99 99 99 99 99 ---------------------------------------- ------------------- ,transcriber's ,note3 ,inconsistent hyphenation in the original document has been preserved4 ,some text in this document has been moved to avoid multi-page tables being inserted mid-paragraph4 ,obvious typographical errors have been corrected in this text4 ,for a complete list1 please see the end of this document4 ---------------------------------------- ------------------- 99 99 99 99 99 ,illustration3 ,,louis ,,agassiz ,a natural law is as sacred as a moral principle ,,civics ,,and ,,health ,,by ,,william ,h4 ,,allen ,,secretary1 ,,bureau ,,of ,,municipal ,,research ,,former ,,secretary ,,of ,,the ,,new ,,york ,,committee ,,on ,,physical ,,welfare ,,of ,,school ,,children1 ,,author ,,of ,,efficient ,,democracy ,,and ,,rural ,,sanitary ,,administration ,,in ,,pennsylvania1 ,,joint ,,author ,,of ,,school ,,reports ,,and ,,school ,,efficiency ,,with ,,an ,,introduction ,,by ,,william ,t4 ,,sedgwick ,,professor ,,of ,,biology ,,in ,,the ,,massachusetts ,,institute ,,of ,,technology ,,ginn ,,and ,,company ,,boston ,,new ,,york ,,chicago ,,london ,,entered ,,at ,,stationers' ,,hall ,,copyright1 #aiji ,,by ,,william ,h4 ,,allen ,,all ,,rights ,,reserved #iaj4d ,the ,athenum ,press ,,ginn ,,and ,,company ,,proprietors ,,boston ,u4,s4,a4 ,,introduction ,it is a common weakness of mankind to be caught by an idea and captivated by a phrase4 ,to rest therewith content and to neglect the carrying of the idea into practice is a weakness still more common4 ,it is this frequent failure of reformers to reduce their theories to practice1 their tendency to dwell in the cloudland of the ideal rather than to test it in action1 that has often made them distrusted and unpopular4 ,with our forefathers the phrase mens sana in corpore sano was a high favorite4 ,it was constantly quoted with approval by writers on hygiene and sanitation1 and used as the text or the finale of hundreds of popular lectures4 ,and yet we shall seek in vain for any evidence of its practical usefulness4 ,its words are good and true1 but passive and actionless1 not of that dynamic type where words are words indeed1 but words that draw armed men behind them4 ,our age is of another temper4 ,it yearns for reality4 ,it no longer rests satisfied with mere ideas1 or words1 or phrases4 ,the modern ,ulysses would drink life to the dregs4 ,the present age is dissatisfied with the vague assurance that the ,lord will provide1 and1 rightly or wrongly1 is beginning to expect the state to provide4 ,and while this desire for reality has its drawbacks1 it has also its advantages4 ,our age doubts absolutely the virtues of blind submission and resignation1 and cries out instead for prevention and amelioration4 ,disease is no longer regarded1 as ,cruden regarded it1 as the penalty and the consequence of sin4 ,nature herself is now perceived to be capable of imperfect work4 ,time was when the human eye was referred to as a perfect apparatus1 but the number of young children wearing spectacles renders that idea untenable to-day4 ,meanwhile the multiplication of state asylums and municipal hospitals1 and special schools for deaf or blind children and for cripples1 speaks eloquently and irresistibly of an intimate connection between civics and health4 ,there is a physical basis of citizenship1 as there is a physical basis of life and of health2 and any one who will take the trouble to read even the ,table of ,contents of this book will see that for ,dr4 ,allen prevention is a text and the making of sound citizens a sermon4 ,given the sound body1 we have nowadays small fear for the sound mind4 ,the rigid physiological dualism implied in the phrase mens sana in corpore sano is no longer allowed4 ,to-day the sound body generally includes the sound mind1 and vice versa4 ,if mental dullness be due to imperfect ears1 the remedy lies in medical treatment of those organs1--not in education of the brain4 ,if lack of initiative or energy proceeds from defective aration of the blood due to adenoids blocking the air tides in the windpipe1 then the remedy lies not in better teaching but in a simple surgical operation4 ,shakespeare1 in his wildwood play1 saw sermons in stones and books in the running brooks4 ,we moderns find a drama in the fateful lives of ordinary mortals1 sermons in their physical salvation from some of the ills that flesh is heir to1 and books--like this of ,dr4 ,allen's--in striving to teach mankind how to become happier1 and healthier1 and more useful members of society4 ,dr4 ,allen is undoubtedly a reformer1 but of the modern1 not the ancient1 type4 ,he is a prophet crying in our present wilderness2 but he is more than a prophet1 for he is always intensely practical1 insisting1 as he does1 on getting things done1 and done soon1 and done right4 ,no one can read this volume1 or even its chapter-headings1 without surprise and rejoicing3 surprise1 that the physical basis of effective citizenship has hitherto been so utterly neglected in ,america2 rejoicing1 that so much in the way of the prevention of incapacity and unhappiness can be so easily done1 and is actually beginning to be done4 ,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 health1 the happiness1 and the well-being of the people1 and hence of the first importance to every ,american community1 every ,american citizen4 ,,william ,t4 ,,sedgwick ,,massachusetts ,,institute ,,of ,,technology ,,contents ,,part ,i4 ,,health ,,rights ,,chapter ,,page ,i4 ,,health ,a ,,civic ,,obligation #c ,,ii4 ,,seven ,,health ,,motives ,,and ,,seven ,,catchwords #aa ,,iii4 ,,what ,,health ,,rights ,,are ,,not ,,enforced ,,in ,,your ,,community8 #bc ,,iv4 ,,the ,,best ,,index ,,to ,,community ,,health ,,is ,,the ,,physical ,,welfare ,,of ,,school ,,children #cc ,,part ,,ii4 ,,reading ,,the ,,index ,,to ,,health ,,rights ,v4 ,,mouth ,,breathing #de ,,vi4 ,,catching ,,diseases1 ,,colds1 ,,diseased ,,glands #eg ,,vii4 ,,eye ,,strain #gb ,,viii4 ,,ear ,,trouble1 ,,malnutrition1 ,,deformities #hc ,,ix4 ,,dental ,,sanitation #hi ,x4 ,,abnormally ,,bright ,,children #ajd ,,xi4 ,,nervousness ,,of ,,teacher ,,and ,,pupil #ajg ,,xii4 ,,health ,,value ,,of ,,unbossed ,,play ,,and ,,physical ,,training #aae ,,xiii4 ,,vitality ,,tests ,,and ,,vital ,,statistics #abd ,,xiv4 ,,is ,,your ,,school ,,manufacturing ,,physical ,,defects8 #aci ,,xv4 ,,the ,,teacher',s ,,health #aeb ,,part ,,iii4 ,,co,,peration ,,in ,,meeting ,,health ,,obligations ,,xvi4 ,,european ,,remedies3 ,,doing ,,things ,,at ,,school #aei ,,xvii4 ,,american ,,remedies3 ,,getting ,,things ,,done #aff ,,xviii4 ,,co,,peration ,,with ,,dispensaries ,,and ,,child-,,saving ,,agencies #agd ,,xix4 ,,school ,,surgery ,,and ,,relief ,,objectionable1 ,,if ,,avoidable #ahd ,,xx4 ,,physical ,,examination ,,for ,,working ,,papers #aij ,,xxi4 ,,periodical ,,physical ,,examination ,,after ,,school ,,age #bja ,,xxii4 ,,habits ,,of ,,health ,,promote ,,industrial ,,efficiency #bjh ,,xxiii4 ,,industrial ,,hygiene #bah ,,xxiv4 ,,the ,,last ,,days ,,of ,,tuberculosis #bbi ,,xxv4 ,,the ,,fight ,,for ,,clean ,,milk #beb ,,xxvi4 ,,preventive ,,humanized ,,medicine3 ,,physician ,,and ,,teacher #bfh ,,part ,,iv4 ,,official ,,machinery ,,for ,,enforcing ,,health ,,rights ,,xxvii4 ,,departments ,,of ,,school ,,hygiene #bhc ,,xxviii4 ,,present ,,organization ,,of ,,school ,,hygiene ,,in ,,new ,,york ,,city #bif ,,xxix4 ,,official ,,machinery ,,for ,,enforcing ,,health ,,rights #cjb ,,xxx4 ,,school ,,and ,,health ,,reports #caj ,,xxxi4 ,,the ,,press #cbb ,,part ,v4 ,,alliance ,,of ,,hygiene1 ,,patriotism1 ,,and ,,religion ,,xxxii4 ,,do-,,nothing ,,ailments #cbi ,,xxxiii4 ,,heredity ,,bugaboos ,,and ,,heredity ,,truths #cce ,,xxxiv4 ,,ineffective ,,and ,,effective ,,ways ,,of ,,combating ,,alcoholism #cdc ,,xxxv4 ,,is ,,it ,,practicable ,,in ,,presenting ,,to ,,children ,,the ,,evils ,,of ,,alcoholism ,,to ,,tell ,,the ,,truth1 ,,the ,,whole ,,truth1 ,,and ,,nothing ,,but ,,the ,,truth8 #ceg ,,xxxvi4 ,,fighting ,,tobacco ,,evils #cfc ,,xxxvii4 ,,the ,,patent-,,medicine ,,evil #cfi ,,xxxviii4 ,,health ,,advertisements ,,that ,,promote ,,health #cgh ,,xxxix4 ,,is ,,class ,,instruction ,,in ,,sex ,,hygiene ,,practicable8 #chd ,,xl4 ,,the ,,element ,,of ,,truth ,,in ,,quackery2 ,,hygiene ,,of ,,the ,,mind #cia ,,xli4 ,a ,,natural ,,law ,,is ,,as ,,sacred ,,as ,a ,,moral ,,principle #cih ,,index #dje ,,civics ,,and ,,health ,,part ,i4 ,,health ,,rights ,,chapter ,i ,,health ,a ,,civic ,,obligation ,in forty-five states and territories the teaching of hygiene with special reference to alcohol and tobacco is made compulsory4 ,to hygiene alone1 of the score of subjects found in our modern grammar-school curriculum1 is given statutory right of way for so many minutes per week1 so many pages per text-book1 or so many pages per chapter4 ,for the neglect of no other study may teachers be removed from office and fined4 ,yet school garrets and closets are full of hygiene text-books unopened or little used1 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 legislation4 ,to complete the paradox1 this least interesting subject happens also to be the most vital to the child1 to the home1 to industry1 to social welfare1 and to education itself4 ,whether the subject of hygiene is necessarily dull1 whether the statutes requiring regular instruction in the laws of health are violated with impunity1 whether health principles are flaunted by health practice at school1--these are questions of immediate concern to parents as a class1 to employers as a class1 to every pastor1 every civic leader1 every health officer1 every taxpayer4 ,interviews with teachers and principals regarding the present apathy to formal hygiene instruction have brought out the following points that merit the serious consideration of those who are struggling for higher health standards4 #a4 ,there is many a slip 'twixt the making of a law and its enforcement4 ,if laws regarding hygiene instruction are not enforced1 we should not be surprised4 ,it has been nobody's business to see whether and how hygiene is being taught4 ,the moral crusade spent itself in forcing compulsory laws upon the statute books of every state and territory4 ,making a fetish of ,legislation1 the advocates of anti-alcohol and anti-tobacco instruction failed to see the truth that experienced political reformers are but slowly coming to see--,legislation which does not provide machinery for its own enforcement is apt to do little good and frequently will do much harm4 ,machinery1 however admirably adapted to the work to be done1 will get out of order and become useless1 or even harmful1 unless constantly watched and efficiently directed4 ,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 hygiene1 if state officials never enforce the penalty8 ,so long as the penalty is not enforced for flagrant violation1 what difference does it make whether the reason is indifference1 ignorance1 or desire to thwart the law8 ,fortunately1 it is easy for each one of us to learn how often and in what way the children in our community are being taught hygiene1 and how the schools of our state teach and practice the laws of health4 ,if either the spirit or the letter of the law regarding instruction in hygiene is being violated1 we can measure the penalty paid in health and morals by our children and our community4 ,we can learn whether law1 text-book1 curriculum1 or teacher should be changed4 ,we can insist upon discussion of the facts and upon remedies suggested by the facts4 #b4 ,teachers give as one reason for neglecting hygiene1 that they are often compelled to struggle with a curriculum which requires more than they are able to teach and more than pupils are able to learn in the time allowed4 ,while an overcharged curriculum may explain1 it surely does not justify1 the violation of law and the dropping of hygiene from our school curriculum4 ,if there is any class of citizen who should teach and practice respect for law as law1 it is the teacher4 ,parents1 school directors1 county and state superintendents1 university presidents1 social workers1 owe it not only to themselves1 but to the ,american school-teacher1 either to repeal the laws that enjoin instruction in hygiene or else so to adjust the curriculum that teachers can comply with those laws4 ,the present situation that discredits both law and hygiene is most demoralizing to teacher1 pupil1 and community4 ,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 cigarettes4 ,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 cigarettes8 ,if practice and precept must be consistent1 shall the man be removed1 shall he change his habits1 shall the law regarding instruction in hygiene be changed1 or shall other provision be made for bringing child and essential facts together in a way that will not dull the child's receptivity8 #c4 ,teachers are made to feel that while arithmetic and reading are essential1 hygiene is not essential4 ,whatever may be the facts regarding the relative value of arithmetic and hygiene1 whether or not our state legislators have made a mistake in declaring hygiene to be essential1 are questions altogether too important for child and state to be left to the discretion of the individual teacher or superintendent4 ,it is fair to the teachers who say they cannot afford to turn aside from the three ,r's to teach hygiene1 to admit that they have not hitherto identified the teaching of hygiene with the promotion of the physical welfare of children4 ,teachers awake to the opportunity will sacrifice not only hygiene but any other subject for the sake of promoting children's health4 ,they do not really believe that arithmetic is more important than health4 ,what they mean to say is that hygiene1 as taught by them1 has not heretofore had an appreciable effect upon their pupils' health2 that other agencies exist1 outside of the school1 to teach the child how to avoid certain diseases and how to observe the fundamental laws of health1 whereas no other agencies exist to give the child the essentials of arithmetic1 reading1 and geography4 ,we teach 7or try to teach7 what our classes are examined in4 ,if you want a subject taught1 you must test a class in it and hold a teacher responsible for results1 and examinations are mercilessly unhygienic1 you know4 #d4 ,teachers believe that they get better results for their children from teaching hygiene informally and indirectly than from stated formal lessons4 ,whether instruction should be informal or formal is merely a question of method to be determined by results4 ,what the results are1 can be determined by principals1 superintendents1 and students of education4 ,it is easy to understand how at the time of a fever epidemic children could be taught as much in one week about infection1 disease germs1 antiseptics1 value of cleanliness1 etc41 as in five or ten months when vivid illustration is lacking4 ,physicians themselves learn more from one epidemic of smallpox than from four years of book study4 ,to make possible and to require a daily shower bath will undoubtedly do more to inculcate habits of health than repeated lessons about the skin1 pores1 evaporation1 and discharge of impurities4 ,if one illustration is better than ten lessons1 if an open window is worth more than all that text-books have to say about ventilation1 if a seat adjusted to the child is better than an anatomical chart1 this does not mean that instruction in hygiene should cease4 ,on the contrary1 it means that provision should be made for every teacher to open windows1 to adjust desks1 to use the experience of individual children for the education of the class4 ,if the rank and file of teachers have not hitherto been sufficiently observant of physiological and hygienic facts1 if they are unprepared from their own lives to detect or to furnish illustrations for the child1 this again does not mean that the child should be denied the illustrations1 but that the teacher should either have instruction and experience to incite interest and to stimulate powers of observation1 or else be asked to give place to another teacher who is able to furnish such qualifications4 #e4 ,children1 like adults1 can be interested in other people1 in rules of conduct1 in social conditions1 in living and working relations more easily than in their own bodies4 ,the normal1 healthy child thinks very little of himself apart from the other boys and girls1 the games1 the studies1 the animals1 the nature wonders1 the hardships that come to him from the outside4 ,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 at1 hear1 enjoy4 ,the power to concentrate attention upon oneself is a sign either of a diseased body1 a diseased mind1 or a highly trained mind4 ,to study others and to recognize the similarity between others and oneself is as natural as the body itself4 ,teachers are consulting this line of easiest access to children's attention when they honor children according to cleanliness of hands1 of teeth1 of shoes4 ,human interest attaches to what parks or excursions are doing for sickly children1 how welfare work is improving factory employees1 how smallpox is conquered by vaccination1 how insurance companies refuse to take risks upon the lives of men or women addicted to the excessive use of alcohol or tobacco4 ,other people's interests--tenement conditions1 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 playground1 at home1 on the way to school or to work4 ,once upon a time-- will always arrest attention more quickly than ,the human frame consists--4 ,what others think of me helps me to obey law--statutory1 moral1 or hygienic--more than what ,i know of law itself4 ,how social instincts dominate may be illustrated by an experience in advertising a public bath near a thoroughfare traveled daily by thousands of working girls4 ,i prepared a card to be distributed among these girls that began3 ,a cool1 refreshing bath1 etc4 ,this card was criticised by one who knows the ways of girls and women1 as follows3 ,of course you get no success when you have a man stand on the street corner and pass out cards telling girls to get clean4 ,every girl that is worth while is affronted by the insinuation4 ,acting upon this expert advice1 we then got out a neatly printed card reading as follows3 ,for a clear complexion1 sprightly step1 and bounding vitality1 visit the ,center ,market ,baths1 open from #f ,a4,m4 to #i ,p4,m4 daily4 ,the board of managers shook their sage masculine heads and reluctantly gave permission to issue these appeals4 ,woman's judgment was vindicated1 however1 and the advantage was proved of urging health for society's sake rather than for health's sake1 when the patronage of the bath jumped at once to considerable proportions4 #f4 ,other people's habits of health influence our well-being quite as much1 if not more1 than our own4 ,because we are social beings1 ability to get along with our families1 our friends1 our employers1 is--at least so it seems to most of us--quite as important as individual health4 ,for too many of us1 living hygienically is absolutely impossible without inconveniencing and bothering the majority of persons with whom we live4 ,i remember a girl in college1--a fresh-air fiend1--who every morning1 no matter how cold1 threw the windows wide open4 ,then1 with forty others1 ,i thought this girl a nuisance as well as a menace to health1 but now1 twenty years afterwards1 ,i find myself wanting to do the same thing4 ,professor ,patten1 the economist1 whom ,i shall quote many times because he is particularly interested in the purpose of this book1 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 standards4 ,to be true to my own health needs1 ,i ought to have declined nearly everything that has been offered me for dinner1 but in the long run1 if ,i am going to visit1 my eating what is placed before me is better for society than making those who entertain me feel uncomfortable4 ,most of us know what uphill work it is to live hygienically in an unhygienic environment4 ,i remember how hard it was to eat happily when sitting beside a college professor who took brown pills before each meal1 yellow pills between each course1 and a dose of black medicine after the meal was over4 ,mariano1 an ,italian lad cured of bone tuberculosis by out-of-door salt air at ,sea ,breeze1 returned to his tenement home an ardent apostle of fresh air day and night1 winter and summer4 ,his family allowed him to open the window before going to bed1 but closed it as soon as he was asleep4 ,lawrence ,veiller1 our greatest expert on tenement conditions1 says3 ,to bathe in a tenement where a family of six occupy three rooms often involves the sacrifice of privacy and decency1 which are quite as important to social betterment as cleanliness4 ,to live unhygienically where others live hygienically is quite as difficult4 ,witness the speedy improvement of dissipated men when boarding with country friends who eat rationally and retire early4 ,it must have been knowledge of this fact that prompted the tramways of ,belfast to post conspicuous notices3 ,spitting is a vile and filthy habit1 and those who practice it subject themselves to the disgust and loathing of their fellow-passengers4 ,it is almost impossible to have indigestion1 blues1 and headache when one is camping1 particularly where action and enjoyment fill the day4 ,our practical question is1 therefore1 not ,what shall ,i eat1 how many hours shall ,i sleep1 what shall ,i wear1 but ,how can ,i manage to get into an environment among living and working conditions where the people ,i live with and want to please1 those who influence me and are influenced by me1 make healthy living easy and natural8 #g4 ,because the problems of health have to do principally with environment1--home1 street1 school1 business1--it is worth while trying to relate hygiene instruction to industry and government1 to preach health from the standpoint of industrial and national efficiency rather than of individual well-being4 ,since healthful living requires the coperation of all persons in a household1 in a group1 or in a community1 we must find some working programme that will make it easy for all the members of the group to observe health standards4 ,a city government that spends taxes inefficiently can produce more sickness1 wretchedness1 incapacity in one year than pamphlets on health can offset in a generation4 ,failure to enforce health laws is a more serious menace to health and morals than drunkenness or tobacco cancer4 ,unclean streets1 unclean dairies1 unclean1 overcrowded tenements can do more harm than alcohol and tobacco because they can breed an appetite that craves stimulants and drugs4 ,others have taught how the body acts1 what we ought to eat1 how we should live4 ,we are concerned here not with repeating the laws of health1 but with a consideration of the mechanism that will make it possible for us so to work together that we can observe those laws4 ,,chapter ,,ii ,,seven ,,health ,,motives ,,and ,,seven ,,catchwords ,in making a health programme as in making a boat1 a garden1 or a baseball team1 the first step is to look about and see what material there is to work with4 ,a baseball team will fail miserably unless the captain places each man where he can play best4 ,gardening is profitless when the gardener does not know the habits of plants and the possibilities of different kinds of soil4 ,so in planning a health programme we must study our materials and use each where it will fit best4 ,the materials of first importance to a health programme in civilized countries are men2 for men working together can control water sources1 drainage1 and ventilation1 or else move away to surroundings better suited to healthful living4 ,therefore the first concern of the leader in a health crusade is the human kind he has to work for and work with4 ,seven kinds of man are to be found in every community1 seven different points of view with regard to health administration4 ,each individual1 likewise1 may have seven attitudes toward health laws1 seven reasons for demanding health protection4 ,these seven points of view1 seven stages of development1 are clearly marked in the evolution of sanitary administration throughout the civilized world4 ,with few exceptions1 it is possible1 by examining ourselves1 our friends1 and our communities1 to see where one motive begins and leaves off1 giving way to or mixing with one or more other motives4 ,a friend once asked me if ,i could keep this number seven from growing to eight or nine4 ,perhaps not4 ,perhaps there are more kinds of people1 more health motives1 more stages in health progress2 but ,i am sure of these seven1 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 ,city4 ,the number seven was not reached hit-or-miss fashion1 nor was it chosen for its biblical prestige4 ,on the contrary1 it came as the result of studying health administration in twoscore ,british and ,american cities1 and of reading scores of books on sanitary evolution4 ,seven catchwords make it easy to remember the characteristics and the source of every motive1 every kind of person1 and every stage in the evolution of sanitary standards4 ,these seven catchwords are3 ,instinct1 ,display1 ,commerce1 ,anti-nuisance1 ,anti-slum1 ,pro-slum1 ,rights4 ,by the use of these catchwords any teacher1 parent1 public official1 educator1 or social worker should be able to size up the situation1 the needs1 and the opportunity of the individuals or the communities for whom a health crusade is planned4 ,instinct was the first health officer and made the first health laws4 ,instinct warns us against unusual and offensive odors1 sights1 and noises1 just as it causes us to seek that which is agreeable4 ,primitive man in common with other animals learned by sad experience to avoid certain herbs as poisons2 to bury or to move away from the dead2 to shun discolored drinking water4 ,during the roaming period sun and air and water acted as scavengers4 ,when tribes settled down in one spot for long periods1 habits that had hitherto been inoffensive and safe became noticeably injurious and unpleasant4 ,heads of tribes gave orders prohibiting such habits and restricting disagreeable acts and objects to certain portions of the camp4 ,instinct places outhouses on our farms and then gradually removes them farther and farther from dwellings4 ,in many school yards1 more particularly in country districts and small towns1 outhouses are a crying offense against animal instinct4 ,in visiting slum districts in ,irish and ,scotch cities1 and in ,london1 ,paris1 ,berlin1 and ,new ,york1 ,i never found conditions so offensive to crude animal instinct as those ,i knew when a boy in ,minnesota school yards1 or those ,i have since seen in a ,boy ,republic4 ,but the evil is not corrected because it is not made anybody's business to execute instinct's mandates4 ,in the ,boy ,republic the leaders were waiting for the children themselves to revolt1 as does primitive man4 ,,table ,i ,,typhoid ,a ,,rural ,,disease#a ,average ,average ,per ,cent ,typhoid ,fever of ,rural ,death ,rate ,population per #ajj1jjj ---------------------------------------- ---------------------------- ,five states in which the urban population was more than #fj of the total #cj #be ,six states in which the urban population was between #dj and #fj #di #db ,seven states in which the urban population was between #cj and #dj #fg #ch ,eight states in which the urban population was between #bj and #cj #ge #df ,twelve states in which the urban population was between #aj and #bj #hg #fb ,twelve states in which the urban population was between #j and #aj #ie #fg ,among large numbers of persons1 in city as well as country1 washing the body is still a matter of instinct1 a bath not being taken until the body is offensive1 the hands not being washed until their condition interferes with the enjoyment of food or with one's treatment by others4 ,there is a point of neglect beyond which instinct will not permit even a tramp to go4 ,if cleanliness is next to godliness1 the average child is most ungodly by nature1 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 action4 ,the chief form of legislation of the instinct age is provision of penalties for those who poison food1 water1 or fellow-man4 ,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 poisoner4 ,display has always been an active health crusader4 ,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 slippers1 white stockings1 a white dress1 and white hat4 ,why8 ,because they would at once notice and resent the dirt on the street1 in their hallways1 and in their own homes4 ,people that have nothing to spoil really do not see dirt1 for it interferes in no way with their comfort so far as they can see4 ,their windows are crusted with dust1 their babies' milk bottles are yellow with germs4 ,who cares8 ,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 cleanliness4 ,but let the tenement mother or the isolated farmer's wife entertain the minister or the school-teacher1 the candidate for sheriff or the ward boss1 let her go to ,coney ,island or to the county fair1 and at once an outside standard is set up that requires greater regard for personal appearance and leads to cleaning up4 ,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 see4 ,entertainments and sociables1 ,saturday choir practice and church have led many a young man to bathe for others' sake when quite satisfied to forego the ordeal so far as his own comfort and health were concerned4 ,streets on which the well-to-do live are kept clean4 ,why8 ,not because ,madam ,well-to-do cares so much for health1 but because she associates cleanliness with social prestige4 ,it is necessary for the display of her carriages and dresses1 just as paved streets and a plentiful supply of water for public baths and private homes were essential to the display of ,rome's luxury4 ,generally speaking1 residence streets are cleaned in small towns just as waterworks are introduced1 to gratify the display motive of those who have lawns to water and clothes to show4 ,instinct strengthens the display motive4 ,as every one can be interested in instinct hygiene1 so every one is capable of this display motive to the extent that his position is affected by other people's opinion4 ,it was love of display quite as much as love of beauty that gave ,greece the goddess ,hygeia1 the worship of whom expressed secondarily a desire for universal health1 and primarily a love of the beautiful among those who had leisure to enjoy it4 ,commerce brooks no preventable interference with profits1 whether by disease1 death1 impassable streets1 or disabled men4 ,the age of chivalry was also the age of indescribable filth1 plague1 ,black ,death1 and spotted fever that cost the lives of millions4 ,it would be impossible in the civilized world to duplicate the combination of luxury and filthy1 disease-breeding conditions in the midst of which ,queen ,bess and her courtiers held their revels4 ,the first protest was made1 not by the church1 not by sanitarians1 but by the great merchants who were unable to insure against loss and ruin from the plagues that thrived on filth and overcrowding4 ,by an interesting coincidence the first systematic street cleaning and the first systematic ship cleaning--maritime quarantine--date from the same year1 #acdh ,a4,d42 the former in the foremost ,german trading town1 ,cologne1 and the latter in ,venice1 the foremost trading town of ,italy4 ,the merchants of ,philadelphia and ,new ,york started the first boards of health in the ,united ,states4 ,for what purpose8 ,to prevent business losses from yellow fever4 ,desire for passable streets1 drains1 waterworks1 and strong boards of health has generally started with merchants4 ,for commercial reasons many of our states vote more money for the protection of cattle than for the protection of human life1 and the ,united ,states votes millions for the study of hog cholera1 chicken pip1 and animal tuberculosis1 while neglecting communicable diseases of men4 ,no class in a community will respond more quickly to an appeal for the rigid enforcement of health laws than the merchant class2 none will oppose so bitterly as that which makes profits out of the violation of health laws4 ,,table ,,ii ,,cost ,,in ,,life ,,capital ,,of ,,preventable ,,diseases#b ,multiply by the number of deaths for each ,estimated age group to learn the cost in life ,value of capital to your community in loss of life ,age ,human ,life from one or all preventable diseases4 ---------------------------------------- ---------------------------- #j-e years #a1ejj #e-aj #b1cjj #aj-ae #b1ejj #ae-bj #c1jjj #bj-be #e1jjj #be-cj #g1ejj #cj-ce #g1jjj #ce-dj #f1jjj #dj-de #e1ejj #de-ej #e1jjj #ej-ee #d1ejj #ee-fj #d1ejj #fj-fe #b1jjj #fe-gj #a1jjj #gj- #a1jjj ,anti-nuisance motives do not affect health laws until people with different incomes and different tastes try to live together4 ,in a small town where everybody keeps a cow and a pig1 piggeries and stables offend no one2 but when the doctor1 the preacher1 the dressmaker1 the lawyer1 and the leading merchant stop keeping pigs and cows1 they begin to find other people's stables and piggeries offensive4 ,the early laws against throwing garbage1 fish heads1 household refuse1 offal1 etc41 on the main street were made by kings and princes offended by such practices4 ,the word nuisance was coined in days when neighbors lived the same kind of life and were not sensitive to things like house slops1 ash piles1 etc4 ,the first nuisances were things that neighbors stumbled over or ran into while using the public highway4 ,next1 goats and other animals interfering with safety were described as nuisances1 and legal protection against them was worked out4 ,it has never been necessary to change the maxim which originally defined a nuisance3 ,so use your own property that you will not injure another in the use of his property4 ,the thing that has changed and grown has been society's knowledge of acts and objects that prevent a man from enjoying his own property4 ,to-day the number of things that the law calls nuisances is so great that it takes hundreds of pages to describe them4 ,stables and outhouses must be set back from the street4 ,every man must dispose of garbage and drainage on his own property4 ,stables and privies must be at least a hundred feet from water reservoirs4 ,factories may not pollute streams that furnish drinking water4 ,merchants may be punished if they put banana skins in milk cans1 or if they fail to scald and cleanse all milk receptacles before returning them to wholesalers4 ,automobile drivers may be punished for disturbing sleep4 ,anything that injures my health will be declared a nuisance and abolished1 if ,i can prove that my health is being injured and that ,i am doing all ,i can to avoid that injury4 ,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 neighbors4 ,the rich are able to run away from nuisances that they cannot have abated4 ,if proper publicity is given to living conditions among those who do not resist nuisances1 the presence of such conditions will itself become offensive to the well-to-do1 who will take steps to remove the nuisance4 ,jacob ,riis in this way made the slums a nuisance to rich residents in ,new ,york ,city and stimulated tenement reform1 building of parks1 etc4 ,anti-slum motives originated in cities where there is a clear dividing line between the clean and the unclean1 the infected and the uninfected1 the orderly and the disorderly1 high and low vitality4 ,as soon as one district becomes definitely known as a source of nuisance1 infection1 and disease1 better situated districts begin to make laws to protect themselves4 ,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 income1 high vitality against low vitality1 houses with rooms to spare against houses that are overcrowded4 ,to the small town and the country the slum means generally the near-by city whose papers talk of epidemic scarlet fever1 diphtheria1 or smallpox4 ,cities have only recently begun to experience anti-slum aversion to country dairies whose uncleanliness brings infected milk to city babies1 or to filthy factories and farms that pollute water reservoirs and cause typhoid4 ,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 broadcast4 ,every individual knows of some family or some district that is immediately pictured when terms like disease1 epidemic1 slum1 are pronounced4 ,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 #ca4 ,illustration3 ,a ,,country ,,menace ,,to ,,city ,,health ,pro-slum motives are not exactly born of anti-slum motives1 but1 thanks to the instinctive kindness of the human heart1 follow promptly after the dangers of the slum have been described4 ,you and ,i work together to protect ourselves against neglect1 nuisance1 and disease4 ,in a district by which we must pass and with which we must deal1 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 ourselves4 ,charles ,dickens so described ,oliver ,twist and ,david ,copperfield that ,great ,britain organized societies and secured legislation to improve the almshouse1 school1 and working and living conditions4 ,when health reports1 newspapers1 and charitable societies make us see that the slum menaces our health and our happiness1 we become interested in the slum for its own sake4 ,we then start children's aid societies1 consumer's leagues1 sanitary and prison associations1 child-labor committees1 and efficient government clubs4 ,rights motives are the last to be evolved in individuals or communities4 ,the well-to-do protect their instinct1 their comfort1 their commerce1 but run away from the slums and build in the secluded spots or on the well-policed and well-cleaned avenues and boulevards4 ,uptown is often satisfied with putting health officials to work to protect it against downtown4 ,pro-slum motives are shared by too few and are expressed too irregularly to help all of those who suffer from crowded tenements1 impure milk1 unclean streets1 inadequate schooling4 ,so long as those who suffer have no other protection than the self-interest or the benevolence of those better situated1 disease and hardship inevitably persist4 ,health administration is incomplete until its blessings are given to men1 women1 and children as rights that can be enforced through courts1 as can the right to free speech1 the freedom of the press1 and trial by jury4 ,there is all the difference in the world between having one's street clean because it is a danger to some distant neighbor1 or because that neighbor takes some philanthropic interest in its residents1 and because one has a right to clean streets1 regardless of the distant neighbor's welfare or interest4 ,when the right to health is granted health laws are made1 and all men within the jurisdiction of the lawmaking power own health machinery that provides for the administration of those laws4 ,a system of public baths takes the place of a bathhouse supported by charity2 a law restricting the construction and management of all tenements takes the place of a block of model tenements1 financed by some wealthy man2 medical examination of all school children takes the place of a private dispensary2 a probation law takes the place of the friendly visitor to the county jail4 ,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 acts1 pleasures1 and necessities4 ,when our political rights were formulated in maxims1 living was relatively simple4 ,there was no factory problem1 no transportation problem1 no exploitation of women and children in industry4 ,our ancestors firmly believed that if the strong could be prevented from interfering with the political rights of the weak1 all would have an equal chance4 ,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 it1 to trial by jury if charged with crime1 to speak or print the truth about men or governments4 ,if1 however1 anybody should interfere with our freedom in this respect1 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 opinion4 ,the time is past when any one seriously believes that political freedom or personal liberty will be universal1 just because everybody has a right to talk1 to move from place to place1 to print stories in the newspapers4 ,the relation of man to man to-day requires that we formulate rules of action that prevent one man's taking from another those rights1 economic and industrial1 that are as essential to twentieth-century happiness as were political rights to eighteenth-century happiness4 ,political maxims showed how1 through common desire and common action1 steps could be taken by the individual and by the whole of society for the protection of all4 ,health rights1 likewise1 are to be obtained through common action4 ,a modern city must know who is accountable when an automobile runs over a pedestrian1 when a train load of passengers lose their lives because of an engineer's carelessness1 when an employee is incapacitated for work by an accident for which he is not responsible1 or when fever epidemics threaten life and liberty without check4 ,how can a child who is prevented by removable physical defects from breathing through his nose be enthusiastic over free speech8 ,of what use is freedom of the press to those who find reading harder than factory toil8 ,how futile the right to trial by jury if removable physical defects make children unable to do what the law expects6 ,who would not exchange rights of petition for ability to earn a living8 ,children permanently incapacitated to share the law's benefits cannot appreciate the privilege of pursuing happiness4 ,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 health4 ,the truest index to economic status and to standards of living is health environment4 ,the best criterion of opportunity for industrial and political efficiency is the conditions affecting health4 ,the seven catchwords that describe seven motives to health legislation and health administration1 seven ways of approaching health needs1 and seven reasons for meeting them1 should be found helpful in analyzing the problem confronting the individual leader4 ,generally speaking1 we cannot watch political rights grow1 but health rights are evolved before our eyes all the time4 ,if we wish1 we can see in our own city or township the steps taken1 one by one1 that have slowly led to granting a large number of health rights to every ,american4 ,,footnotes3 #a ,prepared