UNTIL quite recently the term school hygiene stood for one idea, namely, compulsory instruction in physiology and hygiene, more particularly in the evils of alcohol and nicotine. In the near future school hygiene will suggest practice, not precept; not class-room recitation by pupils, but control of school environment by school authorities; not ideas to be conveyed to the brain of the child, but protection to be given to the child’s body. While it is true that heretofore but a small number of men have seen the need of this new definition of school hygiene, those few men are now proceeding with such thorough and skillful educational methods, and with such profound conviction, that the school world is bound to respond to their leadership.
There are many evidences that the time is ripe for recognizing as an important factor in hygiene instruction the hygiene practiced at school by janitor and teacher, and by curriculum and building-makers. Chicago is enthusiastic over its Bureau for Child Study; Cleveland over its Department of School Hygiene; Philadelphia, Memphis, and Utica over examinations for defective vision ; Detroit, Montclair, and the Oranges over their school nurses; and Massachusetts over its Medical Inspection Law. Several hundred representatives of charities and correction from all sections of the United States and Canada, meeting at Minneapolis last June, gave special attention to the limitations of the present hygiene.1 The second International Congress of School Hygiene, which met in London lust August, gave a week to various phases of the new hygiene. Even more direct and more continuous results are promised by the American SchoolHygiene Association, organized by a group of representative educators, physicians, and social workers in May, 1907, to secure for all schools of all states what Dr. Luther H. Gulick so aptly terms “ biological engineering.”
New York first startled itself and the nation by the revelation of its school physicians that over four hundred thousand children now in the public schools are in need of medical, dental, and surgical attention, or belter nourishment. Later, it helped the nation by naming causes that exist everywhere, and remedies that are universally applicable. At a recent conference in New York City on the physical welfare of school children, a school principal declared that our present curriculum is manufacturing more physical defects every year than school physicians and school nurses can correct. To the surprise of the laymen present, the school men were of one mind as to the havoc wrought by school life upon the physical and mental energy of the child. We were told that eyes are weakened, if not ruined, by glazed paper, small type, lines of wrong length, unsteady or dazzling light, or prolonged concentration. Dry sweeping fills the air with dust, and combines with bad ventilation, lack of water, and dust-raising physical exercises, to supply conditions that favor the growth of disease germs, more particularly the tubercle bacilli. Seats and desks deform the spine and hips, and cramp the lungs. Required home-study deprives the child of play and sleep, and accentuates the effects of harmful school environment. Highly trained teachers explain the composition of air in an atmosphere often more poisonous than that of the average city sweat-shop. Boys and girls unable to breathe through the nose because of adenoids and enlarged tonsils are deprived of recess for not being able to describe the passage that leads from the nose to the windpipe and lungs. Children fortunate enough to be physically able to meet school requirements are handicapped in their studies, and for that reason reduced in industrial efficiency, because they must march side by side with children suffering from removable physical defects.
These physical needs are found, upon investigation of thousands of homes by the New York Committee on Physical Welfare of School Children, to be due not so much to deficient income as to remediable defects at home, school, and factory. Homes with comfortable standards of living and honor rolls of higher grades, American homes as well as Italian and Yiddish homes, furnish a goodly share of children needing attention. The mere statement of such facts in numbers so large as those from New York City has led teachers and parents throughout the United States to look about them, and to realize that in families poor and well-todo, in country as well as city, child-life has been neglected in spite of compulsory instruction in the laws of health.
If there is any country in the world where such conditions should not have been permitted to exist so long without being detected, it is our country, where state laws declare that whatever else is done with a child’s time in school he shall be taught hygiene and physiology. To these subjects alone is given right of way for so many minutes per week, so many pages per text-book, or so much of each chapter; for failing to teach this subject with the frequency prescribed by law teachers may be arrested, fined, and removed from office; boards of education that fail to enforce state requirements as to the number of times per week these subjects are taught may be refused their proportion of school funds distributed by their state. While practical considerations compel instruction in the three R’s, the hygiene which we know is kept in the schools, as it was put there, by a rare combination of missionary zeal and pecuniary needs. Yet in spite of laws in every state and territory, and in spite of the army of crusaders and publishers’ agents ready at a moment’s notice to jump to the defense of these laws, physical defects and unhygienic living are quite as common here as in countries where opposition to alcohol and tobacco is not strong enough to influence legislation. What is even more alarming to many of us who are trying to check alcoholism and nicotinism, the per capita consumption of tobacco and alcoholic preparations is increasing.
