p> +</div> + +<p>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 <span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span>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?</p> + +<p>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:</p> + +<div class="block" style="font-size: 95%;"><p>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.</p> + +<p>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."</p> + +<p>3. Satisfactory quality and use of voice.</p> + +<p>4. Personal bearing, cleanliness, appearance, manners.</p> + +<p>5. Self-command and power to win and hold the respect of teachers, +school authorities, and the community.</p> + +<p>6. Capacity for school discipline, power to maintain order and to +secure the willing obedience and the friendship of pupils.</p> + +<p>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.</p> + +<p>8. Capacity for supervision, for organization and administration +of a school, and for the instructing, assisting, and inspiring of +teachers.</p></div> + +<p>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, <span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span>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 <i>periodic tests</i> by principal, +superintendent, and school board, <i>to determine the continuing +fitness</i> 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."</p> + +<p>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 +<span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span>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.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="PART_III_COOPERATION_IN_MEETING_HEALTH_OBLIGATIONS" id="PART_III_COOPERATION_IN_MEETING_HEALTH_OBLIGATIONS"></a><a name="CHAPTER_XVI" id="CHAPTER_XVI"></a><hr /> +<span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span><br /> +<br /> +<br /> +<br /> + +<h2 class="wrap">PART III. COÖPERATION IN MEETING HEALTH OBLIGATIONS</h2> + +<br /> + +<h3>CHAPTER XVI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>EUROPEAN REMEDIES: DOING THINGS AT SCHOOL</h4> +<br /> + +<p>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 +<i>ends</i> of sanitary administration may be the same in ten communities, +health <i>machinery</i> should fit a particular community like a +tailor-made suit.</p> + +<p><span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span>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.</p> + +<p>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. <span class='pagenum'><a name="Page_161" id="Page_161">[161]</a></span>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.</p> + +<p>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."</p> + +<p>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 <span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span>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.</p> + +<p>Would it not be nice for country children to know that toward the end +of the school year they would be given an excursion to the largest +city of their state, to its slums, its factories, parks, and art +galleries? They would grow up more intelligent about geography. They +would read history, politics, sociology, and civil government with +greater interest. They would have less contracted sympathies. They +might even decide that they would rather live their life in the +spacious country than in the crowded, rushing city.</p> + +<p>City children, on the other hand, would reap worlds of physical +benefit and untold inspiration from periods of recreation and study in +the country, with its quiet, its greens and bronzes and yellows, its +birds and animals, its sky that sits like a dome on the earth, its +hopefulness. Winter sleigh rides and coasting would give new vigor and +ambition. Why spend so much on teaching physiology, geography, and +nature study, if in the end we fail to send the child where alone +nature and hygiene tell their story? Why tax ourselves to teach +history and sociology and commercial geography out of books when +excursions to the city and country will paint pictures on the mind +that can never be erased? What more attractive or more reasonable than +appetizing, warm meals, or cool salads and drinks for <span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span>the boys and +girls who carry their little dinner pails and baskets down the long +road where everything runs together in summer and everything freezes +in winter? One needs little imagination to see the "smile that won't +come off," health, punctuality, and school interest resulting from the +school meal.</p> + +<p>Again, if children must have teeth filled and pulled, eyes tested and +fitted for glasses, adenoids and enlarged tonsils removed, surely the +school environment offers the least affrighting spot for the tragedy. +Thence goblins long ago fled. There courage, real or feigned, is +brought to the surface by the anxious, critical, competitive interest +of one's peers.</p> + +<div class="imgr" style="width: 40%;"> +<a href="images/imagep163.jpg"> +<img border="0" src="images/imagep163.jpg" width="95%" alt="A South Ireland Argument For "Doing Things"" /></a><br /> +<p class="cen" style="margin-top: .2em; font-size: 80%;">A SOUTH IRELAND ARGUMENT FOR "DOING THINGS"</p> +</div> + +<p>The economic defense of these remedies is many-sided. An English +drummer once instructed me during a railroad journey from southern to +northern Ireland. As we entered the fertile fields of Lord Dunraven's +estate near Athlone, I expressed sympathy for other countries +impoverished of soil, of wealth, and of thrift. My instructor replied: +"It would pay the government to bring them all to this land free once +a year, just to show them what they are missing." That his idea of an +investment is sound has been proved by railroads and land companies +and even by states, who give away excursions to entice settlers and +buyers. Ambition at almost any cost is cheaper than indifference to +opportunity. It would be cheaper for our American taxpayer to send +school children to city and country than to pay the penalty for having +a large number of citizens with narrow interests, unconscious of the +struggles and joys of <span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span>their co-citizens. Free meals, free books, free +rides, free eyeglasses, are cheaper than free instruction for the +second, third, and sixth terms in studies not passed because of +physical defects,—infinitely cheaper than jails and almshouses, +truant officers and courthouses.</p> + +<p>The demoralizing results of giving "something for nothing" did not +follow free schooling or free text-books. Perhaps they would not +follow the free remedies that we are asked to copy from Europe. In +fact, the word "free" is the wrong word. These remedies rather require +coöperation of parent with parent. It has demoralized nobody because +the streets are cleaned by all of us, country roads made by the +township, police paid for by taxes and not by volunteer subscription.</p> + +<p>The man whose children do not need glasses or nourishment or operation +for adenoids would find it cheaper to pay for European remedies than +for the useless schooling of boys unable to get along in school +because of removable defects. An unruly, uninterested boy sitting +beside your boy in public school, a pampered, overfed, undisciplined +child sitting beside yours at private school, is taxing you without +your consent and doing your child injury that may prove irreparable.</p> + +<p>It costs $2.50 to furnish a child with eyeglasses. It costs $25 to $50 +to give that child a year's schooling. If the child cannot see right +and fails in his studies, we have lost a good investment and, after +one year so lost, we are out $22.50. In two years we have lost $47.50. +But, what is more serious, we have discouraged that boy. Used to +failure in school, his mind turns to other things. He is made to think +that it is useless for him to try for first place. Perhaps he can play +ball, and excels. He chooses a career of ball playing. Valuable years +are lost.</p> + +<p>Initiative and competition are not interrupted any more by free +eyeglasses and free operation for adenoids than by <span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span>free schooling. +There is only one place in the world where there is less competition +or less struggle than among the ignorant, and that is among the +ignorant and unwell. The boy who can't see the blackboard, who can't +learn to spell, who can't breathe through his nose, and can't be +interested, doesn't compete at all with the bright, healthy boy. +Remove the adenoids, give glasses, make interest possible, and fitness +to survive takes a higher level because larger numbers become fit to +survive.</p> + +<p>Professor Patten says that it is easier to support in the almshouse +than in competitive industry a man who cannot earn more than $1.50 a +day. The question, therefore, regarding European remedies is not, To +what general theory do they belong? but, What will they accomplish? +How do they compare with other remedies of which we know?</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XVII" id="CHAPTER_XVII"></a><hr /> +<span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span><br /> + +<h3>CHAPTER XVII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>AMERICAN REMEDIES: GETTING THINGS DONE</h4> +<br /> + +<p>In New York City there is a committee called the Committee on the +Physical Welfare of School Children. The word "welfare" was used +rather than "condition" because the committee proposed to use whatever +facts it could gather for the improvement of home and school +conditions prejudicial to child welfare. The following programme was +adopted:</p> + +<div class="block2"><p class="hang2">1. <i>Study of the physical welfare of school children.</i></p> + +<div class="block"><p class="hang2"><i>a.</i> Examination of board of health records of children needing +medical, dental, or ocular care, and better nourishment.</p> + +<p class="hang2"><i>b.</i> Home visitation of such children, in order to ascertain +whether their need arises from deficient income or from +other causes.</p> + +<p class="hang2"><i>c.</i> Effort to secure proper treatment, either from parents or +from free clinics or other established agencies.</p> + +<p class="hang2"><i>d.</i> Effort to secure proper physical surroundings of children +while at school—playgrounds, baths, etc.</p></div> + +<p class="hang2">2. <i>Effort to secure establishment of such a system of school +records and reports</i> as will disclose automatically significant +school facts,—e.g. regarding backward pupils, truancy, +regularity of attendance, registered children not attending, +sickness, physical defects, etc.</p> + +<p class="hang2">3. <i>Effort to utilize available information regarding school needs</i> +so as to stimulate public interest and thus aid in securing +adequate appropriations to meet school needs.</p></div> + +<p>The committee grew out of the discussion, in the year 1905, of the +following proposition: <i>To insure a race physically able to receive +our vaunted free education, we must provide at school free meals, free +eyeglasses, free medical <span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span>and dental care.</i> Thanks to the +superintendent of schools of New York City, to Robert Hunter's +<i>Poverty</i>, to John Spargo's <i>Bitter Cry of the Children</i>, hundreds of +thousands of American citizens were made to realize for the first time +that a large proportion of our school children are in serious need of +medical, dental, or ocular attention, or of better nourishment.</p> + +<p>Because physicians, dentists, oculists, hospitals, dispensaries, +relief agencies, had seemingly been unconscious of this serious state +of affairs, they had no definite, constructive remedy to propose. +Their unpreparedness served to strengthen the arguments for the +European method of <i>doing things</i>. France, Germany, Italy, England, +had found it necessary to do things at school. Arguing from their +experience, it was only a matter of time when American cities must +follow their example. Why not, therefore, begin at once to deal +radically with the situation and give school meals, school eyeglasses, +etc.? Those who organized the Committee on the Physical Welfare of +School Children realized the danger of trying to settle so great a +question with the little definite information then available. If +<i>doing things at school</i> were to be adopted as a principle and +logically carried out, vast sums must be added to the present cost of +the public school system. Complications would arise with private and +parochial schools, whose children might have quite as serious physical +defects, even though not educated by public funds. It would be +difficult to obtain proper rooms for medical and dental treatment and +meals, and perhaps still more difficult to insure proper food, skilled +oculists, dentists, surgeons, and physicians. No one was clear as to +how the problem was to be solved by small cities and rural districts, +whose needy children are no less entitled to public aid simply because +their numbers are smaller. Great as were the difficulties, however, +the committee saw that difficulties are in themselves no reason for +not doing the right thing. On the <span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span>other hand, if doing things at +school is wrong, if school meals fail to correct and remove physical +defects, great social and educational wrong would result from New +York's setting an example that would not only misdirect funds and +attention in that city, but would undoubtedly lead other cities to +move in the wrong direction. Right could be hastened, wrong could be +prevented more effectually by facts than by any amount of theory. +School meals had been made a political issue in England. The arguments +supporting them were stronger than any possible arguments against +them, except proof that they would be less effective in helping +children than other means that might be proposed. If the American +people must choose between sickly, unteachable, dull children without +school meals, on the one hand, and bright, teachable, healthy children +plus school meals, on the other hand, they will not hesitate because +of expense or eighteenth-century objections to "socialism."</p> + +<p>During one year of investigation and of <i>getting things done</i> the +committee has prepared three studies for publication: (1) a report on +the home conditions of fourteen hundred school children of different +nationalities, found by school physicians to have defects of vision, +breathing, hearing, teeth, and nourishment; (2) an examination of +fifty schools—curriculum, buildings, home-study requirements, play +space and playtime, physical culture—in an attempt to answer the +question, How far does school environment directly cause or aggravate +physical defects of school children; (3) a comparative study of +methods now employed in a hundred cities to record, classify, and make +public significant school facts.</p> + +<p>The results of the first year's work prove conclusively that physical +defects are not caused solely by the inability of parents to pay for +proper food. Among the twenty significant facts reported by the +committee are the following:</p> + +<div class="block" style="font-size: 95%;"><p>1. Physical defects found in public schools are, for the most<span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span> +part, such as frequently occur in wealthy families and do not of +themselves presume as the cause insufficient income. Of 145 +reported for malnutrition, 44 were from families having over $20 +weekly.</p> + +<p>2. Few of the defects can be corrected by nourishment alone; +plenty of fresh air, outside nourishment at school, or extra +nourishment at home will not entirely counteract the influences of +bad ventilation and bad light in school buildings. Country +children have adenoids, bad teeth, and malnutrition. Plenty of +food will not prevent bad teeth and bad ventilation from causing +adenoids, enlarged tonsils, and malnutrition.</p> + +<p>3. Children whose parents have long lived in the United States +need attention quite as much as the recent immigrant.</p> + +<p>4. A large part of the defects reported could be produced by +conditions due directly to neglect of teeth.</p></div> + +<p>From twenty such statements of fact and from its experience in +<i>getting things done</i> for one year, the committee drew fifteen +practical conclusions, among which the following deserve emphasis +here:</p> + +<div class="block"><p>1. The only new thing about the physical defects of school +children is not their existence, but our recent awakening to their +existence, their prevalence, their seriousness if neglected, and +their cost to individual children, to school progress, to +industry, and to social welfare.</p> + +<p>2. <i>Physical deterioration</i>, applied to America's school children, +is a misnomer. No evidence whatever has been given that the +percentage of children suffering from physical defects in 1907 is +greater than the percentage of children suffering from such +defects in 1857. On the contrary, the small proportion of defects +that are not easily removable, as well as a vast amount of +evidence from medical experience and vital statistics, indicates +that, if a comparison were possible, the children of 1907 would be +found to have sounder bodies and fewer defects than their +predecessors of fifty years ago. If there is an exception to this +statement, it is probably defects of vision, with regard to which +school authorities and oculists seem to agree that confinement in +school for longer <span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span>hours and more constant application under +unfavorable lighting conditions have caused a marked increase. +Positive evidence as to tendencies will be easily obtained after +thorough physical examination has been carried on for a +generation.</p> + +<p>3. The effect of massing facts as to physical defects of school +children should not be to cause alarm, but to stimulate remedial +and preventive measures, to invoke congratulations and aggressive +optimism, not doleful pessimism and palliative measures born of +despair.</p> + +<div class="imgr" style="width: 25%;"> +<a href="images/imagep171.jpg"> +<img border="0" src="images/imagep171.jpg" width="90%" alt="The Dark-Hall Evil Is Here Indexed By Adenoids." /></a><br /> +<p class="cen" style="margin-top: .2em; font-size: 80%; margin-left: .5em; margin-right: .5em;">THE DARK-HALL EVIL IS HERE INDEXED BY ADENOIDS.</p> +</div> + +<p>4. The causes of physical defects are not confined to "marginal" +incomes, but, while more apt to be present in families having +small incomes, are found among all incomes wherever there exist +bad ventilation, insufficient outdoor exercise, improper light, +irregular eating, overeating, improper as well as insufficient +food, lack of medical, dental, and ocular attention.</p> + +<p>5. Whatever may be said of free meals at school as a means of +insuring punctual attendance or better attention, they are +inadequate to correct physical conditions that home and street +environment produce.</p> + +<p>6. <i>To remove physical defects, causal conditions among all income +classes should be treated, and not merely symptoms revealed at +school by children of the so-called poor.</i></p> + +<p>7. Parents can and will correct the greater part of the defects +discovered by the physical examination of school children, if +shown what steps to take. Where parents refuse to do what can be +proved to be within their power, and where existing laws are +nonenforced or inadequate, the segregation of children having +physical defects in special classes might prove an effective +stimulus to obstinate parents.</p> + +<p>8. Where parents are unable to pay for medical, dental, and ocular +care and proper nourishment, private philanthropy must either +provide adequately or expect the state to step in and assume the +duty.</p> + +<p>9. Private dispensaries and hospitals must either arrange +themselves to treat cases and to educate communities as to the +importance of detecting and correcting physical defects, or must +expect the state to provide hospital and dispensary care. Until +private hospitals and dispensaries take steps to prevent people +<span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>with adequate incomes from imposing upon them for free treatment, +it is difficult to make out a case against free eyeglasses and +free meals for school children.</p> + +<p>10. Either private philanthropy or the state must take steps to +procure more dental clinics and an educational policy on the part +of the dental profession that will prevent the exploitation of the +poor when dental care is needed.</p> + +<p>11. The United States Bureau of Education is the only agency with +authority and equipment adequate to secure from all sections of +the country proper attention to the subject. Nothing in the world +can prevent free meals, free eyeglasses, free medical care, free +material relief at school, unless educational use is made by each +community of the facts learned through physical examination to +correct home, school, and street conditions that produce and +aggravate physical defects. The national bureau can mass +information in such a way as to convince budget makers in city, +county, and state to vote gladly the funds necessary to promote +the physical welfare of school children.</p></div> + +<p>How the committee got things done is often referred to. There is +something about a request for coöperation, whether by schools or by +any other agency, that enlists the interest of those whose help is +asked. The reason is not that people are flattered by requests to +serve on committees, or that human nature finds it difficult to be +unfriendly or unkind. On the contrary, men and women are by nature +social; there is more joy in giving than in withholding, in working +with others than in working alone. Men and women, official and +volunteer agencies, will coöperate with school-teachers when invited, +for the same reason and <span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span>with the same readiness that ninety-nine +farmers out of a hundred, on the prairie or in the mountain, will +welcome a request for food and lodging.</p> + +<div class="img"> +<a href="images/imagep172.jpg"> +<img border="0" src="images/imagep172.jpg" width="80%" alt="Where "Getting Things Done" Is Possible But "Doing Things" Ineffective" /></a><br /> +<p class="cen" style="margin-top: .2em;">WHERE "GETTING THINGS DONE" IS POSSIBLE BUT "DOING THINGS" INEFFECTIVE</p> +</div> + +<p>Mothers will naturally take a greater interest in the welfare of their +children if held responsible for proper food and proper home +surroundings than if not reminded of their responsibility. In New York +City a woman district superintendent of schools, Miss Julia Richman, +has organized a unique "social settlement." She and several +school-teachers occupy a house, known as "The Teachers' House." This +is their residence. Here they are subject to neither intrusion nor +importunity; no clubs or classes are held here; visitors are treated +as guests, not as beneficiaries. The purpose these teachers have in +living together is to work out the methods of interesting private and +official leaders in community needs disclosed at school.</p> + +<p><span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span>Where clubs and social gatherings are held in school buildings, it is +not unusual for a thousand mothers, recent immigrants, to meet +together in one hall to hear talks on the care of children. Thus, +instead of principals, teachers, and physicians taking the place of +mothers (which they nowhere have succeeded in doing), they do succeed +in harnessing mothers to the school programme. It may take two, three, +or ten visits to get a particular mother to do the necessary thing for +her child, but when once convinced and once inspired to do that thing, +she will go on day in and day out doing the right thing for that child +and for all others in her home. It may take a year to convert a police +magistrate whose sympathy for delinquent parents and truant children +is an active promoter of disorder; but a magistrate convinced, +efficient, and interested is worth a hundred volunteer visitors. To +get things done in this way for a hundred thousand children costs less +in time and money than to do the necessary things for one thousand +children.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XVIII" id="CHAPTER_XVIII"></a><hr /> +<span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span><br /> + +<h3>CHAPTER XVIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>COÖPERATION WITH DISPENSARIES AND CHILD-SAVING AGENCIES</h4> +<br /> + +<p>Scientists agree that the human brain is superior to the animal brain, +not because it is heavier, but because it is finer and better supplied +with nerves. As one writer has said, the human brain is better +"wired," has better organized "centrals." A poor system of centrals +will spoil a telephone service, no matter how many wires it provides. +An independent wire is of little use, because it will not reach the +person desired at the other end. The ideal system is that which almost +instantly connects two persons, no matter how far away or how many +other people are talking at the same time on other wires.</p> + +<div class="imgr" style="width: 30%;"> +<a href="images/imagep175.jpg"> +<img border="0" src="images/imagep175.jpg" width="90%" alt="Adequate Relief Recognizes The Family As The Unit" /></a><br /> +<p class="cen" style="margin-top: .2em; font-size: 80%;">ADEQUATE RELIEF RECOGNIZES THE FAMILY AS THE UNIT</p> +</div> + +<p>The school that tries to do everything for its pupils without using +other existing agencies for helping children<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a> will be like the man +who refuses to connect his telephone with a central switch board, or +like a bank that will not use the central clearing house. As one +telephone center can enable scores of people to talk at once, and as +one clearing house can make one check pay fifty debts, so hospital and +relief agencies enable a teacher who employs "central" to help several +times as many children as she alone can help.</p> + +<p>It seems easier for a teacher to give twenty-five cents to a child in +distress than to see that the cause of the misery is removed. In New +York City there are over five hundred school principals, under them +are over fifteen thousand <span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span>teachers, and the average attendance of +children is about six hundred thousand, representing one hundred and +fifty thousand homes. If teachers give only to those children who ask +for help, many will be neglected. In certain sections of the city +principals have combined to establish a relief fund to be given out to +children who need food, clothes, shoes, etc. One principal had to stop +replacing stolen overcoats because, when it was known that he had a +fund, an astonishingly large number of overcoats disappeared. At +Poughkeepsie school children get up parties, amateur vaudeville, +minstrel shows, basket picnics, to obtain food and clothing for +children in distress. They are, of course, unable to help parents or +children not in school. Of this method a district superintendent in +New York said to his teachers and principals: "For thirty-two years I +have been working in the schools of this district. I have given food +and shoes to thousands of children. I know that however great our +interest in a particular child when it comes to us with trouble at +home, our duty as teachers prevents us from following our gift into +the home and learning the cause of the child's trouble. This last +winter we have made an experiment in using a central society, which +makes it a business to find out what the family needs, to supply +necessaries, country board, medicine, etc. We now know that we can put +a slip of paper with the <span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span>name and address of the child into a general +hopper and it will come out eyeglasses, food, rent, vacation parties, +as the need may be."</p> + +<p>Relief at home through existing agencies was brought about by the +distribution of cards like those on opposite page, which offer winter +and summer coöperation.</p> + +<div class="img" style="clear: both;"> +<a href="images/imagep176.jpg"> +<img border="0" src="images/imagep176.jpg" width="80%" alt="Fresh-Air Agencies Like Sea Breeze Prefer To Aid Children In Order Of Need" /></a><br /> +<p class="cen" style="margin-top: .2em;">FRESH-AIR AGENCIES LIKE SEA BREEZE PREFER TO AID CHILDREN IN ORDER OF NEED</p> +</div> + +<p>When these cards were first distributed several teachers went from +room to room, asking children who needed help to raise the hand. In +many cases parents were very angry that their children should have +asked for help. But help given in instances like the following soon +proved to teachers that they could afford the time necessary to notice +children who appeared neglected, when so much good would ensue:</p> + +<div class="block"><p>The father is sick and unable to work. They cannot get clothes for +the children, who are not attending school on that account. +Children were provided with shoes and clothes.</p> + +<p>November 30, 1907, a school principal reported that six children +in one family needed underwear. A visitor discovered that one of +the boys who had the reputation of being unruly and light-fingered +also had adenoids. He was taken to a hospital for operation, and +was later interested in his school work.</p> + +<div class="img"><span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span> +<a href="images/imagep177.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep177.png" width="40%" alt="Facsimile of flyer for the New York Association for Improving the Condition of the Poor." /></a><br /> +</div> + +<p><span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span>A little girl was unruly and truant. No attempt was made to keep +her at school, but she was reported to the Committee on the +Physical Welfare of School Children. The parents could not control +her. The girl was taken for examination by a specialist and found +to be feeble-minded. Later she was sent to a custodial institute.</p> + +<p>Another little girl was nine years old, but could not talk. A +University Extension Society worker found that she was not kept at +school because it was too much trouble. The child was taken to a +physician who operated and corrected the tongue-tie.</p> + +<p>A girl of twelve said she must stay home to "help mother." The +mother was found to be a janitress, temporarily incapacitated by +rheumatism. A substitute was provided until the mother was well, +and all the children were properly clad for school.</p> + +<p>After the adenoid operations in a New York school that occasioned +the East Side riots of 1906, the physicians and principals who had +persuaded parents to permit the operations were fearful lest the +summer in unsanitary surroundings might make the demonstration +less complete. Over forty children in three parties were sent away +for the summer, where they had wholesome food and all the milk +they could drink and fresh air day and night. When they returned +in the fall the principal wrote: "The improvement in each +individual is simply marvelous. We shall try to continue this +condition and shall constantly urge the parents to keep up the +good work by means of proper food and fresh air."</p></div> + +<p>In none of these instances could the teachers have accomplished equal +results for the individual children or for the families without +neglecting school duties. By informing other agencies as to children's +needs, teachers started movements that have since helped practically +every school child in New York City. Dispensaries are setting aside +separate hours for school children; fresh-air agencies are giving +preference to children found by teachers or school physicians to be in +physical need; relief agencies are making "rush orders" of every note +from teachers; the health board is more active because volunteer +agencies <span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span>have added their voice to that of teacher and health officer +in demanding adequate funds for physical examination of school +children.</p> + +<div class="img"> +<a href="images/imagep179.jpg"> +<img border="0" src="images/imagep179.jpg" width="80%" alt=""Central" Found The Mother Sick in a Hospital, the Father Killed--The Children were Boarded in the Country until the Mother Recovered" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">"CENTRAL" FOUND THE MOTHER SICK IN A HOSPITAL, THE +FATHER KILLED—THE CHILDREN WERE BOARDED IN THE COUNTRY UNTIL THE MOTHER RECOVERED</p> +</div> + +<p>Coöperation is at present easier in New York than in any other city. +Charitable societies, hospitals, dispensaries, are probably more +keenly alive to their responsibilities and are at least more apt to +have acquired the habit of coöperation when asked. Yet even here I +have been told repeatedly by teachers: "If we have to wait for that +hospital or that charitable society, our children will go barefoot." +In small communities where hospital and relief agencies are for +emergencies only and generally inactive, it seems that the first thing +to do is to ask some friends to establish a small relief fund, just as +it is easier to give a child a five-cent <span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span>meal than to teach its +mother how to prepare its food. But the school-teacher will find that +it takes very much less energy to arouse the relief society than to +maintain her own relief work. In fact, in many cities nothing could do +more to strengthen hospitals and charitable societies than to put them +in touch with the needs of school children. For a principal to make +known the fact that school children are neglected will help the +charitable society and hospital to get the funds necessary to do their +part better than they are now doing it and better than the school +could ever do it. Finally, one reason for a breakdown of charitable +societies is not their own inadequacy, but rather the failure of the +<span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span>school and church to make use of an agency better equipped than +themselves to give material relief. The teacher sees the child every +day, while the relief society will never see it and has no reason to +see it until some one calls attention to it. The very first step, and +an indispensable one in relief policy, is for teachers to be on the +lookout for children not adequately provided for, and then have the +physical evidence discovered at school followed to the home for the +cause of the child's distress.</p> + +<div class="img"> +<a href="images/imagep180.jpg"> +<img border="0" src="images/imagep180.jpg" width="70%" alt="Home-to-Home Instruction in Cooking" /></a><br /> +<p class="cen" style="margin-top: .2em;">HOME-TO-HOME INSTRUCTION IN COOKING<br />Anæmic condition of child due to bad cooking, not to lack of income</p> +</div> + +<p><i>Coöperation</i> removes the cause of distress; <i>doing</i> may aggravate it. +Teachers would do well to draw up for themselves a chart which will +show exactly what part of the community's work can be best done by +their school. On the following page is charted the social work now +being conducted at the Massachusetts General Hospital, Boston. So far +as agencies exist to deal with any individual or family problem coming +into the social-work square, the hospital aims to utilize that agency. +Its own direct dealing with neurasthenics, with hygiene education, +with sexual deviates, is primarily for the purpose of giving adequate +treatment to the needy, and secondarily to demonstrate how adequate +treatment should be organized for the community. Please to note that +governmental agencies are not mentioned in Dr. Cabot's chart. This +does not mean that he would not emphasize the importance of those +agencies, but that up to the present time, for the particular cases +dealt with in his clinics, governmental agencies can be reached most +effectively through the private charitable agencies in the reference +square. So the teacher will frequently find that the relief bureau, +children's society, public education association, or church can get +better results for her pupils from public health and correctional +agencies than can she by writing directly.</p> + +<div class="img"><span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span> +<a href="images/imagep182.png"> +<img border="0" src="images/imagep182.png" width="55%" alt="Chart of Social Work, Massachusetts General Hospital" /></a><br /> +</div> + +<p><span class='pagenum'><a name="Page_183" id="Page_183">[183]</a></span>In country districts no plan has yet been worked out for adequate +relief. Fortunately, however, the distress is generally of such a +kind, and the teacher so well acquainted with all the parents of her +district, that it will not be difficult to procure such attention as +is necessary. Country schools should be furnished by county and state +superintendents with clear directions for getting the treatment +afforded in the immediate vicinity. Where teachers are alone in seeing +the need for coöperation they can quickly interest young and old, +physicians, dentists, pastors, health officers, in home visiting, +street cleaning, nursing, helping truants, needed changes of +curriculum, etc. <i>Getting things done</i> is easy because it is human to +love the <i>doing</i>; getting things done is <i>doing</i> of the highest order.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> The importance of recognizing the family as the unit of +social treatment is presented in Edward T. Devine's <i>Principles of +Relief</i>, and in Homer Folks's <i>Care of Dependent, Defective, and +Delinquent Children</i>.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XIX" id="CHAPTER_XIX"></a><hr /> +<span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span><br /> + +<h3>CHAPTER XIX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>SCHOOL SURGERY AND RELIEF OBJECTIONABLE, IF AVOIDABLE</h4> +<br /> + +<p>The popular arguments for free meals, free relief, free medical +treatment at school, are based upon the assumption that there are but +two ways to travel, one leading to a physically sound, moral, +teachable child, the other to an undernourished, subnormal, backward +child. They tell us we must choose either school meals or +malnutrition, school eyeglasses or defective vision, free coal or +freezing poor, free rent or people sleeping on the streets, free +dental clinics at school or indigestion and undernourishment, free +operation at school for adenoids or backward, discouraged pupils. If +there is no other alternative than neglect of the child, if we must +either waste fifty dollars in giving a child education that he is +physically unable to take, or pay two, three, four, or even fifty +dollars to fit him for that education, the American people will not +hesitate. Whether there are other roads to healthy children, whether +it is cheaper and better for the school to see that outside agencies +prepare the child for education rather than itself to take the place +of those outside agencies, is a question of fact, not of theory.</p> + +<p>Facts prove, as we have seen, that there is more than one way to +prevent malnutrition. Parents can be taught to attend to their +children; hospitals and dispensaries will furnish eyeglasses where +parents are unable to pay for them; charitable societies will go back +of the need for eyeglasses to the conditions that produce that need +and will do vastly more for the child than can eyeglasses alone. If +<span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span>parents, hospitals, dispensaries, and charitable societies will attend +to children's needs, then relief at school is unnecessary, even though +it may seem desirable.</p> + +<p>The objection to school surgery should be clearly before us, so that +we can judge of the two methods that are open to us,—<i>treatment at +school</i> vs. <i>treatment away from school</i>.</p> + +<p>Society is so organized that the treatment of serious physical defects +and social needs at school would upset the machinery a very great +deal. For the school to do for its children whatever they may need +during their school years will require the setting up of a miniature +society in every school building or under every school board. Unless +schools are to equip themselves to take the place of all existing +facilities for relief and surgery, children would not be so well taken +care of as at present. It should not be forgotten that the physical +welfare of the school child is the most accurate index to the physical +needs of the community. After all, the child lives for six important +years before coming to the school and leaves at the early age of +fourteen or fifteen; even while attending school it sleeps at home and +is influenced more by home and street standards of ventilation, +cleanliness, and morality than by conditions at school. It would seem, +therefore, the wider use of the school's influence to use the child's +appeal to strengthen every agency having to do with community health, +rather than to concentrate upon the child himself. If babies were +properly cared for up to the sixth year, the protection of the school +child's health would be infinitely easier. To take our eyes from the +child not yet in school and from the child just out of school is to +make the mistake that so many advocates of the child labor movement +have made of going whither and only so far as our interest leads us +and of not continuing until our work is accomplished.</p> + +<div class="img"> +<a href="images/imagep186.jpg"> +<img border="0" src="images/imagep186.jpg" width="52%" alt=""Doing Things" Through Model Tenements" /></a><br /> +<p class="cen" style="margin-top: .2em;">"DOING THINGS" THROUGH MODEL TENEMENTS</p> +</div> + +<p>Do we want to make of our schools miniature hospitals, dispensaries, +relief bureaus, parks? Or shall we use the <span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span>momentum of society's +interest in the school child to put within the reach of every school +building adequate hospitals, dispensaries, relief centers, and parks +for school child and adult? Shall every little school have its +library, or shall the child be taught at school how to use the same +library that <span class='pagenum'><a name="Page_187" id="Page_187">[187]</a></span>is available to his parents and older brothers and +sisters? If the library is to be under the school roof, if dispensary +and relief hospital are to be conducted on the same site as the +school, shall they be known as dispensary, library, relief bureau, +each under separate management, or shall <span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span>they be known as school +under the management of school principal and superintendent? So +complicated and many-sided is the problem of working together with +one's neighbor for mutual benefit that it is a safe rule for the +schools to adopt: <i>We shall do nothing that is unnecessary or +extravagant. We shall have done our part if we do well what no one +else can do. Whatever any agency can do better than we, we shall leave +to that agency. Work that another agency ought to have done and has +left undone, we shall try to have done by that agency.</i></p> + +<div class="img"> +<a href="images/imagep187.jpg"> +<img border="0" src="images/imagep187.jpg" width="52%" alt="Immediately Opposite The Model Tenements, But Uninfluenced" /></a><br /> +<p class="cen" style="margin-top: .2em;">IMMEDIATELY OPPOSITE THE MODEL TENEMENTS, BUT UNINFLUENCED<br /> +"Getting things done" by the Tenement House Department their special need</p> +</div> + +<p>I know a hospital where a welfare nurse was recently employed. Within +a few blocks were three different relief agencies and two +visiting-nurse's associations, having among them over one hundred +visitors and nurses going to all sections of Manhattan. This nurse had +the choice of telephoning to one of these agencies and asking it to +call at the needy home of one of her hospital patients, or of going to +the home herself. Had she chosen to use another agency, she could have +been the means of furnishing the kind of help needed in every needy +home discovered in her hospital rounds, but she chose to do the +running about herself and thus of helping ten families where she ought +to have helped five hundred. Much the same condition confronts the +school that tries to do all extra work for its child instead of seeing +that the work is done. Illustration is afforded by the New York +tenement department. Whereas European cities have built a few model +tenements, New York City secured a law declaring that everybody who +built a tenement and everybody who owned a tenement should provide +sanitary surroundings. At the present time a philanthropist, by +spending two million dollars, could give sanitary surroundings to +thirty-five families; by spending each year the interest on one tenth +that sum he could insure the enforcement of the tenement laws +affecting every tenement resident in New York City.</p> + +<p><span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span>If schools are to perform surgical operations, they are in danger of +being sued for malpractice; discipline will be interfered with. +Finally, let us not forget that we are dealing with buildings, +teachers, and school institutions as they exist. Where education is +made compulsory, the unpleasant and the controversial should be kept +out of school. Because a democratic institution, the American school +should represent at all times a maximum of general agreement.</p> + +<p>To take <i>palliative measures to public schools</i> not only <i>leaves +undone remedial</i> work necessary for the health of public school +children but <i>neglects entirely the still large numbers who go to +parochial, private pay, and private free schools</i>; no one has had the +temerity to suggest that the public shall force upon nonpublic schools +a system of free operations, free eyeglasses, free meals.</p> + +<p>Civilization has painstakingly developed a large number of agencies +for the education and protection of mankind. Of these agencies the +school is but one. Its first and peculiar function is <i>to teach and to +train</i>. This it can do better than any other agency or combination of +agencies. In attempting to "bring all life under the school roof," we +use but a small part of our resources. Instead of persuading each of +the agencies for the promotion of health to do its part for school +children, we set up the school in competition with them. Thus in +trying to <i>do things</i> for school children we are in danger of +crippling agencies equipped to do things for both school children and +their parents, for babies before they come to school, and for wage +earners after they leave school.</p> + +<p><i>Getting things done</i> will lead schools to study underlying causes; +<i>doing things</i> has heretofore caused schools to confine themselves to +symptoms. <i>Getting things done</i> will leave the school free to +concentrate its attention upon school problems; <i>doing things</i> will +lead it afield into the problem of medicine, surgery, restaurant +keeping, and practical charity.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XX" id="CHAPTER_XX"></a><hr /> +<span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span><br /> + +<h3>CHAPTER XX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>PHYSICAL EXAMINATION FOR WORKING PAPERS</h4> +<br /> + +<p>There is no sacred right to work when our work involves injury to +ourselves and to our neighbor. Work at the expense of health is an +unjustifiable tax upon the state. It is the duty of society to protect +itself against such depletion of national efficiency.</p> + +<p>Three classes of workmen need special attention: (1) those who are +physically unfit to work; (2) those who are physically unfitted for +the work they are doing; (3) those who are subjected to unhealthful +surroundings while at work. Viewing these three classes from the +standpoint of their neighbors, we have three social rights that should +be enforced by law: (1) the right to freedom from unhealthy work; (2) +the right to work fitted to the body; (3) the right to healthy +surroundings at work.</p> + +<p>It is undoubtedly true that just as the sick child may be found at the +head of his class, so unhealthy men and women are often good business +managers, good salesmen, good typewriters, successful capitalists. +They excel, however, not because of their ill health, but in spite of +it, excepting of course those instances where men and women, because +of ill health, have devoted to business an attention that would have +been given to recreation if bad health had not deprived recreation of +its pleasure. As statistics in school have proved that the majority of +mentally superior children are also physically superior, so statistics +will probably prove that the number of the "sick superior" among the +working classes is very small, while the danger of inefficiency that +comes from physical defect is very great.</p> + +<p><span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span>There is one time in the individual's working life when the state may +properly step in and demand an inventory of physical resources, and +that is when the child asks the state for permission to go to work. +Strategically, this is probably the most important of all contact as +yet provided between society and the future wage earner. Here at the +threshold of his industrial career the boy may be told for what work +he is physically fitted, what physical defects need to be remedied, +what physical precautions he needs to take, in order to do justice to +himself and his opportunity.</p> + +<p>Every year from two to three million children leave the public schools +of this country to join the army of workers. The percentage of those +recruits who have physical defects needing attention is undoubtedly +great; how great we shall never know until the benefits of physical +examination are given to all of them. What steps is your state taking +to ascertain the physical fitness of the children who present +themselves each year for working papers? How does it insure itself +against the risk of their defective eyesight, chorea, deafness, or +general debility? Does it inform children of their defects, or tell +them how they may increase their earning power by correcting these +defects? What effort does it make to induce children to avoid +dangerous trades, or trades that are particularly dangerous for their +physiques?</p> + +<p>At the close of school last spring I had my secretary look in upon the +New York board of health and see what demands that city makes upon its +boys and girls before allowing them to drive its machinery, to run its +elevators, to match its colors, to sew on its buttons, to set its +type, to carry its checks to the bank. The officer at the door of the +room where the children were being examined, greeted her as follows: +"You must bring your child with you; bring his birth certificate or +swear that he is fourteen years old, and bring a signed statement from +his teacher that he has been in school for one hundred and thirty +consecutive days <span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span>within twelve months." "Is there no physical +examination or test?" she asked. "No, no," he answered impatiently. +Yet the board of health certifies that "said child has in our opinion +reached the normal development of a child of its age, and is in sound +health and is physically able to perform the work which it intends to +do." In addition the blank calls for place and date of birth, color of +hair and of eyes, height, weight, and facial marks. Volunteer +societies in practically every state in the Union have been working +for years to have it made a criminal offense to employ a child who has +not been in school a minimum of days after a stated age (12, 13, 14, +15). Even in New York, however, the center of this agitation, no +strong demand was made upon the board of health to apply a +physical-fitness test as well as an age test until 1908 when +examination for working papers was added to the programme for child +hygiene. Yet who does not know girls and boys of sixteen less fit for +factory or shop work than other boys and girls of twelve? It is the +fetich of age which has made possible the "democracy" that permits a +child of fourteen to work all day on condition that he go to school at +night!</p> + +<div class="img"> +<a href="images/imagep192.jpg"> +<img border="0" src="images/imagep192.jpg" width="80%" alt="Children Enlisting in the Industrial Army" /></a><br /> +<p class="cen" style="margin-top: .2em;">CHILDREN ENLISTING IN THE INDUSTRIAL ARMY</p> +</div> + +<div class="img"><span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span> +<a href="images/imagep193.jpg"> +<img border="0" src="images/imagep193.jpg" width="80%" alt="Waiting to be Examined for Working Papers" /></a><br /> +<p class="cen" style="margin-top: .2em;"> WAITING TO BE EXAMINED FOR WORKING PAPERS<br /> +An excellent opportunity for physical-fitness tests</p> +</div> + +<p>So great is the risk of defective, sickly, or intemperate employees, +that in some trades employers take every precaution to exclude them. +One man with defective eyesight or unsteady nerves may cost a railroad +thousands of dollars. As insurance companies rank trades as first-, +second-, or third-class risks, so many factories, from long +experience, debar men with certain characteristics which have been +found detrimental to business. The Interborough Rapid Transit Company +of New York City examines all applicants for employment, as to age, +weight, height, keenness of vision, hearing, color perception, lungs, +hearts, arteries, alcoholism, and nicotinism. Those who fall below the +standard are rejected, but in each case the physical condition is +explained to the applicant. Where defects are removable or +correctable, the applicant is told what to do and invited to take +another test after treatment. Moreover, accepted employees are +periodically reëxamined. While designed to <span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span>increase company profits +and to reduce company losses, this examination obviously decreases the +employees' losses also, and increases the certainty of work and +prospect of promotion.</p> + +<p>Our states, and many of our industries, still have the attitude of a +certain manufacturer who employs several hundred boys and girls. I +asked him what tests he employed. "I look over a long line of the +applicants and say," pointing his finger, "I want you, and you, and +you; the rest may go." I asked him if he made a point of picking out +those who looked strong. "No. The work is easy, sitting down all day +long and picking over things. I select those whose faces I like. Yes, +there is one question we now ask of all the girls. One day a girl in +the workroom had an epileptic fit and it frightened everybody and +upset the work so that the foreman always asks, 'Do you have fits? +Because if you do, you can't work here.'" He makes no attempt to +determine the physical fitness and endurance of the children employed, +because when the strength of one is spent there is always another to +step into her place.</p> + +<p>Because the apprentice's future is of no value to the manufacturer, +the state must restrict the manufacturer's freedom to spend like water +society's capital,—the health of the coming generation. Could there +be a grosser mis-management of society's business than to permit trade +to waste children on whose education society spends so many millions +yearly? The most effective and most timely remedy is physical +examination as a condition of the work certificate. A simple, easily +applied, inexpensive measure that imposes only a legitimate +restriction upon individual freedom, it is absolutely necessary in +order to get to the bottom of the child labor problem. If thoroughly +applied, children of the nation will no longer be exploited by +unscrupulous or indifferent employers, nor will their health be +hazarded by lack of discriminating examination that rejects the +obviously sick and favors the apparently robust. Furthermore, +knowledge <span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span>that this test will be applied when work certificates are +required, will be an incentive to the school boy and girl to keep +well. Tell a boy that adenoids or weak lungs will keep him from +getting a job, and you will make him a strong advocate of operation +and of fresh air. Show him that his employers will not wish his +services when his week is out if he is physically below par, and he +will gladly submit to a <span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span>board of health examination and ask to be +told what his defects are and how to correct them.</p> + +<div class="img"> +<a href="images/imagep195.jpg"> +<img border="0" src="images/imagep195.jpg" width="57%" alt="Children at Work below both Age Limit and Vitality Limit" /></a><br /> +<p class="cen" style="margin-top: .2em;">CHILDREN AT WORK BELOW BOTH AGE LIMIT AND VITALITY LIMIT<br /> +National Child Labor Committee</p> +</div> + +<p>Some there are who will object to this appeal to the child's economic +instinct. This objection does not remove the instinct. The normal +child is greedy for a job. His greed, as well as that of the +manufacturer and parent, is responsible for much of the child labor; +his greed for activity, for association, for money, and so for work. A +little boy came into my office and wanted to hire as an office boy. I +looked at him and said: "My little fellow, you ought to be in school. +What do you want to hire out here for?" He said, "I am tired of +school; nothing doing." He doesn't care about work for its own sake; +he doesn't care about wealth for its own sake; he wants to get into +life; to be where there is "something doing." In this lies one potent +argument for vocational training. To tell a boy of his physical needs +just before he has taken his first business step is to put him +everlastingly in our debt. Then he is responsive, and, fortunately for +the extreme cases, necessarily dependent, for he knows that his +refusal would stand between himself and his ambition.</p> + +<p>When boys and girls go for work certificates to Dr. Goler, medical +officer of health at Rochester, he requires not merely evidence of age +and of schooling, but examines their eyes for defective vision and for +disease, their teeth for cavities and unhealthy gums, and their noses +and throats for adenoids and enlarged tonsils. If a boy has sixteen +decayed teeth, Dr. Goler explains to him that teeth are meant to be +not only ornaments and conveniences, but money getters as well. The +boy learns that decayed teeth breed disease, contaminate food, +interfere with digestion, make him a disagreeable companion and a less +efficient worker. If he will go and have them put into proper +condition he will enjoy life better and earn good wages sooner. After +the teeth are attended to the boy secures his work <span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span>certificate. If +the boy's mother protests in tears or in anger that her boy does not +work with his teeth, she learns what she never learned at school, that +sound teeth help pay the rent. If a girl applicant for working papers +has adenoids, she is asked to look in the mirror and to notice how her +lips fail to meet, how the lower jaw drops, how much better she looks +with her jaws and lips together. She is told that other people breathe +through the nose, and that perhaps the reason she dislikes school and +does not feel as she used to about play is that she cannot breathe +through her nose as she used to. She is shown that her nose is stopped +up by a spongy substance, as big as the end of her little finger, +which obstruction can be easily removed. She is shown adenoids and +enlarged tonsils that have been removed from some other girl, and is +so impressed with the before-operation and after-operation contrast +and by the story of the other girl's rapid increase in wages, that she +and her mother both decide not to wait for the adenoids to disappear +by absorption. After the operation they come back with proof that the +trouble is gone, and get the "papers." Similar instruction is given +when defects of vision seriously interfere with a child's prospects of +getting ahead in his work, or when evidence of incipient tuberculosis +makes it criminal to put a child in a store or factory.</p> + +<div class="imgr" style="width: 40%;"> +<a href="images/imagep197.jpg"> +<img border="0" src="images/imagep197.jpg" width="90%" alt="The Grenfell Association finds Mouth Breathers at work in Labrador" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 5%; margin-right: 5%; font-size: 80%;">THE GRENFELL ASSOCIATION FINDS MOUTH BREATHERS AT WORK IN LABRADOR</p> +</div> + +<p>No law as yet authorizes the health officer of Rochester to refuse +work certificates to children physically unfit to become wage earners. +A higher law than that which any legislature can pass or revoke, has +given Dr. Goler power <span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span>over children and parents, namely, interest in +children and knowledge of the industrial handicap that results from +physical defects. This higher law authorizes every health officer in +the United States to examine the school child before issuing a work +certificate, to tell the child and his parents what defects need to be +removed, for what trades he is physically unfitted, what trades will +not increase his physical weakness, and to what trade he is physically +adapted.