by ,dr4 ,john ,s4 ,fulton1 secretary of the state board of health1 ,maryland1 and quoted by ,dr4 ,george ,c4 ,whipple in ,typhoid ,fever4 #b ,marshall ,o4 ,leighton1 quoted in ,whipple's ,typhoid ,fever4 ,,chapter ,,iii ,,what ,,health ,,rights ,,are ,,not ,,enforced ,,in ,,your ,,community8 ,laws define rights4 ,men enforce them4 ,for definitions we go to books4 ,for record of enforcement we go to acts and to conditions4#c ,what health rights a community pretends to enforce will1 as a rule1 be found in its health code4 ,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 live4 ,a street1 a cellar1 a milk shop1 a sick baby1 or an adult consumptive tells more honestly the story of health rights enforced and health rights unenforced than either sanitary code or sanitary squad4 ,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 state4 ,the health code of one city looks very much like the health code of every other city4 ,this is natural because those who write health codes generally copy other codes4 ,even small cities are given complicated sanitary legislative powers by state legislatures4 ,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 instruction4 ,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 powers4 ,illustration3 ,a ,,dairy ,,inspector',s ,,outfit ,the slip 'twixt law making and law enforcement is everywhere found4 ,in #ahfd ,new ,york state prohibited the sale of adulterated milk4 ,law after law has been made since that time1 giving health officials power to revoke licenses of milk dealers and to send men to jail who violated milk laws4 ,we now know that no law will ever stop the present frightful waste of infant lives1 counted in thousands annually1 unless dairies are frequently inspected and forced to be clean2 unless milk is kept at a temperature of about fifty degrees on the train1 in the creamery1 at the receiving station1 and in the milk shop2 unless dealers scald and thoroughly cleanse cans in which milk is shipped2 unless licenses are taken from farmers1 creameries1 and retailers who violate the law2 unless magistrates use their power to fine or imprison those who poison helpless babies by violating milk laws2 and unless mothers are taught to scald and thoroughly cleanse bottles1 nipples1 cups1 and dishes from which milk is fed to the baby4 ,we know that these things are not being done except where men or women make it their business to see that they are done4 ,experience tells us that inspectors will not consistently do their duty unless those who direct them have regular records of their inspections1 study those records1 find out work not done properly or promptly1 and insist upon thorough inspection4 ,whether work is done right1 whether inspectors do their full duty1 whether babies are protected1 can be learned only from statements in black and white that show accurately the conditions of dairies and milk shops1 the character of milk found and tested by inspectors1 and the number of babies known to have been sick or known to have died from intestinal diseases chiefly due to unsafe milk4 ,any teacher or parent can learn for himself1 or can teach children to learn1 what steps are taken to guarantee the right to pure milk by using a table such as ,table ,,iii4 ,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 7,table ,,iv74 ,,table ,,iii ,,milk ,,inspection ,,within ,,new ,,york ,,city1 #aijf ,new ,york ,each borough ---------------------------- ,stores ,wagons ,stores ,wagons ---------------------------- ,,field ,permits issued during #aijf ,permits revoked during #aijf ,for discontinuance of selling ,for violation of law ,average permits in force in #aijf ,,inspection ,regular inspections ,inspections at receiving stations ,total ,average inspections per permit per year ,specimens examined ,samples taken ,,conditions ,,found ,inspections finding milk above #ej of such discoveries to total inspections ,inspections finding adulteration ,warning given ,prosecuted of adulterations found to inspections ,rooms connected contrary to sanitary code ,ice box badly drained ,ice box unclean ,store unclean ,utensils unclean ,milk not properly cooled ,infectious disease ,persons found selling without permit ,,action ,,taken ,,destruction ,,of ,,milk ,lots of milk destroyed for being over #ej ,quarts so destroyed ,lots of milk destroyed for being sour ,quarts so destroyed ,lots of milk destroyed for being otherwise adulterated ,quarts so destroyed ,total quarts destroyed ,,notices ,,issued ,to drain and clean ice box ,to clean store ,,criminal ,,actions ,,begun ,for selling adulterated milk ,for selling without permit ,for interference with inspector ,total ,,table ,,iv ,perfect ,score #ajj ,score allowed 444 ,file ,no444444444444 ,,department ,,of ,,health 7,thirteen items are here omitted7 ,dairy ,inspection ,division of ,inspections #a ,inspection ,no4 444444 ,time 444444 ,a4 ,p4 ,m4 ,date 444444 #aij #b ,all persons in the households of those engaged in producing or handling milk are 444444 free from all infectious disease 444444 #c ,date and nature of last case on farm 444444 #d ,a sample of the water supply on this farm taken for analysis 444444 #aij444 and found to be 444444 ,,stable ,perfect ,allow ---------------------------------------- ---------------------------- #e ,,cow ,,stable is 444 located on elevated ground with no stagnant water1 hog pen1 or privy within #ajj feet #a 444 #f ,,floors are 444 constructed of concrete or some nonabsorbent material #a 444 #g ,floors are 444 properly graded and water-tight #b 444 #h ,,drops are 444 constructed of concrete1 stone1 or some nonabsorbent material #b 444 #i ,drops are 444 water-tight #b 444 #aj ,,feeding ,,troughs1 platforms1 or cribs are 444 well lighted and clean #a 444 #aa ,,ceiling is constructed of 444 and is 444 tight and dust proof #b 444 #ab ,ceiling is 444 free from hanging straw1 dirt1 or cobwebs #a 444 #ac ,,number ,,of ,,windows 444 total square feet 444 which is 444 sufficient #b 444 #ad ,window panes are 444 washed and kept clean #a 444 #ae ,,ventilation consists of 444 which is sufficient #c1 fair #a1 insufficient #j #c 444 #af ,,air ,,space is 444 cubic feet per cow which is 444 sufficient 7#fjj and over--#c7 7#ejj to #fjj--b7 7#djj to #ejj--a7 7under #djj--j7 #c 444 #ag ,,interior of stable painted or whitewashed on 444 which is satisfactory #b1 fair #a1 never #j #b 444 #ah ,,walls ,,and ,,ledges are 444 free from dirt1 dust1 manure1 or cobwebs #b 444 #ai ,,floors ,,and ,,premises are 444 free from dirt1 rubbish1 or decayed animal or vegetable matter #a 444 #bj ,,cow ,,beds are 444 clean #a 444 #ba ,,live ,,stock1 other than cows1 are 444 excluded from rooms in which milch cows are kept #b 444 #bb ,there is 444 direct opening from barn into silo or grain pit #a 444 #bc ,,bedding used is 444 clean1 dry1 and absorbent #a 444 #bd ,,separate ,,building is 444 provided for cows when sick #a 444 #be ,separate quarters are 444 provided for cows when calving #a 444 #bf ,,manure is 444 removed daily to at least #bjj feet from the barn 7 444 ft47 #b 444 #bg ,manure pile is 444 so located that the cows cannot get at it #a 444 #bh ,,liquid ,,matter is 444 absorbed and removed daily and 444 allowed to overflow and saturate ground under or around cow barn #b 444 #bi ,,running ,,water supply for washing stables is 444 located within building #a 444 #cj ,,dairy ,,rules of the ,department of ,health are 444 posted #a 444 ,,cow ,,yard #ca ,,cow ,,yard is 444 properly graded and drained #a 444 #cb ,cow yard is 444 clean1 dry1 and free from manure #b 444 ,,cows ,perfect ,allow #cc ,,cows have 444 been examined by veterinarian 444 ,date 444 #aij ,report was #c 444 #cd ,cows have 444 been tested by tuberculin1 and all tuberculous cows removed #e 444 #ce ,cows are 444 all in good flesh and condition at time of inspection #b 444 #cf ,cows are 444 all free from clinging manure and dirt4 7,no4 dirty 444 7 #d 444 #cg ,,long ,,hairs are 444 kept short on belly1 flanks1 udder1 and tail #a 444 #ch ,,udder ,,and ,,teats of cows are 444 thoroughly cleaned before milking #b 444 #ci ,,all ,,feed is 444 of good quality and all grain and coarse fodders are 444 free from dirt and mold #a 444 #dj ,,distillery waste or any substance in a state of fermentation or putrefaction is 444 fed #a 444 #da ,,water ,,supply for cows is 444 unpolluted and plentiful #b 444 ,,milkers ,,and ,,milking #db ,,attendants are 444 in good physical condition #a 444 #dc ,special ,milking ,suits are 444 used #a 444 #dd ,clothing of milkers is 444 clean #a 444 #de ,hands of milkers are 444 washed clean before milking #a 444 #df ,,milking is 444 done with dry hands #b 444 #dg ,,fore ,,milk or first few streams from each teat is 444 discarded #b 444 #dh ,milk is strained at 444 and 444 in clean atmosphere #a 444 #di ,milk strainer is 444 clean #a 444 #ej ,,milk is 444 cooled to below #ej ,f4 within two hours after milking and kept below #ej ,f4 until delivered to the creamery 444 #b 444 #ea ,milk from cows within #ae days before or #e days after parturition is 444 discarded #a 444 ,,utensils #eb ,,milk ,,pails have 444 all seams soldered flush #a 444 #ec ,milk pails are 444 of the small-mouthed design1 top opening not exceeding #h inches in diameter4 ,diameter 444 #b 444 #ed ,milk pails are 444 rinsed with cold water immediately after using and washed clean with hot water and washing solution #b 444 #ee ,drying racks are 444 provided to expose milk pails to the sun #a 444 ,,milk ,,house #ef ,,milk ,,house is 444 located on elevated ground with no hog pen1 manure pile1 or privy within #ajj feet #a 444 #eg ,milk house has 444 direct communication with 444 building #a 444 #eh ,milk house has 444 sufficient light and ventilation #a 444 #ei ,floor is 444 properly graded and water-tight #a 444 #fj ,milk house is 444 free from dirt1 rubbish1 and all material not used in the handling and storage of milk #a 444 #fa ,milk house has 444 running or still supply of pure clean water #a 444 #fb ,ice is 444 used for cooling milk and is cut from 444 #a 444 ,,water #fc ,,water ,,supply for utensils is from a 444 located 444 feet deep and apparently is 444 pure1 wholesome1 and uncontaminated #e 444 #fd ,is 444 protected against flood or surface drainage #b 444 #fe ,there is 444 privy or cesspool within #bej feet 7 444 feet7 of source of water supply #b 444 #ff ,there is 444 stable1 barnyard1 or pile of manure or other source of contamination within #bjj feet 7 444 feet7 of source of water supply #a 444 --------- #ajj ---------------------------------------- ---------------------------- ,it is a great pity that we ,americans have taken so long to learn that laws do not enforce themselves1 that even good motives and good intentions in the best of officials do not insure good deeds4 ,thousands of lives are being lost every year1 millions of days taken from industry and wasted by unnecessary sickness1 millions of dollars spent on curing disease1 the working life of the nation shortened1 the hours of enjoyment curtailed1 because we have not seen the great gap between health laws and health-law enforcement4 ,in our municipal1 state1 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 does4 ,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 power4 ,in protecting health1 as in reforming government1 an ounce of efficient achievement is worth infinitely more than a moral explosion4 ,one month of routine--unpicturesque1 unexciting efficiency--will accomplish more than a scandal or catastrophe4 ,such routine is possible only when special machinery is constantly at work1 comparing work done with work expected1 health practice with health ideals4 ,where such machinery does not yet exist1 volunteers1 civic leagues1 boys' brigades1 etc41 can easily prove the need for it by filling out an improvised score card for the school building1 railroad station1 business streets1 well-to-do and poor resident streets1 such as follows3 ,,table ,v ,,score ,,card ,,for ,,citizen ,,use ,perfect,allow ---------------------------------------- ---------------------------- ,schoolhouse ,well ventilated1 #bj2 badly1 #j-aj #bj 444 ,cleaned regularly1 #bj2 irregularly1 #j-aj #bj 444 ,feather duster prohibited1 #aj #aj 444 ,no dry sweeping1 #aj #aj 444 ,has adequate play space1 #aj2 inadequate1 #j-e #aj 444 ,has clean drinking water1 #aj #aj 444 ,has clean outbuildings and toilet1 #bj3 unclean1 #j-aj #bj 444 ------ #ajj ,church and ,sunday ,school ,well ventilated1 #bj2 badly1 #j-aj #bj 444 ,heat evenly distributed1 #bj2 unevenly1 #j-aj #bj 444 ,cleaned regularly1 #bj2 irregularly1 #j-aj #bj 444 ,without carpets1 #bj #bj 444 ,without plush seats1 #bj #bj 444 ------ #ajj ,streets ,sewerage underground1 #bj2 surface1 #j-aj #bj 444 ,no pools neglected1 #aj #aj 444 ,no garbage piled up1 #aj #aj 444 ,swept regularly1 #bj2 irregularly1 #j-aj #bj 444 ,sprinkled and flushed1 #aj #aj 444 ,has baskets for refuse1 #aj #aj 444 ,all districts equally cleaned1 #bj2 unequally1 #j-aj #bj 444 ------ #ajj ---------------------------------------- ---------------------------- ,until recently the most reliable test of health rights not enforced was the number of cases of preventable1 communicable1 contagious1 infectious1 transmissible diseases1 such as smallpox1 typhoid fever1 yellow fever1 scarlet fever1 diphtheria1 measles1 whooping cough4 ,by noticing streets and houses where these diseases occurred1 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 die4 ,the well-to-do remove from their houses and their streets the dirt1 the decomposed garbage1 and stagnant pools from which fevers seem to spring4 ,it was because fevers and congestion go together that laws were made to protect the well-to-do1 the comfortable1 and the clean against the slum4 ,it is true to-day that if you study your city and stick a pin in the map1 street for street1 where infection is known to exist1 you will find the number steadily increase as you go from uncongested to congested streets and houses1 from districts of high rent to districts of low rent4 ,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 health1 and because our laws grant protection against communicable diseases to a child in whatever district he may be born1 the record of cases of communicable diseases has heretofore been the best test of health rights unenforced4 ,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 disease1 and then follow up the record with a search for conditions that gave the disease a good chance4 ,but to wait for contagion before taking action has been found an expensive way of learning where health protection is needed4 ,even when infected persons and physicians are prompt in reporting the presence of disease it is often found that conditions that produced the disease have been overlooked and neglected4 ,for example1 smallpox comes very rarely to our cities to-day4 ,wherever boards of health are not worried by children's diseases1 as is often the case1 and wait for some more fearful disease such as smallpox1 there you will find that garbage in the streets1 accumulated filth1 surface sewers1 congested houses1 badly ventilated1 unsanitary school buildings and churches are furnishing a soil to breed an epidemic in a surprisingly short time4 ,where1 on the other hand1 boards of health regard every communicable disease as a menace to health rights1 you will find that health officials take certain steps in a certain order to remove the soil in which preventable diseases grow4 ,these steps1 worked out by the sanitarians of ,europe and ,america after a century of experiment1 are seen to be very simple and are applicable by the average layman and average physician to the simplest village or rural community4 ,how many of these steps are taken by your city8 by your county8 by your state8 #a4 ,notification of danger when it is first recognized4 #b4 ,registration at a central office of facts as to each dangerous thing or person4 #c4 ,examination of the seat of danger to discover its extent1 its cost1 and new seats of danger created by it4 #d4 ,isolation of the dangerous thing or person4 #e4 ,constant attention to prevent extension to other persons or things4 #f4 ,destruction or removal of disease germs or other causes of danger4 #g4 ,analysis and record1 for future use1 of lessons learned by experience4 #h4 ,education of the public to understand its relation to danger checked or removed1 its responsibility for preventing a recurrence of the same danger1 and the importance of promptly recognizing and checking similar danger elsewhere4 ,with a chart showing what districts have the greatest number of children and adults suffering from measles1 typhoid fever1 scarlet fever1 consumption1 one can go within his own city or to a strange city and in a surprisingly short time locate the nuisances1 the dangerous buildings1 the open sewers1 the cesspools1 the houses without bathing facilities1 the dark rooms1 the narrow streets1 the houses without play space and breathing space1 the districts without parks1 the polluted water sources1 the unsanitary groceries and milk shops4 ,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 stoop1 whether the well1 the barn1 and the privy are near together4 ,illustration3 ,,the ,,baby1 ,,not ,,the ,,law1 ,,is ,,the ,,test ,,of ,,infant ,,protection ,,in ,,country ,,and ,,in ,,city ,testing health rights requires not only that there be a board of health keeping track of and publishing every case of infection1 but it requires further that one community be compared with other communities of similar size1 and that each community be compared with itself year for year4 ,these comparisons have not been made and records do not exist in many states4 ,,footnotes3 #c ,a striking demonstration of law enforcement that followed lawmaking is given in ,the ,real ,triumph of ,japan1 ,l4,l4 ,seaman1 ,m4,d4 ,,chapter ,,iv ,,the ,,best ,,index ,,to ,,community ,,health ,,is ,,the ,,physical ,,welfare ,,of ,,school ,,children ,compulsory education laws1 the gregarious instinct of children1 the ambition of parents1 their self-interest1 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 public1 parochial1 or private schools for some part of the year4 ,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 child1 but to protect the community against the social and industrial evils and the dangers that result from ignorance4 ,great sacrifices are made by state1 individual taxpayer1 and individual parent in order that children and state may be benefited by education4 ,almost no resistance is found to any demand made upon parent or taxpayer1 if it can be shown that compliance will remove obstructions to school progress4 ,if1 therefore1 by any chance1 we can find at school a test of home conditions affecting both the child's health and his progress at school1 it will be easy1 in the name of the school1 to correct those conditions1 just as it will be easy to read the index1 because the child is under state control for six hours a day for the greater part of the years from six to fourteen4#d ,illustration3 7,facsimile7 ,,physical ,,record4 ,what1 then1 is this test of home conditions prejudicial to health that will register the fact as a thermometer tells us the temperature1 or as a barometer shows moisture and air pressure8 ,the house address alone is not enough1 for many children surrounded by wealth are denied health rights1 such as the right to play1 to breathe pure air1 to eat wholesome food1 to live sanely4 ,scholarship will not help1 because the frailest child is often the most proficient4 ,manners mislead1 for1 like dress1 they are but externals1 the product of emulation1 of other people's influence upon us rather than of our living conditions4 ,nationality is an index to nothing significant in ,america1 where all race and nationality differences melt into ,americanisms1 all responding in about the same way to ,american opportunity4 ,no1 our test must be something that cannot be put on and off1 cannot be left at home1 cannot be concealed or pretended1 something inseparable from the child and beyond his control4 ,this test it has been conclusively proved in ,chicago1 ,boston1 ,brookline1 ,philadelphia1 and particularly in ,new ,york ,city1 is the physical condition of the school child4 ,to learn this condition the child must be examined and rexamined for the physical signs called for by the card on page #cd4 ,weight1 height1 and measurements are needed to tell the whole story4 ,when this card is filled out for every child in a class or school or city1 the story told points directly to physical1 mental1 or health rights neglected4 ,if for every child there is begun a special card1 that will tell his story over and over again during his school life1 noting every time he is sick and every time he is examined1 the progress of the community as well as of the child will be clearly shown4 ,such a history card 7p4 #cad7 is now in use in certain ,new ,york schools1 as well as in several private schools and colleges4 ,have you ever watched such an examination8 ,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 school4 ,the school physician goes at nine o'clock to the doctor's room in the public school1 or1 if there is no doctor's room1 to that portion of the hall or principal's office where the doctor does his work4 ,the teacher or the nurse stands near to write the physician's decision4 ,the doctor looks the child over1 glances at his eyes1 his color1 the fullness of his cheeks1 the soundness of his flesh1 etc4 ,if the physician says ,b1 the principal or nurse marks out the other letter opposite to number #a1 so that the card shows that there is bad nutrition4 ,in looking at the teeth and throat a little wooden stick is used to push down the tongue4 ,there should be a stick for every child1 so that infection cannot possibly be carried from one to the other4 ,if this is impossible1 the stick should be dipped in an antiseptic such as boric acid or listerine4 ,if1 because of swollen tonsils1 there is but a little slit open in the throat1 or if teeth are decayed1 the mark is ,y or ,b4 ,the whole examination takes only a couple of minutes1 but the physician often finds out in this short time facts that will save a boy and his parents a great deal of trouble4 ,very often this examination tells a story that overworked mothers have studiously concealed by bright ribbons and clean clothes4 ,i remember one little girl of fourteen who looked very prosperous1 but the physician found her so thin that he was sure that for some time she had eaten too little1 and called her anmic4 ,he later found that the mother had seven children whom she was trying to clothe and shelter and feed with only ten dollars a week4 ,a way was found to increase her earnings and to give all the children better living conditions1--all because of the short story told by the examination card4 ,in another instance the card's story led to the discovery of recent immigrant parents earning enough1 but1 because unacquainted with ,american ways and with their new home1 unable to give their children proper care4 ,illustration3 ,,looking ,,for ,,enlarged ,,tonsils ,,and ,,bad ,,teeth ,note the mouth breather waiting ,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 #aije4 ,from ,march1 #aije1 to ,january #a1 #aijh1 #bge1fda children have been examined1 and #aih1aci or #ga4i per cent have been found to have defects1 as shown in ,table ,,vi4 ,,table ,,vi ,,physical ,,examination ,,of ,,school ,,children--,,performed ,,by ,,the ,,department ,,of ,,health ,,in ,,the ,,borough ,,of ,,manhattan1 #aije-aijg ,total ,percentage ---------------------------------------- -------------------------- ,number of children examined #bge1fda #ajj ,number of children needing treatment #aih1aci #ga4i ,defects found3 ,malnutrition #af1jba #e4h ,diseased anterior or posterior cervical glands #abe1eee #de4e ,chorea #c1ggf #a4c ,cardiac disease #c1che #a4b ,pulmonary disease #b1hda #a4j ,skin disease #d1eeg #a4f ,deformity of spine1 chest1 or extremities #d1hib #a4g ,defective vision #eh1did #ba4b ,defective hearing #c1edj #a4b ,obstructed nasal breathing #dc1fac #ae4h ,defective teeth #acf1adf #di4j ,deformed palate #c1fbe #a4c ,hypertrophied tonsils #ge1dca #bg4d ,posterior nasal growths #df1fca #af4i ,defective mentality #g1jij #b4e ,it is generally believed that ,new ,york children must have more defects than children elsewhere4 ,if this assumption is wrong1 if children in other parts of the ,united ,states are as apt to have eye defects1 enlarged tonsils1 and bad teeth as the children of the great metropolis1 then the army of children needing attention would be seven out of ten1 or over #ad1jjj1jjj4 ,whether these figures overstate or understate the truth1 the school authorities of the country should find out4 ,the chances are that the school in which you are particularly interested is no exception4 ,to learn what the probable number needing attention is1 divide your total by ten and multiply the result by seven4 ,the seriousness of every trouble and its particular relation to school progress and to the general public health will be explained in succeeding chapters4 ,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 diseases1 least able to withstand an attack1 less fitted to profit fully from educational and industrial opportunity4 ,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 examination4 ,no other means to-day exists by which the state can1 in a recognized and acceptable way1 discover the failure of these well-to-do parents to protect their children's health and take steps to teach and1 if necessary1 to compel the parents to substitute living conditions that benefit for conditions that injure the child4 ,among the important health rights that deserve more emphasis is the right to be healthy though not poor4 ,a child's lungs may be weak1 breathing capacity one third below normal1 weight and nutrition deficient1 and yet that child cannot contract tuberculosis unless directly exposed to the germs of that disease4 ,but such a child can contract chronic hunger1 can in a hundred ways pay the penalty for being pampered or otherwise neglected4 ,physical examination is needed to find every child that has too little vitality1 no zest for play1 little resistance1 even though sent to a private school and kept away from dirt and contagion4 ,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 card4 ,while they found that low incomes have more than their proper share of defects and of unsanitary living conditions1 yet they saw emphatically also that low incomes do not monopolize physical defects and unsanitary living conditions4 ,many families having #bj1 #cj1 #dj a week gave their children neither medical nor dental care4 ,the share each income had in unfavorable conditions is shown by the summary in the following table4 ,,table ,,vii ,,showing ,,per ,,cent ,,share ,,of ,,physical ,,defects ,,of ,,children1 ,,unfavorable ,,housing ,,conditions1 ,,and ,,child ,,mortality ,,found ,,among ,,each ,,family-,,income ,,group ,,weekly ,,family ,,income --------------------------------------- #cj #j-ajaj-aeaf-aibj-bebe-bi and #ajj over --------------------------------------- ---------------------------------------- ----------------------- ,proportion to total families #h4d #cb4g #ae4b #bc4h #c4i #ae4f #ajj ,physical defects3 ,malnutrition #ac4h #dc4d #ab4d #ag4i #c4d #i4 ,enlarged glands #h4f #cg4d #ad4f #bb4f #c4f #ac4b ,defective breathing #i4f #cb4c #ae4e #bd4d #b4h #ae4d ,bad teeth #h4a #cb4b #ae4c #bd4e #d4h #ae4a ,defective vision #h4b #cd4f #af4e #bb4a #a4d #ag4c ,unfavorable housing conditions3 ,dark rooms #h4b #ce4d #ah4a #ah4d #c4h #ae4i ,closed air shaft #f4i #cj4b #ah4i #bf4d #c4b #ai4f ,no baths #aj4a #ch4e #af4e #ai4g #d4d #aj4h ,paying over #be rent #h4f #bg4f #ba4g #ad4g 444 #bg4f ,child ,mortality3 ,families losing children #aj4c #ce4e #ad4g #bj4e #e4d #ac4f ,families losing no children #f4d #cj4a #ae4g #bf4i #b4d #ah4f ,children dead #aa4g #cf4b #ac4a #bj4h #f4a #ab4a ,infants dying from intestinal diseases #h4i #cg4f #ah4c #ah4h #d4 #ab4d ,children working #d4b #ai4e #ac4b #cj4c #aa4e #ba4c ,the index should be read in all grades from kindergarten to high school and college4 ,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 principals4 ,he began by saying1 ,this question does not concern you as directly as it does the grammar-school principals1 but you can help secure funds to help their pupils4 ,one after another the high-school principals present told--one of his own daughter1 another of his honor girls1 a third of his honor boys--the same story of neglected headaches due to eye strain1 breakdowns due to undiscovered underfeeding1 underexercise1 or overwork4 ,are we coming to the time when the state will step in to prevent any boy or girl in high school1 college1 or professional school from earning academic honors at the expense of health8 ,harmful conditions within schoolrooms and on school grounds will not be neglected where pupils1 teachers1 school and family physicians1 and parents set about to find and to remove the causes of physical defects4 ,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 center4 ,if a child sleeps in a dark1 ill-ventilated1 crowded room1 the result will show in his eyes and complexion2 if he has too little to eat or the wrong thing to eat1 he will be underweight and undersized2 if his nutrition is inadequate and his food improper1 he is apt to have eye trouble1 adenoids1 and enlarged tonsils4 ,he may have defective lung capacity1 due to improper breathing1 too little exercise in the fresh air1 too little food4 ,existence of physical defects throws little light on income at home1 but conclusively shows lack of attention or of understanding4 ,several days' absence of a child from school leads1 in every well-regulated school1 to a visit to the child's home or to a letter or card asking that the absence be explained4 ,even newly arrived immigrants have learned the necessity and the advantage of writing the teacher an excuse when their children are absent4 ,furthermore1 neighbors' children are apt to learn by friendly inquiry what the teacher may not have learned by official inquiry1 why their playmate is no longer on the street or at the school desk4 ,while physicians are sometimes willing to violate the law that compels notification of infection1 rarely would a physician fail to caution an infected family against an indiscriminate mingling with neighbors4 ,whether the family physician is careless or not1 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 ill4 ,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 labor1 it should be remembered that the best physical test is the child's presence at school4 ,the first step in thorough physical examination is a thorough school census1--the counting of every child of school age4 ,moreover1 a relatively small number of children who violate the child labor law are the only members of the family who ought to be in school4 ,younger children furnish the index and occasion the visit that should discover the violation of law4 ,appreciation of health1 as well as its neglect1 is indexed by the physical condition of school children4 ,habits of health are the other side of the shield of health rights unprotected4 ,physical examination will discover what parents are trying to do as well as what they fail to do because of their ignorance1 indifference1 or poverty4 ,in so far as parents are alive to the importance of health1 the school examination furnishes the occasion of enlisting them in crusades to protect the public health and to enforce health rights4 ,the ,committee on the ,physical ,welfare of ,school ,children found many parents unwilling to answer 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' children4 ,generally speaking1 fathers and mothers can easily be interested in any kind of campaign in the name of health and in behalf of children4 ,the advantage of starting this health crusade from the most popular ,american institution1 the public school1--the advantage of instituting corrective work through democratic machinery such as the public school1--is incalculable4 ,to any teacher1 pastor1 civic leader1 health official1 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 adult1 the best possible advice is to learn the facts disclosed by the physical examination of your school children4 ,see that those facts are used first for the benefit of the children themselves1 secondly for the benefit of the community as a whole4 ,if your school has not yet introduced the thorough physical examination of school children1 take steps at once to secure such examination4 ,if necessary1 volunteer to test the eyes and the breathing of one class1 persuade one or two physicians to coperate until you have proved to parent1 taxpayer1 health official1 and teacher that such an examination is both a money-saving1 energy-saving step and an act of justice4 ,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 health4 ,the ,united ,states ,weather ,bureau saves millions of dollars annually1 not because flags are raised and bulletins issued foretelling the weather1 but because shipowners1 sailors1 farmers1 and fruit growers obey the warnings4 ,mere examination of school children does little good4 ,the child does not breathe better or see better because the school physician fills out a card stating that there is something wrong with his eyes1 nose1 and tonsils4 ,the examination tells where the need is1 what children should have special attention1 what parents need to be warned as to the condition of the child1 what home conditions need to be corrected4 ,if the facts are not used1 that is an argument not against obtaining facts but against disregarding them4 ,in understanding medical examination we should keep clearly in mind the distinction between medical school inspection1 medical school examination1 and medical treatment at school4 ,medical inspection is the search for communicable disease4 ,the results of medical inspection1 therefore1 furnish an index to the presence of communicable diseases in the community4 ,medical examination is the search for physical defects1 some of which furnish the soil for contagion4 ,its results are an index not only to contagion but to conditions that favor contagion by producing or aggravating physical defects and by reducing vitality4 ,medical treatment at school refers to steps taken under the school roof1 or by school funds1 to remove the defects or check the infection brought to light by medical inspection and medical examination4 ,treatment is not an index4 ,in separate chapters are given the reasons for and against trying to treat at school symptoms of causes that exist outside of school4 ,when1 how often1 and by whom inspection and examination should be made is also discussed later4 ,the one point of this chapter is this3 if we really want to know where in our community health rights are endangered1 the shortest cut to the largest number of dangers is the physical examination of children at school1--private1 parochial1 reformatory1 public1 high1 college4 ,apart from the advantage to the community of locating its health problems1 physical examination is due every child4 ,no matter where his schooling or at whose expense1 every child has the right to advance as fast as his own powers will permit without hindrance from his own or his playmates' removable defects4 ,he has the right to learn that simplified breathing is more necessary than simplified spelling1 that nose plus adenoids makes backwardness1 that a decayed tooth multiplied by ten gives malnutrition1 and that hypertrophied tonsils are even more menacing than hypertrophied playfulness4 ,he has the right to learn that his own mother in his own home1 with the aid of his own family physician1 can remove his physical defects so that it will be unnecessary for outsiders to give him a palliative free lunch at school1 thus neglecting the cause of his defects and those of fellow-pupils4 ,,footnotes3 #d ,sir ,john ,e4 ,gorst in ,the ,children of the ,nation reads the index of the health of school children in the ,united ,kingdom2 ,john ,spargo1 in ,the ,bitter ,cry of the ,children1 and ,simon ,n4 ,patten in ,the ,new ,basis of ,civilization1 suggest the necessity for reading the index in the ,united ,states and for heeding it4 ,,part ,,ii4 ,,reading ,,the ,,index ,,to ,,health ,,rights ,,chapter ,v ,,mouth ,,breathing ,if the physical condition of school children is our best index to community health1 who is to read the index8 ,unless the story is told in a language that does not require a secret code or cipher1 unless some one besides the physician can read it1 we shall be a very long time learning the health needs of even our largest cities1 and until doomsday learning the health needs of small towns and rural districts4 ,fortunately the more important signs can be easily read by the average parent or teacher4 ,fortunately1 too1 it is easy to persuade mothers and teachers that they can lighten their own labors1 add to their efficiency1 and help their children by being on the watch for mouth breathing1 for strained1 crossed1 or inflamed eyes1 for decaying teeth1 for nervousness and sluggishness4 ,years ago1 when ,i taught school in a ,minnesota village1 ,i had never heard of adenoids1 hypertrophied tonsils1 myopia1 hypermetropia1 or the relation of these defects and of neglected teeth to malnutrition1 truancy1 sickness1 and dullness4 ,i now see how ,i could have saved myself several failures1 the taxpayers a great deal of money1 the parents a great deal of disappointment1 and many children a life of inefficiency1 had ,i known what it is easy for all teachers and parents to learn to-day4 ,illustration3 ,,mouth ,,breathers ,,before ,,adenoid ,,party ,the features in the following cut are familiar to teachers the world over4 ,parents may reconcile themselves to such lips1 eyes1 and mouths1 but seldom do even neglectful parents fail to notice mouth breathing4 ,children afflicted by such features suffer torment from playfellows whose scornful epithets are echoed by the looking-glass4 ,no fashion plate ever portrays such faces4 ,no athlete1 thinker1 or hero looks out from printed page with such clouded1 listless eyes4 ,the more wonder1 therefore1 that the meaning of these outward signs has not been appreciated and their causes removed2 conclusive reason1 also1 for not being misled by recent talk of mouth breathing1 adenoids1 and enlarged tonsils1 into the belief that the race is physically deteriorating4 ,three generations ago ,charles ,dickens in his ,uncommercial ,traveller 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 listened4 ,he was speaking of delinquent girls from seventeen to twenty years old in ,wapping ,workhouse3 ,i have never yet ascertained why a refractory habit should affect the tonsils and the uvula2 but ,i have always observed that refractories of both sexes and every grade1 between a ,ragged ,school and the ,old ,bailey1 have one voice1 in which the tonsils and uvula gain a diseased ascendency4 ,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 wish4 ,physical examinations show now1 and might just as well have shown fifty years ago1 that the great majority of truants and juvenile offenders have adenoids and enlarged tonsils4 ,a recent examination made by the ,new ,york board of health on #aej children in one school made up from the truant school1 the juvenile court1 and ,randall's ,island1 showed that only three were without some physical defect and that #acg had adenoids and large tonsils4 ,dickens wrote his observations in #ahfj2 in #ahed the ,new ,york ,juvenile ,asylum was started1 and up to #aijh cared for #dj1jjj children2 in #ahfj ,william ,meyer pointed out1 so that no one need misunderstand1 the harmful effects of adenoids4 ,what would have been the story of juvenile waywardness1 of sickness1 of educational advancement1 had examinations for defective breathing been started in #ahec or #ahfj instead of #aije2 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 intelligence8 ,illustration3 ,a ,,degenerate ,,made ,,normal ,,by ,,removal ,,of ,,adenoids ,william ,hegel1 who is pictured on page #dh1 before his tonsils and adenoids were removed was described by his father in this way3 ,when playing with other boys on the street he seems dazed1 and sluggish to grasp the various situations occurring in the course of the game4 ,when he decides to do something he runs in a heedless1 senseless way1 as if running away1--will bump against something1 pedestrian or building1 before he comes to himself2 seems dazed all the time4 ,when told something by his mother he giggles in the most exasperating way1 for which he receives a whipping quite often4 ,the father said the whipping was of no avail4 ,the child was restless1 talkative1 and snored during sleep4 ,he had an insatiable appetite4 ,he was removed or transferred from five different schools in ,new ,york ,city4 ,to get redress the father took him to the board of education1 whence he was referred to the assistant chief medical inspector of the department of health1 whose examination revealed immensely large fungous-looking tonsils and excessive pharyngeal granulations 7adenoids74 ,he was operated on at a clinic4 ,the tonsils and adenoids removed are pictured on the opposite page1 reduced one third4 ,after the operation the child was visited by the assistant medical inspector4 ,there was a marked improvement in his facial expression1--he looked intelligent1 was alert and interested4 ,when asked how he felt1 he answered1 ,i feel fine now4 ,it required about fifteen minutes to get his history1 during all of which time he was responsive and interested1 constantly correcting statements of his father and volunteering other information4 ,eleven days after the operation he was reported to have had no more epileptic seizures4 ,doesn't talk in sleep4 ,doesn't snore4 ,doesn't toss about the bed4 ,has more self-control4 ,tries to read the paper4 ,his immoderate appetite is not present4 ,illustration3 ,,reason ,,enough ,,for ,,mouth ,,breathing ,adenoid and tonsils reduced one third ,while the open mouth is a sure sign of defects of breathing1 it is not true that the closed mouth1 when awake and with other people1 is proof that there are no such defects4 ,children breathe through the mouth not because they like to1 not because they have drifted into bad habits1 not because their parents did1 not because the human race is deteriorating1 but because their