How far is our school hygiene responsible for this paradoxical gap between our teaching and our practice? There will be many different answers to this question, but there can be little difference of opinion as to the possibility of securing better health habits than we have yet obtained from the daily contact of five hundred thousand teachers with the nation’s children. Biological engineering can do much to discipline the child in habits antagonistic to excess of every kind and to waste of vitality; a broader motive for school instruction in hygiene can do much to fix indelibly in the mind the principles of healthy living and to make attractive the vitality and the efficiency that come only from health.
The chief purpose of school hygiene has hitherto been, not to promote personal or community health, but to lessen the use of alcohol and tobacco. To those who drafted laws making hygiene compulsory, it seemed certain that boys and girls would come to fear — if not to hate — whiskey, beer, cigars, and cigarettes, if told often enough through text-books and by teachers that alcohol and nicotine, in whatever quantities, necessarily deplete one’s vitality, necessarily decrease one’s earning power, necessarily prevent the highest personal success. Text-books have been expected to present the point of view of those who in all sincerity believe that alcohol and tobacco are chiefly responsible for poverty, insanity, crime, sickness, incapacity, and wretchedness. No statement has been too strong, no case too exceptional, to justify its use in making an impression upon the childmind. When an author is told by law that he must give one-quarter of his space to alcohol and tobacco, or that every chapter must close with a reference to the effect of alcohol and tobacco upon the organ or function discussed, we cannot in fairness expect any greater scientific accuracy or more judicial emphasis than from the modern history of which California stipulated, when still in her teens, that one-half the space should be given to the history of California. It is because they are commissioned to tell the child an unforgettable story that eight textbook writers relate: —
“ A baby was once killed by washing its head with tobacco-water; a boy once drank some whiskey from a flask and died soon after; any drink that contains alcohol is a poison to hurt and at last to kill; a boy who uses cigarettes is irresistibly led to a violation of the law; by giving drinks such as root-beer to children an appetite for alcohol may be cultivated; the flesh of these unfortunate persons becoming saturated with alcohol took fire upon being exposed to a flame as of a lighted candle, or indeed without any external cause; nicotine stunts the growth of the (young) body as a whole, retards and weakens the nervous system, makes the user cross, peevish, and unfits him for the best society; a murderer was about to kill a baby and the little creature looked up into his face and smiled; ‘ but,’ he said, ‘ I drank a large glass of brandy and then I did n’t care.’ ”
The foregoing statements are taken from text-books now in use. Earlier and more grotesque inaccuracies and extravagances have not been quoted because both publishers and authors have been trying of late to break away from the temptation to over-state. Several recent text-books, in discussing the effects of alcohol and nicotine, draw more or less clear lines between youth and maturity, and between occasional, or moderate, and excessive. But so strong is the temptation besetting the author that one of the latest and best books for older grades prints without qualification the following facts as to New York City : —
Expense of Police Department $10,199,206
Police courts, jails, workhouses, reformatories $1,310,411
Hospitals, asylums, and other charities $4,754,380
The author does not say that the saloons cause all the arrests and, single-handed, fill the jails, workhouses, and hospitals. He does say, however, that the bills for charity, hospital, asylum, reformatory, and police would “ shrivel up ” if the saloons were wiped out.
The schoolboy able to read a misstatement is also able and apt to challenge its accuracy and sincerity if it does not ring true with his personal observation. He reads in the papers, learns from parents or friends, and sees with his own eyes that his standards of success — the family physician, bishop, priest, governor, president, philanthropist — use alcoholic beverages and tobacco. He knows of many police, hospital, and charity bills due to other causes than the saloon. He sees that total abstainers have accidents, succumb to fever, go insane, violate law. Physiological evidences before his eyes differ from the physiological effects described by text-books. He does not take the text-book seriously if it fails to teach him to analyze and understand the discrepancies between its statements and the life about him, if it fails to interpret to him the environment and social needs with which he must cope.