</p> + +<p>We should not forget that a large proportion of our children never +apply for work certificates; some because they never intend to work; +some because they expect to remain in school until sixteen or later; +some because they live on farms, in small towns, or in cities and +states where prohibition of child labor is not enforced. Because there +is no reason for this large proportion of children to visit a board of +health, some substitute must be found. This substitute has been +already suggested by principals and district superintendents in New +York City, who claim that the natural place for the examination of +children is the school and not health headquarters. Developing the +idea that the school should pronounce the child's fitness to leave +school and to engage in work, we are led to the suggestion that the +state, which compels evidence that every child, rich or poor, is being +taught during the compulsory school age, shall also at the age of +fourteen or sixteen require evidence that the child is physically fit +to use his education, and that it shall not, because of preventable +ill health, prove a losing investment.</p> + +<p>Parochial and private schools, the ultra-religious and ultra-rich, may +resent for a time public supervision of the physical condition of +children who do not ask for work certificates. This position will be +short-lived, because however much we may disagree about society's +right to control a child's act after his physical defects are +discovered, few of us will question the state's duty to tell that +child and his <span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span>parents the truth about his physical needs before it +accepts his labor or permits him to go to college, to "come out," to +"enter society," or to live on an income provided by others. Thus an +invaluable commencement present can be given by the state to children +in country schools and to those compelled to drop out of fourth or +fifth grades of city schools.</p> + +<div class="img"> +<a href="images/imagep199.jpg"> +<img border="0" src="images/imagep199.jpg" width="80%" alt="The Health Department's Clinical Care and Home Instruction come after Wage Losses" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">THE HEALTH DEPARTMENT'S CLINICAL CARE AND HOME INSTRUCTION COME AFTER WAGE LOSSES, +WHILE WORK CERTIFICATES PRECEDE BREAKDOWNS FROM TUBERCULOSIS</p> +</div> + +<p>A brief test of this method of helping children, such as is now being +made by several boards of health at the instance of the National +Bureau of Labor, will prove conclusively that parents are grateful for +the timely discovery of these defects which handicap because of their +existence, not because of their discovery. Of the cadets preparing for +war at West Point, it has recently been decided that those "who in the +physical examinations are found to have deteriorated below the +prescribed physical standard will be dropped from the rolls of the +academy." Shall not cadets preparing <span class='pagenum'><a name="Page_200" id="Page_200">[200]</a></span>for an industrial life and +citizenship be given at least a knowledge of an adequate physical +standard? To allow the school child to deteriorate whether before or +after going to work is only to waste potential citizenship. Citizens +who use themselves up in the mere getting of a living have no surplus +strength or interest for overcoming incompetence in civic business, or +for achieving the highest aim of citizenship,—the art of +self-government for the benefit of all the governed.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXI" id="CHAPTER_XXI"></a><hr /> +<span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span><br /> + +<h3>CHAPTER XXI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>PERIODICAL PHYSICAL EXAMINATION AFTER SCHOOL AGE</h4> +<br /> + +<p>Governor Hughes, in his address to the students in Gettysburg College, +pleaded for such lives that strength would be left for the years of +achievement. How many men and women can you count who are squandering +their health bank account? How many do you know who are now physically +bankrupt? The man who is prodigal of his health may work along all +right for years, never realizing until the test comes that he is +running behind in his vitality. The test may be hard times, promotion, +exposure to cold, heat, fever, or a sudden call for all his control in +avoiding accident. If his vitality fails to stand the test, his career +may be ruined, "all for the want of a horseshoe nail": because of no +health bank account to draw upon in time of need,—failure; because of +vitality depleted by alcohol, tobacco, overeating, underexercise, or +too little sleep,—no power to resist contagious diseases; because of +ignorance of existing lung trouble,—a year or more of idleness, +perhaps poverty for his family; or there is neglected ear or eye +trouble,—and thousands of lives may be lost because the engineer +failed to read the signals.</p> + +<p>Adults are now examined when applying for insurance or accident +policies, for work on railroads, for service in the army and on the +police and fire forces of cities that provide pensions. It is somewhat +surprising that the hundreds of thousands who carry life insurance +policies have not realized that a test which is rigorously imposed for +business reasons by insurance companies can be applied by individuals +for <span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span>business reasons. Generations hence the state will probably +require of every person periodic physical examination after school +age. Decades hence business enterprises will undoubtedly require +evidence of health and vitality from employees before and during +employment, just as schools will require such evidence from teachers. +It is, after all, but a step from the police passport to the health +passport. Why should we not protect ourselves against enemies to +health and efficiency as well as against enemies to order? But for the +present we must rely upon the intelligence of individuals to recognize +the advantage to themselves, their families, and their employers, of +knowing that their bodies do not harbor hidden enemies of vitality and +efficiency. From a semi-annual examination of teeth to a semi-annual +physical examination is but a short step when once its effectiveness +is seen by a few in each community.</p> + +<div class="img"> +<a href="images/imagep202.jpg"> +<img border="0" src="images/imagep202.jpg" width="80%" alt="The Old Southfield, now Anchored at Bellevue Hospital's Dock, New York City" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">THE OLD SOUTHFIELD, NOW ANCHORED AT BELLEVUE HOSPITAL'S DOCK, NEW YORK CITY, +GIVES DAILY LESSONS IN THE PREVENTABLE TAX LEVIED BY TUBERCULOSIS</p> +</div> + +<p><span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>Ignorance of one's physical condition is a luxury no one can afford. +No society is rich enough to afford members ignorant of physical +weaknesses prejudicial to others' health and efficiency. Every one of +us, even though to all appearances physically normal, needs the +biological engineer. New conditions come upon us with terrific +rapidity. The rush of work, noise, dust, heat, and overcrowding of +modern industry make it important to have positive evidence that we +have successfully adapted ourselves to these new conditions. Only by +measuring the effects of these environmental forces upon our bodies +can we prevent some trifling physical flaw from developing into a +chronic or acute condition. As labor becomes more and more highly +specialized, the body of the laborer is forced to readapt itself. The +kind of work a man does determines which organs shall claim more than +their share of blood and energy. The man who sets type develops +keenness of vision and manual dexterity. The stoker develops the +muscles of his arms and back, the engineer alertness of eye and ear. +All sorts of devices have been invented to aid this specialization of +particular organs, as well as to correct their imperfections: the +magnifying glass, the telescope, the microscope, extend the powers of +the eye; the spectacle or an operation on the eye muscles enables the +defective eye to do normal work. A man with astigmatism might be a +policeman all his life, win promotion, and die ignorant of his defect; +whereas if the same man had become a chauffeur, he might have killed +himself and his employer the first year, or, if an accountant, he +might have been a chronic dyspeptic from long-continued eye strain. It +is a soul tragedy for a man to attempt a career for which he is +physically unadapted.<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a> It is a social tragedy when men and women +squander their health. A great deal of the success attributed to luck +and opportunity, or unusual <span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span>mental endowment, is in reality due to a +chance compatibility of work with physique. To secure such +compatibility is the purpose of physical examination after school age.</p> + +<p>If the periodic visit to the doctor is the first law of adult health, +still more imperative is the law that competent physicians should be +seen at the first indication of ill health. Even when competent +physicians are at hand, parents and teachers should be taught what +warning signs may mean and what steps should be taken. In Germany +insurance companies find that it saves money to provide free medical +and dental care for the insured. Department stores, many factories and +railroads, have learned from experience that they save money by +inducing their employees to consult skilled physicians at the first +sign of physical disorder. Many colleges, schools, and "homes" have a +resident physician. Wherever any large number of people are assembled +together,—in a hotel, factory, store, ship, college, or +school,—there should be an efficient consulting physician at hand. If +people are needlessly alarmed, it is of the utmost importance to show +them that there is nothing seriously wrong. Therefore visits to the +consulting physician should be encouraged.</p> + +<p>The reader's observation will suggest numerous illustrations of pain, +prolonged sickness, loss of life, that could have been prevented had +the physician been semi-annually visited. A strong man, well educated, +with large income, personally acquainted with several of the foremost +physicians of New York City, after suffering two weeks from pains +"that would pass away," was hurriedly taken to a hospital at three +o'clock in the morning, operated upon immediately, and died at nine. A +business man of means put off going to a physician for fifteen years, +for fear he would be told that his throat trouble was tobacco cancer, +or incipient tuberculosis, or asthma; a physical examination showed +that a difficulty of breathing and chronic throat <span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span>trouble were due to +a growth in the nose, corrected in a few minutes by operation.</p> + +<p>A celebrated economist was forced to give up academic work, and +consecrated his life to painful and chronic dyspepsia because of eye +trouble detected upon the first physical examination. A woman +secretary suffered from alleged heart trouble; paralysis threatened, +continuous headache and blurred vision forced her to give up work and +income; a physical examination found the cause in nasal growths, whose +removal restored normal conditions. A woman lecturer on children's +health heard described last summer a friend's experience with receding +gums: "'Why, I never heard of that disease.' she said. 'Don't you know +you have it yourself'? I asked. She had never noticed that her gums +were growing away in little points on her front teeth. I touched the +uncovered portion and she winced. That ignorance has meant intense +pain and ugly fillings. If it had gone longer, it might have meant the +loss of her front teeth." A teacher lost a month from nervous +prostration; physical examination would have discovered the eye +trouble that deranged the stomach and produced the nerve-racking +shingles which forced him to take a month's vacation. A journalist +lost weeks each year because of strained ankles; since being told that +he had flat foot, and that the arch of his foot could be strengthened +by braces and specially made shoes, he has not lost a minute. A relief +visitor, ardent advocate of the fresh-air, pure-milk treatment for +tuberculosis, had a "little cough" and an occasional "cold sweat"; +medical friends knew this, but humored her aversion to examination; +when too late, she submitted to an examination and to the treatment +which, if taken earlier, would most certainly have cured her. A +mother's sickness cost a wage-earning daughter nearly $3000; softening +of the brain was feared; after six years of suffering and unnecessary +expense, physical examination disclosed an easily removable cause, +<span class='pagenum'><a name="Page_206" id="Page_206">[206]</a></span>and for two years she has contributed to the family income instead of +exhausting it. Untold suffering is saved many a mother by knowledge of +her special physical need in advance <span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span>of her baby's birth. Untold +suffering might be saved many a woman in business if she could be told +in what respects she was transgressing Nature's law.</p> + +<div class="img"> +<a href="images/imagep206.jpg"> +<img border="0" src="images/imagep206.jpg" width="50%" alt="New York City's Tuberculosis Sanatorium at Otisville is Sending Home Apostles Of Semi-Annual Examinations" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;">NEW YORK CITY'S TUBERCULOSIS SANATORIUM AT OTISVILLE IS +SENDING HOME APOSTLES OF SEMI-ANNUAL EXAMINATIONS</p> +</div> + +<div class="img"> +<a href="images/imagep207.jpg"> +<img border="0" src="images/imagep207.jpg" width="80%" alt="Boston's Picturesque Day Camp for Tuberculosis Patients is teaching the need for a Periodic Inventory of Physical Resources" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">BOSTON'S PICTURESQUE DAY CAMP FOR TUBERCULOSIS PATIENTS +IS TEACHING THE NEED FOR A PERIODIC INVENTORY OF PHYSICAL RESOURCES</p> +</div> + +<p>To encourage periodic physical examination is not to encourage morbid +thinking of disease. One reason for our tardiness in recognizing the +need for thorough physical examination is the doctor's tradition of +treating symptoms. After men and women are intelligent enough to +demand an inventory of their physical resources,—a balance sheet of +their physical assets and liabilities,—physicians will study the +whole man and not the fraction of a man in which they happen to be +specializing or about which the patient worries. By removing the +mystery of bodily ailments and by familiarizing ourselves with the +essentials to healthy living, we find protection against charlatans, +quacks, faddists, and experimenters. By taking a periodic inventory of +our physical resources we discharge a sacred obligation of +citizenship.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> See <i>Dangerous Trades</i>, compiled by Thomas Oliver; also +list of reports by the United States Bureau of Labor.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXII" id="CHAPTER_XXII"></a><hr /> +<span class='pagenum'><a name="Page_208" id="Page_208">[208]</a></span><br /> + +<h3>CHAPTER XXII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>HABITS OF HEALTH PROMOTE INDUSTRIAL EFFICIENCY</h4> +<br /> + +<p>Education's highest aim is to train us to do the right thing at the +right moment without having to think. The technic of musician, +stenographer, artist, electrician, surgeon, orator, is gained only +from patient training of the body's reflex muscles to do brain +work.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a> The lower nerve centers are storehouses for the brain +energy, just as central power houses are used for storing electric +energy to be spent upon demand. From habit, not from mental effort, we +turn to the right, say "I beg pardon" when we step on another's foot, +give our seats to ladies or to elderly persons, use acceptable table +manners. No person seems "to the manner born" who has to think out +each act necessary to "company manners." How numerous are the mental +and physical processes essential to good manners no one ever +recognizes but the very bashful or the uncouth person trying to +cultivate habits of unconsciousness in polite society. The habit of +living ethically enables us to go through life without being tempted +to steal or lie or do physical violence. No person's morals can be +relied upon who is tempted constantly to do immoral acts; ethical +training seeks to incapacitate us for committing unethical deeds and +to habituate us to ethical acts alone.</p> + +<p>Eight different elements of industrial efficiency are concerned with +the individual's health habits,—the industrial worker, his industrial +product, his employer, his employer's <span class='pagenum'><a name="Page_209" id="Page_209">[209]</a></span>profit, his trade or +profession, its product, his nation, national product. Obviously few +men have so little to do that they have time to think out in detail +how this act or that indulgence will affect each of these eight +factors of industrial efficiency. Once convinced, however, that all of +these elements are either helped or injured by the individual's method +of living, each one of us has a strong reason for imposing habits of +health upon all industries, upon employees and operatives, upon all +who are a part of industrial efficiency. When these eight relations +are seen, parents and teachers have particularly strong reasons for +inculcating habits of health in their children.</p> + +<p>That industrial inefficiency results from chronic habits of unhealthy +living is generally recognized. The alcoholic furnishes the most vivid +illustration. The penalties suffered by him and his family are grave +enough, but because he has not full possession of his faculties he is +unpunctual, wastes material, disobeys instructions, endangers others' +lives, decreases the product of his trade and of his employer, lessens +the profits of both, depresses wages, increases insurance and business +risks. Because no one can foresee when the "drop too much" will be +taken, industry finds it important to know that the habit of drinking +alcoholics moderately has not been acquired by train dispatcher, +engineer, switchman, chauffeur. Because the habit of drinking +moderately is apt, among lower incomes, to go hand in hand with other +habits injurious to business and fatal to integrity, positions of +trust in industry seek men and women who have the habit of declining +drink.</p> + +<p>In the aggregate, milder forms of unhealthy living interfere with +industrial efficiency even more than alcoholism. Many capable men and +women, even those who have had thorough technical training, fail to +win promotion because their persons are not clean, their breath +offensive, their clothes suggestive of disorderly, uncleanly habits. +Persons <span class='pagenum'><a name="Page_210" id="Page_210">[210]</a></span>of extraordinary capacity not infrequently achieve only +mediocre results because they fail to cultivate habits of cleanliness +and health. An employer can easily protect his business from loss due +to alcoholism among his own employees; but loss through employees' +constipation, headache, bad ventilation at home, irregular meals, +improper diet, too many night parties, nicotinism, personal +uncleanliness, is loss much harder to anticipate and avoid. Because +evil results are less vivid, it is also hard to convince a clerk that +intemperance in eating, sleeping, and playing will interfere with his +earning capacity and his enjoyment capacity quite as surely as +intemperance in the use of alcohol and nicotine. Where employees are +paid by the piece, instead of by the hour, day, or week, the employer +partially protects himself against uneven, sluggish, slipshod workmen; +but, other things being equal, he awards promotion to those who are +<span class='pagenum'><a name="Page_211" id="Page_211">[211]</a></span>most regular and who are most often at their best, for he finds that +the man who does not "slump" earns best profits and deserves highest +pay.</p> + +<div class="img"> +<a href="images/imagep210.jpg"> +<img border="0" src="images/imagep210.jpg" width="80%" alt="These Patients on the old Southfield are Taxing Their Unions and Their Trades as well as their Families and the Tuberculosis Committee" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">THESE PATIENTS ON THE OLD SOUTHFIELD ARE TAXING THEIR +UNIONS AND THEIR TRADES AS WELL AS THEIR FAMILIES AND THE TUBERCULOSIS COMMITTEE</p> +</div> + +<p>There are exceptions, it is true, where both industrial promotion and +industrial efficiency are won by people who violate laws of +health,—but at what cost to their efficiency? Your efficiency should +be measured not by some other person's advancement, but by what you +yourself ought to accomplish; while the effect of abusing your +physical strength is shown not only in the shortening of your +industrial life and in the diminishing returns from your labor, but by +the decrease of national and trade efficiency. "Sweating" injures +those who buy and those in the same trade who are not "sweated" just +as truly as it injures the "sweated."</p> + +<div class="img"> +<a href="images/imagep211.jpg"> +<img border="0" src="images/imagep211.jpg" width="70%" alt="Habits Of Health Among Dairymen Mean Safe Milk For Babies" /></a><br /> +<p class="cen" style="margin-top: .2em;">HABITS OF HEALTH AMONG DAIRYMEN MEAN SAFE MILK FOR BABIES</p> +</div> + +<p><span class='pagenum'><a name="Page_212" id="Page_212">[212]</a></span>What are the health habits that should become instinctive and +effortless for every worker? What acts can we make our lower nerve +centers—our subconscious selves—do for us or remind us to do? The +following constitutes a daily routine that should be as involuntary as +the process of digestion:</p> + +<div class="block"><p>1. Throw the bedding over the foot of the bed.</p> + +<p>2. Close the window that has been open during the night.</p> + +<p>3. Drink a glass of water.</p> + +<p>4. Bathe the face, neck, crotch, chest, armpits (finishing if not +beginning with cold water), and particularly the eyes, ears, and +nose. If time and conveniences permit, bathe all over.</p> + +<p>5. Cleanse the finger nails.</p> + +<p>6. Cleanse the teeth, especially the places that are out of sight +and hard to reach.</p> + +<p>7. Breakfast punctually at a regular hour. Eat lightly and only +what agrees with you. If you read a morning paper, be interested +in news items that have to do with personal and community +vitality.</p> + +<p>8. Visit the toilet; if impracticable at home, have a regular time +at business.</p> + +<p>9. Have several minutes in the open air, preferably walking.</p> + +<p>10. Be punctual at work.</p> + +<p>11. As your right by contract, insist upon a supply of fresh air +for your workroom with the same emphasis you use in demanding +sufficient heat in zero weather.</p> + +<p>12. Eat punctually at noon intermission; enjoy your meal and its +after effects.</p> + +<p>13. Breathe air out of doors a few minutes, preferably walking.</p> + +<p>14. Resume business punctually.</p> + +<p>15. Stop work regularly.</p> + +<p>16. Take out-of-door exercise—indoor only when fresh air is +possible—that you enjoy and that agrees with you.</p> + +<p>17. Be regular, temperate, and leisurely in eating the evening +meal; eat nothing that disagrees with you.</p> + +<p>18. Spend the evening profitably and pleasantly and in ways +compatible with the foregoing habits.</p> + +<p><span class='pagenum'><a name="Page_213" id="Page_213">[213]</a></span>19. Retire regularly at a fixed hour, making up for irregularity +by an earlier hour next night.</p> + +<p>20, 21, 22. Repeat 4, 6, 8.</p> + +<p>23. Turn underclothes wrong side out for ventilation.</p> + +<p>24. Open windows.</p> + +<p>25. Relax mind and body and go to sleep.</p></div> + +<p>No man chronically neglects any one of the above rules without +reducing his industrial efficiency. No man chronically neglects all of +them without becoming, sooner or later, a health bankrupt.</p> + +<p>In addition to this daily routine, there are certain other acts that +should become habitual:</p> + +<div class="block"><p>1. Bathing less frequently than once a week is almost as dangerous +to health as it is to attractiveness.</p> + +<p>2. Distaste for unclean linen or undergarments and for acts or +foods that interfere with vitality should become instinctive.</p> + +<p>3. Excesses in eating or playing should be automatically corrected +the next day and the next. Parties we shall continue to have. It +will be some time before reasonable hours and reasonable +refreshments will prevail. Meanwhile it is probably better for an +individual to sacrifice somewhat his own vitality for the sake of +the union, the class, or the church. While trying to improve group +habits, one can acquire the habit of not eating three meals in +one, of eating less next day, of sleeping longer next night, of +being particularly careful to have plenty of outdoor air.</p> + +<p>4. Visits to the dentist twice a year at least, and whenever a +cavity appears, even if only a week after the dentist has failed +to find one; whenever the gums begin to recede; and whenever +anything seems to be wrong with the teeth.</p> + +<p>5. Periodic physical examination by a physician.</p> + +<p>6. Examination by a competent physician whenever any disorder +cannot be satisfactorily explained by violation of the daily +routine or by interruption of business or domestic routine.</p></div> + +<p>Health habits do not become instinctive until a continued, conscious +effort is made to accustom the body to them. When this is once done, +however, the body not only <span class='pagenum'><a name="Page_214" id="Page_214">[214]</a></span>attends to its primary health needs +automatically, but it rebels at their omission, as surely as does the +stomach at the omission of dinner. Witness the discomfort of the +consumptive, trained to fresh air at a sanatorium, when he returns to +his overheated and underventilated home, or the actual pain +experienced in readjusting our own healthy bodies to the stuffy +workroom or schoolroom after a summer vacation out of doors. I heard a +consumptive say that he left a sanatorium for a day class after trying +for three nights to sleep in an unventilated ward. For many people the +regular morning bath is at first a trial, then a pleasure, and finally +a need; if omitted, the body feels thirsty and dissatisfied, the eyes +sleepy, and the spirit flags early in the day.</p> + +<div class="img"> +<a href="images/imagep214.jpg"> +<img border="0" src="images/imagep214.jpg" width="80%" alt="Improvised Seaside Hospital for Nonpulmonary Tuberculosis" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">IMPROVISED SEASIDE HOSPITAL FOR NONPULMONARY +TUBERCULOSIS AT SEA BREEZE TEACHES PASSERS-BY THE FRESH-AIR GOSPEL</p> +</div> + +<p>Cold baths are not essential or even good for everybody. The same diet +or the same amount of food or time for eating is not of equal value +for all. The temperature of bath <span class='pagenum'><a name="Page_215" id="Page_215">[215]</a></span>water, the kind and quality of food, +are influenced by one's work and one's cook. Set rules about these +things do more harm than good. Such questions must be decided for each +individual,—by his experience or by the advice of a physician,—but +they must be decided and the decisions converted into health habits if +he would attain the highest efficiency of which he is capable. Here +again our old contrast between "doing things" and "getting things +done" applies. Get your body to attend to the essential needs for you, +and get it to remind you when you let the exigencies of life +interfere. Don't burden your mind every day with work that your body +will do for you if properly trained.</p> + +<div class="img"> +<a href="images/imagep215.jpg"> +<img border="0" src="images/imagep215.jpg" width="80%" alt="Crippled Children leaving Sea Breeze Hospital for Bone Tuberculosis Find Stale Air Offensive by Night or by Day" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">CRIPPLED CHILDREN LEAVING SEA BREEZE HOSPITAL FOR BONE +TUBERCULOSIS FIND STALE AIR OFFENSIVE BY NIGHT OR BY DAY</p> +</div> + +<p>Obstacles to habits of health are numerous; therefore the importance +of correcting those habits of factory, family, trade, city, or nation +that make health habits impracticable. <span class='pagenum'><a name="Page_216" id="Page_216">[216]</a></span>We must change others' +prejudices before we can breathe clean air on street cars without +riding outside. When one's co-workers are afraid of fresh air, +ventilation of shop, store, and office is impossible. So long as +parents fear night air, children cannot follow advice to sleep with +windows open. Unless the family coöperates in making definite plans +for the use of toilet and bath for each member, constipation and bad +circulation are sure to result. Indigestion is inevitable if employees +are not given lunch periods and closing hours that permit of regular, +unhurried meals. Cleanliness of person costs more than it seems to be +worth where cities fail either to compel bath tubs in rented +apartments or to erect public baths. A temperate subsistence on +adulterated, poisonous, or drugged foods might be better for one's +health than gormandizing on pure foods. No recipe has ever been found +for bringing up a healthy baby on unclean, infected milk; for avoiding +tuberculosis among people who are <span class='pagenum'><a name="Page_217" id="Page_217">[217]</a></span>compelled to work with careless +consumptives in unclean air; or for making a five-story leap as safe +as a fire escape. Perfect habits of health on the part of an +individual will not protect him against enervation or infection +resulting from inefficient enforcement of sanitary codes by city, +county, state, and national authorities.</p> + +<div class="img"> +<a href="images/imagep216.jpg"> +<img border="0" src="images/imagep216.jpg" width="80%" alt="At Junior Sea Breeze, Teaching Mothers The Health Routine For Babies" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">AT JUNIOR SEA BREEZE, TEACHING MOTHERS THE HEALTH ROUTINE FOR BABIES</p> +</div> + +<p>The "municipalization" or "public subsidy" of health habits is +indispensable to protecting industrial efficiency. Public lavatories, +above or below ground, have done much to reduce inefficiency due to +alcoholism, constipation of the bowels, and congestion of the kidneys. +Theaters, churches, and assembly rooms could be built so as to drill +audiences in habits of health instead of fixing habits of uncleanly +breathing. Street flushing, drinking fountains, parks and breathing +spaces, playgrounds and outdoor gymnasiums, milk, food, and drug +inspection, tenement, factory, and shop supervision, enforcement of +anti-spitting penalties, restriction of hours of labor, prohibition of +child labor,—these inculcate community habits of health that promote +community efficiency. It is the duty of health boards to compel all +citizens under their jurisdiction to cultivate habits of health and to +punish all who persistently refuse to acquire these habits, so far as +the evils of neglect become apparent to health authorities. The +unlimited educational opportunity of health boards consists in their +privilege to point out repeatedly and cumulatively the industrial and +community benefits that result from habits of health, and the +industrial and community losses that result from habits of unhealthy +living.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> Serviceable guides to personal habits of health are +<i>Aristocracy of Health</i> by Mary Foote Henderson, and <i>Efficient Life</i> +by Dr. Luther H. Gulick.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXIII" id="CHAPTER_XXIII"></a><hr /> +<span class='pagenum'><a name="Page_218" id="Page_218">[218]</a></span><br /> + +<h3>CHAPTER XXIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>INDUSTRIAL HYGIENE</h4> +<br /> + +<p>To call the movement for better factory conditions the "humanizing of +industry" implies that modern industry not influenced by that movement +is brutalized. The brutalizing of industry was due chiefly to a +general ignorance of health laws,—an ignorance that registers itself +clearly and promptly in factory and mine. It is not that a man is +expected to do too much, but that too little is expected of the human +body. The present recognition of the body's right to vitality is not +because the employer's heart is growing warmer, or because competition +is less vicious, but because the precepts of hygiene are found to be +practical. Where better ventilation used to mean more windows and +repair bills, it now means greater output. Where formerly a +comfortable place in which to eat lunch meant giving up a workroom and +its profits, it now means 25 per cent more work done in all workrooms +during the afternoon. The general enlightenment as to industrial +hygiene has been accelerated by the awakening that always follows +industrial catastrophes, by the splendid crusade against tuberculosis, +and by compulsory notification and treatment of communicable diseases.</p> + +<p>Catastrophes, however, have dominated the vocabulary that describes +factory "welfare work." Because accidents such as gas in mines, fire +in factories, fever in towns, and epidemics of diseases incident to +certain trades were beyond the power of the workers themselves to +control or prevent, wage earners have come to be looked upon as +helpless victims of the cupidity and inhumanity of their employers. +<span class='pagenum'><a name="Page_219" id="Page_219">[219]</a></span>This attitude has weakened the usefulness of many bodies organized to +promote industrial hygiene. Although the term "industrial hygiene" is +broad enough to include all sanitary and hygienic conditions that +surround the worker while at work, it is restricted by some to the +efforts made by altruistic or farsighted employers in the interest of +employees; others think of prohibitions and mandates, in the name of +the state, that either prevent certain evils or compel certain +benefits; for too few it refers to what the wage earner does for +himself.</p> + +<p>Pity for the employee has caused the motive power of the employee to +be wastefully allowed to atrophy. Yet when a man becomes an employee, +he does not forfeit any right of citizenship, nor does being an +employee relieve him from the duties of citizenship. In too many cases +it has been overlooked that a worker's carelessness about habits of +health, as well as about his machinery, causes accidents and increases +industrial diseases. Too often the worker himself is responsible for +uncleanliness and lack of ventilation and his own consequent lack of +vitality. A study into the conditions of ventilation and cleanliness +of workers' homes will prove this.</p> + +<p>Knowing that a light, well-aired, clean, safe factory would not of +itself insure healthy men, many employers have built and supplied +houses for their workmen at low rents. Just as these employers failed +to see that they could reach more people and secure more permanent +results if they demanded that tenement laws and the sanitary code be +enforced as well as the laws for the instruction of children in +hygiene, so the employee has failed to see that he is a part of the +public that passes laws and determines the efficiency of factory +inspection. The enforcement of state legislation for working hours, +proper water and milk supply, proper teaching of children, proper +tenement conditions, efficient health administration, is dependent +upon the interest and <span class='pagenum'><a name="Page_220" id="Page_220">[220]</a></span>activity of the public, of which the working +class is no small or uninfluential part.</p> + +<div class="img"> +<a href="images/imagep220.jpg"> +<img border="0" src="images/imagep220.jpg" width="80%" alt="Country Club House for New York Social Workers" /></a><br /> +<p class="cen" style="margin-top: .2em;">COUNTRY CLUB HOUSE FOR NEW YORK SOCIAL WORKERS<br /> +Given by the founder of Caroline Rest Educational Fund</p> +</div> + +<p>The first and most important step in securing hygienic rights for +workingmen is to make sure that they know the rights that the law +already gives them. Men still throw out their chests when talking of +their rights. The posting of the game laws in a club last summer, and +the instruction of all the natives of the countryside in regard to +their rights as against those of outsiders, meant that for the first +time in their history the game laws were enforced. All the natives, +instead of poaching as has been their wont, joined together in +protecting club property from intruding outside sportsmen. Poachers +were caught and served with the full penalties of the law. Over winter +fires these people's heroism will grow, but their respect for law will +grow also, and it is doubtful if the game laws can be violated in that +section so long as the tradition of this summer's work <span class='pagenum'><a name="Page_221" id="Page_221">[221]</a></span>lives. And so +it would be in a factory, if employees once realized that by uniting +they could, as citizens, enforce health rights in the factory.</p> + +<p>The hygiene of the workshop is not the same problem as the hygiene of +the home and schoolhouse, because there are by-products of factory work +that contaminate the air, overheat the room, and complicate the +ordinary problems of ventilation. Certain trades are recognized as +"dangerous trades." The problem of adequate government control of +factories is one for a sanitary engineer. It has to do with +disease-bearing raw material that comes to a factory, disease-producing +processes of manufacture. There is need for revision of the +dangerous-trade list. Many of the industries not so classed should be; +many of the so-called dangerous trades can be made comparatively +harmless by devices for exhausting harmful by-products. Industrial +diseases should be made "notifiable," so that they can be controlled by +the factory or health department. It is those trades that are dangerous +because of remediable unsanitary and unhygienic conditions which demand +the employer's attention. Complaints should be made by individuals when +carelessness or danger becomes commonplace.</p> + +<p>The manner in which many organizations have tried to better working +conditions is similar to the manner in which Europeans are trying to +help defective school children. Here, as there, is the difference +between <i>doing things</i> and <i>getting things done</i>. Here more than there +is the tendency to exaggerate legislation and to neglect enforcement +of law. Instead of harnessing the whole army of workingmen to the +crusade and strengthening civic agencies such as factory, health, and +tenement departments, houses are built and given to men, clubs are +formed to amuse factory girls, amateur theatricals are organized. All +this is called "welfare work." "What is welfare work?" reads the +pamphlet of a large national association. "It is especial +consideration <span class='pagenum'><a name="Page_222" id="Page_222">[222]</a></span>on the part of the employer for the welfare of his +employees." In the words of this pamphlet, the aim of this association +"is to organize the best brains of the nation in an educational +movement toward the solution of some of the great problems related to +social and industrial progress." The membership is drawn from +"practical men of affairs, whose acknowledged leadership in thought +and business makes them typical representatives of business elements +that voluntarily work together for the general good." As defined by +this organization, welfare work is something given to the employee by +the employer for the welfare of both. It is not something the employee +himself does to improve his own working conditions.</p> + +<div class="block"><p>We are told that employees should assume the management of welfare +work.</p> + +<p>Should they install sanitary conveniences? Of course not.</p> + +<p>Would they know the need of a wash room in a factory if they never +had had one? No.</p> + +<p>Should they manage lunch rooms? A few employers have attempted +unsuccessfully to turn over the management of the lunch rooms to +the employees, the result being that one self-sacrificing +subofficial in each concern would find the burden entirely on his +shoulders before working hours, during working hours, and after +working hours. Employees cannot attend committee meetings during +working hours, and they are unwilling to do so afterwards, for +they generally have outside engagements. Furthermore, the +employees know nothing about the restaurant business. If they did, +they would probably be engaged in it instead of in their different +trades. All experiments along this line of which we have heard +have failed. The so-called "democratic idea," purely a fad, never +has been successfully operated.</p> + +<p>Many employers would introduce welfare work into their +establishments were it not for the time and trouble needed for its +organization. The employment of a welfare director removes this +obstacle. Successful prosecution of welfare work requires +concentration of responsibility. All of its branches must be under +the supervision of one person, or efforts in different directions +may conflict, or special and perhaps pressing needs may escape +attention. Pressure of daily business routine usually relegates +welfare work to the last consideration, but the average employer +is interested in his men and is willing to improve their condition +if only their needs are brought to his attention.</p></div> + +<div class="img"><span class='pagenum'><a name="Page_223" id="Page_223">[223]</a></span> +<a href="images/imagep223.jpg"> +<img border="0" style="border: 1px black solid;" src="images/imagep223.jpg" width="50%" alt="First Lessons in Industrial Hygiene" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIRST LESSONS IN INDUSTRIAL HYGIENE</p> +</div> + +<div class="img"><span class='pagenum'><a name="Page_224" id="Page_224">[224]</a></span> +<a href="images/imagep224.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep224.png" width="50%" alt="Welfare Work That Counts" /></a><br /> +<p class="cen" style="margin-top: .2em;">WELFARE WORK THAT COUNTS</p> +</div> + +<p><span class='pagenum'><a name="Page_225" id="Page_225">[225]</a></span>This method of promoting the welfare of the worker may have been a +necessary step in the development of industrial hygiene. Undoubtedly +it has succeeded, in many cases, in bringing to an employer's +consciousness the needs of his workmen, in accustoming employees to +higher sanitary standards, and in teaching them to demand health +rights from their employers. In many cases, however, "welfare work" +has miseducated both employer and employee. The fact that "the +so-called democratic idea, purely a fad, has never been successfully +operated," is due to the interpretation given to "democratic idea." +The two alternatives in the paragraph above quoted are lunch rooms, +wash rooms, as gifts from employers to employees, or lunch rooms and +wash rooms to be furnished by employees at their own expense. The true +democratic idea, however, is that factory conditions detrimental to +health shall be prohibited by factory legislation, and this +legislation enforced by efficient factory inspectors, regardless of +what may be given to employees above the requirement of hygiene.</p> + +<p>Until employees are more active as citizens and more sensitive to +hygienic rights, it is desirable that welfare directors be employed in +factories to arbitrate between employer and employee, to raise the +moral standard of a factory settlement, to organize amusements.</p> + +<p>Welfare work at its best is a method of dividing business profits +among all who participate in making these profits. Too often welfare +secretaries teach employees how to be happy in the director's way, +rather than in their own way. This adventitious position increases +suspicion on both sides, <span class='pagenum'><a name="Page_226" id="Page_226">[226]</a></span>disturbs the discipline of the foreman, +weakens rather than strengthens the worker's efficiency, because it +depends upon other things than work well done and the relation of +health to efficiency. In a small factory town the owner of a large +cotton mill has recognized the financial benefit of physically strong +workers, and is trying the experiment of a welfare director. The man +himself works "with his sleeves up." The social worker has an office +in the factory. A clubhouse is fitted up for the mill hands to make +merry in. A room in the factory is reserved for a lunch room, with +plants, tables, and chairs for the comfort of the women. Parties are +given by the employer to the employees, which he himself attends. He +has thrown himself into whatever schemes his director has suggested. +The director complained that the reason the new lunch room was not +more popular was because a piano was needed. A second-hand one would +not do, for that would cultivate bad taste in music. This showed the +employer that soon everything would be expected from the "big house on +the hill." An event which happened at the time when the pressure was +greatest on him for the piano, convinced him that his employees could +supply their real needs without any trouble or delay. The assistant +manager was about to leave, and in less than a week five hundred +dollars was raised among the workers for his farewell gift. Walking +home that night late from his office the owner was attracted by the +sound of jollity, and saw a little room jammed full of mill people +enjoying the improvised music of a mouth organ played to the +accompaniment of heels. He resolved henceforth to train his employees +to do his work well and to earn more pay,—and to let them amuse +themselves. From that time on he refused to be looked upon as the +<i>deus ex machina</i> of the town. He decided that the best way to give +English lessons to foreigners was to improve the school. His +beneficence in supplying them with pure water at the mill did <span class='pagenum'><a name="Page_227" id="Page_227">[227]</a></span>not +prevent a ravaging typhoid epidemic because the town water was not +watched. He saw that the best way to improve health was to strengthen +the health board and to make his co-workers realize that they were +citizens responsible for their own privileges and rights.</p> + +<p>Emergency hospitals and Y.M.C.A. buildings are sad substitutes for +safety devices and automatic couplers. Christmas shopping in November +is less kind than prevention of overwork in December. Night school and +gymnastic classes are a poor penance for child labor and for work +unsuited to the body. The left hand cannot dole favors enough to +offset the evils of underpay, of unsanitary conditions, of inefficient +enforcement of health laws tolerated by the right hand.</p> + +<p>Just because a man is taking wages for work done, is no reason why he +should forfeit his rights as a citizen, or allow his children, +sisters, neighbors, to work in conditions which decrease their +efficiency and earning power. What the employee can do for himself as +a citizen, having equal health rights with employers, he has never +been taught to see. Factory legislation is state direction of +industries so far as relates to the safety, health, and moral +condition of the people,—and which embraces to-day, more than in any +other epoch, the opinion of the workers themselves. No government, +however strong, can hope successfully to introduce social legislation +largely affecting personal interests until public opinion has been +educated to the belief that the remedies proposed are really +necessary. Until schools insist upon a better ventilation than the +worst factories, how can we expect to find children of working age +sensitive to impure air? Where work benches are more comfortable than +school desks, where drinking water is cleaner and towels more +sanitary, however unsanitary they may be, than those found in the +schoolhouse, the worker does not realize that they menace his right to +earn a living wage as much as does a temporary shut-down.</p> + +<p><span class='pagenum'><a name="Page_228" id="Page_228">[228]</a></span>Employers are by no means solely to blame for unhealthy working +conditions. A shortsighted employee is as anxious to work overtime for +double pay as a shortsighted employer is to have him. Among those who +are agitating for an eight-hour day are many who, from self-interest +or interest in the cause, work regularly from ten to sixteen hours.</p> + +<p>Would it help to punish employees for working in unhealthy places? The +highest service that can be rendered industrial hygiene is to educate +the industrial classes to recognize hygienic evils and to coöperate +with other citizens in securing the enforcement of health rights.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXIV" id="CHAPTER_XXIV"></a><hr /> +<span class='pagenum'><a name="Page_229" id="Page_229">[229]</a></span><br /> + +<h3>CHAPTER XXIV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE LAST DAYS OF TUBERCULOSIS</h4> +<br /> + +<p>If the historian Lecky was right in saying that the greatest triumphs of +the nineteenth century were its sanitary achievements, the Lecky of the +twenty-first century will probably honor our generation not for its +electricity, its trusts, and its scientific research, but for its +crusade against the white plague and for its recognition of health +rights. Thanks to committees for the prevention of tuberculosis,—local, +state, national, international,—we are fast approaching the time when +every parent, teacher, employer, landlord, worker, will see in +tuberculosis a personal enemy,—a menace to his fireside, his income, +and his freedom. Just as this nation could not exist half slave, half +free, we of one mind now affirm that equal opportunity cannot exist +where one death in ten is from a single preventable disease.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></p> + +<div class="imgl" style="width: 35%;"> +<a href="images/imagep230.jpg"> +<img border="0" src="images/imagep230.jpg" width="90%" alt="Dr. Trudeau's "Little Red Cottage" at Saranac--birthplace of Out-of-door Treatment in America" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 5%; margin-right: 5%; font-size: 80%;">DR. TRUDEAU'S "LITTLE RED COTTAGE" AT SARANAC—BIRTHPLACE OF OUT-OF-DOOR TREATMENT IN AMERICA</p> +</div> + +<p>Of no obstacle to efficient living is it more true than of +tuberculosis, that the remedy depends upon enforcing rather than upon +making law, upon practice rather than upon precept, upon health habits +rather than upon medical remedies, upon coöperation of lay citizens +rather than upon medical science or isolated individual effort. +Without learning another fact about tuberculosis, we can stamp it out +if we will but apply, and see that officers of health apply, lessons +of cleanliness and natural living already known to us.</p> + +<p><span class='pagenum'><a name="Page_230" id="Page_230">[230]</a></span>Perhaps the most striking results yet obtained in combating +tuberculosis are those of the Massachusetts General Hospital in +Boston. To visit its tuberculosis classes reminds one more of the +sociable than the clinic. In fact, one wonders whether the milk diet +and the rest cure or the effervescing optimism and good cheer of the +physicians and nurses should be credited with the marvelous cures. The +first part of the hour is given to writing on the blackboard the +number of hours that the class members spent out of doors the +preceding week. So great was the rivalry for first place that the +nurse protested that a certain boy in the front row gave himself +indigestion by trying to eat his meals in ten or fifteen minutes. It +was then suggested that twenty hours a day would be enough for any one +to stay out of doors, and that plenty of time should be taken for +meals with the family and for cold baths, keeping clean, etc. +Interesting facts gathered by personal interviews of two physicians +with individual patients are explained to the whole class. Next to the +number of hours out of doors, the most interesting fact is the number +of hours of exercise permitted. A man of forty, the head of a family, +beamed like a school child when told that, after nearly a year of +absolute rest, he might during the next week exercise ten minutes a +day. A graduate drops in, the very picture of health, weighing two +hundred pounds. An apparently hopeless case would brighten up and have +confidence when told that this strong, handsome man has gained fifty +pounds by rest, good cheer, fresh air, all on his own porch. One young +man, just back from a California sanatorium where he progressively +lost strength in spite of change of climate, is now returning to work +and is back at normal weight.</p> + +<div class="img" style="clear: both;"><span class='pagenum'><a name="Page_231" id="Page_231">[231]</a></span> +<a href="images/imagep231.jpg"> +<img border="0" style="border: 1px black solid;" src="images/imagep231.jpg" width="50%" alt="Outdoor Life Chart." /></a><br /> +<p class="cen" style="margin-top: .2em;">OUTDOOR LIFE CHART.</p> +</div> + +<div class="img"><span class='pagenum'><a name="Page_232" id="Page_232">[232]</a></span> +<a href="images/imagep232.jpg"> +<img border="0" src="images/imagep232.jpg" width="80%" alt="Fighting Tuberculosis In The Mountains--Saranac" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS IN THE MOUNTAINS—SARANAC</p> +</div> + +<p>Every patient keeps a daily record, called for by the following +instructions:</p> + +<div class="block"><p>Make notes of temperature and pulse at 8, 12, 4, and 8 o'clock, +daily; movements of bowels; hours in open air; all food taken; +total amount of milk; total amount of oil and butter; appetite; +digestion; spirits; cough (amount, chief time); expectoration +(amount in 24 hours, color, nature); exercise (if allowed), with +temperature and pulse 15 minutes after exercise; sweats; visitors.</p></div> + +<p>The following simple instructions can be followed in any home, even +where open windows must take the place of porches:</p> + +<div class="block"><p>Rest out of doors is the medicine that cures consumption. Absolute +rest for mind and body brings speedy improvement. It <span class='pagenum'><a name="Page_233" id="Page_233">[233]</a></span>stops the +cough and promotes the appetite. The lungs heal more quickly when +the body is at rest. Lie with the chest low, so the blood flow in +the lungs will aid to the uttermost the work of healing. The rest +habit is soon acquired. Each day of rest makes the next day of +rest easier, and shortens the time necessary to regain health. The +more time spent in bed out of doors the better. Do not dress if +the temperature is above 99 degrees, or if there is blood in the +sputum. It is life in the open air, not exercise, that brings +health and strength. Just a few minutes daily exercise during the +active stage of the disease may delay recovery weeks or months. +Rest favors digestion, exercise frequently disturbs digestion. +When possible have meals served in bed. Never think the rest +treatment can be taken in a rocking-chair. If tired of the cot, +shift to the reclining chair, but sit with head low and feet +elevated. Do not write letters. Dictate to a friend. Do not read +much and do not hold heavy books. While reading remain in the +recumbent posture.</p></div> + +<div class="img"> +<a href="images/imagep233.jpg"> +<img border="0" src="images/imagep233.jpg" width="80%" alt="Fighting Tuberculosis In Day Camps--Boston" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS IN DAY CAMPS—BOSTON</p> +</div> + +<p>Once having learned the simple facts that must be noted and the simple +laws that must be followed, once <span class='pagenum'><a name="Page_234" id="Page_234">[234]</a></span>having placed oneself in a position +to secure the rest, the fresh air, and the health diet, no better next +steps can be taken than to observe the closing injunction in the rules +for rest:</p> + +<div class="block"><p>There are few medicines better than clouds, and you have not to +swallow them or wear them as plasters,—only to watch them. +Keeping your eyes aloft, your thoughts will shortly clamber after +them, or, if they don't do that, the sun gets into them, and the +bad ones go a-dozing like bats and owls.</p></div> + +<div class="img"> +<a href="images/imagep234.png"> +<img border="0" src="images/imagep234.png" width="70%" alt="The Back Of A Street-Car Transfer, Sundays, New York City" /></a><br /> +<p class="cen" style="margin-top: .2em;">THE BACK OF A STREET-CAR TRANSFER, SUNDAYS, NEW YORK CITY</p> +</div> + +<p>Important as are sanatoriums in mountain and desert, day or night +camps within and near cities, milk and egg clinics, home visiting, +change of air and rest for those who are known to be tuberculous, +their importance is infinitesimal compared with the protection that +comes from clean, healthy environment and natural living for those not +known to be tuberculous. This great fact has been recognized by the +various bodies now engaged in popularizing the truth about +tuberculosis by means of stationary and traveling exhibits, +illustrated lectures, street-car transfers, advertisements, farmers' +institutes, anti-spitting signs in public vehicles and public +buildings, board of health instructions in many languages, magazine +stories, and press reports of conferences. This brilliant campaign of +education shows what can be done by national, state, and county +superintendents of schools, if they will make the most of school +hygiene and civics.</p> + +<div class="img"><span class='pagenum'><a name="Page_235" id="Page_235">[235]</a></span> +<a href="images/imagep235.jpg"> +<img border="0" style="border: 1px black solid;" src="images/imagep235.jpg" width="50%" alt="An Example In Coöperation That Anti-tuberculosis Crusaders Should Follow" /></a><br /> +<p class="cen" style="margin-top: .2em;">AN EXAMPLE IN COÖPERATION THAT ANTI-TUBERCULOSIS CRUSADERS SHOULD FOLLOW</p> +</div> + +<p><span class='pagenum'><a name="Page_236" id="Page_236">[236]</a></span>Is it not significant that America's national movement is due +primarily to the organizing capacity of laymen in the New York Charity +Organization Society rather than to schools or hospitals? Most of the +local secretaries are men whose inspiration came from contact with the +non-medical relief of the poor in city tenements. The secretary of the +national association is a university professor of anthropology, who +has also a medical degree. The child victim's plea—Little Jo's +Smile—was nationalized by an association of laymen, aided by the +advertising managers of forty magazines. The smaller cities of New +York state are being aroused by a state voluntary association that for +years has visited almshouses, insane asylums, and hospitals. These +facts I emphasize, for they illustrate the opportunity and the duty of +the lay educator, whether parent, teacher, labor leader, or trustee of +hospital, orphanage, or relief society.</p> + +<p>Three fundamental rules of action should be established as firmly as +religious principles:</p> + +<div class="block"><p>1. The public health authorities should be told of every known and +every suspected case of tuberculosis.</p> + +<p>2. For each case proved by examination of sputum to be +tuberculous, the public-health officers should know that the germs +are destroyed before being allowed to contaminate air or food.</p> + +<p>3. Sick and not yet sick should practice habits of health that +build up vitality to resist the tubercle bacilli and that abhor +uncleanliness as nature abhors a vacuum.</p></div> + +<div class="img"><span class='pagenum'><a name="Page_237" id="Page_237">[237]</a></span> +<a href="images/imagep237.jpg"> +<img border="0" src="images/imagep237.jpg" width="80%" alt="Fighting Tuberculosis With A National Organization" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS WITH A NATIONAL ORGANIZATION</p> +</div> + +<p>All laws, customs, and environmental conditions opposed to the +enforcement of these three principles must be modified or abolished. +If the teachers of America will list for educational use in their own +communities the local obstacles to these rules of action, they will +see exactly where their local problem lies. The illustrations that are +given in this book show in how many ways these rules of action are now +being universalized. Three or four important steps deserve especial +comment:</p> + +<div class="block"><p>1. Compulsory notification of all tuberculous cases.</p> + +<p>2. Compulsory removal to hospital of those not able at home to +destroy the bacilli, or compulsory supervision of home care.</p> + +<p>3. Examination of all members of a family where one member is +discovered to be tuberculous.</p> + +<p>4. Special provision for tuberculous teachers.</p> + +<p>5. Protection of children about to enter industry but predisposed +to tuberculosis.</p> + +<p>6. Prohibition of dry cleaning of schools, offices, and streets.</p> + +<p>7. Tax provision for educational and preventive work.</p></div> + +<p>Compulsory notification was introduced first in New York City by +Hermann M. Biggs, M.D., chief medical <span class='pagenum'><a name="Page_238" id="Page_238">[238]</a></span>officer: 1893, partially +voluntary, partially compulsory; 1897, compulsory for all. Physicians +who now hail Dr. Biggs as a statesman called him persecutor, autocrat, +and violator of personal freedom fifteen years ago. Foreign +sanitarians vied with American colleagues in upbraiding him for his +exaggeration of the transmissibility of consumption and for his +injustice to its victims. As late as 1899 one British expert +particularly resented the rejection of tuberculous immigrants at Ellis +Island, and said to me, "Perhaps if you should open a man's mouth and +pour in tubercle bacilli he might get phthisis, but compulsory +notification is preposterous." In 1906 the International Congress on +Tuberculosis met in Paris and congratulated New York upon its +leadership in securing at health headquarters a list of the known +disease centers within its borders; in 1906 more than twenty thousand +individual cases were reported, ten thousand of these being reported +more than once. To know the nature and location of twenty thousand +germ factories is a long step toward judging their strength and their +probable product. To compulsory notification in New York City is +largely due the educational movements of the last decade against the +white plague, more particularly the growing ability among physicians +to recognize and to treat conditions predisposing to the disease. As +in New York City, the public should provide free of cost +bacteriological analysis of sputum to learn positively whether +tuberculosis is present. Simpler still is the tuberculin test of the +eyes, with which experiments are now being made on a large scale in +New York City, and which bids fair to become cheap enough to be +generally used wherever physical examinations are made. This test is +known as Calmette's Eye Test. Inside the eyelid is placed a drop of a +solution—95 per cent alcohol and tuberculin. If conjunctivitis +develops in twenty-four hours, the patient is proved to have +tuberculosis. Some physicians still fear to use this test. Others +question its proof. The "skin test" is also being thoroughly tried in +several American cities and, if finally found trustworthy, will +greatly simplify examination for tuberculosis. Dr. John W. Brannan, +president of Bellevue and Allied Hospitals, New York City, is to +report on skin and eye tuberculin tests for children at the +International Congress on Tuberculosis, mentioned later.