noses are stopped up1--because they must4 ,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 room4 ,what extra effort adenoids mean can be ascertained by closing the nostrils for a forenoon4 ,for many reasons it is perhaps unfortunate that we can breathe at all when the nose is stopped up4 ,if we could see with our ears as well as with our eyes1 we should probably not take as good care of our eyes4 ,in this respect the whole race has experienced the misfortune of the man of whom the coroner reported1 ,killed by falling too short a distance4 ,because we can breathe through the mouth we have neglected for centuries the nasal passages4 ,when a cold stops the nose we necessarily breathe through the mouth4 ,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 mind4 ,mouth breathing will show with the child asleep1 before the child awake loses power to accommodate his effort to the task4 ,therefore the importance of a physical test at school to detect the beginnings of adenoids and large tonsils before these symptoms become obvious to others4 ,no child should be exempted from this examination because of apocryphal theories that only the poor1 the slum child1 the refractory1 or the unclean have defects in breathing4 ,this very afternoon a friend has told me of her year abroad with a girl of nine1 whose parents are very wealthy4 ,the girl is anmic4 ,her backwardness humiliates her parents1 especially because she gave great promise until two years ago4 ,high-priced physicians have prescribed for her4 ,it happens that they are too eminent to give attention to such simple troubles as adenoids that can be felt and seen4 ,they are looking for complications of the liver or inflammation of muscles at the base of the brain4 ,one celebrated ,french savant found the adenoids1 assured the mother that the child would outgrow them1 and advised merely that she be compelled to breathe through the nose4 ,the mother and nursemaids nag the child all day4 ,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 adenoids4 ,the mother is made nervous4 ,of course this makes the child more nervous and adds to the evil effects of adenoids4 ,if the mother had the good fortune to be very poor1 she could not sit up nights1 and would long ago have decided either to let the child alone or else to have the trouble removed4 ,adenoids are not a city specialty4 ,country earache is largely due to adenoids or to inflammation that quickly leads to adenoids4 ,in #dae villages of ,new ,york state twelve per cent were found to be mouth breathers4 ,for two summers ,i have known a lad named ,fred4 ,he lives at the seashore4 ,throughout his twelve years he has lived in a veritable ,el ,dorado of health and nature beauty4 ,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 living4 ,yet to a child1 ,fred's schoolmates are experts on patent medicines and on the heredity that is alleged to be responsible for bad temper1 running sores1 tuberculosis1 anmia1 and weak eyes4 ,freddie is particularly favored4 ,his well-to-do parents have supplied him with ponies1 games1 and bicycles4 ,nothing prevents his breathing salt air fresh from the north pole but hermetically sealed windows4 ,the father thinks it absurd to make a fuss over adenoids4 ,didn't he have them when a boy1 and doesn't he weigh two hundred pounds and make good money8 ,the mother never knew of operations for such trifles when she taught school2 she supposes her boy needs an operation1 but just can't bear to see the dear child hurt4 ,as for ,fred1 he breathes through his mouth1 talks through his nose1 grows indifferent to boy's fun1 fails to earn promotion at school1 and fears that ,i won't be strong in spite of all the patent medicine ,i've taken4 ,father1 mother1 and ,fred feel profound pity for the city child living so far from nature4 ,adenoids are not monopolized by children whose parents are ignorant of the importance of them and of physical examination4 ,last summer ,i was asked by a small boy to buy some chocolate4 ,a glance at his cigar box with its two or three uninviting things for sale showed that the boy was really begging4 ,he had thick lips1 open mouth1 misty eyes1 and a nasal twang4 ,i asked him if his teacher had not told him he had lumps back of his nose and could not breathe right4 ,he said1 ,no4 ,i explained then that he could make a great deal more money if he talked like other boys1 stepped livelier1 and breathed as other people breathe4 ,he said he had been by a doctor onct but didn't want to be op'rated4 ,i turned to my companion and asked1 ,have you never noted those same lines on your boy's face8 ,although he had been lecturing on mouth breathers1 he had never noticed his own boy's trouble4 ,he hastened home and found the infallible signs4 ,the mother declared it could not be true of her boy4 ,about five months before1 their family physician had said of the child's earache1 ,the same inflammation of the nasal passages that causes earache causes adenoids2 you must be on the lookout4 ,although in the country1 the boy's appetite was not good and his zest for play had flagged4 ,they had looked for the trouble to back generations and in psychology books1--everywhere but at the boy's face1 in his mouth1 and in his nose4 ,after the operation1 which took less than two minutes1 the appetite was ravenous1 the eyes cleared1 and the spirit rebounded to its old buoyancy that craved worlds to conquer4 ,the new personal experience made a deep impression upon my friend's mind4 ,he wanted everybody to know how easy it was to overlook a child's distress4 ,one person after another had a story to tell him2 even the janitor said3 ,you'd ought to have seen our ,john at sixteen4 ,he spent a week by the hospital4 ,the only people who do not seem to know more than the new convert are the mouth breathers whom he religiously stops on the street4 ,the indexes to adenoids and large tonsils for the teacher to read at school are3 #a4 ,inability to breathe through the nose4 #b4 ,a chronically running nose1 accompanied by frequent nose-bleeds and a cough to clear the throat4 #c4 ,stuffy speech and delayed learning to talk4 ,common is pronounced cobbd2 nose1 dose2 and song1 sogg4 #d4 ,a narrow upper jaw and irregular crowding of the teeth4 #e4 ,deafness4 #f4 ,chorea or nervousness4 #g4 ,inflamed eyes and conjunctivitis4 ,the adenoids and large tonsils discovered at school are an index3 #a4 ,to children needlessly handicapped in school work4 #b4 ,to teachers needlessly burdened4 #c4 ,to whole classes held back by afflicted children4 #d4 ,to breeding grounds for disease4 #e4 ,to homes where children's diseases and tuberculosis are most likely to break out and flourish4 #f4 ,to parents who need instruction in their duty to their children1 to themselves1 and to their neighbors1 and who are ignorant of the way in which catching diseases originate and spread4 ,the riot that occurred when the adenoids of children in a school on the ,east ,side in ,new ,york ,city were removed without the preliminary of convincing the parents as to the advantages of the operation was merely a demand for the right to knowledge1 which is never overlooked with impunity4 ,reluctance to permit operation on a young child1 and the natural shrinking of a parent at seeing a child under the surgeon's knife1 require the teacher or school physician or nurse to answer fully the usual questions of the hesitant mother and father4 #a4 ,is the operation necessary8 ,will the child not outgrow its adenoids8 ,usually the adenoid growths atrophy or dry up after the age of puberty4 ,adenoids are not uncommon in adults1 however4 ,the surgeon general of the army reports that during the year #aije1 out of #cjjd operations on officers and enlisted men in service1 there were #bbe operations on the nose1 mouth1 and pharynx1 #ajc of which were operations for adenoids and enlarged or hypertrophied tonsils4 ,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 endangered4 ,beginning at the age of the second dentition1 the bones of jaw1 nose1 throat1 and chest are undergoing important changes--nasal occlusion4 ,adenoids left to atrophy--if large enough to cause mouth breathing--may mean atrophy of this developing process1 permanent disfiguration of face1 and permanent deformity of chest and lungs4 #b4 ,will the growth recur8 ,in a few cases it does recur2 frequently either because it was not desirable to make a complete removal of the adenoid tissue or because the surgeon was careless4 ,if the growths do recur1 then they must be removed again4 #c4 ,is the operation a dangerous one8 #d4 ,is an ansthetic necessary8 #e4 ,will the operation cure the child of all its troubles8 ,these questions are best answered by the process and results of an adenoid party1 which was given especially for the benefit of this book1 every step and symptom of which were carefully studied4 ,the seven children pictured here were discovered by their school physician to have moderately large adenoid growths1--one boy having enlarged tonsils also4 ,illustration3 ,,mouth ,,breathers ,,immediately ,,after ,,adenoid ,,party ,the picture on page #df was taken by flash light at #b4cj ,p4,m41 ,january #ae1 #aijh4 ,at #c ,p4,m4 the principal escorted these children into the operating room at ,vanderbilt ,clinic4 ,the doctor examined the throat and nose of each child1 entered the name and age of each1 together with his diagnosis1 on a clinic card1 sending each child into the next room after examination4 ,he then called the first boy and explained that it would hurt1 but that it would be over in a minute4 ,the principal stood by and told him to be brave and remember the five cents he could have for ice cream afterwards4 ,the clinic nurse tied a large towel about him and put him in her lap2 with one hand she held his clasped hands1 while the other held his head back4 ,the doctor then took the little instrument--the curette--and pushed it up back of the soft palate1 and with one twist brought out the offending spongy lump4 ,the boy's head was immediately held over a basin of running water4 ,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 ceased4 ,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 companions4 ,at #c4cj ,p4,m4 all seven children were out in the hall1 all seven mouths were closed1 and all seven faces were clothed with the sleepy1 peaceful expression that comes with rest from the prolonged labor of trying to get enough air4 ,at #c4de ,p4,m4 they had been all rexamined by the doctor1 and a few tag ends were picked out of the nasopharynx of one child4 ,at #d ,p4,m4 the party had returned to the ,children's ,aid ,society's school and to the ice cream that follows each adenoid party4 ,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 growths1 and how their bodies fairly bloom when the mysterious and awful incubus is removed1 to use the words of one school principal4 ,it is worth while to show them before and after pictures1 and before and after children1 and before and after school marks4 ,,chapter ,,vi ,,catching ,,diseases1 ,,colds1 ,,diseased ,,glands ,deadly fevers1 the plague1 black death1 cholera1 malaria1 smallpox1 taught mankind invaluable lessons4 ,millions of human beings died before the mind of man devoted itself to preventing the diseases for which no sure cure had been found4 ,efforts to conquer these diseases were tardy because men were taught that some unseen power was punishing men and governments for their sins4 ,the difference between the old and the new way is shown powerfully by a painting in the ,liverpool ,gallery entitled ,the ,plague4 ,a medival village is strewn with the dead and dying4 ,bloated1 spotted faces look into the eyes of ghouls as laces and jewelry are torn from bodies not yet cold4 ,in the foreground a muscular giant1 paragon of conscious virtue1 clad like ,john the ,baptist and ,bible in hand1 finds his way among his plague-stricken fellow-townsmen1 urging them to turn from their sins4 ,modern efficiency learns of the first outbreak of the plague1 isolates the patient1 kills rats and their fleas which spread the disease1 thoroughly cleanses or destroys1 if necessary1 all infected clothing1 bedding1 floors1 and walls1 and makes it possible for us to go on living for each other with a better chance of bringing forth fruits worthy for repentance4 ,where boards of health make it compulsory to report cases of sickness due to contagion1 health records are a reliable index to catching diseases4 ,but now that the chief infection is the kind that afflicts children1 we can read the index before the outbreak that calls in a physician to diagnose the case4 ,school examination shows which children have defects that welcome and encourage disease germs4 ,it points to homes that cultivate germs1 and consequently menace other homes4 ,to locate children who have enlarged tonsils may prevent a diphtheria epidemic4 ,to detect in ,september those who are undernourished1 who have bad teeth1 and who breathe through the mouth will help forecast winter's outbreaks of scarlet fever and measles4 ,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 diseases4 ,it is harder at first to interest a community in medical examination than in medical inspection1 because we are all afraid of catching diseases1 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 light4 ,courses in germ sociology are therefore of prime necessity4 ,how do germs act8 ,on what do they live8 ,why do they move from place to place8 ,what causes them to become extinct8 ,with few exceptions1 germs migrate for the same reason as man1--search for food1 love of conquest1 and love of adventure4 ,when there is plenty of food they multiply rapidly4 ,full of life1 overflowing with vitality1 they move out for new worlds to conquer4 ,like human beings1 they will do their best to get away from a country that provides a scanty food supply4 ,like men and women1 they starve if they cannot eat4 ,like boys and girls1 they avoid enemies2 the weak give way to the strong1 the slow to the swift1 the devitalized to the vitalized4 ,human sociology imprisons1 puts to death1 deprives of opportunity to do evil1 or reforms those who murder1 steal1 or slander4 ,germ sociology teaches us to do the same with injurious germs4 ,we imprison them1 we take away their food supply1 we kill them outright1 or we starve them slowly4 ,they have a peculiar diet1 being especially partial to decomposing vegetable and animal matter and to what human beings call dirt4 ,by putting this diet out of their reach we make it impossible for them to propagate their kind4 ,by placing poison within their reach or by forcing it upon them we can successfully eliminate them as enemies4 ,as the president of ,mexico restored order by setting a thief to catch a thief1 so modern science is setting germs to kill germs that harm crops and human stock4 ,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 germ4 ,if we are false to our guard1 it will turn traitor and join invaders in attacking us4 ,but here1 as in dealing with evils that originate with human beings1 an ounce of prevention is worth a ton of cure4 ,the most effectual way to eliminate germ diseases is to remove the cause--the food supply of disease germs4 ,the fact that many germs are plants1 not animals1 does not weaken the analogy1 for weeds do not get a chance in well-tilled soil4 ,perhaps the most notable recent example of government germ extermination is the triumph over the yellow-fever and malaria mosquito in ,panama4 ,when the ,french started to build a canal in ,panama1 the first thing they did was to build a hospital4 ,the hospital was always full and the canal was given up4 ,at the time the ,united ,states proposed to re-attempt the work1 it was thought that it could not be done without great loss of life and without great labor difficulties4 ,instead of taking the sickness for granted and enlarging the ,french hospital1 the chief medical inspector1 ,gorgas1 took for granted that there need be no unusual sickness if proper preventive measures were taken4 ,he knew what the ,french had not known1 that the yellow-fever scourge depends for its terrors upon mosquitoes4 ,accordingly1 with the aid of six thousand men and five million dollars he set about to starve out the few infected and infectious kinds of mosquito1--the yellow-fever or house mosquito and the malaria or meadow mosquito4 ,he introduced waterworks and hydrants1 paved the streets1 drained the swamps and pools in which they breed1 and instituted a weekly house-to-house inspection to prevent even so much as a pail of stagnant water offering harbor to these enemies4 ,the grass of the meadows where the malaria mosquito breeds was cut short and kept short within three hundred feet of dwellers1--as far as the mosquito can fly4 ,all ditches were disinfected with paraffin1 and the natives were forced to observe sanitary laws4 ,president ,roosevelt1 in his special message to ,congress on the ,panama ,canal in #aijf1 stated that in the weekly house-to-house visit of the inspectors at the time he was in ,panama but two mosquitoes were found4 ,these were not of the dangerous type4 ,as a consequence of this sanitary engineering there is very little sickness in ,panama1 the hospital is seldom one third full1 and the canal is progressing very much faster than was expected4 ,panama1 like ,havana1 is now safer than many ,american cities1 because cleaner and less hospitable to disease germs4 ,any place where numbers of people are accustomed to assemble favors the propagation of germs1--whether it be the meetinghouse1 the townhall1 the theater1 or the school4 ,every teacher can be the sanitary engineer of her own schoolroom1 school1 or community by coperating with the school doctor1 the town board of health1 family physicians1 and mothers4 ,every teacher can exterminate disease by applying the very same principles to her schoolroom as ,chief ,medical ,inspector ,gorgas applied to ,panama4 ,knowledge1 disinfection1 absolute cleanliness1 education1 and inspection are the essential steps4 ,first she must know that children's diseases are not necessary4 ,she should discountenance the old superstition that every child must run the gamut of children's diseases1 that every child must sooner or later have whooping cough1 measles1 chicken pox1 mumps1 scarlet fever1 just as they used to think yellow fever and cholera inevitable4 ,the price of this terrible ignorance has been not only expense1 loss of time1 acquisition of permanent physical defects1 and loss of vitality1 but1 for the majority of children1 death before reaching five years of age4 ,all these catching diseases are germ diseases1 which disinfection can eliminate4 ,the free use of strong yellow soap and disinfectants on the school floor1 windows1 benches1 desks1 blackboards1 pencils1 in the coat closets and toilets1 plus the natural disinfectants1 hot sun and oxygen1 will prevent the schoolroom from being a source of danger4 ,one or more of these germ-killing remedies must be constantly applied2 cleansing deserves a larger part in every school budget4 ,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 window4 ,their astonishment was soon changed to panic when that shower of snow resulted in a deadly epidemic of scarlet fever4 ,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 fingers4 ,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 contagion1 where ignorance more often than carelessness is the cause of uncleanliness4 ,by hygiene lessons1 illustrating practically the proper methods of cleaning a room1 much may be done to enlist school children in the battle against germs4 ,through the enthusiasm of the children as well as through visits to the homes parents may be instructed as to the danger of letting well children sleep with sick children2 the wisdom of vaccination to prevent smallpox1 of antitoxin to prevent serious diphtheria1 of tuberculin tests to settle the question whether tuberculosis is present2 why anything that gathers dust is dangerous unless cleansed and aired properly2 and why bedding1 furniture1 floor coverings1 and curtains that can be cleansed and aired are more beautiful and more safe than carpets1 feather beds1 upholstery1 and curtains that are spoiled by water and sunshine2 how to care for the tuberculous member of the family1 etc4 ,anti-social acts may be prevented1 such as carrying an infected child to the doctor in a public conveyance1 thereby infecting numberless other people2 sending infected linen to a common laundry2 mailing a letter written by an infected person without first disinfecting it2 sending a child with diphtheria to the store2 returning to the dairy unscalded milk bottles from a sick room4 ,the daily inspection of school children for contagious diseases by the school physician has1 where tried1 been found to reduce considerably the amount of sickness in a town4 ,such inspection should be universally adopted4 ,moreover1 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 call4 ,like the little girl who never stuttered except when she talked1 school children and school-teachers are rarely frightened until too late to prevent trouble4 ,the easy diseases such as measles1 whooping cough1 etc41 cost our communities more than the more terrible diseases like typhoid and smallpox4 ,during one typical week ending ,may #ah1 #fcj new cases of measles were reported to one department of health4 ,obviously the nineteen deaths reported give no conception of the suffering1 the cost1 the anxiety caused by this preventable disease4 ,the same may be said of diphtheria and croup1 of which only thirty-two deaths are reported1 but #cjf cases of sickness4 ,yet no one to-day will send a child to sleep with a playmate so as to catch diphtheria and be done with it4 ,the most strategic point of attack is almost universally unrecognized4 ,that is the child's mouth4 ,here the germs find lodgment1 here they find a culture medium--at the gateway of the human system4 ,the mouth is never out of service and is almost never in a state of true cleanliness4 ,solid particles from the breath1 saliva1 food between the teeth1 and other dbris form a deposit on the teeth and decompose in a constant temperature of ninety-eight degrees ,fahrenheit4 ,in the normal mouth from eight to twenty years of age the teeth present from twenty to thirty square inches of dentate surface1 constantly exposed to ever-changing1 often inimical1 conditions4 ,this bacterially infected surface makes a fairly large garden plot4 ,every cavity adds to the germ-nourishing soil4 ,dental caries--tooth decay--is a disease hitherto almost universal from birth to death4 ,thus the air taken in through the mouth becomes a purveyor of its poisonous emanations and affects the lung tissues and the blood4 ,food and water carry hostile germs down into the stomach4 ,thence they may be carried into any organ or tissue1 just as nourishment or poison is carried4 ,moreover1 the child with an unclean mouth not only infects and reinfects himself but scatters germs in the air whenever he sneezes or coughs4 ,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 feet4 ,germs are also scattered through the air by means of salivary or mucous droplets4 ,it is this fact that makes colds so dangerous4 ,,table ,,viii ,city of ,manchester ,education ,committee ,,infectious ,,or ,,contagious ,,diseases ,,in ,,schools ,,information ,,for ,,teachers ,four columns are omitted3 7#a7 ,interval between ,exposure to ,infection and the ,first ,signs of the ,disease2 7#b7 ,day from ,onset of ,illness on which ,rash appears2 7#c7 ,period of ,exclusion from ,school after ,exposure to ,infection2 7#d7 ,period of ,exclusion from ,school of ,person suffering from the ,disease ---------------------------------------- ------------------------------- ,,disease ,,principal ,,signs ,,and ,,symptoms ,method of ,,remarks ,infection ---------------------------------------- ------------------------------- ,measles ,begins like cold in the ,after effects head1 with feverishness1 often severe4 running nose1 inflamed and ,period of greatest watery eyes1 and sneezing2 risk of infection small crescentic groups of ,breath and first three or mulberry-tinted spots appear discharges four days1 before about the third day2 rash from nose the rash appears4 first seen on forehead and and mouth4 ,may have repeated face4 ,the rash varies with attacks4 ,great heat2 may almost disappear if variation in type the air is cold1 and come out of disease4 again with warmth4 ---------------------------------------- ------------------------------- ,german ,illness usually slight4 ,onset ,measles sudden4 ,rash often first thing noticed2 no cold in ,breath and head4 ,usually have discharges ,after effects feverishness and sore from nose slight4 throat1 and the eyes may and mouth be inflamed4 ,rash something between ,measles and ,scarlet ,fever1 variable4 ---------------------------------------- ------------------------------- ,chicken ,sometimes begins with ,when children ,pox feverishness1 but is usually return1 examine very mild and without sign head for of fever4 ,rash appears on overlooked spots4 second day as small pimples1 ,all spots should which in about a day become have disappeared filled with clear fluid4 ,breath and before child ,this fluid then becomes crust of returns4 ,a mild matter1 and then the spot spots4 disease and dries upand the crust falls seldom any after off4 effects4 ,may have successive crops of of rash until tenth day4 ---------------------------------------- ------------------------------- ,whooping ,begins like cold in the ,after effects ,cough head1 with bronchitis and often very severe sore throat1 and a cough and the disease which is worse at night4 ,breath and causes great ,symptoms may at first be very discharges debility4 ,relapses mild4 ,characteristic from nose are apt to occur4 whooping cough develops and mouth4 ,second attack in about a fortnight1 and the rare4 ,specially spasm of coughing often ends infectious for with vomiting4 first week or two4 ,if a child is sick after a bout of coughing1 it is most probably suffering from whooping cough4 ,great variation in type of disease4 ---------------------------------------- ------------------------------- ,mumps ,onset may be sudden1 beginning with sickness and fever1 and pain about the angle of the ,breath and ,seldom leaves jaw4 ,the glands become discharges after effects4 swollen and tender1 and the from nose ,very infectious4 jaws stiff1 and the saliva and mouth4 sticky4 ---------------------------------------- ------------------------------- ,scarlet ,the onset is usually sudden1 ,breath1 ,dangerous both ,fever or with headache1 languor1 discharges during attack and ,scarlatina feverishness1 sore throat1 from nose from after effects4 and often the child is sick4 and mouth1 ,great variation ,usually within twenty-four particles in type of disease4 hours the rash appears1 and of skin1 ,slight attacks is finely spotted1 evenly and as infectious as diffused1 and bright red4 discharges severe ones4 ,many ,the rash is seen first on from mild cases not the neck and upper part of suppuratorydiagnosed and many chest1 and lasts three to glands or concealed4 ,the ten days1 when it fades and ears4 ,milk peeling may last the skin peels in scales1 specially six to eight weeks4 flakes1 or even large apt to ,a second attack is pieces4 ,the tongue becomes convey rare4 ,when scarlet whitish1 with bright red infection4 fever is occurring spots4 ,the eyes are not watery in a school1 all or congested4 cases of sore throat should be sent home4 ---------------------------------------- -------------------------------- ,diphtheria ,onset insidious1 may be rapid ,breath and ,very dangerous or gradual4 ,typically sore discharges both during attack throat1 great weakness1 and from nose1 and from after swelling of glands in the mouth1 and effects4 ,when neck1 about the angle of the ears4 diphtheria is jaw4 ,the back of the throat1 occurring in a tonsils1 or palate may show school all children patches like pieces of suffering from sore yellowish-white kid4 ,the most throat should be pronounced symptom is great excluded4 ,there is debility and lassitude1 and great variation of there may be little else type1 and mild noticeable4 ,there may be cases are often not hardly any symptoms at all4 recognized but are as infectious as severe cases4 ,there is no immunity from further attacks4 ,fact of existence of disease sometimes concealed4 ---------------------------------------- -------------------------------- ,influenza ,begins with feverishness1 ,breath and ,excessively pain in head1 back1 and discharges infectious4 ,after limbs1 and usually cold in from nose effects often very the head4 and mouth4 serious and accompanied with great prostration and nervous debility4 ---------------------------------------- --------------------------- ,smallpox ,the illness is usually well ,breath1 ,peculiarly marked and the onset rather all infectious4 ,when sudden1 with feverishness1 discharges1smallpox occurs in severe backache1 and and connection with a sickness4 ,about third day particles school or with any a red rash of shotlike of skin of the children's pimples1 felt below the skin1 or scabs4 homes1 an endeavor and seen first about the should be made to face and wrists4 ,spots have all persons develop in two days1 then over seven years form little blisters1 and of age in other two days become revaccinated4 yellowish and filled with matter4 ,scabs then form1 ,cases of modified and these fall off about smallpox--in the fourteenth day4 vaccinated persons--may be1 and often are1 so slight as to escape detection4 ,fact of existence of disease may be concealed4 ,mild or modified smallpox as infectious as severe type4 ---------------------------------------- ------------------------------ ,in the following diseases only the affected child is excluded ,erysipelas4 ,child should not ,ringworm on ,scalp4 ,child should return till all swelling and be excluded till cured4 ,very peeling of skin has disappeared4 difficult to cure and often takes a very long time4 ,ophthalmia4 ,child should not return till all traces have ,phthisis 7,consumption74 ,if in disappeared4 advanced stage and coughing much or spitting1 child should be ,scabies or ,itch4 ,child should be excluded4 7,infection from breath excluded until cured4 and dried spit floating in the air as dust47 ,ringworm on ,skin4 ,child should be excluded till cured4 ,this takes ,impetigo 7,contagious ,sore74 only a few days if properly ,child should be excluded until treated4 cured4 ,a week or ten days should suffice4 ,a4 ,,brown ,,ritchie1 ,medical ,officer to ,education ,committee4 ,most people still think that colds are due to cold air or draughts rather than to a cold germ1 which finds a body unequipped with resisting power1 with its germ police off guard1 exhausted from overwork1 or disaffected and ready to turn traitor if the enemy seems stronger than our vitality4 ,sometimes it seems as if we contracted it from a sneezing fellow-passenger1 sometimes from a draught from an open car window4 ,an uninformed opponent of the theory that colds are a germ disease wrote the following letter last winter to a ,new ,york newspaper3 ,in addition to the ,society for the ,suppression of ,noises there should be in this town a ,society for the ,suppression of ,fresh-,air ,fiends4 ,the newspapers report an epidemic of pneumonia1 grippe1 and colds4 ,it is almost entirely due to the fact that the average ,new ,yorker is compelled to live1 move1 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 hogs1 who1 with blood almost bursting through their skins1 demand fresh air in order to keep from suffocating4 ,everywhere a man goes1 day or night1 he is in a draught caused by the crazy ideas about fresh air4 ,our wise ancestors1 who as a rule lived much longer than we do1 and had much better health1 said3 ,if the wind should blow through a hole1 ,god have mercy on your soul4 ,after the correspondent has learned that our ancestors had more colds than we1 had poorer health1 and died twenty years younger1 perhaps he will listen to proof that his unclean warm air weakens the body and makes it an easy prey to cold germs4 ,many physicians preach and practice this fallacy as to fresh air and colds1 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 irritated4 ,until medical specialists are agreed1 and until they have definitely located the cold germ1 we laymen must choose for ourselves a working theory4 ,the weight of opinion at the present time declares that colds are due to germs4 ,strong membranes with good circulation and drainage provide poor food for germs4 ,congested membranes furnish proper conditions for propagation4 ,the germ theory explains the spread of germs from the nose to the passages of the head1 and from head to arteries and lungs4 ,a cold can always be charged to some one else4 ,how many can be laid to our account8 ,there is one right that is universally not recognized1 and that is the right of protection from the germs showered in the air we breathe1 over the food we eat1 by the sneezes of our unfortunate neighbor at school1 in the street car1 at the restaurant4 ,the chief danger of a cold is to our neighbor1 not to ourselves4 ,a cold which a strong person may throw off in a day or two may mean death to his tuberculous neighbor4 ,though for our own health lying up for a mere cold is an unnecessary bore1 the failure to do so may deprive our neighbor of a right greater than the right to protection against scarlet fever or smallpox4 ,though formerly this statement would not have been true1 rights change with conditions1 and the fact that to-day the three most deadly diseases are pneumonia1 tuberculosis1 and diphtheria1--all diseases of the respiratory organs1--justifies the assertion that we have a right to protection against colds4 ,the prevalence of colds1 sore throats1 irritated vocal cords1 bad voices1 catarrh1 bronchitis1 laryngitis1 and asthma in ,america to-day demands summary measures4 ,one can learn to sneeze into a handkerchief1 not into a companion's face or into a room4 ,school children can be taught to avoid handkerchiefs on which mucus has dried4 ,in the far distant future we may be willing to use cheesecloth1 and boil it or throw it away1 or1 like the ,japanese1 use soft paper handkerchiefs and burn them after using4 ,,table ,,ix ,,death ,,rate ,,per #aj1jjj ,,population1 ,,pneumonia ,,and ,,bronchitis ,,five-,,year ,,period1 #ahif-aijj ,england and ,wales #bb4gj ,scotland #bg4dj ,stockholm #bf4gj ,london #ca4bj ,berlin #af4aj ,vienna #ci4gj ,christiania #ba4cj ,boston #cj4fj ,chicago #bd4bj ,philadelphia #be4aj ,new ,york ,city #cf4fj ,one child with a cold can infect a whole class or family1 thus depriving the class and family of the top of their vitality and efficiency without their consent4 ,because a person is thought a weakling who lies up for a mere cold1 one is inclined to wish that colds were as prostrating as typhoid1 in which case there would be some hope of their extermination4 ,the exclusion of children with colds from school deserves trial as a check to children's diseases4 ,many of these catching diseases start with a cold in the head1 as1 for instance1 measles1 influenza1 and whooping cough4 ,the first symptom of mumps1 diphtheria1 and scarlet fever is a sore throat or swollen glands1 which1 because they commonly accompany a cold1 are not at first distinguished from it4 ,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 overshoes1 then to note whether the children put them on when they go out for lunch or recess4 ,whether cold settles in the nasal passages1 ear1 or stomach depends upon which is the weak spot4 ,draughts1 thin soles1 wet soles1 exposure when perspiring1 may be the immediate cause of the nutritional or respiratory disturbances that give cold germs a foothold4 ,adenoids1 diseased teeth1 inflamed ears1 may furnish the food supply4 ,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 teeth1 or colds due to adenoids1 said a physician when examining a party of children for a summer outing4 ,the great preventive measure to be taken for catching diseases1 colds1 diseased glands1--in fact all germ diseases1--is the repeated cleansing of those portions of the human body in which germs may find lodgment1--the mouth1 the nose1 the eyes1 and the ears4 ,in caring for young infants great pains is taken to cleanse all the orifices daily1 but as soon as the child washes himself this practice is usually abandoned4 ,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 wounds4 ,oftentimes the douching of the nostrils with salt water will stop a cold at once4 ,the mouth is the most important place of all1 and the teacher should take care of her pupils' mouths first and foremost4 ,as bad teeth1 enlarged tonsils1 and adenoids harbor germs and putrescent matter that vitiate every incoming and outgoing breath1 these defects should be immediately corrected4 ,are we coming to a time when a thorough house-cleaning in the mouth of every child will take place before he enters the schoolroom1 preferably in the presence of the teacher8 ,two other catching diseases cause city schools a great deal of trouble1--trachoma and pediculosis 7head lice74 ,there are probably no two diseases more quickly transmitted from one person to another4 ,almost before their presence is known1 all children of a school or all persons of a group have contracted them4 ,when at college twenty men of my fraternity discovered almost at the same time that they had an infectious eye trouble2 yet we thought we were using different towels and otherwise taking sanitary precautions4 ,last summer a ,vassar graduate took a party of tenement children for a country picnic4 ,she returned with head lice that required constant attention for weeks4 ,what then may we expect of children who live in homes where there is neither water1 time1 nor privacy for bathing1 where one towel must serve a family of six1 where mothers work for wages away from home and see their children only before seven and after six8 ,unfortunately for thousands of children1 many parents still believe these troubles will be outgrown4 ,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 each4 ,the only condition was that the heads should be free from lice and nits 7eggs74 ,from the list furnished by school-teachers--girls supposed to have been cured by school nurses--not one in five was accepted4 ,a baby two weeks old1 brought to ,caroline ,rest1 had already begun to suffer from this easily preventable scourge4 ,of #abai children examined in ,edinburgh1 ,scotland1 #iji1 or #fi per cent1 had some skin disease1 and #fj per cent had sores due to head lice4 ,even when neglect has caused the loss of hair and ugly sores on the head1 mothers deceive themselves into believing that some other cause is responsible4 ,trachoma1 if neglected1 not only impairs the health of the eye1 but may cause blindness4 ,tears carry the germs from the eye to the face1 where they are taken up on handkerchiefs1 towels1 and fingers and infect other eyes4 ,of late1 thanks to school nurses and physicians and hygiene instruction1 ,american cities have found relatively little trachoma except among recent immigrants4 ,so dangerous is the germ and so insidious its methods of propagation1 that a physician should be summoned at once at the first sign of inflammation4 ,conjunctivitis is due to a germ1 and will spread unless checked4 ,since the board of health of ,new ,york ,city has instituted the systematic examination of the eyes of the children in the public schools1 it has found fully one third affected with some form of conjunctivitis4 ,many of these cases are out-and-out trachoma1 others acute conjunctivitis1 and a larger proportion are mild trachoma4 ,this last form of the disease is found to a great extent among children who have adenoids4 ,the adenoids should be regarded as a predisposing factor rather than a direct cause4 ,therefore sore eyes are given as one of the indexes of adenoids4 ,when we consider that adenoids are made up of lymphoid material1 and that trachoma follicles are made up of the same sort of tissue1 it is not surprising that the two conditions are found in the same child4 ,the catarrhal inflammation produced by adenoids in the nasal mucous membrane travels up the lachrymal duct and thus infects the conjunctiva by contiguity4 ,in preventing pediculosis and infection of the eye vigilance and cleanliness are indispensable4 ,after the diseases are advanced1 after the germ colonies have taken title1 some antiseptic or germ killer more violent than water is needed1--kerosene for the hair or strong green oil soap2 for the eye1 only what a physician prescribes4 ,,chapter ,,vii ,,eye ,,strain ,wherever school children's eyes have been examined1 from six to nine out of thirty are found to be nearsighted1 farsighted1 or otherwise in need of attention4 ,a child is dismissed from school for obstinately declaring that the letter between c and t in cat is an o2 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 child2 a boy is punished for being backward4 ,these three cases are typical4 ,examinations showed that the first child was astigmatic and not obstinate2 the boy had run a pin into one eye ten years before and destroyed its sight2 while the second girl was found to be afflicted with diplopia1 and in a friendly chat told the following story3 ,i very often see two words where there is only one4 ,when ,i was a very little girl ,i used to write every word twice4 ,then ,i was scolded for being careless4 ,so ,i learned that ,i must not say two words even when ,i saw them4 ,as ,miss ,alida ,s4 ,williams1 principal of ,public ,school #cc in ,new ,york ,city1 has in many articles and addresses freely illustrated from school experience1 the art of seeing is acquired1 not congenital1 and every human being who possesses it has learned it4 ,the large proportion of children suffering more or less seriously from eye trouble has led many persons to suggest physical deterioration as the cause4 ,eye specialists1 however1 assure us that eye troubles are probably as old as man4 ,our tardiness in learning the facts regarding these troubles is due in part to the lack1 until recently1 of instruments for examining the eye and for manufacturing glasses to correct eye defects2 in part1 also1 to the tendency of the medical profession1 which ,i shall repeatedly mention1 to explain disorders by causes remote and hard to find rather than