The teachers’ attitude toward school hygiene is reflected in the reply of one capable principal who is sufficiently interested in the physical welfare of his pupils to have every window open, to insist strictly upon personal cleanliness, and to make educational use of every emergency such as a fever or trachoma epidemic or a bruised knee. This principal resents the law that forces teachers to do special pleading, — to teach as solemn truths what they know to be only partly and occasionally true, to consume time on subjects to which they can devote neither their heart nor their educational efficiency. That this principal is not alone in his attitude is proved by testimony presented in the report of the Committee of Fifty, and by the fact that school hygiene is not given a department in the National Association of High School Superintendents or the National Educational Association. It is significant, furthermore, that, in her list of Ethical Gains through Legislation, Mrs. Florence Kelly has not included any gains from anti-alcohol, anti-tobacco instruction. How many teachers, principals, or school trustees do you know who count school hygiene among the chief privileges and duties of their schools ?
What is the alternative to exaggeration ? Many would think it perilous to admit in text-books that a small percentage of drinkers are drunkards; that the use of alcohol does not affect all persons in the same way; that some organs are not perceptibly affected even when certain other organs are seriously injured; that fatty degeneration, hardened liver, delirium tremens represent extreme cases, where evil effects tend to concentrate on one organ; that many men drink and smoke for a lifetime with physiological effects that seem to be no more serious than other men suffer from the regular use of coffee and tea, or from irregular eating, insufficient sleep, or neglect of constipation. Several years ago, after Professor Atwater announced his opinion that under certain conditions alcohol was a food, not a poison, I asked him if the slight inaccuracy of the statement that alcohol is always a poison was not justifiable, in view of the great danger that his dispassionate statement of alleged scientific truths would be misunderstood and undervalued by the child-mind. He asked, “In what other study would you substitute exaggeration for truth ?” I have since become convinced by my own experience that the truth itself about alcohol and tobacco will prove more effectual than over-truth in promoting teetotalism and in preventing the diseases due to excessive use of alcohol and nicotine.
There is every reason to believe that the most extreme opponents of the saloon can be brought to support a method of school hygiene that will tell the truth, and nothing but the truth, about alcohol and tobacco, and at the same time further the purpose for which school hygiene is made compulsory. We can prove 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 how the children of our communities are affected by hygiene now taught. We can compel discussion of the facts, and action in accordance with those facts. Without questioning the motive back of the particular textbooks used by our schools, every one of us can learn for our community how big that motive is, and how adequate or inadequate is the method of executing it.
Alcohol and tobacco occupy but a small share of the interest and attention of even those men and women by whom they are habitually used. Only a fraction of life’s ills are due to alcohol and tobacco. Alcoholism and nicotinism are themselves in many instances the result of social, industrial, and municipal conditions that proper school hygiene would enable us to remove. Outside the textbook 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 the socalled moderate use—of narcotics. Of the many reasons for not drinking and not smoking, physiology gives those which least interest and impress the child. Most of the direct physiological effects are in the majority of instances less serious in themselves than the direct effects of over-eating, of eating irregularly, of combining milk with acids, of failing to walk on the sunny side of life. 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, yellow skin, inactive stomach lining, would outweigh the pleasing—even though deceiving—sensation of alcoholic beverages and cigarettes.
While physiology may be individual and self-centred, hygiene should be social and altruistic in its point of view. The strong appeal to the child or man is the effect upon his mother, his associates, his employer, his wife, his children. Such terms as " extravagant,”“ useless expenditure,” “ depleted vitality ” should be translated into terms of happiness and pleasures denied, offenses committed, sickness and wretchedness caused by acts physiologically harmful. 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 throughout their school days in the science of avoiding offense and giving happiness; but unless the categories, acts that give offense and acts that give happiness, are wide enough to include the main acts committed in the normal relation of son, companion, employer, husband, father, and citizen, those who set out to avoid alcohol and tobacco find themselves illequipped to discharge the obligations of temperate, law-abiding citizens. Things do not happen as described in the textbook. Other things not mentioned hinder progress and happiness. The enemies that cause us trouble come from unexpected sources. We find it infinitely easier to refuse alcohol and tobacco than to avoid living and working conditions that insidiously undermine our aversion to stimulants and narcotics. The reasons for avoiding alcohol and tobacco in the interest of others are more numerous and more cogent than the reasons for avoiding them for one’s own sake. The altruistic reason for shunning narcotics cannot be implanted in the child unless he sees the evil of excess and selfishness wherever found, and unless he becomes thoroughly grounded in the life-relations and healthrelations to which he should adapt himself.