</p> + +<div class="img"><span class='pagenum'><a name="Page_239" id="Page_239">[239]</a></span> +<a href="images/imagep239.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep239.png" width="45%" alt="Fighting Tuberculosis By Organized Coöperative Dispensary Work" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS BY ORGANIZED COÖPERATIVE DISPENSARY WORK</p> +</div> + +<div class="img"> +<a href="images/imagep240.jpg"> +<img border="0" src="images/imagep240.jpg" width="80%" alt="Fighting Bone Tuberculosis at Sea Breeze, where Eye and Skin Tuberculin Tests are Being Made" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING BONE TUBERCULOSIS AT SEA BREEZE, WHERE EYE AND SKIN TUBERCULIN TESTS ARE BEING MADE</p> +</div> + +<p><span class='pagenum'><a name="Page_240" id="Page_240">[240]</a></span>Compulsory removal of careless consumptives is yet rare. One obstacle +is the lack of hospitals. In New York ten thousand die annually from +tuberculosis and fifty thousand are known to have it, yet there are +only about two thousand beds available. So long as the patients +anxious for hospital care exceed the number of beds, it does not seem +fair to give a bed to some one who does not want it. On the other +hand, it should not be forgotten that patients are taken forcibly to +smallpox and scarlet-fever hospitals, not for their own good, but for +the protection of others. The last person who should be permitted to +stay at home is the tuberculous person who is unable, unwilling, or +too ignorant to take the necessary precautions for others' +<span class='pagenum'><a name="Page_241" id="Page_241">[241]</a></span>protection. A rigid educational test should be applied as a condition +of remaining at home without supervision.</p> + +<p>The objections to compulsory removal are two: (1) it is desired to +make sanatorium care so attractive that patients will go at the +earliest stage of the disease; (2) an unwilling patient can defeat the +sanitarian's effort to help him and others. The alternative for +compulsory removal is gratuitous, and, if need be, compulsory, +supervision of home care, such as is now given in New York City. In +Brighton, England, Dr. Newsholme treats his municipal sanatorium as a +vacation school, giving each patient one month only. Thus one bed +helps twelve patients each year. Almost any worker can spare one month +and in that time can be made into a missionary of healthy living.</p> + +<p>Family examining parties were begun in New York by Dr. Linsly R. +Williams, for the relief agency that started the seaside treatment of +bone tuberculosis. Many of the crippled children at Sea Breeze were +found to have consumptive fathers or mothers. In one instance the +father had died before Charlie had "hip trouble." Long after we had +known Charlie his mother began to fail. She too had consumption. +Family parties were planned for 290 families. Weights were taken and +careful examination made, the physician explaining that predisposition +means defective lung capacity or deficient vitality. Of 379 members, +supposedly free from tuberculosis, sixteen were found to have +well-marked cases. (Of twenty Boston children whose parents were in a +tuberculosis class, four had tuberculosis.) In one instance the father +was astonished to learn not only that he was tuberculous, but that he +had probably given the disease to the mother, for whom he was tenderly +concerned. Of special benefit were the talks about teeth and +nourishment, and about fresh air and water as germ killers. One +examination of this kind will organize a family crusade against +carelessness.</p> + +<div class="img"><span class='pagenum'><a name="Page_242" id="Page_242">[242]</a></span> +<a href="images/imagep242.jpg"> +<img border="0" src="images/imagep242.jpg" width="55%" alt="Fighting Tuberculosis in Small Cities" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS IN SMALL CITIES<br /> +New York State Charities Aid Association</p> +</div> + +<p>Tuberculous teachers ought to be excluded from schoolrooms not merely +because they may spread tuberculosis, but because they cannot do +justice to school work without sacrifices that society ought not to +accept. A tuberculous teacher ought to be generous enough to permit +public hospitals to restore her strength or enterprising enough <span class='pagenum'><a name="Page_243" id="Page_243">[243]</a></span>to +join tuberculosis classes. It is selfish to demand independence at the +price which is paid by schools that employ tuberculous teachers.</p> + +<div class="img"> +<a href="images/imagep243.jpg"> +<img border="0" src="images/imagep243.jpg" width="80%" alt="Fighting Bone Tuberculosis With Salt Water And Salt Air" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING BONE TUBERCULOSIS WITH SALT WATER AND SALT AIR</p> +</div> + +<p>Predisposition to tuberculosis should be understood by every child +before he is accepted as an industrial soldier. Many trades now +dangerous would be made safe if workers knew the risk they run, and if +society forbade such trades needlessly to exhaust their employees. A +perfectly sound man is predisposed to tuberculosis if he elects to +work in stale, dust-laden air. Ill-ventilated rooms, cramped +positions, lack of exercise in the open air, prepare lungs to give a +cordial reception to tubercle bacilli. Rooms as well as persons become +infected. Fortunately, opportunities to work are so varied in most +localities that workers predisposed to tuberculosis may be sure of a +livelihood in an occupation suited to their vitality. Destruction of +germs in the air, in carpets, on walls, on streets, is quite as +important as <span class='pagenum'><a name="Page_244" id="Page_244">[244]</a></span>destruction of germs in lungs. Why should not tenants +and workers require health certificates stating that neither house nor +working place is infected with tubercle bacilli? Some cities now +compel the disinfection of premises occupied by tuberculous persons +<i>after</i> their removal. Landlords, employers, tenants, and employees +can easily be taught to see the advantage of disinfecting premises +occupied by tuberculous cases <i>before</i> detection.</p> + +<div class="img"> +<a href="images/imagep244.jpg"> +<img border="0" src="images/imagep244.jpg" width="80%" alt="Fighting Feather Dusters Is One Object Of Sea-Air Hospitals For Bone Tuberculosis" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING FEATHER DUSTERS IS ONE OBJECT OF SEA-AIR HOSPITALS FOR BONE TUBERCULOSIS</p> +</div> + +<p>Dry cleaning, feather dusters, dust-laden air, will disappear from +schoolrooms within twenty-four hours after school-teachers declare +that they shall disappear. We have no right to expect street cleaners, +tenement and shop janitors, or overworked mothers to be more careful +than school-teachers. Last year I said to a janitress, "Don't you +realize that you may get consumption if you use that feather duster?" +Her reply caused us to realize our carelessness: "I don't want any +more than I've got now." Shall we some day have compulsory examination +and instruction of all cleaners, starting with school cleaners?</p> + +<div class="img"><span class='pagenum'><a name="Page_245" id="Page_245">[245]</a></span> +<a href="images/imagep245.jpg"> +<img border="0" src="images/imagep245.jpg" width="80%" alt="FIGHTING TUBERCULOSIS IN OPEN TENTS" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS IN OPEN TENTS</p> +</div> + +<p>Taxing is swift to follow teaching in matters of health. Teachers can +easily compute what their community loses from tuberculosis. The +totals will for some time prove a convincing argument for cleanliness +of air, of body, and of building wherever the community is responsible +for air, building, and body. The annual cost of tuberculosis to New +York City is estimated at $23,000,000 and to the United States at +$330,000,000. The cost of exterminating it will be but a drop in the +bucket if school-teachers do their part this next generation with the +twenty million children whose day environment they control for three +fourths of the year, and whose habits they can determine.</p> + +<p>The first meeting in America of the International Congress on +Tuberculosis was held at Washington, D.C., September 21 to October 12, +1908. For many years the <span class='pagenum'><a name="Page_246" id="Page_246">[246]</a></span>proceedings of this congress will +undoubtedly be the chief reference book on the conquest of +tuberculosis.<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a></p> + +<p>How many aspects there are to this problem, and how many kinds of +people may be enlisted, may be seen from the seven section names: I. +Pathology and Bacteriology; II. Sanatoriums, Hospitals, and +Dispensaries; III. Surgery and Orthopedics; IV. Tuberculosis in +Children—Etiology, Prevention, and Treatment; V. Hygienic, Social, +Industrial, and Economic Aspects; VI. State and Municipal Control of +Tuberculosis; VII. Tuberculosis in Animals and Its Relation to Man.</p> + +<div class="img"> +<a href="images/imagep246.jpg"> +<img border="0" src="images/imagep246.jpg" width="80%" alt="Fighting Tuberculosis In Cheap Shacks, $125 Per Bed, Otisville, New York" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING TUBERCULOSIS IN CHEAP SHACKS, $125 PER BED, OTISVILLE, NEW YORK</p> +</div> + +<p><span class='pagenum'><a name="Page_247" id="Page_247">[247]</a></span>How many-sided is the responsibility of each of us for stamping out +tuberculosis is shown by the preliminary programme of the eight +sessions of Section V. These topics suggest an interesting and +instructive year's study for clubs of women, mothers, or teachers, or +for advanced pupils.</p> + +<br /> + +<p class="cen sc">I. Economic Aspects of Tuberculosis</p> + +<div class="block3"> +<p class="hang2">1. The burdens entailed by tuberculosis:</p> + +<div class="block"> + <p class="noin"><i>a.</i> On individuals and families.<br /> + <i>b.</i> On the medical profession.<br /> + <i>c.</i> On industry.<br /> + <i>d.</i> On relief agencies.<br /> + <i>e.</i> On the community.<br /> + <i>f.</i> On social progress.</p> +</div> + +<p class="hang2">2. The cost of securing effective control of tuberculosis:</p> + +<div class="block"> + <p class="noin"><i>a.</i> In large cities.<br /> + <i>b.</i> In smaller towns.<br /> + <i>c.</i> In rural communities.</p> +</div> +</div> + +<br /> + +<p class="cen sc">II. Adverse Industrial Conditions</p> + +<div class="block3"> +<p class="hang2">1. Incidence of tuberculosis according to occupation.</p> + +<p class="hang2">2. Overwork and nervous strain as factors in tuberculosis.</p> + +<p class="hang2">3. Effect of improvements in factory conditions on the health of + employees.</p> + +<p class="hang2">4. Legitimate exercise of police power in protecting the life and + health of employees.</p> +</div> + +<br /> + +<p class="cen sc">III. The Social Control of Tuberculosis</p> + +<div class="block3"> +<p class="hang2">1. Outline of a comprehensive programme for:</p> + +<div class="block"> + <p class="noin"><i>a.</i> National, state, and municipal governments.<br /> + <i>b.</i> Departments of health and departments of public relief.<br /> + <i>c.</i> Private endowments.<br /> + <i>d.</i> Voluntary associations for educational propaganda.<br /> + <i>e.</i> Institutions, such as schools and relief agencies, which + exist primarily for other purposes.</p> +</div> + +<p class="hang2"><span class='pagenum'><a name="Page_248" id="Page_248">[248]</a></span>2. A symposium on the relative value of each of the features in an + aggressive campaign against tuberculosis:</p> + +<div class="block"> + <p class="noin"><i>a.</i> Compulsory registration.<br /> + <i>b.</i> Free sputum examination.<br /> + <i>c.</i> Compulsory removal of unteachable and dangerous cases.<br /> + <i>d.</i> Laboratory research.<br /> + <i>e.</i> Hospital.<br /> + <i>f.</i> Sanatorium.<br /> + <i>g.</i> Dispensary.<br /> + <i>h.</i> The tuberculosis class.<br /> + <i>i.</i> Day camp.<br /> + <i>j.</i> Private physician.<br /> + <i>k.</i> Visiting nurse.<br /> + <i>l.</i> After-care of arrested cases.<br /> + <i>m.</i> Relief fund.<br /> + <i>n.</i> Climate.<br /> + <i>o.</i> Hygienic instruction,—personal and in class.<br /> + <i>p.</i> Inspection of schools and factories.<br /> + <i>q.</i> Educational propaganda.</p> +</div> +</div> + +<br /> + +<p class="cen sc">IV. Early Recognition and Prevention</p> + +<div class="block3"> +<p class="hang2">1. Importance of discovering the persons who have tuberculosis + before the disease has passed the incipient stage.</p> + +<p class="hang2">2. Examination of persons known to have been exposed or presumably + predisposed.</p> + +<p class="hang2">3. Systematic examination of school children during their course + and on leaving school to go to work.</p> + +<p class="hang2">4. Professional advice as to choice of occupation in cases where + there is apparent predisposition to disease.</p> +</div> + +<br /> + +<p class="cen sc">V. After-Care of Arrested Cases</p> + +<div class="block3"> +<p class="hang2">1. Instruction in healthful trades in the sanatorium.</p> + +<p class="hang2">2. Training for professional nursing in institutions for the care + of tuberculous patients.</p> + +<p class="hang2">3. Farm colonies.</p> + +<p class="hang2">4. Convalescent homes or cottages.</p> + +<p class="hang2">5. Aid in securing suitable employment on leaving the sanatorium.</p> + +<p class="hang2">6. How to deal with the danger of a return to unfavorable home + conditions.</p> +</div> + +<br /> + +<p class="cen sc"><span class='pagenum'><a name="Page_249" id="Page_249">[249]</a></span>VI. Educational Methods and Agencies</p> + +<div class="block3"> +<p class="hang2">1. Special literature for general distribution.</p> + +<p class="hang2">2. Exhibits and lectures.</p> + +<p class="hang2">3. The press.</p> + +<p class="hang2">4. Educational work of the nurse.</p> + +<p class="hang2">5. Labor organizations.</p> + +<p class="hang2">6. Instruction in schools of all grades.</p> + +<p class="hang2">7. Presentation and discussion of leaflets awarded prizes by the + congress.</p> +</div> + +<br /> + +<p class="cen sc">VII. Promotion of Immunity</p> + +<div class="block3"> +<p class="hang2">1. Development of the conception of physical well-being.</p> + +<p class="hang2">2. Measures for increasing resistance to disease:</p> + +<div class="block"> + <p class="noin"><i>a.</i> Parks and playgrounds.<br /> + <i>b.</i> Outdoor sports.<br /> + <i>c.</i> Physical education.<br /> + <i>d.</i> Raising the standards of living: housing, diet, + cleanliness.</p> +</div> + +<p class="hang2">3. Individual immunity and social conditions favorable to general + immunity.</p> +</div> + +<br /> + +<p class="cen sc">VIII. Responsibility of Society for Tuberculosis</p> + +<div class="block3"> +<p class="hang2">1. A symposium of representative</p> + +<div class="block"> + <p class="noin"><i>a.</i> Citizens.<br /> + <i>b.</i> Social workers.<br /> + <i>c.</i> Employers.<br /> + <i>d.</i> Employees.<br /> + <i>e.</i> Physicians.<br /> + <i>f.</i> Nurses.<br /> + <i>g.</i> Educators.<br /> + <i>h.</i> Others.</p> +</div> +</div> + +<br /> + +<p>Cash prizes of one thousand dollars each are offered: (1) for the best +evidence of effective work in the prevention or relief of tuberculosis +by any voluntary association since 1905; (2) for the best exhibit of a +sanatorium for working classes; (3) for the best exhibit of a +furnished home for the poor, designed primarily to prevent, but also +to permit the cure of tuberculosis.</p> + +<div class="img"><span class='pagenum'><a name="Page_250" id="Page_250">[250]</a></span> +<a href="images/imagep250.png"> +<img border="0" src="images/imagep250.png" width="50%" alt="Boston fights Tuberculosis with a Comprehensive Plan" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 15%; margin-right: 15%;">BOSTON FIGHTS TUBERCULOSIS WITH A COMPREHENSIVE PLAN<br /> +<i>A-D, F, H-J</i>, private hospitals and agencies reporting cases to the +official center; <i>E</i>, home care; <i>K, L, M</i>, day camp and hospitals for +incipient and advanced cases</p> +</div> + +<p>A white-plague scrapbook containing news items, articles, and +photographs will prove an interesting aid to self-education or to +instruction of children, working girls' clubs, or mothers' meetings. +Everybody ought to enlist in this war, for the fight against +tuberculosis is a fight for cleanliness <span class='pagenum'><a name="Page_251" id="Page_251">[251]</a></span>and for vitality, for a fair +chance against environmental conditions prejudicial to efficient +citizenship.</p> + +<p>So sure is the result and so immediate the duty of every citizen that +Dr. Biggs wrote in 1907: <i>In no other direction can such large results +be achieved so certainly and at such relatively small cost. The time +is not far distant when those states and municipalities which have not +adopted a comprehensive plan for dealing with tuberculosis will be +regarded as almost criminally negligent in their administration of +sanitary affairs and inexcusably blind to their own best economic +interests.</i></p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> The best literature on tuberculosis is in current +magazines and reports of anti-tuberculosis crusaders. For a +scientific, comprehensive treatment, libraries and students should +have <i>The Prevention of Tuberculosis</i> (1908) by Arthur Newsholme, M.D. +A popular book is <i>The Crusade against Tuberculosis</i>, by Lawrence F. +Flick, of the Henry Phipps Institute for the Study, Treatment, and +Prevention of Tuberculosis.</p></div> + +<div class="footnote"><p class="noin"><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Those desiring copies this year or hereafter will do +well to write to The National Association for the Study and Prevention +of Tuberculosis, 105 East 22d St., New York City. The congress is +under the control of the National Association and is managed by a +special committee appointed by it. Even after a national board of +health is established, the National Association for the Study and +Prevention of Tuberculosis will continue to be a center for private +interest in public protection against tuberculosis. One of its chief +functions is the preparation and distribution of literature to those +who desire it.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXV" id="CHAPTER_XXV"></a><hr /> +<span class='pagenum'><a name="Page_252" id="Page_252">[252]</a></span><br /> + +<h3>CHAPTER XXV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE FIGHT FOR CLEAN MILK</h4> +<br /> + +<p>"With the approval of the President and with the coöperation of the +Department of Agriculture,<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a> the [national quarantine] service has +undertaken to prepare a complete report upon the milk industry from +farm to the consumer in its relation to the public health." This +promise of the United States Treasury insures national attention to +the evils of unclean milk and to the sanitary standards of farmer and +consumer. Nothing less than a national campaign can make the vivid +impression necessary to wean dairymen of uncleanly habits and mothers +of the ignorant superstition that babies die in summer just because +they are babies. When two national bureaus study, learn, and report, +newspapers will print their stories on the first page, magazines will +herald the conclusions, physicians will open their minds to new +truths, state health secretaries will carry on the propaganda, +demagogues and quacks will become less certain of their short-cut +remedies, and <i>everybody will be made to think</i>.</p> + +<p>The evolution of this newly awakened national interest in clean milk +follows the seven stages and illustrates the seven health motives +presented in Chapter II. I give the story of Robert M. Hartley because +he began and prosecuted his pure-milk crusade in a way that can be +duplicated in any country town or small city.</p> + +<p>Robert M. Hartley was a strong-bodied, strong-minded, country-bred +man, who started church work in New York City almost as soon as he +arrived. He distributed religious <span class='pagenum'><a name="Page_253" id="Page_253">[253]</a></span>tracts among the alleys and hovels +that characterized lower New York in 1825. Meeting drunken men and +women one after another, he first wondered whether they were helped by +tracts, and then decided that the mind befogged with alcohol was unfit +to receive the gospel message. Then for fifteen years he threw himself +into a total-abstinence crusade, distributing thousands of pamphlets, +calling in one year at over four thousand homes to teach the +industrial and moral reasons for total abstinence. Finally, he began +to wonder whether back of alcoholism there was not still a dark closet +that must be explored before men could receive the message of religion +and self-control. So in 1843 he organized the New York Association for +Improving the Condition of the Poor, which ever since has remembered +how Hartley found alcoholism back of irreligion, and how back of +alcoholism and poverty and ignorant indifference <span class='pagenum'><a name="Page_254" id="Page_254">[254]</a></span>he found indecent +housing, unsanitary streets, unwholesome working conditions, and +impure food.</p> + +<div class="img"> +<a href="images/imagep253.jpg"> +<img border="0" src="images/imagep253.jpg" width="80%" alt="Fighting Infant Mortality by a School For Mothers" /></a><br /> +<p class="cen" style="margin-top: .2em;">FIGHTING INFANT MORTALITY BY A SCHOOL FOR MOTHERS IN +THE HEART OF NEW YORK CITY,—JUNIOR SEA BREEZE</p> +</div> + +<div class="img"> +<a href="images/imagep254.jpg"> +<img border="0" src="images/imagep254.jpg" width="80%" alt="Providing Against Germ Growth" /></a><br /> +<p class="cen" style="margin-top: .2em;">PROVIDING AGAINST GERM GROWTH AND ADAPTING MILK TO THE +INDIVIDUAL BABY'S NEED,—ROCHESTER'S MODEL DAIRY</p> +</div> + +<p>Hartley's instinct started the first great pure-milk agitation in this +country. While visiting a distillery for the purpose of trying to +persuade the owner to invest his money in another business, he noticed +that "slops smoking hot from the stills" were being carried to cow +stables. He followed and was nauseated by the sights and odors. +Several hundred uncleaned cows in low, suffocating, filthy stables +were being fed on "this disgusting, unnatural food." Similar disgust +has in many other American cities caused the first effort to better +dairy conditions. Hartley could never again enjoy milk from distillery +cows. Furthermore, his story of 1841 made it impossible for any +readers of newspapers in New York to enjoy milk until assured that it +was not produced by distillery slops. The instinctive loathing and the +discomfort of buyers awakened the commerce motives of milk dealers, +who covered their wagons with signs declaring that they "no longer" or +"never" fed cows on distillery refuse. But Hartley could not stop when +the anti-nuisance stage was reached. He did not let up on his fight +against impure or adulterated milk until the state legislature +declared in 1864 that <i>every baby, city born or country born, no +matter how humble its home, has the right to pure milk</i>.</p> + +<div class="img"><span class='pagenum'><a name="Page_255" id="Page_255">[255]</a></span> +<a href="images/imagep255.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep255.png" width="50%" alt="Clean Milk for New York City (pamphlet page 1)" /></a><br /> +</div> + +<div class="img"><span class='pagenum'><a name="Page_256" id="Page_256">[256]</a></span> +<a href="images/imagep256.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep256.png" width="50%" alt="Clean Milk for New York City (pamphlet page 2)" /></a><br /> +</div> + +<div class="img"><span class='pagenum'><a name="Page_257" id="Page_257">[257]</a></span> +<a href="images/imagep257.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep257.png" width="50%" alt="Clean Milk for New York City (pamphlet page 3)" /></a><br /> +</div> + +<p><span class='pagenum'><a name="Page_258" id="Page_258">[258]</a></span>Unfortunately Hartley and his contemporaries had never heard of +disease germs that are carried by unclean milk into the human stomach. +Science had not yet proved that many forms of barnyard filth could do +quite as much harm as distillery refuse. Commerce had not invented +milk bottles of glass or paper. The law of 1864 failed in two +particulars: (1) it did not demand cleanliness from cow to consumer; +(2) it did not provide means for its own enforcement, for learning +whether everything and everybody that had to do with milk was clean. +Not knowing of germs and their love for a warm climate and warm food, +they naturally did not prohibit a temperature above fifty degrees from +the time of milking to the time of sale. How much has been left for +our generation to do to secure pure milk is illustrated by the opening +sentence of this chapter, and more specifically by the programme of a +milk conference held in New York in November, 1906, the board of +health joining in the call. The four-page folder is reproduced in +facsimile (excepting the names on the fourth page), because it states +the universal problem, and also because it suggests an effective way +to stimulate relevant discussion and to discourage the long speeches +that spoil many conferences.</p> + +<p>This conference led to the formation of a milk committee under the +auspices of the association founded by Hartley. Business men, +children's specialists, journalists, clergymen, consented to serve +because they realized the need for a continuing public interest and a +persisting watchfulness. Such committees are needed in other cities +and in states, either as independent committees or as subcommittees of +general organizations, such as women's clubs, sanitary leagues, county +and state medical societies. Teachers' associations might well <span class='pagenum'><a name="Page_259" id="Page_259">[259]</a></span>be +added, especially for rural and suburban districts where they are more +apt than any other organized body to see the evils that result from +unclean milk. The New York Milk Committee set a good example in paying +a secretary to give his entire time to its educational programme,—a +paid secretary can keep more volunteers and consultants busy than +could a dozen volunteers giving "what time they can spare." Thanks +chiefly to the conference and the Milk Committee's work, several +important results have been effected. The general public has realized +as never before that two indispensable adjectives belong to safe +milk,—<i>clean</i> and <i>cool</i>. Additional inspectors have been sent to +country dairies; refrigeration, cans, and milk have been inspected +upon arrival at night; score cards have been introduced, thanks to the +convincing explanations of their effectiveness by the <span class='pagenum'><a name="Page_260" id="Page_260">[260]</a></span>representatives +of the Bureau of Animal Industry of the national Department of +Agriculture; 8640 milch cows were inspected by veterinary +practitioners (1905-1907), to learn the prevalence of bovine +tuberculosis (of these thirty-six per cent reacted to the tuberculin +test); state societies and state departments have been aroused to +demand an efficient live-stock sanitary board; magistrates have fined +and imprisoned offenders against the milk laws, where formerly they +"warned"; popular illustrated milk lectures were added to the public +school courses; illustrated cards were distributed by the thousand, +telling how to keep the baby well; finally, private educational and +relief societies, dispensaries, settlements, have been increasingly +active in teaching mothers at home how to prepare baby's milk. In 1908 +a Conference on Summer Care of Babies was organized representing the +departments of health and education, and fifty private agencies for +the care of sick babies and the instruction of mothers. The +superintendent of schools instructed teachers to begin the campaign by +talks to children and by giving out illustrated cards. Similar +instructions were sent to parochial schools by the archbishop.</p> + +<div class="img"> +<a href="images/imagep259.jpg"> +<img border="0" src="images/imagep259.jpg" width="80%" alt="Night Inspection Of Country Milk Upon Arrival In New York City" /></a><br /> +<p class="cen" style="margin-top: .2em;">NIGHT INSPECTION OF COUNTRY MILK UPON ARRIVAL IN NEW YORK CITY</p> +</div> + +<p>As elsewhere, there are two schools of pure-milk crusaders: (1) those +who want cities to <i>do things</i>, to pasteurize all milk, start milk +farms, milk shops, or pure-milk dispensaries; and (2) those who want +cities and states to <i>get things done</i>. So far the New York Milk +Committee has led the second school and has opposed efforts to +municipalize the milk business. The leader of the other school is the +noted philanthropist, Nathan Strauss, who has established +pasteurization plants in several American and European cities. The +discussion of the two schools, similar in aim but different in method, +is made more difficult, because to question philanthropy's method +always seems to philanthropy itself and to most bystanders an +ungracious, ungrateful act. As the issue, however, is clean milk, not +personal motive, it is important <span class='pagenum'><a name="Page_261" id="Page_261">[261]</a></span>that educators and parents in all +communities benefit from the effective propaganda of both schools, +using what is agreed upon as the basis for local pure-milk crusades, +reserving that which is controversial for final settlement by research +over large fields that involve hundreds of thousands of tests.</p> + +<div class="img"> +<a href="images/imagep261.jpg"> +<img border="0" src="images/imagep261.jpg" width="80%" alt="A New York Milk Committee's Infant Depot And School For Mothers" /></a><br /> +<p class="cen" style="margin-top: .2em;">A NEW YORK MILK COMMITTEE'S INFANT DEPOT AND SCHOOL FOR MOTHERS</p> +</div> + +<p>Pasteurization, municipal dairies, municipal milk shops, municipal +infant-milk depots, are the four chief remedies of the <i>doing things</i> +school. European experience is cited in support of each. We are told +that cow's milk, intended by nature for an infant cow with four +stomachs, is not suited, even when absolutely pure, to the human +infant's single stomach. Cow's milk should be modified, weakened, +diluted, to fit the digestive powers of the individual infant; hence +the municipal depot or milk dispensary that provides exactly the right +milk for each baby, prescribed by municipal physicians and nurses who +know. That the well-to-do and the just-past-infancy may have milk as +safe as babies receive <span class='pagenum'><a name="Page_262" id="Page_262">[262]</a></span>at the depot, municipalization of farm and +milk shop is advocated. Some want the city to run only enough farms +and milk shops to set a standard for private farmers, as has been done +in Rochester. This is city ownership and operation for educational +purposes only. Finally, because raw milk even from clean dairies may +contain germs of typhoid, scarlet fever, or tuberculosis, +pasteurization is demanded to kill every germ. There are advocates of +pasteurization that deprecate the practice and deny that raw milk is +necessarily dangerous; they favor it for the time being until farms +and shops have acquired habits of cleanliness. Likewise many would +prefer private pasteurization or laws compelling pasteurization of all +milk offered for sale; but they despair of obtaining safe milk unless +city officials are held <span class='pagenum'><a name="Page_263" id="Page_263">[263]</a></span>responsible for safety. Why wait to discuss +political theories about the proper sphere for government, when, by +acting, hundreds of thousands of lives can be saved annually? These +methods of <i>doing things</i> will not add to the price of milk; it is, in +fact, probable that the reduction in the cost of caring for the sick +and for inspecting farms and shops will offset the net cost of depots, +farms, and dairies.</p> + +<div class="img"> +<a href="images/imagep262.jpg"> +<img border="0" src="images/imagep262.jpg" width="80%" alt="One Of Rochester's Schools In Cleanliness" /></a><br /> +<p class="cen" style="margin-top: .2em;">ONE OF ROCHESTER'S SCHOOLS IN CLEANLINESS</p> +</div> + +<div class="img"> +<a href="images/imagep263.jpg"> +<img border="0" src="images/imagep263.jpg" width="80%" alt="Rochester's Model Dairy Farm" /></a><br /> +<p class="cen" style="margin-top: .2em;">ROCHESTER'S MODEL DAIRY FARM</p> +</div> + +<p>As to pasteurization, its cost is negligible, while the cost of +cleanliness is two, four, or ten cents a quart. Whether ideally clean +milk is safe or not, raw milk that is not clean is unfit for human +consumption. All cities should compel evidence of pasteurization as a +condition of sale. Large cities should have their own pasteurizing +plants, just as many cities now have their own vaccine farms and +antitoxin laboratories. Parents in small towns and in the country +should be taught to pasteurize all milk.</p> + +<p>The <i>getting things done</i> school admits the need for modified milk of +strength suited to the infant's stomach; affirms the danger of milk +that contains harmful germs; demands educational work by city, state, +and nation; confesses that <span class='pagenum'><a name="Page_264" id="Page_264">[264]</a></span>talk about cleanliness will not make milk +safe. On the other hand, it denies that raw milk is necessarily +dangerous; that properly modified, clean, raw milk is any safer when +pasteurized; that talking about germ-proof milk insures germ +extinction. It maintains that pasteurization kills benign germs +essential to the life of milk, and that after benign germs are killed, +pasteurized milk, if exposed to infection, is more dangerous than raw +milk, for the rapid growth of harmful germs is no longer contested by +benign germs fighting for supremacy. While it is admitted that raw +milk produced under ideal conditions may become infected by some +person ignorant of his condition, and before detection may cause +typhoid, scarlet fever, or consumption, it has not been proved that +such instances are frequent or that the aggregate of harm done equals +that which pasteurized milk may do. Pasteurization does not remove +chemical impurities; boiling dirt does not render it harmless. The +remedy for germ-infected milk is to keep germs out of milk. The remedy +for unclean milk is cleanliness of cow, cow barn, cowyard, milker, +milk can, creamery, milk shop, bottle, nipple. If the sale of unclean +milk is prevented, farmers will, as a matter of course, supply clean +milk. By teaching farmers and milk retailers the economic advantages +of cleanliness they will cultivate habits that guarantee a clean milk +supply. By punishing railroads and milk companies that transport milk +at a temperature which encourages germ growth, and by dumping in the +gutter milk that is offered for sale above 50 degrees, the +refrigerating of milk will be made the rule. Purging magistrates' +courts of their leniency toward dealers in impure, dangerous milk is +better than purging milk of germs. Boiling milk receptacles will save +more babies than boiling milk. Teaching mothers about the care of +babies will bring better results than giving them a false sense of +safety, because only one of many dangers has been removed by +pasteurization. Educating consumers to demand <span class='pagenum'><a name="Page_265" id="Page_265">[265]</a></span>clean milk and to +support aggressive work by health departments leaves fewer evils +unchecked than covering up uncleanliness by pasteurization.</p> + +<div class="img"> +<a href="images/imagep264.jpg"> +<img border="0" style="border: 1px black solid;" src="images/imagep264_th.jpg" width="80%" alt="New York Milk Committee's Graphic Method Of Showing Babies' Progress" /></a><br /> +<p class="cen" style="margin-top: .2em;">NEW YORK MILK COMMITTEE'S GRAPHIC METHOD OF SHOWING BABIES' PROGRESS</p> +</div> + +<div class="img"> +<a href="images/imagep265.jpg"> +<img border="0" src="images/imagep265.jpg" width="80%" alt="Producing Winter Conditions In Midsummer By Proper Refrigeration For Milk In Freight Cars" /></a><br /> +<p class="cen" style="margin-top: .2em;">PRODUCING WINTER CONDITIONS IN MIDSUMMER BY PROPER REFRIGERATION FOR MILK IN FREIGHT CARS</p> +</div> + +<p>When doctors disagree what are we laymen to do? We can take an +intelligent interest in the inquiries that are now being made by city, +state, and national governments. Because everybody believes that clean +milk is safer than unclean milk, that milk at 50 degrees will not +breed harmful germs, we can demand milk inspection that will tell our +health officers and ourselves which dealers sell only clean milk at 50 +degrees and never more than 60 degrees, that never shows over 100,000 +colonies to the cubic centimeter. We can get our health departments to +publish the results of their scoring of dairies and milk shops in the +papers, as has been done in Montclair. We can tell our health officers +that the best results in fighting infant mortality are at Rochester, +which city, winter and summer, <span class='pagenum'><a name="Page_266" id="Page_266">[266]</a></span>by inspection, correspondence, and +punishment, educates farmers and dealers in cleanliness, not only +censuring when dirty or careless, but explaining how to make more +money by being clean. Finally, mothers can be taught at home how to +cleanse the bottles, the nipples, all milk receptacles, and all things +in rooms where milk is kept. Absolutely clean milk of proper +temperature <i>at the shop</i> may not safely be given to a baby in a dirty +bottle. Infant milk depots, pasteurization, the best medical and +hospital care, breast feeding itself, cannot prevent high baby +mortality if mothers are not clean. The most effective volunteer +effort for pure milk is that which first makes the health machinery do +its part and then teaches, teaches, teaches mothers and all who have +to do with babies.</p> + +<div class="img"> +<a href="images/imagep266.jpg"> +<img border="0" src="images/imagep266.jpg" width="80%" alt="Neither Pasteurization nor Inspection can make it Safe to Sell "Dip Milk" Under Such Unclean Conditions" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-right: 10%; margin-left: 10%;">NEITHER PASTEURIZATION NOR INSPECTION CAN MAKE IT SAFE TO SELL "DIP MILK" UNDER SUCH UNCLEAN CONDITIONS</p> +</div> + +<p><span class='pagenum'><a name="Page_267" id="Page_267">[267]</a></span>"Clean air, clean babies, clean milk," has been the slogan of Junior +Sea Breeze,—a school for mothers right in the heart of New York's +upper East Side. In the summer of 1907 twenty nurses went from house +to house telling 102,000 mothers how to keep the baby well. This was +the only district that had fewer baby deaths than for 1906. Had other +parts of the city shown the same gain, there would have been a saving +of 1100 babies. The following winter a similar work was conducted by +nurses from the recently founded Caroline Rest, which has an +educational fund for instruction of mothers in the care of babies, +especially babies not yet born and just born. Heretofore the baby has +been expected to cry and to have summer complaint before anybody +worried about the treatment it received. If the baby lived through its +second summer, it was considered great good fortune. Junior Sea Breeze +and Caroline Rest start their educational work before the baby is +sick, in fact, before it is born. Their results have been so notable +that several well-to-do mothers declare that they wish they too might +have a school. Dispensaries and diet kitchens and more particularly +maternity wards of hospitals, family physicians, nurses, and midwives, +should be required to know how to teach mothers to feed babies +regularly, the right quantities, under conditions that insure +cleanliness whether the breast or the bottle is used. Perhaps some day +no girl will be given a graduating certificate, or a license for work, +teaching, or marriage, until she has demonstrated her ability to give +some mother's baby "clean air, clean body, clean milk."</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Libraries should obtain all reports on milk, Bureau of +Animal Industry, Washington, D.C.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXVI" id="CHAPTER_XXVI"></a><hr /> +<span class='pagenum'><a name="Page_268" id="Page_268">[268]</a></span><br /> + +<h3>CHAPTER XXVI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>PREVENTIVE "HUMANIZED" MEDICINE: PHYSICIAN AND TEACHER</h4> +<br /> + +<p>No profession, excepting possibly the ministry, is regarded with +greater deference than the medical profession. Our ancestors listened +with awe and obedience to the warnings and behests of the medicine +man, bloodletter, bonesetter, family doctor. In modern times doctors +have disagreed with each other often enough to warrant laymen in +questioning the infallibility of any individual healer or any sect, +whether homeopath, allopath, eclectic, osteopath, or scientist. Yet to +this day most of us surround the medical profession or the healing art +with an atmosphere of necromancy. Even after we have given up faith in +drugs or after belief is denied in the reality of disease and pain, we +revere the calling that concerns itself, whether gratuitously or for +pay, with conquering bodily ills.</p> + +<p>Self-laudation continues this hold of the medical profession upon the +lay imagination. One physician may challenge another's faults, +ridicule his remedies, call his antitoxin dangerous poison, but their +common profession he proudly styles "the most exalted form of +altruism." Young men and women beginning the study or the practice of +medicine are exhorted to continue its traditions of self-denial, and +in their very souls to place human welfare before personal or +pecuniary advancement. Newspapers repeat exhortation and laudation. We +laymen pass on the story that we know is not universally +true,—physicians know, physicians apply what they know without +consciousness of error, physicians must be implicitly trusted.</p> + +<p><span class='pagenum'><a name="Page_269" id="Page_269">[269]</a></span>For a physician to give poison when he means to give food is worse, +not better, than for a layman to make the same mistake. Neither the +moral code nor the law of self-preservation enjoins a tuberculous +mother to take alcohol or to sleep in an unventilated room, even if an +uninformed physician prescribes it. Instruction in physiology and +hygiene would be futile if those who are educated as to the elementary +facts of hygiene and physiology must blindly follow blind physicians. +A family doctor who gives cod-liver oil for anæmia due to adenoids may +do a child as much harm as a nurse who drugs the baby to make it +sleep. The physician who refuses to tell the board of health when +smallpox or typhoid fever first breaks out takes human life just as +truly as if he tore up the tracks in front of an express train. This +is another way of saying that parents and teachers must fit themselves +to know whether the family physician and their community's physicians +are efficient practitioners and teachers. Every one can learn enough +about the preventable causes of sickness and depleted vitality to +insist upon the ounce of education and prevention that is better than +a pound of cure.</p> + +<p>For its sins of omission, as for its sins of commission, the medical +profession shares responsibility with laymen. For years leading +educators, business men, hospital directors, public officials, have +known that communicable diseases could be stamped out. The methods +have been demonstrated. There is absolutely no excuse to-day for +epidemics of typhoid in Trenton, Pittsburg, or Scranton, for epidemics +of scarlet fever in the small towns of Minnesota, for uninterrupted +epidemics of tuberculosis everywhere. Had either laymen, physicians, +or school-teachers made proper use of the knowledge that has been in +text-books for a generation, this country would be saving thousands of +lives and millions of dollars every year. Our <i>doing</i> and <i>getting +done</i> have lagged behind our <i>knowing</i>.</p> + +<p><span class='pagenum'><a name="Page_270" id="Page_270">[270]</a></span>The failure of physicians to "socialize" or "humanize" their knowledge +is due to two causes: (1) no one has been applying <i>result tests</i> to +the profession as a whole and to the state in its capacity as doctor, +testing carefully the sickness rate, the death rate, and the expense +rate of preventable diseases; (2) physicians themselves have not +needed to know, either at college or in practice, the tax levied upon +their communities by preventable sickness. Public schools can do much +to secure result tests for individual physicians, for the profession +as a whole, and for boards of health. Schooling in preventive +medicine, or, better named, schooling in preventive hygiene, will fit +physicians to do their part in eradicating preventable disease.</p> + +<p>Preventive hygiene is not an essential part of the training of +American physicians or nurses to-day. Not only are there no colleges +of preventive hygiene, but medical schools have not provided +individual courses. It is possible for a man to graduate with honors +from our leading medical colleges without knowing what "vital +statistics" means. Even boards of health, their duties and their +educational opportunities, are not understood by graduates; it is an +accident if the "social and economic aspects of medical practice," +"statistical fallacies," "hospital administration," "infant +mortality," are familiar terms. It is for this reason, rather than +because physicians are selfish, that indispensable and beneficent +legislation is so generally opposed by them when the prerogatives of +their profession seem in danger. Practically every important sanitary +advance of the past century has been fought at the outset by those +whose life work should have made them see the need. Physicians +bitterly attacked compulsory vaccination, medical inspection of +schools, compulsory notification of communicable diseases. What is +perhaps more significant of the physician's indifference to preventive +hygiene is the fact that most of the sanitary movements that have +<span class='pagenum'><a name="Page_271" id="Page_271">[271]</a></span>revolutionized hygienic conditions in America owe their inception and +their success to laymen, for example, tenement-house reform, +anti-child labor and anti-tuberculosis crusades, welfare work in +factories, campaigns for safety appliances, movement for a national +board of health, prison, almshouse, and insane-asylum reform, schools +for mothers, and milk committees. The first hospital for infectious +diseases, the first board of health, the first out-of-door sea-air +treatment of bone tuberculosis in the United States, were the result +of lay initiative.</p> + +<p>Dr. Hermann M. Biggs says that in America the greatest need of the +medical profession and of health administration is training that will +enable physicians and lay inspectors to use their knowledge of +preventive hygiene for the removal of living and working conditions +that cause preventable sickness. A physician without knowledge of +preventive hygiene is simply doing a "general repair" business.</p> + +<p>For a few months in 1907 New York City had a highly efficient +commissioner of street cleaning, who, in spite of the unanimous +protests and appeals of the press, refused to give up the practice of +medicine. Hitherto the board of health of that city has been unable to +obtain the full time of its physicians because professional standards +give greater credit to the retail application of remedies than to the +wholesale application of preventives.</p> + +<p>Statesmanship as well as professional ability is expected of +physicians in the leading European cities, more particularly of those +connected with health departments. There it is not felt that a medical +degree is of itself a qualification for sanitary or health work. After +the professional course, physicians must take courses in preventive +hygiene and in health administration. Medical courses include such +subjects as vital statistics, duties of medical officers of health, +sanitary legislation, state medicine.</p> + +<p><span class='pagenum'><a name="Page_272" id="Page_272">[272]</a></span>The needless cost for one year of "catching" diseases in New York City +would endow in perpetuity all the schools and lectureships and +journals necessary to teach preventive hygiene in every section of +this great country. That city alone sacrifices twenty-eight thousand +lives annually to diseases that are officially called preventable. The +yearly burial cost of these victims of professional and community +neglect is more than a million dollars. When to the doctor bills, +wages lost, burial cost of those who die are added the total doctor +bills, wages lost, and other expenses of the sick who do not die, we +find that one city loses in dollars and cents more every year from +communicable diseases than is spent by the whole United States for +hospitals and boards of health.</p> + +<p>Many diseases and much sickness are preventable that are not +communicable. Indigestion due to bad teeth is not itself communicable, +but it can be prevented. One's vitality may be sapped by irregular +eating or too little sleep; others will not catch the trouble, +although too often they imitate the harmful habits. Adenoids and +defective vision are preventable, but not contagious. Spinal curvature +and flat foot are unnecessary, but others cannot catch them. +Preventive hygiene, however, should teach the physician's duty to +educate his patient and his community regarding all controllable +conditions that injure or promote the health.</p> + +<p>In the absence of special attention to preventive medicine new truth +is forced to fight its way, sometimes for generations, before it is +accepted by the medical profession. So strong are the traditions of +that profession and so difficult is it for the unconventional or +heterodox individual to retain the confidence of conservative +patients, that the forces of honorable medical practice tend to +discourage research and invention. The man who discovers a surgical +appliance is forced by the ethics of his profession either <span class='pagenum'><a name="Page_273" id="Page_273">[273]</a></span>to +commercialize it and lose his professional standing, or to abide the +convenience of his colleagues and their learned organizations in +testing it. Rather than be branded a quack, charlatan, or crank, the +physician keeps silent as to convictions which do not conform to the +text-books. Many a life-saving, health-promoting discovery which ought +to be taken up and incorporated into general practice from one end of +the country to the other, and which should be made a part of the +minimum standard of medical practice and medical agreement, must wait +twenty-five or fifty years for recognition.</p> + +<div class="img"> +<a href="images/imagep273.jpg"> +<img border="0" src="images/imagep273.jpg" width="80%" alt="The Disciple of Fresh Air and Home Instruction is still an Outcast in Scores of Hospitals" /></a><br /> +<p class="cen" style="margin-top: .2em;">THE DISCIPLE OF FRESH AIR AND HOME INSTRUCTION IS STILL AN OUTCAST IN SCORES OF HOSPITALS</p> +</div> + +<p>For want of a school of preventive medicine to emphasize universally +every new truth, the medical colleges are permitted to remain +twenty-five or fifty years behind absolutely demonstrated facts as to +medical truth and medical <span class='pagenum'><a name="Page_274" id="Page_274">[274]</a></span>practice. In 1761 a German physician, +Avenbruger, after discovering that different sounds revealed diseased +tissue, used "chest tapping" in the diagnosis of lung trouble. In 1815 +Lëannec discovered that sound from the chest was more distinct through +a paper horn. On that principle the modern stethoscope is built. He +made an accurate diagnosis of tuberculosis, and while suffering from +that disease treated himself as a living clinical study. In 1857 +Pasteur proved the presence of germs "without which no putrefaction, +no fermentation, no decay of tissue takes place." In 1884 Trudeau +started the first out-of-door care of pulmonary tuberculosis in +America. In 1892 Biggs secured the compulsory notification of +pulmonary tuberculosis. In 1904 began our first out-of-door sea-air +treatment for bone tuberculosis. Yet there are thousands of physicians +to-day who sincerely believe that they are earning their fees, who, +from houses shut up like ovens, give advice to patients for treatment +of tuberculosis, who prescribe alcohol and drugs, who diagnose the +disease as malaria for fear patients will be scared, who oppose +compulsory registration, and who never look for the tuberculous origin +of crippled children. Just think of its being possible, in 1908, for a +tuberculous young man of thirty to pay five dollars a day to a +sanatorium whose chief reliance is six doses of drugs a day!</p> + +<p>In 1766 America's first dentist came to the United States. By 1785 +itinerant dentists had built up a lucrative practice. In 1825 a course +of lectures on dentistry was delivered before the medical class at the +University of Maryland. As early as 1742 treatises were written "Upon +Dentition and the Breeding of Teeth in Children." In 1803 the +possibility of correcting irregularities was pointed out, as was the +pernicious effect of tartar on the teeth in 1827. In 1838 attempts +were made to abolish, "in all common cases, the pernicious habit of +tooth drawing." In 1841 treatises were written on the importance of +regulating <span class='pagenum'><a name="Page_275" id="Page_275">[275]</a></span>the teeth of children before the fourteenth year and on +the importance of preserving the first teeth. Yet in 1908 it is +necessary to write the chapter on Dental Sanitation. Few physicians, +whether in private practice or hospitals or just out of medical +college, consider it necessary to know the conditions of the mouth +before prescribing drugs for physical illness.</p> + +<p>Osteopathy furnishes an up-to-date illustration. Discredited by the +medical profession, by medical journals and medical schools, it has in +fifteen years built up a practice of eight thousand men, having from +one to three years' training, including over one hundred physicians +with full medical training plus a course in osteopathy. There were +means of learning fifteen years ago what was truth and what was +quackery about the practice of osteopathy. By refusing to look for its +truth and by concentrating attention upon its quackery the medical +profession has lost fifteen years. Whereas the truth of osteopathy +should have been adopted by the medical colleges and a knowledge of +its possibilities and limitations required of every practicing +physician, a position has been reached where alleged quackery seems in +several important points to be discrediting the sincerity, the +intelligence, and the efficiency of orthodox medicine. No appeal to +the natural can be stronger, no justification of schools of preventive +medicine more complete, than the following paragraph from an +osteopathic physician who is among the small number who, having both +the medical and osteopathic degrees, see both the possibilities and +limitations of manual surgery and demand the inclusion of this new +science in the medical curriculum.</p> + +<div class="block"><p>The physical method of treating disease presents a tremendous and +significant departure from the empiricism of medicine and the +experimentation of dietetics, the restricted fields of +electricity, suggestion, water cures, and massage. The patient as +an individual is not treated; the disease as a disease is not +treated; the <span class='pagenum'><a name="Page_276" id="Page_276">[276]</a></span>symptoms are not treated; but the entire physical +organism, with its many parts and diverse functions, is +exhaustively examined until each and every abnormal condition, +whether of structure or of function, causing disease and +maintaining symptoms, is found and administered to with the skill +of a definite art, based upon the data of an exact science.</p></div> + +<p>Likewise the truths underlying Christian Science have been disdained +by medical schools and medical experts, just as its spiritual truth +has been disdained by religious leaders, until it has grown to such +strength that laymen are almost forced to question the sincerity and +the efficacy of the conventional in religion as well as medicine. In +May, 1907, the Emmanuel Church in Boston organized a clinic for the +purpose of utilizing for neurasthenics particularly both the spiritual +and the physical truths underlying religion and the various branches +of medical science. Daily papers and magazines are giving a great deal +of space to this experiment in "psychotherapy," which is discussed in +the chapter on Mental Hygiene. Schools and chairs in preventive +hygiene would soon give to the medical profession a point of view that +would welcome every new truth, such as the alliance of religion and +medicine, and estimate its full worth promptly. Truth seeking would be +not only encouraged but made a condition of professional standing.</p> + +<p>Just what attitude any particular physician takes can be learned by +the teacher or parents whose children he treats. If he pooh-poohs or +resents board of health regulations as to isolation of scarlet-fever +patients, he is a dangerous man, no matter how noble his personal +character. If he says cross-eyes will straighten, weak eyes will +strengthen, or nose-stopping adenoids "absorb," he is bound to do +harm. If he says tuberculosis is incurable, noncommunicable, +hereditary, or curable by drugs, or if he tries to cure cancer by +osteopathy, he can do more injury than an insane criminal. If he fails +to teach a mother how to bathe, feed, <span class='pagenum'><a name="Page_277" id="Page_277">[277]</a></span>and clothe the baby, how to +ventilate a room for the sick or the well, he is an expensive luxury +for family or for school, and belongs to an age that knew neither +school nor preventive hygiene. If he takes no interest in health +administration; if he overlooks unclean milk or unclean streets, open +sewers, and unsanitary school buildings, street cars, churches, and +theaters; if he does not help the health board, the public hospitals, +the schools, the factory, and tenement departments enforce sanitary +laws, he is derelict as a citizen and as a member of an "exalted +profession." <span class='pagenum'><a name="Page_278" id="Page_278">[278]</a></span>If he sees only the patients he himself treats or one +particular malady, he is derelict as a teacher, no matter how charming +his personality or how skilled in his specialty. If a school physician +is slovenly in his work, if he spends fifteen minutes when he is paid +for an hour, should the efficient school-teacher conceal the fact from +her superiors because he is a physician? If private hospitals +misrepresent facts or compromise with political evils for the sake of +a gift of public money, their offense is more heinous because of their +exalted purpose. The test of a physician's worth to his patients and +to his community is not what he is or what he has learned, and not +what his profession might be, but what happens to patient and to +community. Human welfare demands that the medical profession be judged +by what it does, not by what it might do if it made the best possible +use of its knowledge or its opportunity.</p> + +<div class="img"> +<a href="images/imagep277.jpg"> +<img border="0" src="images/imagep277.jpg" width="67%" alt="Too Many Physicians and even Maternity Hospitals fail to Teach Mothers" /></a><br /> +<p class="cen" style="margin-top: .2em; margin-left: 10%; margin-right: 10%;">TOO MANY PHYSICIANS AND EVEN MATERNITY HOSPITALS FAIL TO TEACH MOTHERS, EITHER BEFORE OR AFTER BABIES ARE BORN<br /> +Caroline Rest Educational Fund was given to show the value of such teaching</p> +</div> + +<p>A dispensary that treats more patients than it can care for properly +is no better than a street-car company that chronically provides too +few seats and too many straps. Unless physicians test themselves and +their profession by results, we shall be compelled to "municipalize +the medical man." Preventable sickness costs too much, causes too much +wretchedness, and hampers too many modern educational and industrial +activities to be neglected. If the medical profession does not fit +itself to serve general interests, then cities, counties, and states +will take to themselves the cure as well as the prevention of +communicable and other preventable sickness. Human life and public +health are more precious than the medical profession, more important +even than theories and traditions against public interference in +private matters. The unreasoning opposition of medical men to +government protection of health, their concentration on cure, and +their tardy emphasis on prevention have forced many communities to +stumble into the evil practices mentioned in Chapter XVI. +Incidentally, <span class='pagenum'><a name="Page_279" id="Page_279">[279]</a></span>the best physicians have learned that the prosperity of +their profession increases with every increase in the general standard +of living. It is the man in the ten-room house not the man in one room +who supports physicians in luxury. It is the healthy man and the +healthy community that value efficient medical service.