by those near at hand4 ,about #ahgj ,dr4 ,s4 ,weir ,mitchell's attention was called to the marked relief of headache1 insomnia1 and other reflex symptoms following the correction of optical defects by glasses4 ,in #ahgd and #ahgf he wrote two articles that impressed upon the general profession the grave significance of eye strain4 ,since that time1 in ,philadelphia at least1 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 disturbance4 ,the new fact1 therefore1 is not weak eyes or strained eyes1 but rather 7#a7 an increase in the regular misuse of eyes by school children1 seamstresses1 stenographers1 lawyers1 etc42 and 7#b7 the incipient propaganda growing out of school tests that show the relation of eye strain to headache1 nervous diseases1 stomach disorder1 truancy1 backwardness4 ,every school1 private and parochial as well as public1 should supply itself with the ,snellen card for testing eyes4 ,employers would do well to have these cards in evidence also1 for they may greatly increase profits by decreasing inefficiency and risks4 ,if there is no expert optician near1 apply for cards to your health board or school board2 failing there1 write to your state health and school boards4 ,in many states rural teachers are already supplied with these cards by state boards4 ,in ,october1 #aijg1 the ,new ,york state board of health sent out cards1 with instructions for their use1 to #ddf incorporated towns4 ,the state commissioner of education also sent a letter giving school reasons for using the cards4 ,results from #dae schools having shown that nearly half the children had optical defects1 it is proposed to secure state legislation that will make eye tests obligatory in all schools4 ,such a test in ,massachusetts recently discovered twenty-two per cent of the school children with defective vision1 and from forty to fifty thousand in need of immediate care by specialists4 ,illustration3 ,,positions ,,often ,,suggest ,,eye ,,strain ,of course eye specialists1--oculists1--if skillful1 know more about eyes and eye troubles than general medical practitioners or teachers4 ,preliminary eye tests1 however1 may be made by any accurate person who can read4 ,the ,massachusetts state board of health reports that tests made by teachers were not less efficient than tests made by specialists4 ,in ,june1 #aijg1 a group of eminent oculists recommended to the school board of ,new ,york ,city that teachers make this first test after being instructed by oculists4 ,persons interested in the schools nearest them can quickly interest teachers and pupils by starting tests with this card4 ,in cities oculists can be found who will be glad to explain to teachers1 individually or in groups1 how the cards should be used and what dangers to avoid4 ,nature intended the human eye to read the last line of this card at a distance of ten feet4 ,this conclusion is not a guess1 but is based upon the examination of thousands of eyes4 ,in making the test1 the number of feet the eye ought to see is written as the denominator of the fraction2 the distance the eye can see clearly is the numerator4 ,if the child's card reads1 ,right eye #aj_/aj1 left eye #aj_/bj1 it means that the right eye sees without conscious strain the distance it is intended to see1 while the left eye must be within ten feet to see what it ought to see twenty feet away4 ,the practical steps for a teacher to take in making eye tests are3 #a4 ,scrutinize the faces for a strained or worried expression while reading or writing1 for squint eyes1 for unnatural positions1 and for improper distances 7more or less than nine inches7 from eye to book4 #b4 ,select for first tests the children who obviously need attention and will be obviously benefited4 ,use the eye test to help trace the cause of headaches1 nervousness1 inattention4 #c4 ,let the children mark off the distances with a foot rule and chalk1 going as high as twenty4 ,be sure to get the best light in the room4 #d4 ,start all children on the ten-foot line4 ,if a child cannot read at ten feet the letter which should be seen at that distance1 move the child forward1 have it step forward and backward1 and note the result carefully4 ,it is better to have ten separate letters of exactly the right size and the same size than a row of letters on one card1 as in the ,snellen test1 otherwise memory will aid the eye1 or1 as happened recently1 a whole class may agree to feign remarkable nearsightedness or farsightedness by confusing letters learned in advance from the card4 ,if the ,snellen card is used1 and if it is more convenient to have both child and card stationary1 satisfactory results will be obtained by having the child read from large letters down as far as he can see4 #e4 ,have the child read from right to left1 from left to right1 or skip about so that memory cannot aid the eye4 #f4 ,test each eye separately4 ,i was twenty-five years old before ,i learned that my left eye did practically all of the close sight work4 ,a grown woman discovered just a few days ago that she was almost blind in the left eye2 when she rubbed the right one while reading she was shocked to find that she could see nothing with the left eye4 #g4 ,if the card is stationary and the child moved1 and if only one size of the letter is used1 put in the denominator the number of feet at which the normal eye should see clearly1 and in the numerator the distance at which each eye and both together can easily see4 ,if the regular ,snellen card is used containing letters of different size1 place in the denominator the number of the lowest line each eye and both eyes together can read easily1 and in the numerator the number of feet from card to eye4 #h4 ,explain the result to the child1 to his fellows1 to his parents4 ,if the left eye reads #aj_/bj and the right eye #aj_/cj1 it means that neither eye is normal1 and that reading small type is a constant strain1 even though unnoticed4 ,the right eye must be within ten feet to read what it should read at twenty feet4 ,the left eye must be within ten feet to read what it should read at thirty feet4 ,if the two eyes read at ten1 it means that in working together they successfully strain for a result that is not worth what it is costing4 ,when eyes thus unconsciously see what they are not intended to see1 it is only a matter of time when stomach and nervous system will announce that the strain can no longer be borne4 ,indigestion1 dislike of study1 restlessness follow4 ,if1 however1 the eyes are so near the normal that their story reads #ab_/aj or #h_/aj1 the strain will be negligible for the present4 ,if1 on the other hand1 the only difficulty is a confusion of x and z with c and g1 it means that there is a strain due to astigmatism1 and that the child should be sent to an oculist4 #i4 ,teach children and parents 7and practice what you preach7 the urgent importance of periodic rexamination1 just as you would teach them to visit a dentist twice a year4 ,this is needed by those who wear eyeglasses1 and more particularly by those who have recently put them on4 ,moreover1 as shown below1 it is needed by children able to pass satisfactorily the ,snellen test4 #aj4 ,acquire the habit of reading the eye for evidence of temperate or intemperate living1 sleeping1 eating1 dancing1 drinking1 and smoking4 ,inflamed eyes are results1--signals of danger4 ,the organ may be faultless in construction and in its work poor1 because of nerve exhaustion1 or1 in a less and more easily recoverable degree1 nerve fatigue4 ,if unusual eye conditions are not readily explained by mode of living or by eye tests1 an oculist should be consulted4 ,the limits of the card test must be constantly kept in mind3 7#a7 it does not register eye sickness due to dust1 smoke1 or disease germs2 7#b7 it does not show unconscious eye strain due to successful accommodation4 ,but it will discover a great part of the children who most need care4 ,sooner or later1 too1 inflammation of the eyelids1 due to external causes1 will affect the nerves of the eye and their power to conceal by accommodation the eye's defects4 ,just as we unconsciously open the mouth when a cold stops up the nose1 the eye adapts itself to our needs without our realizing it4 ,we expect it to see4 ,it sees4 ,if our eyes are not made alike1 they do their best to work together4 ,like a good team of horses1 the slow one hurries1 the fast one holds back a little4 ,but if one eye is #aj_/ae and the other #aj_/aj1 they will both be unnatural and strained if both read the same type4 ,the effects of this strain frequently upset the stomach before the eyes rebel4 ,i learned that ,i needed eyeglasses after a case of protracted indigestion1 first diagnosed as nervous and later traced to eyes4 ,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 strain4 ,to prove the influence of eye strain on indigestion1 persuade some obstinate parent to wear improperly focused glasses for a day2 she will then be willing to have her child's eyes attended to4 ,it is unfortunate that the eyes will overwork without protesting4 ,for years many persons suffer without learning that their eyes are unlike1 or1 as often happens1 that one eye does all the close range work4 ,even when being tested1 eyes will seem to see easily what requires a great effort of accommodation4 ,to prevent this self-deception skilled oculists do not trust the eye card1 but put a drug in the eye that benumbs the muscles of accommodation4 ,they cannot contract or expand if they want to4 ,the oculist then studies the length of the eye and the muscle of accommodation4 ,with this absolute knowledge of how each eye is made he knows what is wrong1 exactly at what angle light enters the eye1 whether objects are focused too soon or too late1 exactly what kind of eyeglasses or what operation upon the eye is needed to enable it to do its work without undue straining or accommodation4 ,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 sight4 ,practically1 however1 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 card4 ,where eye strains escape this test teachers will find evidence in complaints of headache1 nervousness1 sick stomach1 chorea1 or even epilepsy4 ,the constant strain may also cause red or inflamed lids4 ,parents and teachers must be on the constant lookout for these symptoms of good sight persisting in spite of imperfect eyes4 ,an epidemic of eyeglasses is usually the consequence of eye tests4 ,so naturally do we associate eyeglasses with eye defects that some people assert that the eye tests at school originate with opticians more intent upon selling spectacles than upon helping children4 ,in fact1 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 strain4 ,the women principals of ,new ,york ,city have sounded an alarm1 and urge more attention to light and to reading position1 more rest1 more play1 more hand work1 less home study and less eye work at school1 rather than more eyeglasses to conceal temporarily the effect of abusing children's eyes4 ,putting glasses on children without changing causal conditions is like giving alcohol to consumptives4 ,the feeling of relief is deceptive4 ,the trouble grows worse4 ,for some time to come eye tests will find eye troubles by the wholesale in every industrial and social class1 in country as well as city schools4 ,in #dae ,new ,york villages #dh4g per cent of school children had defects of vision1--this without testing children under seven1--while #aa4c per cent had sore eyes4 ,there are three possible ways of remedying defects3 7#a7 changing the eye by operation2 7#b7 changing the light as it enters the eye by eyeglasses2 7#c7 decreasing the demands made upon the eye4 ,to change eyes or light requires a technical skill which few physicians as yet possess4 ,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 defects4 ,until a generation of physicians has been trained by medical colleges to learn the facts about the eye and to apply scientific remedies1 it is especially necessary that teachers and parents reduce the demands made upon children's eyes2 oral can be substituted for written work1 manual for optical work1 relaxed and natural movement for discipline1 outdoor exercise for less home study4 ,other requirements are suitable light and proper position1 and abolition of shiny paper1 shiny blackboard1 and fine print4 ,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 eyes4 ,because we are born farsighted1 nearsighted1 and astigmatic1 we must be watchful to eradicate conditions that aggravate these troubles4 ,finally1 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 teeth4 ,the education of physician1 oculist1 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 needed4 ,because knowledge of chemistry preceded knowledge of the human body1 the teaching of medicine still shows the effect of predilection for the remote1 the problematical1 the impossible4 ,this predilection has influenced many specialists as well as many general practitioners1 both overlooking too frequently obvious causes that even intelligent laymen can be taught to detect4 ,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 specialist4 ,thus we have the optician1 the painless tooth extractor1 and quack cures for consumption4 ,opticians are placing before hundreds of thousands simple truths about the eye not otherwise taught as yet4 ,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 limitations4 ,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 prescription4 ,the justification for this feeling should be based not upon the commercial motive of the optician but upon his ignorance4 ,a physician uninformed as to eye troubles is just as unsafe as an optician determined to sell glasses4 ,it must be made unethical and unprofessional for physician and optician alike to prescribe in the dark4 ,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 wares4 ,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 welfare1 not their own profits4 ,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 science4 ,whether opticians and physicians are unprofessional or unethical may be told by rexamination if the examiner is himself competent and ethical4 ,there is no better judge of their efficiency than the patient himself1 who can tell whether the results promised have been effected4 ,whether the work of a country oculist is efficient and ethical can be learned3 7#a7 by teaching country school children to recognize eye strain2 7#b7 by comparing his results with those of other physicians4 ,as soon as one or two states have tested eyes1 we shall have an average by which to compare each class1 school1 and city with others of their size under similar conditions4 ,if a particular physician finds half as many more or only half the average number1 the presumption will be that his results are inaccurate and warrant an investigation4 ,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 schools4 ,finally1 it must be remembered by teachers1 employers1 parents1 and all eye users that eyes are constantly changing2 that eyes may need glasses six months after they are examined and found sound2 that glasses change or develop the eye1 so that they may be unnecessary and harmful six months after they are prescribed1 or the eye may require a stronger glass2 that eyeglasses become bent and scratched1 so that they worry and strain the eye2 that a periodic examination is essential to the health of the eye4 ,in caring for the health of the eye1 we should also remember that our eyes are our chief interpreters of the world that gives us problems1 profits1 and pleasures4 ,out of gratitude1 if not out of enlightened self-interest1 we owe our eyes protection1 attention1 and training1 so that without straining we shall always be able to see truth and beauty4 ,,chapter ,,viii ,,ear ,,trouble1 ,,malnutrition1 ,,deformities ,the presence of adenoids is a frequent cause of both slight and aggravated deafness4 ,of #aef deaf mutes examined #ei per cent had adenoids1 while only #f per cent of the general run of the children in the neighborhood had this trouble4 ,in mouth breathing1 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 eardrum1 causing it to sink in and to blunt the hearing4 ,an examination of the eardrums of school children in ,new ,york who are mouth breathers showed a high percentage of deafness1 incipient or pronounced1 accompanying adenoids4 ,for example1 of #i mouth breathers selected from one class 7average age #g-h years71 #f were well-marked cases of deafness4 ,of #h mouth breathers 7average age #h-i years71 and of #e mouth breathers 7average age #e-f years71 all had noticeable defects of hearing4 ,many adults that suffer from deafness maintain that they never had any trouble in childhood4 ,yet the evidences of nose and throat trouble in childhood persist and disprove such statements4 ,the foundations of deafness in later life are1 in most instances1 laid in childhood4 ,since the majority of cases of ear trouble occurring in school children accompany diseased conditions of the nose and throat1 the proper care of nose and throat will1 in large measure1 balance the shortcomings of the aural examinations4 ,since the examination of the drum itself is not practicable1 especial care should be given to the examination of the nose and throat4 ,the figures published by ,new ,york ,city's department of health show that of #bgd1fda children examined from ,march1 #aije1 to ,january1 #aijh1 #cedj1 or #a4b per cent1 gave evidence of defective hearing4 ,ear specialists suggest that this small percentage results from employing the whisper test at twenty feet4 ,the whisper test at sixty feet has been set by experts as a test of normal hearing4 ,but preciseness with this test is well-nigh impossible when we consider that the acoustics1 the quality of the examiner's voice1 the weather1 the vowel or consonant sounds1 all are variable quantities4 ,the watch test is frequently used1 but since a young teacher in her enthusiasm used an alarm clock to make the test1 specialists have decided that the volume of sound differs in watches to such a degree as to make the watch test unreliable4 ,the examination of the eye has been reduced to mathematical precision1 due altogether to the anatomy of that organ4 ,as yet there is no instrument for the ear comparable to the ophthalmoscope4 ,the acoumeter is largely used by aurists and can be obtained from the optician4 ,this instrument has an advantage over the whisper or watch tests in that its tick is uniform4 ,each ear should be tested separately4 ,let the child place his finger against the flap of one ear while the other is being tested4 ,then compare the farthest distance from the ear at which the tick can be heard with the normal1 standard distance4 ,during the test all sound should be eliminated as far as possible and the eyes should be closed4 ,at a demonstration of ear testing at ,teachers ,college1 one student stated that she could not hear the tick of the watch at a distance greater than twenty inches4 ,then the tester walked noisily toward her1 leaving the watch on the desk1 five feet away from the patient4 ,she heard it now4 ,when the class burst out laughing she opened her eyes1 and1 seeing the watch so far away1 exclaimed1 ,why1 ,i thought ,i imagined it4 ,be careful in testing a child to distinguish between what he thinks he imagines and what he really hears4 ,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 expert4 ,detection of slight deafness may lead to the discovery of serious defects of nose or throat4 ,inflammation from cold or catarrh may cause deafness1 which if neglected may permanently injure the ear4 ,often deafness is due to an accumulation of wax4 ,a running ear should receive immediate attention1 as it is an indication of inflammation which may imperil the integrity of the eardrum1 and1 if neglected1 may eat its way through the thin partition between the ear and the brain and cause death4 ,it should never be assumed that deafness is incurable4 ,stupidity1 inattention1 and slowness to grasp a situation accompany difficulty of hearing and should cause the teacher to examine the ears4 ,no ear trouble is negligible4 ,children and parents should be taught that the normal ear is intended to hear for us1 not to divert our attention to itself4 ,when the ear aches or runs or rumbles there is something wrong1 and it should be examined together with the throat and nose4 ,,nervousness ,in ,new ,york ,city one child in ninety-one already examined has had the form of nervous disease known as ,st4 ,vitus's ,dance1 or chorea4 ,so prone are we to overlook moderate evils and moderate needs that the child with aggravated ,st4 ,vitus's ,dance is apt to be cured sooner than the child who is just nervous4 ,teachers cannot know whether twitching eyes1 emotional storms1 constant motion of the fingers or feet are due to chorea1 to malnutrition1 to eye strain1 or to habits acquired in babyhood or early childhood and continued for the advantage that accrues when discipline impends4 ,many a child treasures as his chief asset in time of trouble the ability to lose his temper1 to have a fit1 to exhibit nervousness that frightens parent1 teacher1 or playmate1 incites their pity1 and wards off punishment4 ,the school examination will settle once for all whether the trouble can be cured4 ,the family physician will explain what steps to take4 ,,tests ,,of ,,malnutrition ,we ,americans were first interested in the physical examination of school children by exaggerated estimates of the number of children who are underfed4 ,as fast as figures were obtained for eye defects1 breathing defects1 bad teeth1 some one was ready to declare that these were results of underfeeding4 ,hence the conclusion3 give children at least one meal a day at school4 ,scientific men began to set us straight and to give undernourishment a technical meaning1--soft bones1 flabby tissue1 under size1 anmia4 ,while too little food might cause this condition1 it was also explained that too much food of the wrong sort1 or even food of the right sort eaten irregularly or hurriedly or poisoned by bad teeth1 might also cause undernourishment1 including the extreme type known as malnutrition4 ,in extreme instances the symptoms enable an observant teacher who has learned to distinguish between the pretty hair ribbon and clean collar and the sunken1 pale1 or hectic cheek and lusterless eyes to detect the cause4 ,but as with eyes and nose1 an unhealthy condition of nourishment may exist long before outward symptoms are noticeable4 ,therefore the value of the periodic searching examination by the school physician4 ,illustration3 ,,same ,,age1 ,,same ,,school1 ,,different ,,nutrition ,,bone ,,tuberculosis2 ,,orthopedic ,,tests ,only recently have we laymen learned that knee trouble1 clubfoot1 ankle sores1 spine and hip troubles1 scrofula1 running sores at joints1 etc41 are not hereditary and inevitable1 but are rather the direct result of carelessness on the part of adult consumptives4 ,these conditions in school are indices of homes and houses where tuberculosis is or has been active1 and of health boards that are or have been inactive in checking the white plague4 ,early examination may disclose the small lump on the child's spine1--which one mother diagnosed as inherited round shoulders1--and save a child from being a humpback for life4 ,moreover1 the examination of the crippled child's brothers and sisters will often show the beginnings of pulmonary tuberculosis4 ,illustration3 ,a ,,grievous ,,penalty ,,for ,,neglect ,,by ,,adult ,,consumptives ,,enlarged ,,glands--,,tuberculosis ,in almost every class are one or more children who are proud of small or big lumps under one or more jaws4 ,only physicians can find very small lumps4 ,many family doctors will say1 ,oh1 he will outgrow those1 or ,those lumps will be absorbed4 ,like most other evils that we outgrow or that pass away1 these lumps shriek not to be neglected4 ,they mean interference with nourishment and prevent proper action of the lymphatic system1 as adenoids prevent free breathing4 ,even when not actually infected with tubercle bacilli1 they are fertile soil for the production of these germs4 ,if detected early1 they point to home conditions and personal habits that can be easily corrected4 ,in ,new ,york one child in four has these enlarged glands4 ,if the same proportion prevails in other parts of the ,united ,states1 there are #e1djj1jjj children whose strength is being needlessly drained1 many of whom1 if neglected1 will need repeated operations4 ,illustration3 ,,model ,,of ,,america',s ,,first ,,hospital ,,for ,,seashore ,,fresh-,,air ,,treatment ,,of ,,nonpulmonary ,,tuberculosis ,,in ,,children ,to be erected at ,rockaway ,beach1 ,new ,york ,city ,,chapter ,,ix ,,dental ,,sanitation ,have their teeth attended to first1 and many of the eye defects will disappear4 ,this was an unexpected contribution to the debate upon free eyeglasses for the school children of ,new ,york ,city4 ,so little do most of us realize the importance of sound1 clean teeth1 and the interrelation of stomach and sense nerves1 that even the school principals thought the eye specialist was exaggerating when he declared that bad teeth cause indigestion and indigestion causes eye strain4 ,bad teeth mean to most people dirty teeth and offensive odors1 loose1 crooked1 or isolated teeth1 or black stumps4 ,even among dentists a great many1 probably the majority1 do not appreciate that bad teeth mean indigestion1 lowered vitality1 plague spots for contaminating sound teeth and for breeding disease germs4 ,until recently the only rule about the teeth of new recruits in the ,united ,states army was3 ,there must be two opposing molars on each side of the mouth4 ,it doesn't matter how rotten these molars may be4 ,the surgeon general was persuaded to change to four opposing molars on each side2 still nothing as to the condition of the two additional molars6 ,in the ,german army there is a regular morning inspection of teeth and toothbrushes4 ,several ,german insurance companies give free dental treatment to policy holders1 not to bestow charity but to increase profits4 ,neglecting baby teeth and adenoids may mean crooked second teeth that will cause3 7#a7 hundreds of dollars for straightening2 7#b7 permanent business handicap because crooked teeth are disagreeable to others1 because mastication is less perfect1 and because a disfigured mouth means dis-arranged nerves2 or perhaps 7#c7 large dental bills because it is difficult to clean between cramped1 crooked teeth4 ,unfortunately the great majority of parents rarely think of their children's teeth until too late to preserve them intact4 ,even among families where the rule of brushing the teeth twice daily prevails1 regular dental examination is often not required4 ,doctors and dentists themselves have not been trained to realize that the teeth are a most dangerous source of infection when unclean4 ,does your dentist insist upon removing tartar and food particles beyond your reach1 upon polishing and cleansing1 or does he regard these as vanity touches1 to be omitted if you are in a hurry8 ,illustration3 ,,industrial ,,handicaps ,,discovered ,,at ,,school ,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 himself4 ,tonics are given to women whose teeth are breeding and harboring disease germs that tear down vitality4 ,nurses watch their suffering patients and do the heavier tasks heroically1 but are not trained to teach the simple truths about dental hygiene4 ,the far-reaching results of neglect of teeth will not be understood until greater emphasis is placed on the bacteriology1 the economics1 the sociology1 and the sthetics of clean1 sound teeth4 ,whether or not there is at present a tendency to exaggerate the importance of sound teeth1 there is no difference of opinion as to the fact that the teeth harbor virulent germs1 that the high temperature of the mouth favors germ propagation1 that the twenty to thirty square inches of surface constantly open to bacterial infection offer an extensive breeding ground1 and that the formation of the teeth invites the lodgment of germs and of particles of food injurious both to teeth and to other organs4 ,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 stomach4 ,by applying a little iodine and then washing it off with water1 your teeth may show stains4 ,these stains are called gelatinous plaques1 which are transparent and invisible to the naked eye except when colored by iodine4 ,these plaques protect the germs1 which ferment and create the acid which destroys tooth structure4 ,their formation can be prevented by vigorous brushing and by eating hard food4 ,the individual with decayed teeth1 even with unclean teeth1 is open to infection of the lungs1 tonsils1 stomach1 glands1 ears1 nose1 and adenoid tissues4 ,every time food is taken1 and at every act of swallowing1 germs flow over the tonsils into the stomach4 ,mouth breathers with teeth in this condition cannot get one breath of uncontaminated air1 for every breath becomes infected with poisonous emanations from the teeth4 ,bad teeth are frequently the sole cause of bad breath and dyspepsia1 and can convey to the system tuberculosis of the lungs1 glands1 stomach1 or nose1 and many other transmissible diseases4 ,they may also cause enlarged tonsils and ear trouble4 ,apart from decomposing food and stagnant septic matter from saliva injured by indigestion1 and by sputum which collects in the healthy mouth1 there are in many infected mouths pus1 exudations from the irritated and inflamed gum margins1 gaseous emanations from decaying teeth1 putrescent pulp tissue1 tartar1 and chemical poisons4 ,every spray from such a mouth in coughing1 sneezing1 or even talking or reading1 is laden with microbes which vitiate the air to be breathed by others4 ,indigestion from imperfect mastication and imperfect salivation 7themselves often due solely to bad teeth7 is far less serious than indigestion from germ infection4 ,germs taken into the stomach can so change the composition of saliva 7a natural disinfectant when healthy7 as to render it no longer able to kill germs4 ,indigestion may result in excess of uric acid and toxic material1 so that the individual becomes subject to gout and rheumatism1 which in turn frequently destroy the bony support of the teeth and bring about ,riggs's ,disease4 ,the last named is a prevalent and disfiguring disease1 whose symptom is receding gums4 ,the irritating toxins deposited on the teeth cause inflammation of the tissues at the gum margins4 ,the gums withdraw more and more from sections of the teeth2 the poisons get underneath and work back toward the roots2 the infection increases and hastens the loosening of the teeth4 ,i know of a man who had all of his teeth extracted at twenty-one years of age1 because he was told that this was the only treatment for this disease1 which was formerly thought to be incurable4 ,yet thorough cleansing and removal of this matter from under the edges of the gums1 disinfection1 a few visits to the dentist1 will stop the recession but cannot regain lost ground4 ,among those who regularly use the toothbrush1 instinct1 comfort1 or display is the ruling motive1 while a small percentage have evolved to the anti-nuisance stage1 where the sthetic standard of their group forbids any member to neglect his teeth4 ,the anti-slum and pro-slum motives for mouth cleanliness and dental sanitation have been awakened in but one or two places4 ,a significant pro-slum activity is the dental clinic organized by forty volunteer dentists1 acting for an industrial school maintained by the ,new ,york ,children's ,aid ,society4 ,illustration3 ,,new ,,york ,,children',s ,,aid ,,society',s ,,dental ,,clinic ,,for ,,school ,,children ,here #eej children have been examined1 #ddg teeth extracted1 #bhd teeth filled1 #bjj teeth treated for diseased pulp 7and only #bd sets cleaned71 #dj dentists taking turns in giving time to this work4 ,the equipment cost but #bci2 cards and stationery1 #gb2 incidentals1 #cc4 ,the principal attends the clinic1 because in her presence no child is willing to confess fear or unwillingness4 ,to supplement this work1 the dentists have prepared for free distribution a leaflet which tells in short1 clear sentences how to care for the teeth4 ,illustration3 7leaflet7 ---------------------------------------- ------------------------------ ,a ,,dental ,,catechism ,when should they be cleansed8 ,what are the teeth for8 ,immediately after the morning and noonday meals and before going to ,to masticate food2 that is1 bed4 grind it into fine particles1 mix it with saliva1 and so ,by what means should they be begin its digestion2 also to cleansed8 aid in speaking and singing4 ,by a moderately stiff brush1 ,how long should they last8 water1 and floss silk4 ,to the very end of life4 ,how should these be used8 ,how do we lose them8 ,the brush should be first used in a general way1 high up on the ,by decay1 by loosening1 and by gums length-wise of the jaws1 to accident4 remove large particles and stimulate the gums1 then the ,what causes teeth to decay8 brush and the teeth should be carefully rinsed with water4 ,the ,particles of food decaying in brush should next be used with a contact with them4 rolling or circular motion1 so that the bristles will follow the ,where does food lodge8 lines of all the grooves and spaces in which the particles of ,all along the edges of the gums1 food have lodged1 and so brush in the spaces between the teeth1 them out4 ,then again the mouth and in the crevices of their should be rinsed with water4 grinding surfaces4 ,should the gums be brushed8 ,can we prevent this loss8 ,yes1 moderate friction helps to ,yes1 to a large extent4 keep them healthy4 ,how can we do it8 ,how can the spaces between the teeth be reached8 ,by using the teeth properly and by keeping them clean and the ,by dental floss silk passed gums healthy4 between the teeth1 drawn carefully back and forth till it ,what does using them properly reaches the gum1 pressed firmly mean8 against the side of each tooth in turn and drawn out towards the #a4 ,using sufficient hard or grinding end of the tooth1 and fibrous food to give the teeth this repeated several times in and gums full exercise4 each space4 #b4 ,taking time enough to ,should tooth powder or paste be masticate food thoroughly before used8 swallowing4 ,usually once a day4 ,how often should teeth be cleansed8 ,as often as they are used4 ---------------------------------------- ------------------------------ ,such a leaflet should be given out at dispensaries1 hospitals1 dental offices1 schools1 and from many ,sunday schools and missions4#e ,the time for the schools to begin is when the child is first registered4 ,examination and rexamination must be accompanied by explanation of the serious disadvantages of neglected teeth1 and the physical1 social1 and economic advantages of clean1 sound teeth4 ,instruction at school must be followed by education of parents4 ,the school or health authorities should examine the teeth of all children before issuing work certificates4 ,finally1 the dental1 medical1 and nursing professions and the press must be enlisted in the school's campaign for dental hygiene4 ,the ,dental ,hygiene ,council of ,massachusetts should be copied in all states4 ,a preliminary examination of teeth can be made by parent or teacher4 ,crooked1 loose1 dirty1 or black teeth or receding gums can be detected by a layman's naked eye4 ,in fact1 children can be interested in finding the most obvious defects in their own or their brothers' teeth4 ,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 filling4 ,the most urgent need can thus be ascertained without expert aid4 ,but because parent1 teacher1 or child cannot discover defects does not prove that dental care is not imperative2 hence the importance of examination by a dentist or by a physician competent to discover dental needs4 ,if a private1 public1 or parochial school has no paid visiting dentist1 a zealous school officer can1 at least in large towns1 persuade one or more dentists or physicians to make a few first tests to confirm the teacher's findings1 and to persuade the community that regular examination and rexamination are necessary and a saving of pain1 beauty1 and money4 ,rexamination is necessary because decay may start the day after a dentist has pronounced a tooth sound4 ,for most of us twice a year is often enough4 ,a rexamination should be made upon the slightest suspicion of decay1 breaking1 or loosening4 ,educational use should be made by the teacher of the results of school examination4 ,children cannot be made self-conscious and cleanly by telling them that their teeth will ache three or five years from now4 ,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 mouth garbage4 ,all decay of human teeth starts from the outside through the enamel that covers the soft bone of the tooth4 ,this enamel can be destroyed by accidentally cracking or breaking it1 or by acids eating into it4 ,these acids come from 7#a7 particles of food allowed to remain in the teeth2 7#b7 tartar1 etc41 that adheres to the teeth and can be removed only by a dentist2 7#c7 saliva brought up from an ill-conditioned stomach4 ,even where the enamel is destroyed1 absolute cleanliness will prevent serious decay of the tooth4 ,a perfectly clean tooth will not decay4 ,generally speaking1 unless particles of food or removable acids remain on or between the teeth long enough to decompose1 teeth cannot decay4 ,decay always means1 therefore1 uncleanliness4 ,to unclean teeth is due in large part the offensive odor of many schoolrooms4 ,uncleanliness becomes noticeable to our neighbors sooner or later4 ,there is no offense we are so reluctant to commit as that of having uncleanliness of our bodies disagreeable to those about us4 ,very young children will make every effort in their power to live up to the school's standard of cleanliness4 ,the other side to this reason for having clean teeth is vanity4 ,because all cleanliness is beautiful to us1 clean teeth are one attribute of beauty that all of us can possess4 ,habits of cleanliness are easily fixed4 ,in the most crowded1 most overworked section of large cities visitors from uptown are surprised by the children's bright hair ribbons1 clean aprons1 clean faces1 and smoothly combed hair4 ,it will be easy to add clean teeth to the list of things necessary to personal and family standing4 ,armenian children are taught to clean their teeth after eating1 even if only an apple between meals4 ,they covet beautiful teeth4 ,american standards will soon prevent these ,armenians from cleaning their teeth in public1 but desire for beautiful teeth will stay1 and will remind them to care for their teeth in private4 ,as coarse food gives way to sugars and soft foods1 stiff toothbrushes must supplement tongue and toothpicks4 ,illustration3 ,,an ,,armenian ,,school ,,girl ,strong as are the instinct and display motives in cleaning teeth1 both parents and children need to be reached through the commerce motive4 ,instinct makes children afraid of the dentist1 or content when the tooth stops aching4 ,display may be satisfied with cleaning the front teeth1 as many boys comb only the front hair or as girls hide dirty scalps under pompadours and pretty ribbons4 ,desire to save money may give stronger reasons for not going to the dentist than instinct and comfort can urge for going4 ,but parents can be made to see1 as can children after they begin to picture themselves as wage earners1 that a dentist in time saves nine1 and that no regular family investment will earn more money than the price of prompt and regular dental care4 ,a problem in arithmetic would be convincing1 if1 by questions such as those on page #ih1 we could compare the family cost of neglecting teeth with the cost of toothbrushes1 bicarbonate of soda1 pulverized chalk or tooth powder1 early and repeated examination by a dentist1 and treatment when needed4 ,how many members in your family8 ,what does a toothbrush cost8 ,how many teeth have they8 ,how many do you need in one year8 ,how many teeth have they lost8 ,how much does tooth powder ,how many false teeth have they8 cost8 ,how many teeth have been filled8 ,how much is needed for one year8 ,what is the total cost to date8 ,how much would two examinations ,how many days have been lost a year by a dentist cost8 from work because of toothache8 ,how many teeth are now decayed8 ,what will it cost to have them attended to8 ,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 family4 ,how effective and economical is thorough cleaning is confessed by an eminent dentist1 who taught an assistant to clean his patients' teeth4 ,do you know1 he said1 ,i had to stop it1 so perceptibly did my work decrease4 ,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 toothache4 ,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 teeth4 ,it is not enough1 however1 to send one message to parents4 ,illustrated lectures1 mothers' meetings1 demonstrations at hospitals and fresh-air homes are all very serviceable1 but listening is a poor substitute for understanding4 ,schools should see that parents understand the sthetics1 the economics1 the humanity of dental hygiene4 ,the best test of whether the parent has understood is the child's tooth4 ,dental examination of children applying for work certificates gives the health and school authorities a means of enforcing their precepts4 ,when no child is allowed to go to work whose teeth cause malnutrition or disgust1 the news will spread1 and both child and parent will see clearly the grave need for dental care4 ,illustration3 ,,won ,,by ,,the ,,economic ,,argument ,finally1 local papers can be interested4 ,they will print almost anything the teacher sends about the need for dental care4 ,they like particularly facts about the number of cavities found1 the number of children needing care1 efforts made to procure care1 and new facts about diseases that can be caused by bad teeth or about diseases that can injure teeth4 ,teachers can persuade dentists and physicians to write stories4 ,no newspaper will refuse to print such statements as this3 ,a tuberculous patient in six weeks lost ground steadily4 ,i persuaded him to go to a dentist to clean the vestibule to his digestive system1 and to have a set of false teeth4 ,he enjoys his meals1 and has gained twelve pounds in six weeks4 ,popular magazines and newspapers mention