Failure to enforce health laws is a more serious menace to health and morals than drunkenness or tobacco cancer. Unclean streets, unclean milk, congested tenements can do more harm than alcohol and tobacco, because in spite of the best intentions they breed the physique that craves alcohol and tobacco. Adenoids and defective vision will injure a larger proportion of those afflicted than will beer and cigarettes, because they earlier and more certainly substitute handicap for equal chance, discouragement for hope. The foremost teachers already know these propositions to be true. They are eager to impart such knowledge to the child. They would welcome text-books enabling a child to reason about working and living conditions. They would, if encouraged, give their best educational ability to explaining the relation of health to efficiency, earning power, and community welfare. They would like to interest children in the social and industrial consequences of adenoids, enlarged tonsils, eye-strain, ear-trouble, bad teeth, defective lung capacity; to coöperate with the family physician and health physician in enforcing sanitary regulations; to teach the need for hospital and dispensary in country and suburban districts; to show children how to detect and remove the elements in their school, home, and street environment which are manufacturing physical and mental defects; to guard the abnormally bright child who overworks and underplays; to rank “ do-nothing ” ailments with ailments that come from overwork and underpay ; to stimulate a desire for periodical physical examination after school age; to show how habits of health enhance efficiency; to shatter heredity bugaboos and illuminate heredity truths; to make of every school child a militant teetotaler who abstains from measles, typhoid, scarlet fever, tuberculosis, dirty streets, and impure air as well as from alcohol and tobacco; to arouse as much indignation against waste of babylife because of unclean milk or ignorant care as against the pipe and decanter; to inculcate a love of self-control and selfrespect that will operate against coffee and tea and gormandizing as well as against cocktails and cigarettes; to break up the alliance of patent-medicine venders with newspapers and legislators; to teach, in a word, that “ natural law is as sacred as a moral principle,” and that the violation of natural law by means of corsets, high-heeled shoes, cosmetics, needless visits to physician and drug store, or unnatural living, is anti-social even though the citizen never touches alcohol or tobacco. Finally, children may be taught to realize that their own bounding vitality is a most important factor in determining the health and efficiency of all who come in contact with it.
But no matter how broad the motive for hygiene precept, children will not be convinced and will not practice what they are taught, unless drilled during schoollife in habits of health. It is here that biological engineering is indispensable. Children who sit in unclean schoolrooms, badly lighted and ventilated, will tolerate unclean bedrooms, impure air, and bad light at home. Children who are permitted to spend years in one grade because unable to breathe through the nose, will not of their own initiative correct living conditions at home that produce adenoids, enlarged tonsils, bad teeth, and undernourishment. The biological engineer, be he an agent of the Department of School Hygiene proposed for every city, county, and state, or school physician, county superintendent, or mere teacher, can tell whether eyes and teeth and nose need attention; whether there is dry sweeping or no sweeping; whether floors are cleansed and rooms ventilated once a week, once a month, or daily; whether hygienic living is possible and necessary for the children in his care. National, state, and city superintendents should see to it that neither curriculum, home-study, schoolbuilding, nor school-atmosphere manufactures physical defects.
Children drilled throughout their school-days to live up to and stand up for their health rights, as they are drilled on the playground to stand up for their personal rights, will know how to live up to and stand up for the rights conferred upon them as factory operatives, tenants, and taxpayers. All of these gains are compatible with the desire to lessen the evils that come from alcohol and tobacco. When hygiene practice at school approximated hygiene instruction, and when the hygiene taught at school aids the child to discharge the duties of wage-earner and citizen without jeopardizing the health of his neighbor, the power of alcohol and tobacco will be seriously threatened, and a race with increasing vitality insured.
- The Fiftieth Convention of the National Education Association discussed the “ Rational teaching; of hygiene in the public schools,” and “ How to make the theoretical teaching of school physiology of practical value for school life.”↩