</p> + +<p>Many American cities maintain dispensaries and hospitals for the poor. +Whether they will go to the logical conclusion of engaging physicians +to give free treatment to all regardless of income depends largely +upon what the next generation of private physicians do. The state +already says when a physician's training fits him to practice. It will +soon expect him to pass rigid examinations in the social and economic +aspects of his profession,—its educational opportunity, vital +statistics, sick and death rates. Will it need to municipalize him in +order to protect itself?</p> + +<p>Obviously the teacher or parent should not begin cooperation with +physicians by lecturing them or by assuming that they are selfish and +unwilling to teach. The best first step is to ask questions that they +should be able to answer:</p> + +<div class="block"><p>What causes cholera morbus or summer complaint? When does milk +harm the baby? How can unclean milk be made safe? Whose fault is +it that the milk is sold unclean and too warm? What agencies help +sick babies? What is the health board doing to teach mothers?</p></div> + +<p>Or, if a school physician, the teacher can ask:</p> + +<div class="block"><p>Why not remove these adenoids? What causes them? When will they +disappear by absorption? What harm can they do in the meantime? +How long would an operation take? Would it hurt very much? What +would be the immediate effects? Why not act at once? What +provisions are there in town for such operations? Why have the +physicians paid so little attention to breathing troubles? What +could your state do to interest physicians in school hygiene? Will +the school physician talk to a <span class='pagenum'><a name="Page_280" id="Page_280">[280]</a></span>mothers' meeting? What agencies +will give outings to sick children? What dispensaries are +accessible? Who is the proper person to organize a public health +league?</p></div> + +<p>Physicians love to teach. If teachers and parents will love to learn +and will ask the right questions, all physicians can be converted into +hygiene missionaries, heralds of a statesmanship that guarantees +health rights to all.</p> + +<br /> + +<p class="cen sc">Licensing the Practitioner</p> + +<p>Three parties are interested in setting a high standard for +physicians, dentists, druggists, nurses, and veterinary surgeons—the +profession itself, the schools that educate, and the general public on +whom the arts are practiced. The schools and the practitioners are, +for the most part, primarily interested in protecting a monopoly of +skill. Their interest in restrictive legislation is analogous to that +of the labor union which limits the number of apprentices. This trade +unionism among professional colleges and professional graduates of +these colleges has gradually developed a higher and higher standard +that results in greater protection to the public. The first step is +generally to demand that all persons entering a profession after a +given date shall prove to the state their ability to "practice" +without injury to clients. It is almost impossible to get such laws +through unless the original law exempts all persons by whatever name, +who are practicing the art in question at the time the law is passed. +Whether we are speaking of medicine, law, dentistry, accountancy, +osteopathy, or barbering, this has been the history of compulsory +restriction and of state examinations.</p> + +<p>As with regard to most other legislation, the enforcement of the law +lags behind its definition. Moreover nothing is done after a man has +passed a certain examination to see that he remains fit and safe to +treat the public. Because no supervision is provided except on the day +of <span class='pagenum'><a name="Page_281" id="Page_281">[281]</a></span>examination, it is possible for men and women to fill their brains +for a week or two weeks with the information necessary to pass what +coaches and tutors have learned will, in all probability, be asked. +Forever after, the public is left to protect itself. Out of this +condition have arisen the evil, unethical, and unprofessional +practices represented particularly by painless dentists, by ignorant +or dishonest physicians, and by osteopaths and careless nurses.</p> + +<p>The machinery for preventing these evils is discussed in Chapter XXIX. +Suffice it here to present to parents and teachers the need for +examination in advance of certification that will show whether or not +those who make a livelihood by caring for others' health are equipped +to mitigate rather than aggravate evils, and for further tests by +which the public can learn from time to time which, among those +professional men who are protected by the public against competition, +continue to be safe. Finally, if, as will be clearly seen, it is +desirable that what we call professional ethics persist and that +self-advertisement be discouraged, society must, for its own +protection, adopt some other means than epithets to correct the evils +of self-advertisement and quackery. Even though we admit the +responsibility of each citizen when he goes to the house of a private +practitioner who has made no other effort to lure him thither than to +place a card in the window, it must be seen that we cannot hold +responsible for their choice men and women who receive through +newspapers, magazines, or circulars convincing notices that Dr. +So-and-So or the Integrity Company or the Peerless Dental Parlor will +place at their disposal, at prices within their reach, skill and +devotion absolutely beyond their reach at the office of an efficient +private practitioner. Some way must be found by which departments of +health will currently impose tests of methods and results upon +physicians, opticians, pharmacists, manufacturers of medicine, and +dentists.</p> + +<p><span class='pagenum'><a name="Page_282" id="Page_282">[282]</a></span>As laymen become more intelligent regarding their own bodies and +healthy living, it grows harder and harder for quacks and incompetents +to mislead and exploit them. Better than any possible outside +safeguard is hygienic living. Fortunately, we can all learn the simple +tests of environment and of living necessary to the selection of +physicians, dentists, and opticians, or other "architects of health" +whose efficiency and integrity are beyond question.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="PART_IV_OFFICIAL_MACHINERY_FOR_ENFORCING_HEALTH_RIGHTS" id="PART_IV_OFFICIAL_MACHINERY_FOR_ENFORCING_HEALTH_RIGHTS"></a><a name="CHAPTER_XXVII" id="CHAPTER_XXVII"></a><hr /> +<span class='pagenum'><a name="Page_283" id="Page_283">[283]</a></span><br /> +<br /> +<br /> +<br /> + +<h2 class="wrap">PART IV. OFFICIAL MACHINERY FOR ENFORCING HEALTH RIGHTS</h2> + +<br /> + +<h3>CHAPTER XXVII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>DEPARTMENTS OF SCHOOL HYGIENE</h4> +<br /> + +<p>The term "school hygiene" generally suggests no other school than the +public school. State laws say nothing about compulsory hygiene in +military academies, ladies' seminaries, or other preparatory and +finishing schools. Yet when one thinks of it, one must conclude that +the right to health and to healthful school environment cannot +equitably be confined to the children whose tuition is given at public +expense. There is a better way to check "swollen" fortunes than by +ruining the health of "fortune's children." The waste and danger of +slow-minded, noticeably inefficient children are no less when parents +are rich than when parents are poor. There is no justification for +neglecting the health of children in parochial schools, in private +schools for the well-to-do or rich, or in commercial schools for the +ambitious youth of lower income strata. Nor has the commercial, +parochial, private school, or college, any clearer right than the +public school to injure or to fail to promote pupils' health. So far +as school hygiene is advisable, so far as it is right to make hygiene +compulsory, its personal and social benefits should be shared by +children of school age without regard to income, and its laws should +be enforced by all teachers, principals, and officers that have <span class='pagenum'><a name="Page_284" id="Page_284">[284]</a></span>to do +with school. In presenting a programme for school hygiene this chapter +refers to the hygiene taught, the hygiene practiced, the hygiene not +taught, and the hygiene not practiced in buildings and on grounds +where children and youth are at school, whether these children are in +kindergarten or high school, in reformatory or military academy, in +charitable school, or in finishing and preparing center for society's +juniors.</p> + +<p>The question of the local, state, and national machinery by which +proper standards of school hygiene shall be made effective will be +taken up after we have considered individual steps in a comprehensive +programme for school hygiene.</p> + +<p>1. <i>Thorough physical examination of all candidates for teachers' +positions and periodic reëxamination of accepted teachers.</i></p> + +<p>Teachers would be grateful to be told in time their own physical needs +and the relations of their vitality to the vitality of their pupils. +Are your teachers examined? Do they know the laws of health and the +signs of child health? Are they permitted to continue in schoolrooms +after tuberculosis is discovered? Are normal graduates given physical +tests before being permitted to teach and before being permitted to +give four years to preparation for teaching?</p> + +<p>2. <i>Thorough physical examination of every single child in every +single school upon entering and periodically during school life.</i></p> + +<p>We believe a vast number of things that "ain't so" about the health of +country children as compared with city children, of private-school +children as compared with public-school children. Where do we find +more degenerate men, physically and morally, than in so-called +"American settlements," where, for generations, children have had all +outdoors to play in, except when in homes and schoolhouses that are +seldom cleansed and seldom ventilated? Open <span class='pagenum'><a name="Page_285" id="Page_285">[285]</a></span>mouths and closed minds +clog the "little red schoolhouse"; there headaches do not suggest eye +strain; there deafness and running ears are frankly attributed to +scarlet fever which everybody must have with all the other "catching" +diseases, the earlier the better; there colds begin in December and +run until March, to the serious injury of attendance and promotion +records; there bone tuberculosis is called "knee trouble" or "spine +trouble in the family"; there boys like my little friend Fred count +the bottles of cod-liver oil they take to cure adenoids that could be +removed in two minutes.</p> + +<p>The index to community life and community living conditions should be +read in the country, not only for the country's sake, but also for the +sake of the city whose milk and water, poisoned in the country, cause +thousands of deaths annually, besides annual sick bills exceeding many +times over the Russell Sage and Carnegie Foundations, which we rightly +call munificent. Reading the index of private schools and colleges is +important for their children and youth, but still more important for +the community upon which unbridled passion, inability to work or to +spend properly, inconsequential thinking, mediæval ideals of caste, +etc., can inflict greater injuries than can typhoid fever or cholera.</p> + +<p>The physical record of each child should be kept from date of entrance +to date of leaving school, showing condition at successive +examinations, absence because of illness, etc.</p> + +<p>3. <i>Thorough physical examination of children when leaving school, or +when passing compulsory school age, as a condition to "working papers" +and to "coming out."</i></p> + +<p>To give working papers to children seriously handicapped by physical +defects is to buy future industrial trouble, hospital and poorhouse +bills. A boy with adenoids, a girl with eye trouble, should not be +permitted to begin the fight for self-support without at least being +clearly shown that the <span class='pagenum'><a name="Page_286" id="Page_286">[286]</a></span>correction of these defects will increase +their earning power. At present a schoolgirl with incipient +tuberculosis, or predisposed to that disease, can get working papers, +go to a hammock or tobacco factory, work long hours, breathe bushels +of dust, deplete her vitality, spread tuberculosis among her +co-workers and home associates, infect a tenement,—and all this +without any help or advice or any protection from society until she is +too sick to work and her physician notifies the health department that +she is a danger center. We may disagree about society's right to +control a child's act after the defects are discovered, but who will +question society's duty to tell that child and her parents the truth +about her physical needs before it accepts her labor or permits her to +"enter society"?</p> + +<p>4. <i>Supervision by physicians of hygiene practiced in schoolrooms and +on playgrounds.</i></p> + +<p>Superintendent Maxwell, of New York City, and other educational +leaders urge teachers to do their utmost to learn the physical +conditions and home environment of the individual child, and to fit +school treatment to the individual possibilities and handicaps. But +experience proves conclusively that try as they will, teachers and +principals have neither the special knowledge nor the time to acquire +the special knowledge requisite to use the facts disclosed by the +physical examination of school children. Physicians and nurses are +needed, not so much for treating children, as for teaching children, +parents, teachers, family and dispensary physicians.</p> + +<p>Private schools have visiting physicians who may be consulted; they +need physicians to supervise, with power to examine or to require +certificates of examination. The Committee on the Physical Welfare of +School Children found that when a visitor was detailed for that +purpose it was easy to secure the coöperation of parents, teachers, +family physicians, dispensaries, school boards, and <span class='pagenum'><a name="Page_287" id="Page_287">[287]</a></span>charitable +societies. The Hawthorne Club's school secretary has been similarly +successful in Boston, as have those of Hartley House, Greenwich House, +and the Public Education Association in New York.</p> + +<p>5. <i>Restriction of study hours at school and at home to limits +compatible with health.</i></p> + +<p>Whether the hours of study at school and at home are excessive cannot +be learned from treatises on pedagogics or physiology. Because +children differ in vitality as in ability to learn, the maximum limit +for study hours should be determined by the individual child's +physical condition. When the Japanese went to war with Russia the +highest authority in the field was the army surgeon. To this fact was +largely due the astonishingly small amount of sickness and the high +fighting capacity and endurance of the Japanese, working under +unfavorable conditions. No board of school superintendents or board of +directors, no state superintendent of schools or college professor, +has the right to compel or to allow study hours beyond the maximum +compatible with the individual student's physical condition and +endurance. The physician responsible for school hygiene should have an +absolute veto upon any educational policy, method, or environment +demonstrably detrimental to children's vitality.</p> + +<p>6. <i>Establishment of a "follow-up" plan to insure action by parents to +correct physical defects and to attend to physical needs.</i></p> + +<p>The advantages of <i>getting things done</i> over <i>doing things</i> have been +repeatedly emphasized. In smaller cities and in rural districts it is +particularly important for schools to get things done better by +existing local agencies, such as churches, health and street-cleaning +departments, hospitals, clinics, medical and sanitary societies, trade +unions, young people's societies, and women's clubs. Where parents who +have been followed up and taught, obstinately or <span class='pagenum'><a name="Page_288" id="Page_288">[288]</a></span>ignorantly refuse to +attend to their children's needs, the segregation of the physically +defective or needy will encourage the coöperation of children +themselves in persuading parents to act intelligently for the child's +sake. No child wants to remain "queer" or "dopey" or behind his peers. +The city superintendent of schools for New York City has asked for +laws compelling parents to permit operations and punishing them for +neglecting to take steps, within their power, to remove physical +defects discovered at school.</p> + +<div class="img"> +<a href="images/imagep288.jpg"> +<img border="0" src="images/imagep288.jpg" width="65%" alt="Teaching A Mother To Care For One Child Insures Better Care For All Her Children" /></a><br /> +<p class="cen" style="margin-top: .2em;">TEACHING A MOTHER TO CARE FOR ONE CHILD INSURES BETTER CARE FOR ALL HER CHILDREN</p> +</div> + +<p><span class='pagenum'><a name="Page_289" id="Page_289">[289]</a></span>7. <i>Physiological age should influence school classification and +school curriculum.</i> On this subject the studies of Dr. C. Ward +Crampton, referred to in the chapter on Vitality Tests, are invaluable +and as convincing as they are revolutionary. Scientists accept his +proof that our present high school curriculum is ill adapted to a +large proportion of children; the "physiologically too young" drop +out; only the physiologically mature succeed. The two physiological +ages should be given different work. Children whose bodies yearn for +pictures, muscular and sense expression, should be given a chance in +school for normal development. Analysis should wait for action. +Organized play and physical training antedated physical examination in +our schools. Like the curriculum they often disregard physiological +age, doing harm instead of good. Facts as to physical condition and +physiological development would enable us to utilize the momentum of +these two to broaden school hygiene and to insure proper physical +supervision. Only good would result from adopting Leipsic's plan of +having school children examined without clothing, in the presence of +parents if parents desire. Expensive? Not so expensive as high school +"mortality" due to maladjusted curriculums that force the great +majority of boys and girls to drop out before graduation and ruin the +health of a large fraction of those who remain.</p> + +<p>8. <i>Construction of school building and of curriculum so that, when +properly conducted, they shall neither produce nor aggravate physical +defects.</i></p> + +<p>When the state for its own protection compels a child to go to school, +it pledges itself not to injure itself by injuring the child. +Thousands of children are now being subjected to conditions in school +far more injurious than the factory and shop conditions against which +the national and state child labor committees have aroused universal +indignation. Two illuminating studies of school buildings in New <span class='pagenum'><a name="Page_290" id="Page_290">[290]</a></span>York +City were made last year by the Committee on the Physical Welfare of +School Children, and later by the Board of Education. Similar studies +should be made of every schoolroom. Whereas our discussions of +buildings and curriculum have hitherto proceeded largely from abstract +principles of light, ventilation, heating, and pedagogics, these two +reports deal with rooms, equipment, courses of study, and school +habits as they are, with obvious detrimental effects on child victims. +Numerous questions that it is practicable to answer are given in +Chapter XIV.</p> + +<p>What and when to build can be better determined after we have learned +the what and the where of present equipment.</p> + +<p>In passing it is worth while to note that in large cities teachers are +frequently forced to choose between bad ventilation and street noises. +From Boston comes the suggestion that we avoid noises and evils of +congestion by building schoolhouses for city children on the outskirts +in the midst of fields, transporting, and, if necessary, feeding +children at public expense. While it is true that the public funds now +spent in attempting to cure physical and moral ills would purchase +ample country reservations, the practical next step seems to be to +provide ample play space and breathing space within the city for every +school building already erected, and without fail for all buildings to +be erected hereafter.</p> + +<p>9. <i>Hygiene should be so taught that children will cultivate habits of +health and see clearly the relation of health and vitality to present +happiness and future efficiency.</i> Social rather than personal, public +rather than private, health needs emphasis. Children can be shown how +their health affects their neighbor; why money spent for health boards +is a better investment than money given to corrupt politicians; that +the cost of accepting Thanksgiving turkey or a park picnic from a +political leader who encourages inefficient government is sickness, +misery, deficient schooling, lifelong <span class='pagenum'><a name="Page_291" id="Page_291">[291]</a></span>handicap; that children and +adults have health rights in school and factory, on street and +playground, which the law will protect if only they know when these +rights are infringed.</p> + +<p>10. <i>Central supervision of school hygiene.</i> In private and public, +boarding and day, country and city, reformatory and military, +commercial and high schools, the index—physical welfare of school +children—should be read and interpreted. Headquarters should learn +whether or not physical examinations are made and whether harmful +conditions are corrected. So far as public schools are concerned, +"headquarters" means for cities the fact center that informs city +superintendent or school board; for rural schools, it means the county +superintendent's office. Whether city or county headquarters have the +facts and act accordingly should be known by state superintendents. +Whether state superintendents are demanding the facts and educating +the county and city headquarters of their states should be known to +the national commissioner of education and by him published for all +the world. Some people think the state health board should be +responsible, others the state educational authority. The important +thing is to make some one officer responsible. Methods can be easily +worked out if the need is conceded. Legislatures will gladly confer +the powers necessary to reading the index of all public schools.</p> + +<p>As for parochial and private schools, they may resent for a time +public supervision of their hygiene teaching and practice. However, +the case could be so presented that they would ask for it, because it +would help not only their pupils and society but the schools +themselves. No religious belief or private investment can afford to +admit that it disregards child health; state supervision would require +nothing more than evidence of adequate school hygiene.</p> + +<p>11. <i>Information gained at school regarding conditions prejudicial to +community health should be published and <span class='pagenum'><a name="Page_292" id="Page_292">[292]</a></span>made the basis of an +aggressive campaign for the enforcement of sanitary laws.</i> Ten +thousand uses can be made of the information gained at school, ten +thousand forces can be made to do educational work, but only a few +kinds of work can be done effectively at school. Franklin Ford has +said: "You can relate school to all life, but you cannot bring all +life under the school roof." As Chapters XVI-XVIII make clear, to +socialize the point of view of dispensaries and hospitals is more +effective than to put clinics in school buildings. To <i>do for</i> or +<i>give to</i> people who can help themselves is to <i>give up</i> and <i>do up</i> +power of self-help.</p> + +<p>Machinery that must some day exist for the execution of this programme +will be approximately the following:</p> + +<br /> + +<div class="block"><p class="cen sc">I. National Machinery</p> + +<p>1. Clearing house for facts regarding school hygiene as taught and +practiced in all schools under the Stars and Stripes; this to be a +part of the National Bureau of Education.</p> + +<p>2. Scientific research to be conducted by the National Bureau of +Education or by the future National Board of Health.</p> + +<br /> + +<p class="cen sc">II. State Machinery</p> + +<p>1. Clearing house for facts regarding school hygiene taught and +practiced in all schools within state limits; this to be +maintained by the state educational authorities.</p> + +<p>2. Agents to make special inquiries as to practice and teaching of +school hygiene.</p> + +<p>3. Agents to inspect and to instruct county superintendents, +county physicians, teachers, normal schools, etc.</p> + +<p>4. A bureau of experts—architect, sanitarian, teacher—whose +approval must be obtained before any school building can be +erected. (A plan which brought excellent results when applied by +state boards to charitable institutions, hospitals for the insane, +etc.)</p> + +<p>5. Standard making by normal schools, state universities, +hospitals, or other educational and correctional institutes under +direct state management.</p> + +<br /> + +<p class="cen sc"><span class='pagenum'><a name="Page_293" id="Page_293">[293]</a></span>III. County Machinery</p> + +<p>1. Clearing house for facts regarding school hygiene taught and +practiced in all schools within county limits; this to be +maintained by the county superintendent of schools.</p> + +<p>2. Physician and nurse to organize inspection and instruction for +rural schools, to give lessons and make demonstrations at county +institutes, to show teachers how to interest physicians, dentists, +health officers, and parents in the physical welfare of school +children.</p> + +<br /> + +<p class="cen sc">IV. Town and Township Machinery</p> + +<p>1. Teachers intelligent as to physical needs, as to sanitation of +buildings, etc.</p> + +<p>2. An examining physician, to be salaried where the population +justifies; elsewhere to work as a volunteer in coöperation with +teacher and with county physician.</p> + +<p>3. Physical history of each child from date of entrance to date of +leaving school, to be kept up to date by teacher.</p> + +<br /> + +<p class="cen sc">V. City Machinery</p> + +<p>1. A division to be known as the Department of School Hygiene, +headed by an officer who gives his entire time to that department.</p> + +<p>2. A subcommittee of the Board of Education.</p> + +<p>3. Clearing house for facts regarding school hygiene taught and +practiced in all schools within city limits.</p> + +<p>4. Specialists to examine applicants for teaching positions, and +to reëxamine teachers to determine fitness for continuance, for +promotion, and for special assignments.</p> + +<p>5. A bureau for inspection and control of all hygiene of school +buildings, old and new, with power to compel repairs or to reject +plans that do not make adequate sanitary provision.</p> + +<p>6. Similar supervision of curriculum and of study hours +prescribed.</p> + +<p>7. A bureau for the inspection and control of curriculum, required +home study, exercise, physical training, etc., so far as relates +to the health of pupils, and to the physical ability of children +to be in certain grades or to be promoted. This will decide <span class='pagenum'><a name="Page_294" id="Page_294">[294]</a></span>the +duration of lessons, frequency of intermissions, sequence of +subjects, time and method of recess throughout the various grades.</p> + +<p>8. Supervision of indoor and outdoor playgrounds, roof gardens, +indoor and outdoor gymnasiums, swimming pools, etc.</p> + +<p>9. Supervision of instruction in school hygiene.</p> + +<p>10. A staff of inspectors for communicable diseases of pupils and +teachers, to be subject to the board of education or the board of +health.</p> + +<p>11. A staff of examiners adequate to examine all children and +teachers at least once a year for defects of eye, ear, teeth, +nose, throat, lungs, spine, bones, glands, etc., and for weight +and height to be under the control of the board of education or +the board of health. The expense would not be as great as the +penalty paid for omitting such examination.</p> + +<p>12. A staff of nurses to assist medical examiners to give children +practical demonstrations in cleanliness, to teach mothers the care +of children both at their homes and in mothers' meetings, to +enlist the coöperation of family physician and neighborhood +facilities, such as hospitals, dispensaries and relief agencies, +magistrates' courts and probation officers,—all to be under the +control of the board of education or the board of health.</p></div> + +<br /> + +<p>Whether inspectors, examiners, and nurses shall be directed by the +board of education or the board of health is a question that it is +impossible to decide without knowledge of local conditions. So far as +state and county organizations are concerned, it is clear that +whatever the boards of health may do, it will be necessary for state +and county superintendents of education to equip themselves with the +machinery above recommended. In cities it is quite clear that a board +of education should be responsible for all of the machinery suggested, +excepting the three divisions that have to do with work hitherto +considered as protection against transmissible diseases, namely, +inspection, examination, district visiting. In Cleveland these are +school duties. In New York they are duties of the health department. +Boston has school nurses and health <span class='pagenum'><a name="Page_295" id="Page_295">[295]</a></span>department physicians. The state +law of Massachusetts provides that where health boards do not examine +school children, school boards may spend money for the purpose.</p> + +<p>As to inspection for transmissible diseases, it seems quite clear that +health boards should not delegate their authority or responsibility to +any other body, for they alone are accountable to their communities +for protection against contagion. It is clear, too, that in the +interest of community health, departments of health are justified in +pointing out in advance of contagion those children most likely to +become a menace. Similar grounds of public interest justify the health +boards in sending nurses and physicians to the home as a means of +getting things done.</p> + +<p>Dr. Biggs feels that responsibility for the physical welfare of school +children will strengthen health work in all cities, and, given proper +interest on the part of school officials, should make possible +universal coöperation in a constructive programme. On the other hand, +he believes that division of responsibility between school and health +boards will weaken both in their appeals for funds and for support of +a constructive programme. I have heard principals and superintendents +maintain also that the moral effect of a visit to the school by a +representative of the health board vested with powers of that board +was much greater than a visit by a representative of the school board. +They further allege that a physician coming from the outside is more +apt to see things that need correction and less apt to accept excuses +than an inspector who feels that he belongs to the same working group +as the school-teacher. Because the follow-up work in the homes +incident to successful use of knowledge gained at school involves so +many sanitary remedies, it is theoretically better organization to +hold the health authority responsible.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXVIII" id="CHAPTER_XXVIII"></a><hr /> +<span class='pagenum'><a name="Page_296" id="Page_296">[296]</a></span><br /> + +<h3>CHAPTER XXVIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>PRESENT ORGANIZATION OF SCHOOL HYGIENE IN NEW YORK CITY</h4> +<br /> + +<p>Many of the elements of the machinery outlined in the preceding +chapter already exist in New York City. All of them brought together, +either by amalgamation or by proper coördination, would present a very +strong front. Unfortunately, however, there is not only unsatisfactory +team work, but the efficiency of individual parts is seriously +questioned by the heads of the health and school departments.</p> + +<p>The inspection for contagious diseases, the examination for physical +defects, the follow-up work by nurses and physicians, are in charge of +the department of health. Physical training and athletics for +elementary and high schools, winter recreation centers, and vacation +playgrounds are under directors and assistants employed by the board +of education. Heretofore inadequate powers and inadequate assistance +for training or for research have been given to the physical director.</p> + +<p>The city superintendent of schools, in his report for the year 1907, +presented to the board of education in January, 1908, declares that +the "present arrangements have been inadequate.... In only 248 +schools—less than half the total number—were any examinations for +possible diseases made. In these 248 schools not more than one third +of the pupils were examined. It is only a few months since any +examinations for physical defects were made outside of the boroughs of +Manhattan and The Bronx, and then only on account of the New York +Committee on the Physical Welfare of School Children."</p> + +<p><span class='pagenum'><a name="Page_297" id="Page_297">[297]</a></span>As is so often the case, it is difficult to decide the merits of a +method that has not been efficiently executed. The department of +health has not hitherto done its best in its school relations. The +commissioner of health, in a public interview, expresses resentment at +the strictures by the school authorities. Yet in 1907 he permitted to +accumulate an unexpended balance of $33,000 specifically voted for +school inspectors, and repeatedly tried to have this amount +transferred to other purposes. The interest of the Bureau of Municipal +Research in municipal budgets that tell for what purposes money is +voted and then prevent transfers without full publicity, preserved +this particular fund. Moreover, the discussion that prevented its +diversion from physical examinations strengthened the health +department's interest in this important responsibility. Neither +physicians nor nurses have been adequately supervised. Instead of +seeing that defects were removed, the department of health sent out +postal cards like the following:</p> + +<div class="img"> +<a href="images/imagep297.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep297.png" width="60%" alt="Postal Card sent out by Department of Health" /></a><br /> +</div> + +<p>From 118,000 such notices sent out only 9600 replies were received, of +which only one in twenty stated that attention had actually been given +the needy child. The <span class='pagenum'><a name="Page_298" id="Page_298">[298]</a></span>department had been satisfied with evidence that +family physicians had advised parents properly, as in the case of the +child above reported:</p> + +<div class="img"> +<a href="images/imagep298.png"> +<img border="0" style="border: 1px black solid;" src="images/imagep298.png" width="60%" alt="Postal Card sent out by Department of Health" /></a><br /> +</div> + +<p>For a candid, complete criticism of the medical examination work up to +June, 1908, consult the report of the Bureau of Municipal Research, +presented to the Washington Congress of Public Education Associations +in October, 1908, by Commissioner of Health, Dr. Darlington. The +bureau's study is entitled <i>A Bureau of Child Hygiene</i>, and, in +addition to the story of medical examination in New York City schools, +gives the blank forms adopted for use in September, 1908. Important as +are the facts given in this study, its greatest value, its authors +declare, is in its account of "the method of intelligent +self-criticism and experiment which alone enables a public department +to keep its service abreast of public needs."</p> + +<p>The Bureau of Municipal Research made its study for the purpose of +learning whether the disappointing results emphasized by the school +authorities were due to "dual responsibility in the school—that of +the board of education and that of the department of health"—and to +"lack of power or inclination to compel parents to remedy defects," +<span class='pagenum'><a name="Page_299" id="Page_299">[299]</a></span>or to <i>deficient administration</i> of power and inclination by health +officials. Coöperating with school physicians and nurses in three +schools, 1442 children were examined, of whom 1345, or 93.2 per cent, +had 3458 defects that needed treatment. The postal-card notice was +followed by an interview with the parent either at school or at home. +Only 4.2 per cent of the total number of parents refused to act, 81 +per cent secured or permitted treatment for one or more defects, while +15 per cent promised to take the proper steps at the earliest possible +date. Three fourths of the parents acted after one personal interview. +"The net average result of a day's work by a nurse was the actual +treatment of over five children, three of them completely, and two of +them for one or more defects,"—sixty cents per child!</p> + +<div class="imgr" style="width: 40%;"> +<a href="images/imagep299.jpg"> +<img border="0" src="images/imagep299.jpg" width="90%" alt="A Photograph Of Mouth Breathing May Make Compulsion Unnecessary" /></a><br /> +<p class="cen" style="margin-top: .2em;">A PHOTOGRAPH OF MOUTH BREATHING MAY MAKE COMPULSION UNNECESSARY</p> +</div> + +<p>Having established the willingness—even eagerness—of parents to do +all in their power to remove defects that handicapped their children, +it was obviously the duty of the health department so to organize its +work that it could insure the education of parents. The new Bureau of +Child Hygiene gives foremost place to instruction of parents in care +of babies, in needs of school children, and in the importance of +physical examination when enlisting in the industrial army. Whether +this work is well done is learned by result tests applied at +headquarters, where work done <span class='pagenum'><a name="Page_300" id="Page_300">[300]</a></span>and results are reported daily and +summarized weekly. No longer will it be possible, without detection, +for one physician to find only eye trouble and to neglect all other +defects; for two inspectors examining different children in the same +school to report results differing by 100 per cent; for physicians in +different schools to find one 18 per cent, another 100 per cent with +defects; for two inspectors examining identical children to agree on +51 out of 101 cases of vision, on 49 out of 96 cases of adenoids, or 3 +out of 10 cases of skin disease.</p> + +<p>So conclusive were the results of follow-up work efficiently +supervised by the department of health, that school officials are, for +the present, inclined to waive the demand for the transfer of +physicians and nurses to the board of education, and to substitute +education for compulsion with parents who obstinately refuse to take +proper remedial measures for their children when reported defective.</p> + +<p>This present plan requires the entire working time of inspectors and +nurses for school work. Thus New York has for the present definitely +abandoned the plan of having the district inspection for contagious +diseases done by school physicians. The purpose of the change is not +to reduce danger of infection, which was negligible, but to increase +the probability of scientific attention to school children.</p> + +<p>Before a final settlement is made for New York City there should be +tests showing what the school authorities would do if physicians and +nurses were subordinate to them. It is conceivable that one physician +working from nine to five would accomplish more than six physicians +working the alleged three hours a day. So imperative are the demands +of school hygiene that it seems probable that in New York and in other +large cities school physicians, whether paid by the board of health or +the board of education, must be expected to be at the service of +school children, subject to the call of school officers, during as +many <span class='pagenum'><a name="Page_301" id="Page_301">[301]</a></span>hours of the day as teachers themselves must give. It is even +conceivable that effective use of the knowledge gained by physical +examinations of school children, and by those responsible for school +hygiene, will require evening office hours or evening visits to homes, +and regular Saturday office hours and Saturday visits by school +physicians and nurses. Finally, it must be expected that the programme +for school hygiene will need the special attention of physicians and +nurses during the summer months, and other vacation periods when +children and parents alike have time to receive and to carry out their +instructions.</p> + +<p>One danger in New York City is that the board of education, like the +board of health, when compelled to choose between so-called standard, +necessary, traditional duty and school hygiene, will sacrifice the +latter. The school authorities, without any more funds and without +physicians and nurses, could already have made, had they desired, eye +tests and breathing tests sufficiently accurate to detect the majority +of children needing attention. The outcome of the discussion as to the +jurisdiction of the two boards will undoubtedly be to interest both in +their joint responsibility for children's welfare, and to increase the +attention given by both to the physical condition of the child when he +presents himself for registration as a wage earner.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXIX" id="CHAPTER_XXIX"></a><hr /> +<span class='pagenum'><a name="Page_302" id="Page_302">[302]</a></span><br /> + +<h3>CHAPTER XXIX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>OFFICIAL MACHINERY FOR ENFORCING HEALTH RIGHTS</h4> +<br /> + +<p>The argument for <i>getting things done</i> presumes adequate active +machinery, official and private, for <i>doing things</i> that schools are +being urged to do. The chapter on Departments of School Hygiene +suggests local, county, state, and national machinery necessary (1) to +protect the child from injuries due to school environment, school +methods, and school curriculum; (2) to getting those things done for +the child at home and on the street, need for which is disclosed by +physical and vitality tests at school. It is unreasonable to confine +the school to the activities above outlined unless health machinery, +adequate to the demands placed upon it by school and other community +needs, is devised and kept in order.</p> + +<p>Generally speaking, adequate health machinery is already provided for +by city charters and by the state laws under which villages, +townships, and counties are organized. Quite as generally, however, +machinery and methods of adequate administration are undeveloped. How +much machinery has already been set to work by New York City is shown +by the accompanying chart. A useful exercise for individuals or school +classes wishing to study health administration would be to chart in +this way the machinery actually at work in their locality, county, and +state. Even for New York it should be remembered that this chart does +not include national quarantine, the state protection of the port, the +state dairy and health commissions, or the state and national food +inspection. <span class='pagenum'><a name="Page_303" id="Page_303">[303]</a></span>To get an idea of the vast amount of attention given +to health in New York City there should be added to this chart the +work of many departments other than the department of health. The +building bureau, tenement-house department, board of water supply, +sewage commission, street cleaning, public baths and comfort stations, +the department of water, gas, and electricity, and finally the +department of hygiene and physical training in the public schools.</p> + +<div class="img"> +<a href="images/imagep302.jpg"> +<img border="0" style="border: 1px black solid;" src="images/imagep302_th.jpg" width="90%" alt="Chart Showing how New York City's Department of Health Exercises it's Authority" /></a><br /> +<p class="cen" style="margin-top: .2em;">CHART SHOWING HOW NEW YORK CITY'S DEPARTMENT OF HEALTH EXERCISES IT'S AUTHORITY<br /> +Courtesy of Bureau of Municipal Research</p> +</div> + +<br /> + +<p>Five elements of adequate machinery are generally lost sight of:</p> + +<div class="block"><p>1. The voter.</p> + +<p>2. The nonvoter, subject to health laws and often apt to violate +them.</p> + +<p>3. The mayor, governor, or president who appoints health officers.</p> + +<p>4. The council, board of aldermen, legislature, or congress that +enacts health laws.</p> + +<p>5. The police courts and the judiciary—police, circuit and +supreme—that decide whether society has suffered from violation +of law and what penalties should be inflicted for such violation.</p></div> + +<p>Legislative bodies have hitherto slighted their responsibilities +toward public health. The chairman of a committee on public health of +a state legislature was heard to remark, "I asked for that committee +because there isn't a blooming thing to do." If voters, nonvoters, and +health officials will follow the suggestion of this book to secure +school and health reports that will disclose community and health +needs, it will be increasingly difficult for legislators to refuse +funds necessary to efficient health administration.</p> + +<p>To the courts tradition has required such deference that one hesitates +to find out in how far they have been responsible in the past for the +nonenforcement of health laws. Yet nothing is more obstructive of +sanitary progress than the failure of magistrates to enforce adequate +<span class='pagenum'><a name="Page_304" id="Page_304">[304]</a></span>penalties for truancy, adulteration of milk, maintaining a public +nuisance, defiling the air with black smoke, offering putrid meats for +sale, running an unclean lodging house, defying tenement-house or +factory regulations, working children under age and overtime, spitting +in public places, or failing to register transmissible diseases.<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a></p> + +<p>The appointing officer cannot, of course, be held responsible unless +voters and nonvoters know in how far his appointees are inefficient, +and in how far he himself has failed to do his utmost to secure funds +necessary to efficiency. Too frequently appointments to health +positions have been made on political grounds, and catastrophes have +been met by blundering incapacity. The political appointee has been +made the scapegoat, and the appointing officer, whether mayor, +governor, or president, has regained public confidence by replacing an +old with a new incompetent.</p> + +<p>In order to have health machinery work properly, the appointing +officer should not be allowed to shift responsibility for failure to +his subordinates. For example, it was recently found in New York City +that while the tenement-house commissioner was being condemned for +failing to enforce the law, he had turned over to the corporation +counsel, also appointed by the mayor, for prosecution ten thousand +"violations" to which no attention whatever had been paid!</p> + +<p>The voter, nonvoter, appointing officer, legislative officer, and +judicial officer determine the character and purpose of machinery and +are analogous to the surveyors, stock-holders, directors, and +constructors who provide railroads with tracks and with running stock. +The actual running force of health department or railroad is what is +meant by its official machinery. What this machinery should be +depends, of course, upon the amount of business to be <span class='pagenum'><a name="Page_305" id="Page_305">[305]</a></span>done, and +differs with the size of the district and the character of population +to be served.</p> + +<div class="img"> +<a href="images/imagep305.jpg"> +<img border="0" src="images/imagep305.jpg" width="80%" alt="For Push-Cart Food, Inspection is Particularly Needful" /></a><br /> +<p class="cen" style="margin-top: .2em;">FOR PUSH-CART FOOD, INSPECTION IS PARTICULARLY NEEDFUL</p> +</div> + +<p>Local health machinery should guarantee protection against the evils +mentioned in preceding chapters. In general, one man is better than +three to execute, although three may be better than one to legislate. +Where small communities do not wish to have the entire state sanitary +code rigidly administered, they can adopt New York's method of a +legislative board of three members, headed by an executive, whose +business it is to act, not talk; to watch subordinates, and to enforce +rigidly and continuously ordinances passed by the board. The National +Bureau of Census places under the general heading Health and +Sanitation the following activities: health administration, street +cleaning and refuse disposal, sewers and sewage disposal. Sanitarians +generally emphasize also the health significance of efficient water +service.</p> + +<p><span class='pagenum'><a name="Page_306" id="Page_306">[306]</a></span>A community's health programme should be clearly outlined in the +annual budget. Where health work is given funds without specification +of the kinds of work to be done, serious evils may be overlooked and +lesser evils permitted to monopolize the energies of health officers. +Again, after money has been voted to prevent an evil, records should +be made of work done when done, and of money spent when spent, so that +any diversion will be promptly made known. The best present guides to +budget making, to educational health reports, and to records that show +efficiency or inefficiency of health administrators are the budget and +report of the department of health for New York City, and the story of +their evolution told in <i>Making a Municipal Budget</i>, by the Bureau of +Municipal Research.</p> + +<p>To find out whether local machinery is adequate, the reader must +enumerate the things that need to be done in his community, +remembering that in all parts of the United States to-day there are +sanitary laws offering protection against dangers to health, excepting +some dangers not understood until recently, such as child labor, +dangerous trades, lack of safety devices. Adequate local protection, +however, will not become permanent until adequate state machinery is +secured.</p> + +<p>State health machinery should be of two kinds,—fact-gathering and +executive supervision through inspection. The greatest service of +state boards of health is to educate localities as to their own needs, +using the experience of all communities to teach each community in how +far its health administration menaces itself and its neighbors. In +addition to registration of contagious diseases, facts as to deaths +and births should be registered. State health boards should "score" +communities as dairies and milk shops are now being scored by the +National Bureau of Animal Industries and several boards of health. +When communities persist in maintaining a public nuisance and <span class='pagenum'><a name="Page_307" id="Page_307">[307]</a></span>in +failing to enforce health laws, state health machinery should be made +to accomplish by force what it has failed to accomplish by education.</p> + +<div class="img"> +<a href="images/imagep307.jpg"> +<img border="0" src="images/imagep307.jpg" width="80%" alt="National Machinery Has Stimulated Local Milk Inspection And State Dairy Inspection" /></a><br /> +<p class="cen" style="margin-top: .2em;">NATIONAL MACHINERY HAS STIMULATED LOCAL MILK INSPECTION AND STATE DAIRY INSPECTION</p> +</div> + +<p>States alone can cope adequately with dangers to milk and water +sources and to food. The economic motive of farmers has developed +strong veterinary boards for the protection of cattle. Similar +executive precaution must soon be taken by cities for the protection +of babies and adults of the human species. It is far more economical +to insure clean dairies, clean water sources, and wholesome +manufactured foods by state inspectors than by local inspectors. At +present the task of obtaining clean milk and clean water falls upon +the few cities enlightened enough and rich enough to finance the +inspection of community foods. Once tested, it would be very easy to +prove that <span class='pagenum'><a name="Page_308" id="Page_308">[308]</a></span>properly supported state health authorities will save many +times the cost of their health work in addition to thousands of lives.</p> + +<p>County or district machinery is little known in America. For that +reason rural sanitary administration is neglected and rural hospitals +are lacking. In the British Isles rural districts are given almost as +careful inspection as are cities. Houses may not be built below a +certain standard of lighting, ventilation, and conveniences. +Outbuildings must be a safe distance from wells. Dairies must be kept +clean. Patients suffering from transmissible diseases may be removed +by force to hospitals. What is more to the point, rural hospitals have +proved that patients cared for by them are far more apt to recover +than patients cared for much more expensively and less satisfactorily +at home, while less likely to pollute water and milk sources or +otherwise to endanger health.</p> + +<p>With national machinery the chapter on Vital Statistics has already +dealt. We shall undoubtedly soon have a national board of health. Like +the state boards, its first function should be educative. In addition, +however, there are certain administrative functions where inefficiency +may result in serious losses to nation, state, and locality. National +quarantine, national inspection of meats, foods, and drugs are +administrative functions of vital consequence to every citizen. +Authorities are acquainted at the present time with the fact that the +sanitary administration of the army and navy is unnecessarily and +without excuse wasteful of human energy and human life. In the Spanish +American War 14 soldiers died of disease for 1 killed in battle; in +the Civil War 2 died of disease to 1 killed in battle; during the wars +of the last 200 years 4 have died of disease for 1 killed in battle. +Yet Japan in her war with Russia, by using means known to the United +States Army in 1860, gave health precedence over <span class='pagenum'><a name="Page_309" id="Page_309">[309]</a></span>everything else and +lost but 1 man to disease for 4 killed in battle. Diseases are still +permitted to make havoc with American commerce because the national +government does not apply to its own limits the standards which it has +successfully applied to Cuba and Panama.</p> + +<p>"The Japanese invented nothing and had no peculiar knowledge or skill; +they merely took occidental science and used it. The remarkable thing +is not what they did, but that they were allowed to do it. It is a +terrible thing that Congress should choose to make one of its rare +displays of economy in a matter where a few thousand dollars saved +means, in case our army should have anything to do, not only the +utterly needless and useless loss of thousands of lives, but an +enormous decrease of military efficiency, and might, conceivably, make +all the difference between victory and defeat."</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> The technic and principles of municipal engineering have +been treated in detail in <i>Principles of Sanitary Science and the +Public Health</i>, by William T. Sedgwick, and in <i>Municipal Sanitation +in the United States</i>, by Charles N. Chapin, M.D.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXX" id="CHAPTER_XXX"></a><hr /> +<span class='pagenum'><a name="Page_310" id="Page_310">[310]</a></span><br /> + +<h3>CHAPTER XXX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>SCHOOL AND HEALTH REPORTS</h4> +<br /> + +<p>For every school-teacher or school physician responsible for the +welfare of children at school, there are fifty or more parents +responsible for the physical welfare of children at home. Therefore it +is all important for parents to know how to read the index for their +own children, for their children's associates, and for their +community. School reports and health reports should tell clearly and +completely the story of the school child's physical needs.</p> + +<div class="img"> +<a href="images/imagep310.png"> +<img border="0" src="images/imagep310.png" width="65%" alt="Necessary To Efficient Democracy" /></a><br /> +<p class="cen" style="margin-top: .2em;">NECESSARY TO EFFICIENT DEMOCRACY</p> +</div> + +<p>It is impracticable at the present time to expect a large number of +men and women to be interested in the reports published by school and +health boards, for, with few exceptions, little effort is made to +write these reports so that they will interest the parent. +Fortunately, a small number of persons wishing to be intelligent can +compel public officials to ascertain the necessary facts and to give +them to the public. So backward is the reporting of public business +<span class='pagenum'><a name="Page_311" id="Page_311">[311]</a></span>that at the present time there is probably no service that a citizen +can render his community which would prove of greater importance than +to secure proper publicity from health and school boards.</p> + +<p>Generally speaking, these published reports fail to interest the +citizen, not because officials wish to conceal, but because officials +do not believe that the public is interested. A mayor of Philadelphia +once furnished a notable exception. He called at the department of +health and complained against publishing the number of cases of +typhoid and smallpox lest stories in the newspapers "frighten the city +and injure business." A sanitary inspector who was in the room asked +if Philadelphia's business was more important than the health of +Philadelphia's citizens. As a result of her "impertinence" the +inspector was removed. That same year an epidemic of smallpox spread +through all the rural districts and cities of Pennsylvania, because +physicians thought it would be kinder to the patients not to make +known to their neighbors the presence of so disagreeable a disease. +Almost all health and school authorities, however, can be made to see +the advantage of taking the public into their confidence, because +public confidence means both public recognition and greater success in +obtaining funds. With more funds comes the power to do more work.</p> + +<p>Other details with regard to health reports will be found in the +chapter on Vital Statistics. As to school reports, little thought has +been given in the past to their educational possibilities. A book was +recently published—<i>School Reports and School Efficiency</i>—by the +Committee on the Physical Welfare of School Children, which tells the +origins of school reports; contains samples of reports from one +hundred cities; gives lists of questions frequently answered, +occasionally answered, and never answered; and shows how to study a +particular report so as to learn whether or not important questions +are answered. The United States commissioner <span class='pagenum'><a name="Page_312" id="Page_312">[312]</a></span>of education has +organized among state and city superintendents special committees on +uniform and adequate reporting. His aggressive leadership is welcomed +by school men generally, and promises vast benefits.</p> + +<p>Just because the physical welfare of the school child is an index to +health needs, the school report can put into one statement for a city +or a state the story told by the index. The accompanying card tells +facts that the individual teacher and individual parent want to know +about a child, what a superintendent wants to know about all children, +and what a community wants to know about all children. A modification +of this card will soon be adopted in New York City. It is both a card +index and a card biography of the individual boy or girl. It is +expected to follow the child from class to class, each teacher telling +the story of his physical welfare and his progress. When the boy goes +to a new school or new grade, his new teacher can see at a glance not +only what subjects have given him trouble, but what diseases or +physical defects have kept him out of school or otherwise retarded his +progress. With this card it is easy to take a hundred children of the +same age and the same grade, to put down in one column those who have +eye defects, and in another those who have no eye defects, for every +school, every district, and for the schools as a whole. Schools that +use these record cards are enabled, by thus classifying the total, to +learn where the defects of children are, how serious the problem is, +how many days children lose from school because of preventable +defects, and in what section of the city the defects are most +prevalent.</p> + +<p>The mere reporting of facts will stimulate teachers, principals, and +parents to give attention. For example, assume a table:</p> + +<p class="cen sc">Field of Inspection</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="50%" summary="Field of Inspection"> + <tr> + <td width="80%" class="tdl">Total number of public schools</td> + <td width="20%" class="tdr">7</td> + </tr> + <tr> + <td class="tdl">Public schools under inspection</td> + <td class="tdr">3</td> + </tr> + <tr> + <td class="tdl">Public schools not under inspection</td> + <td class="tdr">4</td> + </tr> +</table> +</div> + +<p class="noin">The reader wonders why four schools are neglected and which particular +schools they are. Let the next table read:</p> + +<p class="cen sc">Examination</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="50%" summary="Field of Inspection"> + <tr> + <td width="80%" class="tdl">Total registration in all schools</td> + <td width="20%" class="tdr">1500</td> + </tr> + <tr> + <td class="tdl">Number of children examined</td> + <td class="tdr">500</td> + </tr> + <tr> + <td class="tdl">Number of children not examined</td> + <td class="tdr">1000</td> + </tr> +</table> +</div> + +<p class="noin">Parents begin to wonder whether or not their children were examined, +and why the taxes spent for school examination of all children go to +one third of the children. The next table arrests attention:</p> + +<p class="cen sc">Treatment</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="50%" summary="Field of Inspection"> + <tr> + <td width="80%" class="tdl">Number needing treatment</td> + <td width="20%" class="tdr">200</td> + </tr> + <tr> + <td class="tdl">Number known to have been treated</td> + <td class="tdr">50</td> + </tr> + <tr> + <td class="tdl">Number not known to have been treated</td> + <td class="tdr">150</td> + </tr> +</table> +</div> + +<p class="noin">We ask, at once, if examination is worth while, and if treatment +really corrects the defects, saves the pupil's time and teacher's +time, discovers many defects; and we want to find out whether the one +hundred and fifty reported not treated have since been attended to.