teeth seldom1 because those who best know the interesting vital things are making money1 not writing articles or otherwise concerning themselves with dental education4 ,it is said that of forty thousand ,american dentists not over eleven thousand are readers of dental journals1 and probably not three hundred contribute to professional literature4 ,one dentist who is working for the children's clinic described above1 when asked by the board of education to lecture to the people on the care of the teeth and to recommend simple1 readable books1 told me that he knew no good books to suggest4 ,five obstacles exist to practicing what is here preached3 #a4 ,the expensiveness of proper dentistry4 #b4 ,the untrustworthiness of cheap dental service and painless dental parlors2 the domination of the supply houses wishing to sell instruments and other supplies4 #c4 ,the ethical objection to any kind of advertising or to work by wholesale4 #d4 ,the lack of dispensaries4 #e4 ,the profit-making basis of dental education4 ,additional reasons these for cleanliness that will make the dentist serviceable for his knowledge rather than for his time and gold4 ,good dentists really come too high for both the poor and the comfortably situated4 ,families in ,new ,york ,city that have four or five thousand dollars a year hesitate to go to a dentist whom they thoroughly trust1 because his time is worth more than they feel they can afford to pay4 ,the free-extraction dental parlors undoubtedly are doing a vast amount of harm4 ,in every city are dental quacks that injure wage-earning adults as much as soothing-sirup quacks injure babies4 ,instead of teaching people to preserve their teeth1 they extract1 and then1 by dint of overpersuading by a pretty cashier hired for the purpose1 make a contract for a gold crown or a false set at an exorbitant price4 ,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 lifetime4 ,its question is not1 ,what can ,i do for this patient8 but ,what is there in this mouth for me8 ,many parlors never expect to see the same person twice1 because they do not make him comfortable or gain his confidence2 they put a filling in on top of decayed matter or even diseased pulp2 put in plates and bridges that do not fit2 charge more than the examination at first leads one to expect2 refuse to correct mistakes2 deny having ever seen the patient before4 ,yet true and severe as this arraignment is1 many of these parlors1 with their liveried runners in1 are doing an educational service not otherwise provided2 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 needs4 ,i realize that advertising is unethical among dentists as among physicians4 ,humbug and imposition are supposed to go inevitably with self-advertising by the methods used in selling shoes or automobiles4 ,therefore such advertising is prohibited4 ,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 way1 if we are ever to control diseases and evils due to bad teeth4 ,the rich that one dentist can help are able to pay for his good taste1 his neat attendants1 his automobile1 his club dues1 his vacations at fashionable resorts1 his hours without work1 his standard of living4 ,all of these things advertise him1 just as hospital appointments and social position may and do advertise successful physicians4 ,the patients of moderate means that one dentist can treat cannot afford to pay for rent1 time disengaged1 and indirect advertising4 ,either they must have free treatment1 must go without treatment1 or must go to a dental parlor where dental needs are organized so that a very large number will contribute to rent and display4 ,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 afford1 and at the same time admit of every patient being properly treated when necessary4 ,judging from every other branch of work1 the solution of the problem lies partly in free care for those who can pay nothing or very little1 and partly in coperative treatment through the heretofore objectionable dental parlors4 ,if instead of inveighing against advertisers1 honorable and capable dentists worked through dental and medical societies to secure adequate public supervision of dental practice1 more progress would be made against dental malpractice4 ,dental clinics will quickly follow the publication of facts that schools should gather4 ,in some places these should be separate2 but at first the best thing is to make every hospital1 every children's home1 every settlement a clinic1 and every school an examining center4 ,a skilled dentist informs me3 ,the demand that will follow examination of school children's teeth will make it profitable for young dentists to adopt a coperative scheme1 where several young men hire a parlor in a cheap district1 and1 under the supervision of some experienced dentist1 give good advice at reasonable rates4 ,this is the best antidote to the dental parlor which exploits the public so shamelessly4 ,bellevue ,hospital in ,new ,york is the first general hospital to establish regular dental examination2 others will undoubtedly soon follow4 ,dental education for profit rather than for instruction and for health has been the rule4 ,even where universities have put in dental courses1 they have demanded a net profit from tuition4 ,instead of protecting society against men incapable of caring for teeth1 the schools have marketed certificates to as large numbers as slowly enlightened self-interest would permit4 ,much progress has been made toward uniform standards of admission and graduation1 but dental colleges sadly need the light and the inspiration of school facts about teeth4 ,of fourteen dental journals in ,america1 only one has the advancement of dental science as its first reason for existence4 ,thirteen are trade journals4 ,not one of these would print articles proving that the supplies advertised by their backers were inimical to dental hygiene4 ,many dental colleges still retain on their faculties agents or editors in the pay of supply houses1 ,harvard's new dental school being a notable exception4 ,this trade motive tolerates and encourages the disreputable practices of existing dental parlors4 ,largely because of this prostitution of the dental profession1 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 body4 ,dental journalism for the sale of supplies cannot outlive the dentist's reading of the school's index4 ,many dentists will say that they must learn dentistry before they learn the economics and sociology of clean teeth4 ,being a young profession1 it is natural that dentistry should first devote itself to learning its own mechanics1--the tricks of the trade--how to fill teeth4 ,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 decades4 ,we need training and exercise to determine what kind of filling will be most comfortable and most serviceable2 whether the pulp of the teeth needs treating or removing before the filling is inserted2 whether it is worth while to fill a deciduous or baby tooth4 ,sociology will never take the place of dental technic4 ,the few dentists who have studied the social significance and social responsibility of their profession declare1 however1 that careless workmanship and indifferent education of patients continue chiefly because dentists themselves do not see the community's interest in dental hygiene4 ,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 children4 ,,footnotes3 #e ,the ,teeth and ,their ,care1 by ,thaddeus ,p4 ,hyatt1 ,d4,d4,s41 is a short1 concise treatment of the principles of dental sanitation4 ,,chapter ,x ,,abnormally ,,bright ,,children ,what is commonly considered abnormal brightness in a school child is often a tendency to live an abnormal physical life4 ,being a child bookworm means that time is spent indoors that should be spent playing games with one's fellows4 ,excellence in the activities of children1 not ability to imitate the activities of adults1 should be the test of child brightness4 ,to be able to hit a bull's-eye1 to throw a ball accurately1 to calculate the swing of a curve or the bound of a grounder1 these are tests of brightness quite as indicative of mental power as the ability to win highest marks in school1 while less injurious to physical power4 ,the child who is abnormally bright requires special treatment just as much as the child who is abnormally dull4 ,the former as well as the latter must have his abnormal condition corrected if he is to grow into a normally bright man4 ,the college man who sacrifices health to marks is thus described by the director of physical training at ,harvard ,university3 ,a drooping head1 a pale face1 dull1 sunken eyes1 flat chest and rounded shoulders1 with emaciated limbs1 soft flabby muscles1 and general lack of good physical1 mental1 and moral tone4 ,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 scholarship4 ,if scholarship men cannot be induced to take time to improve their physique for fear of lowering their college standing1 then give them credit for standing in physical work4 ,the abnormally bright1 at whatever age1 is as much a subject for examination and treatment as the child with adenoids and pulmonary tuberculosis4 ,such attention will increase the percentage of abnormally bright schoolmates who figure in active business in later life4 ,moreover1 it will decrease the number of high school superintendents who declare that their honor pupils are physical wrecks4 ,there are children who develop very rapidly1 both physically and mentally1 and whose mental superiority is not at the expense of their bodies4 ,protection of such children requires that their minds be permitted to progress as rapidly as bodily health justifies4 ,it is as cruel to keep back a physically and mentally superior child1 as to push the physically or mentally defective beyond his powers4 ,worry and fatigue can be produced by lack of interest as well as by overwork4 ,normal should not be confused with average4 ,to keep a bright child back with the average child--marking time till the dull ones catch up--is to make him abnormal4 ,the tests that we have employed for grading pupils are either the tests of age in years or of mental capacity4 ,the first takes no account of slowness or rapidity of physiological development1--of physiological age4 ,the second encourages mental activity at the expense of physique4 ,the entrance of a child into school1 the promotion from one class to another1 the entrance into college1 are thus determined either by the purely artificial test of age or by the individual teacher's discretion4 ,there is nothing to prevent the ambitious teacher or the ambitious parent from pushing a child into kindergarten at four1 high school at twelve1 college at fifteen4 ,if this cannot be done at the public school1 a private school is resorted to4 ,a community of college professors once started a school for faculty children4 ,a tremendous pressure was put upon these scions of intellectual aristocracy to enter the high school at twelve4 ,no thought was given to the ventilation of the school4 ,the windows were so arranged that they could not be opened without the air blowing on some child's back4 ,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 school1 because he feared that in this environment she would become like the other little puny1 pale1 undersized children of that school4 ,the ,university of ,pennsylvania has instituted a psychological clinic4 ,parents and teachers are invited to bring any deviation from the usual or the expected to the attention of this clinic4 ,every month a bulletin is published called the ,psychological ,clinic1 which will be found of great service in dealing with the abnormally bright as well as with the abnormally dull4 ,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 retarded4 ,abnormal brightness means power to be happy and to be serviceable that is above the average4 ,every school can be a miniature psychological clinic4 ,while every teacher cannot be an expert1 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 power4 ,,chapter ,,xi ,,nervousness ,,of ,,teacher ,,and ,,pupil ,nervousness of teacher and pupil deserves special mention4 ,so universal is this physical defect that we take it for granted1 especially for teachers4 ,teachers themselves feel that they need not even apologize for nervousness1 in fact they too frequently use it as an excuse for impatience1 ugly temper1 discourtesy1 and unfairness4 ,children1 slates1 papers1 parents1 blackboards get on their nerves4 ,nervousness of teacher causes nervousness of pupils and adds to the evil results of mouth breathing1 bad teeth1 eye strain1 and malnutrition4 ,these conditions1 added to bad ventilation1 bad light1 and an overcrowded schoolroom1 render the atmosphere thoroughly charged with electricity--nerves--toward the end of the day4 ,lack of oxygen to breathe as well as inability to breathe it2 lack of well-printed books and good light1 as well as lack of the power to use them2 toothache1 earache1 headache1 deplete the vitality of both teacher and pupil4 ,most of the disturbances at school are but outward signs of unwholesome physical conditions4 ,if the teacher attempts to treat these causes by crushing the child1 she makes confession of her own nervousness and inadequacy and visits her own suffering upon her pupils4 ,a transfixing glance prolonged into an overbearing stare1 a loud1 sharp voice1 a rough manner1 are successful only so far as they work on the nervousness of her pupil4 ,she finds that it is temporarily effective1 and so by her example and practice sets the child an example in losing control of himself4 ,the position often assumed by school children when before authority1 of hands held stiffly at the side1 head drooped1 and roving eye1 does not mean control3 it means a crushed spirit1 hypocrisy1 or brooding anarchy4 ,the mother or teacher who obtains obedience by clapping her hands1 pointing her finger1 distorting her face1 is copying in her own home the attitudes of caste in ,india1 of serfdom in ,russia1 the discipline of the prison the world over1 a modern reminder of the power of life and death or of physical torture4 ,a young college girl unfamiliar with the ways of the public school was substituting in the highest grammar grade4 ,the time for civics arrived4 ,here1 she thought1 is a subject in which ,i can interest them4 ,the boys showed a vast amount of press information1 as well as decided opinions on the politics of the day4 ,the candidates which they elected for the position of ideal ,american patriot were ,rockefeller1 ,lincoln1 and ,sharkey the prize fighter4 ,during the ensuing debate1 which gave back to ,lincoln his proper rank1 the boys in the back of the room had moved forward and were sharing seats with the boys in the front4 ,every boy was engrossed in the discussion4 ,the room was in perfect order1--not1 however1 according to the ideas of the principal1 who entered at that moment to see how the new substitute was managing the class1 famed for its bad boys4 ,with the stern look of a ,simon ,legree she demanded1 ,how dare you leave your seats6 ,when one child started to explain she shouted3 ,how dare you speak without permission6 ,don't you know your teacher never permits it8 ,every boy take his own seat at his own desk4 ,this principal was far more to be pitied than the boys1 for they had before them the prospect of work papers and a grind less monotonous and more productive than the principal's discipline4 ,she was a victim of a nerve-racking system1 more sinned against than sinning4 ,there is nothing in school life per se to cause nervousness4 ,given a well-aired1 sunny room1 where every child has enough fresh air to breathe1 where he can see without strain1 where he has a desk fitted to his body and work fitted to his maximum abilities1 a teacher who is physically strong and mentally inspiring1 and plenty of play space and play time1 there will be no nervousness4 ,one who visits vacation schools is struck with the difference in the atmosphere from that of the winter day schools4 ,here are the same rooms1 the same children1 and in many cases the same teachers1 but different work4 ,each child is busy with a bright1 interested1 happy expression and easy attitude4 ,some are at nature study1 some are weaving baskets1 making dresses1 trimming hats1 knitting bright worsted sacks and mittens for the winter4 ,boys are at carpentering1 raffia1 or wrought-iron work4 ,in none of the rooms is the absolute unity or the methodical order of the winter schoolroom1 but rather the hum of the workroom and the order that comes from a roomful of children interested in the progress of their work4 ,this condition only illustrates what a winter schoolroom might be were physical defects corrected or segregated1 windows open1 light good1 and work adapted to the child4 ,illustration3 ,,vacation ,,school ,,interest3 ,,an ,,antidote ,,to ,,nervousness ,nervousness is not a monopoly of city teachers and city pupils4 ,in country schools that ,i have happened to know1 nervous children were the chief problem4 ,nervousness led in scholarship1 in disorder1 in absences1 in truancy1 and in backwardness4 ,after reading ,mac,donald's ,annals of a ,quiet ,neighborhood1 ,i became interested in one or two particularly nervous children1 just to see if ,i could overcome my strong dislike for them4 ,to one boy ,i gave permission to leave the room or to go to the library whenever he began to lose his self-control4 ,my predecessors had not been able to control him by the rod4 ,a few weeks after ,willie's emancipation from rules1 the county superintendent was astonished to see that the county terror led my school in history1 reading1 and geography4 ,had ,i known what every teacher should be taught in preparation1--the relation of eye strain1 bad teeth1 adenoids1 overattention1 and malnutrition to nervousness and bad behavior1--,i could have restored many incorrigibles to nerve control4 ,had ,i been led at college to study child psychology and child physiology1 ,i should not have expected a control that was possible only in a normal adult4#f ,in its primary aspect the question of nervousness in the schoolroom is purely physiological1 and the majority of principals and teachers are not trained by professional schools how to deal with it4 ,normal schools should teach the physical laws which govern the child's development2 should show that the pupil's mental1 moral1 and physical nature are one and inseparable2 that children cannot at one time be docile1 sickly1 and intelligent1--perfect mentally and imperfect physically4 ,until teachers are so taught1 the condition cannot be changed that makes of our schools manufactories of nervous teachers and pupils4 ,country nervousness1 like city nervousness1 is of three kinds3 7#a7 that caused by defective nervous systems2 7#b7 that resulting from physical defects other than defects of the nervous system1 but reacting upon it2 7#c7 that due to habit or to lack of self-control4 ,children who suffer from a defective nervous system should1 in city schools1 be segregated where they can have special care under constant medical supervision4 ,such children in schools too small for special classes should be given special treatment4 ,their parents should know that they have chorea1 which is the same trouble as ,st4 ,vitus's ,dance1 although often existing in a degree too mild to attract attention4 ,special treatment does not mean that such children should be permitted to interfere with the school progress of other children4 ,in many rural schools1 where special privileges cannot be given children suffering with chorea without injury to other children1 it would be a kindness to the unfortunates1 to their parents1 and to all other children1 were the parents requested to keep such children at home4 ,nervousness that results from removable physical defects--eye strain1 adenoids1 indigestion1 earache--will be easily detected by physical examination1 and easily corrected by removing the physical defect4 ,preventable nervousness due to habit can be quite as serious in its effects upon the mind and health as the other two forms of nervousness4 ,twitching the face1 biting the nails1 wetting the lips1 blinking the eyelids1 continually toying with something1 being in perpetual motion and never relaxing1 always changing from one thing to the next1 being forever on the rush1 never accomplishing anything1 are common faults of both teacher and pupil4 ,we call them mannerisms or tricks of personality4 ,they are readily imitated by children4 ,i once knew a young lawyer who had started life as an oyster dealer1 whose power of imitation helped to make him responsive to both helpful and harmful influences4 ,after being at the same table for two weeks with a talented man whom he admired1 he acquired the latter's habit of constantly twitching his shoulder and making certain gestures4 ,these habits in turn quickly produced a nervousness that interfered with his power to reason straight4 ,nervousness is often confused with aggressiveness1 initiative1 confidence4 ,think twice before you jump1 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 control4 ,it is said that the confusion of city life causes habits of nervousness4 ,unfortunately no one knows whether the city children or the country children have the highest percentage of nervousness4 ,there is a general feeling that city life causes an unwholesome degree of activity1 yet one finds that those people in the city who least notice the elevated railway are those whose windows it passes4 ,city noises irritate those who come from the country1 or the city man on returning to the city from the country1 but a similar irritation is felt by the city-bred man on coming to the country4 ,mr4 ,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 nerves4 ,at the time of the opening of the ,new ,york schools in #aijg a newspaper published an editorial on ,where can the city child study8 showing that in ,new ,york the curriculum1 the schoolhouse1 and the tenements are so crowded and so noisy that study is practically impossible4 ,lack of sleep1 lack of a quiet place in which to study at school and at home1 are causes for nervousness1 whether these conditions are in the city or in the country4 ,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 pupil8 ,the index is there2 it should be read4 ,in breaking habits of nervousness the first step is to explain how easily habits are formed1 why their effects may be serious1 and how a little attention will correct them4 ,when a habit loses its mystery it becomes unattractive4 ,children will take an interest in coperating with each other and with the teacher in curing habits acquired either at home or at school4 ,my pupils greatly enjoyed overcoming the habit of jumping or screaming after some sudden noise4 ,i told them how1 when a boy1 my imagination had been very much impressed by one of ,thackeray's characters1 the last remnant of aristocratic traditions1 almost a pauper1 but possessing one attribute of nobility1--absolute self-control4 ,when his house burned he stood with his ankles crossed1 leaning on his cane1 the only onlooker who was not excited4 ,for months ,i imitated that pose1 using sticks and rakes and fork handles4 ,the result was that when ,i taught school1 a scream1 a broken desk1 or unusual noise outside reminded me of my old aristocrat in time to prevent my muscles from jumping4 ,in a very short time several fidgety and nervous girls and boys had learned to think twice and to relax before jumping4 ,one test of thorough relaxation in a dentist's chair proves the folly of tightening one's muscles4 ,when in school or out the remedy for nervousness is relaxation4 ,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 rod4 ,it has been said of our schools that children are not worked to death but bored to death4 ,wherever a room must be stripped of all beauty and interest to induce concentration1 wherever the greater part of the teacher's time must be spent in keeping order1 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 pupils4 ,nervous habits will be inevitable until the pupil's attention is obtained through interest4 ,sustained interest will be impossible until teacher and pupil alike practice relaxation1 not once a morning or twice a day1 not during recess or lunch hour1 but whenever relaxation is needed4 ,in overcoming nervousness of teacher and pupil1 both must be interested in home causes as well as school causes of that nervousness4 ,time must be found to ask questions about those causes and to discuss means for removing them4 ,naturally it will be embarrassing for a very nervous teacher to discuss nervousness with children1--until after she has overcome her own lack of nerve stability4 ,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 physician1 of her doctor1 and of superintendent and trustees4 ,the outside point of view is necessary1 because of the peculiar fact that almost every nervous person believes that he has unusually good control over his nerves1 just as a man in the midst of his anger will declare that he is cool and self-controlled4 ,had ,robert ,burns been thinking of the habit of nervousness he could not have thought of a better cure than when he wrote3 ,oh wad some power the giftie gie us ,to see oursel's as ithers see us2 ,it wad frae mony a blunder free us1 ,and foolish notion4 ,,footnotes3 #f ,the ,unconscious ,mind by ,schofield1 ,the ,study of ,children and their ,school ,training by ,dr4 ,frances ,warner1 and ,the ,development of the ,child by ,nathan ,oppenheimer show clearly the physical and mental limitations and possibilities of children4 ,,chapter ,,xii ,,health ,,value ,,of ,,unbossed ,,play ,,and ,,physical ,,training ,a boy without play means a father without a job4 ,a boy without physical training means a father who drinks4 ,when people have wholesome1 well-disciplined bodies there will be less demand for narcotics as well as for medicines4 ,on these three propositions enthusiasm has built arguments for city parks and playgrounds1 for school gymnastics1 and for temperance instruction4 ,we have tried the remedies and now realize that too much was expected of them4 ,neither movement appreciated the mental and physical education of spontaneous games and play4 ,like hygiene instruction1 physical training was made compulsory by law in many states1 and1 like hygiene instruction1 physical training had to yield to the pressure of subjects in which children are examined4 ,at the outset both were based upon distorted psychology and physiology4 ,of late physical training has been revived to correct defects of the school desk and to relieve the strain of too prolonged study periods4 ,in ,new ,york grammar schools ten minutes a day for the lower grades1 and thirty minutes a week for the higher grades1 are set aside for physical training4 ,with the exception of eighteen schools where apparatus is used1 the exercise has been in the class rooms4 ,it consists of what are known as setting-up exercises1--deep breathing and arm movements for two minutes between each study period1 often forgotten until it is time to go home1 when the children are tired and need it least4 ,many teachers so conduct these exercises that children keenly enjoy them4 ,illustration3 ,,serviceable ,,relief ,,from ,,school ,,strain1 ,,but ,a ,,poor ,,substitute ,,for ,,outdoor ,,play ,like hygiene instruction1 physical training preceded physical examination4 ,generally speaking1 it has not yet1 either in schools or in colleges1 been related to physical needs of the individual pupil4 ,in fact1 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 children4 ,formal exercises in cramped space1 in ill-ventilated rooms1 with tight belts and heavy shoes1 are conceded to be pernicious4 ,formal exercises should never be given to any child without examination and prescription by a physician4 ,children with heart weakness1 enlarged tonsils1 adenoid growths1 spinal curvature1 uneven shoulders1 are frequently seen doing exercises for which they are physically unfit1 and which but serve to deplete further their already low vitality4 ,attention might be called to many a class engaged in breathing exercises when by actual count over half the boys were holding their mouths open4 ,special exercises are needed by children who show some marked defect like flat foot1 flat chest1 weak abdominal muscles1 habitual constipation1 uneven shoulders1 spinal trouble1 etc4 ,that no physical training should be provided for normal children is the belief of many leading trainers4 ,this special training is useful to develop athletes or to correct defects4 ,like massage1 osteopathy1 or medicine1 it should follow careful diagnosis4 ,the time is coming when formal indoor gymnasium exercises for normal pupils or normal students will be considered an anomaly4 ,there is all the difference in the world between physical development and what is called physical training4 ,the test of physical development is not the hours spent upon a prescribed course of training1 but the physical condition determined by examination4 ,to be refused permission to substitute an hour's walk for an hour's indoor apparatus work is often an outrage upon health laws4 ,given a normal healthy body1 plenty of space1 and plenty of playtime1 the spontaneous exercise which a child naturally chooses is what is really health sustaining and health giving4 ,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 air4 ,eustace ,miles1 ,m4,d41 amateur tennis player of ,england1 says3 ,i do not consider a mere athlete to be a really healthy man4 ,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 house4 ,they become a good house1 and1 indeed1 they are indispensable to a good house1 but at present the good house exists only in potentiality4 ,the healthy-mindedness and physical morality which play and games foster rarely result from physical training as a business1 at stated times1 indoors1 under class direction4 ,it is too much like taking medicine4 ,a certain breakfast food is said to have lost much of its popularity since advertised as a health food4 ,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 spirit4 ,is the little girl on the street who springs into a hornpipe or a jig to the tune of a hurdy-gurdy1 or even the boy who runs before automobiles or trolley cars or under horses' noses1 getting less physical education than those who play a round game in silence under the supervision of a teacher in the school basement1 or who stretch their arms up and down to the tune of one1 two1 three1 four1 five1 six8 ,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 originality1 more lung power1 and better arteries than the child of fortune who is led by the hand of a governess up and down ,fifth ,avenue4 ,children have not forgotten how to play1 but adults have forgotten to leave space in cities1 and time out of school1 home work1 and factory work in which children may play4 ,again1 the child--whether a city child or a country child--rarely needs to be taught how to play4 ,teaching him games will not produce vitality4 ,games are the spontaneous product of a healthy body1 active mind1 and a joy in living4 ,give the children parks and piers1 roof gardens and playgrounds in which they may play1 and leave the rest to them4 ,give them time away from school and housework1 and leave the rest to them4 ,instead of lamenting the necessity for playing in the streets1 let us reserve more streets for children's play4 ,there are too many students of child welfare whose reasoning about play and games is like that of a lady of ,cincinnati1 who1 upon reading the notice of a child-labor meeting1 said3 ,well1 ,i am glad to see there is going to be a meeting here for child labor4 ,it is high time some measure was taken to keep the children off the streets4 ,physical examinations would prove that streets are safer and better than indoor gymnasiums for growing children4 ,intelligent physical training will train children to go out of doors during recess2 will train pupils and teachers not to use recess for study1 discipline1 or eating lunch4 ,illustration3 ,,spontaneous ,,play ,,on ,,one ,,of ,,new ,,york ,,city',s ,,school ,,roof ,,playgrounds ,after-school conditions are quite as important as physical training and gymnastics at school4 ,not long ago a nurse was visiting a sick tenement mother with a young baby4 ,she found a little girl of twelve standing on a stool over a washtub4 ,this child did all the housework1 took care of the mother and two younger children1 got all the meals except supper1 which her father got on his return from work4 ,as the nurse removed the infant's clothes to give it a bath1 the little girl seized them and dashed them into the tub4 ,yes1 ,i am pretty tired when night comes1 she confessed4 ,this child has prototypes in the country as well as the city1 and she did not need physical training4 ,she did not lack initiative or originality4 ,she did need playmates1 open air1 a run in the park1 and fun4 ,the educational value of games and outdoor play should be weighed against the advantages of lowering the compulsory school age1 and of bridging over the period from four to seven with indoor kindergarten training4 ,neither physical training nor education is synonymous with confinement in school4 ,the whole tendency of ,nature's processes in children is nutritional2 it is not until adolescence that she makes much effort to develop the brain4 ,overuse of the young mind results1 therefore1 in diverting natural energy from nutritive processes to hurried growth of the overstimulated brain4 ,the result is a type of child with a puny body and an excitable brain1--the neurotic4 ,the young eye1 for example1 is too flat 7hypermetropic7--made to focus only on objects at a distance4 ,close application to print1 or even to weaving mats or folding bits of paper accurately1 causes an overstrain on the eye1 which not only results in the chronic condition known as myopia1--short-sightedness1--so common to school children1 but which acts unfavorably on the constitution and on the whole development of the child4 ,at the recent ,international ,congress of ,school ,hygiene in ,london1 ,dr4 ,arthur ,newsholme1 medical officer of health of ,brighton1 made a plea for the exclusion of children under five years of age from schools4 ,during the time the child is in the infant department it has chiefly to grow4 ,nutrition and sleep are its chief functions4 ,paints1 pencils1 paper1 pins1 and needles should not be handled in school by children below six4 ,luther ,burbank1 in an article on ,the ,training of the ,human ,plant1 says3 ,the curse of modern child life in ,america is overeducation1 overconfinement1 overrestraint4 ,the injury wrought to the race by keeping too young children in school is beyond the power of any one to estimate4 ,the work of breaking down the nervous systems of the children of the ,united ,states is now well under way4 ,every child should have mud pies1 grasshoppers1 and tad-poles1 wild strawberries1 acorns1 and pine cones1 trees to climb and brooks to wade in1 sand1 snakes1 huckleberries1 and hornets1 and any child who has been deprived of these has been deprived of the best part of his education4 ,not every child can have these blessings of the country1 but every child can be protected from the stifling of the nature instinct of play by formal indoor bossed exercises1 whether called games1 physical training1 gymnastics1 or ,delsarte4 ,illustration3 ,,new ,,york ,,city',s ,,school ,,farm ,,does ,,not ,,stifle ,,nature ,,instinct ,the answer to the protest against too early and too constant confinement in school has always been3 ,where will the child be if out of school8 ,will its environment at home not work a worse injury to its health8 ,will not the street injure its morals8 ,because we have not yet worked out a method of supervising the health of those children who are not in school1 it does not follow that such supervision is impossible4 ,perhaps the time will come when there will be state supervision over the health of children from birth1 parents being expected to present them once a year at school for examination by the school physician4 ,in this way defects can be corrected and health measures devised to build up a physique that should not break down under the strain of school life4 ,for children whose mothers work during the day1 and for those whose home environment is worse than school1 it might be cheaper in the long run to assign teachers to protect them from injury while they play in a park1 roof garden1 or out-of-door gymnasium4 ,if parks and playgrounds come too slowly1 why not adopt the plan advocated by ,alida ,s4 ,williams1 a ,new ,york principal1 of reserving certain streets for children between the hours of three and five1 and of diverting traffic to other streets less suitable for children's play8 ,so great is the value--mentally1 morally1 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 fifteen4 ,it is generally admitted that the child who enters school at eight rather than at six will be the gainer at twelve4 ,what a travesty upon education to insist upon schooling for children because they are apt to be run over on the street1 or to be neglected at home1 to shoot craps1 or belong to a gang and develop bad morals4 ,educators will some day be ashamed to have made the schools the catch-all or the court-plaster for the evils of modern industry4 ,instead of pupils and mothers going to the school1 enough hygiene teachers1 and play teachers1 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 book4 ,such a course of action would have an incalculable effect on the reduction of tuberculosis1 not only in making healthier physiques but by inculcating habits of outdoor life and love of fresh air4 ,the danger of those contagious diseases which ravish childhood would be greatly reduced4 ,an ambition for physical integrity would make unnatural living unpopular4 ,competition in games with children of the same physical class develops accuracy1 concentration1 dispatch1 resourcefulness1 as much as does instruction in arithmetic4 ,smoking can easily be discredited among boys trying to hit the bull's-eye4 ,a boy would sooner give up a glass of beer than the championship in rifle shooting or a home run4 ,the influence of the spirit of the game on practical life has been described thus by ,new ,york's director of physical training1 ,dr4 ,luther ,h4 ,gulick3 ,play is the spontaneous enlistment of the entire personality in the pursuit of some coveted end4 ,we do not have to pursue the goal2 we wish to--it is our main desire4 ,this is the way in which greatest discoveries1 fortunes1 and poems are made4 ,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 game1 capable of enlisting all the energy and enthusiasm we have to put into it4 ,the people who accomplish things are the people who play the game4 ,they let themselves go2 they are not afraid4 ,under the stimulus and enthusiasm of play muscles contract more powerfully and longer than under other conditions4 ,blood pressure is higher in play4 ,it is far more interesting to play the game than to work at it4 ,when you work you are being driven1 when you play you are doing the driving yourself4 ,we play not by jumping the traces of life's responsibilities1 but by going so far beyond life's compulsions as to lose sight of the compulsion element4 ,play up1 play up1 and play the game4 ,,chapter ,,xiii ,,vitality ,,tests ,,and ,,vital ,,statistics ,two things will disclose the strength or weakness of a bank and the soundness or unsoundness of a nation's banking policy1 namely1 a financial crisis or an expert audit4 ,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 debts4 ,it continues to do business so long as no obvious weaknesses appear1 analogous to measles1 adenoids1 or paralysis4 ,a frequent disorder of banking results from doing too big a business on too little capital1 in making too many loans for the amount of cash held ready to pay depositors upon demand4 ,this disorder always comes to light in a crisis--too late4 ,it can be discovered if looked for in advance of a crisis4 ,many individuals and communities are likewise physically solvent only because their physical resources are not put to the test4 ,weaknesses that lie near the surface can be discovered before a crisis by physical examination for individuals and sanitary supervision for communities4 ,whether individuals or communities are trying to do too much business for their health capital1 whether the health reserves will pay debts that arise in a crisis1 whether we are ill or well prepared to stand a run on our vitality1 can be learned only by carefully analyzing our health reserves4 ,health debits are compared with health credits for individuals by vitality tests1 for communities by vital statistics4 ,of the many vitality tests none is practicable for use in the ordinary class room4 ,scientific training is just as necessary for such tests as for discovering the quality of the blood1 the presence or absence of tubercle bacilli in the sputum1 diphtheria germs in throat mucus1 or typhoid germs in milk4 ,but scientific truth1 the results of scientific tests1 can be made of everyday use in all class rooms4 ,state and national headquarters for educators1 and all large cities1 can afford to engage scientists to apply vitality tests to school children for the sake of discovering1 in advance of physical breakdown and before outward symptoms are obvious1 what curriculum1 what exercise1 what study1 recreation1 and play periods are best suited to child development4 ,it will cost infinitely less to proceed this way than to neglect children or to fit school methods to the loudest1 most persistent theory4 ,the ergograph is an interesting strength tester4 ,it takes a picture 7#a7 of the energy exerted1 and 7#b7 of the regularity or fitfulness of the manner in which energy is exerted4 ,perhaps the time will come when science and commerce will supply every tintype photographer with an ergograph and the knowledge to use it4 ,then we shall hear at summer resorts and fairs1 ,your ergograph on a postal card1 three for a quarter4 ,we can step inside1 harness our middle finger to the ergograph1 lift it up and down forty-five times in ninety seconds1 and lo6 a photograph of our vitality6 ,if we have strong muscles or good control1 the picture will be like this3 ,illustration3 ,,fig4 #a4 ,ergogram of ,t4,r41 a strong1 healthy girl1 before taking #dj minutes' work