</p> + +<div class="img"><span class='pagenum'><a name="Page_313" id="Page_313">[313]</a></span> +<a href="images/imagep313.jpg"> +<img border="0" src="images/imagep313.jpg" width="80%" alt="Pupil's Record" /></a><br /> +</div> + +<div class="img"><span class='pagenum'><a name="Page_314" id="Page_314">[314]</a></span> +<a href="images/imagep314.jpg"> +<img border="0" src="images/imagep314.jpg" width="80%" alt="Department Of Health City of New York Report" /></a><br /> +</div> + +<p><span class='pagenum'><a name="Page_315" id="Page_315">[315]</a></span>Again, if three out of five of those examined need treatment, people +will wonder whether among the thousand not examined there is the same +proportion—three out of five, or six hundred—who have some trouble +that needs attention. Having begun to wonder, they will ask questions, +and will expect the board of health or the school physicians to see +that the questions are answered. As has been proved in New York, +taxpayers and the press will go farther and will demand that the +annual budget provide for making general next year the benefits found +to result last year from a test of health policies.</p> + +<p>The story of the prevalence of contagious diseases in school children +could be told by a table such as is now in use by New York's +department of health:</p> + +<br /> + +<p class="cen sc">Table XII<span class='pagenum'><a name="Page_316" id="Page_316">[316]</a></span></p> + +<p class="cen sc">Prevalence of Contagious Diseases in School Children</p> + +<p class="cen">(Case rate schools)</p> + + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="90%" summary="Prevalence of Contagious Diseases in School Children"> + <tr> + <td rowspan="4" class="tdctrb sc" style="border-left: 2px black solid;">School</td> + <td colspan="5" class="tdctrlb sc">General Communicable Diseases <span class="fnanchor">1</span></td> + <td colspan="5" class="tdctrlb sc" style="border-right: 2px black solid;">Communicable Diseases of Eye and Skin<span class="fnanchor">2</span></td> + </tr> + <tr> + <td colspan="4" class="tdcsc" style="border: 1px black solid;">Number</td> + <td rowspan="3" class="tdc" style="border: 1px black solid;">Number per 1000 Registered in Schools Inspected</td> + <td rowspan="3" class="tdc" style="border: 1px black solid;">Number found by Inspectors and Nurses</td> + <td rowspan="3" class="tdc" style="border: 1px black solid; border-right: 2px black solid">Number per 1000 Registered in Schools Inspected</td> + </tr> + <tr> + <td class="tdc" colspan="2" style="border: 1px black solid;">Found by Inspectors</td> + <td class="tdc" rowspan="2" style="border: 1px black solid;">Reported by Attending Physician</td> + <td class="tdc" rowspan="2" style="border: 1px black solid;">Total</td> + </tr> + <tr> + <td class="tdl" style="border: 1px black solid;">In School</td> + <td class="tdl" style="border: 1px black solid;">Among Absentee</td> + </tr> + <tr> + <td width="16%" class="tdcrlt" style="border-left: 2px black solid;">A</td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt"> </td> + <td width="12%" class="tdcrlt" style="border-right: 2px black solid;"> </td> + </tr> + <tr> + <td class="tdcrl" style="border-left: 2px black solid;">B</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl" style="border-right: 2px black solid;"> </td> + </tr> + <tr> + <td class="tdcrl" style="border-left: 2px black solid; border-bottom: 2px black solid; padding-bottom: .5em;">C</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-right: 2px black solid; border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + </tr> + <tr> + <td colspan="8" class="tdl"><span class="fnanchor">1 </span> Smallpox, diphtheria, scarlet fever, measles, chicken pox, mumps, + and whooping cough; excluded when found.</td> + </tr> + <tr> + <td colspan="8" class="tdl"><span class="fnanchor">2 </span> Trachoma and other contagious eye diseases, ringworm, impetigo, + scabies, favus, and pediculosis; excluded only for persistent + nontreatment.</td> + </tr> +</table> +</div> + +<br /> + +<p>Another table shows the following facts for each disease:</p> + +<br /> + +<p class="cen sc">Table XIII</p> + +<p class="cen sc">Contagious Diseases Found in Schools by Inspectors and Nurses</p> + +<p class="cen">(Number and disposition of cases)</p> + +<div class="centered"> +<table border="0" cellpadding="1" cellspacing="0" width="100%" summary="Contagious Diseases Found in Schools by Inspectors and Nurses"> + <tr> + <td width="36%" class="tdctrb sc" rowspan="2" style="border-bottom: 1px black solid;"> </td> + <td class="tdctlb sc" colspan="8">General Communicable Diseases</td> + </tr> + <tr style="font-size: 90%;"> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Diphtheria</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Scarlet fever</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Measles</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Smallpox</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Chicken pox</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Whooping cough</td> + <td width="8%" class="tdc" style="border: 1px black solid; vertical-align: bottom;">Mumps</td> + <td width="8%" class="tdctlb" style="vertical-align: bottom; border-top: 1px black solid; padding-bottom: 0em;">Total</td> + </tr> + <tr> + <td class="tdlr" style="border-top: 1px black solid; padding-top: .5em;">Cases found in school</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdlr">Cases excluded from school</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Cases treated in school</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Cases instructed in school or evidence of treatment furnished</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Number of treatments</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr" style="padding-bottom: .5em;">Number of instructions</td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcrl" style="padding-bottom: .5em;"> </td> + <td class="tdcl" style="padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + + +<div class="centered"> +<table border="0" cellpadding="1" cellspacing="0" width="100%" summary="Contagious Diseases Found in Schools by Inspectors and Nurses, Part 2"> + <tr> + <td width="36%" class="tdctrb sc" rowspan="3" style="border-bottom: 1px black solid;"> </td> + <td class="tdctlb sc" colspan="9">Communicable Diseases of Eye and Skin</td> + </tr> + <tr> + <td class="tdctrlb sc" colspan="2" style="border-top: 1px black solid;">Eye</td> + <td class="tdctlb sc" colspan="7" style="border-top: 1px black solid;">Skin</td> + </tr> + <tr style="font-size: 90%;"> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Trachoma</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Other</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Ringworm</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Impetigo</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Scabies</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Favus</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Pediculosis</td> + <td class="tdc" style="border: 1px black solid; vertical-align: bottom;">Misc.</td> + <td class="tdctlb" style="vertical-align: bottom; border-top: 1px black solid; padding-bottom: 0em;">Total</td> + </tr> + <tr> + <td class="tdlr" style="border-top: 1px black solid; padding-top: .5em;">Cases found in school</td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="7%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="8%" class="tdcl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdlr">Cases excluded from school</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Cases treated in school</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Cases instructed in school or evidence of treatment furnished</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Number of treatments</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr" style="border-bottom: 2px black solid; padding-bottom: .5em;">Number of instructions</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + +<br /> + +<p><span class='pagenum'><a name="Page_317" id="Page_317">[317]</a></span>The story of noncontagious physical defects found and treated is set +forth in the following table:</p> + +<br /> + +<p class="cen sc">Table XIV</p> + +<p class="cen sc">Medical Examination of School Children: Noncontagious Physical +Defects Found and Treated, 1906</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="100%" summary="Noncontagious Physical Defects Found and Treated, 1906"> + <tr> + <td class="tdctrb sc" rowspan="3">Defects</td> + <td class="tdctrlb sc" colspan="4">School A</td> + <td class="tdctrlb sc" colspan="4">School B</td> + <td class="tdctlb sc" colspan="4">School C</td> + </tr> + <tr> + <td class="tdc" colspan="2" style="border: 1px black solid;">Found</td> + <td class="tdc" colspan="2" style="border: 1px black solid;">Reported Treated</td> + <td class="tdc" colspan="2" style="border: 1px black solid;">Found</td> + <td class="tdc" colspan="2" style="border: 1px black solid;">Reported Treated</td> + <td class="tdc" colspan="2" style="border: 1px black solid;">Found</td> + <td class="tdc" colspan="2" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">Reported Treated</td> + </tr> + <tr style="font-size: 75%;"> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border: 1px black solid;">% of Total Defects Found</td> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border: 1px black solid;">% of Total Defects Found</td> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border: 1px black solid;">% of Total Defects Found</td> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border: 1px black solid;">% of Total Defects Found</td> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border: 1px black solid;">% of Total Defects Found</td> + <td class="tdc" style="border: 1px black solid;">No.</td> + <td class="tdc" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">% of Total Defects Found</td> + </tr> + <tr> + <td class="tdlr" width="22%" style="padding-top: .5em; border-top: 1px black solid;">Adenoids</td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcrl" width="3%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + <td class="tdcl" width="10%" style="padding-top: .5em; border-top: 1px black solid;"> </td> + </tr> + <tr> + <td class="tdlr">Nasal breathing</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Hyper-trophied tonsils</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Defective palate</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Defective hearing</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Defective vision</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Defective teeth</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Bad nutrition</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Diseased anterior cervical glands</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Diseased posterior cervical glands</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Heart disease</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Chorea</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Pulmonary disease</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Skin disease</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Deformity of spine</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Deformity of chest</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Deformity of extremities</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Defective mentality </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr" style="padding-bottom: .5em; border-bottom: 2px black solid;">Total</td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcrl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + <td class="tdcl" style="padding-bottom: .5em; border-bottom: 2px black solid;"> </td> + </tr> +</table> +</div> + +<br /> + +<p>The effect of a report telling what schools have enough seats, proper +ventilation, adequate medical inspection, safe drinking water, ample +play space, and what schools are without these necessities is to cause +the reader to rank the <span class='pagenum'><a name="Page_318" id="Page_318">[318]</a></span>particular school that he happens to know; +i.e. he says, "School A is better equipped than School B; or, School C +is neglected." County and state superintendents in many states have +acquired the habit of ranking schools according to the number of +children who pass in arithmetic, algebra, etc. It would greatly +further the cause of public health and, at the same time, advance the +interest of education if state superintendents would rank individual +schools, and if county superintendents would rank individual schools, +<i>according to the number of children found to have physical defects, +the number afflicted with contagious diseases, and the number properly +treated</i>.</p> + +<p>It is difficult to compare one school with another, because it is +necessary to make subtractions and divisions and to reduce to +percentages. It would not be so serious for a school of a thousand +pupils as for a school of two hundred, to report 100 for adenoids. To +make it possible to compare school with school without judging either +unfairly, the state superintendent of schools for Connecticut has made +tables in which cities are ranked according to the number of pupils, +average attendance, per capita cost, etc. As to each of these +headings, cities are grouped in a manner corresponding to the line up +of a battalion, "according to height." A general table is then shown, +which gives the ranking of each city with respect to each important +item. Applied to schools, this would work out as follows:</p> + +<br /> + +<p class="cen sc">Table XV</p> + +<p class="cen sc">Table of Ranking-Schools Arranged Alphabetically</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="Table of Ranking-Schools Arranged Alphabetically"> + <tr> + <td width="20%" class="tdctrb sc" rowspan="2">School</td> + <td class="tdctlb sc" colspan="5">Rank in</td> + </tr> + <tr> + <td width="16%" class="tdc" style="border: 1px black solid;">Register</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Defects Found</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Children Needing Treatment</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Children Treated</td> + <td width="16%" class="tdc" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">Children not Treated</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid; border-top: 1px black solid; padding-top: .5em;">A</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">10</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">11</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">11</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">12</td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .5em;"> 6</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid;">B</td> + <td class="tdcrl">20</td> + <td class="tdcrl">22</td> + <td class="tdcrl">22</td> + <td class="tdcrl">24</td> + <td class="tdcl">12</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid; border-bottom: 2px black solid; padding-bottom: .5em;">C</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">30</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">33</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">30</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">36</td> + <td class="tdcl" style="border-bottom: 2px black solid; padding-bottom: .5em;">18</td> + </tr> +</table> +</div> + +<br /> + +<p><span class='pagenum'><a name="Page_319" id="Page_319">[319]</a></span>Such a table fails to convey its significance unless the reader is +reminded that rank 18 in children not treated is as good a record for +a school that ranks 30 in register as is rank 6 for a school that +ranks 10 in register.</p> + +<p>The Connecticut report makes a serious mistake in failing to arrange +schools according to population. If this were done, schools of a size +would be side by side and comparison would be fair. When, as in the +above table, schools are arranged alphabetically, a school with four +thousand pupils may follow or precede a school with four hundred +pupils, and comparison will be unfair and futile.</p> + +<p>Where, on the other hand, schools are arranged in order of register, a +table will show whether schools confronted with practically the same +problems, the same number of defects, the same number of children +needing treatment, are equally successful, or perhaps equally +inactive, in correcting these defects. The following table brings out +clearly marked unequal achievement in the face of relatively equal +need.</p> + +<br /> + +<p class="cen sc">Table XVI</p> + +<p class="cen sc">Table of Ranking-Schools Arranged according to Register, not Alphabetically</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="Table of Ranking-Schools Arranged according to Register, not Alphabetically"> + <tr> + <td width="20%" class="tdctrb sc" rowspan="2">School</td> + <td class="tdctlb sc" colspan="5">Rank in</td> + </tr> + <tr> + <td width="16%" class="tdc" style="border: 1px black solid;">Register</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Defects Found</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Children Needing Treatment</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Children Treated</td> + <td width="16%" class="tdc" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">Children not Treated</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid; border-top: 1px black solid; padding-top: .5em;">A</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 9</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 9</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 9</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 9</td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .5em;">9</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid;">X</td> + <td class="tdcrl">10</td> + <td class="tdcrl">10</td> + <td class="tdcrl">10</td> + <td class="tdcrl">14</td> + <td class="tdcl">6</td> + </tr> + <tr> + <td class="tdc" style="border-right: 1px black solid; border-bottom: 2px black solid; padding-bottom: .5em;">H</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">11</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">11</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">11</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;">17</td> + <td class="tdcl" style="border-bottom: 2px black solid; padding-bottom: .5em;">3</td> + </tr> +</table> +</div> + +<br /> + +<p>If the number of schools in a state is so large that it is unlikely +that people will read the table of ranking because of the difficulty +of finding their own school, an alphabetical table might be given that +would show where to look in the general ranking table for the school +or schools in which the reader is interested.</p> + +<p><span class='pagenum'><a name="Page_320" id="Page_320">[320]</a></span>Experience will demonstrate to public school superintendents the +strategic advantage of putting together all the things they need and +of telling the community over and over again just what needs there +are, what penalties are paid for want of them, and what benefits would +result from obtaining them. If health needs of school children were +placed side by side with mental results, the relation would come out +so clearly that parents, school boards, and taxpayers would realize +how inextricably they are bound together and would see that health +needs are satisfied. To this end superintendents should require +teachers to keep daily reports of school conditions.</p> + +<br /> + +<p class="cen sc">Table XVII</p> + +<p class="cen sc">Weekly Class-Room Schedule</p> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="Weekly Class-Room Schedule"> + <tr> + <td class="tdctrb" rowspan="2"> </td> + <td class="tdctlb sc" colspan="3">Temperature</td> + <td class="tdctlb sc" colspan="3">Cleaning</td> + <td class="tdctlb sc" colspan="2">Exercise</td> + </tr> + <tr> + <td class="tdc" style="border: 1px black solid;">10.30</td> + <td class="tdc" style="border: 1px black solid;">12.00</td> + <td class="tdc" style="border: 1px black solid;">2.00</td> + <td class="tdc" style="border: 1px black solid;">Dry</td> + <td class="tdc" style="border: 1px black solid;">Wet</td> + <td class="tdc" style="border: 1px black solid;">Disinfecting</td> + <td class="tdc" style="border: 1px black solid;">In Room</td> + <td class="tdc" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">Out of Room</td> + </tr> + <tr> + <td width="19%" class="tdlr" style="border-top: 1px black solid; padding-top: .5em;">Monday</td> + <td width="8%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="8%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="8%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="10%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="10%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="11%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="13%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + <td width="13%" class="tdcl" style="border-top: 1px black solid; padding-top: .5em;"> </td> + </tr> + <tr> + <td class="tdlr">Tuesday</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Wednesday</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr">Thursday</td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcrl"> </td> + <td class="tdcl"> </td> + </tr> + <tr> + <td class="tdlr" style="border-bottom: 2px black solid; padding-bottom: .5em;">Friday</td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcrl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + <td class="tdcl" style="border-bottom: 2px black solid; padding-bottom: .5em;"> </td> + </tr> +</table> +</div> + +<br /> + +<p>The teacher's daily report of the temperature of a schoolroom, taken +three times a day, tells the parent exactly what is the efficiency of +the ventilating and heating apparatus in the particular school in +which he is interested; whereas the report of the department of +buildings gives only the number of schools which have an approved +system of ventilation and steam heat. School authorities may or may +not know that this system of ventilation is out of order, that the +thermometer in the indoor playground of School A stood at forty +degrees for many days in winter. But they must know it when the +principal of School A sends in a daily record; the school board, the +parents, or the press <span class='pagenum'><a name="Page_321" id="Page_321">[321]</a></span>will then see that the condition is remedied. +If the condition is due to lack of funds, funds will never be +forthcoming so long as the condition is concealed.</p> + +<p>Similar results will follow publicity of overcrowding, too little play +space, dry cleaning of school buildings, etc. The intent of such +reporting is not to "keep tabs" on the school-teacher, the school +child, the janitor, the principal, superintendent, or board, but to +insure favorable conditions and to correct bad conditions. This is +done best by giving everybody the facts. The objective test of the +efficiency of a method throws emphasis on the method, not on the +motive of those operating it. The blackboard method of publishing +facts concentrates attention upon the importance of those facts and +enlists aid in the attainment of the end sought.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXI" id="CHAPTER_XXXI"></a><hr /> +<span class='pagenum'><a name="Page_322" id="Page_322">[322]</a></span><br /> + +<h3>CHAPTER XXXI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE PRESS</h4> +<br /> + +<p>The president of Princeton University declares that for several +decades we have given education that does not instruct and instruction +that does not educate. Others tell us that because we read daily +papers and magazines our minds become superficial, that our power to +concentrate or memorize is weakened,—that we read so much of +everything that we learn little of anything. As the habit of reading +magazines and newspapers is constantly increasing, I think we must +assume that it has come to stay. If we cannot check it, we can at +least turn it to good advantage, systematize it, and discipline +ourselves.</p> + +<p>Among the subjects continually described in newspapers and magazines, +and even on billboards and in street-car advertising, is the subject +of hygiene. No greater service can be rendered the community than for +those who are conducting discussions of health to teach people how to +read correctly this mass of information regarding health, to separate +misinformation from information, and to apply the lessons learned to +personal and public hygiene. There is no better way of doing this than +to teach a class or a child to clip out of magazines and newspapers +all important references to health, and then to classify these under +the subject-matter treated. A teacher, parent, or club leader might +practice by using the classification of subjects outlined in the +Contents of this book. It is surprising how rapidly one builds up a +valuable collection serviceable for talks or papers, but more +particularly for giving one a vital and intelligent interest in +practical health topics.</p> + +<p><span class='pagenum'><a name="Page_323" id="Page_323">[323]</a></span>Interested in comparing the emphasis placed on health topics in a +three-cent paper having a small circulation with a penny paper having +twenty times the circulation, I made during one week thirty-eight +clippings from the three-cent paper and ninety-five from the penny +paper. The high-priced paper had no editorial comment within the field +of health, whereas the penny paper had three columns, in which were +discussed among other things: <i>The Economics of Bad Teeth</i>; <i>Need for +Individual Efficiency</i>; <i>"Good Fellows" Lower Standard of Living by +Neglecting their Families</i>. The penny paper advertised fifty-two +foods, garments, whiskies, patent medicines, or beautifiers urged upon +health grounds. In the three-cent paper twenty-six out of thirty-eight +items advertised food, clothing, patent medicine, or whisky. One issue +of a monthly magazine devoted to woman's interests contained +twenty-eight articles and editorials and fifty-five advertisements +that concern health,—thirty-seven per cent of total reading matter +and thirty-seven per cent of total advertisement.</p> + +<p>Excellent discipline is afforded by this clipping work. It is +astonishing how few men and women, even from our better colleges, know +how to organize notes, clippings, or other data, so that they can be +used a few weeks later. There is a satisfaction in seeing one's material +grow, as is remembered by all of us, in making picture scrapbooks or +collections of picture postal cards and stamps. "Collections" have +generally failed for want of classification,—putting things of a kind +together. Chronological arrangement is uninteresting because +unprofitable. One never knows where to find a picture, or a stamp, or a +health clipping. Clippings, like libraries, will be little used if not +properly catalogued so that use is easy. If a health-clipping collection +is attempted, there are four essentials: (1) arrangement by topic; (2) +inclusion of advertisements; (3) inclusion of items from magazines; (4) +cross references.</p> + +<p><span class='pagenum'><a name="Page_324" id="Page_324">[324]</a></span>For classification, envelopes can be used or manila cards 10×12 +inches. The teacher, parent, or advanced student will probably think +the envelope most useful because most easily carried and filed,—most +likely to be used. But clippings should be bound together in orderly +appearance, or else it will be disagreeable working with them. +Children, however, will like the pasting on sheets, which show clearly +the growth of each topic. Envelopes or cards should not have clippings +that deal with only one health topic. Unless a test is made to see how +many health references there are in a given period, it should be made +a rule not to clip any item that does not contain something new,—some +addition to the knowledge already collected.</p> + +<p>Advertisements will prove interesting and educative. When newspapers +and magazines announce some new truth, the commercial motive of +manufacturer or dealer sees profit in telling over and over again how +certain goods will meet the new need. Children will soon notice that +the worst advertisements appear in the papers that talk most of +"popular rights," "justice," and "morality." They will be shocked to +see that the popular papers accept money to tell falsehoods about fake +cures. They will be pleased that the best monthly magazines contain no +such advertisements. They will challenge paper or magazine, and thus +will be enlisted while young in the fight against health +advertisements that injure health.</p> + +<p>To clip articles from magazines will seem almost irreverent at first. +But the reverence for magazines and books is less valuable to +education than the knowledge concealed in them. Except where families +preserve all magazines, clippings will add greatly to their +serviceability.</p> + +<p>The art of cross-referencing is invaluable to the organized mind. The +purpose of classifying one's information is not to show how much there +is, but to answer questions quickly and to guide constructive +thinking. A clipping that deals <span class='pagenum'><a name="Page_325" id="Page_325">[325]</a></span>with <i>alcoholism</i>, <i>patent medicine</i>, +and <i>tuberculosis</i> must be posted in three places, or +cross-referenced; otherwise it will be used to answer but one question +when it might answer three. If magazines may not be cut, it will be +easy to record the fact of a useful article by writing the title, +page, and date on the appropriate index card, or inclosing a slip so +marked in the proper envelope.</p> + +<p>While it is true that the most important bibliography one can have in +his private library is a classification of the material of which he +himself has become a part while reading it, there are a number of +health journals that one can profitably subscribe for. In fact, it is +often true that the significant discoveries in scientific fields, or +the latest public improvements, such as parks, bridges, model +tenements, will not be appreciated until one has read in health +journals how these improvements affect the sickness rate and the +enjoyment rate of those least able to control their living conditions. +The physician and nurse in their educational work for hospitals are +distributors of health propaganda.</p> + +<p>Wherever there is a local journal devoted to health, parents, +teachers, educators, and club leaders would do well to subscribe and +to hold this journal up to a high standard by quoting, thanking, +criticising it. In New Jersey, for example, is a monthly called the +<i>New Jersey Review of Charities and Corrections</i> that deals with every +manner of subject having to do with public health as well as with +private and public morality and education.</p> + +<p>A similar journal, intended for national instruction, is <i>The Survey</i>, +whose topical index for last year enumerates two hundred and +thirty-two articles dealing with subjects directly connected with +public hygiene, e.g.:</p> + +<div class="block"><p>Schools, 6; school inspection, 3; eyes,—school children, 1; sex +instruction in the schools, 2; psychiatric clinic, special +children, 2; industrial education, 5; child labor, 18; +playgrounds, 26; alley, crap, playing in streets, 3; labor +conditions, 18; <span class='pagenum'><a name="Page_326" id="Page_326">[326]</a></span>industrial accidents, 10; wage-earner's +insurance, 4; factory inspection, 1; consumer's league, 3; women's +work, 6; tuberculosis, 23; hospitals, dispensaries (social), 5; +tenement reform, 10; living conditions, 2; baths, 1; public +comfort stations, 2; lodging houses, 1; clean streets, 6; clean +milk, 6; smoke, 1; noises, 1; parks, 1; patent medicines, 2; +sanitary code, 1; mortality statistics, 2; social settlements and +public health, 1; midwives, 1; children's bureau, 1; juvenile and +adult delinquent, 25; dependent, defective, and insane, 7; blind, +5; cripples, 1; homes for aged, 1; inebriates, 3; Traveler's Aid +Committee, 1; infant mortality, 2; social diseases, 2.</p></div> + +<hr style='width: 15%;' /> + +<p><i>The National Hospital Record</i>, the <i>Dietetic and Hygienic Gazette</i>, +the <i>Journal of Nursing</i>, are three other magazines primarily intended +for nurses and physicians, but full of suggestive material for +unprofessional readers. National magazines concerned with health, but +seeking popular circulation, are <i>Good Health</i> and <i>Physical Culture</i>. +In England there is a special magazine called <i>Children's Diseases</i>, +which could be of great help to a school library for special +reference. The same can be said of the <i>Psychological Clinic</i>, +<i>Pediatrics</i>, and other technical journals published in this country. +For many persons, to make the best use of any one copy of these +magazines, clipping is of course impossible, but noting on a card or +envelope is practicable.</p> + +<p>Of late many of the national popular magazines have several columns +devoted to health. We have not appreciated the educational +possibilities of these columns. In most large cities there are monthly +book reviews which may be profitably consulted in learning the new +thought in the health field. If teachers would either write their +experience or ask questions, if children knew that in a certain +magazine or newspaper questions as to ventilation, bathing, exercise, +would be answered, they would take a keen interest in the progress of +discussions. The large daily papers make a great feature of their +health hints. It is not <span class='pagenum'><a name="Page_327" id="Page_327">[327]</a></span>their fault if questioners care more about +cosmetics and hair bleaches than about the fresh-air cure of +headaches. They will coöperate with teachers and parents in securing +more general discussion of other problems than beauty doctoring.</p> + +<p>Finally, persons wanting not only to have intelligence as to matters +promoting health, but actually to exert a helpful influence in their +community, ought to want the published reports of the mayor, health +department, the public schools, and other institutions, noting +carefully all that is said about conditions relating to health and +about efforts made to correct all unfavorable conditions. The best +literature of our day, with regard to social needs, appears in the +reports of our public and private institutions and societies. Of +increasing value are the publications of the national government +printing office. Because it is no one's business to find out what +valuable material is contained in such reports, and because no +educational museum is comparing report with report, those who live +nearest to our health problems and who see most clearly the health +remedies, are not stimulated to give to the public their special +knowledge in an interesting, convincing way.</p> + +<p>Teaching children how to find health lessons in public documents will +advance the cause of public ethics as well as of public health. At the +New York State Conference of Charities, of 1907, one official +complained that the physicians made no educational use of their +valuable experience for public education. He stated that a study of +medical journals and health articles in popular magazines revealed the +fact that the number of papers prepared by physicians in state +hospitals averaged one to a doctor for every five or six years of +service. This state of affairs is even more exaggerated in strictly +educational institutions. Columbia University has recently instituted +a series of lectures to be given by its professors to its professors, +so that they may have a general knowledge of the work being done in +other <span class='pagenum'><a name="Page_328" id="Page_328">[328]</a></span>fields besides their own at their own university. This is +equally important for teachers and heads of departments in elementary +schools. It is now admitted by most educators that elementary schools +and young children present more pedagogical difficulties and pressing +biological problems than higher schools. If teachers and parents would +realize that their method of solving the health problems that arise +daily in the schoolroom and in the home would interest other mothers +and teachers, their spirit of coöperation would soon be reflected in +school journals, popular magazines, and daily newspapers.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="PART_V_ALLIANCE_OF_HYGIENE_PATRIOTISM_AND_RELIGION" id="PART_V_ALLIANCE_OF_HYGIENE_PATRIOTISM_AND_RELIGION"></a><a name="CHAPTER_XXXII" id="CHAPTER_XXXII"></a><hr /> +<span class='pagenum'><a name="Page_329" id="Page_329">[329]</a></span><br /> +<br /> +<br /> +<br /> + +<h2 class="wrap">PART V. ALLIANCE OF HYGIENE, PATRIOTISM, AND RELIGION</h2> + +<br /> + +<h3>CHAPTER XXXII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>DO-NOTHING AILMENTS</h4> +<br /> + +<p>"Men have died, from time to time, and worms have eaten them, but not +for love"—<i>nor for work</i>. Work of itself never killed anybody nor +made anybody sick. Work has caused worry, mental strain, and physical +breakdown, only when men while working have been deprived of air, sun, +light, exercise, sleep, proper food at the proper time, opportunity to +live and work hygienically. Fortunately for human progress, doing +nothing brings ailments of its own and has none of the compensations +of work. As the stomach deprived of substantial food craves unnatural +food,—sweets, stimulants,—so the mind deprived of substantial, +regular diet of wholesome work turns to unwholesome, petty, fantastic, +suspicious, unhappy thoughts. This state of mind, combined with the +lack of bodily exercise that generally accompanies it, reacts +unfavorably on physical health. An editor has aptly termed the +do-nothing condition as a self-inflicted confinement:</p> + +<div class="block"><p>A great deal of the misery and wretchedness among young men that +inherit great fortunes is caused by the fact that they are +practically in jail. They have nothing to do but eat, drink, and +enjoy themselves, and they cannot understand why their lives are +dull.</p> + +<p>We have had the owner of a great railroad system pathetically +telling the public that he is unhappy. That is undoubtedly true, +<span class='pagenum'><a name="Page_330" id="Page_330">[330]</a></span>because with all his race horses, and his yachts, and all the +things that he imagines to be pleasures, he is not really doing +anything.</p> + +<p>If he were running one little railroad station up the road, +handling the freight, fussing about dispatches, living above the +railroad station in two rooms, and buying shoes in a neighboring +village for fifteen children he would be busy and happy.</p> + +<p>But he cannot be happy because he is in prison,—in a prison of +money, a prison that is honorable because it gives him everything +that he wants, and he wants nothing.</p></div> + +<p>A New York newspaper that circulates among the working classes where +young men and women are inclined to associate health and happiness +with doing nothing recently gave two columns to "Dandy Jim," the +richest dog in the world. Dandy Jim's mistress left him a +ten-thousand-dollar legacy. During his lifetime he wore diamonds. +Every day he ate candy that cost eighty cents a pound. The coachman +took him driving in the park sunny afternoons. He had no cares and +nothing to work for. His food came without effort. He had fatty +degeneration of the vital organs. He was pampered, coddled, and killed +thereby. Thousands of men and women drag out lives of unhappiness for +themselves and others because, like Dandy Jim, they have nothing to +work for, are pampered, coddled victims of fatty degeneration. When +President Butler of Columbia University finds it necessary to censure +"the folly and indifference of the fathers, vanity and thoughtless +pride of the mothers" who encourage do-nothing ailments; and when the +editor of the <i>Psychological Clinic</i> protests that the fashionable +private schools and the private tutor share with rich fathers and +mothers responsibility for life failures,—it is time that educators +teach children themselves the physical and moral ailments and +disillusions that come from doing nothing.</p> + +<p>Ten years ago a stenographer inherited two hundred and fifty thousand +dollars. Her dream of nothing to do <span class='pagenum'><a name="Page_331" id="Page_331">[331]</a></span>was realized. She gave up her +strenuous business life. Possessions formerly coveted soon clogged her +powers of enjoyment. She imagined herself suffering from various +diseases, shut herself up in her house, and refused to see any one. +She grew morbid and was sure that every person who approached her had +some sneaking, personal, hostile motive. Though always busy, she +accomplished little. Desultory work, procrastination, and +self-indulgence destroyed her power of concentration. She could not +think long enough on one subject to think it out straight, therefore +she was constantly deceived in her friends and interests. She first +trusted everybody, then mistrusted everybody. Infatuation with every +new acquaintance was quickly followed by suspicion. For years she was +a very sick woman, a victim of do-nothing ailments.</p> + +<p>Doing nothing has of late been seriously recommended to American +business men. They are advised to retire from active work as soon as +their savings produce reasonable income. It is true, this suggestion +has been made as an antidote to greed rather than for the happiness of +the business man. What retiring from business is apt to mean, is +indicated by a gentleman who at the age of sixty decided to sell his +seat on the New York Stock Exchange and to enjoy life. He became +restless and very miserable. He threw himself violently into one thing +after another; in less than a year he became an ill, broken old man, +after trying vainly to buy back his business.</p> + +<p>Both mind and body were made to work. The function of the brain is to +think to a purpose, just as the function of the heart is to pump +blood. The habit of doing nothing is very easily formed. The +"out-of-work" soon become "the work-shy." Having too little to do is +worse for the body and mind than having too little to eat. Social +reformers emphasize the bad effect on society of vagrancy. Evils of +indiscriminate relief to the poor are vividly described year <span class='pagenum'><a name="Page_332" id="Page_332">[332]</a></span>after +year. The philanthropist is condemned, who, by his gifts, encourages +an employee's family to spend what they do not earn, and to shun work. +Yet the idleness of the tramp, street loafer, and professional +mendicant is a negligible evil compared with the hindrance to human +progress caused by the idleness of the well-to-do, the rich, the +educated, the refined, the "best" people. It is as much a wrong to +bring up children in an atmosphere of do-nothingism, as to refuse to +have their teeth attended to or to have glasses fitted to weak eyes.</p> + +<p>From the point of view of community welfare it is far more serious for +the rich child to be brought up in idleness or without a purpose than +for the poor child to become a public charge. Not only has society a +right to expect more from rich children in return for the greater +benefits they enjoy, but so long as rich children control the +expenditure of money, they control also the health and happiness of +other human beings. Unless taught the value and joy of wholesome work +they cannot themselves think straight, nor are they likely to want to +understand how they can use their wealth for the benefit of mankind. +To quote President Butler again:</p> + +<div class="block"><p>The rich boy who receives a good education and is trained to be a +self-respecting member of the body politic might in time share on +equal terms the chance of the poor boy to become a man of genuine +influence and importance on his own account, just as now by the +neglect, or worse, of his parents the very rich boy is apt to be +relegated to the limbo of curiosities, and too often of decadence.</p></div> + +<p>Nervous invalids make life miserable for themselves and for others, +when often their sole malady is lack of the right kind of work to do.</p> + +<p>Suiting work to interest and interest to work is an economy that +should not be overlooked. The energy <span class='pagenum'><a name="Page_333" id="Page_333">[333]</a></span>spent in forcing oneself to do a +distasteful task can be turned to productive channels when work is +made pleasurable. The fact is frequently deplored that whereas +formerly a man became a full-fledged craftsman, able to perform any +branch of his trade, he is now confined to doing special acts because +neither his interest nor his mind is called into play. Work seems to +react unfavorably on his health. He has not the pride of the artisan +in the finished product, for he seldom sees it. He does a task. His +employer is a taskmaster. He decides that work is not good for him as +easily as when a school-boy he grasped the meaning of escape from his +lessons. By failing to fit studies to a student's interest, or by +failing to insure a student's interest in his studies, schools and +colleges miseducate young men and young women to look upon all work as +tasks, as discipline, necessary but irksome, and to be avoided if +possible. Just as there is a way of turning all the energy of the play +instinct into school work, so there is a way of interesting the +factory and office worker in his job. However mechanical work may be, +there is always the interest in becoming the most efficient worker in +a room or a trade. Routine—accurate and detailed work—does not mean +the stultification of the imagination. It takes more imagination to +see the interesting things in statistical or record work than to write +a novel. Therefore employers should make it a point to help their +employees to realize the significance of the perfection of each detail +and the importance of each man's part. The other day a father said to +me, "I want my boys to be as ashamed to do work in which they are not +interested as to accept graft." When interest in work and efficiency +in work are regarded as of more importance than the immediate returns +for work, when it is as natural for boys and girls to demand enjoyment +and complete living in work as it is to thrill at the sight of <span class='pagenum'><a name="Page_334" id="Page_334">[334]</a></span>the +Stars and Stripes, do-nothing ailments will be less frequent and less +costly.</p> + +<p>Work—that one enjoys—is an invaluable unpatented medicine. It can +make the sick well and keep the well from getting sick. It is the +chief reliance of mental hygiene. "I should have the grippe if I had +time," said a business woman to me the other day; but she did not have +time, hence she did not have the grippe.</p> + +<div class="poem"><div class="stanza"> +<span class="i0">If you're sick with something chronic,<br /></span> +<span class="i0">And you think you need a tonic,<br /></span> +<span class="i4">Do something.<br /></span> +<span class="i0">There is life and health in doing,<br /></span> +<span class="i0">There is pleasure in pursuing;<br /></span> +<span class="i0">Doing, then, is health accruing—<br /></span> +<span class="i4">Do something.<br /></span> +</div><div class="stanza"> +<span class="i0">And if you're seeking pleasure,<br /></span> +<span class="i0">Or enjoyment in full measure,<br /></span> +<span class="i4">Do something.<br /></span> +<span class="i0">Idleness, there's nothing in it;<br /></span> +<span class="i0">'Twill not pay you for a minute—<br /></span> +<span class="i4">Do something.<br /></span> +</div></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXIII" id="CHAPTER_XXXIII"></a><hr /> +<span class='pagenum'><a name="Page_335" id="Page_335">[335]</a></span><br /> + +<h3>CHAPTER XXXIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>HEREDITY BUGABOOS AND HEREDITY TRUTHS</h4> +<br /> + +<p>One of the red-letter days of my life was that on which I learned that +I could not have inherited tuberculosis from two uncles who died of +consumption. For years I had known that I was a marked victim. +Silently I carried my tragedy, suspecting each cold and headache to be +the telltale messenger that should let others into my secret. He was a +veritable emancipator who informed me that heredity did not work from +uncle to nephew; that not more than a predisposition to consumption +could pass even from parent to child; that a predisposition to +consumption would come to nothing without the germ of the disease and +the environmental conditions which favor its development; and that if +those so predisposed avoid gross infection, lead a healthy life, and +breathe fresh air they are as safe as though no tuberculous lungs had +ever existed in the world. Some years later I learned to understand +the other side of the case; I realized how I had been in real danger +of contracting consumption in the darkened, ill-ventilated sick room +of the uncle who taught me my letters and gave me my ideal of God's +purpose in sending uncles to small boys.</p> + +<p>There are two distinct things which make each individual life: the +living stuff, the physical basis of life, handed down from parent to +child; and the environmental conditions which surround it and play +upon it and rouse its reactions and its latent possibilities. It is +like the seed and the cultivation. You cannot grow corn from wheat, +but you can grow the best wheat, or you may let your crop fail through +careless handling.</p> + +<p><span class='pagenum'><a name="Page_336" id="Page_336">[336]</a></span>It is well that we should think seriously about the part played by +heredity, for the living stuff of the future depends upon our sense of +responsibility in this regard. The intelligent citizen would do well +to read such a book as J. Arthur Thompson's <i>Heredity</i> (1908), in +which the latest conclusions of science are clearly and soundly set +forth.</p> + +<p>The main problem of to-day, however, is to use well the talents that +we have. Here two things should always be kept in mind: First, the +inherited elements which make up our minds and bodies are complex and +diverse. Health and strength are inherited as well as disease and +weakness; they have indeed a better chance of survival. In the most +unpromising ancestry there are latent potentialities which may be made +fruitful by effort. No limit whatever can be set to the possibilities +of improvement in any individual.</p> + +<p>In the second place, if science has shown anything more clearly than +the importance of heredity, it is the importance of environment. This +influence upon human lives is within our control, and it is a grave +error to neglect what lies clearly within our power and to bemoan what +does not. Science has wrought no benefits greater than those which +result from drawing a clear line between heredity bugaboos and +heredity truths. An overemphasis on the hereditary factor in +development at the expense of the environmental factor, I call a +heredity bugaboo; and it is a tendency which cannot be too strongly +condemned. To fight against the sins and penalties of one's +grandfather is a forlorn task that quickly discourages. To overcome +diseases of environment, of shop and street, of house and school, +seems, on the contrary, an easy task. Heredity bugaboos dishearten, +enervate, encourage excesses and neglect. Heredity truths stimulate +remedial and preventive measures.</p> + +<p>We may well watch with interest the progress of eugenics, that new +science which biologists and sociologists hope will some day remake +the very living stuff of the human <span class='pagenum'><a name="Page_337" id="Page_337">[337]</a></span>race. But meanwhile let us take up +with hope and courage and enthusiasm the great hemisphere of human +fate which lies within our grasp. Good food and fresh air, well-built +cities, enlightened schools and well-ordered industries, stable and +free and expert government,—given these things, we can transform the +world with the means now at our disposal. We can reap, if we will, +splendid possibilities now going to waste, and by intelligent +biological and sociological engineering we can hand on to the next +generation an environmental inheritance which will make their task far +easier than ours.</p> + +<p>"Physical deterioration" is a bugaboo that is discovered by some in +heredity and by others in modern industrial evils. The British +director general called attention a few years ago to the fact that +from forty to sixty per cent of the men who were being examined for +military service were physically unfit. A Commission on Physical +Deterioration was appointed to investigate the cause, and to learn +whether the low physical standard of the would-be Tommy Atkins was due +to inherited defects. The results of this study were published in a +large volume called <i>Report on Physical Deterioration, 1904</i>, in which +is set forth a positive programme for obtaining periodically facts as +to the physique of the nation. In the course of the commission's +exhaustive investigation there was found no evidence that any +progressive deterioration was going on in any function of the body +except the teeth. "There are happily no grounds for associating dental +degeneracy with progressive physical deterioration." The increase in +optical defects is attributed not to the deterioration of the eye, but +to greater knowledge, more treatment, and better understanding of the +connection between optical defects and headache.</p> + +<div class="img"><span class='pagenum'><a name="Page_338" id="Page_338">[338]</a></span> +<a href="images/imagep338.png"> +<img border="0" src="images/imagep338.png" width="90%" alt="Testing Environment--House Score" /></a><br /> +</div> + +<div class="img"><span class='pagenum'><a name="Page_339" id="Page_339">[339]</a></span> +<a href="images/imagep339.png"> +<img border="0" src="images/imagep339.png" width="90%" alt="Definitions of Terms Used in House Score Card" /></a><br /> +</div> + +<p><span class='pagenum'><a name="Page_340" id="Page_340">[340]</a></span>The commission hoped "that the facts and opinions they have collected +will have some effect in allaying the apprehensions of those who, as +it appears, on insufficient grounds, have made up their minds that +progressive deterioration is to be found among people generally." In +regard to the facts which started the fear, the report says: (1) the +evidence adduced in the director general's memorandum was inadequate +to prove that physical deterioration had affected the classes referred +to; (2) no sufficient material (statistical or other) is at present +available to warrant any definite conclusions on the question of the +physique of the people by comparison with data obtained in past times.</p> + +<div class="img"> +<a href="images/imagep340.jpg"> +<img border="0" src="images/imagep340.jpg" width="80%" alt="The Best Inheritance Is A Mother Who Knows How To Keep Her Baby Well" /></a><br /> +<p class="cen" style="margin-top: .2em;">THE BEST INHERITANCE IS A MOTHER WHO KNOWS HOW TO KEEP HER BABY WELL</p> +</div> + +<p>The topics dealt with in the report refer to only a partial list of +conditions that need to be carefully studied before we can know what +environment heredity we are preparing for those who follow us:</p> + + +<div class="block"> + +<p class="cen sc">I. As to Babies</p> + +<p>Training of mothers, provident societies and maternity funds, +feeding of infants, milk supply, milk depots, sterilization and +<span class='pagenum'><a name="Page_341" id="Page_341">[341]</a></span>refrigeration of milk, effect of mother's employment upon infant +mortality, still births, cookery, hygiene and domestic economy, +public nurseries, crèches.</p> + +<br /> + +<p class="cen sc">II. As to Children</p> + +<p>Anthropometric measurements, sickness and open spaces, medical +examination of school children, teeth, eyes, and ears, games and +exercises for school children, open spaces and gymnastic +apparatus, physical exercise for growing girls and growing boys, +clubs and cadet corps, feeding of elementary school children, +partial exemption from school, special schools for "retarded" +children, special magistrate for juvenile cases, juvenile smoking, +organization of existing agencies for the welfare of lads and +girls, education, school attendance in rural districts, defective +children.</p> + +<br /> + +<p class="cen sc">III. As to Living and Working Conditions</p> + +<p>Register of sickness, medical certificates as to causes of death, +overcrowding, building and open spaces, register of owners of +buildings, unsanitary and overcrowded house property, rural +housing, workshops, coal mines, etc., medical inspection of +factories, employment of women in factories, labor colonies, +overfatigue, food and cooking, cooking grates, adulteration, smoke +pollution, alcohol, syphilis, insanity.</p> + +<br /> + +<p class="cen sc">IV. As to Health Machinery</p> + +<p>Medical officers of health, local, district, and national boards, +health associations.</p></div> + +<p>Scientists of the next generation will continue to differ as to +heredity truths and heredity bugaboos unless records are kept now, +showing the physical condition of school children and of applicants +for work certificates and for civil service and army positions. The +British investigators declared that "anthropometric records are the +only accredited tests available, and, if collected on a sufficient +scale, they would constitute the supreme criterion of physical +deterioration, or the reverse.... The school population and <span class='pagenum'><a name="Page_342" id="Page_342">[342]</a></span>the +classes coming under the administration of the Factory Acts offer +ready material for the immediate application of such tests." In +addition to the physical tests proposed in other chapters, there is +great educational opportunity in the records of private and public +hospitals. Every nation, every state, and every city should enlist all +its educational and scientific forces to ascertain in what respects +social efficiency is endangered by physical deficiencies that can be +avoided only by restricting parenthood, and the environmental +deficiencies that can be avoided by efficient health machinery.</p> + +<p>The greatest of all heredity truths are these: (1) the deficiencies of +infants are infinitesimal compared with the deficiencies of the world +with which we surround them; (2) each of us can have a part in +begetting for posterity an environment of health and of opportunity.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXIV" id="CHAPTER_XXXIV"></a><hr /> +<span class='pagenum'><a name="Page_343" id="Page_343">[343]</a></span><br /> + +<h3>CHAPTER XXXIV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>INEFFECTIVE AND EFFECTIVE WAYS OF COMBATING ALCOHOLISM</h4> +<br /> + +<p>Wherever the Stars and Stripes fly over school buildings it is made +compulsory to teach the evils of alcoholism. For nearly a generation +the great majority of school children of the United States have been +taught that alcohol, in however small quantities, is a poison and a +menace to personal and national health and prosperity. Yet during this +very period the per capita consumption of every kind of alcoholic +beverage has increased. Whereas 16.49 gallons of spirituous liquors +were consumed per capita of population in 1896, 22.27 gallons were +used in 1906. Obviously the results of methods hitherto in vogue for +combating alcoholism are disappointing.</p> + +<p>Why this paradoxical relation of precept to practice? Why is this, the +most hygiene-instructed country in the world, the Elysium of the +patent-medicine and cocaine traffic? If we have only the expected +divergence of achievement from ideal, then there is nothing for us to +do but to congratulate ourselves and posterity upon the part played by +compulsory legislation in committing all states and territories to +hygiene instruction in all public schools. If, on the other hand, our +disappointment is due to ineffective method, then the next step is to +change our method.</p> + +<p>The chief purpose of school hygiene has hitherto been not to promote +personal and community health, but to lessen the use of alcohol and +tobacco. Arguments were required against whisky, beer, cigars, and +cigarettes. As the strongest arguments would probably make the most +lasting impression upon the school child and the best profits for +<span class='pagenum'><a name="Page_344" id="Page_344">[344]</a></span>author and bookseller, writers vied with one another in the rhetoric +and hyperbole of platform agitation. What effect would it have upon +you if you were exhorted frequently during the next eight years to +avoid tobacco because a mother once killed a child by washing its head +in tobacco water? What is the effect on the mind of a boy or a girl +who sees that the family doctor, the minister, the teacher, the judge, +the governor, the President, and the philanthropist use tobacco and +alcoholic beverages, when taught that "boys who use tobacco and +alcoholic beverages will find closed in their faces the doors to +strength, good health, skill in athletics, good scholarship, long +life, best companions, many business positions, highest success"? It +is probably true that "a boy once drank some whisky from a flask and +died within a few hours." But that story is about as typical of boys +and of whisky as that a boy once drank whisky from a flask and did not +die for ninety years afterwards, or that George Washington drank +whisky and became the Father of his Country.</p> + +<p>How special pleading has dominated the teaching of school hygiene is +illustrated by a recent book which, for the most part, successfully +breaks away from the narrow point of view and the crude methods +hitherto prevailing. It presents the following facts concerning New +York City:</p> + +<div class="centered"> +<table border="0" cellpadding="1" cellspacing="0" width="60%" summary="New York City"> + <tr> + <td width="80%" class="tdl">Saloons</td> + <td width="20%" class="tdr">10,821</td> + </tr> + <tr> + <td class="tdl">Arrests</td> + <td class="tdr">133,749</td> + </tr> + <tr> + <td class="tdl">Expense of police department</td> + <td class="tdr">$10,199,206</td> + </tr> + <tr> + <td class="tdl">Police courts, jails, workhouses, reformatories</td> + <td class="tdr">1,310,411</td> + </tr> + <tr> + <td class="tdl">Hospitals, asylums, and other charities</td> + <td class="tdr">4,754,380</td> + </tr> +</table> +</div> + +<p class="noin">It is fair to the author to state that she does not declare in so many +words that the shutting up of the saloons would obviate all the +arrests and all the hospital, jail, and charity bills. Instead of +<i>wipe out</i> she says <i>shrivel</i>. No truth would have been lost by +avoiding all misrepresentation.</p> + +<p><span class='pagenum'><a name="Page_345" id="Page_345">[345]</a></span>The author probably felt as I did when I took my total abstainer's +protest to a celebrated scientist who had exposed certain +misstatements regarding the effect of small quantities of alcohol: "Is +not the untruth of these exaggerated statements less dangerous than +the untruth of dispassionate, scientific statement? So long as the +child mind takes in only an impression, is it not better to write this +impression indelibly?" He sadly but indulgently replied, "And in what +other studies would you substitute exaggeration for truth?"</p> + +<p>The reaction has already begun against exaggeration in hygiene +text-books, against drawing lessons from accidental or exceptional +cases of excessive use of alcohol, against classing moderate drinking +and smoking with drunkenness as sins of equal magnitude, and against +overlooking grave social and industrial evils that threaten children +far earlier and more frequently than do tobacco and alcohol. Instead +of adding an ell to the truth, text-book writers are now adding only +an inch or two at a time. No longer do we favor highly colored charts +that picture in purple, green, and black the effect of stimulants and +narcotics upon the heart and brain, the stomach, the liver, the knee, +and the eardrum, <i>assuming that all resultant evils are concentrated +in one organ</i>. Menacing habits, such as overeating and indulgence in +self-pity, are beginning to receive attention. It is also true that +physiology and anatomy are progressively made more interesting. +Publishers are looking for the utmost originality compatible with the +purpose of the present laws and with the only effective public +sentiment that has hitherto been interested in the interpretation of +those laws.</p> + +<p>A score of improvements in the method of carrying out a small ideal +will not take the place of enlarging that ideal. If existing laws +stand in the way of broadening the purpose of school hygiene, let the +laws be changed. If text-book publishers stand in the way, let us +induce or compel them to get out of the way. If we fear rumsellers, +their money, <span class='pagenum'><a name="Page_346" id="Page_346">[346]</a></span>and the insidious political methods that they might +employ to bring in undertruth if overtruth is once sacrificed, let us +go to our communities and locate the rumseller's guns, draw their +fire, tell the truth about their opposition, and educate the public to +overcome it. If, on the other hand, misguided teetotalism stands in +the way, then, as one teetotaler, I suggest that we prove, as we can, +in our respective communities that there is a better way of +inculcating habits of temperance and self-restraint than by telling +untruths, overtruths, or half truths about alcohol and tobacco. Let us +prove, as we can, that a subject vital to every individual, to every +industry, and to every government is now prevented from fulfilling its +mission not by its enemies but by its friends. We can learn the +character of hygiene instruction in our schools and the interest taken +in it by teachers, principals, and superintendents. We can learn how +teachers practice hygiene at school, and how the children of our +communities are affected by the hygiene instruction now given. +Finally, we can compel a public discussion of the facts, and action in +accordance with facts. Without questioning anybody's avowed motive, we +can learn how big that motive is and how adequate or inadequate is the +method of executing it.</p> + +<p>Alcohol and tobacco really occupy but a very small share of the +interest and attention of even those men and women by whom they are +habitually used. Hygiene, on the other hand, is of constant, +uninterrupted concern. Why, therefore, should it be planned to have +alcohol and tobacco displace the broader subject of personal and +public hygiene in the attention and interest of children throughout +the school life? Beyond the text-book and schoolroom a thousand +influences are at work to teach the social evils, the waste of energy, +and the unhappiness that always accompany the excessive use—and +frequently result from a moderate use—of stimulants and narcotics. Of +the many reasons for not drinking and smoking, physiology gives those +that least <span class='pagenum'><a name="Page_347" id="Page_347">[347]</a></span>interest and impress the child. The secondary effects, +rather than the immediate effects, are those that determine a child's +action. Most of the direct physiological effects are, in the majority +of instances, less serious in themselves than the effects of +overeating, of combining milk with acids, of eating irregularly, of +neglecting constipation. Were it not for the social and industrial +consequences of drunkenness and nicotinism, it is doubtful if the most +lurid picture of fatty degeneration, alcoholic consumption, hardened +liver, inactive stomach lining, would outweigh the pleasing—and +deceiving—sensations of alcoholic beverages and cigarettes.</p> + +<p>The strong appeal to the child or man is the effect these habits have +upon his mother, his employer, his wife, his children. The vast +majority of us will avoid or stop using anything that makes us +offensive to those with whom we are most intimately associated, and to +those upon whom our professional and industrial promotion depends. +Children will profit from drill in and out of school in the science of +avoiding offense and of giving happiness, but unless the +categories—<i>acts that give offense</i> and <i>acts that give +happiness</i>—are wide enough to include the main acts committed in the +normal relations of son, companion, employer, husband, father, and +citizen, those who set out to avoid alcohol and tobacco find +themselves ill equipped to carry the obligations of a temperate, +law-abiding citizen.</p> + +<p>Things do not happen as described in the early text-book. Other things +not mentioned hinder progress and happiness. The child at work resents +the mis-education received at school and suspects that he has been +following false gods. The enemies that cause him trouble come from +unexpected sources. He finds it infinitely easier to eschew alcohol +and tobacco than to avoid living conditions that insidiously undermine +his aversion to stimulants and narcotics. The reasons for avoiding +stimulants in the interest of others are more <span class='pagenum'><a name="Page_348" id="Page_348">[348]</a></span>numerous and more +cogent than the reasons for avoiding stimulants and narcotics for +one's own sake. The altruistic reasons for shunning stimulants and +narcotics cannot be implanted in the child unless he sees the evil of +excess <i>per se</i> in anything and everything, and unless he becomes +thoroughly grounded in the life relations and health relations to +which he must adapt himself.</p> + +<p>Unclean streets, unclean milk, congested tenements, can do more harm +than alcohol and tobacco, because they breed a physique that craves +stimulants and drugs. Adenoids and defective vision will injure a +larger proportion of the afflicted than will alcohol and tobacco, +because they earlier and more certainly substitute discouragement for +hope, handicap for equal chance. Failure to enforce health laws is a +more serious menace to health and morals than drunkenness or tobacco +cancer.</p> + +<p>If it is true that we must attack the problem of alcohol from the +standpoint of its social and industrial effects, we are forced at once +to consider the machinery by which cities and governments control the +manufacture and sale of alcohol. It is not an exaggeration to say that +courses in regulating the traffic in alcohol are more necessary than +courses in the effects of alcohol upon digestion and respiration.</p> + +<p>If Sunday closing of saloons, local option, high license, and +prohibition have failed, there is no evidence that the failure is due +to the principles underlying any one of these methods. Until more +earnest effort is made to study the effects of these methods, the +results of their enforcement and the causes of their nonenforcement, +no one is justified in declaring that either policy is successful or +unsuccessful. It is very easy to select from the meager facts now +available convincing proofs both that prohibition does not prohibit +and that high license leads to increased drunkenness. The consequence +is that the movements to control, restrict, or prohibit the use of +alcohol are emotional, not rational.</p> + +<p><span class='pagenum'><a name="Page_349" id="Page_349">[349]</a></span>It is impossible to keep emotion, sensation, sentiment, at white heat. +Most extremists worship legislation and do not try to keep interest +alive by telling every week or every month new facts about the week or +the month before. No new fuel is added to the anti-saloon fire, which +gradually cools and dies down. Not so, however, with those who make +money by the sale of intoxicants. The greater the opposition, the more +brains, the more effort, the more money they put into overcoming or +circumventing that opposition. Fuel is piled on and the bonfire is fed +freely. Every day the anti-restriction bonfire becomes larger and +larger, and the anti-saloon bonfire becomes smaller and smaller. By +carefully selecting their facts, by counting the number of arrests for +drunkenness and the number of saloons open on Sunday, by reiteration +of their story the pro-saloonists gradually win recruits from the +opposition, and, when the next election comes, their friends outnumber +their enemies and the "dry" policy of a city, county, or state is +reversed.</p> + +<p>The failures attributed to prohibitive or restrictive measures are +probably no more numerous than the failures of government in other +respects. The present ambassador from England, James Bryce, writing +his <i>American Commonwealth</i>, declared that municipal government was +America's "most conspicuous failure." The mayor of Toledo, writing in +1907, says, "There has been a pessimism, almost enthusiastic, about +the city." These failures are due not to any lack of desire for good +government, not to any fundamental evils of cities, but to the fact +that municipal reform, like the crusade against alcohol, has been +based upon emotionalism, not upon definite proof. Reformers have been +unable to lead in the right direction, because they have looked at +their lantern instead of their road. Not having cumulative information +as to government acts, they have been unable to keep their fires +burning. To illustrate: in November, 1907, the governor of New York +state, the <span class='pagenum'><a name="Page_350" id="Page_350">[350]</a></span>mayor of New York City, and reformers of national +reputation eulogized the tenement-house department; yet this +department, whose founding was regarded as a national benefaction, was +the only department of the city government that did not receive an +increase for 1908. It is in the position of temperance legislation, +the facts of whose enforcement or nonenforcement are not promptly and +continuously made public.</p> + +<p>Fear of the negro victim of alcoholism, social evils of intemperance, +whether among white or black, industrial uncertainty and waste due to +alcoholism, are the three chief motives that have swept alcohol +traffic out of the greater part of the South. Knowledge of +physiological evils has had little influence, except as it may have +rendered more acceptable the claim that alcoholism is a disease +against which there is no insurance except abolition of alcohol as a +beverage. Religious revivals, street parades by day and by night, +illustrated banners, personal intercession, lines of women and +children at the polls, made it necessary for voters to make known +their intention, and made it extremely difficult for respectable men, +engaged in respectable business, to vote for saloons. Some states have +gone so far as to prohibit the manufacture of alcoholic stimulants, +even though not offered for sale within state limits. In Georgia wine +cannot be used at the communion service, nor can druggists sell any +form of liquor except pure alcohol. In Louisiana it is illegal for +representatives of "wet districts" to solicit orders for liquor in any +of the "dry districts." In Texas the sale of liquor in dining cars is +forbidden, and the traveler may not even drink from his own flask. +Congress is being urged by senators and congressmen, as well as by +anti-saloon advocates, to pass laws prohibiting common carriers from +delivering alcoholics to any "dry" community. The more optimistic +anti-saloon workers believe it is but a matter of a short time when +Congress will pass laws prohibiting <span class='pagenum'><a name="Page_351" id="Page_351">[351]</a></span>the manufacture or sale of +alcoholic beverages within any limits protected by the United States +Constitution.</p> + +<p>Southern states have been warned that they could not afford the +depreciation of real estate values, of rents, and of business that +would surely follow the "confiscation of capital" and "interference +with personal liberty." This warning has been met by plausible +arguments that the buyers of legitimate and nonpoisonous commodities +could pay better rents, better profits on business and on real estate, +if freed from the uneven fight against temptation to drink. The +argument that schools and streets and health must suffer if the +license money was withdrawn, has been met by the plausible argument +that the ultimate taxpayer—the family that wants clothing, food, and +shelter—will save enough money to be able to spend still larger sums +than heretofore upon education, health, and public safety.</p> + +<p>For the first time dealers in alcohol recognize the possibility of a +great national movement and of national prohibition. Both the defects +in methods hitherto used to oppose saloon legislation and the reasons +for meeting the present situation by new methods are presented in the +May issue (1907) of the <i>Transactions of the American Brewing +Institute</i>. Under the title, "Social Order and the Saloon—the Measure +of the Brewer's Responsibility," Mr. Hugh F. Fox, known throughout the +Union as a defender of child rights, advocate of probation and +children's courts, promoter of health and education, outlined a plan +for research that is indispensable to the proper settling of this +great question. Whether brewer or anti-saloon leaguist, total +abstainer or moderate drinker, employer or trade unionist, it is +necessary to the intelligent control of alcohol that each of us +approach this momentous question of control or abolition of the saloon +in the spirit expressed in this paper, whose thoroughness and whose +social point of view would do credit to a church conference. The +address is <span class='pagenum'><a name="Page_352" id="Page_352">[352]</a></span>quoted and its questions copied because both show how much +depends upon knowing whether laws are enforced and how much greater is +the difficulty of coping with a conciliatory antagonist who professes +willingness to submit to tests of evidence.</p> + +<div class="block"><p>The regulation of the liquor business involves fundamental +questions of the function and scope of government, and there is +hardly any department of organized human activity that has been +the subject of so much experiment and futile tinkering.... The +only people who are perfectly consistent are the prohibitionists, +whose policy is abolition. Let us, however, try to detach +ourselves from any personal interest that we may have in the +subject, and consider it impartially as a matter of public +concern.</p> + +<p>What the brewer as an individual cannot do, the brewers as an +organization have done successfully in many places in spite +sometimes of official negligence, corruption, or incapacity. The +Texas Brewers' Association is reported as having successfully +prosecuted two thousand cases against keepers of disreputable +resorts during the past three years. The object of their campaign +was to purify the retail liquor trade from unclean and law-defying +elements.</p> + +<p>The greatest gain that has come to society, as distinguished from +the individual, through the temperance movement is its effect in +unconsciously informing the public that the regulation and +administration of licensing is in itself a great and vital +problem; and as a secondary result of such agitation, I should +cite the growing sensitiveness of all persons in the business to +the power of public opinion.</p> + +<p>The recognition by brewers of the force of public opinion is a +recent affair. In former years they were totally indifferent to +it, if indeed they did not openly flout it. Even now their appeal +to public sentiment is mainly a special plea for defensive +purposes, and has little or no educational value. Brewers have +opposed practically every effort to effect a change in excise +laws, often without any convincing reason, but simply because the +proposed change involved temporary inconvenience and uncertainty, +and perhaps a temporary loss. The brewing trade has utterly failed +to develop a constructive programme in connection with the public +<span class='pagenum'><a name="Page_353" id="Page_353">[353]</a></span>regulation of its affairs. It does not seem to have any fixed +principles or positive convictions as to excise methods and liquor +laws. Its policy has been that of an opportunist, at the best,—or +an obstructionist, at the worst. As in all other industries which +affect the welfare of the people, reforms have been forced from +the outside, with no help from within. Of course this is equally +true of insurance and railroad corporations, of food purveyors, +mine owners, cotton merchants, and a score of other interests. It +is due not merely to human selfishness but to shortsightedness; in +other words, to a lack of statesmanship.</p> + +<p>To call your opponents hypocrites, cranks, fakirs, and fanatics +may relieve your feelings, but it doesn't convince anybody, and +only hurts a just cause. It is foolish to question the motives of +men who, without thought of personal gain, are trying to remedy +the evils of inebriety.</p> + +<p>The church is perfectly right in urging total abstinence upon the +individual. The only path of safety lies in abstinence for some +individuals....</p> + +<p>The recognition of the right of a community to establish its own +licensing conditions carries with it the right of the community to +determine whether there shall be any licenses at all!</p> + +<p>To make the discussion of this subject as fruitful as possible, I +venture to submit the following questions for your consideration. +None of them involve any direct moral issue, but there is an +honest difference of opinion about each one of them, and they are +certainly of vital importance in determining the course of wise +and just administration.</p> + +<p>What has been the effect of high license?</p> + +<p>How much public revenue should the traffic yield?</p> + +<p>Does high license stimulate unlawful trade?</p> + +<p>How much license tax should be imposed upon local bottlers and +grocers? Should they be allowed to peddle beer or to sell it in +single bottles?</p> + +<p>Should the place or the individual be licensed?</p> + +<p>Should the licensing authorities be appointive or elective? By +whom should they be appointed, and for what term of office?</p> + +<p>Have the courts made good or bad licensing authorities? Where the +courts issue licenses, what has been the effect on the court?</p> + +<p><span class='pagenum'><a name="Page_354" id="Page_354">[354]</a></span>Should the licensing authority alone have the power to revoke a +license, and discretion to withhold a license?</p> + +<p>How can the licensing authority enforce the law? Should it not be +independent of the police?</p> + +<p>What should be the penalty for breach of the law? Do not severe +penalties miscarry?</p> + +<p>On what plea, and under what conditions, should licenses be +transferred?</p> + +<p>What has been the effect of limiting the number of saloons?</p> + +<p>Should limitation be according to area or to population?</p> + +<p>Is there any relation between the number of saloons and the volume +of consumption?</p> + +<p>What should be the limit to the hours of selling?</p> + +<p>Should saloons be allowed to become places of entertainment?</p> + +<p>How can the sale of liquor by druggists be controlled?</p> + +<p>How can spurious drinking clubs be prevented or controlled?</p> + +<p>How can the operation of disreputable hotels be prevented? What +should be the definition of a hotel? Who should define it? By whom +should it be licensed? What special privileges should be given to +it?</p> + +<p>How can the "back-room" evil be stopped? Is it legal (i.e. +constitutional) to prohibit the sale or serving of liquor to +women?</p> + +<p>Has the removal of screens reduced the volume of consumption? Has +it improved the character of saloons? Has it solved the problem of +Sunday prohibition for any length of time? What has been the +general effect of it in the tenement districts?</p> + +<p>Should the state undertake to regulate the liquor business or to +enforce liquor laws?</p> + +<p>Is it possible to devise any working plan which will apply with +equal effectiveness and equity in communities of compact and of +scattered population?</p> + +<p>Should, or should not, the principle of self-government be +carefully preserved in the whole scheme of legislation to regulate +the liquor business?</p></div> + +<p>Whether the present prohibition wave shall wash away the legalized +saloon, as ocean waves have from time to time engulfed peninsulas, +islands, and whole continents, <span class='pagenum'><a name="Page_355" id="Page_355">[355]</a></span>depends upon the power of American +educators and American officials to answer right such questions as the +foregoing. The great danger is that we shall, as usual, over-emphasize +lawmaking, underemphasize lawbreaking, and go to sleep during the next +two or three years when we should be wide-awake and constantly active +in seeing that the law is enforced. Unless exactly the same principles +of law enforcement are applied in "dry districts" as we have urged for +eradication of smallpox, typhoid, scarlet fever, and adenoids, local +and city prohibition are doomed to failure. There must be:</p> + +<div class="block"><p>1. Inspection to discover disease centers—"blind pigs," "blind +tigers," etc.</p> + +<p>2. Compulsory notification by parents and landlords, and by police +and other officials.</p> + +<p>3. Prompt investigation upon complaint from private citizens.</p> + +<p>4. Prompt removal of the disease and disinfection of the center.</p> + +<p>5. Segregation of individual units that disseminate disease, +whether bartender, saloon keeper, owner of premises, or +respectable wholesaler, none of whom should be permitted to shift +to another the responsibility for violating liquor laws.</p> + +<p>6. Persistent publicity as to the facts regarding enforcement and +violation, so that no one, whether saloon leaguist or anti-saloon +leaguist, shall be uninformed as to the current results of "dry" +laws.</p></div> + +<p>It is perfectly safe to assume that none of these things will be done +consistently unless funds are provided to pay one or more persons in +each populous locality to give their entire time to the enforcement of +laws, just as the improvement of other ills of municipal government +require the constant attention of trained investigators. Cogent +arguments for such funds have recently appeared in the <i>New York +Evening Post's</i> symposium on "How to Give Wisely," by Mrs. Emma +Garrett Boyd, of Atlanta, and Miss Salmon, of Vassar College.</p> + +<p><span class='pagenum'><a name="Page_356" id="Page_356">[356]</a></span>If the saloon is here to stay, we must all agree that it is a +frightful waste of human energy and of educational momentum to be +appealing for its abolition when we might be hastening its proper +control. On the other hand, if the saloon is destined to be abolished +as a public nuisance and a private wrong, as a menace to industry and +social order, is it not a frightful, unforgivable waste of energy to +permit prohibition laws to fail, and thus to discredit the principle +of prohibition? Philanthropists have provided millions for scientific +research, for medical research, for the study of tuberculosis, and for +the study of living conditions. It is to be hoped that a large +benefaction, or that an aggregation of small benefactions, will apply +to governmental attempts to regulate the sale of alcohol those methods +of scientific research which have released men from the thraldom of +ignorance and diseases less easily preventable than alcoholism.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXV" id="CHAPTER_XXXV"></a><hr /> +<span class='pagenum'><a name="Page_357" id="Page_357">[357]</a></span><br /> + +<h3>CHAPTER XXXV<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>IS IT PRACTICABLE IN PRESENTING TO CHILDREN THE EVILS OF ALCOHOLISM TO<br /> +TELL THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT THE TRUTH?</h4> +<br /> + +<p>If children are taught that the most effective way of combating +alcoholism is to insure the enforcement of existing laws and to profit +from lessons taught by such enforcement; if children are taught that +the strongest reasons for total abstinence are social, economic, and +industrial rather than individual and physiological,—there is much to +be gained and little to lose from telling them the truth, the whole +truth, and nothing but the truth about alcohol. To stimulate a child's +imagination by untruths about alcohol is as vicious as to stimulate +his body with alcohol. Whisky drinking does not always lead to +drunkenness, to physical incapacity, to short life, or to obvious loss +of vitality. Beer drinking is not always objected to by employers. +Neither crime, poverty, immorality, lack of ambition, nor ignorance +can always be traced to alcohol. On the contrary, it is unquestionably +true that the majority of the nation's heroes have used alcoholics +moderately or excessively for the greater part of their lives. It is +probably true that among the hundred most eminent officials, pastors, +merchants, professors, and scientists of to-day, the great majority of +each class are moderate users of one or more forms of alcoholics. +Overeating of potatoes or cake or meat, sleeping or working in +ill-ventilated rooms, neglect of constipation, may occasion +physiological and industrial <span class='pagenum'><a name="Page_358" id="Page_358">[358]</a></span>injuries that are not only as grave in +themselves as the evils of moderate drinking, but, in addition, +actually tempt to moderate drinking.</p> + +<p>All of this can be safely admitted, because whether parents and +teachers admit it or deny it, children by observation and by reading +will become convinced that up to the year 1908 the noblest and the +most successful men of America, as well as the most depraved and least +successful, have used alcoholics. To be candid enough to admit this +enables us to gain a hold upon the confidence and the intelligence of +children and youth that will strengthen our arguments, based upon +social and industrial as well as physiological grounds, against +running the risks that are inevitably incurred by even the moderate +use of alcohol.</p> + +<p>Other things being equal, the same man will do better work without +alcohol than with alcohol; the same athlete will be stronger and more +alert without alcohol than with alcohol; the clerk or lawyer or +teacher will win promotion earlier without alcohol than with alcohol; +man or woman will grow old quicker with than without alcohol. Other +things being equal, a man of fifty will have greater confidence in a +total abstainer than in a man of identical capacity who uses alcohol +moderately; a mother will give better vitality and better care to her +children without than with alcohol; a policeman or fireman or +stenographer is more apt to win promotion without than with alcohol. +Whatever the physical ailment, there is in every instance a better +remedy for an acute trouble, and infinitely better remedies for +deep-seated troubles, than alcoholics.</p> + +<p>The percentage of failure to use alcoholics moderately is so high, the +uncertainty as to a particular individual's ability to drink +moderately is so great, as to lead certain insurance companies, first, +to give preference to men who never use alcoholics, and later, to +refuse to insure moderate drinkers. Life insurance companies have the +general rule <span class='pagenum'><a name="Page_359" id="Page_359">[359]</a></span>that habitual drinkers are bad risks, as the alcohol +habit is prejudicial to health and longevity; but they have no means +of studying the risk of moderate drinkers, because, except where +alcohol has already left a permanent impression upon the system, the +indications are by no means such as to enable the medical examiner to +trace its existence with certainty. For this reason the life insurance +companies have little effect in <i>preventing</i> alcoholism. Though they +are agreed that habitual drinkers ought to be declined altogether, +only a few companies have taken the decided stand of declining them. +"Habitual drinkers, if not too excessive, are admitted into the +general class where the expected mortality, according to the +experience of the Pennsylvania Mutual Life Insurance Company, is 80 +per cent, as against 56 per cent for the temperate class. Though it is +only necessary to look over the death losses presented each day to see +that intemperance in the use of liquors, as shown by cirrhosis of the +liver, Bright's disease, diseases of the heart, brain, and nervous +system, is the cause of a large proportion of the deaths, these +companies prefer to grade the premiums accordingly rather than to +decline habitual drinkers altogether. While this is partly due to the +difficulty and expense of diagnosis, it is more probably due to an +objection to take a definite stand on the temperance question."</p> + +<p>Thus the insurance companies' rules touch only the confirmed drinker, +whose physique is often irreparably injured. One company writes: "Men +who have been intemperate and taken the Keeley or other cures are +never accepted until five years have elapsed from the date of taking +the cure, and only when it can be conclusively shown that during the +whole period they have refrained entirely from the use of alcoholic +liquor, and that their former excesses have not in any way impaired +the physical risk."</p> + +<p>Thus far American insurance companies are doing little preventive and +educational work on the alcohol question, <span class='pagenum'><a name="Page_360" id="Page_360">[360]</a></span>though they have the very +best means at their command for so doing. According to the +Metropolitan Life Insurance Company nine tenths of the school children +in New York City are insured by them, and an even greater proportion +of workingmen. Even though this is done "at twice the normal cost," +the most cursory medical examination is given and no attempt is made +to instruct them in the relation of their physical condition to their +working power, or in the evils of the alcohol and the smoking habits.</p> + +<p>Naturally the moderate drinker is first rejected for positions where +an occasional overindulgence would be most noticeable and most +serious. The manager of a large factory tells his men: "You cannot +work here unless you are sober. If you must drink at parties, stay at +home if necessary until 12 o'clock the next day and sleep it off, but +don't come here till you are straight. We cannot afford it." +Occasionally his men stay at home and not a word is said, but the +minute they are found at work in an unsteady condition they are +summarily discharged. From this position it is but a step to that of +an upholsterer in New York City, who prints on his order blanks, "No +drinking man employed." His company recently discharged a man after +twenty years of service because a customer for whom this man was +working detected a whisky breath. Men reported to trade unions for +frequent intoxication are blacklisted. A certain financial corporation +permits no liquor on its grounds or in its lunch rooms. The head of +one of its large branches was heard to say recently that he would +discharge on the spot a man who showed evidences of drinking, even +though he had previously worked faithfully for years.</p> + +<p>Rejection of moderate drinkers by business houses is not done on moral +grounds alone, but because experience has proved the danger of +employing men who have not their faculties fully under control <i>all</i> +the time they are at work. The rules are especially strict for men +working for a railroad <span class='pagenum'><a name="Page_361" id="Page_361">[361]</a></span>or street railway company. The Pennsylvania +Railroad Company replied to my inquiry as to their custom of +discriminating against drinking men in these words: "We have no +printed rules in regard to this except in a general way,—that no +employee is allowed to go into a saloon during his hours of work or +wearing the company's uniform. Of course the men are promptly +discharged or disciplined if they show the effects of liquor while on +duty, and the whole tendency of the administration of the rules is to +get rid of any men who are habitual drinkers, but the administration +of the rules and discipline is left to the superintendent of each +division." The Interborough Rapid Transit Company of New York has +these printed rules for the physical standard required for applicants +for employment:</p> + +<div class="block"><p>1. <i>Examination of heart and arteries.</i> Rejection of candidates +showing excessive or long-continued use of tobacco and alcohol, +with explanation of condition, causes, and dangers of continued +use. Warning to chiefs of departments regarding those accepted who +show tendency to drink at times, but whose physical examination +does not disclose sufficient evidence to warrant their +disqualifications. Foremen and chiefs of departments to be +notified and to carry out the policy of employing only men who are +at all times sober and not under the influence of alcohol at all.</p> + +<p>2. <i>On reëxamination of employees.</i> Warning to or rejection of +those showing, on physical examination, indulgence to excess of +alcohol, tobacco, or drugs. Warning to chief of department of +evidence of such habits on part of any employee examined for any +reason, but retained in service of the company with injunction to +chief of department to speak with such employee and have him under +proper supervision.</p></div> + +<p>The blacklisting of habitual drinkers by their union, and the growing +tendency on the part of large corporations, factories, and business +houses to take a decided stand against drinking, are having a marked +effect in reducing drunkenness where it does most harm. This practice +has been declared by John Bach McMasters, the noted American +historian, to have exerted a stronger influence in promoting +temperance and total abstinence than all the temperance crusades from +Hartley's time to the prohibition wave of <span class='pagenum'><a name="Page_362" id="Page_362">[362]</a></span>1907. The school, by +instructing children how the alcohol habit will affect their chances +of business success, future usefulness as citizens, and enjoyment of +life, will inevitably reduce the evils of alcohol. By teaching based +on facts that intimately concern the life of the child, as well as by +caring for his health and his environment, the schools can help +supplant the desire for alcohol with other more healthy desires.</p> + +<p>No truth about alcohol is more important than that the craving for +alcohol or something just as bad will exist side by side with +imperfect sanitation, too long hours of work, food that fails to +nourish, lack of exercise, rest, and fresh air. Conditions that +produce bounding vitality and offer freedom for its expression at work +and at play will supplant the craving for stimulants. Finally, the +great truth contained in the last chapter must be taught, that success +in coping with alcoholism is a community task requiring efficient +government above all else.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXVI" id="CHAPTER_XXXVI"></a><hr /> +<span class='pagenum'><a name="Page_363" id="Page_363">[363]</a></span><br /> + +<h3>CHAPTER XXXVI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>FIGHTING TOBACCO EVILS</h4> +<br /> + +<p>"It is not necessarily vicious or harmful to soothe excited nerves." +This editorial comment explains, even if it condemns while trying to +justify, the tobacco habit. To soothe excited nerves by lying to them +about their condition and by weakening where we promise to nourish, is +vicious and harmful just as other lying and robbery are vicious and +harmful. Yet two essential facts in dealing with tobacco evils must be +considered: tobacco does soothe excited nerves, and the harm done to +the majority of smokers seems to them to be negligible. For these two +reasons the tobacco user, unless frightened by effects already +visible, refuses to listen to physiological arguments against his +amiable self-indulgence. Cheerfully he admits the theoretical +possibility that by its method of soothing nerves tobacco kills nerve +energy. But in all sincerity he points to men who have found the right +stopping point up to which tobacco hurts less perhaps than coffee or +tea, candy or lobster, overeating or undersleeping. Therefore the +physician, the bishop, the school superintendent, candidly run the +necessary risk for the sake of nerve soothing and sociability.</p> + +<p>Less harm would be done by tobacco if it were more harmful. Like so +many other food poisons, its use in small quantities does not produce +the prompt, vivid, unequivocal results that remove all doubt as to the +user's injuries and intemperance. As inability to see the +physiological effect upon himself encourages the tobacco user to +continue smoking or chewing, so failure to identify evil physiological +effects upon the smoker encourages the nonuser to begin <span class='pagenum'><a name="Page_364" id="Page_364">[364]</a></span>smoking or +chewing. A very few smokers give up the habit because they fear its +results, but too often the man who can see the evil results would +rather give up almost anything else. The one motive that most +frequently stops inveterate smoking—fear—is the least effective +motive in dissuading those who have not yet acquired the habit; every +young man, unless already suffering from known heart trouble, thinks +he will smoke moderately and without harm. Unfortunately, every boy +who begins to smoke succeeds in picturing to himself the adult who +shows no surface sign of injury from tobacco, rather than some other +boy who has been stunted physically, mentally, and morally by +cigarettes.</p> + +<p>For adult and child, therefore, it behooves us to find some other +weapons against tobacco evils in addition to fear of physiological +injuries. Among these weapons are:</p> + +<p>1. Enforcement of existing laws that make it an offense against +society for dealer, parent, or other person to furnish children under +sixteen with tobacco in any form; and raising the age limit to +twenty-one, or at least to eighteen.</p> + +<p>2. Enforcement of restrictions as to place and time when smoking is +permitted.</p> + +<p>3. Agitation against tobacco as a private and public nuisance.</p> + +<p>4. Explanation of commercial advantages of abstinence.</p> + +<p>Because the childish body quickly shows the injurious effects of what +in adults would be called moderate smoking, the proper physical +examination of school children will reveal injuries which in turn will +show where and to what extent the cigarette evil exists among the +children of a community. Even the scientists who claim that "in some +cases tobacco aids digestion," or that "tobacco may be used without +bad effects when used moderately by people who are in condition to use +it," declare emphatically that tobacco "must not be used in any form +by growing children or youths." Prohibitive laws can be rigidly +enforced if a small <span class='pagenum'><a name="Page_365" id="Page_365">[365]</a></span>amount of attention is given to organizing the +strong public sentiment that exists against demoralizing children by +tobacco. Thus children and youths will not need to make a decision +regarding their own use of tobacco until after other arguments than +physiological fear have been used for many years by parent, teacher, +and society.</p> + +<p>One effective weapon is the sign on a ferryboat or street car: "No +smoking allowed on this side," or "Smoking allowed on three rear seats +only." Public halls and vehicles in increasing numbers either prohibit +smoking altogether or put smokers to some considerable inconvenience. +The trouble involved in going to places where smoking is permitted +tends gradually to irritate the nerves beyond the power of tobacco to +soothe. Again, many men would rather not soothe their excited nerves +after five, than have their nerves excited all day waiting for freedom +to smoke. Restrictions as to time or place make possible and expedite +still further restrictions. Thus gradually the army of occasional +smokers or nonsmokers is being recruited from the army of regular +smokers.</p> + +<p>The anti-nuisance motive follows closely upon the drawing of sharp +lines of time and place for the use of tobacco. Like treason, smoking +in the presence of nonsmokers can be considered respectable only when +the numbers who profess and practice it are numerous. If the two +first-mentioned weapons are effectively used, there will be an +increasing proportion of nonsmokers and not-yet-smokers who will give +attentive ear to proof that nicotinism is a nuisance. The physical +evidences of the cigarette habit can easily be made distasteful to all +nonsmokers if frankly pointed out,—the yellow fingers, the yellow +teeth, the nasty breath, the offensive excretions from the pores that +saturate the garments of all who cannot afford a daily change of +underwear. The anti-nuisance argument is always insidious and abiding. +In the presence of nonsmokers accustomed to <span class='pagenum'><a name="Page_366" id="Page_366">[366]</a></span>regard tobacco using as a +nuisance, smokers become self-conscious and sensitive. Men and women +alike would prefer a reputation for cleanliness to the pleasures of +tobacco. The educational possibility of fighting tobacco with the name +"nuisance" was recognized the other day by an editorial that protested +against a law to prevent women from using cigarettes in restaurants. +"The way for any man who has the desire to reform some woman addicted +to the cigarette habit is insidiously and gently to point out the +injurious effects on her appearance. Cigarette smoking stains a +woman's fingers and discolors her teeth. It also tends to make her +complexion sallow and to detract from the rubiness of her lips. It +bedims the sparkle of her eyes. It makes her less attractive +mornings." Chewing has practically disappeared, not because it ceased +to soothe excited nerves but because it was seen to be a nasty +nuisance.</p> + +<p>Finally, the selfishness of the smoker is a nuisance that continues +only because it has not been called by its right name. "Do you mind if +I smoke?" was a polite question two hundred years ago when tobacco was +rare enough to make smoking a distinction, or fifty years ago when +everybody smoked at home and in public. But it is effrontery to-day +when people do mind, when smoking pollutes the air of drawing room and +office, and while soothing the excited nerves of the smoker lowers the +vitality of nonsmokers compelled to breathe smoke-laden air. It is +selfish to intrude upon others a personal weakness or a personal +appetite. It is selfish to divert from family purposes to "soothing +excited nerves" even the small amounts necessary to maintain the cigar +or cigarette habit. It is selfish to run the risk of shortening one's +life, of reducing one's earning capacity. Because the tobacco habit is +selfish it is anti-social and a nuisance, and should be fought by +social as well as personal weapons, as are other recognized nuisances, +such as spitting in public or offensive manners.</p> + +<p><span class='pagenum'><a name="Page_367" id="Page_367">[367]</a></span>The economic motive for avoiding and for eliminating tobacco is +gaining in strength. The soothing qualities of all drugs are found to +be expensive to physical and business energy if enjoyed during +business hours. Strangely enough, employers who smoke are quite as apt +as are nonsmokers, to forbid the use of tobacco by employees at work. +Some of this seeming inconsistency is due to a dislike for cheaper +tobacco or for mixed brands in one atmosphere; some of it is due to +the smoker's knowledge that "soothing nerves" and sustained attention +do not go hand in hand, while "pipe dreams" and unproductive +meditation are fast companions; finally no little of the opposition to +tobacco in business is due to fear of fire. These various motives, +combining with the anti-nuisance motive among nonsmokers, have led +many business enterprises to prohibit the use of tobacco in any form +on their premises or during business hours, even when on the premises +of others. Notable examples are railroads that permit no passenger +trainman to use tobacco while on duty. (Freight trainmen are +restricted more tardily because the risk of damages is less and the +anti-nuisance objection is wanting.)</p> + +<p>From penalizing excessive use and prohibiting moderate use in business +hours, it is a short cut to choosing men who never use tobacco and +thus never suffer any of its effects and never exhibit any of its +offensive evidences. No young man expects to obtain a favorable +hearing if he offers himself for employment while smoking or chewing +tobacco. Business men dislike to receive tobacco-scented messengers. +Cars and elevators contain signs prohibiting lighted cigars or +cigarettes. Insurance companies reject men who show signs of excessive +use of tobacco. Why? Because they are apt to die before their time. +The Interborough Rapid Transit Company of New York City rejects +applicants for motormen and conductors "for excessive or +long-continued use of tobacco." Why? Because, other things being +equal, <span class='pagenum'><a name="Page_368" id="Page_368">[368]</a></span>such men are more apt to lose their nerve in an emergency and +to fail to read signals or instructions correctly.</p> + +<p>Armed with these weapons against tobacco, parents and teachers can +effectively introduce physiological arguments against excessive use, +against use by those who suffer from nervous or heart trouble, and +against any use whatever by those who have not reached physical +maturity. By avoiding physiological arguments that children will +not—cannot—believe contrary to their own eyes, parents and teachers +are able to speak dogmatically of that which children will +believe,—injuries to children, evils of excess, restrictions as to +time and place, and offensiveness to nonsmokers. But even here it is +wrong, as it is inexpedient, to leave the physical strength of the +next generation to the persuasive power of parents and teachers or to +the faith and knowledge of minors. Society should protect all minors +against their own ignorance, their own desires, the ignorance of +parents and associates, and against the economic motive of tobacco +sellers by machinery that enforces the law.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXVII" id="CHAPTER_XXXVII"></a><hr /> +<span class='pagenum'><a name="Page_369" id="Page_369">[369]</a></span><br /> + +<h3>CHAPTER XXXVII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE PATENT-MEDICINE EVIL</h4> +<br /> + +<div class="block"><p>"Dhrugs," says Dock O'Leary, "are a little iv a pizen that a +little more iv wud kill ye. Ye can't stop people fr'm takin' +dhrugs, an' ye might as well give thim somethin' that will look +important enough to be inthrojuced to their important and fatal +cold in th' head. If ye don't, they'll leap f'r th' patent +medicines. Mind ye, I haven't got annything to say agin' patent +medicines. If a man wud rather take them thin dhrink at a bar or +go down to Hop Lung's f'r a long dhraw, he's within his rights. +Manny a man have I known who was a victim iv th' tortures iv a +cigareet cough who is now livin' comfortable an' happy as an opeem +fiend be takin' Dr. Wheezo's Consumption Cure." The Dock says th' +more he practices medicine th' more he becomes a janitor with a +knowledge iv cookin'. He says if people wud on'y call him in +befure they got sick he'd abolish ivry disease in th' ward except +old age and pollyticks.</p></div> + +<p>Thus Mr. Dooley with his usual wit and insight tells the American +people why they spend over two hundred million dollars annually on +patent medicines. Americans consume more drugs and use more patent +medicines than the people of any other country on the civilized globe. +Self-medication has grown to tremendous proportions. Everywhere—in +cars, on transfers, on billboards, in magazines, in newspapers, in the +mails—are advertised medicines to cure disease and devices to promote +health. When we consider that electric cars contain from thirty-two to +fifty-two advertisements each, three fourths of which are directly or +indirectly concerned with health; when we multiply these by the number +of cars actually in use in American cities; when we consider the +number of advertisements in magazines and daily papers, and the +enormous circulation of these papers and magazines; <span class='pagenum'><a name="Page_370" id="Page_370">[370]</a></span>when we consider +that an increasingly large proportion of advertising space is devoted +to health,—we begin to realize the cumulative power for good or for +evil that health advertisements must have.</p> + +<p>To illustrate advertisements devoted to health to-day, I have kept +clippings for one week of news items, editorials, and advertisements +in a penny and a three-cent paper, and had them classified according +to the subjects treated:</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="80%" summary="advertisements devoted to health"> + <tr> + <td width="24%" class="tdctrb" rowspan="2"> </td> + <td class="tdctlb sc" colspan="3" style="border-right: 1px black solid;">Penny Paper</td> + <td class="tdctlb sc" colspan="3">Three-Cent Paper</td> + </tr> + <tr> + <td width="11%" class="tdc" style="border: 1px black solid;">News Item</td> + <td width="11%" class="tdc" style="border: 1px black solid;">Editorial</td> + <td width="16%" class="tdc" style="border: 1px black solid;">Advertisement</td> + <td width="11%" class="tdc" style="border: 1px black solid;">News Item</td> + <td width="11%" class="tdc" style="border: 1px black solid;">Editorial</td> + <td width="16%" class="tdc" style="border-top: 1px black solid; border-bottom: 1px black solid; border-left: 1px black solid;">Advertisement</td> + </tr> + <tr> + <td class="tdlr" style="border-top: 1px black solid; padding-top: .5em;">Milk</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 3</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">—</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 2</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 3</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">—</td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .5em;"> 2</td> + </tr> + <tr> + <td class="tdlr">Teeth</td> + <td class="tdcrl">—</td> + <td class="tdcrl">1</td> + <td class="tdcrl"> 2</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 1</td> + </tr> + <tr> + <td class="tdlr">Shoes</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 4</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 1</td> + </tr> + <tr> + <td class="tdlr">Food</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 4</td> + </tr> + <tr> + <td class="tdlr">Alcohol</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 5</td> + <td class="tdcrl"> 3</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 7</td> + </tr> + <tr> + <td class="tdlr">Tuberculosis</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcl">—</td> + </tr> + <tr> + <td class="tdlr">Patent medicine</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcrl">17</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl">—</td> + </tr> + <tr> + <td class="tdlr">Constipation cures</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 4</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 5</td> + </tr> + <tr> + <td class="tdlr">Eyes</td> + <td class="tdcrl"> 3</td> + <td class="tdcrl">—</td> + <td class="tdcrl"> 5</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcl">—</td> + </tr> + <tr> + <td class="tdlr">Beauty</td> + <td class="tdcrl"> 2</td> + <td class="tdcrl">5</td> + <td class="tdcrl"> 8</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 6</td> + </tr> + <tr> + <td class="tdlr" style="border-bottom: 1px black solid;">General</td> + <td class="tdcrl" style="border-bottom: 1px black solid;"> 8</td> + <td class="tdcrl" style="border-bottom: 1px black solid;">3</td> + <td class="tdcrl" style="border-bottom: 1px black solid;"> 3</td> + <td class="tdcrl" style="border-bottom: 1px black solid;"> 5</td> + <td class="tdcrl" style="border-bottom: 1px black solid;">—</td> + <td class="tdcl" style="border-bottom: 1px black solid;">—</td> + </tr> + <tr> + <td class="tdlr" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; padding-left: 1.5em; border-bottom: 2px black solid;">Total</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">18</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">9</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">51</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">14</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">—</td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">26</td> + </tr> +</table> +</div> + +<br /> + +<p>The following list of health topics was treated in the advertisements, +editorials, and articles of a popular monthly periodical devoted to +women:</p> + +<br /> + +<div class="centered"> +<table border="0" cellpadding="2" cellspacing="0" width="70%" summary="health topics"> + <tr> + <td class="tdctrb"> </td> + <td class="tdctlb" style="border-right: 1px black solid;">Article</td> + <td class="tdctlb" style="border-right: 1px black solid;">Editorial</td> + <td class="tdctlb">Advertisement</td> + </tr> + <tr> + <td width="40%" class="tdlr" style="border-top: 1px black solid; padding-top: .5em;">Babies</td> + <td width="20%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;"> 1</td> + <td width="20%" class="tdcrl" style="border-top: 1px black solid; padding-top: .5em;">—</td> + <td width="20%" class="tdcl" style="border-top: 1px black solid; padding-top: .5em;">11</td> + </tr> + <tr> + <td class="tdlr">Soaps and powders</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 5</td> + </tr> + <tr> + <td class="tdlr">Beauty</td> + <td class="tdcrl"> 3</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 6</td> + </tr> + <tr> + <td class="tdlr">Quack cures</td> + <td class="tdcrl">—</td> + <td class="tdcrl">2</td> + <td class="tdcl">—</td> + </tr> + <tr> + <td class="tdlr">Tooth powders</td> + <td class="tdcrl">—</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 4</td> + </tr> + <tr> + <td class="tdlr">Household</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 5</td> + </tr> + <tr> + <td class="tdlr">Food and cooking</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">—</td> + <td class="tdcl">14</td> + </tr> + <tr> + <td class="tdlr">Clothes</td> + <td class="tdcrl">13</td> + <td class="tdcrl">—</td> + <td class="tdcl"> 5</td> + </tr> + <tr> + <td class="tdlr">Teaching sex laws</td> + <td class="tdcrl"> 1</td> + <td class="tdcrl">2</td> + <td class="tdcl">—</td> + </tr> + <tr> + <td class="tdlr" style="border-bottom: 1px black solid;">Medicine</td> + <td class="tdcrl" style="border-bottom: 1px black solid;"> 4</td> + <td class="tdcrl" style="border-bottom: 1px black solid;">1</td> + <td class="tdcl" style="border-bottom: 1px black solid;">—</td> + </tr> + <tr> + <td class="tdlr" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; padding-left: 1.5em; border-bottom: 2px black solid;">Total</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">24</td> + <td class="tdcrl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">5</td> + <td class="tdcl" style="border-top: 1px black solid; padding-top: .25em; padding-bottom: .25em; border-bottom: 2px black solid;">50</td> + </tr> +</table> +</div> + +<br /> + +<p><span class='pagenum'><a name="Page_371" id="Page_371">[371]</a></span>Besides the classic patent medicines, such as Lydia Pinkham's +Vegetable Compound, Castoria, Cod Liver Oil, etc., there are "Colds +Cured in One Day," "Appendixine," health foods, massage vibrators, +violet rays, Porosknit underwear, sanitary tooth washes, soaps, +vitopathic, naturopathic, and faith cures. New ones appear every +day,—enough to make a really sick person dizzy, let alone a person +suffering from imaginary ailments. All seem to outline my particular +symptoms. After they have flamed at me in red letters in the surface +cars, pursued me in the elevated and underground, accompanied me out +into the country and back again to the city, greeted me each morning +in the daily paper and in my daily mail, each week or each month in +the periodical, the coincidence of a familiar package on a drug-store +counter seems to be providential and therefore irresistible. I know +that I ought to be examined by a physician, but I am busy and not +unwilling to gamble for my health; it cannot kill me and there is a +chance that it will cure me. If there is nothing the matter with us, +we may be cured by our faith. If we are taking a cure for consumption, +the morphine in it may lull us into thinking we feel better. If we are +taking a tonic for spring fever, the cheap alcohol may excite us into +thinking our vitality has been heightened. Soothing sirup soothes the +baby, often doping its spirit for life, or soothing it into a sleep +from which it never wakes.</p> + +<p>In spite of the fact that the "Great American Fraud" has been exposed +repeatedly in newspapers and magazines of wide circulation, the appeal +of the quack still catches men and women of intelligence. The other +night a friend went out to a dinner and conference with a lawyer in +the employ of the national government. Annoyed by a nagging headache, +he made for the nearest drug store and ordered a "headache powder." He +admitted that it was an awful dose, but he had been told that it +always "did the business." <span class='pagenum'><a name="Page_372" id="Page_372">[372]</a></span>He knew the principle was bad, confessed +to a scorn for friends of his whom he knew to be bromo-seltzer fiends, +but he had the headache and the work to do—a sure cure and a quick +one seemed imperative. The headache was due to overwork, indigestion, +constipation. Plain food and quiet sleep was what he needed most. But +the dinner conference plus the headache was the unanswerable argument +for a dose with an immediate result.</p> + +<p>Last winter an Irish maid slowly lost her rosy cheeks and grew +hollow-eyed and thin. She was taken to a specialist who discovered a +rapidly advancing case of consumption. He said that owing to the +girl's ignorance, stupidity, and homesickness, her only chance of +recovery was to return to the "auld countrie" at once. The girl agreed +to go, but insisted on a few days "to talk it over with her cousins in +New York." After two weeks had elapsed she was found in a stuffy, +overcrowded New York tenement. She had found a doctor who had given +her a little bottle of medicine for two dollars, which would cure her +in the city. It was futile to protest. Days in the unventilated +tenement and nights in a "dark room" meant that she would never live +to finish the bottle.</p> + +<p>For a year Miss H. took a patent preparation for chronic catarrh. It +seemed to "set her up"; but it so undermined her strength, through its +artificial nerve spur, that chronic catarrh was followed by +consumption. It later transpired that the cure's chief ingredient was +whisky, and cheap whisky. A good grandmother, herself a vigorous +temperance agitator and teetotaler, offered to pay for it as long as +my friend would take it faithfully. The irony of it makes one wonder +how many earnest advocates of total abstinence are in reality addicted +to the liquor habit.</p> + +<p>Last summer a district nurse of the summer corps who visited city +babies under two years of age encountered in the hallway of a tenement +a bevy of frenzied women. A <span class='pagenum'><a name="Page_373" id="Page_373">[373]</a></span>baby lay on the bed gasping and "rolling +its eyes up into the top of its head." The nurse asked the frightened +mother what she had been giving it. "Nothing at all," said the woman. +But a telltale bottle of soothing sirup showed that the child was +dying from morphine poisoning. Happily the nurse came in time to save +it.</p> + +<p>Is it not pitiful, this grasping for a poison in an extremity; this +seizing of a defective rope to escape the fire?