in the gymnasium4 ,weight used1 #c4e kg4 ,distance lifted1 #aea cm4 ,work done1 #ebh4e kg4-cm4 ,if weak and nervous1 we shall look like this before taking exercise3 ,illustration3 ,,fig4 #b4 ,ergogram of ,c4,e41 a weak and somewhat nervous girl1 before taking #dj minutes' work in the gymnasium4 ,weight used1 #c4e kg4 ,distance lifted1 #hi cm4 ,work done1 #caa4e kg4-cm4 ,and like this after gymnasium exercise3 ,illustration3 ,,fig4 #c4 ,ergogram of ,c4,e4 after taking #dj minutes' work in the gymnasium1 showing that the exercise proved very exhausting4 ,weight used1 #c4e kg4 ,distance lifted1 #ee cm4 ,in ,chicago1 two of whose girls are above photographed1 the physician was surprised to have four pupils show more strength late in the day than in the morning4 ,upon investigation it was found that the teacher of the four pupils had been called from school1 and that they had no regular work1 but had been sent to another room and employed themselves1 as they said1 in having a good time4 ,the chart on page #abg shows the effect of the noon recess and of the good time after three o'clock4 ,chicago's child-study experts concluded after examining a large number of children3 #a4 ,in general there is a distinct relationship in children between physical condition and intellectual capacity1 the latter varying directly as the former4 #b4 ,the endurance 7ergographic work7 of boys is greater than that of girls at all ages1 and the difference seems to increase after the age of nine4 #c4 ,there are certain anthropometric 7body measurements7 indications which warrant a careful and thorough investigation into the subject of coeducation in the upper grammar grades4 #d4 ,physical condition should be made a factor in the grading of children for school work1 and especially for entrance into the first grade4 #e4 ,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 grades4 #f4 ,the classes in physical culture should be graded on a physical instead of an intellectual basis4 ,illustration3 ,,fig4 #d ,to these conclusions certain others should be added1 not as settled beyond any possibility of modification1 but as being fairly indicated by these tests4 #a4 ,the pubescent period is characterized by great and rapid changes in height1 weight1 strength of grip1 vital capacity1 and endurance4 ,there seems to accompany this physical activity a corresponding intellectual and emotional activity4 ,it therefore is a period when broad educational influences are most needed4 ,from the pedagogic standpoint it is preminently a time for character building4 #b4 ,the pubescent period is characterized by extensive range of all physical features of the individuals in it4 ,hence1 although a period fit for great activity of the mass of children1 it is also one of numerous individual exceptions to this general law4 ,during this period a greater per cent of individuals than usual pass beyond the range of normal limits set by the mass4 ,it is a time1 therefore1 when the weak fail and the able forge to the front1 and hence calls for a higher degree than usual of individualization of educational work and influence4 #c4 ,unidexterity is a normal condition4 ,rapid and marked accentuation of unidexterity is a pubescent change4 ,on the whole1 there is a direct relationship between the degree of unidexterity and the intellectual progress of the pupil4 ,at any given age of school life bright or advanced pupils tend toward accentuated unidexterity1 and dull or backward pupils tend toward ambidexterity4444 ,training in ambidexterity is training contrary to a law of child life4 #d4 ,boys of school age at the ,bridewell 7reform school7 are inferior in all physical measurements to boys in the ordinary schools1 and this inferiority seems to increase with age4 #e4 ,defects of sight and hearing are more numerous among the dull and backward pupils4 ,these defects should be taken into consideration in the seating of pupils4 ,only by removing the defects can the best advancement be secured4 #f4 ,the number of eye and ear defects increases during the first years of school life4 ,the causes of this increase should be investigated1 and1 as far as possible1 removed4 #g4 ,there are certain parts of the school day when pupils1 on the average1 have a higher storage of energy than at other periods4 ,these periods should be utilized for the highest forms of educational work4 #h4 ,the stature of boys is greater than that of girls up to the age of eleven1 when the girls surpass the boys and remain greater in stature up to the age of fourteen4 ,after fourteen1 girls increase in stature very slowly and very slightly1 while boys continue to increase rapidly until eighteen4 #i4 ,the weight of the girl surpasses that of the boy about a year later than her stature surpasses his1 and she maintains her superiority in weight to a later period of time than she maintains her superiority in height4 #aj4 ,in height1 sitting1 girls surpass boys at the same age as in stature1 namely1 eleven years1 but they maintain their superiority in this measurement for one year longer than they do in stature1 which indicates that the more rapid growth of the boy at this age is in the lower extremities rather than in the trunk4 #aa4 ,commencing at the age of thirteen1 strength of grip in boys shows a marked accentuation in its rate of increase1 and this increase continues as far as our observations extend1 namely1 to the age of twenty4 ,in girls no such great acceleration in muscular strength at puberty occurs1 and after sixteen there is little increase in strength of grip4 ,the well-known muscular differentiation of the sexes practically begins at thirteen4 #ab4 ,as with strength of grip1 so with endurance as measured by the ergograph2 boys surpass girls at all ages1 and this differentiation becomes very marked after the age of fourteen1 after which age girls increase in strength and endurance but very slightly1 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 life4 #ac4 ,the development of vital capacity bears a striking resemblance to that of endurance1 the curves representing the two being almost identical4 ,physiological age1 according to studies made in ,new ,york ,city1 should be considered in grading1 not only for physical culture classes but for all high school or continuation classes4 ,dr4 ,c4 ,ward ,crampton1 assistant physical director1 while examining boys in the first grade of the ,high ,school of ,commerce1 noticed a greater variation in physical advancement than in years4 ,he kept careful watch of the educational progress and discovered three clear divisions3 7#a7 boys arrived at puberty1--postpubescent2 7#b7 boys approaching maturity1--pubescent2 7#c7 boys not yet approaching maturity1--prepubescent4 ,the work in lower grades they had all passed satisfactorily1 but in high school only the most advanced class did well4 ,practically none of the not-yet-maturing boys survived and few of the almost mature4 ,in other words1 the high school course was fitted to only one of the three classes of boys turned out of the grammar schools4 ,the others succumbed like hothouse azaleas at ,christmas time1 forced beyond their season4 ,physiological age1 not calendar years or grammar school months1 should determine the studies and the companions of children after the tenth year4 ,physiological strength and vitality1 not ability to spell or to remember dates1 should be the basis of grading for play and study and companionship among younger children4 ,vitality1 power to endure physically1 should be the test of work and recreation for adults4 ,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 endurance4 ,teachers may train themselves to recognize signs of fatigue in school children and to adapt each day's1 each hour's work to the endurance of each pupil4 ,one woman principal has written3 ,school programmes1 after they have been based upon the laws of a child's development1 should provide for frequent change of subject1 alternating studies requiring mental concentration with studies permitting motor activity1 and arranging for very short periods of the former4 ,anmic children should be relieved of all anxiety as to the results of their efforts1 and only short hours of daylight work required of them4 ,the disastrous consequences of eye strain should be understood by all in charge of children who are naturally hypermetropic4 ,the ventilation of a class room is far more important than its decoration or even than a high average percentage in mathematics1 and the lack of pure air is one of the auxiliary causes of nervous exhaustion in both pupils and teachers4 ,deficient motor control is a most trustworthy indication of fatigue in children1 and teachers may safely use it as a rough index of the amount of effort to be reasonably expected of their pupils4 ,facial pallor or feverish flushes are both evidences of overtasking1 and either hints that fatigue has already begun4 ,as to unfavorable atmospheric conditions1 the teacher herself will undoubtedly realize them as soon as the children1 but she should remember that effort carried to the point of exhaustion1 injurious as it is in an adult1 is yet less harmful than it is to the developing nerve centers of the child4 ,because adults at work and at play reluctantly submit themselves to vitality tests1 because few scientists are beseeching individuals to be tested1 because almost no one yearns to be tested1 the promotion of adult vitality and of community vitality can best be hastened by demanding complete vital statistics4 ,industrial insurance companies and mutual benefit societies are doing much to educate laborers regarding the effect upon vitality of certain dangerous and unsanitary trades1 and of certain unhygienic habits1 such as alcoholism and nicotinism4 ,progress is slower than it need be because state boards of health are not gathering sufficiently complete information about causes of sickness and death4 ,american health and factory inspection is not even profiting1 as it should1 from ,british1 ,german1 and ,french statistics4 ,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 sanitarians4#g ,the vital statistics of greatest consequence are not the number of deaths or the number of births1 not even the number of deaths from preventable diseases1 but rather the number of cases of sickness from transmissible diseases4 ,the cost and danger to society from preventable diseases1 such as typhoid1 diphtheria1 scarlet fever1 measles1 are imperfectly represented by the number of deaths4 ,medical skill could gradually reduce death rates in the face of increasing prevalence of infectious disease4 ,with few exceptions1 only those patients who refuse to follow instructions will die of measles1 diphtheria1 or smallpox4 ,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 dies4 ,dr4 ,w4 ,leslie ,mackenzie1 who has recently written ,the ,health of the ,school ,child1 said ten years ago1 while health officer of ,leith3 ,death is the ultimate and most severe injury that any disease can inflict1 but short of death there may be disablement1 permanent or temporary1 loss of wages1 loss of employment1 loss of education1 increase of home labor1 increase of sickness outlays1 increase of worry1 anxiety and annoyance1 disorganization of the household1 general impairment of social efficiency4 ,the best guarantee against such loss1 the best protection of health1 and the most essential element of vital statistics is prompt1 complete record of cases of sickness4 ,statistics of sickness are confined to sickness from transmissible diseases1 because we have not yet arrived at the point where we recognize the state's right to require information1 except when the sick person is a menace to the health of other persons4 ,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 #abf4 ,as ragged1 rapidly shortening lines show nervousness and depleted vitality1 so charts and diagrams can be made to show the needless waste of infant life during the summer months1 the price paid for bad ventilation in winter time1 when closed windows cause the sickness-and-death line from diphtheria and scarlet fever to shoot up from the summer level4 ,in cities it is now customary for health boards to report weekly the number of deaths from transmissible diseases4 ,health officers will gladly furnish facts as to cases of sickness1 if citizens request them4 ,newspapers will gladly publish such information if any one will take the pains to supply it4 ,wherever newspapers have published this information1 it quickly takes its place with the weather reports among the news necessities4 ,marked changes are commented on editorially4 ,children can easily be interested1 as can adults1 in filling out week by week a table that will show increases and decreases in preventable sickness due to transmissible diseases4 ,,table ,x ,,cases ,,of ,,infectious ,,and ,,contagious ,,diseases ,,reported ,,week ,,ending ---------------------------------------- -- ,oct4 ,nov4 ,nov4 ,nov4 ,nov4 ,nov4 ,dec4 #bf #b #i #af #bc #cj #g ---------------------------------------- ------------------- ,tuberculosis pulmonalis #cej #cej #cag #cfd #cde #ccg #dbb ,diphtheria and croup #cac #bfd #bhc #cca #bhb #cdc #cbf ,measles #adb #bab #bjc #bfa #bic #cbc #dgb ,scarlet fever #bjh #bbh #bca #beb #bgh #cbc #cgb ,smallpox -- #a -- #a -- -- #b ,varicella #dj #hc #ia #afb #acf #aae #afg ,typhoid fever #ajf #aje #ajg #abc #hf #gg #ga ,whooping cough #f #ac #ae #ad #bg #i #h ,cerebro-spinal meningitis #f #aa #c #d #d #h #ae ---------------------------------------- ------------------- ,total #aaga #abfg #abej #aeab #adea #aece #ahee ,,week ,,ending ------------------------------------ ,dec4 ,dec4 ,dec4 ,jan4 ,jan4 ,jan4 #ad #ba #bh #d #aa #ah ---------------------------------------- ------------- ,tuberculosis pulmonalis #cfj #ced #cjh #cdd #dcb #djb ,diphtheria and croup #cfi #cch #cdg #cjh #cgj #djf ,measles #dga #eag #cdf #eha #fia #hjc ,scarlet fever #cig #dag #dbf #dgh #efb #ehe ,smallpox #d #c #b -- #b -- ,varicella #afj #aih #abc #ih #aii #afi ,typhoid fever #fb #ce #db #cg #ee #cf ,whooping cough #ab #ai #c #be #bd #ad ,cerebro-spinal meningitis #ac #g #f #aa #af #ac ---------------------------------------- ------------- ,total #ahdd #ahhh #afjc #ahhb #bcea #bdbh ,in cities where physicians are not compelled to notify the health board of danger centers1--that is1 of patients sick from measles1 smallpox1 or diphtheria1--and in smaller communities where notices are sent only to state boards of health1 parents will find it difficult to take a keen interest in vital statistics4 ,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 disease1 both they and their pupils would discover a new interest in efficient health administration4 ,after a national board of health is organized we may reasonably expect that either state boards of education or state boards of health will regularly supply teachers with reports that will lead them to compare the vitality photographs of their own schools and communities with the vitality photographs of other schools and other communities working under similar conditions4 ,then children old enough to study physiology and hygiene will be made to see the happiness-giving possibilities of vitality tests and vital statistics4 ,illustration3 ,,vital ,,statistics ,,can ,,make ,,disease ,,centers ,,as ,,obvious ,,and ,,as ,,offensive ,,as ,,the ,,smoke ,,nuisance ,instead of discussing the theory of vital statistics1 or the extent to which statistics are now satisfactory1 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 personal1 industrial1 and community vitality4 ,five economic reasons are assigned for establishing a national department of health3 #a4 ,to enable society to increase the percentage of exceptional men of each degree1 many of whom are now lost through preventable accidents1 and also to increase the total population4 #b4 ,to lessen the burden of unproductive years by increasing the average age at death4 #c4 ,to decrease the burden of death on the productive years by increasing the age at death4 #d4 ,to lessen the cost of sickness4 ,it is estimated that if illness in the ,united ,states could be reduced one third1 nearly #ejj1jjj1jjj would be saved annually4 #e4 ,to decrease the amounts spent on criminality that can be traced to overcrowded1 unwholesome1 and unhygienic environment4 ,in addition to the economic gain1 the establishment of a national department of health would gradually but surely diminish much of the misery and suffering that cannot be measured by statistics4 ,sickness is a radiating center of anxiety2 and often death in the prime of life closes the gates of happiness on more than one life4 ,let us not forget that the bitter cry of the children still goes up to heaven1 and that civilization must hear1 until at last it heeds1 the imprecations of forever wasted years of millions of lives4 ,if progress is to be real and lasting1 it must provide whatever bulwarks it can against death1 sickness1 misery1 and ignorance2 and in an organization such as a national department of health1 adequately equipped1--a vast preventive machine working ceaselessly1--an attempt at least would be made to stanch those prodigal wastes of an old yet wastrel world4 ,among the branches of the work proposed for the national bureau are the following3 infant hygiene2 health education in schools2 sanitation2 pure food2 registration of physicians and surgeons2 registration of drugs1 druggists1 and drug manufacturers2 registration of institutions of public and private relief1 correction1 detention and residence2 organic diseases2 quarantine2 immigration2 labor conditions2 disseminating health information2 research libraries and equipment2 statistical clearing house for information4 ,given such a national center for health facts or vital statistics1 there will be a continuing pressure upon state1 county1 and city health officers1 upon physicians1 hospitals1 schools1 and industries to report promptly facts of birth1 sickness1 and death to national and state centers able and eager to interpret the meaning of these facts in such simple language1 and with such convincing illustrations1 that the reading public will demand the prompt correction of preventable evils4 ,our tardiness in establishing a national board of health that shall do this great educational work is due in part to the fact that ,american sanitarians have frequently chosen to do things when they should have chosen to get things done4 ,almost every state has its board of health1 with authority to require registration of births1 deaths1 and sickness due to transmissible disease2 with few exceptions the heads of these state boards have spent their energies in abating nuisances4 ,in a short time they have degenerated into local scavengers1 because they have shown the public neither the meaning of the vital statistics gathered nor its duty to support efficient health administration4 ,the state reports of vital statistics have not been accurate2 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 cattle1 and an inactive1 uninformed state board of health failing to protect the health of the farmer and the consumer4 ,vital statistics presume efficient health administration4 ,an inefficient health officer will not take the initiative in gathering health statistics4 ,if some one else compels him to collect vital statistics1 or furnishes him with statistics1 they are as a lantern to a blind man4 ,unless some one also compels him to make use of them1 unless we remove the causes of transmissible or infectious diseases and check an epidemic when we first hear of it1 the collection of information is of little social value4 ,statistics is of the same derivation as states and statesmen4 ,statistics have always been distinguished from mere facts1 in that statistics are instruments in the hands of the statesman4 ,wherever the term statistics is applied to social facts it suggests action1 social control of future contingencies1 mastery of the facts whose action they chronicle4 ,the object of gathering social facts for analysis is not to furnish material for future historians4 ,they are to be used in shaping future history4 ,they are facts collected with a view to improving social vitality1 to raising the standard of life1 and to eliminating permanently those forces known to be destructive to health4 ,unless they are to be used this way1 they are of interest only to the historical grub4 ,no city or state can afford to erect a statistical office to serve as a curiosity shop4 ,unless something is to be done to prevent the recurrence of preventable diseases annually experienced by your community or your school1 it is not reasonable to ask the public printer to make tables which indicate the great cost of this preventable sickness4 ,a tax collector cannot discharge his duties unless he knows the address of every debtor4 ,the police bureau cannot protect society unless it knows the character and haunts of offenders4 ,a health officer cannot execute the law for the protection of society's health unless he knows the haunts and habits of diseases4 ,for this he must look to vital statistics4 ,but the greatest service of vital statistics is the educational influence4 ,health administration cannot rise far above the hygienic standards of those who provide the means for administering sanitary law4 ,the taxpaying public must believe in the economy1 utility1 and necessity of efficient health administration4 ,power and funds come from town councils and state legislatures4 ,to convince and move these keepers of the purse1 trustworthy vital statistics are indispensable4 ,information will be used for the benefit of all as soon as it is possessed by all4 ,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 communities4 ,if years of study of mathematics and of the statistical method were required1 we should despair of obtaining light within a century4 ,but the facts we want are1 for the most part1 common1 everyday facts1 easily recognizable even by laymen2 for example1 births1 deaths1 age at death1 causes of death1 cases of transmissible diseases1 conditions found upon examination of children applying for work certificates1 etc4 ,where expert skill is required1 as at state and national headquarters1 it can be found4 ,every layman can train himself to use skillfully the seven ingredients of the statistical method which it is his duty to employ1 and to know when to pay for expert analysis and advice4 ,we can all learn to base judgment of health needs upon the seven pillars1--desire to know1 unit of inquiry1 count1 comparison1 percentages1 classification1 and summary4 ,,footnotes3 #g ,dr4 ,arthur ,newsholme's ,vital ,statistics should be in public libraries and on the shelves of health officers1 public-spirited physicians1 and school superintendents4 ,,chapter ,,xiv ,,is ,,your ,,school ,,manufacturing ,,physical ,,defects8 ,last year a conference on the physical welfare of school children was told by a woman principal3 ,of course we need physicians to examine our children and to teach the parents1 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 year4 ,at the same meeting the physical director of schools of ,new ,york ,city appealed eloquently for biological engineers at school1 who would test the child's strength as building engineers are employed to test the strength of beams and foundations4#h ,as explanation for the need of the then recently organized ,national ,school ,hygiene ,association1 he elaborated the proposition that school requirements and school environment damage child health4 ,ocular defects are in direct ratio to the length of time the pupil has attended school4444 ,a desk that is too high may easily be the indirect agent for causing scoliosis1 producing myopia or astigmatism4444 ,physically examine school children by all means1 but do not fail to examine school desks4 ,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 defects4#i ,the results1 tabulated and analyzed1 prove that the woman principal was right2 many schools are so built or so conducted1 many school courses are so devised or so executed1 that children are inevitably injured by the environment in which the compulsory education law forces them to spend their formative years4 ,illustration3 ,,one ,,of ,,new ,,york ,,city',s ,,roof ,,playgrounds ,recently ,i noticed that our little office girl1 so anmic and nervous when she left school that we hesitated to employ her1 was becoming rosy and spirited4 ,the child herself explained the change3 ,i like it better4 ,i have more money to spend4 ,i get more outdoor exercise1 and then1 oh1 the room is so much sunnier and there is more air and the people are all so nice6 ,and these were just the necessities which were lacking in the school from which she came4 ,moreover1 it is a fair commentary on the school work and the school hygiene in too many of our towns and cities to-day4 ,i like it better means that school work is not adapted to the dominant interests of the child1 that the curriculum includes subjects remote from the needs and ambitions of the modern school child1 and fails to include certain other subjects which it recognizes as useful and necessary1 and therefore finds interesting4 ,i have more money to spend means that this little girl was able to have certain things1 like a warm1 pretty dress1 rubbers1 or an occasional trolley ride1 which she longed for and needed4 ,i get more outdoor exercise means that there was no open-air playground for her school1 that setting up exercises were forgotten1 that recess was taken up in rushing home1 eating lunch1 and rushing back again1 and that after school was filled up with helping mother with the housework4 ,the office is so much sunnier and ,i get more air accounts for the increase in vitality2 and the people are all so nice1 for the happy expression and initiative which the undiscriminating discipline at school had crushed out4 ,illustration3 ,,bone ,,tuberculosis ,,is ,,one ,,of ,,the ,,penalties ,,for ,,dry ,,sweeping ,,and ,,feather ,,dusters ,for such unsanitary conditions crowded sections of great cities have no apologies to make to rural districts4 ,a wealthy suburb recently learned that there was overcrowding in every class room1 and that one school building was so unsanitary as to be a menace to the community4 ,unadjustable desks1 dry sweeping1 feather dusters1 shiny blackboards1 harassing discipline that wrecks nerves1 excessive home study and subjects that bore1 are not peculiar to great cities4 ,in a little western town a competition between two self-governing brigades for merit points was determined by the amount of home study2 looking back fifteen years1 ,i can see that ,i was encouraging anmic and overambitious children to rob themselves of play1 sleep1 and vitality4 ,many a rural school violates with impunity more laws of health than city factories are now permitted to transgress4 ,after child labor is stopped1 national and state child labor committees will learn that their real interest all the time has been child welfare1 not child age1 and will be able to use much of the old literature1 simply substituting for factory the word school when condemning hazardous occupations likely to sap children's nervous energy1 stunt their physical growth1 blight their minds1 destroy their moral fiber1 and fit them for the moral scrap heap4 ,many of the evils of school environment the teacher can avert1 others the school trustee should be expected to correct4 ,so far as unsanitary conditions are permitted1 the school accentuates home evils1 whereas it should counteract them by instilling proper health habits that will be taken home and practiced4 ,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 it4 ,especially should principals1 superintendents1 directors1 and volunteer committeemen apply such tests to the public1 parochial1 or private school1 orphanage or reformatory for which they may be responsible4 ,i4 ,,neighborhood ,,health ,,resources #a4 ,is the district congested8 #b4 ,is congestion growing8 #c4 ,how far away is the nearest public park8 a4 ,is it large enough8 b4 ,has it a playground or beauty spot8 c4 ,has it swings and games8 d4 ,is play supervised8 e4 ,have children of different ages equal opportunities1 or do the large children monopolize the ground8 f4 ,are children encouraged by teachers and parents to use this park8 #d4 ,are the streets suitable for play8 a4 ,does the sun reach them8 b4 ,are they broad8 c4 ,are they crowded with traffic8 #e4 ,how far away is the nearest public bath8 a4 ,has it a swimming pool8 b4 ,has it showers8 c4 ,is it used as an annex to the school8 ,illustration3 ,,vacation-,,school ,,play ,,clinic ,,on ,a ,,vacant ,,city ,,lot ,,owned ,,by ,,the ,,rockefeller ,,institute ,,for ,,medical ,,research ,,ii4 ,,effect ,,of ,,school ,,equipment ,,upon ,,health #a4 ,is there an indoor yard8 a4 ,is the area adequate or inadequate8 b4 ,is the floor wood1 cement1 or dirt8 c4 ,is the heat adequate or deficient8 d4 ,is the ventilation adequate or deficient8 e4 ,is the daylight adequate1 deficient1 or almost lacking8 f4 ,is there equipment for light gymnastics and games8 g4 ,is it used out of school hours2 by special classes1 athletic teams1 etc41 or by pupils generally8 #b4 ,is there an outdoor yard8 a4 ,is the area ample or inadequate8 b4 ,is the area mainly occupied by toilets8 c4 ,is the daylight sufficient or deficient8 d4 ,for how many hours does the sun reach it8 e4 ,is it equipped for games8 f4 ,how much larger ought it to be8 g4 ,is it used out of school hours2 by special classes1 athletic teams1 etc41 or by pupils generally8 #c4 ,is there a gymnasium8 a4 ,is it large enough8 b4 ,is it used for a gymnasium8 c4 ,is it cut up into class rooms8 d4 ,is it used out of school hours2 by special classes1 athletic teams1 etc41 or by pupils generally8 #d4 ,is there a roof playground8 a4 ,is there open ventilation8 b4 ,is it used in the daytime8 c4 ,is it used at night8 d4 ,is it used during the summer8 e4 ,is it monopolized by the larger children8 f4 ,is it used out of school hours2 by special classes1 athletic teams1 etc41 or by pupils generally8 #e4 ,are washing facilities adequate8 a4 ,how many pupils per washbasin8 b4 ,are there individual towels8 c4 ,have eye troubles been spread by roller towels8 d4 ,are only clean towels permitted8 e4 ,are there bathing facilities2 are these adequate8 f4 ,are swimming pools used for games1 contests1 etc48 g4 ,are bathing facilities used out of school hours8 h4 ,who is responsible for cleanliness of towels1 washbasins1 and swimming pools8 i4 ,how often is water changed in swimming pool1 or is it constantly changing8 #f4 ,is adequate provision made for clean drinking water8 a4 ,are sanitary fountains used that prevent contamination of faucet or water8 b4 ,how often are cups or faucets cleaned8 #g4 ,is provision made for airing outer clothing8 a4 ,are children permitted to pile their clothing in the class room8 b4 ,are there hooks for each child8 c4 ,are lockers provided with wire netting to permit ventilation8 d4 ,are lockers or hooks in the halls or in the basement8 e4 ,have you ever thought of the disciplinary and social value of cheap coat hangers to prevent wrinkling and tearing8 ,illustration3 ,,an ,,attempt ,,to ,,overcome ,,the ,,disadvantages ,,of ,,congestion--,a ,,boys' ,,high ,,school1 ,,new ,,york ,,city ,,iii4 ,,the ,,class ,,room ,,as ,a ,,place ,,of ,,confinement #a4 ,how many sittings are provided8 a4 ,how many pupils are there8 #b4 ,what is the total floor area8 a4 ,what proportion is not occupied by desks8 #c4 ,are the seats adjustable8 a4 ,are the seats adjusted to pupils8 b4 ,where desks are adjustable1 are short children seated in low desks1 or are children seated according to class or according to discipline exigencies without regard to size of desk8 c4 ,are seats placed properly with reference to light8 #d4 ,is the light ample and proper8 a4 ,for how many hours must artificial light be used in the daytime8 b4 ,is artificial light adequate for night work8 c4 ,does the reflection of light from blackboard and walls injure the eye8 d4 ,are the blackboards black enough8 e4 ,are the walls too dark8 f4 ,is the woodwork too dark8 g4 ,are window panes kept clean8 #e4 ,is the air always fresh8 a4 ,is ventilation by open windows8 b4 ,is ventilation artificial8 c4 ,does the ventilating apparatus work satisfactorily8 d4 ,are the windows thrown open during recess1 and after and before school8 e4 ,do unclean clothes vitiate the atmosphere8 f4 ,do unclean persons vitiate the atmosphere8 g4 ,does bad breath vitiate the atmosphere8 h4 ,are pupils and parents taught that unclean clothes1 unclean persons1 and bad breath may decrease the benefits of otherwise adequate ventilation and seriously aggravate the evils of inadequate ventilation8 #f4 ,is the temperature properly regulated8 a4 ,has every class room a thermometer8 b4 ,are teachers required to record the thermometer's story three or more times daily8 c4 ,is excess or deficiency at once reported to the janitor8 #g4 ,are the floors1 walls1 desks1 and windows always clean8 a4 ,how often are they washed8 b4 ,is twice a year often enough8 c4 ,do the floors and walls contain the dust of years8 d4 ,is dry sweeping prohibited8 e4 ,has wet sawdust or even wet sand been tried8 f4 ,has oil ever been used to keep down surface dust on floors8 g4 ,are feather dusters prohibited8 h4 ,are dust rags moist or dry8 i4 ,is an odorless disinfectant used8 #h4 ,does overheating prevail8 a4 ,do you know teachers and principals who protest against insufficient ventilation1 particularly against mechanical ventilation1 while they themselves are in heavy winter clothing in a small room closely sealed1 the thermometer at #hj degrees8 ,,iv4 ,,exercise ,,and ,,recreation #a4 ,how much time and at what periods is exercise provided for in the school schedule8 a4 ,indoors8 b4 ,outdoors8 #b4 ,how much exercise indoors and outdoors is actually given8 #c4 ,are the windows open during exercise8 #d4 ,is exercise suited to each child by the school physician after physical examination1 or are all children compelled to take the same exercise8 #e4 ,whose business is it to see that rules regarding exercise are strictly enforced8 #f4 ,do clouds of dust rise from the floor during exercise and play8 #g4 ,are children deprived of exercise as a penalty8 #h4 ,should hygiene talks be considered as exercise8 ,illustration3 ,,home ,,workshops ,,need ,,fresh ,,air ,v4 ,,the ,,school ,,janitor ,,and ,,cleaners #a4 ,do they understand the relation of cleanliness to vitality8 #b4 ,is their aim to do the least possible amount of work1 or to attain the highest possible standard of cleanliness8 #c4 ,will the teacher's complaint of uncleanliness be heeded by trustees8 ,if so1 is the teacher not responsible for uncleanliness8 #d4 ,have you ever tried to stimulate the pride of janitors and cleaners for social service8 a4 ,have you ever tried to show them how much work they save themselves by thorough cleansing8 b4 ,have you ever shown them the danger1 to their own health1 of dust and dirt that may harbor infection and reduce their own vitality8 #e4 ,what effort is made to instruct janitors and cleaners by your school trustees or by your community8 #f4 ,have you explained to pupils the important responsibility of janitors for the health of those in the tenements1 office buildings1 or schools8 a4 ,do you see in this an opportunity to emphasize indirectly the mother's responsibility for cleanliness of home8 ,illustration3 ,,school ,,workshops ,,also ,,need ,,fresh ,,air ,,vi4 ,,requirements ,,of ,,curriculum #a4 ,how much home study is there8 a4 ,how much is required8 b4 ,what steps are taken to prevent excessive home study8 c4 ,are light and ventilation conditions at home considered when deciding upon amount of home study8 #b4 ,is the child fitted to the curriculum1 or is the curriculum fitted to the child8 a4 ,does failure or backwardness in studies lead to additional study hours or to regrading8 b4 ,are there too many subjects8 c4 ,are the recitation periods too long8 d4 ,are the exercise periods too short and too few8 e4 ,is there too much close-range work8 f4 ,is it possible to give individual attention to individual needs so as to awaken individual interest8 #c4 ,is follow-up work organized to enlist interest of parents1 or1 if necessary1 of outside agencies in fitting a child to do that for which1 if normal1 he would be physically adapted8 ,by reducing the harm done by old buildings and by the traditions of curriculum and discipline1 teachers can do a great deal4 ,perhaps they cannot move the windows or the desks1 but they can move the children4 ,if they cannot insure sanitary conditions for home study1 they can cut down the home study4 ,if the directors do not provide proper blackboards1 they can do less blackboard work4 ,they can make children as conscious1 as afraid1 and as resentful of dirty air as of dirty teeth4 ,they can make janitors believe that dry sweeping or feather dusting may give them consumption1 and leave most of the dirt in the room to make work for the next day2 that adjustable desks are made to fit the child's legs and back1 not the monkey wrench2 that the thermometer in the schoolroom is a safer guide to heat needed than a boiler gauge in the basement2 that fresh air heated by coal is cheaper for the school fund than stale air heated by bodies and by bad breath4 ,finally1 they can make known to pupils1 to parents1 to principals and superintendents1 to health officials and to the public1 the extent to which school environment violates the precepts of school hygiene4 ,if the state requires the attendance of all children between the ages of five and fourteen at school for five hours a day1 for five days in the week1 for ten months in the year1 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 development4 ,if the amount of close-range work is rapidly manufacturing myopic eyes2 if bad ventilation1 whether due to faulty construction or to faulty management1 is preparing soil for the tubercle bacillus2 if children with contagious diseases are not found and segregated2 if desks are so ill adapted to children's sizes and physical needs that they are forming crooked spines2 if too many children are crowded into one room2 if lack of air and light is producing strained eyes and malnutrition2 if neither open air1 space1 nor time is provided for exercise1 games1 and physical training2 if school discipline is adapted neither to the psychology nor the physiology of child or teacher1 then the state is depriving the child of a greater right than the compulsory education law forces it to endure4 ,not only is the right to health sacrificed to the right to education1 but education and health are both sacrificed4 ,in undertaking to enforce the compulsory education law1 to put all truants and child laborers in school1 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 himself4 ,,table ,,xi ,,effects ,,of ,a ,,child ,,labor ,,law ,increase in ,chicago ,attendance ,grades #d-i #aija-aijb #aijb-aijc #aijc-aijd ,grades #i-ae #aija-aijb #aijb-aijc #aijc-aijd ,,footnotes3 #h ,the ,sanitation of ,public ,buildings1 by ,william ,paul ,gerhard1 contains a valuable discussion of how the school may avoid manufacturing physical defects4 #i ,by ,professor ,lila ,v4 ,north1 ,baltimore ,college for ,women1 for the ,new ,york ,committee on the ,physical ,welfare of ,school ,children1 #aje ,east #bb;d ,street1 ,new ,york ,city4 ,,chapter ,,xv ,,the ,,teacher',s ,,health ,teachers1 gentlemen1 no less than pupils1 have a heaven-ordained right to work so adjusted that the highest possible physical condition shall be maintained automatically4 ,this declaration thundered out by an indignant physician startled a well-meaning board of school directors4 ,the teacher's right to health was1 of course1 obvious when once mentioned1 and the directors concluded3 #a4 ,school conditions that injure child health also injure teacher health4 #b4 ,poor health of teacher causes poor health of pupil4 #c4 ,poor health of pupil often causes poor health of teacher4 #d4 ,adequate protection of children requires adequate protection of their teachers4 #e4 ,teachers have a right to health protection for their own sake as well as for their children's sake4 ,too little concern has hitherto been shown for the vitality of teachers in private or public schools and colleges4 ,without protest1 and without notice until too late1 teachers often neglect their own health at home and at school1--recklessly overwork1 undersleep1 and undernourish2 ruin their eyes1 their digestion1 and their nerves4 ,school-teachers are frequently sweated as mercilessly as factory operatives4 ,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 defenders4 ,a school curriculum or a college tradition that breaks down teachers is as inexcusable as a gun that kills the gunner when discharged4 ,experience everywhere else proves that periodic physical examinations and health precautions1 not essays about happy teachers--happy pupils1 are indispensable if teachers' health rights are to be protected4 ,physical tests are imposed upon applicants for teachers' licenses by many boards of education4 ,in ,new ,york ,city about three per cent of those examined are excluded for defects of vision1 of hearing1 of probable endurance4 ,once a teacher1 however1 there is no further physical examination1--no way of discovering physical incapacity1 nothing to prevent a teacher from exposing class after class to pulmonary tuberculosis contracted because of overwork and underventilation4 ,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' health4 ,seldom do training schools apply physical tests to students who intend to become teachers4 ,one young girl says that before starting her normal course she is going to the physician of the board of education for examination1 so as to avoid the experience of one of her friends1 who1 after preparing to be a teacher1 was rejected because of pulmonary tuberculosis4 ,during her normal course no examination will be necessary4 ,overwork during the first year may cause pulmonary tuberculosis1 and in spite of her foresight she1 too1 may be rejected four years hence4 ,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 teachers4 ,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 test4 ,no school should engage a teacher who has not good proof that she can do the required work without injury to her own or her pupils' health4 ,long before physicians can