</p> + +<div class="img"> +<a href="images/imagep373.jpg"> +<img border="0" src="images/imagep373.jpg" width="80%" alt="Learning How To Keep Baby Well Without Patent Medicines" /></a><br /> +<p class="cen" style="margin-top: .2em;">LEARNING HOW TO KEEP BABY WELL WITHOUT PATENT MEDICINES<br /> +Recreation Pier, New York City, Summer, 1908</p> +</div> + +<p>The patent-medicine evil cannot be cured by occasional exposure or by +overexposure. Nor can it be cured by legislation, legislation, +legislation, unless laws are rigidly enforced.</p> + +<p>Occasional exposure is no better than occasional advertising of good +things. The patent-medicine business thrives on constant, not +occasional, advertising. Leading advertisers expect so little from the +first notice that they would not take the trouble to write out a +single advertisement. That is the reason merchants charge advertising +in <span class='pagenum'><a name="Page_374" id="Page_374">[374]</a></span>the programmes of church, festival, and glee-club concert to +charity, not to business. Warning people once does no more lasting +good than sending a child to school once a month. The exposure of +patent-medicine evils must be as constant as efforts to sell the +medicines.</p> + +<p>Overexposure is ineffective. It is the evils of patent medicines that +do harm, not their name and not their patents. The medical profession +has in vain protested against proprietary medicines. Ethical barriers +cannot be erected by resolution. Calling things unethical does not +make them unethical. The mere patenting of medicines for profit does +not make the medicine injurious any more than the mere mixing of +unpatented drugs makes a physician safe. Physicians who would not +themselves patent a drug will use certain patented drugs whose +ingredients are known to be safe and uniform. True exposure of +patent-medicine evils will enable the average physician and the +average layman to distinguish the dangerous from the safe, the fraud +from the genuine, lies from truths.</p> + +<p>Legislation is needed to crystallize modern knowledge and to establish +in courts the right to protection against the evils of patent +medicines. The national Pure Food Law, passed January 1, 1907, and now +in force throughout the country, requires on the "labels of all +proprietary medicines entering into interstate commerce, a statement +of the quantity or proportion of any alcohol, morphine, opium, heroin, +chloroform, cannabis indica, chloral hydrate, or acetanilid, or any +derivative or preparation of any such substance contained therein; +this information must be in type not smaller than eight-point capital +letters; also <i>the label shall embody no statement which shall be +false or misleading in any particular</i>." This law does not forbid +patent medicines nor the use of alcohol and narcotics in patent +medicines; it merely says, "Let the label tell, that all who <i>buy</i> may +read." It does not require that all <span class='pagenum'><a name="Page_375" id="Page_375">[375]</a></span>who <i>run</i> may read, for <i>it does +not say that advertisements of a patent medicine shall tell the truth +about its ingredients or its action on the human body</i>; only that the +label on the bottle shall tell. The object of this law is to explain +to the consumer the exact nature of the medicine. But to the majority +of people the word "acetphenitidin" on the label of a headache +medicine does not explain. The new order that requires manufacturers +to substitute acetanilid for acetphenitidin does no more than replace +fog with mist. Protection requires legislation that cannot be evaded +by technical terms. The present law requires that packages must be +properly labeled <i>on entering the state</i>. To carry out the national +law, state laws should make it an offense for dealers to have in their +possession proprietary medicines without explanatory labels that +explain. Where state laws to this effect do not exist, the packages +once in the state may be deprived of their labels and sold as secret +remedies, thus nullifying the whole effect of the national law.</p> + +<p>Enforcement must be insured. Impure drugs may do as much harm as +patent medicines containing harmful drugs. In New York a vigorous +campaign was recently inaugurated by the department of health to drive +out impure drugs. Drugs are dangerous enough at their best. When they +are not what they pretend to be, whether patented or not, they may +take life. One extreme case where a patient's heart was weakened when +it ought to have been strengthened, led to the discovery that +practically all of one particular drug offered for sale in New York +City was unfit to use and calculated to kill in the emergency where +alone it would be used. Yesterday four lives and several million +dollars were lost in a New York fire because the hose was rotten or +weak. As inspection and testing were needed to insure hose equal to +emergency pressure, so inspection and testing of patent medicines and +drugs are needed to make legislation effectual.</p> + +<p><span class='pagenum'><a name="Page_376" id="Page_376">[376]</a></span>Legislation and enforcement should reach the newspaper, magazine, +billboard, street car, that advertises a falsehood or less than the +essential truth regarding drugs, foods, and patent medicines. Public +sentiment condemns the advertising of many opportunities to commit +crime or to be disorderly or indecent or to injure one's neighbor. The +facts about hundreds of nostrums can be absolutely determined. The +advertising agency, whether secular or religious, that carries +misrepresentation of drugs and foods should be forbidden circulation +through the mails. The existence of such advertisements should be made +evidence of complicity in a public offense and punished accordingly. +Treat them as we treated the Louisiana lottery. Boards of health, +instead of furnishing names to druggists and manufacturers who want to +sell patent foods and medicines, should print circulars exposing +frauds, and punish so far as the law permits.</p> + +<p>While trying to secure adequate legislation and efficient +administration of the above-mentioned standards, there is much that +can be done by individuals and clubs. We can give preference to those +journals that refuse drug and food advertisements unless evidence is +produced that the truth is told and that the goods are not harmful. We +can refuse to have in the house a paper or journal which prints +notices that lie or that conceal the truth. If this drastic measure +would cut us off entirely from daily papers, we could choose the least +offensive and petition it to exclude specific lying methods. When it +preaches health, honesty, and philanthropy, we can cut out of one +issue the noble editorial and the exploiting advertisements and send +them to the editor with our protest. Knowledge of the ingredients and +dangers of patent medicines should be a prerequisite for the practice +of medicine or pharmacy. We can help bring about such conditions, and +we can patronize physicians who send patients to drug stores that +cater to intelligence rather than to ignorance.</p> + +<p><span class='pagenum'><a name="Page_377" id="Page_377">[377]</a></span>Fighting patent-medicine evils is a civic duty to be accomplished by +civic coöperation, not private effort. It is impossible to organize +unofficial educational agencies that can offset the cumulative, lying +advertisement. Personal opposition is but the beginning. Official +machinery must be set running and kept running so as to protect the +public health against the commercial motive that preys upon ignorance +and easily inspired faith.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXVIII" id="CHAPTER_XXXVIII"></a><hr /> +<span class='pagenum'><a name="Page_378" id="Page_378">[378]</a></span><br /> + +<h3>CHAPTER XXXVIII<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>HEALTH ADVERTISEMENTS THAT PROMOTE HEALTH</h4> +<br /> + +<p>It is usually considered futile to attempt to defeat the devil with +his own methods, because he knows so much better how to use them. But +abuse does not do away with use, and the success of quacks in reaching +the people demands our respect. There is no reason why their methods, +based on a knowledge of human nature and human psychology, should not +be employed to appeal to needs rather than to weaknesses. A good thing +may lie unused because of lack of advertisement. Vitality is coming to +be the passion of the American people. It is on this sincere passion +that fakirs have so long traded.</p> + +<p>There can be no doubt that advertisements of health-promoting goods +are quite as profitable as health advertisements that injure health, +when equally effective methods are used to make them reach the public. +The tradition has been repeatedly mentioned in this book that the +better the doctor, the less he advertises himself, except in medical +and scientific journals that notoriously fail to reach the people. The +same is too often true of reputable remedies and goods. The theory +that these things stand or fall on their merits is not borne out by +practical experience,—conspicuously in the case of "fake" remedies. +Purely philanthropic undertakings for the advancement of health fail, +if not placed before the people whom they aim to help in an +attractive, convincing form. Failure to advertise a worthy cause +limits its usefulness, and is therefore unjustifiable, whether we +speak of medicine, legal aid, or dental clinics.</p> + +<p><span class='pagenum'><a name="Page_379" id="Page_379">[379]</a></span>An intensive study of the methods used to advertise patent medicines +will suggest means of extending the usefulness of health-promoting +goods. Aside from clever methods of suggestion that lead many people +to take medicine for imaginary ailments, especially seasonal ailments, +patent-remedy advertisers have employed (as an argument for the +efficiency of their cures) scientific theory, bacterial origin of +diseases, recent medical or physiological discoveries, and state and +national movements for promoting health. In fact, they have turned to +their own uses the very law that seeks to control them and the +exposures that seek to exterminate them. Whatever may be the merits of +Castoria, the "Don't Poison Baby" advertisement on the following page, +printed just after the accompanying "Babies Killed by Patent +Medicines," which appeared in a home journal, was surely a clever bit +of advertising. Upon an editorial in a daily paper on the relation of +eyeglasses to headache and indigestion, an optician based a promise of +immediate relief for these ailments if he himself were patronized. The +recent investigations of the Department of Agriculture, and of +Professors Chittenden and Fisher, in regard to foodstuffs, are proving +helpful to food quacks and advertisers of pills for constipation and +indigestion. Since the passage of the Pure Food Law one health food is +advertised in a column headed "Pure Food."</p> + +<p>When the season for pneumonia comes around numerous medicines are +"sure cures" for grippe and pneumonia. "Rosy teachers look better in +the schoolroom than the sallow sort," is surely a good introduction to +a new food. Woman's vanity sells many a remedy advertised to +counteract the "vandal hand of disease, which robs her of her beauty, +yellows and muddies her complexion, lines her face, pales cheek and +lip, dulls the brilliancy of her eye, which it disfigures with dark +circles, aging her before her time." Who in your town is as good a +friend to "owners of bad breath" as the advertiser who tells them that +they "whiff out odor which makes <span class='pagenum'><a name="Page_380" id="Page_380">[380]</a></span>those standing near them turn their +heads away in disgust"? The climax of effective educational +advertising as well as of consummate presumption and villainy is +reached in the notice of an alcoholic concoction that uses the +headline, "Medical Supervision Needed to Prevent the Spread of +Consumption in the Schools." Thus grafting itself on the successful +results of the medical examination in the Massachusetts schools, it +enlists the aid of teachers, trades on the fear of tuberculosis, even +indorses the fresh-air treatment. So convincing was this appeal that +it was reprinted in the <span class='pagenum'><a name="Page_381" id="Page_381">[381]</a></span>news columns of a daily paper in New York as +official advice to school children.</p> + +<div class="img"> +<a href="images/imagep380.jpg"> +<img border="0" src="images/imagep380.jpg" width="50%" alt="Don't Poison Baby." /></a><br /> +</div> + +<p>So clever are these methods of advertising and so successful are they +in reaching great numbers of people, that if reputable physicians +would take lessons of them, they might conduct a health crusade that +would exterminate tuberculosis, diminish the use of alcohol and +tobacco, and save thousands of babies that die unnecessarily. The +theory of patent-medicine advertising is sound. It emphasizes the joys +of health, the beauty of health, the earning power of health. It +adapts its message to season, event, and need. It offers testimonials +of real persons cured. It is all-appealing, promising, convincing,—a +fearful menace to health when the remedies offered are dishonest, a +universal opportunity for promoting health if the cure is genuine.</p> + +<p>A classic example of health advertising that promotes health is +Sapolio. The various hygiene lessons that have promoted Sapolio have +done much to raise the standard of living in the United States. Few +eminent physicians have done so much for public health as the "Poor +M.D. of Spotless Town who scoured the country for miles around, but +the only case he could find was a case of Sapolio."</p> + +<p>Recent press discussions about furnishing free eyeglasses to the +children in the public schools have so enlightened people as to the +need for expert examination of their eyes that opticians will be +forced to employ competent oculists to make the preliminary +examination and to see that the glasses are properly adjusted. In +spite of the long mis-education by makers of corsets, the persistent +advertising of "good health" and "common-sense" waists has gained an +increasing number of recruits from the ranks of the self-persecuting. +It is only a matter of time when the term "stylish" will be +transferred to the advocates of health, because advertisers who tell +the truth will, if persistent, gain a larger patronage than +advertisers of falsehoods; there <span class='pagenum'><a name="Page_382" id="Page_382">[382]</a></span>is profit in retaining old +customers. The advertisement of a window device for "Fresh air while +you sleep" will make prevention of tuberculosis more profitable than +"sure cures" that lie and kill.</p> + +<p>A man deserves profit who sends this message to millions of readers:</p> + +<div class="block"><p class="noin">There are three kinds of cleanliness:</p> + +<p class="noin">First, the ordinary soap-and-water cleanliness.<br /> +Second, the so-called "beauty" cleanliness.<br /> +Third, prophylactic cleanliness, or the cleanliness that "guards +against disease."</p></div> + +<p class="noin">But the man who sells soap ought to be the one to use this +advertisement, not a man who sells toothwash that, when pure, is +little better than water, that is seldom pure, and that always hurts +the teeth. Many children and adults are being cured of flat foot by +men who make money by selling shoes designed to strengthen the arch of +the foot. Millions would never know how to discover the evil effects +upon themselves of coffee and alcohol except for money-making +advertisements. Little Jo's Smile taught a nation that the majority of +crippled children are victims of neglect on the part of adult +consumptives.</p> + +<p>Certain it is that advertising is an art promoted by the severest +competition of the cleverest brains. It is a force which we cannot +afford to ignore. If we can harness it to the promotion of aids to +health, it will do more good than all the hygiene books ever written. +To this end we must educate ourselves to distinguish between goods +which do what they profess to do and those which do not. A good eye +opener would be to keep for a week clippings from a high-priced daily +paper, a penny daily paper, and one or two representative magazines, +including a religious paper. Teachers and parents can very easily +interest children in such clippings. Moreover, they can use the +bulletin method, <span class='pagenum'><a name="Page_383" id="Page_383">[383]</a></span>the stereopticon exhibit, the <i>cumulative +illustration</i> of a fact, which is the essence of successful +advertising. Boards of health can use all the typographical aids to +clear understanding,—cuts, diagrams, interesting anecdotes. In New +York both the health board and the school board have issued circulars +and given illustrated lectures, some of them being in school and some +on public squares. Medical and sanitary societies and other educators +can be induced to follow what a successful business man has called the +three cardinal rules of advertising:</p> + +<div class="block"><p>First, put your advertisement where it will be seen. (Tell your +story where it will be heard.)</p> + +<p>Second, write it so that people will read it. (Tell it so that +people will understand it.)</p> + +<p>Third, tell the truth, so that people will believe it.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XXXIX" id="CHAPTER_XXXIX"></a><hr /> +<span class='pagenum'><a name="Page_384" id="Page_384">[384]</a></span><br /> + +<h3>CHAPTER XXXIX<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>IS CLASS INSTRUCTION IN SEX HYGIENE PRACTICABLE?</h4> +<br /> + +<p>Among remedies for preventable disease and preventable poverty, the +following was urged at a national conference for the betterment of +social conditions: "We have been too prudish. Because we have been +unwilling to teach school children the evils of violating sex hygiene, +we have been unsuccessful in combating evils justly attributable to +ignorance on the part of girls as to the duties and dangers of +motherhood." This point of view is shared by so many men and women +that a national body was organized in 1905 to promote the teaching of +sex hygiene,—the Society for Sanitary and Moral Prophylaxis. This +society has its headquarters in New York, and distributes at cost +lectures and essays. The second of its educational pamphlets is +addressed to teachers, and is entitled "Instruction in the Physiology +and Hygiene of Sex." The introduction asks eleven questions of the +teachers as follows:</p> + +<div class="block"><p>1. Do you wish a pamphlet on sex subjects to hand to your pupils? +Why?</p> + +<p>2. Do you wish separate pamphlets for boys and girls?</p> + +<p>3. For what age limits and social conditions do you wish them?</p> + +<p>4. What topics do you wish the pamphlets for boys to "handle"?</p> + +<p>5. What topic do you wish the pamphlet for girls to "handle"?</p> + +<p>6. If you think one pamphlet sufficient for both sexes, what +should it consider?</p> + +<p>7. How far do you go in teaching sexual hygiene or reproduction? +By what method?</p> + +<p><span class='pagenum'><a name="Page_385" id="Page_385">[385]</a></span>8. What special difficulties do you find in teaching it?</p> + +<p>9. What special need of teaching it have you found?</p> + +<p>10. What special benefits (or otherwise) have you noticed from +teaching it?</p> + +<p>11. What criticisms (favorable or otherwise) do you encounter?</p></div> + +<p>The difficulty of introducing formal instruction in sex hygiene, even +in the upper grades of public and private schools, is hinted at in the +pamphlet. The purpose of the publishing society as given in its +constitution is "to eliminate the spread of diseases which have their +origin in the social evil." Although sex hygiene does not begin with +sex immorality, almost every text-book on sex hygiene, and almost +every pamphlet urging class instruction in sex hygiene, begins with +sex immorality. Yet only the exceptional school child is in danger of +violating sex morals, while every school child needs instruction in +sex hygiene.</p> + +<p>Instruction in sex hygiene, whether at school or at home, should deal +with sex normality, sex health, sex temperance. Instruction in sex +immorality is objectionable, not merely because it offends prudists, +not because it is difficult, but because it can be shown by experience +to be less efficacious than training in sex health.</p> + +<p>To expect fear to prompt sex hygiene is to make a mistake that has +retarded the development of sound measures in the treatment of +offenders against criminal law. For centuries man failed in attempts +to fit the punishment to the crime. To deter men from committing crime +by holding up a threat of prolonged and dreadful punishment has been +found futile. Individuals take the risk because they think they will +escape detection. It is an axiom of criminal procedure that a would-be +offender is deterred by the certainty, not by the severity, of +punishment. The modern theory of probation is, that children and +adults may be best led away from evil practices by crowding out old +influences with newer and stronger interests. Occupations <span class='pagenum'><a name="Page_386" id="Page_386">[386]</a></span>that are +wholesome are made to rival diversions or occupations that are harmful +and criminal.</p> + +<div class="img"> +<a href="images/imagep386.jpg"> +<img border="0" src="images/imagep386.jpg" width="80%" alt="Object Lessons for Instruction in Sex Health" /></a><br /> +<p class="cen" style="margin-top: .2em;">OBJECT LESSONS FOR INSTRUCTION IN SEX HEALTH<br /> +Note the uncomfortable, unhealthy overdressing</p> +</div> + +<p>Abnormal conditions of mind and body in regard to sex can almost +always be traced to general physical ill health or to an unhealthy +moral environment. Cure and prevention require two kinds of treatment +within reach of parents and teachers: (1) build up the child's +physical condition; and (2) give him other interests. Proper physical +care, and work adjusted to body and mind, may be relied upon to do +infinitely more to promote sex hygiene than instruction, either at +home or at school, in immoral sex diseases. That sex morality is weak +and untrustworthy which is based upon fear of sex diseases. Like +alcoholism and nicotinism, the saddest results of sex diseases are +social and economic. The strongest reasons against such diseases are +economic and social, not physiological.</p> + +<div class="img"><span class='pagenum'><a name="Page_387" id="Page_387">[387]</a></span> +<a href="images/imagep387.jpg"> +<img border="0" src="images/imagep387.jpg" width="80%" alt="The Study Of Infant Health is Conducive to Pure-Mindedness" /></a><br /> +<p class="cen" style="margin-top: .2em;">THE STUDY OF INFANT HEALTH IS CONDUCIVE TO PURE-MINDEDNESS<br /> +Note the simple, comfortable, hygienic dress</p> +</div> + +<p>Once having made up our minds to concentrate the teaching of sex +hygiene upon sex health rather than upon sex immorality, upon sex +functions rather than upon sex diseases, the chief objection to school +instruction and to instruction in class will disappear. Our school +text-books in history, literature, and biology abound in references to +sex distinctions, sex functions, and sex health. In enumerating the +daily routine of health habits I mentioned daily bathing of the +armpits and crotch. There is nothing in this injunction to offend or +injure a boy or girl. If studies and physical training are to be +adapted to physiological age, and if children are to know why they are +graded according to physiological age as well as mental brightness, we +shall soon be talking of mature, maturing and not-yet-maturing <span class='pagenum'><a name="Page_388" id="Page_388">[388]</a></span>girls +and boys, so that everybody will be instructed in sex hygiene without +offense. Any teacher who can explain the family troubles of King Henry +VIII without becoming self-conscious can easily learn to look a class +of girls and boys in the face and explain how a mother's health will +injure her baby before its birth, why breast-fed babies are more apt +to live than bottle-fed babies, why it is as important for the mother +to keep a nursing breast absolutely clean as to clean the nipple of a +nursing bottle. Words whispered by children, or marked in +dictionaries, to be stealthily and repeatedly looked upon and talked +over with other children, lose all their glamour when pronounced by a +teacher.</p> + +<p>In these days of state subsidy of school libraries the child is hard +to find who has not free access to books of fiction full of voluptuous +allusions that make undesirable impressions which only blunt, candid +discussion of sex facts can make harmless. Children now learn, whether +in fashionable private schools or crowded slums, practically all that +is lascivious and unwholesome about sex. For teachers to explain that +which is wholesome and pure will disinfect the minds of most children +and protect them against miseducation.</p> + +<p>Class instruction in hygiene is practicable for all matters pertaining +to normal sex health. Girls of thirteen should be taught in classes +the fact and meaning of menstruation, and its grave importance to the +health, in order that they may care for themselves not only before, +during, and immediately after the menstrual period, but throughout the +month, in order that menstruation itself shall not be unnecessarily +painful, enervating, and harmful to efficiency. It is not yet +advisable to discuss dangers peculiar to girls or dangers peculiar to +boys in mixed classes. Generally speaking, it is undesirable that men +teachers discuss girls' troubles with girl pupils. But why should it +not become possible for women teachers to explain health dangers +peculiar to girls to classes of boys?</p> + +<p><span class='pagenum'><a name="Page_389" id="Page_389">[389]</a></span>Individual instruction in sex matters should be reserved for the +diseased mind, for the boy or girl who has already been morbidly +instructed. Discussion of immoral sex diseases should be confined to +individual talk. This field teachers have already entered. Repeated +physical examination of children will detect symptoms of sex +abnormality. When detected, the fact and the meaning should be +explained to the individual by school physician, school nurse, or +school-teacher. While much can be done through mothers' meetings and +through individual instruction of parents, the most effective means of +improving the general attitude towards sex health is to give the +simple truth to the millions of children who have not yet left school. +Armed with the A B C's of sex hygiene at school, boys and girls will +be prepared to select employment, associates, and newspapers that will +permit normal, healthy sex development. Men and women who are leading +normal lives, who have plenty of work, sleep, fresh air, nourishing +food, amusement, and exercise are unlikely to be sexually abnormal.</p> + +<p>After all, the question of instruction in sex hygiene will quickly +settle itself when it is made a condition of a teacher's certificate +that the applicant shall himself or herself know the personal and +social reasons for sex health. The woman who does not know how to take +care of her own sex health, the man who is ignorant of a woman's +special needs, cannot do justice to the requirements of arithmetic, +language, and discipline. Whether men and women teachers are mentally, +physically, and morally equipped to be sexually normal and to teach +the law of sex health will be disclosed as soon as trustees and +superintendent dare to ask the necessary questions. Whether an +instructor's personality will enable him to fill the minds of children +with interests more wholesome, more absorbing than obscene stories or +morbid sex curiosity can also be learned. When school-teachers are +prepared to teach the <span class='pagenum'><a name="Page_390" id="Page_390">[390]</a></span>social and economic aspects of general health +they will quickly solve the problem of instruction in sex health.</p> + +<p>Just one word about country morality. It is customary to deplore the +influence of large cities on the young. Of late, however, there has +been a tendency to question whether, after all, sex morality is apt to +be higher in the country than in the city. Parents and teachers in +small towns and in rural districts will do well to take an inventory +of the influences surrounding their children. It will always be +impossible to give country children city diversions. One great +disadvantage of country children frequently counter-acts the +beneficial influence of out-of-door living; namely, isolation. The +city child is practically always in or about to be in the sight of, if +not in the presence of, other people. Numbers and close contact with +people, though they be strangers, mean restraint and pervading social +conscience. City children find it difficult to have good times in +pairs. No amount of instruction of rural pupils in sex hygiene will +take the place of amusements and entertainments for groups of +children, forming thus a special antidote for "two's company, three's +a crowd." Liberating and standardizing normal intersex relations and +discouraging cramped social intersex relations are more urgent needs +than instruction in sex diseases. A working environment that permits +pure-mindedness will do more to inculcate a reverence for sex +cleanliness and for parenthood than lectures and essays on moral +prophylaxis.</p> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XL" id="CHAPTER_XL"></a><hr /> +<span class='pagenum'><a name="Page_391" id="Page_391">[391]</a></span><br /> + +<h3>CHAPTER XL<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>THE ELEMENT OF TRUTH IN QUACKERY; HYGIENE OF THE MIND</h4> +<br /> + +<p>Patent medicines and other forms of quackery could not pay such +enormous dividends unless there was some truth in their claims; unless +their victim found some beneficial return for his money. They win +confidence because they raise hopes and combat fear. They do cure +thousands of people of fear and of "ingrowing thoughts." In so doing +they remove the sole cause of much disability.<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a> In so doing they +are merely applying by wholesale principles of mental hygiene that are +legitimately used by physicians, tradesmen, teachers, and parents who +deal successfully with nervousness.</p> + +<p>Quackery makes cures and makes money because of the undoubted +influence of mind in causing and in removing those ailments that +originate in fear, imagination, or morbid introspection. A few years +ago a little out-of-the-way town in southern Minnesota was visited by +train loads of the sick and crippled from miles around. Miraculous +cures were heralded broadcast. Life-long cripples left wagon loads of +crutches and braces to decorate the little church with the enchanted +transom. People who had not walked for years returned to their homes +cured. The marvels of famous shrines were fast being duplicated when +the church authorities at St. Paul issued an explanation of the +alleged miraculous appearance of biblical figures in the transom of +the new church. The outlines of a mother carrying a baby had <span class='pagenum'><a name="Page_392" id="Page_392">[392]</a></span>been +vaguely impressed in the transom glass when molten. When the mystery +was explained the excursions and the cures stopped.</p> + +<p>Nearly every physician and practically every medical charlatan can +count scores of cures of ailments that had previously defied the skill +of eminent physicians. A child's bumps actually stop aching after the +mother or nurse kisses the abused spot. Invalids forget their +limitations under stress of some great excitement or some intense +desire for pleasures incompatible with invalidism. Many a physician of +reputation owes his success in great part to the discriminating use of +the <i>placebo</i>,—a bread pill designed to supplant the patient's fear +with confidence. Hypnotism and "suggestion" have been successfully +used to cure alcoholism and to fill patients' minds with conviction +stronger than the fear that produced the sickness. A well-known writer +and preacher cures insomnia by auto-suggestion, telling himself he is +sleepy, is very sleepy, is going to sleep, is almost asleep, is fast +asleep. Treatment by osteopathy has been followed by disappearance of +diseases that cannot possibly be cured by osteopathy. Christian +Science has restored to health and happy usefulness hundreds of +thousands of chronic invalids. Verily is hygiene of the mind an +important factor in the civics of health.</p> + +<p>Fear can originate with mind. Fear produces fear. Fear disarranges +circulation of the blood and the nourishment of muscle and nerve. Fear +can produce many bodily disorders which in turn feed fear. Fear cannot +last unless bodily symptoms exist or arise to justify and feed it. +Fear can be cured and removed in two ways: (1) by driving away fear +and releasing bodily disorders from its thraldom; (2) by removing the +disorders and making fear impossible to the logical mind. An enforced +sea voyage begins with the disorder; a clever, buoyant physician +begins with the fear. Patent-medicine proprietors, quacks, and fakes +of every <span class='pagenum'><a name="Page_393" id="Page_393">[393]</a></span>kind begin by displacing the fear with hope or cheer; the +physical disorders frequently vanish by the same window as fear. For +<i>fear</i> write <i>self-pity</i>, <i>morbid self-consciousness</i>, <i>hypertrophied +submission</i>; to <i>hope</i> and <i>cheer</i> add <i>smile</i>, <i>relaxation</i>, and +<i>zest</i>; and we have the chief elements of mental hygiene and the +reason why intelligent as well as unintelligent men like to be +swindled by medical or other quacks.</p> + +<p>The social aspects of mental hygiene are particularly important. Once +admitting the power of the mind to decrease vitality, we recognize the +duty of seeming happy, buoyant, cheerful, vital, at least when with +others, for the sake of others' minds and bodies. Secondly, we find +the duty to refrain from commenting on others' appearance in a way +that will start "ingrowing thoughts." A "grouchy" foreman can give +blues and indigestion to a roomful of factory girls. A self-pitying +teacher can check the heart beats of her class, cause arteries and +lungs to contract, and deprive the brain of fresh blood. An +oversympathetic neighbor can put a strong man to bed by discovering +signs of nervous disintegration. Shall we gradually work out a code of +mental hygiene rights and nuisances that will require compulsory +notification of the "blues" and compulsory segregation of every person +unable to "smile dull care away"? Is the time coming when boards of +health will accompany infection leaflets with messages such as this +from James Whitcomb Riley:</p> + +<div class="poem"><div class="stanza"> +<span class="i0">Talk health. The dreary, never-changing tale<br /></span> +<span class="i0">Of mortal maladies is worn and stale.<br /></span> +<span class="i0">You cannot charm or interest or please<br /></span> +<span class="i0">By harping on that minor chord, disease.<br /></span> +</div><div class="stanza"> +<span class="i0">"Whatever the weather may be," says he,<br /></span> +<span class="i0">"Whatever the weather may be,<br /></span> +<span class="i0">It's the songs ye sing, and the smiles ye wear,<br /></span> +<span class="i0">That's a-making the sun shine everywhere."<br /></span> +</div></div> + +<p><span class='pagenum'><a name="Page_394" id="Page_394">[394]</a></span>Mental hygiene has hitherto enjoyed an evil reputation and has been +condemned to generally evil associations, because the rank and file +have been ignorant of hygiene of every kind. Medical science has so +long enveloped itself in mystery that it is in danger now of becoming +discredited and of falling heir to the mantle of quackery.</p> + +<p>Quacks often get social and economic results more agreeable to the +patient and more helpful to society than orthodox medicine. "When +traitors become numerous enough treason becomes respectable." So when +mental hygiene succeeds, it becomes science for the case in question, +and for that case orthodox medicine loses its respectability. For the +layman there is no safety except in having intelligence enough to know +whether his trouble has defied the sincere application of mental +treatment, auto-suggestion, and loyalty to the health ideal.</p> + +<p>Mental hygiene admits the existence of dental cavities, scarlet fever +germs, adenoids, cross-eyes, uncleanliness, broken legs, inflamed +eyes, overeating. The organic, structural defects which are to be +sought by physical examination are all admitted by mental hygienists. +They work for an orderly, daily routine and affirm the penalties of +its violation. They would even favor going periodically to a +physician, provided that we never go to him except when organic or +structural disorders may safely be assumed from the fact that cheer +and relaxation treatment does not give relief. Unhygienic living and +mind cure cannot go together. The mind that tries to deceive itself +cannot cure either mind or body. The man who violates the habits of +health cannot patch his injuries or conceal the ravages of dissipation +by mental hygiene. Here is the great advantage of knowing how to live +hygienically, of observing habits of health, and then concerning +ourselves not with ourselves, but with conditions of living for all +those whose health can be affected by our health, or can affect our +health and efficiency.</p> + +<p><span class='pagenum'><a name="Page_395" id="Page_395">[395]</a></span>The most recent practical application of mental hygiene for moral and +physical uplifting is the "moral clinic" or "psychotherapeutic" clinic +established by Emmanuel Church in Boston. This clinic represents the +union of three forces,—religion, medical diagnosis, mental hygiene. +As a result of this alliance it is anticipated that both religion and +medicine will be humanized, socialized, vitalized, made to express +more accurately and more consistently that community consciousness and +that yearning for equal opportunity and equal happiness which +constitute the profoundest religious impulse. No person is treated at +this moral clinic whose trouble is organic or structural. In +determining whether the case belongs to this clinic, expert medical +diagnosis is relied upon rather than the credulity of the patient or +the zeal of the clergyman. Medical scientists of highest repute can +consistently coöperate, because they recognize two scientific facts: +first, that many troubles are due primarily to mental disorder; and, +second, the greatest asset of the human mind is that something called +religion, which is no less real and potent because peculiar to each +individual. Whatever may be that deepest current of thought and +feeling, whatever that synthetic philosophy, that explanation of +being, which guides my life, it can be of inestimable aid if enlisted +in an effort to secure normal vitality of mind and body.</p> + +<p>The controlling motive of the moral clinic has proved infectious. +There is reason to believe that the alliance of medicine and religion +has come to stay, and that the present excitement over +psychotherapeutics will settle down into a scientific utilization of +religious motive and medical knowledge to prevent mental and moral +disease. Unwholesome, morbid, self-centered thought is driven out. A +recognition of others' claims takes its place. Hypnotism, suggestion, +and group enthusiasm are used to their utmost possibilities. The +success of the Boston moral clinic is due to establishing <span class='pagenum'><a name="Page_396" id="Page_396">[396]</a></span>in the mind +of the neurasthenic, the alcoholic, the world-weary, and the +purposeless a truer conception of the pleasures that result from +vitality and from altruistic effort.</p> + +<p>It is too early to classify by kind of functional disorder the +patients treated. Results from one patient have been described in +newspapers as follows:</p> + +<div class="block"><p>A school-teacher, as a result of nervous collapse, had lost +control, began to fear the children under her care, and thought of +relinquishing her profession. She was instructed in the art of +self-control and the control of others; the notion of fear was +dislodged and a sentiment of love for her little charges took its +place. In the course of a few weeks this conscientious and +experienced teacher regained her poise and found herself +performing her duties better than ever before.</p></div> + +<p>Many alcoholics have for months given evidences of complete cure. +Stories almost incredible are quickening pastor and physician alike +throughout the country. After individual treatments are given, after +religious motive is appealed to, and the soul stirred to heed the +lessons of religion, medicine, and sociology, patients are given the +work cure. Thus a branch of social service is established, where +after-treatment is given to the patient whose thoughts have been +turned from himself to others. All of a sudden the church finds itself +in need of definite knowledge as to opportunities for altruistic work, +as to definite community needs not met, as to people in distress who +can be relieved by volunteers, as to agencies which can be called upon +to coöperate both in treating the individual and in utilizing his +energies for others' benefits.</p> + +<p>Because a relatively small percentage of men and women are +neurasthenic, melancholy, morbid, alcoholic, the lesson of the moral +clinic is most serviceable when extended for the benefit of the "not +yet alcoholic" and the "not quite neurasthenic." In other words, +individuals in thinking of <span class='pagenum'><a name="Page_397" id="Page_397">[397]</a></span>themselves must learn the health value and +soul value of purpose that centers in others' happiness. That thing +which we have called tact in personality, and which in the past was +discovered by induction, namely, the law of mental hygiene and the +control it gives over others' health, must be taught in schools to +children by wholesale, must be taught in medical and theological +schools, to all physicians and all pastors. This alliance of medicine +and religion, which is at present confined to one or two moral +clinics, should be incorporated into education, into social work, into +church work, becoming thus a part of civilization's normal point of +view.</p> + +<p>Mental hygiene cannot survive conscious violation of the fundamental +laws of medicine and religion. The alliance of medicine and religion +will prove utterly futile unless habits of living and of thinking are +inculcated that conform to nature's law of self-preservation and to +God's law of brotherly love. Self-centered religion, like +self-centered medicine, destroys both body and soul.</p> + +<br /> +<hr style="width: 15%;" /> +<br /> + +<h4>FOOTNOTES:</h4> + +<div class="footnote"><p class="noin"><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> The alliance of mental hygiene, medicine, and religion +is discussed in the Emmanuel Church book, <i>Religion and Medicine; the +Moral Control of Nervous Disorders</i>; also in its bulletins, <i>Religion +and Medicine</i>.</p></div> + +<br /> +<br /> +<br /> +<br /> +<a name="CHAPTER_XLI" id="CHAPTER_XLI"></a><hr /> +<span class='pagenum'><a name="Page_398" id="Page_398">[398]</a></span><br /> + +<h3>CHAPTER XLI<span class="totoc"><a href="#toc">ToC</a></span></h3> + +<h4>"A NATURAL LAW IS AS SACRED AS A MORAL PRINCIPLE"</h4> +<br /> + +<p>When a grammar-school boy I learned from the game "Quotations" that +Louis Agassiz, scientist, had written the sentence with which I +introduce a final appeal for living that will permit physical and +civic efficiency. Agassiz has been called "America's greatest +educator," and again "the finest specimen yet discovered of the genus +<i>homo</i>, of the species <i>intelligens</i>." The story of his long life as +teacher of teachers reads like a romance. But among his gifts to +education and citizenship none can be made to mean more than the +simple proposition that natural law is as sacred as a moral principle. +All who remember this "beatitude" will be helped to solve many +perplexing problems of dress, diet, play, education, philanthropy, +morals, and civics.</p> + +<p>Reverence for the natural carries with it a distaste for the +unnatural. Those who obey natural law soon come to regard its +violation as a nuisance when not immoral. On the other hand, +compromise with the unnatural, like compromise with vice, quickly +leads first to toleration and thence to interest and practice. +Therefore the importance of giving children Agassiz's conception of +the sacredness of the laws that govern the human body. A passion for +the natural is a strong foundation for habits of health and a +priceless possession for one who wishes to know morality in its +highest sense.</p> + +<p>"Natural" is less attractive to us than it would be had Agassiz first +interpreted it for us rather than Rousseau or present-day exponents of +"the simple life," "back to nature," <span class='pagenum'><a name="Page_399" id="Page_399">[399]</a></span>and "back to the land." It is +too often forgotten that no one sins against natural law more +grievously than the primitive man or the isolated man in daily contact +with non-human nature. Communing with nature seems not only to require +communing with man but to give joys in proportion as the nature lover +is concerned for the human society of which he is a part. Natural law +does not become a moral principle until man is benefited or injured by +man's use of nature's resources within and about him. Natural living +according to natural law must be something sounder, more beautiful, +and more progressive than can be read into or out of mountains, trees, +brooks, and sky, or primitive society.</p> + +<p>Natural law points to a Nature Fore as well as a Nature Back, to a +Nature Up and Beyond as well as a Nature Down and Behind. The Nature +that was yesterday will not do for to-morrow, any more than a man is +willing to give up his nature aspirations for the careless, animal +ways of romping childhood. Civilization is constantly urged at each +step to repeat the prayer of Holmes's old man who dreams for the +Autocrat of the Breakfast Table:</p> + +<div class="poem"><div class="stanza"> +<span class="i0">Oh for one hour of youthful joy!<br /></span> +<span class="i2">Give back my twentieth spring!<br /></span> +<span class="i0">I'd rather laugh a bright-haired boy<br /></span> +<span class="i2">Than reign a gray-beard king!<br /></span> +</div><div class="stanza"> +<span class="i0">Off with the wrinkled spoils of age!<br /></span> +<span class="i2">Away with learning's crown!<br /></span> +<span class="i0">Tear out life's wisdom-written page,<br /></span> +<span class="i2">And dash its trophies down!<br /></span> +</div><div class="stanza"> +<span class="i0">One moment let my life blood stream<br /></span> +<span class="i2">From boyhood's fount of flame!<br /></span> +<span class="i0">Give me one giddy, reeling dream<br /></span> +<span class="i2">Of life all love and fame!<br /></span> +</div></div> + +<p class="noin">But every experiment in turning back exalts the present and the +future. Gifts as well as problems are seen to come <span class='pagenum'><a name="Page_400" id="Page_400">[400]</a></span>with complexity, +and civilization flatly refuses to relinquish these gifts. Sound +maturity is better than youth or age:</p> + +<div class="poem"><div class="stanza"> +<span class="i0">The smiling angel dropped his pen,—<br /></span> +<span class="i2">"Why, this will never do;<br /></span> +<span class="i0">The man would be a boy again,<br /></span> +<span class="i2">And be a father too!"<br /></span> +</div></div> + +<p>Problems of health and of civics can never be solved by appealing to +Nature Back, when only the few could be healthy, when one baby in +three died in infancy, when old age was toothless and childish, when +infection ravished nations, when the average life was twenty years +shorter than now, and when unspeakable filth was tolerated in air, +street, and house. They can all be solved by appeals to Nature Fore, +which holds up an ideal of mankind physically able to enjoy all the +benefits and to conquer all the dangers of civilization. It is not +looking back, but looking in and forward that reveals what natural law +promises to those who obey it.</p> + +<p>By using numerous tests which have been suggested in preceding +chapters we can learn how far we and our communities obey natural law +when working and playing. Health for health's sake has nowhere been +urged. On the contrary, healthful living has been frankly valued for +its aid to efficient living by individual and by community; wherefore +the emphasis upon others' health and upon the civic aspects of our own +health. Tests furnish us with the technic necessary to efficient +living; civics, with the larger reason; natural law, with the "pillar +of fire by night" to help us choose our path among habits and +pleasures whose immediate results upon efficient living cannot easily +be determined.</p> + +<p>Fashions, tastes, mannerisms, personal indulgences, have been left for +Agassiz to deal with. Generally speaking, we all know of numerous acts +committed and numerous acts <span class='pagenum'><a name="Page_401" id="Page_401">[401]</a></span>omitted in our daily routine that convict +us of not living up to our knowledge of physiology and +hygiene,—wearing tight shoes or tight corsets, drinking strong +coffee, smoking, reading while reclining, failing to insure clean air +and clean bodies. Then there are other acts whose omission or +commission violate no physical law so far as we can see, but whose +unnaturalness we concede,—putting chalk on the eyebrows, wearing +false hair or curious puffs, putting perfumery in the bath or on +handkerchiefs, assuming artificial poses of body or mouth. These +violations of natural law are forced upon us by "style" or "custom" or +family convenience. When we come to choose between following fashions +and disobeying them, we generally decide that it is better to do a +foolish or slightly harmful thing than to occasion criticism, mirth, +or even special notice by our dress or our abstemiousness.</p> + +<p>Last night I went to a dinner party at eight. I ate and ate a great +variety of palatable foods that Nature Back never knew. After two +hours of eating I imbibed for two hours the tobacco smoke of the +gentlemen who made up the party. I knew that eight o'clock was too +late for me to begin eating, that two hours was too long to eat, that +the tobacco of others was bad for my health and for to-day's +efficiency. All this I knew when I accepted the invitation to dinner. +I went with no intention of preventing others from smoking or of +lecturing my host or his chef or his guests for the unhygienic +practices of our day. Yet the physical ills were more than offset by +certain definite gains to the school children of New York that will +result from last night's meeting. Natural law was abated in part. But +I declined certain dishes that would not agree with me, helped myself +sparingly of many dishes, avoided tobacco and wines, and by a +three-mile walk in the open air, a bath, and a good long night's sleep +have almost recovered my right to talk of the sacredness of natural +law.</p> + +<p><span class='pagenum'><a name="Page_402" id="Page_402">[402]</a></span>Nature Back says I should not have gone to this dinner. But I was +compelled to go. I know I am going to others. I cannot do my work +unless I overdraw my current health account. Nature Fore tells me that +effective coöperation with others will frequently require me to eat at +the dinner hour of others, to retire at others' sleeping time, to wear +what others will approve, to violate natural law. But Nature Fore also +tells me how to build up a health reserve so that I can meet these +emergencies without endangering my health credit.</p> + +<p>Nature Back demands "dress reform." Nature Fore tells me that I can +march in step with my contemporaries without either attracting +attention or discrediting and affronting natural law. Passion for the +natural has effected numerous reforms in dress, diet, and social +habits, until commerce provides a natural adaptation of practically +every fashion. With regard to few things is it necessary to-day for +any one who reads magazines to do violence to bodily health for +fashion's sake. We may wear what we will, eat what we prefer, decline +what is unnatural for us, without inviting censure. The debauches of +those unfortunate people who live an unnatural, purposeless existence, +affect such a small number that their laws need not be considered +here. Natural law makes obedience to itself attractive; hence commerce +is rapidly learning to cater to distaste for the unnatural. With few +exceptions, only temporary concessions to unnatural living are +required in order to dress and act conventionally.</p> + +<p>Nature Back throws little light upon conditions necessary for modern +labor. It can do nothing but demand the abolition of the factory, the +big store, the tenement, the school. Nature Fore says we cannot +abolish the means of working out the highest forms of coöperation. But +we can make them compatible with natural living. We can modify +conditions so that earning a livelihood will not compel workers <span class='pagenum'><a name="Page_403" id="Page_403">[403]</a></span>to +violate natural law at any or all times. The greatest need of factory +and tenement reform is for parents and teachers to make a religion of +Nature Fore and to instill its principles in the minds of children. +Parents and teachers must live the natural before they can make +children love the natural. Parents and teachers cannot possibly be +natural in this day, cannot live or love natural law unless they know +the machinery by which their communities are combating conditions +prejudicial to health, morals, and civic efficiency.