discover pulmonary tuberculosis they can find depleted vitality which invites this disease4 ,headaches due to eye trouble1 undernourishment due to mouth breathing1 preventable indigestion1 are insidious enemies that cannot escape the physical test4 ,three objections to physical tests for teachers will be urged1 but each loses its force when considered in the light of general experience4 #a4 ,a sickly teacher is often the most efficient teacher in a school or a county4 ,it is true that some sickly teachers exert a powerful influence over their pupils1 but in most instances their influence and their efficiency are due to powers that exist in spite of devitalizing elements4 ,rarely does sickness itself bring power4 ,it must be admitted that many a man is teaching who would be practicing law had his health permitted it4 ,many a woman's soul is shorn of its self-consciousness by suffering4 ,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 exclude4 #b4 ,there are not enough healthy candidates to supply our schools4 ,this is begging the question4 ,in fact1 no one knows it is true4 ,on the contrary1 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 teaching1--after we all believe what leading educators now believe1 that the highest fulfillment of human possibilities requires a normal1 sound body1 abounding in vitality4 #c4 ,examination by a physician1 especially if a social acquaintance1 is an unnecessary embarrassment4 ,the false modesty that makes physical examination unwelcome to many adults1 men as well as women1 is easily overcome when the advantages of such examination are understood4 ,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 needs4 ,the programme for school hygiene outlined in ,chapter ,,xxvii1 ,part ,,iv1 assumes that state and county superintendents will provide for the examination of teachers as well as of pupils4 ,illustration3 ,,teachers ,,will ,,prefer ,,physical ,,examinations ,,to ,,forced ,,vacations ,boston ,society for ,relief and ,study of ,tuberculosis ,because the health of others furnishes a stronger motive for preventive hygiene than our own health1 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 development4 ,children at school age are so susceptible and imitative that their future habits of body and mind1 their dispositions1 their very voices and expressions1 are influenced by those of their teachers4 ,experts in child study say that a child's vocal chords respond to the voices and noise about him before he is able to speak1 so that the tones of his voice are determined before he is able to express them4 ,this influence is also marked when the child begins to talk4 ,babies and young children instinctively do what adults learn not to do only by study1--follow the pitch of others' voices4 ,can we then overestimate the effect upon pupils' character of teachers who radiate vitality8 ,the character and fitness1 aside from scholarship1 of applicants for teachers' licenses are now subjected by the board of examiners of ,new ,york ,city to the following tests3 #a4 ,moral character as indicated in the record of the applicant as a student or teacher or in other occupation1 or as a participant in an examination4 #b4 ,physical fitness for the position sought1 reference being had here to all questions of physical fitness other than those covered in a physician's report as to sound health4 #c4 ,satisfactory quality and use of voice4 #d4 ,personal bearing1 cleanliness1 appearance1 manners4 #e4 ,self-command and power to win and hold the respect of teachers1 school authorities1 and the community4 #f4 ,capacity for school discipline1 power to maintain order and to secure the willing obedience and the friendship of pupils4 #g4 ,business or executive ability1--power to comprehend and carry out and to accomplish prescribed work1 school management as relating to adjustment of desks1 lighting1 heating1 ventilation1 cleanliness1 and attractiveness of schoolroom4 #h4 ,capacity for supervision1 for organization and administration of a school1 and for the instructing1 assisting1 and inspiring of teachers4 ,these tests probably exclude few applicants who should be admitted4 ,experience proves that they include many who1 for their own sake and for children's sake1 should be rejected4 ,the moral character1 physical fitness1 quality of voice1 personal bearing1 self-command1 executive ability1 capacity for supervision1 are qualities that are modified by conditions4 ,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 noises4 ,on parade applicants are equally cleanly2 this cannot be said of teachers in the service1 coming from different home environments4 ,self-command is much easier in one school than in another4 ,physical fitness in a girl of twenty may1 during one short year of teaching1 give way to physical unfitness4 ,therefore the need for periodic tests by principal1 superintendent1 and school board1 to determine the continuing fitness of a teacher to do the special task assigned to her1 based upon physical evidence of her own vitality and of her favorable influence upon her pupils' health and enjoyment of school life4 ,shattered nerves due to overwork may explain a teacher's shouting3 ,you are a dirty boy4 ,your mother is a dirty woman and keeps a dirty store where no decent people will go to buy4 ,a physical examination of that unfortunate teacher would probably show that she ought to be on leave of absence1 rather than1 by her overwork and loss of control1 to cause the boys of her class to feel what one of them expressed3 ,grandmother1 if she spoke so of my mother ,i would strike her4 ,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 country1 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 pupil2 slovenliness1 ugly temper1 frowning1 crossness1 lack of ambition1 cynicism1--these should be blackballed as well as consumption1 contagious morphine habit1 and contagious skin disease4 ,crooked thinking by teacher leads to crooked thinking by pupil4 ,disregard of health laws by teacher encourages unhygienic living by pupils4 ,a man whose fingers are yellow1 nerves shaky1 eyes unsteady1 and mind alternately sleepy and hilarious from cigarettes1 cannot convey pictures of normal1 healthy physical living1 nor can he successfully teach the moral and social evils of nicotinism4 ,both teacher and pupil have a right to the periodic physical examination of teachers that will give timely warning of attention needed4 ,until there is some system for giving this right to all teachers in private1 parochial1 charitable1 and public schools1 we shall produce many nervous1 acrid1 and physically threadbare teachers1 where we should have only teachers who inspire their pupils with a passion for health by the example of a good complexion1 sprightly step1 bounding vitality1 and forceful personality born of hygienic living4 ,,part ,,iii4 ,,co,,peration ,,in ,,meeting ,,health ,,obligations ,,chapter ,,xvi ,,european ,,remedies3 ,,doing ,,things ,,at ,,school ,recently ,i traveled five hundred miles to address an audience on methods of fitting health remedies to local health needs4 ,i told of certain dangers to be avoided1 of results that had always followed certain remedies1 of motives to be sought and used1 of community ends to seek4 ,not knowing the local situation1 ,i could not tell them exactly what to do next1 or how or with whom to do it2 not seeing the patient or his symptoms1 ,i did not diagnose the disease or prescribe medicine4 ,several members of the audience who were particularly anxious to start a new organization on a metropolitan model were disappointed because they were told1 not just how to organize1 but rather how to find out what sort of organization their town needed4 ,they were right in believing that it was easier to copy on paper a plan tried somewhere else1 than to think out a plan for themselves4 ,they had forgotten for the time being their many previous disappointments due to copying without question some plan of social work1 just as they copy ,paris or ,new ,york fashions4 ,they had not expected to leave this meeting with the conviction that while the ends of sanitary administration may be the same in ten communities1 health machinery should fit a particular community like a tailor-made suit4 ,american-like1 they had a mania for organization4 ,i once heard an aged kindergartner--the savant of an isolated ,german village--describe my fellow-,americans as follows3 ,every ,american belongs to some organization4 ,the total abstainers are organized1 the brewers are organized1 the teachers are organized1 the parents are organized1 the young people and even the juniors are organized4 ,finally1 those who belong to no organization go off by themselves and organize a society of the unorganized4 ,love of organization and love of copying have given us ,americans a feverish desire for what we see or read about in ,europe4 ,when we talk about our ,european remedies we try to make ourselves believe that we are broad-minded and want to learn from others' experience4 ,in a large number of cases our impatient demand for ,european remedies is similar to the schoolboy's desire to show off the manners1 the slang1 or the clothes picked up on his first visit away from home4 ,with many travelers and readers ,european remedies or ,european ways are souvenirs of a pleasant visit1 to be described like a collection of postal cards1 a curious umbrella1 a cane associated with ,alpine climbing1 or a stolen hymnal from an historic cathedral4 ,experience proves1 however1 that just as ,roman walls and ,norman castles look out of place in ,new ,york and ,kansas1 so ,european laws and ,european remedies are too frequently misfits when tried by ,american schools1 hospitals1 or city governments4 ,yesterday a ,canadian clergyman1 after preaching an eloquent sermon1 met a professional beggar on the street in ,new ,york ,city and emptied his purse--of ,canadian money6 ,quite like this is the enthusiastic demand of the tourist who has seen or read about the way it's done in ,germany4 ,the trouble is that ,european remedies are valued like ruins1 by their power to interest1 by their antiquity or picturesqueness1 or1 like the beggar1 by their power to stimulate temporary emotion4 ,but we do not sleep in ruins1 go to church regularly in thirteenth-century abbeys1 or live under the remedies that fire our imagination4 ,we do not therefore see their everyday1 practical-result side4 ,the souvenir value of ,european remedies is due to the assumption that no better way was open to the ,european1 and that the remedy actually does what it is intended to do4 ,because free meals are given at school to cure and prevent undernourishment1 it is taken for granted that undernourishment stops when free meals are introduced2 therefore ,america must have free meals4 ,because it is made compulsory in a charming ,italian village for every child to eat the free school meal1 it is taken for granted that the children of that village have no physical defects2 therefore let ,kansas ,city1 ,seattle1 and ,boston introduce compulsory free meals4 ,but when one goes to ,europe to see exactly how those much-advertised1 eulogized remedies operate from day to day1 it is often necessary to write1 as did a great ,american sanitarian recently1 of health administration in foreign cities continually held up as models to ,american cities3 ,in spite of the rules and theories over here1 the patient has better care in ,new ,york ,city4 ,we have been asked of late to copy several very attractive ,european remedies for the physiological ills of school children1 and for the physical deficiencies of the next generation of adults3 breakfasts or lunches1 or both1 at school for all children1 rich as well as poor1 whether they want school nourishment or not2 school meals for the poor only2 school meals to be given the poor1 but to be bought by those who can afford the small sum required2 free eyeglasses for the poor1 for poor and well-to-do1 for those who wish them1 for those who need them whether they want to wear eyeglasses or not2 free dental care2 free surgical treatment2 free rides and outings during summer and winter2 country children to visit the metropolis1 city children to visit country and village2 free treatment in the country of all children whose parents are consumptives2 free rides on street cars to and from school2 city-owned street railways that will prevent congestion by making the country accessible2 city-built tenements to prevent overcrowding1 dark rooms1 insufficient air and light2 free coal1 free clothes1 free rent for those whose parents are unable to protect them properly against hunger and cold4 ,every one of these remedies is attractive4 ,every one is being tried somewhere1 and can be justified on emotional1 economic1 and educational grounds1 if we think only of its purpose4 ,let us view them with the eyes of their advocates4 ,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 state1 to its slums1 its factories1 parks1 and art galleries8 ,they would grow up more intelligent about geography4 ,they would read history1 politics1 sociology1 and civil government with greater interest4 ,they would have less contracted sympathies4 ,they might even decide that they would rather live their life in the spacious country than in the crowded1 rushing city4 ,city children1 on the other hand1 would reap worlds of physical benefit and untold inspiration from periods of recreation and study in the country1 with its quiet1 its greens and bronzes and yellows1 its birds and animals1 its sky that sits like a dome on the earth1 its hopefulness4 ,winter sleigh rides and coasting would give new vigor and ambition4 ,why spend so much on teaching physiology1 geography1 and nature study1 if in the end we fail to send the child where alone nature and hygiene tell their story8 ,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 erased8 ,what more attractive or more reasonable than appetizing1 warm meals1 or cool salads and drinks for 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 winter8 ,one needs little imagination to see the smile that won't come off1 health1 punctuality1 and school interest resulting from the school meal4 ,again1 if children must have teeth filled and pulled1 eyes tested and fitted for glasses1 adenoids and enlarged tonsils removed1 surely the school environment offers the least affrighting spot for the tragedy4 ,thence goblins long ago fled4 ,there courage1 real or feigned1 is brought to the surface by the anxious1 critical1 competitive interest of one's peers4 ,illustration3 ,a ,,south ,,ireland ,,argument ,,for ,,doing ,,things ,the economic defense of these remedies is many-sided4 ,an ,english drummer once instructed me during a railroad journey from southern to northern ,ireland4 ,as we entered the fertile fields of ,lord ,dunraven's estate near ,athlone1 ,i expressed sympathy for other countries impoverished of soil1 of wealth1 and of thrift4 ,my instructor replied3 ,it would pay the government to bring them all to this land free once a year1 just to show them what they are missing4 ,that his idea of an investment is sound has been proved by railroads and land companies and even by states1 who give away excursions to entice settlers and buyers4 ,ambition at almost any cost is cheaper than indifference to opportunity4 ,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 interests1 unconscious of the struggles and joys of their co-citizens4 ,free meals1 free books1 free rides1 free eyeglasses1 are cheaper than free instruction for the second1 third1 and sixth terms in studies not passed because of physical defects1--infinitely cheaper than jails and almshouses1 truant officers and courthouses4 ,the demoralizing results of giving something for nothing did not follow free schooling or free text-books4 ,perhaps they would not follow the free remedies that we are asked to copy from ,europe4 ,in fact1 the word free is the wrong word4 ,these remedies rather require coperation of parent with parent4 ,it has demoralized nobody because the streets are cleaned by all of us1 country roads made by the township1 police paid for by taxes and not by volunteer subscription4 ,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 defects4 ,an unruly1 uninterested boy sitting beside your boy in public school1 a pampered1 overfed1 undisciplined child sitting beside yours at private school1 is taxing you without your consent and doing your child injury that may prove irreparable4 ,it costs #b4ej to furnish a child with eyeglasses4 ,it costs #be to #ej to give that child a year's schooling4 ,if the child cannot see right and fails in his studies1 we have lost a good investment and1 after one year so lost1 we are out #bb4ej4 ,in two years we have lost #dg4ej4 ,but1 what is more serious1 we have discouraged that boy4 ,used to failure in school1 his mind turns to other things4 ,he is made to think that it is useless for him to try for first place4 ,perhaps he can play ball1 and excels4 ,he chooses a career of ball playing4 ,valuable years are lost4 ,initiative and competition are not interrupted any more by free eyeglasses and free operation for adenoids than by free schooling4 ,there is only one place in the world where there is less competition or less struggle than among the ignorant1 and that is among the ignorant and unwell4 ,the boy who can't see the blackboard1 who can't learn to spell1 who can't breathe through his nose1 and can't be interested1 doesn't compete at all with the bright1 healthy boy4 ,remove the adenoids1 give glasses1 make interest possible1 and fitness to survive takes a higher level because larger numbers become fit to survive4 ,professor ,patten says that it is easier to support in the almshouse than in competitive industry a man who cannot earn more than #a4ej a day4 ,the question1 therefore1 regarding ,european remedies is not1 ,to what general theory do they belong8 but1 ,what will they accomplish8 ,how do they compare with other remedies of which we know8 ,,chapter ,,xvii ,,american ,,remedies3 ,,getting ,,things ,,done ,in ,new ,york ,city there is a committee called the ,committee on the ,physical ,welfare of ,school ,children4 ,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 welfare4 ,the following programme was adopted3 #a4 ,study of the physical welfare of school children4 a4 ,examination of board of health records of children needing medical1 dental1 or ocular care1 and better nourishment4 b4 ,home visitation of such children1 in order to ascertain whether their need arises from deficient income or from other causes4 c4 ,effort to secure proper treatment1 either from parents or from free clinics or other established agencies4 d4 ,effort to secure proper physical surroundings of children while at school--playgrounds1 baths1 etc4 #b4 ,effort to secure establishment of such a system of school records and reports as will disclose automatically significant school facts1--e4g4 regarding backward pupils1 truancy1 regularity of attendance1 registered children not attending1 sickness1 physical defects1 etc4 #c4 ,effort to utilize available information regarding school needs so as to stimulate public interest and thus aid in securing adequate appropriations to meet school needs4 ,the committee grew out of the discussion1 in the year #aije1 of the following proposition3 ,to insure a race physically able to receive our vaunted free education1 we must provide at school free meals1 free eyeglasses1 free medical and dental care4 ,thanks to the superintendent of schools of ,new ,york ,city1 to ,robert ,hunter's ,poverty1 to ,john ,spargo's ,bitter ,cry of the ,children1 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 medical1 dental1 or ocular attention1 or of better nourishment4 ,because physicians1 dentists1 oculists1 hospitals1 dispensaries1 relief agencies1 had seemingly been unconscious of this serious state of affairs1 they had no definite1 constructive remedy to propose4 ,their unpreparedness served to strengthen the arguments for the ,european method of doing things4 ,france1 ,germany1 ,italy1 ,england1 had found it necessary to do things at school4 ,arguing from their experience1 it was only a matter of time when ,american cities must follow their example4 ,why not1 therefore1 begin at once to deal radically with the situation and give school meals1 school eyeglasses1 etc48 ,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 available4 ,if doing things at school were to be adopted as a principle and logically carried out1 vast sums must be added to the present cost of the public school system4 ,complications would arise with private and parochial schools1 whose children might have quite as serious physical defects1 even though not educated by public funds4 ,it would be difficult to obtain proper rooms for medical and dental treatment and meals1 and perhaps still more difficult to insure proper food1 skilled oculists1 dentists1 surgeons1 and physicians4 ,no one was clear as to how the problem was to be solved by small cities and rural districts1 whose needy children are no less entitled to public aid simply because their numbers are smaller4 ,great as were the difficulties1 however1 the committee saw that difficulties are in themselves no reason for not doing the right thing4 ,on the other hand1 if doing things at school is wrong1 if school meals fail to correct and remove physical defects1 great social and educational wrong would result from ,new ,york's setting an example that would not only misdirect funds and attention in that city1 but would undoubtedly lead other cities to move in the wrong direction4 ,right could be hastened1 wrong could be prevented more effectually by facts than by any amount of theory4 ,school meals had been made a political issue in ,england4 ,the arguments supporting them were stronger than any possible arguments against them1 except proof that they would be less effective in helping children than other means that might be proposed4 ,if the ,american people must choose between sickly1 unteachable1 dull children without school meals1 on the one hand1 and bright1 teachable1 healthy children plus school meals1 on the other hand1 they will not hesitate because of expense or eighteenth-century objections to socialism4 ,during one year of investigation and of getting things done the committee has prepared three studies for publication3 7#a7 a report on the home conditions of fourteen hundred school children of different nationalities1 found by school physicians to have defects of vision1 breathing1 hearing1 teeth1 and nourishment2 7#b7 an examination of fifty schools--curriculum1 buildings1 home-study requirements1 play space and playtime1 physical culture--in an attempt to answer the question1 ,how far does school environment directly cause or aggravate physical defects of school children2 7#c7 a comparative study of methods now employed in a hundred cities to record1 classify1 and make public significant school facts4 ,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 food4 ,among the twenty significant facts reported by the committee are the following3 #a4 ,physical defects found in public schools are1 for the most part1 such as frequently occur in wealthy families and do not of themselves presume as the cause insufficient income4 ,of #ade reported for malnutrition1 #dd were from families having over #bj weekly4 #b4 ,few of the defects can be corrected by nourishment alone2 plenty of fresh air1 outside nourishment at school1 or extra nourishment at home will not entirely counteract the influences of bad ventilation and bad light in school buildings4 ,country children have adenoids1 bad teeth1 and malnutrition4 ,plenty of food will not prevent bad teeth and bad ventilation from causing adenoids1 enlarged tonsils1 and malnutrition4 #c4 ,children whose parents have long lived in the ,united ,states need attention quite as much as the recent immigrant4 #d4 ,a large part of the defects reported could be produced by conditions due directly to neglect of teeth4 ,from twenty such statements of fact and from its experience in getting things done for one year1 the committee drew fifteen practical conclusions1 among which the following deserve emphasis here3 #a4 ,the only new thing about the physical defects of school children is not their existence1 but our recent awakening to their existence1 their prevalence1 their seriousness if neglected1 and their cost to individual children1 to school progress1 to industry1 and to social welfare4 #b4 ,physical deterioration1 applied to ,america's school children1 is a misnomer4 ,no evidence whatever has been given that the percentage of children suffering from physical defects in #aijg is greater than the percentage of children suffering from such defects in #aheg4 ,on the contrary1 the small proportion of defects that are not easily removable1 as well as a vast amount of evidence from medical experience and vital statistics1 indicates that1 if a comparison were possible1 the children of #aijg would be found to have sounder bodies and fewer defects than their predecessors of fifty years ago4 ,if there is an exception to this statement1 it is probably defects of vision1 with regard to which school authorities and oculists seem to agree that confinement in school for longer hours and more constant application under unfavorable lighting conditions have caused a marked increase4 ,positive evidence as to tendencies will be easily obtained after thorough physical examination has been carried on for a generation4 #c4 ,the effect of massing facts as to physical defects of school children should not be to cause alarm1 but to stimulate remedial and preventive measures1 to invoke congratulations and aggressive optimism1 not doleful pessimism and palliative measures born of despair4 #d4 ,the causes of physical defects are not confined to marginal incomes1 but1 while more apt to be present in families having small incomes1 are found among all incomes wherever there exist bad ventilation1 insufficient outdoor exercise1 improper light1 irregular eating1 overeating1 improper as well as insufficient food1 lack of medical1 dental1 and ocular attention4 #e4 ,whatever may be said of free meals at school as a means of insuring punctual attendance or better attention1 they are inadequate to correct physical conditions that home and street environment produce4 #f4 ,to remove physical defects1 causal conditions among all income classes should be treated1 and not merely symptoms revealed at school by children of the so-called poor4 #g4 ,parents can and will correct the greater part of the defects discovered by the physical examination of school children1 if shown what steps to take4 ,where parents refuse to do what can be proved to be within their power1 and where existing laws are nonenforced or inadequate1 the segregation of children having physical defects in special classes might prove an effective stimulus to obstinate parents4 #h4 ,where parents are unable to pay for medical1 dental1 and ocular care and proper nourishment1 private philanthropy must either provide adequately or expect the state to step in and assume the duty4 #i4 ,private dispensaries and hospitals must either arrange themselves to treat cases and to educate communities as to the importance of detecting and correcting physical defects1 or must expect the state to provide hospital and dispensary care4 ,until private hospitals and dispensaries take steps to prevent people with adequate incomes from imposing upon them for free treatment1 it is difficult to make out a case against free eyeglasses and free meals for school children4 #aj4 ,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 needed4 #aa4 ,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 subject4 ,nothing in the world can prevent free meals1 free eyeglasses1 free medical care1 free material relief at school1 unless educational use is made by each community of the facts learned through physical examination to correct home1 school1 and street conditions that produce and aggravate physical defects4 ,the national bureau can mass information in such a way as to convince budget makers in city1 county1 and state to vote gladly the funds necessary to promote the physical welfare of school children4 ,illustration3 ,,the ,,dark-,,hall ,,evil ,,is ,,here ,,indexed ,,by ,,adenoids4 ,how the committee got things done is often referred to4 ,there is something about a request for coperation1 whether by schools or by any other agency1 that enlists the interest of those whose help is asked4 ,the reason is not that people are flattered by requests to serve on committees1 or that human nature finds it difficult to be unfriendly or unkind4 ,on the contrary1 men and women are by nature social2 there is more joy in giving than in withholding1 in working with others than in working alone4 ,men and women1 official and volunteer agencies1 will coperate with school-teachers when invited1 for the same reason and with the same readiness that ninety-nine farmers out of a hundred1 on the prairie or in the mountain1 will welcome a request for food and lodging4 ,illustration3 ,,where ,,getting ,,things ,,done ,,is ,,possible ,,but ,,doing ,,things ,,ineffective ,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 responsibility4 ,in ,new ,york ,city a woman district superintendent of schools1 ,miss ,julia ,richman1 has organized a unique social settlement4 ,she and several school-teachers occupy a house1 known as ,the ,teachers' ,house4 ,this is their residence4 ,here they are subject to neither intrusion nor importunity2 no clubs or classes are held here2 visitors are treated as guests1 not as beneficiaries4 ,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 school4 ,where clubs and social gatherings are held in school buildings1 it is not unusual for a thousand mothers1 recent immigrants1 to meet together in one hall to hear talks on the care of children4 ,thus1 instead of principals1 teachers1 and physicians taking the place of mothers 7which they nowhere have succeeded in doing71 they do succeed in harnessing mothers to the school programme4 ,it may take two1 three1 or ten visits to get a particular mother to do the necessary thing for her child1 but when once convinced and once inspired to do that thing1 she will go on day in and day out doing the right thing for that child and for all others in her home4 ,it may take a year to convert a police magistrate whose sympathy for delinquent parents and truant children is an active promoter of disorder2 but a magistrate convinced1 efficient1 and interested is worth a hundred volunteer visitors4 ,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 children4 ,,chapter ,,xviii ,,co,,peration ,,with ,,dispensaries ,,and ,,child-,,saving ,,agencies ,scientists agree that the human brain is superior to the animal brain1 not because it is heavier1 but because it is finer and better supplied with nerves4 ,as one writer has said1 the human brain is better wired1 has better organized centrals4 ,a poor system of centrals will spoil a telephone service1 no matter how many wires it provides4 ,an independent wire is of little use1 because it will not reach the person desired at the other end4 ,the ideal system is that which almost instantly connects two persons1 no matter how far away or how many other people are talking at the same time on other wires4 ,the school that tries to do everything for its pupils without using other existing agencies for helping children#aj will be like the man who refuses to connect his telephone with a central switch board1 or like a bank that will not use the central clearing house4 ,as one telephone center can enable scores of people to talk at once1 and as one clearing house can make one check pay fifty debts1 so hospital and relief agencies enable a teacher who employs central to help several times as many children as she alone can help4 ,illustration3 ,,adequate ,,relief ,,recognizes ,,the ,,family ,,as ,,the ,,unit ,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 removed4 ,in ,new ,york ,city there are over five hundred school principals1 under them are over fifteen thousand teachers1 and the average attendance of children is about six hundred thousand1 representing one hundred and fifty thousand homes4 ,if teachers give only to those children who ask for help1 many will be neglected4 ,in certain sections of the city principals have combined to establish a relief fund to be given out to children who need food1 clothes1 shoes1 etc4 ,one principal had to stop replacing stolen overcoats because1 when it was known that he had a fund1 an astonishingly large number of overcoats disappeared4 ,at ,poughkeepsie school children get up parties1 amateur vaudeville1 minstrel shows1 basket picnics1 to obtain food and clothing for children in distress4 ,they are1 of course1 unable to help parents or children not in school4 ,of this method a district superintendent in ,new ,york said to his teachers and principals3 ,for thirty-two years ,i have been working in the schools of this district4 ,i have given food and shoes to thousands of children4 ,i know that however great our interest in a particular child when it comes to us with trouble at home1 our duty as teachers prevents us from following our gift into the home and learning the cause of the child's trouble4 ,this last winter we have made an experiment in using a central society1 which makes it a business to find out what the family needs1 to supply necessaries1 country board1 medicine1 etc4 ,we now know that we can put a slip of paper with the name and address of the child into a general hopper and it will come out eyeglasses1 food1 rent1 vacation parties1 as the need may be4 ,relief at home through existing agencies was brought about by the distribution of cards like those on opposite page1 which offer winter and summer coperation4 ,illustration3 ,,fresh-,,air ,,agencies ,,like ,,sea ,,breeze ,,prefer ,,to ,,aid ,,children ,,in ,,order ,,of ,,need ,illustration3 7,facsimile of flyer for the ,new ,york ,association for ,improving the ,condition of the ,poor47 ---------------------------------------- ---------------------------- ,for ,school ,children ,compulsory education implies the ability of all families1 even the poorest1 to take advantage of school benefits4 ,this means that children should be fed properly1 clad comfortably1 and healthfully housed4 ,the ,new ,york ,association for ,improving the ,condition of the ,poor aims to coperate with school-teachers in every part of ,manhattan and ,the ,bronx to insure comfort and prevent suffering among school children1 their parents1 and younger brothers and sisters4 ,on one day last winter we received appeals from school principals and teachers in behalf of twenty-nine families4 ,within six hours every family was visited1 emergent aid in food and coal provided for many1 and orders given for shoes and dresses and coats required by the children of school age4 ,during the winter we gave not only clothing1 groceries1 food1 and rent1 but found work for older boys and parents1 taught mothers to prepare food properly1 and sent a visiting cleaner to make sick mothers comfortable and to get the children ready for school4 ,in a word1 we followed that need1 the surface evidence of which comes to the attention of the teacher1 back into the home and its conditions1 aiding throughout the period when the family was unable to do justice by the school child4 ,in many instances the home income was sufficient1 but the home management inefficient4 ,probably such homes could be more effectively benefited through educational work emanating directly from the school4 ,we can be reached by telephone 7#cdh1 #cdi1 and #ahgc ,gramercy7 from #i ,a4,m4 to #ab ,m4 ,letters or postal cards should be addressed to ,mrs4 ,h4 ,ingram1 ,superintendent1 #aje ,east #bb;d ,street4 ,reference slips will be gladly furnished upon application4 ,the ,new ,york ,association for ,improving #ahdc 99 the ,condition of the ,poor 99 #aije ,teachers of ,manhattan and ,the ,bronx ,do you know of such children as these3 #a4 ,convalescent children now out of school1 who would be benefited by a stay at the seashore in ,may or ,june8 #b4 ,children in school whose anmic condition would be greatly improved by a week at ,sea ,breeze during ,july or ,august8 #c4 ,small brothers and sisters 7and tired mothers7 who may need outings or special help8 ,the ,new ,york ,association for ,improving the ,condition of the ,poor will act promptly4 ,write or telephone 7#cdh ,gramercy74 ---------------------------------------- ---------------------------- ,when these cards were first distributed several teachers went from room to room1 asking children who needed help to raise the hand4 ,in many cases parents were very angry that their children should have asked for help4 ,but help given in instances like the following soon proved to teachers that they could afford the time necessary to notice children who appeared neglected1 when so much good would ensue3 ,the father is sick and unable to work4 ,they cannot get clothes for the children1 who are not attending school on that account4 ,children were provided with shoes and clothes4 ,november #cj1 #aijg1 a school principal reported that six children in one family needed underwear4 ,a visitor discovered that one of the boys who had the reputation of being unruly and light-fingered also had adenoids4 ,he was taken to a hospital for operation1 and was later interested in his school work4 ,a little girl was unruly and truant4 ,no attempt was made to keep her at school1 but she was reported to the ,committee on the ,physical ,welfare of ,school ,children4 ,the parents could not control her4 ,the girl was taken for examination by a specialist and found to be feeble-minded4 ,later she was sent to a custodial institute4 ,another little girl was nine years old1 but could not talk4 ,a ,university ,extension ,society worker found that she was not kept at school because it was too much trouble4 ,the child was taken to a physician who operated and corrected the tongue-tie4 ,a girl of twelve said she must stay home to help mother4 ,the mother was found to be a janitress1 temporarily incapacitated by rheumatism4 ,a substitute was provided until the mother was well1 and all the children were properly clad for school4 ,after the adenoid operations in a ,new ,york school that occasioned the ,east ,side riots of #aijf1 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 complete4 ,over forty children in three parties were sent away for the summer1 where they had wholesome food and all the milk they could drink and fresh air day and night4 ,when they returned in the fall the principal wrote3 ,the improvement in each individual is simply marvelous4 ,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 air4 ,in none of these instances could the teachers have accomplished equal results for the individual children or for the families without neglecting school duties4 ,by informing other agencies as to children's needs1 teachers started movements that have since helped practically every school child in ,new ,york ,city4 ,dispensaries are setting aside separate hours for school children2 fresh-air agencies are giving preference to children found by teachers or school physicians to be in physical need2 relief agencies are making rush orders of every note from teachers2 the health board is more active because volunteer agencies have added their voice to that of teacher and health officer in demanding adequate funds for physical examination of school children4 ,illustration3 ,,central ,,found ,,the ,,mother ,,sick ,,in ,a ,,hospital1 ,,the ,,father ,,killed--,,the ,,children ,,were ,,boarded ,,in ,,the ,,country ,,until ,,the ,,mother ,,recovered ,coperation is at present easier in ,new ,york than in any other city4 ,charitable societies1 hospitals1 dispensaries1 are probably more keenly alive to their responsibilities and are at least more apt to have acquired the habit of coperation when asked4 ,yet even here ,i have been told repeatedly by teachers3 ,if we have to wait for that hospital or that charitable society1 our children will go barefoot4 ,in small communities where hospital and relief agencies are for emergencies only and generally inactive1 it seems that the first thing to do is to ask some friends to establish a small relief fund1 just as it is easier to give a child a five-cent meal than to teach its mother how to prepare its food4 ,but the school-teacher will find that it takes very much less energy to arouse the relief society than to maintain her own relief work4 ,in fact1 in many cities nothing could do more to strengthen hospitals and charitable societies than to put them in touch with the needs of school children4 ,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 it4 ,finally1 one reason for a breakdown of charitable societies is not their own inadequacy1 but rather the failure of the school and church to make use of an agency better equipped than themselves to give material relief4 ,the teacher sees the child every day1 while the relief society will never see it and has no reason to see it until some one calls attention to it4 ,the very first step1 and an indispensable one in relief policy1 is for teachers to be on the lookout for children not adequately provided for1 and then have the physical evidence discovered at school followed to the home for the cause of the child's distress4 ,illustration3 ,,home-,,to-,,home ,,instruction ,,in ,,cooking ,anmic condition of child due to bad cooking1 not to lack of income ,coperation removes the cause of distress2 doing may aggravate it4 ,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 school4 ,on the following page is charted the social work now being conducted at the ,massachusetts ,general ,hospital1 ,boston4 ,so far as agencies exist to deal with any individual or family problem coming into the social-work square1 the hospital aims to utilize that agency4 ,its own direct dealing with neurasthenics1 with hygiene education1 with sexual deviates1 is primarily for the purpose of giving adequate treatment to the needy1 and secondarily to demonstrate how adequate treatment should be organized for the community4 ,please to note that governmental agencies are not mentioned in ,dr4 ,cabot's chart4 ,this does not mean that he would not emphasize the importance of those agencies1 but that up to the present time1 for the