</p> + +<br /> +<br /> +<br /> +<span class='pagenum'><a name="Page_404" id="Page_404">[404]</a></span><br /> +<a name="INDEX" id="INDEX"></a><hr /> +<span class='pagenum'><a name="Page_405" id="Page_405">[405]</a></span><br /> + +<h3>INDEX<span class="totoc"><a href="#toc">ToC</a></span></h3> +<br /> + + +<ul><li>Adenoids. See <i>Mouth breathing</i></li> + +<li>Administration, health: + <ul class="nest"> + <li>steps in evolution, <a href="#Page_11">11-22</a>;</li> + <li>knowledge of needs, <a href="#Page_220">220</a>;</li> + <li>machinery, <a href="#Page_302">302-309</a>;</li> + <li>in combating alcoholism, <a href="#Page_362">362</a>;</li> + <li>departments of health: + <ul class="nest2"> +<li>(1) New York City, <a href="#Page_26">26</a>, <a href="#Page_27">27</a>, <a href="#Page_47">47</a>, <a href="#Page_48">48</a>, <a href="#Page_61">61</a>, <a href="#Page_71">71</a>, <a href="#Page_84">84</a>, <a href="#Page_296">296-298</a>, <a href="#Page_302">302</a>;</li> +<li>(2) general, <a href="#Page_265">265</a>, <a href="#Page_281">281</a></li> + </ul> + </li> + </ul> + </li> + +<li>Advertisements: + <ul class="nest"> + <li>motives for, <a href="#Page_8">8</a>;</li> + <li>for dental parlors, <a href="#Page_100">100</a>;</li> + <li>for consumptives, <a href="#Page_234">234</a>;</li> + <li>by physicians, <a href="#Page_281">281</a>;</li> + <li>educational, in newspapers and magazines, <a href="#Page_323">323</a>;</li> + <li>"no smoking" signs, <a href="#Page_365">365</a>;</li> + <li>of patent medicines, <a href="#Page_369">369</a>;</li> + <li>that promote health, <a href="#Page_378">378-383</a></li> + </ul> + </li> + +<li>Agassiz, Louis, <a href="#Page_398">398</a>, <a href="#Page_400">400</a></li> + +<li>Air, night, <a href="#Page_216">216</a>. + <ul class="nest"> + <li>See <i>Fresh air</i></li> + </ul> + </li> + +<li>Alcoholism, <a href="#Page_343">343-362</a>; + <ul class="nest"> + <li>compulsory instruction in, <a href="#Page_3">3</a>;</li> + <li>insurance companies against, <a href="#Page_7">7</a>;</li> + <li>disqualifies for railroad service, <a href="#Page_193">193</a>;</li> + <li>depletes vitality, <a href="#Page_201">201</a>;</li> + <li>results, <a href="#Page_209">209</a>;</li> + <li>Hartley's fight against, <a href="#Page_253">253</a>;</li> + <li>injures the tuberculous, <a href="#Page_274">274</a>;</li> + <li>ineffective ways of combating, <a href="#Page_343">343</a>;</li> + <li>incited by bad living conditions, <a href="#Page_348">348</a>;</li> + <li>injury to negroes, <a href="#Page_350">350</a>;</li> + <li>so-called moderate use, <a href="#Page_358">358</a>;</li> + <li>labor unions blacklist drunkards, <a href="#Page_361">361</a>;</li> + <li>social dangers, <a href="#Page_386">386</a>;</li> + <li>mental hygiene, <a href="#Page_392">392</a>, <a href="#Page_396">396</a></li> + </ul> + </li> + +<li>Animal sanitation, <a href="#Page_252">252</a>, <a href="#Page_260">260</a>, <a href="#Page_307">307</a></li> + +<li>Association for Improving the Condition of the Poor, New York, <a href="#Page_177">177</a>, <a href="#Page_236">236</a>, <a href="#Page_253">253</a><br /><br /></li> + +<li>Babies. See <i>Milk</i></li> + +<li>Bathing: + <ul class="nest"> + <li>motives for, <a href="#Page_8">8</a>, <a href="#Page_13">13</a>;</li> + <li>a social requirement, <a href="#Page_14">14</a>;</li> + <li>cold-water, <a href="#Page_214">214</a></li> + </ul> + </li> + +<li>Beauty, reason for health, <a href="#Page_15">15</a></li> + +<li>Bibliography: + <ul class="nest"> + <li>A Bureau of Child Hygiene (Bureau of Municipal Research), <a href="#Page_298">298</a>;</li> + <li>Annals of a Quiet Neighborhood (MacDonald), <a href="#Page_110">110</a>;</li> + <li>Aristocracy of Health (Henderson), <a href="#Page_208">208</a>;</li> + <li>Bitter Cry of the Children (Spargo), <a href="#Page_33">33</a>, <a href="#Page_167">167</a>;</li> + <li>Bulletins of Emmanuel Church, <a href="#Page_391">391</a>;</li> + <li>Bureau of Municipal Research, publications, <a href="#Page_298">298</a>;</li> + <li>Care of Dependent, Defective, and Delinquent Children (Folks), <a href="#Page_174">174</a>;</li> + <li>Charities and the Commons, <a href="#Page_325">325</a>;</li> + <li>Child Growth (Newsholme), <a href="#Page_120">120</a>;</li> + <li>Children of the Nation (Gorst), <a href="#Page_33">33</a>;</li> + <li>Children's Diseases, <a href="#Page_326">326</a>;</li> + <li>Clean Milk for New York City, <a href="#Page_255">255</a>; + <ul class="nest2"> + <li>clippings, <a href="#Page_370">370</a>, <a href="#Page_382">382</a>;</li> + <li>white-plague scrapbook, <a href="#Page_250">250</a>;</li> + </ul> + </li> + <li>Committee on Physical Welfare of School Children, programme, <a href="#Page_166">166</a>, + <ul class="nest2"> + <li>three studies, <a href="#Page_168">168</a>;</li> + </ul> + </li> + <li>Crusade against Tuberculosis (Flick), <a href="#Page_229">229</a>;</li> + <li>Dangerous Trades (Oliver), <a href="#Page_203">203</a>;</li> + <li>Dental Catechism, <a href="#Page_94">94</a>;</li> + <li>Dentistry, lectures and treatises, <a href="#Page_274">274</a>;</li> + <li>Deterioration, Physical, report on, <a href="#Page_339">339</a>;</li> + <li>Development of the Child (Oppenheimer), <a href="#Page_110">110</a>;</li> + <li>Dietetic and Hygienic Gazette, <a href="#Page_326">326</a>;</li> + <li>Efficient Life (Gulick), <a href="#Page_208">208</a>;</li> + <li>Environment of Child at School (North), <a href="#Page_142">142</a>; + <ul class="nest2"> + <li>Pure Food (U.S. Department of Agriculture), <a href="#Page_379">379</a>;</li> + </ul> + </li> + + <li>Good Health, <a href="#Page_326">326</a>;</li> + <li>Health of the School Child (Mackenzie), <a href="#Page_132">132</a>;</li> + <li>Heredity (Thompson), <a href="#Page_336">336</a>;</li> + <li>How to Give Wisely, <a href="#Page_355">355</a>;</li> + <li>International Congress, Tuberculosis, programme, <a href="#Page_246">246-249</a>;</li> + <li>Journal of Nursing, <a href="#Page_326">326</a>;</li> + <li>Making a Municipal Budget (Bureau of Municipal Research), <a href="#Page_306">306</a>;</li> + <li>Milk Industry, <a href="#Page_252">252</a>;</li> + <li>Municipal Sanitation in the United States (Chapin), <a href="#Page_304">304</a>;</li> + <li>National Hospital Record, <a href="#Page_326">326</a>;</li> + <li>New Basis of Civilization (Patten), <a href="#Page_33">33</a>;</li> + <li>New Jersey Review of Charities and Corrections, <a href="#Page_325">325</a>;</li> + <li>Pediatrics, <a href="#Page_326">326</a>;</li> + <li>Physical Culture, <a href="#Page_326">326</a>;</li> + <li>Poverty (Hunter), <a href="#Page_167">167</a>; + <ul class="nest2"> + <li>press and magazines, <a href="#Page_322">322-328</a>;</li> + </ul> + </li> + + <li>Prevention of Tuberculosis (Newsholme), <a href="#Page_229">229</a>;</li> + <li>Principles of Relief (Devine), <a href="#Page_174">174</a>;</li> + <li>Principles of Sanitary Science and the Public Health (Sedgwick), <a href="#Page_304">304</a>;<span class='pagenum'><a name="Page_406" id="Page_406">[406]</a></span></li> + <li>Psychological Clinic, <a href="#Page_106">106</a>, <a href="#Page_326">326</a>, <a href="#Page_330">330</a>;</li> + <li>Real Triumph of Japan (Seaman), <a href="#Page_23">23</a>;</li> + <li>Religion and Medicine (Emmanuel Church), <a href="#Page_391">391</a>;</li> + <li>reports of schools, <a href="#Page_166">166</a>;</li> + <li>reports of schools and health, <a href="#Page_310">310-321</a>;</li> + <li>reports of institutions and societies, <a href="#Page_327">327</a>;</li> + <li>reports of state and national conferences of charities and corrections, <a href="#Page_327">327</a>;</li> + <li>reports of United States bureau of labor, <a href="#Page_203">203</a>;</li> + <li>Sanitation of Public Buildings (Gerhard), <a href="#Page_139">139</a>;</li> + <li>School Reports and School Efficiency (Snedden and Allen), <a href="#Page_311">311</a>;</li> + <li>Social Order and the Saloon (Fox), <a href="#Page_351">351</a>;</li> + <li>Study of Children and their School Training (Warner), <a href="#Page_110">110</a>;</li> + <li>Study of School Buildings in New York City, <a href="#Page_289">289</a>;</li> + <li>Teeth and their Care (Hyatt), <a href="#Page_94">94</a>;</li> + <li>Training of the Human Plant (Burbank), <a href="#Page_120">120</a>;</li> + <li>Typhoid Fever (Whipple), <a href="#Page_13">13</a>, <a href="#Page_16">16</a>;</li> + <li>Uncommercial Traveller (Dickens), <a href="#Page_46">46</a>;</li> + <li>Unconscious Mind (Schofield), <a href="#Page_110">110</a>;</li> + <li>Vital Statistics (Newsholme), <a href="#Page_131">131</a></li> + </ul> + </li> + +<li>Biggs, Hermann M., M.D., <a href="#Page_237">237</a>, <a href="#Page_251">251</a>, <a href="#Page_271">271</a>, <a href="#Page_274">274</a>, <a href="#Page_295">295</a></li> + +<li>Boston, <a href="#Page_34">34</a>, <a href="#Page_155">155</a>, <a href="#Page_161">161</a>, <a href="#Page_241">241</a>, <a href="#Page_250">250</a>, <a href="#Page_290">290</a>, <a href="#Page_395">395</a></li> + +<li>Boston Society for the Relief and Study of Tuberculosis, <a href="#Page_155">155</a></li> + +<li>Boyd, Emma Garrett, <a href="#Page_355">355</a></li> + +<li>Brannan, John Winters, M.D., <a href="#Page_240">240</a></li> + +<li>Breath, bad, <a href="#Page_360">360</a>, <a href="#Page_379">379</a></li> + +<li>Brightness, abnormal, <a href="#Page_104">104-106</a></li> + +<li>Bronchitis, <a href="#Page_67">67</a></li> + +<li>Brookline, <a href="#Page_34">34</a></li> + +<li>Budget: + <ul class="nest"> + <li>should provide for cleansing, <a href="#Page_61">61</a>;</li> + <li>and tuberculosis, <a href="#Page_237">237</a>;</li> + <li>annual health programme, <a href="#Page_306">306</a>;</li> + <li>reforms in New York City, <a href="#Page_350">350</a></li> + </ul> + </li> + +<li>Burbank, Luther, <a href="#Page_120">120</a></li> + +<li>Bureau of Municipal Research, <a href="#Page_298">298</a>, <a href="#Page_306">306</a></li> + +<li>Butler, Nicholas Murray, LL.D., <a href="#Page_330">330</a>, <a href="#Page_332">332</a><br /><br /></li> + + +<li>Cabot, Richard C., M.D., <a href="#Page_181">181</a></li> + +<li>Calmette's Eye Test, <a href="#Page_238">238</a></li> + +<li>Carnegie Foundation, <a href="#Page_285">285</a></li> + +<li>Caroline Rest, <a href="#Page_70">70</a>, <a href="#Page_267">267</a></li> + +<li>Catching diseases: + <ul class="nest"> + <li>cost of, <a href="#Page_16">16</a>;</li> + <li>unenforced laws, <a href="#Page_30">30</a>;</li> + <li>steps in eradicating, <a href="#Page_31">31</a>;</li> + <li>germ sociology, <a href="#Page_57">57</a>, <a href="#Page_71">71</a>;</li> + <li>favorable soil at school, <a href="#Page_58">58</a>;</li> + <li>instruction concerning, <a href="#Page_62">62</a>;</li> + <li>mouth a breeding ground for, <a href="#Page_63">63</a>;</li> + <li>information for bathers, <a href="#Page_64">64</a>;</li> + <li>dangers of, <a href="#Page_131">131</a>;</li> + <li>reasons for national board of health, <a href="#Page_135">135</a>;</li> + <li>cost of, in New York City, <a href="#Page_272">272</a>;</li> + <li>remedies urged, <a href="#Page_384">384</a></li> + </ul> + </li> + +<li>Charity Organization Society, New York, <a href="#Page_236">236</a>, <a href="#Page_239">239</a></li> + +<li>Chicago, <a href="#Page_34">34</a></li> + +<li>Chicken-pox, <a href="#Page_64">64</a></li> + +<li>Child Hygiene, Bureau of: + <ul class="nest"> + <li>working-paper tests, <a href="#Page_192">192</a>;</li> + <li>established, New York City, <a href="#Page_298">298</a>;</li> + <li>programme, <a href="#Page_299">299</a></li> + </ul> + </li> + +<li>Child labor: + <ul class="nest"> + <li>compulsory school attendance, <a href="#Page_140">140</a>;</li> + <li>welfare or age test, <a href="#Page_142">142</a>;</li> + <li>movement's limitations, <a href="#Page_185">185</a>;</li> + <li>national and local committees, <a href="#Page_33">33</a>, <a href="#Page_192">192</a>;</li> + <li>physical-fitness tests, <a href="#Page_194">194</a></li> + </ul> + </li> + +<li>Children's Aid Society, New York, <a href="#Page_56">56</a>, <a href="#Page_93">93</a></li> + +<li>Child-saving agencies: + <ul class="nest"> + <li>coöperation with schools, <a href="#Page_174">174-183</a>;</li> + <li>do-nothingism in, <a href="#Page_332">332</a></li> + </ul> + </li> + +<li>Chorea. See <i>Nervousness</i></li> + +<li>Christian Science, <a href="#Page_276">276</a>, <a href="#Page_392">392</a></li> + +<li>Christmas shopping, <a href="#Page_227">227</a></li> + +<li>Cigarettes. See <i>Tobacco</i></li> + +<li>Cincinnati, <a href="#Page_118">118</a></li> + +<li>Cleanliness: + <ul class="nest"> + <li>acquired taste, <a href="#Page_14">14</a>;</li> + <li>beauty of, <a href="#Page_96">96</a>;</li> + <li>personal uncleanliness, <a href="#Page_210">210</a>;</li> + <li>cost of, <a href="#Page_216">216</a>;</li> + <li>dry cleaning dangerous, <a href="#Page_244">244</a>;</li> + <li>in fighting tuberculosis, <a href="#Page_250">250</a></li> + </ul> + </li> + +<li>Cleveland, Ohio, <a href="#Page_294">294</a></li> + +<li>Clippings: + <ul class="nest"> + <li>scrapbook, <a href="#Page_250">250</a>;</li> + <li>envelope method, <a href="#Page_324">324</a>;</li> + <li>advertisements, <a href="#Page_382">382</a></li> + </ul> + </li> + +<li>Coffee, strong, <a href="#Page_401">401</a></li> + +<li>Colds, <a href="#Page_63">63-69</a></li> + +<li>College, physical tests, <a href="#Page_39">39</a></li> + +<li>Committee on Physical Welfare of School Children, New York, <a href="#Page_39">39-41</a>, <a href="#Page_166">166</a>, <a href="#Page_168">168</a>, <a href="#Page_178">178</a>, <a href="#Page_286">286</a>, <a href="#Page_290">290</a>, <a href="#Page_311">311</a></li> + +<li>Compulsory laws: + <ul class="nest"> + <li>school hygiene, <a href="#Page_3">3</a>;</li> + <li>purpose of, <a href="#Page_33">33</a>;</li> + <li>registration of catching diseases, <a href="#Page_57">57</a>;</li> + <li>removal of tuberculosis cases, <a href="#Page_237">237</a>;</li> + <li>notification of tuberculosis, <a href="#Page_237">237</a>, <a href="#Page_274">274</a>;</li> + <li>hygiene, for private schools, <a href="#Page_283">283</a>;</li> + <li>to remove physical defects, <a href="#Page_288">288</a>;<span class='pagenum'><a name="Page_407" id="Page_407">[407]</a></span></li> + <li>restricting alcoholism, <a href="#Page_343">343</a></li> + </ul> + </li> + +<li>Conference on Summer Care of Babies, New York, <a href="#Page_260">260</a></li> + +<li>Congestion: + <ul class="nest"> + <li>evils avoided, <a href="#Page_290">290</a>;</li> + <li>and alcoholism, <a href="#Page_348">348</a></li> + </ul> + </li> + +<li>Conjunctivitis, <a href="#Page_71">71</a>. See <i>Eyes</i></li> + +<li>Connecticut's school reports, <a href="#Page_318">318</a></li> + +<li>Constipation, <a href="#Page_210">210</a>, <a href="#Page_216">216</a>, <a href="#Page_347">347</a>, <a href="#Page_357">357</a></li> + +<li>Consumption. See <i>Tuberculosis</i></li> + +<li>Corsets, <a href="#Page_381">381</a>, <a href="#Page_401">401</a></li> + +<li>Cost: + <ul class="nest"> + <li>of preventable diseases, <a href="#Page_16">16</a>;</li> + <li>of bad breath, <a href="#Page_98">98</a>;</li> + <li>of diseases to nation, <a href="#Page_135">135</a>;</li> + <li>of tuberculosis, <a href="#Page_245">245</a></li> + </ul> + </li> + +<li>Crampton, C. Ward, M.D., <a href="#Page_129">129</a>, <a href="#Page_289">289</a><br /><br /></li> + + +<li>Dangerous trades, <a href="#Page_191">191</a></li> + +<li>Darlington, Thomas, M.D., <a href="#Page_297">297</a></li> + +<li>Death rates: + <ul class="nest"> + <li>of bronchitis, <a href="#Page_67">67</a>;</li> + <li>of pneumonia, <a href="#Page_67">67</a>;</li> + <li>how to reduce, <a href="#Page_131">131</a></li> + </ul> + </li> + +<li>Defects, physical: + <ul class="nest"> + <li>index of community needs, <a href="#Page_33">33-44</a>;</li> + <li>removable, of children, <a href="#Page_22">22</a>;</li> + <li>schools manufacture, <a href="#Page_139">139</a>;</li> + <li>income distribution, <a href="#Page_169">169</a></li> + </ul> + </li> + +<li>Delinquency, and mouth breathing, <a href="#Page_47">47</a></li> + +<li>Dental Hygiene Council, <a href="#Page_95">95</a></li> + +<li>Dental sanitation, <a href="#Page_89">89-103</a>; + <ul class="nest"> + <li>surface for breeding germs, <a href="#Page_63">63</a>;</li> + <li>dentists, <a href="#Page_93">93</a>;</li> + <li>state organizations, <a href="#Page_95">95</a>;</li> + <li>clinics needed, <a href="#Page_171">171</a>;</li> + <li>insurance companies treat teeth, <a href="#Page_204">204</a>;</li> + <li>family instruction, <a href="#Page_245">245</a>;</li> + <li>indigestion, <a href="#Page_272">272</a>;</li> + <li>early treatises, <a href="#Page_274">274</a>;</li> + <li>advertising parlors, <a href="#Page_281">281</a></li> + </ul> + </li> + +<li>Devine, Professor Edward T., <a href="#Page_174">174</a></li> + +<li>Diet: + <ul class="nest"> + <li>cooking lessons at home, <a href="#Page_180">180</a>;</li> + <li>overeating, <a href="#Page_201">201</a>, <a href="#Page_347">347</a>;</li> + <li>improper, <a href="#Page_210">210</a>;</li> + <li>proper and regular, <a href="#Page_212">212</a>;</li> + <li>adapted to need, <a href="#Page_214">214</a>, <a href="#Page_401">401</a>;</li> + <li>kitchens, <a href="#Page_267">267</a>;</li> + <li>irregular eating, <a href="#Page_272">272</a>, <a href="#Page_347">347</a></li> + </ul> + </li> + +<li>Diet kitchens, <a href="#Page_267">267</a></li> + +<li>Diphtheria, <a href="#Page_18">18</a>, <a href="#Page_65">65</a></li> + +<li>Dispensaries and hospitals: + <ul class="nest"> + <li>dental supervision, <a href="#Page_102">102</a>;</li> + <li>coöperate with schools, <a href="#Page_174">174-183</a>, <a href="#Page_185">185</a>;</li> + <li>welfare nurse, <a href="#Page_188">188</a>;</li> + <li>emergency, <a href="#Page_227">227</a>;</li> + <li>to prevent duplication, <a href="#Page_239">239</a>;</li> + <li>lack of, <a href="#Page_240">240</a>;</li> + <li>teach baby feeding, <a href="#Page_261">261</a>;</li> + <li>inefficient, <a href="#Page_278">278</a>;</li> + <li>social interest of, <a href="#Page_292">292</a></li> + </ul> + </li> + +<li>Doing things at school, <a href="#Page_159">159-165</a>; + <ul class="nest"> + <li>free meals, <a href="#Page_44">44</a>, <a href="#Page_161">161</a>, <a href="#Page_171">171</a>;</li> + <li>may hurt, <a href="#Page_181">181</a>;</li> + <li>cripple social agencies, <a href="#Page_185">185</a>, <a href="#Page_189">189</a>;</li> + <li>danger of malpractice, <a href="#Page_184">184</a>, <a href="#Page_189">189</a>;</li> + <li>analogous to model tenements, <a href="#Page_186">186</a></li> + </ul> + </li> + +<li>Do-nothing ailments, <a href="#Page_329">329-334</a><br /><br /></li> + + +<li>Ear trouble, <a href="#Page_83">83-85</a>; + <ul class="nest"> + <li>periodic tests for, <a href="#Page_201">201</a>, <a href="#Page_207">207</a></li> + </ul> + </li> + +<li>Edinburgh, <a href="#Page_70">70</a></li> + +<li>Ellis Island, <a href="#Page_238">238</a></li> + +<li>Environment: + <ul class="nest"> + <li>health problem, <a href="#Page_9">9</a>;</li> + <li>tests, <a href="#Page_120">120</a>, <a href="#Page_320">320</a>;</li> + <li>injurious school, <a href="#Page_139">139-150</a>;</li> + <li>effect on physique, <a href="#Page_203">203</a>;</li> + <li>and tuberculosis, <a href="#Page_229">229-251</a>;</li> + <li>do-nothing ailments, <a href="#Page_329">329</a>;</li> + <li>within our control, <a href="#Page_336">336</a>;</li> + <li>in combating liquor, <a href="#Page_362">362</a></li> + </ul> + </li> + +<li>Epidemics, <a href="#Page_18">18</a>, <a href="#Page_38">38</a></li> + +<li>Epilepsy, <a href="#Page_47">47</a>, <a href="#Page_49">49</a></li> + +<li>Ergograph, <a href="#Page_125">125-127</a></li> + +<li>Erysipelas, <a href="#Page_65">65</a></li> + +<li>Ethics, professional, <a href="#Page_81">81</a>, <a href="#Page_101">101</a>, <a href="#Page_281">281</a></li> + +<li>Eugenics, and heredity, <a href="#Page_336">336</a></li> + +<li>European remedies, <a href="#Page_159">159-165</a></li> + +<li>Eye trouble, <a href="#Page_72">72-82</a>; + <ul class="nest"> + <li>in high school, <a href="#Page_40">40</a>;</li> + <li>catching diseases, <a href="#Page_69">69-71</a>;</li> + <li>caused by bad teeth, <a href="#Page_89">89</a>;</li> + <li>eyeglasses, free, <a href="#Page_161">161</a>, <a href="#Page_164">164</a>, <a href="#Page_171">171</a>, <a href="#Page_184">184</a>;</li> + <li>in business, <a href="#Page_193">193</a>;</li> + <li>examination for adults, <a href="#Page_201">201</a>;</li> + <li>tuberculin test, <a href="#Page_238">238</a>;</li> + <li>inefficient inspection of, <a href="#Page_300">300</a>;</li> + <li>teachers' test, <a href="#Page_301">301</a></li> + </ul> + </li> + +<li>Examination, physical: + <ul class="nest"> + <li>of school children, <a href="#Page_33">33-138</a>;</li> + <li>best test of health needs, <a href="#Page_33">33-44</a>;</li> + <li>individual record of, <a href="#Page_35">35</a>, <a href="#Page_312">312</a>;</li> + <li>Snellen test, <a href="#Page_73">73</a>, <a href="#Page_77">77</a>;</li> + <li>of teachers, <a href="#Page_153">153</a>;</li> + <li>for work certificates, <a href="#Page_190">190-200</a>, <a href="#Page_237">237</a>, <a href="#Page_301">301</a>;</li> + <li>by railroads, <a href="#Page_193">193</a>;</li> + <li>at West Point, <a href="#Page_199">199</a>;</li> + <li>periodic after school, <a href="#Page_201">201-207</a>, <a href="#Page_218">218</a>, <a href="#Page_228">228</a>;</li> + <li>semi-annual, <a href="#Page_202">202</a>;</li> + <li>tuberculin tests, <a href="#Page_240">240</a>;</li> + <li>stripped, at Leipsic, <a href="#Page_289">289</a>;</li> + <li>follow-up work, <a href="#Page_295">295-300</a>;</li> + <li>of teachers and sex hygiene, <a href="#Page_389">389</a><br /><br /></li> + </ul> + </li> + + +<li>Family: + <ul class="nest"> + <li>unit of social treatment, <a href="#Page_174">174</a>;</li> + <li>examining parties, <a href="#Page_237">237</a>, <a href="#Page_241">241</a>;</li> + <li>tuberculosis histories, <a href="#Page_241">241</a></li> + </ul> + </li> + +<li>Fear and bodily disorders, <a href="#Page_392">392</a></li> + +<li>Flick, Lawrence F., M.D., <a href="#Page_229">229</a></li> + +<li>Follow-up work, <a href="#Page_295">295-301</a></li> + +<li>Fox, Hugh F., <a href="#Page_351">351</a></li> + +<li>Fresh air: + <ul class="nest"> + <li>others' standards of, <a href="#Page_9">9</a>;</li> + <li>fiends, <a href="#Page_66">66</a>;</li> + <li>outings, <a href="#Page_176">176</a>, <a href="#Page_178">178</a>;</li> + <li>economic value of, <a href="#Page_195">195</a>;<span class='pagenum'><a name="Page_408" id="Page_408">[408]</a></span></li> + <li>ventilation at school, <a href="#Page_142">142</a>;</li> + <li>ventilation at home, <a href="#Page_210">210</a>;</li> + <li>ventilation at work, <a href="#Page_212">212</a>;</li> + <li>ventilation at sanatoriums, <a href="#Page_214">214</a>;</li> + <li>ventilation at churches and theaters, <a href="#Page_217">217</a>.</li> + <li>See <i>Air</i><br /><br /></li> + </ul> + </li> + + +<li>Georgia, <a href="#Page_350">350</a></li> + +<li>Germany, <a href="#Page_160">160</a>, <a href="#Page_204">204</a></li> + +<li>Germs, disease: + <ul class="nest"> + <li>in milk bottles, <a href="#Page_14">14</a>;</li> + <li>isolation, <a href="#Page_31">31</a>;</li> + <li>germ sociology, <a href="#Page_57">57-71</a>;</li> + <li>dental sanitation, <a href="#Page_89">89-103</a>;</li> + <li>locating germ factories, <a href="#Page_238">238</a>;</li> + <li>tuberculosis, <a href="#Page_234">234</a></li> + </ul> + </li> + +<li>Getting things done, <a href="#Page_166">166-173</a>; + <ul class="nest"> + <li>doing of highest kind, <a href="#Page_183">183</a>;</li> + <li>study underlying causes, <a href="#Page_189">189</a>;</li> + <li>by local agencies, <a href="#Page_287">287</a></li> + </ul> + </li> + +<li>Glands, <a href="#Page_88">88</a></li> + +<li>Goler, George W., M.D., <a href="#Page_196">196</a></li> + +<li>Gorgas, William C., M.D., <a href="#Page_59">59</a></li> + +<li>Government. See <i>Administration</i></li> + +<li>Greenwich House, <a href="#Page_287">287</a></li> + +<li>Grenfell Association, <a href="#Page_197">197</a></li> + +<li>Grippe, <a href="#Page_379">379</a></li> + +<li>Gulick, Luther H., M.D., <a href="#Page_123">123</a>, <a href="#Page_208">208</a><br /><br /></li> + + +<li>Habits of health, <a href="#Page_208">208-217</a>; + <ul class="nest"> + <li>combat tobacco, <a href="#Page_364">364</a>;</li> + <li>mental hygiene, <a href="#Page_394">394</a>;</li> + <li>and Nature Fore, <a href="#Page_400">400</a></li> + </ul> + </li> + +<li>Hartley House, <a href="#Page_287">287</a></li> + +<li>Hartley, Robert M., <a href="#Page_252">252</a></li> + +<li>Havana, <a href="#Page_60">60</a></li> + +<li>Hawthorne Club, <a href="#Page_287">287</a></li> + +<li>Headache, <a href="#Page_210">210</a></li> + +<li>Heredity, <a href="#Page_335">335-342</a></li> + +<li>High schools need physical tests, <a href="#Page_39">39</a></li> + +<li>Hip trouble. See <i>Tuberculosis</i></li> + +<li>Home conditions: + <ul class="nest"> + <li>indexed by epidemics, <a href="#Page_32">32</a>;</li> + <li>indexed at school, <a href="#Page_33">33</a>;</li> + <li>among different incomes, <a href="#Page_39">39</a>;</li> + <li>cooking instructions, <a href="#Page_180">180</a>;</li> + <li>weighing parties, <a href="#Page_241">241</a>;</li> + <li>score card, <a href="#Page_337">337</a>;</li> + <li>promote alcoholism, <a href="#Page_348">348</a></li> + </ul> + </li> + +<li>Hughes, Governor Charles E., <a href="#Page_201">201</a></li> + +<li>Hunter, Robert, <a href="#Page_167">167</a></li> + +<li>Hyatt, Thaddeus P., D.D.S., <a href="#Page_94">94</a><br /><br /></li> + + +<li>Impetigo, <a href="#Page_65">65</a></li> + +<li>Income, <a href="#Page_34">34</a>, <a href="#Page_38">38</a>, <a href="#Page_39">39</a></li> + +<li>India, <a href="#Page_108">108</a></li> + +<li>Indigestion: + <ul class="nest"> + <li>anti-social, <a href="#Page_10">10</a>;</li> + <li>due to teeth, <a href="#Page_272">272</a></li> + </ul> + </li> + +<li>Individual record card, <a href="#Page_35">35</a>, <a href="#Page_312">312-314</a></li> + +<li>Industrial hygiene: + <ul class="nest"> + <li>educates laborers, <a href="#Page_131">131</a>;</li> + <li>factory conditions, <a href="#Page_221">221</a>, <a href="#Page_227">227</a>;</li> + <li>factory reforms, <a href="#Page_403">403</a>;</li> + <li>employers, <a href="#Page_3">3</a>, <a href="#Page_210">210</a>, <a href="#Page_218">218</a>, <a href="#Page_360">360</a>, <a href="#Page_367">367</a>;</li> + <li>employees, <a href="#Page_202">202</a>, <a href="#Page_211">211</a>, <a href="#Page_219">219</a>, <a href="#Page_228">228</a>, <a href="#Page_360">360</a></li> + </ul> + </li> + +<li>Influenza, <a href="#Page_65">65-68</a></li> + +<li>Ingram, Helene, <a href="#Page_177">177</a></li> + +<li>Insomnia, <a href="#Page_392">392</a></li> + +<li>Inspection: + <ul class="nest"> + <li>of milk, <a href="#Page_26">26</a>, <a href="#Page_259">259</a>;</li> + <li>score cards, <a href="#Page_27">27</a>, <a href="#Page_29">29</a>, <a href="#Page_337">337</a>;</li> + <li>of school children, <a href="#Page_43">43</a>, <a href="#Page_61">61</a>, <a href="#Page_296">296</a>;</li> + <li>of factories, <a href="#Page_131">131</a>;</li> + <li>of milch cows, <a href="#Page_260">260</a>;</li> + <li>of transmissible diseases, <a href="#Page_295">295</a>;</li> + <li>of foods, <a href="#Page_307">307</a></li> + </ul> + </li> + +<li>Instinct, motive to health, <a href="#Page_12">12</a>, <a href="#Page_14">14</a>, <a href="#Page_94">94</a></li> + +<li>International Congress on tuberculosis, <a href="#Page_238">238</a>, <a href="#Page_245">245</a></li> + +<li>Itch, <a href="#Page_65">65</a><br /><br /></li> + + +<li>Japan, <a href="#Page_23">23</a>, <a href="#Page_287">287</a>, <a href="#Page_309">309</a></li> + +<li>Junior Sea Breeze, <a href="#Page_267">267</a><br /><br /></li> + + +<li>Kansas City, <a href="#Page_161">161</a></li> + +<li>Kidney trouble, <a href="#Page_217">217</a><br /><br /></li> + + +<li>Labrador, <a href="#Page_197">197</a></li> + +<li>Lavatories, public, <a href="#Page_217">217</a></li> + +<li>Laws: + <ul class="nest"> + <li>nonenforcement demoralizing, <a href="#Page_4">4</a>;</li> + <li>define rights, <a href="#Page_23">23</a>;</li> + <li>when not enforced, <a href="#Page_25">25</a>;</li> + <li>should not injure health, <a href="#Page_151">151</a>;</li> + <li>enforcement better than character, <a href="#Page_219">219</a>;</li> + <li>regarding milk, <a href="#Page_258">258</a>;</li> + <li>licensing practitioners, <a href="#Page_280">280</a>;</li> + <li>need machinery, <a href="#Page_303">303</a>, <a href="#Page_348">348</a>;</li> + <li>to control liquor, <a href="#Page_343">343</a>, <a href="#Page_355">355</a>;</li> + <li>test of prohibition, <a href="#Page_353">353</a>;</li> + <li>on patent medicine, <a href="#Page_373">373</a>;</li> + <li>on pure foods, <a href="#Page_379">379</a></li> + </ul> + </li> + +<li>Leipsic, <a href="#Page_289">289</a></li> + +<li>Louisiana, <a href="#Page_350">350</a>, <a href="#Page_376">376</a></li> + +<li>Lung trouble. See <i>Tuberculosis</i><br /><br /></li> + + +<li>Machinery, health: + <ul class="nest"> + <li>unsatisfactory coordination, <a href="#Page_296">296</a>;</li> + <li>necessary, <a href="#Page_302">302-309</a>;</li> + <li>five elements, <a href="#Page_303">303</a></li> + </ul> + </li> + +<li>Mackenzie, W. Leslie, M.D., <a href="#Page_132">132</a></li> + +<li>Magistrates: + <ul class="nest"> + <li>promote disorder, <a href="#Page_173">173</a>;</li> + <li>enforce health laws, <a href="#Page_303">303</a></li> + </ul> + </li> + +<li>Malnutrition, <a href="#Page_35">35</a>; + <ul class="nest"> + <li>income distribution, <a href="#Page_39">39</a>;</li> + <li>signs and tests, <a href="#Page_86">86</a>;</li> + <li>prevention of, <a href="#Page_184">184</a>;</li> + <li>education of family, <a href="#Page_241">241</a></li> + </ul> + </li> + +<li>Massachusetts, <a href="#Page_74">74</a></li> + +<li>Maxwell, Superintendent William H., <a href="#Page_286">286</a>, <a href="#Page_288">288</a><span class='pagenum'><a name="Page_409" id="Page_409">[409]</a></span></li> + +<li>Measles, <a href="#Page_64">64</a></li> + +<li>Mental hygiene, <a href="#Page_391">391-397</a>; + <ul class="nest"> + <li>blues, anti-social, <a href="#Page_10">10</a>;</li> + <li>hospital welfare work, <a href="#Page_182">182</a>;</li> + <li>moral clinics, <a href="#Page_276">276</a>, <a href="#Page_291">291</a>, <a href="#Page_295">295</a>;</li> + <li>and insomnia, <a href="#Page_392">392</a></li> + </ul> + </li> + +<li>Meyer, William, M.D., <a href="#Page_47">47</a></li> + +<li>Milk: + <ul class="nest"> + <li>unclean dairies, <a href="#Page_10">10</a>;</li> + <li>scalding receptacles of, <a href="#Page_17">17</a>;</li> + <li>carries typhoid, <a href="#Page_18">18</a>;</li> + <li>inspector's outfit, <a href="#Page_24">24</a>;</li> + <li>tests of protection, <a href="#Page_25">25</a>;</li> + <li>score cards, <a href="#Page_26">26</a>, <a href="#Page_259">259</a>, <a href="#Page_337">337</a>;</li> + <li>public should know, <a href="#Page_219">219</a>;</li> + <li>fight for pure, <a href="#Page_252">252-267</a>;</li> + <li>New York conferences, <a href="#Page_255">255</a>, <a href="#Page_260">260</a>;</li> + <li>breast feeding, <a href="#Page_266">266</a></li> + </ul> + </li> + +<li>Milk committee, New York, <a href="#Page_258">258</a>, <a href="#Page_260">260</a></li> + +<li>Minnesota, <a href="#Page_45">45</a>, <a href="#Page_269">269</a></li> + +<li>Misgovernment causes sickness, <a href="#Page_10">10</a></li> + +<li>Mitchell, S. Weir, M.D., <a href="#Page_73">73</a></li> + +<li>Montclair, <a href="#Page_265">265</a></li> + +<li>Mosquitoes, <a href="#Page_59">59</a>, <a href="#Page_307">307</a></li> + +<li>Motives, seven health, <a href="#Page_11">11-22</a>, <a href="#Page_377">377</a></li> + +<li>Mouth breathing, <a href="#Page_45">45-56</a>; + <ul class="nest"> + <li>and delinquency, <a href="#Page_47">47</a>;</li> + <li>adenoid parties, <a href="#Page_55">55</a>;</li> + <li>causes deafness, <a href="#Page_83">83</a>;</li> + <li>injures baby teeth, <a href="#Page_89">89</a>;</li> + <li>industrial disadvantage of, <a href="#Page_195">195</a>;</li> + <li>in Labrador, <a href="#Page_197">197</a>;</li> + <li>preventable defect, <a href="#Page_272">272</a>;</li> + <li>inefficient inspection of, <a href="#Page_300">300</a><br /><br /></li> + </ul> + </li> + + +<li>National Association for the Study and Prevention of Tuberculosis, <a href="#Page_236">236</a>, <a href="#Page_246">246</a></li> + +<li>National Board of Health, <a href="#Page_133">133</a>, <a href="#Page_292">292</a>, <a href="#Page_308">308</a></li> + +<li>National Bureau of Labor, <a href="#Page_199">199</a></li> + +<li>National Bureau of Census, <a href="#Page_305">305</a></li> + +<li>National Bureau of Animal Industry, <a href="#Page_306">306</a></li> + +<li>National Bureau of Education, <a href="#Page_171">171</a>, <a href="#Page_292">292</a></li> + +<li>National Playground Association, <a href="#Page_118">118</a></li> + +<li>National School Hygiene Association, <a href="#Page_139">139</a></li> + +<li>Nature Fore and Nature Back, <a href="#Page_398">398-403</a></li> + +<li>Negroes and alcoholism, <a href="#Page_350">350</a></li> + +<li>Nervousness, <a href="#Page_85">85</a>; + <ul class="nest"> + <li>and school life, <a href="#Page_108">108</a>;</li> + <li>physical defects, <a href="#Page_110">110</a>;</li> + <li>preventable, <a href="#Page_111">111</a>;</li> + <li>causes of, <a href="#Page_112">112</a>;</li> + <li>habit, <a href="#Page_111">111</a>, <a href="#Page_113">113</a>;</li> + <li>from tobacco, <a href="#Page_363">363</a></li> + </ul> + </li> + +<li>Neurasthenia. See <i>Mental Hygiene</i></li> + +<li>New Jersey, <a href="#Page_12">12</a></li> + +<li>Newsholme, Arthur, M.D., <a href="#Page_120">120</a>, <a href="#Page_131">131</a>, <a href="#Page_229">229</a>, <a href="#Page_241">241</a></li> + +<li>New York City, <a href="#Page_16">16</a>, <a href="#Page_25">25</a>, <a href="#Page_34">34</a></li> + +<li>New York Juvenile Asylum, <a href="#Page_47">47</a></li> + +<li>New York state, <a href="#Page_12">12</a>, <a href="#Page_24">24</a></li> + +<li>New York State Charities Aid Association, <a href="#Page_236">236</a>, <a href="#Page_242">242</a></li> + +<li>Nicotinism. See <i>Tobacco</i></li> + +<li>Normal schools, <a href="#Page_110">110</a></li> + +<li>North, Professor Lila V., <a href="#Page_142">142</a></li> + +<li>Notification of diseases, <a href="#Page_31">31</a>, <a href="#Page_41">41</a></li> + +<li>Nuisances, <a href="#Page_17">17</a>, <a href="#Page_18">18</a>, <a href="#Page_23">23</a>, <a href="#Page_366">366</a></li> + +<li>Nurses at school, <a href="#Page_230">230</a>, <a href="#Page_286">286</a>, <a href="#Page_293">293</a>, <a href="#Page_300">300</a>. + <ul class="nest"> + <li>See <i>Milk</i><br /><br /></li> + </ul> + </li> + + +<li>Oliver, Thomas, <a href="#Page_203">203</a></li> + +<li>Orthopedics. See <i>Tuberculosis</i></li> + +<li>Ophthalmia, <a href="#Page_65">65</a></li> + +<li>Oppenheimer, Nathan, M.D., <a href="#Page_110">110</a></li> + +<li>Osteopathy, <a href="#Page_275">275</a><br /><br /></li> + + +<li>Panama, <a href="#Page_59">59</a></li> + +<li>Parents: + <ul class="nest"> + <li>and school hygiene, <a href="#Page_3">3</a>;</li> + <li>interested by examinations, <a href="#Page_41">41</a>;</li> + <li>should coöperate with physician, <a href="#Page_279">279</a>;</li> + <li>interested in school examinations, <a href="#Page_297">297</a>;</li> + <li>need health reports, <a href="#Page_310">310</a>;</li> + <li>heredity, <a href="#Page_335">335-342</a>;</li> + <li>nicotinism, <a href="#Page_368">368</a></li> + </ul> + </li> + +<li>Parks and playgrounds, <a href="#Page_7">7</a>, <a href="#Page_32">32</a>, <a href="#Page_118">118</a>, <a href="#Page_122">122</a>, <a href="#Page_142">142</a>, <a href="#Page_186">186</a>, <a href="#Page_290">290</a>, <a href="#Page_294">294</a></li> + +<li>Parochial schools, <a href="#Page_189">189</a>, <a href="#Page_198">198</a></li> + +<li>Patent medicines: + <ul class="nest"> + <li>evils of, <a href="#Page_369">369-377</a>;</li> + <li>advertisements, <a href="#Page_380">380</a></li> + </ul> + </li> + +<li>Patten, Professor Simon N., <a href="#Page_9">9</a>, <a href="#Page_14">14</a>, <a href="#Page_33">33</a>, <a href="#Page_165">165</a></li> + +<li>Pediculosis, <a href="#Page_69">69-71</a></li> + +<li>Pennsylvania, <a href="#Page_311">311</a></li> + +<li>Philadelphia, <a href="#Page_34">34</a></li> + +<li>Phthisis. See <i>Tuberculosis</i></li> + +<li>Physical training, <a href="#Page_115">115-117</a>; + <ul class="nest"> + <li>in New York City, <a href="#Page_296">296</a>;</li> + <li>and sex hygiene, <a href="#Page_387">387</a></li> + </ul> + </li> + +<li>Physician: + <ul class="nest"> + <li>preventive medicine, <a href="#Page_268">268-282</a>;</li> + <li>and eyes, <a href="#Page_81">81</a>;</li> + <li>semi-annual visit to, <a href="#Page_204">204</a>;</li> + <li>self-advertisement, <a href="#Page_378">378</a>;</li> + <li>school, <a href="#Page_173">173</a>, <a href="#Page_286">286</a>, <a href="#Page_293">293</a>, <a href="#Page_315">315</a></li> + </ul> + </li> + +<li>Physiological age, <a href="#Page_105">105</a>, <a href="#Page_289">289</a>, <a href="#Page_387">387</a></li> + +<li>Pittsburgh, <a href="#Page_269">269</a></li> + +<li>Plague, <a href="#Page_15">15</a>, <a href="#Page_57">57</a></li> + +<li>Pneumonia, <a href="#Page_67">67</a>, <a href="#Page_379">379</a></li> + +<li>Preventable diseases:<span class='pagenum'><a name="Page_410" id="Page_410">[410]</a></span> + <ul class="nest"> + <li>those not communicable, <a href="#Page_272">272</a>.</li> + <li>See <i>Catching Diseases</i></li> + </ul> + </li> + +<li>Private schools, <a href="#Page_189">189</a>, <a href="#Page_198">198</a>, <a href="#Page_283">283</a>, <a href="#Page_291">291</a>, <a href="#Page_330">330</a></li> + +<li>Prohibition laws, <a href="#Page_348">348</a>, <a href="#Page_350">350</a>, <a href="#Page_355">355</a></li> + +<li>Pro-slum motive, <a href="#Page_19">19-20</a></li> + +<li>Public Education Association, New York, <a href="#Page_287">287</a>, <a href="#Page_298">298</a></li> + +<li>Publicity, <a href="#Page_45">45</a>, <a href="#Page_81">81</a>, <a href="#Page_99">99</a>, <a href="#Page_292">292</a>, <a href="#Page_310">310-321</a>, <a href="#Page_382">382</a><br /><br /></li> + + +<li>Quarantine, first, <a href="#Page_15">15</a>; + <ul class="nest"> + <li>national, <a href="#Page_308">308</a><br /><br /></li> + </ul> + </li> + + +<li>Records: + <ul class="nest"> + <li>of disease centers, <a href="#Page_31">31</a>;</li> + <li>defective, <a href="#Page_32">32</a>;</li> + <li>individual, <a href="#Page_35">35</a>, <a href="#Page_312">312-314</a></li> + </ul> + </li> + +<li>Reform's failure, <a href="#Page_349">349</a></li> + +<li>Registration: + <ul class="nest"> + <li>of diseases, <a href="#Page_31">31</a></li> + </ul> + </li> + +<li>Relief, material: + <ul class="nest"> + <li>sound principles of, <a href="#Page_174">174</a>;</li> + <li>at school, <a href="#Page_175">175</a>, <a href="#Page_179">179</a>, <a href="#Page_184">184</a>;</li> + <li>indiscriminate, harmful, <a href="#Page_332">332</a></li> + </ul> + </li> + +<li>Richman, Julia, <a href="#Page_172">172</a></li> + +<li>Riggs disease, <a href="#Page_92">92</a></li> + +<li>Rights: + <ul class="nest"> + <li>political, <a href="#Page_21">21</a>;</li> + <li>not enforced, <a href="#Page_23">23-32</a>;</li> + <li>of workmen at work, <a href="#Page_190">190</a>;</li> + <li>machinery for enforcing, <a href="#Page_283">283-322</a></li> + </ul> + </li> + +<li>Riis, Jacob, <a href="#Page_18">18</a></li> + +<li>Ringworm, <a href="#Page_65">65</a></li> + +<li>Rochester, N.Y., <a href="#Page_262">262</a>, <a href="#Page_266">266</a></li> + +<li>Rome, <a href="#Page_15">15</a></li> + +<li>Roosevelt, Theodore, <a href="#Page_60">60</a>, <a href="#Page_118">118</a></li> + +<li>Rural districts: + <ul class="nest"> + <li>encourage disease, <a href="#Page_13">13</a>;</li> + <li>compared, <a href="#Page_32">32</a>;</li> + <li>physical defects, <a href="#Page_74">74</a>;</li> + <li>schools unsanitary, <a href="#Page_141">141</a>;</li> + <li>hygiene in Great Britain, <a href="#Page_308">308</a></li> + </ul> + </li> + +<li>Russia, <a href="#Page_108">108</a><br /><br /></li> + + +<li>Sage Foundation, <a href="#Page_285">285</a></li> + +<li>St. Vitus's dance, <a href="#Page_111">111</a></li> + +<li>Salmon, Professor Lucy M., <a href="#Page_355">355</a></li> + +<li>Scabies, <a href="#Page_65">65</a>. + <ul class="nest"> + <li>See <i>Itch</i></li> + </ul> + </li> + +<li>Scarlatina, <a href="#Page_65">65</a></li> + +<li>Scarlet fever: + <ul class="nest"> + <li>thrives in slums, <a href="#Page_18">18</a>;</li> + <li>signs and method of infection, <a href="#Page_65">65</a>;</li> + <li>"peeling," <a href="#Page_132">132</a>;</li> + <li>compulsory removal of cases, <a href="#Page_240">240</a>;</li> + <li>germ carried in milk, <a href="#Page_264">264</a></li> + </ul> + </li> + +<li>School hygiene: + <ul class="nest"> + <li>and employers, <a href="#Page_3">3</a>;</li> + <li>instruction compulsory, <a href="#Page_3">3-10</a>;</li> + <li>practice of, <a href="#Page_5">5</a>, <a href="#Page_18">18</a>;</li> + <li>biological engineering, <a href="#Page_139">139</a>, <a href="#Page_203">203</a>, <a href="#Page_339">339</a>;</li> + <li>departments of, <a href="#Page_283">283-293</a>;</li> + <li>in New York City, <a href="#Page_294">294</a>, <a href="#Page_296">296-301</a></li> + </ul> + </li> + +<li>Score cards, <a href="#Page_27">27</a>, <a href="#Page_29">29</a>, <a href="#Page_259">259</a>, <a href="#Page_337">337</a></li> + +<li>Scranton, <a href="#Page_269">269</a></li> + +<li>Sea Breeze fresh-air home, <a href="#Page_176">176</a></li> + +<li>Sea Breeze seaside hospital, <a href="#Page_9">9</a>, <a href="#Page_240">240</a></li> + +<li>Seaman, L.L., M.D., <a href="#Page_23">23</a></li> + +<li>Seattle, <a href="#Page_161">161</a></li> + +<li>Sedgwick, Professor William T., <a href="#Page_304">304</a></li> + +<li>Sex hygiene, <a href="#Page_384">384-389</a></li> + +<li>Sexual deviates, <a href="#Page_182">182</a></li> + +<li>Shoes, tight, <a href="#Page_401">401</a></li> + +<li>Sickness, preventable, cost of, <a href="#Page_278">278</a></li> + +<li>Sleep and vitality, <a href="#Page_201">201</a>, <a href="#Page_272">272</a></li> + +<li>Slum, a menace, <a href="#Page_13">13</a>, <a href="#Page_20">20</a></li> + +<li>Smallpox: + <ul class="nest"> + <li>epidemics great teachers, <a href="#Page_6">6</a>;</li> + <li>conquered by vaccination, <a href="#Page_7">7</a>;</li> + <li>neglected in rural Pennsylvania, <a href="#Page_18">18</a>;</li> + <li>comes rarely to cities, <a href="#Page_31">31</a>;</li> + <li>compulsory removal of cases, <a href="#Page_240">240</a></li> + </ul> + </li> + +<li>Snedden, Professor David S., <a href="#Page_33">33</a>, <a href="#Page_165">165</a>, <a href="#Page_311">311</a></li> + +<li>Snellen eye test, <a href="#Page_73">73</a>, <a href="#Page_77">77</a></li> + +<li>Society for Sanitary and Moral Prophylaxis, <a href="#Page_384">384</a></li> + +<li>Southern states, <a href="#Page_351">351</a></li> + +<li>Spargo, John, <a href="#Page_33">33</a>, <a href="#Page_167">167</a></li> + +<li>Spitting, <a href="#Page_223">223</a>, <a href="#Page_235">235</a></li> + +<li>State activity, <a href="#Page_4">4</a>, <a href="#Page_73">73</a>, <a href="#Page_121">121</a>, <a href="#Page_236">236</a>, <a href="#Page_292">292</a>, <a href="#Page_306">306</a></li> + +<li>Statistics, object of, <a href="#Page_131">131</a>, <a href="#Page_134">134</a>, <a href="#Page_333">333</a></li> + +<li>Strauss, Nathan, <a href="#Page_260">260</a></li> + +<li>Streets, <a href="#Page_15">15</a>, <a href="#Page_122">122</a>, <a href="#Page_217">217</a>, <a href="#Page_254">254</a>, <a href="#Page_348">348</a></li> + +<li>Study hours, too long, <a href="#Page_287">287</a></li> + +<li>Sweating, <a href="#Page_152">152</a>, <a href="#Page_211">211</a><br /><br /></li> + + +<li>Taxes, taxpayers. See <i>Budget</i></li> + +<li>Teacher's health: + <ul class="nest"> + <li>tests of, <a href="#Page_152">152-158</a></li> + </ul> + </li> + +<li>Teachers: + <ul class="nest"> + <li>social work, <a href="#Page_172">172</a>;</li> + <li>health passport, <a href="#Page_202">202</a>;</li> + <li>for tuberculous pupils, <a href="#Page_237">237</a>;</li> + <li>excluded when tuberculous, <a href="#Page_242">242</a>;</li> + <li>and physicians, <a href="#Page_279">279</a>;</li> + <li>physical examination of, <a href="#Page_284">284</a>;</li> + <li>use of alcohol, <a href="#Page_358">358</a>;</li> + <li>cigarettes, <a href="#Page_368">368</a>;</li> + <li>use clippings, <a href="#Page_382">382</a></li> + </ul> + </li> + +<li>Teeth. See <i>Dental Sanitation</i></li> + +<li>Temperance. See <i>Alcoholism</i></li> + +<li>Tenement reforms, <a href="#Page_20">20</a>, <a href="#Page_186">186</a>, <a href="#Page_209">209</a>, <a href="#Page_304">304</a>, <a href="#Page_403">403</a></li> + +<li>Thompson, J. Arthur, <a href="#Page_336">336</a></li> + +<li>Tobacco: + <ul class="nest"> + <li>instruction at school, <a href="#Page_3">3</a>;</li> + <li>economic injuries of, <a href="#Page_201">201</a>;</li> + <li>forbidden to employees, <a href="#Page_210">210</a>;</li> + <li>evils of nicotinism, <a href="#Page_363">363-368</a>, <a href="#Page_386">386</a></li> + </ul> + </li> + +<li>Tonsils, hypertrophied, <a href="#Page_44">44</a></li> + +<li>Trachoma, <a href="#Page_69">69-71</a></li> + +<li>Trudeau, E.L., M.D., <a href="#Page_274">274</a><span class='pagenum'><a name="Page_411" id="Page_411">[411]</a></span></li> + +<li>Tuberculosis: + <ul class="nest"> + <li>pupils excluded from school because of, <a href="#Page_65">65</a>;</li> + <li>aggravated by colds, <a href="#Page_68">68</a>;</li> + <li>bone tuberculosis, <a href="#Page_87">87</a>, <a href="#Page_88">88</a>, <a href="#Page_236">236</a>;</li> + <li>and bad teeth, <a href="#Page_90">90</a>, <a href="#Page_99">99</a>;</li> + <li>in teachers, <a href="#Page_153">153</a>;</li> + <li>examination for working papers, <a href="#Page_191">191</a>;</li> + <li>periodical examination for, <a href="#Page_201">201</a>;</li> + <li>last days of, <a href="#Page_229">229-251</a>;</li> + <li>eye and skin tests for, <a href="#Page_240">240</a>;</li> + <li>tests of cows, <a href="#Page_260">260</a>;</li> + <li>carried in milk, <a href="#Page_264">264</a>;</li> + <li>out-of-door treatment, <a href="#Page_274">274</a>;</li> + <li>only predisposition to, inherited, <a href="#Page_335">335</a></li> + </ul> + </li> + +<li>Typhoid: + <ul class="nest"> + <li>a rural disease, <a href="#Page_13">13</a>;</li> + <li>carried in milk, <a href="#Page_264">264</a><br /><br /></li> + </ul> + </li> + + +<li>University Extension Society, <a href="#Page_178">178</a><br /><br /></li> + + +<li>Vacation schools, playgrounds, <a href="#Page_109">109</a>, <a href="#Page_296">296</a></li> + +<li>Veiller, Lawrence, <a href="#Page_9">9</a></li> + +<li>Vitality tests and statistics, <a href="#Page_124">124-138</a><br /><br /></li> + + +<li>Water, drinking: + <ul class="nest"> + <li>reason for works, <a href="#Page_15">15</a>;</li> + <li>factories pollute, <a href="#Page_17">17</a>;</li> + <li>fountains, <a href="#Page_217">217</a>;</li> + <li>public responsibility for, <a href="#Page_226">226</a>;</li> + <li>protecting sources, <a href="#Page_307">307</a></li> + </ul> + </li> + +<li>Welfare work, <a href="#Page_7">7</a>, <a href="#Page_221">221-225</a></li> + +<li>West Point, <a href="#Page_199">199</a></li> + +<li>Wheeler, Herbert L., D.D.S., <a href="#Page_93">93</a></li> + +<li>Whipple, George C., Ph. D., <a href="#Page_13">13</a>, <a href="#Page_16">16</a></li> + +<li>White plague. See <i>Tuberculosis</i></li> + +<li>Whooping cough, <a href="#Page_64">64</a></li> + +<li>Williams, Alida S., <a href="#Page_72">72</a>, <a href="#Page_122">122</a></li> + +<li>Williams, Linsly R., M.D., <a href="#Page_241">241</a></li> + +<li>Work: + <ul class="nest"> + <li>physical examination for working papers, <a href="#Page_190">190-200</a>, <a href="#Page_285">285</a>;</li> + <li>healthful habits, <a href="#Page_208">208-217</a>;</li> + <li>unpatented medicine, <a href="#Page_334">334</a>.</li> + <li>See <i>Industrial Hygiene</i><br /><br /></li> + </ul> + </li> + + +<li>Young Men's Christian Association, <a href="#Page_227">227</a></li> +</ul> + +<br /> +<hr /> +<br /> + +<div class="tr"> +<p class="cen"><a name="TN" id="TN"></a><i>Typographical errors corrected in text:</i></p> +<br /> +Page 60: heath replaced with health<br /> + +<br /> + +<p class="cen"><i>Text moved to avoid splitting paragraphs with tables, etc.:</i></p> + +<p class="noin">First half of last paragraph on page 25, moved to page + 29, following Table III and Table IV on pages 26 to 28.</p> +<p class="noin">First half of last paragraph on page 63, moved to page + 66, following Table VIII on pages 64 to 65.</p> +<p class="noin">First half of last paragraph on page 181, moved to page + 183, following Illustration on page 182.</p> +<p class="noin">Continuation of paragraph begun on page 222, moved from + page 225 to the end of the paragraph on page 222, to + precede text ads/Illustrations on pages 223 and 224.</p> +<p class="noin">Continuation of paragraph begun on page 254, moved from + page 258 to the end of the paragraph on page 254, to + precede Conference information on pages 255 to 257.</p> +<p class="noin">First half of last paragraph on page 337, moved to page + 340, following Score Cards on pages 338 and 339.</p> +</div> + +<br /> +<hr /> +<br /> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of Civics and Health, by William H. Allen + +*** END OF THIS PROJECT GUTENBERG EBOOK CIVICS AND HEALTH *** + +***** This file should be named 21353-h.htm or 21353-h.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/2/1/3/5/21353/ + +Produced by Jeannie Howse, Juliet Sutherland and the Online +Distributed Proofreading Team at https://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +https://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at https://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +https://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at https://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit https://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including including checks, online payments and credit card +donations. To donate, please visit: https://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart was the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + https://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. + + +</pre> + +</body> +</html> diff --git a/21353-h/images/fig1.png b/21353-h/images/fig1.png Binary files differnew file mode 100644 index 0000000..d5d3d87 --- /dev/null +++ b/21353-h/images/fig1.png diff --git a/21353-h/images/fig2.png b/21353-h/images/fig2.png Binary files differnew file mode 100644 index 0000000..a1fd1c0 --- /dev/null +++ b/21353-h/images/fig2.png diff --git a/21353-h/images/fig3.png b/21353-h/images/fig3.png Binary files differnew file mode 100644 index 0000000..7939f2d --- /dev/null +++ b/21353-h/images/fig3.png diff --git a/21353-h/images/fig4.png b/21353-h/images/fig4.png Binary files differnew file mode 100644 index 0000000..519c70a --- /dev/null +++ b/21353-h/images/fig4.png diff --git a/21353-h/images/frontis.jpg b/21353-h/images/frontis.jpg Binary files differnew file mode 100644 index 0000000..88d524a --- /dev/null +++ b/21353-h/images/frontis.jpg diff --git a/21353-h/images/imagep019.jpg b/21353-h/images/imagep019.jpg Binary files differnew file mode 100644 index 0000000..4787617 --- /dev/null +++ b/21353-h/images/imagep019.jpg diff --git a/21353-h/images/imagep024.jpg b/21353-h/images/imagep024.jpg Binary files differnew file mode 100644 index 0000000..cff5448 --- /dev/null +++ b/21353-h/images/imagep024.jpg diff --git a/21353-h/images/imagep032.jpg b/21353-h/images/imagep032.jpg Binary files differnew file mode 100644 index 0000000..92cde2d --- /dev/null +++ b/21353-h/images/imagep032.jpg diff --git a/21353-h/images/imagep034.jpg b/21353-h/images/imagep034.jpg Binary files differnew file mode 100644 index 0000000..58f4802 --- /dev/null +++ b/21353-h/images/imagep034.jpg diff --git a/21353-h/images/imagep036.jpg b/21353-h/images/imagep036.jpg Binary files differnew file mode 100644 index 0000000..e9889c3 --- /dev/null +++ b/21353-h/images/imagep036.jpg diff --git a/21353-h/images/imagep046.jpg b/21353-h/images/imagep046.jpg Binary files differnew file mode 100644 index 0000000..6fde4ba --- /dev/null +++ b/21353-h/images/imagep046.jpg diff --git a/21353-h/images/imagep048.jpg b/21353-h/images/imagep048.jpg Binary files differnew file mode 100644 index 0000000..5355587 --- /dev/null +++ b/21353-h/images/imagep048.jpg diff --git a/21353-h/images/imagep049.jpg b/21353-h/images/imagep049.jpg Binary files differnew file mode 100644 index 0000000..19da762 --- /dev/null +++ b/21353-h/images/imagep049.jpg diff --git a/21353-h/images/imagep055.jpg b/21353-h/images/imagep055.jpg Binary files differnew file mode 100644 index 0000000..5de2f1f --- /dev/null +++ b/21353-h/images/imagep055.jpg diff --git a/21353-h/images/imagep074.jpg b/21353-h/images/imagep074.jpg Binary files differnew file mode 100644 index 0000000..853ae85 --- /dev/null +++ b/21353-h/images/imagep074.jpg diff --git a/21353-h/images/imagep086.jpg b/21353-h/images/imagep086.jpg Binary files differnew file mode 100644 index 0000000..b44a325 --- /dev/null +++ b/21353-h/images/imagep086.jpg diff --git a/21353-h/images/imagep087.jpg b/21353-h/images/imagep087.jpg Binary files differnew file mode 100644 index 0000000..74d3832 --- /dev/null +++ b/21353-h/images/imagep087.jpg diff --git a/21353-h/images/imagep088.jpg b/21353-h/images/imagep088.jpg Binary files differnew file mode 100644 index 0000000..08c9a71 --- /dev/null +++ b/21353-h/images/imagep088.jpg diff --git a/21353-h/images/imagep090.jpg b/21353-h/images/imagep090.jpg Binary files differnew file mode 100644 index 0000000..571fb0e --- /dev/null +++ b/21353-h/images/imagep090.jpg diff --git a/21353-h/images/imagep093.jpg b/21353-h/images/imagep093.jpg Binary files differnew file mode 100644 index 0000000..923e2a5 --- /dev/null +++ b/21353-h/images/imagep093.jpg diff --git a/21353-h/images/imagep094.png b/21353-h/images/imagep094.png Binary files differnew file mode 100644 index 0000000..e325656 --- /dev/null +++ b/21353-h/images/imagep094.png diff --git a/21353-h/images/imagep097.jpg b/21353-h/images/imagep097.jpg Binary files differnew file mode 100644 index 0000000..d913c51 --- /dev/null +++ b/21353-h/images/imagep097.jpg diff --git a/21353-h/images/imagep099.jpg b/21353-h/images/imagep099.jpg Binary files differnew file mode 100644 index 0000000..3b3f2bf --- /dev/null +++ b/21353-h/images/imagep099.jpg diff --git a/21353-h/images/imagep109.jpg b/21353-h/images/imagep109.jpg Binary files differnew file mode 100644 index 0000000..1219cd7 --- /dev/null +++ b/21353-h/images/imagep109.jpg diff --git a/21353-h/images/imagep116.jpg b/21353-h/images/imagep116.jpg Binary files differnew file mode 100644 index 0000000..a70e6ba --- /dev/null +++ b/21353-h/images/imagep116.jpg diff --git a/21353-h/images/imagep119.jpg b/21353-h/images/imagep119.jpg Binary files differnew file mode 100644 index 0000000..3a0c5cb --- /dev/null +++ b/21353-h/images/imagep119.jpg diff --git a/21353-h/images/imagep121.jpg b/21353-h/images/imagep121.jpg Binary files differnew file mode 100644 index 0000000..05e9c00 --- /dev/null +++ b/21353-h/images/imagep121.jpg diff --git a/21353-h/images/imagep134.jpg b/21353-h/images/imagep134.jpg Binary files differnew file mode 100644 index 0000000..bfd8faa --- /dev/null +++ b/21353-h/images/imagep134.jpg diff --git a/21353-h/images/imagep140.jpg b/21353-h/images/imagep140.jpg Binary files differnew file mode 100644 index 0000000..fb7fcf8 --- /dev/null +++ b/21353-h/images/imagep140.jpg diff --git a/21353-h/images/imagep141.jpg b/21353-h/images/imagep141.jpg Binary files differnew file mode 100644 index 0000000..fac064b --- /dev/null +++ b/21353-h/images/imagep141.jpg diff --git a/21353-h/images/imagep143.jpg b/21353-h/images/imagep143.jpg Binary files differnew file mode 100644 index 0000000..bb7a7d9 --- /dev/null +++ b/21353-h/images/imagep143.jpg diff --git a/21353-h/images/imagep145.jpg b/21353-h/images/imagep145.jpg Binary files differnew file mode 100644 index 0000000..133586c --- /dev/null +++ b/21353-h/images/imagep145.jpg diff --git a/21353-h/images/imagep148.jpg b/21353-h/images/imagep148.jpg Binary files differnew file mode 100644 index 0000000..f48a1db --- /dev/null +++ b/21353-h/images/imagep148.jpg diff --git a/21353-h/images/imagep149.jpg b/21353-h/images/imagep149.jpg Binary files differnew file mode 100644 index 0000000..d69a3d8 --- /dev/null +++ b/21353-h/images/imagep149.jpg diff --git a/21353-h/images/imagep151.jpg b/21353-h/images/imagep151.jpg Binary files differnew file mode 100644 index 0000000..0bd634d --- /dev/null +++ b/21353-h/images/imagep151.jpg diff --git a/21353-h/images/imagep155.jpg b/21353-h/images/imagep155.jpg Binary files differnew file mode 100644 index 0000000..cfd772e --- /dev/null +++ b/21353-h/images/imagep155.jpg diff --git a/21353-h/images/imagep163.jpg b/21353-h/images/imagep163.jpg Binary files differnew file mode 100644 index 0000000..2f75a34 --- /dev/null +++ b/21353-h/images/imagep163.jpg diff --git a/21353-h/images/imagep171.jpg b/21353-h/images/imagep171.jpg Binary files differnew file mode 100644 index 0000000..ea3ac49 --- /dev/null +++ b/21353-h/images/imagep171.jpg diff --git a/21353-h/images/imagep172.jpg b/21353-h/images/imagep172.jpg Binary files differnew file mode 100644 index 0000000..6dbbc0c --- /dev/null +++ b/21353-h/images/imagep172.jpg diff --git a/21353-h/images/imagep175.jpg b/21353-h/images/imagep175.jpg Binary files differnew file mode 100644 index 0000000..07f10d6 --- /dev/null +++ b/21353-h/images/imagep175.jpg diff --git a/21353-h/images/imagep176.jpg b/21353-h/images/imagep176.jpg Binary files differnew file mode 100644 index 0000000..2a926f0 --- /dev/null +++ b/21353-h/images/imagep176.jpg diff --git a/21353-h/images/imagep177.png b/21353-h/images/imagep177.png Binary files differnew file mode 100644 index 0000000..7a71897 --- /dev/null +++ b/21353-h/images/imagep177.png diff --git a/21353-h/images/imagep179.jpg b/21353-h/images/imagep179.jpg Binary files differnew file mode 100644 index 0000000..7ff01b2 --- /dev/null +++ b/21353-h/images/imagep179.jpg diff --git a/21353-h/images/imagep180.jpg b/21353-h/images/imagep180.jpg Binary files differnew file mode 100644 index 0000000..629ca5d --- /dev/null +++ b/21353-h/images/imagep180.jpg diff --git a/21353-h/images/imagep182.png b/21353-h/images/imagep182.png Binary files differnew file mode 100644 index 0000000..dc211e3 --- /dev/null +++ b/21353-h/images/imagep182.png diff --git a/21353-h/images/imagep186.jpg b/21353-h/images/imagep186.jpg Binary files differnew file mode 100644 index 0000000..16d9b80 --- /dev/null +++ b/21353-h/images/imagep186.jpg diff --git a/21353-h/images/imagep187.jpg b/21353-h/images/imagep187.jpg Binary files differnew file mode 100644 index 0000000..26759a6 --- /dev/null +++ b/21353-h/images/imagep187.jpg diff --git a/21353-h/images/imagep192.jpg b/21353-h/images/imagep192.jpg Binary files differnew file mode 100644 index 0000000..6915a2a --- /dev/null +++ b/21353-h/images/imagep192.jpg diff --git a/21353-h/images/imagep193.jpg b/21353-h/images/imagep193.jpg Binary files differnew file mode 100644 index 0000000..8913899 --- /dev/null +++ b/21353-h/images/imagep193.jpg diff --git a/21353-h/images/imagep195.jpg b/21353-h/images/imagep195.jpg Binary files differnew file mode 100644 index 0000000..f26b501 --- /dev/null +++ b/21353-h/images/imagep195.jpg diff --git a/21353-h/images/imagep197.jpg b/21353-h/images/imagep197.jpg Binary files differnew file mode 100644 index 0000000..db217ed --- /dev/null +++ b/21353-h/images/imagep197.jpg diff --git a/21353-h/images/imagep199.jpg b/21353-h/images/imagep199.jpg Binary files differnew file mode 100644 index 0000000..af0fed1 --- /dev/null +++ b/21353-h/images/imagep199.jpg diff --git a/21353-h/images/imagep202.jpg b/21353-h/images/imagep202.jpg Binary files differnew file mode 100644 index 0000000..1a53475 --- /dev/null +++ b/21353-h/images/imagep202.jpg diff --git a/21353-h/images/imagep206.jpg b/21353-h/images/imagep206.jpg Binary files differnew file mode 100644 index 0000000..5b23120 --- /dev/null +++ b/21353-h/images/imagep206.jpg diff --git a/21353-h/images/imagep207.jpg b/21353-h/images/imagep207.jpg Binary files differnew file mode 100644 index 0000000..6b082fe --- /dev/null +++ b/21353-h/images/imagep207.jpg diff --git a/21353-h/images/imagep210.jpg b/21353-h/images/imagep210.jpg Binary files differnew file mode 100644 index 0000000..7690b0c --- /dev/null +++ b/21353-h/images/imagep210.jpg diff --git a/21353-h/images/imagep211.jpg b/21353-h/images/imagep211.jpg Binary files differnew file mode 100644 index 0000000..637648a --- /dev/null +++ b/21353-h/images/imagep211.jpg diff --git a/21353-h/images/imagep214.jpg b/21353-h/images/imagep214.jpg Binary files differnew file mode 100644 index 0000000..8710337 --- /dev/null +++ b/21353-h/images/imagep214.jpg diff --git a/21353-h/images/imagep215.jpg b/21353-h/images/imagep215.jpg Binary files differnew file mode 100644 index 0000000..6956ad8 --- /dev/null +++ b/21353-h/images/imagep215.jpg diff --git a/21353-h/images/imagep216.jpg b/21353-h/images/imagep216.jpg Binary files differnew file mode 100644 index 0000000..42ff31e --- /dev/null +++ b/21353-h/images/imagep216.jpg diff --git a/21353-h/images/imagep220.jpg b/21353-h/images/imagep220.jpg Binary files differnew file mode 100644 index 0000000..c027726 --- /dev/null +++ b/21353-h/images/imagep220.jpg diff --git a/21353-h/images/imagep223.jpg b/21353-h/images/imagep223.jpg Binary files differnew file mode 100644 index 0000000..4a919c5 --- /dev/null +++ b/21353-h/images/imagep223.jpg diff --git a/21353-h/images/imagep224.png b/21353-h/images/imagep224.png Binary files differnew file mode 100644 index 0000000..1c5d0dc --- /dev/null +++ b/21353-h/images/imagep224.png diff --git a/21353-h/images/imagep230.jpg b/21353-h/images/imagep230.jpg Binary files differnew file mode 100644 index 0000000..ef81453 --- /dev/null +++ b/21353-h/images/imagep230.jpg diff --git a/21353-h/images/imagep231.jpg b/21353-h/images/imagep231.jpg Binary files differnew file mode 100644 index 0000000..f04ecb0 --- /dev/null +++ b/21353-h/images/imagep231.jpg diff --git a/21353-h/images/imagep232.jpg b/21353-h/images/imagep232.jpg Binary files differnew file mode 100644 index 0000000..d6dab6a --- /dev/null +++ b/21353-h/images/imagep232.jpg diff --git a/21353-h/images/imagep233.jpg b/21353-h/images/imagep233.jpg Binary files differnew file mode 100644 index 0000000..c1ae44e --- /dev/null +++ b/21353-h/images/imagep233.jpg diff --git a/21353-h/images/imagep234.png b/21353-h/images/imagep234.png Binary files differnew file mode 100644 index 0000000..3f6ddaf --- /dev/null +++ b/21353-h/images/imagep234.png diff --git a/21353-h/images/imagep235.jpg b/21353-h/images/imagep235.jpg Binary files differnew file mode 100644 index 0000000..d04148b --- /dev/null +++ b/21353-h/images/imagep235.jpg diff --git a/21353-h/images/imagep237.jpg b/21353-h/images/imagep237.jpg Binary files differnew file mode 100644 index 0000000..cbbba59 --- /dev/null +++ b/21353-h/images/imagep237.jpg diff --git a/21353-h/images/imagep239.png b/21353-h/images/imagep239.png Binary files differnew file mode 100644 index 0000000..296b379 --- /dev/null +++ b/21353-h/images/imagep239.png diff --git a/21353-h/images/imagep240.jpg b/21353-h/images/imagep240.jpg Binary files differnew file mode 100644 index 0000000..2e4a010 --- /dev/null +++ b/21353-h/images/imagep240.jpg diff --git a/21353-h/images/imagep242.jpg b/21353-h/images/imagep242.jpg Binary files differnew file mode 100644 index 0000000..e1c395f --- /dev/null +++ b/21353-h/images/imagep242.jpg diff --git a/21353-h/images/imagep243.jpg b/21353-h/images/imagep243.jpg Binary files differnew file mode 100644 index 0000000..ddebf17 --- /dev/null +++ b/21353-h/images/imagep243.jpg diff --git a/21353-h/images/imagep244.jpg b/21353-h/images/imagep244.jpg Binary files differnew file mode 100644 index 0000000..3c04e97 --- /dev/null +++ b/21353-h/images/imagep244.jpg diff --git a/21353-h/images/imagep245.jpg b/21353-h/images/imagep245.jpg Binary files differnew file mode 100644 index 0000000..cc5e26a --- /dev/null +++ b/21353-h/images/imagep245.jpg diff --git a/21353-h/images/imagep246.jpg b/21353-h/images/imagep246.jpg Binary files differnew file mode 100644 index 0000000..fc69731 --- /dev/null +++ b/21353-h/images/imagep246.jpg diff --git a/21353-h/images/imagep250.png b/21353-h/images/imagep250.png Binary files differnew file mode 100644 index 0000000..4e1a89f --- /dev/null +++ b/21353-h/images/imagep250.png diff --git a/21353-h/images/imagep253.jpg b/21353-h/images/imagep253.jpg Binary files differnew file mode 100644 index 0000000..dc3de27 --- /dev/null +++ b/21353-h/images/imagep253.jpg diff --git a/21353-h/images/imagep254.jpg b/21353-h/images/imagep254.jpg Binary files differnew file mode 100644 index 0000000..efe3f59 --- /dev/null +++ b/21353-h/images/imagep254.jpg diff --git a/21353-h/images/imagep255.png b/21353-h/images/imagep255.png Binary files differnew file mode 100644 index 0000000..ad3bc35 --- /dev/null +++ b/21353-h/images/imagep255.png diff --git a/21353-h/images/imagep256.png b/21353-h/images/imagep256.png Binary files differnew file mode 100644 index 0000000..17363bc --- /dev/null +++ b/21353-h/images/imagep256.png diff --git a/21353-h/images/imagep257.png b/21353-h/images/imagep257.png Binary files differnew file mode 100644 index 0000000..95f5f77 --- /dev/null +++ b/21353-h/images/imagep257.png diff --git a/21353-h/images/imagep259.jpg b/21353-h/images/imagep259.jpg Binary files differnew file mode 100644 index 0000000..60e84d8 --- /dev/null +++ b/21353-h/images/imagep259.jpg diff --git a/21353-h/images/imagep261.jpg b/21353-h/images/imagep261.jpg Binary files differnew file mode 100644 index 0000000..07330b7 --- /dev/null +++ b/21353-h/images/imagep261.jpg diff --git a/21353-h/images/imagep262.jpg b/21353-h/images/imagep262.jpg Binary files differnew file mode 100644 index 0000000..4d3e5fb --- /dev/null +++ b/21353-h/images/imagep262.jpg diff --git a/21353-h/images/imagep263.jpg b/21353-h/images/imagep263.jpg Binary files differnew file mode 100644 index 0000000..aace9f2 --- /dev/null +++ b/21353-h/images/imagep263.jpg diff --git a/21353-h/images/imagep264.jpg b/21353-h/images/imagep264.jpg Binary files differnew file mode 100644 index 0000000..1307a69 --- /dev/null +++ b/21353-h/images/imagep264.jpg diff --git a/21353-h/images/imagep264_th.jpg b/21353-h/images/imagep264_th.jpg Binary files differnew file mode 100644 index 0000000..c5f9993 --- /dev/null +++ b/21353-h/images/imagep264_th.jpg diff --git a/21353-h/images/imagep265.jpg b/21353-h/images/imagep265.jpg Binary files differnew file mode 100644 index 0000000..ad5de43 --- /dev/null +++ b/21353-h/images/imagep265.jpg diff --git a/21353-h/images/imagep266.jpg b/21353-h/images/imagep266.jpg Binary files differnew file mode 100644 index 0000000..2ceab0a --- /dev/null +++ b/21353-h/images/imagep266.jpg diff --git a/21353-h/images/imagep273.jpg b/21353-h/images/imagep273.jpg Binary files differnew file mode 100644 index 0000000..541b561 --- /dev/null +++ b/21353-h/images/imagep273.jpg diff --git a/21353-h/images/imagep277.jpg b/21353-h/images/imagep277.jpg Binary files differnew file mode 100644 index 0000000..c9ab669 --- /dev/null +++ b/21353-h/images/imagep277.jpg diff --git a/21353-h/images/imagep288.jpg b/21353-h/images/imagep288.jpg Binary files differnew file mode 100644 index 0000000..b1b4d2b --- /dev/null +++ b/21353-h/images/imagep288.jpg diff --git a/21353-h/images/imagep297.png b/21353-h/images/imagep297.png Binary files differnew file mode 100644 index 0000000..045b803 --- /dev/null +++ b/21353-h/images/imagep297.png diff --git a/21353-h/images/imagep298.png b/21353-h/images/imagep298.png Binary files differnew file mode 100644 index 0000000..ec3ed74 --- /dev/null +++ b/21353-h/images/imagep298.png diff --git a/21353-h/images/imagep299.jpg b/21353-h/images/imagep299.jpg Binary files differnew file mode 100644 index 0000000..e7fe87d --- /dev/null +++ b/21353-h/images/imagep299.jpg diff --git a/21353-h/images/imagep302.jpg b/21353-h/images/imagep302.jpg Binary files differnew file mode 100644 index 0000000..717896a --- /dev/null +++ b/21353-h/images/imagep302.jpg diff --git a/21353-h/images/imagep302_th.jpg b/21353-h/images/imagep302_th.jpg Binary files differnew file mode 100644 index 0000000..13558b2 --- /dev/null +++ b/21353-h/images/imagep302_th.jpg diff --git a/21353-h/images/imagep305.jpg b/21353-h/images/imagep305.jpg Binary files differnew file mode 100644 index 0000000..ee2105b --- /dev/null +++ b/21353-h/images/imagep305.jpg diff --git a/21353-h/images/imagep307.jpg b/21353-h/images/imagep307.jpg Binary files differnew file mode 100644 index 0000000..4c5bdb4 --- /dev/null +++ b/21353-h/images/imagep307.jpg diff --git a/21353-h/images/imagep310.png b/21353-h/images/imagep310.png Binary files differnew file mode 100644 index 0000000..63c767b --- /dev/null +++ b/21353-h/images/imagep310.png diff --git a/21353-h/images/imagep313.jpg b/21353-h/images/imagep313.jpg Binary files differnew file mode 100644 index 0000000..6a1a5a6 --- /dev/null +++ b/21353-h/images/imagep313.jpg diff --git a/21353-h/images/imagep314.jpg b/21353-h/images/imagep314.jpg Binary files differnew file mode 100644 index 0000000..342de65 --- /dev/null +++ b/21353-h/images/imagep314.jpg diff --git a/21353-h/images/imagep338.png b/21353-h/images/imagep338.png Binary files differnew file mode 100644 index 0000000..e3c9ce1 --- /dev/null +++ b/21353-h/images/imagep338.png diff --git a/21353-h/images/imagep339.png b/21353-h/images/imagep339.png Binary files differnew file mode 100644 index 0000000..56346c2 --- /dev/null +++ b/21353-h/images/imagep339.png diff --git a/21353-h/images/imagep340.jpg b/21353-h/images/imagep340.jpg Binary files differnew file mode 100644 index 0000000..a2945ed --- /dev/null +++ b/21353-h/images/imagep340.jpg diff --git a/21353-h/images/imagep373.jpg b/21353-h/images/imagep373.jpg Binary files differnew file mode 100644 index 0000000..2dd62bf --- /dev/null +++ b/21353-h/images/imagep373.jpg diff --git a/21353-h/images/imagep380.jpg b/21353-h/images/imagep380.jpg Binary files differnew file mode 100644 index 0000000..1dc0616 --- /dev/null +++ b/21353-h/images/imagep380.jpg diff --git a/21353-h/images/imagep386.jpg b/21353-h/images/imagep386.jpg Binary files differnew file mode 100644 index 0000000..3a6d97e --- /dev/null +++ b/21353-h/images/imagep386.jpg diff --git a/21353-h/images/imagep387.jpg b/21353-h/images/imagep387.jpg Binary files differnew file mode 100644 index 0000000..37e9579 --- /dev/null +++ b/21353-h/images/imagep387.jpg |