particular cases dealt with in his clinics1 governmental agencies can be reached most effectively through the private charitable agencies in the reference square4 ,so the teacher will frequently find that the relief bureau1 children's society1 public education association1 or church can get better results for her pupils from public health and correctional agencies than can she by writing directly4 ,illustration3 ,,chart ,,of ,,social ,,work1 ,,massachusetts ,,general ,,hospital ----------------------------------- ,work for the ,tuberculous #a4 ,tuberculosis classes #b4 ,reference to other agencies #c4 ,examination of children #d4 ,stimulation of suburbs ----------------------------------- -------------------------------- -------------------------------- ,psychiatric ,work ,work for ,hygienic ,conditions #a4 ,for neurasthenics and #a4 ,individual instruction hysterics #b4 ,convalescent homes #b4 ,for defectives #c4 ,industrial hygiene #c4 ,for stammerers #d4 ,home hygiene #d4 ,for epileptics -------------------------------- -------------------------------- _/ _/ _/ _/ _/ _/ _/ ---------- _/,,social ,,work _/ ,m4,g4,h4 _/ ---_/----- _/ _/ _/ _/ _/ _/ _/ _/ -------_/-------------------- ,references to ,other ,agencies _/#a4 ,hospitals and sanatoriums _/ #b4 ,associated charities _/ #c4 ,societies for children _/ #d4 ,district and visiting nurses _/ #e4 ,settlements _/ #f4 ,homes--temporary or not _/ _/#g4 ,employment agencies _/ _/ ------------------------------ ------------_/-----_/---- ------------------- ,ward ,work ,work for #a4 ,with cases soon to ,cases of be discharged ,varicose ,ulcer #b4 ,cases needing friendly offices -------------_/--------- -------------------- _/ -----------_/----------- ------------------------ ,work for ,assistance to ,m4,g4,h4 ,sexual ,deviates ------------------ ,financial investigation ,assistance to #a4 ,unmarried but ,other ,agencies 7a7 of ,cases asking free pregnant treatment #b4 ,diseased #a4 ,steering cases 7b7 of ,cases presumably #c4 ,exposed #b4 ,coperation able to pay a physician ----------------------- ------------------- ------------------------- ,in country districts no plan has yet been worked out for adequate relief4 ,fortunately1 however1 the distress is generally of such a kind1 and the teacher so well acquainted with all the parents of her district1 that it will not be difficult to procure such attention as is necessary4 ,country schools should be furnished by county and state superintendents with clear directions for getting the treatment afforded in the immediate vicinity4 ,where teachers are alone in seeing the need for coperation they can quickly interest young and old1 physicians1 dentists1 pastors1 health officers1 in home visiting1 street cleaning1 nursing1 helping truants1 needed changes of curriculum1 etc4 ,getting things done is easy because it is human to love the doing2 getting things done is doing of the highest order4 ,,footnotes3 #aj ,the importance of recognizing the family as the unit of social treatment is presented in ,edward ,t4 ,devine's ,principles of ,relief1 and in ,homer ,folks's ,care of ,dependent1 ,defective1 and ,delinquent ,children4 ,,chapter ,,xix ,,school ,,surgery ,,and ,,relief ,,objectionable1 ,,if ,,avoidable ,the popular arguments for free meals1 free relief1 free medical treatment at school1 are based upon the assumption that there are but two ways to travel1 one leading to a physically sound1 moral1 teachable child1 the other to an undernourished1 subnormal1 backward child4 ,they tell us we must choose either school meals or malnutrition1 school eyeglasses or defective vision1 free coal or freezing poor1 free rent or people sleeping on the streets1 free dental clinics at school or indigestion and undernourishment1 free operation at school for adenoids or backward1 discouraged pupils4 ,if there is no other alternative than neglect of the child1 if we must either waste fifty dollars in giving a child education that he is physically unable to take1 or pay two1 three1 four1 or even fifty dollars to fit him for that education1 the ,american people will not hesitate4 ,whether there are other roads to healthy children1 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 agencies1 is a question of fact1 not of theory4 ,facts prove1 as we have seen1 that there is more than one way to prevent malnutrition4 ,parents can be taught to attend to their children2 hospitals and dispensaries will furnish eyeglasses where parents are unable to pay for them2 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 alone4 ,if parents1 hospitals1 dispensaries1 and charitable societies will attend to children's needs1 then relief at school is unnecessary1 even though it may seem desirable4 ,the objection to school surgery should be clearly before us1 so that we can judge of the two methods that are open to us1--treatment at school vs4 treatment away from school4 ,society is so organized that the treatment of serious physical defects and social needs at school would upset the machinery a very great deal4 ,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 board4 ,unless schools are to equip themselves to take the place of all existing facilities for relief and surgery1 children would not be so well taken care of as at present4 ,it should not be forgotten that the physical welfare of the school child is the most accurate index to the physical needs of the community4 ,after all1 the child lives for six important years before coming to the school and leaves at the early age of fourteen or fifteen2 even while attending school it sleeps at home and is influenced more by home and street standards of ventilation1 cleanliness1 and morality than by conditions at school4 ,it would seem1 therefore1 the wider use of the school's influence to use the child's appeal to strengthen every agency having to do with community health1 rather than to concentrate upon the child himself4 ,if babies were properly cared for up to the sixth year1 the protection of the school child's health would be infinitely easier4 ,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 accomplished4 ,illustration3 ,,doing ,,things ,,through ,,model ,,tenements ,do we want to make of our schools miniature hospitals1 dispensaries1 relief bureaus1 parks8 ,or shall we use the momentum of society's interest in the school child to put within the reach of every school building adequate hospitals1 dispensaries1 relief centers1 and parks for school child and adult8 ,shall every little school have its library1 or shall the child be taught at school how to use the same library that is available to his parents and older brothers and sisters8 ,if the library is to be under the school roof1 if dispensary and relief hospital are to be conducted on the same site as the school1 shall they be known as dispensary1 library1 relief bureau1 each under separate management1 or shall they be known as school under the management of school principal and superintendent8 ,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 adopt3 ,we shall do nothing that is unnecessary or extravagant4 ,we shall have done our part if we do well what no one else can do4 ,whatever any agency can do better than we1 we shall leave to that agency4 ,work that another agency ought to have done and has left undone1 we shall try to have done by that agency4 ,illustration3 ,,immediately ,,opposite ,,the ,,model ,,tenements1 ,,but ,,uninfluenced ,getting things done by the ,tenement ,house ,department their special need ,i know a hospital where a welfare nurse was recently employed4 ,within a few blocks were three different relief agencies and two visiting-nurse's associations1 having among them over one hundred visitors and nurses going to all sections of ,manhattan4 ,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 patients1 or of going to the home herself4 ,had she chosen to use another agency1 she could have been the means of furnishing the kind of help needed in every needy home discovered in her hospital rounds1 but she chose to do the running about herself and thus of helping ten families where she ought to have helped five hundred4 ,much the same condition confronts the school that tries to do all extra work for its child instead of seeing that the work is done4 ,illustration is afforded by the ,new ,york tenement department4 ,whereas ,european cities have built a few model tenements1 ,new ,york ,city secured a law declaring that everybody who built a tenement and everybody who owned a tenement should provide sanitary surroundings4 ,at the present time a philanthropist1 by spending two million dollars1 could give sanitary surroundings to thirty-five families2 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 ,city4 ,if schools are to perform surgical operations1 they are in danger of being sued for malpractice2 discipline will be interfered with4 ,finally1 let us not forget that we are dealing with buildings1 teachers1 and school institutions as they exist4 ,where education is made compulsory1 the unpleasant and the controversial should be kept out of school4 ,because a democratic institution1 the ,american school should represent at all times a maximum of general agreement4 ,to take palliative measures to public schools not only leaves undone remedial work necessary for the health of public school children but neglects entirely the still large numbers who go to parochial1 private pay1 and private free schools2 no one has had the temerity to suggest that the public shall force upon nonpublic schools a system of free operations1 free eyeglasses1 free meals4 ,civilization has painstakingly developed a large number of agencies for the education and protection of mankind4 ,of these agencies the school is but one4 ,its first and peculiar function is to teach and to train4 ,this it can do better than any other agency or combination of agencies4 ,in attempting to bring all life under the school roof1 we use but a small part of our resources4 ,instead of persuading each of the agencies for the promotion of health to do its part for school children1 we set up the school in competition with them4 ,thus in trying to do things for school children we are in danger of crippling agencies equipped to do things for both school children and their parents1 for babies before they come to school1 and for wage earners after they leave school4 ,getting things done will lead schools to study underlying causes2 doing things has heretofore caused schools to confine themselves to symptoms4 ,getting things done will leave the school free to concentrate its attention upon school problems2 doing things will lead it afield into the problem of medicine1 surgery1 restaurant keeping1 and practical charity4 ,,chapter ,,xx ,,physical ,,examination ,,for ,,working ,,papers ,there is no sacred right to work when our work involves injury to ourselves and to our neighbor4 ,work at the expense of health is an unjustifiable tax upon the state4 ,it is the duty of society to protect itself against such depletion of national efficiency4 ,three classes of workmen need special attention3 7#a7 those who are physically unfit to work2 7#b7 those who are physically unfitted for the work they are doing2 7#c7 those who are subjected to unhealthful surroundings while at work4 ,viewing these three classes from the standpoint of their neighbors1 we have three social rights that should be enforced by law3 7#a7 the right to freedom from unhealthy work2 7#b7 the right to work fitted to the body2 7#c7 the right to healthy surroundings at work4 ,it is undoubtedly true that just as the sick child may be found at the head of his class1 so unhealthy men and women are often good business managers1 good salesmen1 good typewriters1 successful capitalists4 ,they excel1 however1 not because of their ill health1 but in spite of it1 excepting of course those instances where men and women1 because of ill health1 have devoted to business an attention that would have been given to recreation if bad health had not deprived recreation of its pleasure4 ,as statistics in school have proved that the majority of mentally superior children are also physically superior1 so statistics will probably prove that the number of the sick superior among the working classes is very small1 while the danger of inefficiency that comes from physical defect is very great4 ,there is one time in the individual's working life when the state may properly step in and demand an inventory of physical resources1 and that is when the child asks the state for permission to go to work4 ,strategically1 this is probably the most important of all contact as yet provided between society and the future wage earner4 ,here at the threshold of his industrial career the boy may be told for what work he is physically fitted1 what physical defects need to be remedied1 what physical precautions he needs to take1 in order to do justice to himself and his opportunity4 ,every year from two to three million children leave the public schools of this country to join the army of workers4 ,the percentage of those recruits who have physical defects needing attention is undoubtedly great2 how great we shall never know until the benefits of physical examination are given to all of them4 ,what steps is your state taking to ascertain the physical fitness of the children who present themselves each year for working papers8 ,how does it insure itself against the risk of their defective eyesight1 chorea1 deafness1 or general debility8 ,does it inform children of their defects1 or tell them how they may increase their earning power by correcting these defects8 ,what effort does it make to induce children to avoid dangerous trades1 or trades that are particularly dangerous for their physiques8 ,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 machinery1 to run its elevators1 to match its colors1 to sew on its buttons1 to set its type1 to carry its checks to the bank4 ,the officer at the door of the room where the children were being examined1 greeted her as follows3 ,you must bring your child with you2 bring his birth certificate or swear that he is fourteen years old1 and bring a signed statement from his teacher that he has been in school for one hundred and thirty consecutive days within twelve months4 ,is there no physical examination or test8 she asked4 ,no1 no1 he answered impatiently4 ,yet the board of health certifies that said child has in our opinion reached the normal development of a child of its age1 and is in sound health and is physically able to perform the work which it intends to do4 ,in addition the blank calls for place and date of birth1 color of hair and of eyes1 height1 weight1 and facial marks4 ,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 7#ab1 #ac1 #ad1 #ae74 ,even in ,new ,york1 however1 the center of this agitation1 no strong demand was made upon the board of health to apply a physical-fitness test as well as an age test until #aijh when examination for working papers was added to the programme for child hygiene4 ,yet who does not know girls and boys of sixteen less fit for factory or shop work than other boys and girls of twelve8 ,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 night6 ,illustration3 ,,children ,,enlisting ,,in ,,the ,,industrial ,,army ,illustration3 ,,waiting ,,to ,,be ,,examined ,,for ,,working ,,papers ,an excellent opportunity for physical-fitness tests ,so great is the risk of defective1 sickly1 or intemperate employees1 that in some trades employers take every precaution to exclude them4 ,one man with defective eyesight or unsteady nerves may cost a railroad thousands of dollars4 ,as insurance companies rank trades as first-1 second-1 or third-class risks1 so many factories1 from long experience1 debar men with certain characteristics which have been found detrimental to business4 ,the ,interborough ,rapid ,transit ,company of ,new ,york ,city examines all applicants for employment1 as to age1 weight1 height1 keenness of vision1 hearing1 color perception1 lungs1 hearts1 arteries1 alcoholism1 and nicotinism4 ,those who fall below the standard are rejected1 but in each case the physical condition is explained to the applicant4 ,where defects are removable or correctable1 the applicant is told what to do and invited to take another test after treatment4 ,moreover1 accepted employees are periodically rexamined4 ,while designed to increase company profits and to reduce company losses1 this examination obviously decreases the employees' losses also1 and increases the certainty of work and prospect of promotion4 ,our states1 and many of our industries1 still have the attitude of a certain manufacturer who employs several hundred boys and girls4 ,i asked him what tests he employed4 ,i look over a long line of the applicants and say1 pointing his finger1 ,i want you1 and you1 and you2 the rest may go4 ,i asked him if he made a point of picking out those who looked strong4 ,no4 ,the work is easy1 sitting down all day long and picking over things4 ,i select those whose faces ,i like4 ,yes1 there is one question we now ask of all the girls4 ,one day a girl in the workroom had an epileptic fit and it frightened everybody and upset the work so that the foreman always asks1 ',do you have fits8 ,because if you do1 you can't work here4' ,he makes no attempt to determine the physical fitness and endurance of the children employed1 because when the strength of one is spent there is always another to step into her place4 ,because the apprentice's future is of no value to the manufacturer1 the state must restrict the manufacturer's freedom to spend like water society's capital1--the health of the coming generation4 ,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 yearly8 ,the most effective and most timely remedy is physical examination as a condition of the work certificate4 ,a simple1 easily applied1 inexpensive measure that imposes only a legitimate restriction upon individual freedom1 it is absolutely necessary in order to get to the bottom of the child labor problem4 ,if thoroughly applied1 children of the nation will no longer be exploited by unscrupulous or indifferent employers1 nor will their health be hazarded by lack of discriminating examination that rejects the obviously sick and favors the apparently robust4 ,furthermore1 knowledge that this test will be applied when work certificates are required1 will be an incentive to the school boy and girl to keep well4 ,tell a boy that adenoids or weak lungs will keep him from getting a job1 and you will make him a strong advocate of operation and of fresh air4 ,show him that his employers will not wish his services when his week is out if he is physically below par1 and he will gladly submit to a board of health examination and ask to be told what his defects are and how to correct them4 ,illustration3 ,,children ,,at ,,work ,,below ,,both ,,age ,,limit ,,and ,,vitality ,,limit ,national ,child ,labor ,committee ,some there are who will object to this appeal to the child's economic instinct4 ,this objection does not remove the instinct4 ,the normal child is greedy for a job4 ,his greed1 as well as that of the manufacturer and parent1 is responsible for much of the child labor2 his greed for activity1 for association1 for money1 and so for work4 ,a little boy came into my office and wanted to hire as an office boy4 ,i looked at him and said3 ,my little fellow1 you ought to be in school4 ,what do you want to hire out here for8 ,he said1 ,i am tired of school2 nothing doing4 ,he doesn't care about work for its own sake2 he doesn't care about wealth for its own sake2 he wants to get into life2 to be where there is something doing4 ,in this lies one potent argument for vocational training4 ,to tell a boy of his physical needs just before he has taken his first business step is to put him everlastingly in our debt4 ,then he is responsive1 and1 fortunately for the extreme cases1 necessarily dependent1 for he knows that his refusal would stand between himself and his ambition4 ,when boys and girls go for work certificates to ,dr4 ,goler1 medical officer of health at ,rochester1 he requires not merely evidence of age and of schooling1 but examines their eyes for defective vision and for disease1 their teeth for cavities and unhealthy gums1 and their noses and throats for adenoids and enlarged tonsils4 ,if a boy has sixteen decayed teeth1 ,dr4 ,goler explains to him that teeth are meant to be not only ornaments and conveniences1 but money getters as well4 ,the boy learns that decayed teeth breed disease1 contaminate food1 interfere with digestion1 make him a disagreeable companion and a less efficient worker4 ,if he will go and have them put into proper condition he will enjoy life better and earn good wages sooner4 ,after the teeth are attended to the boy secures his work certificate4 ,if the boy's mother protests in tears or in anger that her boy does not work with his teeth1 she learns what she never learned at school1 that sound teeth help pay the rent4 ,if a girl applicant for working papers has adenoids1 she is asked to look in the mirror and to notice how her lips fail to meet1 how the lower jaw drops1 how much better she looks with her jaws and lips together4 ,she is told that other people breathe through the nose1 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 to4 ,she is shown that her nose is stopped up by a spongy substance1 as big as the end of her little finger1 which obstruction can be easily removed4 ,she is shown adenoids and enlarged tonsils that have been removed from some other girl1 and is so impressed with the before-operation and after-operation contrast and by the story of the other girl's rapid increase in wages1 that she and her mother both decide not to wait for the adenoids to disappear by absorption4 ,after the operation they come back with proof that the trouble is gone1 and get the papers4 ,similar instruction is given when defects of vision seriously interfere with a child's prospects of getting ahead in his work1 or when evidence of incipient tuberculosis makes it criminal to put a child in a store or factory4 ,illustration3 ,,the ,,grenfell ,,association ,,finds ,,mouth ,,breathers ,,at ,,work ,,in ,,labrador ,no law as yet authorizes the health officer of ,rochester to refuse work certificates to children physically unfit to become wage earners4 ,a higher law than that which any legislature can pass or revoke1 has given ,dr4 ,goler power over children and parents1 namely1 interest in children and knowledge of the industrial handicap that results from physical defects4 ,this higher law authorizes every health officer in the ,united ,states to examine the school child before issuing a work certificate1 to tell the child and his parents what defects need to be removed1 for what trades he is physically unfitted1 what trades will not increase his physical weakness1 and to what trade he is physically adapted4 ,we should not forget that a large proportion of our children never apply for work certificates2 some because they never intend to work2 some because they expect to remain in school until sixteen or later2 some because they live on farms1 in small towns1 or in cities and states where prohibition of child labor is not enforced4 ,because there is no reason for this large proportion of children to visit a board of health1 some substitute must be found4 ,this substitute has been already suggested by principals and district superintendents in ,new ,york ,city1 who claim that the natural place for the examination of children is the school and not health headquarters4 ,developing the idea that the school should pronounce the child's fitness to leave school and to engage in work1 we are led to the suggestion that the state1 which compels evidence that every child1 rich or poor1 is being taught during the compulsory school age1 shall also at the age of fourteen or sixteen require evidence that the child is physically fit to use his education1 and that it shall not1 because of preventable ill health1 prove a losing investment4 ,parochial and private schools1 the ultra-religious and ultra-rich1 may resent for a time public supervision of the physical condition of children who do not ask for work certificates4 ,this position will be short-lived1 because however much we may disagree about society's right to control a child's act after his physical defects are discovered1 few of us will question the state's duty to tell that child and his parents the truth about his physical needs before it accepts his labor or permits him to go to college1 to come out1 to enter society1 or to live on an income provided by others4 ,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 schools4 ,illustration3 ,,the ,,health ,,department',s ,,clinical ,,care ,,and ,,home ,,instruction ,,come ,,after ,,wage ,,losses1 ,,while ,,work ,,certificates ,,precede ,,breakdowns ,,from ,,tuberculosis ,a brief test of this method of helping children1 such as is now being made by several boards of health at the instance of the ,national ,bureau of ,labor1 will prove conclusively that parents are grateful for the timely discovery of these defects which handicap because of their existence1 not because of their discovery4 ,of the cadets preparing for war at ,west ,point1 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 academy4 ,shall not cadets preparing for an industrial life and citizenship be given at least a knowledge of an adequate physical standard8 ,to allow the school child to deteriorate whether before or after going to work is only to waste potential citizenship4 ,citizens who use themselves up in the mere getting of a living have no surplus strength or interest for overcoming incompetence in civic business1 or for achieving the highest aim of citizenship1--the art of self-government for the benefit of all the governed4 ,,chapter ,,xxi ,,periodical ,,physical ,,examination ,,after ,,school ,,age ,governor ,hughes1 in his address to the students in ,gettysburg ,college1 pleaded for such lives that strength would be left for the years of achievement4 ,how many men and women can you count who are squandering their health bank account8 ,how many do you know who are now physically bankrupt8 ,the man who is prodigal of his health may work along all right for years1 never realizing until the test comes that he is running behind in his vitality4 ,the test may be hard times1 promotion1 exposure to cold1 heat1 fever1 or a sudden call for all his control in avoiding accident4 ,if his vitality fails to stand the test1 his career may be ruined1 all for the want of a horseshoe nail3 because of no health bank account to draw upon in time of need1--failure2 because of vitality depleted by alcohol1 tobacco1 overeating1 underexercise1 or too little sleep1--no power to resist contagious diseases2 because of ignorance of existing lung trouble1--a year or more of idleness1 perhaps poverty for his family2 or there is neglected ear or eye trouble1--and thousands of lives may be lost because the engineer failed to read the signals4 ,adults are now examined when applying for insurance or accident policies1 for work on railroads1 for service in the army and on the police and fire forces of cities that provide pensions4 ,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 business reasons4 ,generations hence the state will probably require of every person periodic physical examination after school age4 ,decades hence business enterprises will undoubtedly require evidence of health and vitality from employees before and during employment1 just as schools will require such evidence from teachers4 ,it is1 after all1 but a step from the police passport to the health passport4 ,why should we not protect ourselves against enemies to health and efficiency as well as against enemies to order8 ,but for the present we must rely upon the intelligence of individuals to recognize the advantage to themselves1 their families1 and their employers1 of knowing that their bodies do not harbor hidden enemies of vitality and efficiency4 ,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 community4 ,illustration3 ,,the ,,old ,,southfield1 ,,now ,,anchored ,,at ,,bellevue ,,hospital',s ,,dock1 ,,new ,,york ,,city1 ,,gives ,,daily ,,lessons ,,in ,,the ,,preventable ,,tax ,,levied ,,by ,,tuberculosis ,ignorance of one's physical condition is a luxury no one can afford4 ,no society is rich enough to afford members ignorant of physical weaknesses prejudicial to others' health and efficiency4 ,every one of us1 even though to all appearances physically normal1 needs the biological engineer4 ,new conditions come upon us with terrific rapidity4 ,the rush of work1 noise1 dust1 heat1 and overcrowding of modern industry make it important to have positive evidence that we have successfully adapted ourselves to these new conditions4 ,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 condition4 ,as labor becomes more and more highly specialized1 the body of the laborer is forced to readapt itself4 ,the kind of work a man does determines which organs shall claim more than their share of blood and energy4 ,the man who sets type develops keenness of vision and manual dexterity4 ,the stoker develops the muscles of his arms and back1 the engineer alertness of eye and ear4 ,all sorts of devices have been invented to aid this specialization of particular organs1 as well as to correct their imperfections3 the magnifying glass1 the telescope1 the microscope1 extend the powers of the eye2 the spectacle or an operation on the eye muscles enables the defective eye to do normal work4 ,a man with astigmatism might be a policeman all his life1 win promotion1 and die ignorant of his defect2 whereas if the same man had become a chauffeur1 he might have killed himself and his employer the first year1 or1 if an accountant1 he might have been a chronic dyspeptic from long-continued eye strain4 ,it is a soul tragedy for a man to attempt a career for which he is physically unadapted4#aa ,it is a social tragedy when men and women squander their health4 ,a great deal of the success attributed to luck and opportunity1 or unusual mental endowment1 is in reality due to a chance compatibility of work with physique4 ,to secure such compatibility is the purpose of physical examination after school age4 ,if the periodic visit to the doctor is the first law of adult health1 still more imperative is the law that competent physicians should be seen at the first indication of ill health4 ,even when competent physicians are at hand1 parents and teachers should be taught what warning signs may mean and what steps should be taken4 ,in ,germany insurance companies find that it saves money to provide free medical and dental care for the insured4 ,department stores1 many factories and railroads1 have learned from experience that they save money by inducing their employees to consult skilled physicians at the first sign of physical disorder4 ,many colleges1 schools1 and homes have a resident physician4 ,wherever any large number of people are assembled together1--in a hotel1 factory1 store1 ship1 college1 or school1--there should be an efficient consulting physician at hand4 ,if people are needlessly alarmed1 it is of the utmost importance to show them that there is nothing seriously wrong4 ,therefore visits to the consulting physician should be encouraged4 ,the reader's observation will suggest numerous illustrations of pain1 prolonged sickness1 loss of life1 that could have been prevented had the physician been semi-annually visited4 ,a strong man1 well educated1 with large income1 personally acquainted with several of the foremost physicians of ,new ,york ,city1 after suffering two weeks from pains that would pass away1 was hurriedly taken to a hospital at three o'clock in the morning1 operated upon immediately1 and died at nine4 ,a business man of means put off going to a physician for fifteen years1 for fear he would be told that his throat trouble was tobacco cancer1 or incipient tuberculosis1 or asthma2 a physical examination showed that a difficulty of breathing and chronic throat trouble were due to a growth in the nose1 corrected in a few minutes by operation4 ,a celebrated economist was forced to give up academic work1 and consecrated his life to painful and chronic dyspepsia because of eye trouble detected upon the first physical examination4 ,a woman secretary suffered from alleged heart trouble2 paralysis threatened1 continuous headache and blurred vision forced her to give up work and income2 a physical examination found the cause in nasal growths1 whose removal restored normal conditions4 ,a woman lecturer on children's health heard described last summer a friend's experience with receding gums3 ',why1 ,i never heard of that disease4' she said4 ',don't you know you have it yourself'8 ,i asked4 ,she had never noticed that her gums were growing away in little points on her front teeth4 ,i touched the uncovered portion and she winced4 ,that ignorance has meant intense pain and ugly fillings4 ,if it had gone longer1 it might have meant the loss of her front teeth4 ,a teacher lost a month from nervous prostration2 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 vacation4 ,a journalist lost weeks each year because of strained ankles2 since being told that he had flat foot1 and that the arch of his foot could be strengthened by braces and specially made shoes1 he has not lost a minute4 ,a relief visitor1 ardent advocate of the fresh-air1 pure-milk treatment for tuberculosis1 had a little cough and an occasional cold sweat2 medical friends knew this1 but humored her aversion to examination2 when too late1 she submitted to an examination and to the treatment which1 if taken earlier1 would most certainly have cured her4 ,a mother's sickness cost a wage-earning daughter nearly #cjjj2 softening of the brain was feared2 after six years of suffering and unnecessary expense1 physical examination disclosed an easily removable cause1 and for two years she has contributed to the family income instead of exhausting it4 ,untold suffering is saved many a mother by knowledge of her special physical need in advance of her baby's birth4 ,untold suffering might be saved many a woman in business if she could be told in what respects she was transgressing ,nature's law4 ,illustration3 ,,new ,,york ,,city',s ,,tuberculosis ,,sanatorium ,,at ,,otisville ,,is ,,sending ,,home ,,apostles ,,of ,,semi-,,annual ,,examinations ,illustration3 ,,boston',s ,,picturesque ,,day ,,camp ,,for ,,tuberculosis ,,patients ,,is ,,teaching ,,the ,,need ,,for ,a ,,periodic ,,inventory ,,of ,,physical ,,resources ,to encourage periodic physical examination is not to encourage morbid thinking of disease4 ,one reason for our tardiness in recognizing the need for thorough physical examination is the doctor's tradition of treating symptoms4 ,after men and women are intelligent enough to demand an inventory of their physical resources1--a balance sheet of their physical assets and liabilities1--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 worries4 ,by removing the mystery of bodily ailments and by familiarizing ourselves with the essentials to healthy living1 we find protection against charlatans1 quacks1 faddists1 and experimenters4 ,by taking a periodic inventory of our physical resources we discharge a sacred obligation of citizenship4 ,,footnotes3 #aa ,see ,dangerous ,trades1 compiled by ,thomas ,oliver2 also list of reports by the ,united ,states ,bureau of ,labor4 ,,chapter ,,xxii ,,habits ,,of ,,health ,,promote ,,industrial ,,efficiency ,education's highest aim is to train us to do the right thing at the right moment without having to think4 ,the technic of musician1 stenographer1 artist1 electrician1 surgeon1 orator1 is gained only from patient training of the body's reflex muscles to do brain work4#ab ,the lower nerve centers are storehouses for the brain energy1 just as central power houses are used for storing electric energy to be spent upon demand4 ,from habit1 not from mental effort1 we turn to the right1 say ,i beg pardon when we step on another's foot1 give our seats to ladies or to elderly persons1 use acceptable table manners4 ,no person seems to the manner born who has to think out each act necessary to company manners4 ,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 society4 ,the habit of living ethically enables us to go through life without being tempted to steal or lie or do physical violence4 ,no person's morals can be relied upon who is tempted constantly to do immoral acts2 ethical training seeks to incapacitate us for committing unethical deeds and to habituate us to ethical acts alone4 ,eight different elements of industrial efficiency are concerned with the individual's health habits1--the industrial worker1 his industrial product1 his employer1 his employer's profit1 his trade or profession1 its product1 his nation1 national product4 ,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 efficiency4 ,once convinced1 however1 that all of these elements are either helped or injured by the individual's method of living1 each one of us has a strong reason for imposing habits of health upon all industries1 upon employees and operatives1 upon all who are a part of industrial efficiency4 ,when these eight relations are seen1 parents and teachers have particularly strong reasons for inculcating habits of health in their children4 ,that industrial inefficiency results from chronic habits of unhealthy living is generally recognized4 ,the alcoholic furnishes the most vivid illustration4 ,the penalties suffered by him and his family are grave enough1 but because he has not full possession of his faculties he is unpunctual1 wastes material1 disobeys instructions1 endangers others' lives1 decreases the product of his trade and of his employer1 lessens the profits of both1 depresses wages1 increases insurance and business risks4 ,because no one can foresee when the drop too much will be taken1 industry finds it important to know that the habit of drinking alcoholics moderately has not been acquired by train dispatcher1 engineer1 switchman1 chauffeur4 ,because the habit of drinking moderately is apt1 among lower incomes1 to go hand in hand with other habits injurious to business and fatal to integrity1 positions of trust in industry seek men and women who have the habit of declining drink4 ,in the aggregate1 milder forms of unhealthy living interfere with industrial efficiency even more than alcoholism4 ,many capable men and women1 even those who have had thorough technical training1 fail to win promotion because their persons are not clean1 their breath offensive1 their clothes suggestive of disorderly1 uncleanly habits4 ,persons of extraordinary capacity not infrequently achieve only mediocre results because they fail to cultivate habits of cleanliness and health4 ,an employer can easily protect his business from loss due to alcoholism among his own employees2 but loss through employees' constipation1 headache1 bad ventilation at home1 irregular meals1 improper diet1 too many night parties1 nicotinism1 personal uncleanliness1 is loss much harder to anticipate and avoid4 ,because evil results are less vivid1 it is also hard to convince a clerk that intemperance in eating1 sleeping1 and playing will interfere with his earning capacity and his enjoyment capacity quite as surely as intemperance in the use of alcohol and nicotine4 ,where employees are paid by the piece1 instead of by the hour1 day1 or week1 the employer partially protects himself against uneven1 sluggish1 slipshod workmen2 but1 other things being equal1 he awards promotion to those who are most regular and who are most often at their best1 for he finds that the man who does not slump earns best profits and deserves highest pay4 ,illustration3 ,,these ,,patients ,,on ,,the ,,old ,,southfield ,,are ,,taxing ,,their ,,unions ,,and ,,their ,,trades ,,as ,,well ,,as ,,their ,,families ,,and ,,the ,,tuberculosis ,,committee ,there are exceptions1 it is true1 where both industrial promotion and industrial efficiency are won by people who violate laws of health1--but at what cost to their efficiency8 ,your efficiency should be measured not by some other person's advancement1 but by what you yourself ought to accomplish2 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 labor1 but by the decrease of national and trade efficiency4 ,sweating injures those who buy and those in the same trade who are not sweated just as truly as it injures the sweated4 ,illustration3 ,,habits ,,of ,,health ,,among ,,dairymen ,,mean ,,safe ,,milk ,,for ,,babies ,what are the health habits that should become instinctive and effortless for every worker8 ,what acts can we make our lower nerve centers--our subconscious selves--do for us or remind us to do8 ,the following constitutes a daily routine that should be as involuntary as the process of digestion3 #a4 ,throw the bedding over the foot of the bed4 #b4 ,close the window that has been open during the night4 #c4 ,drink a glass of water4 #d4 ,bathe the face1 neck1 crotch1 chest1 armpits 7finishing if not beginning with cold water71 and particularly the eyes1 ears1 and nose4 ,if time and conveniences permit1 bathe all over4 #e4 ,cleanse the finger nails4 #f4 ,cleanse the teeth1 especially the places that are out of sight and hard to reach4 #g4 ,breakfast punctually at a regular hour4 ,eat lightly and only what agrees with you4 ,if you read a morning paper1 be interested in news items that have to do with personal and community vitality4 #h4 ,visit the toilet2 if impracticable at home1 have a regular time at business4 #i4 ,have several minutes in the open air1 preferably walking4 #aj4 ,be punctual at work4 #aa4 ,as your right by contract1 insist upon a supply of fresh air for your workroom with the same emphasis you use in demanding sufficient heat in zero weather4 #ab4 ,eat punctually at noon intermission2 enjoy your meal and its after effects4 #ac4 ,breathe air out of doors a few minutes1 preferably walking4 #ad4 ,resume business punctually4 #ae4 ,stop work regularly4 #af4 ,take out-of-door exercise--indoor only when fresh air is possible--that you enjoy and that agrees with you4 #ag4 ,be regular1 temperate1 and leisurely in eating the evening meal2 eat nothing that disagrees with you4 #ah4 ,spend the evening profitably and pleasantly and in ways compatible with the foregoing habits4 #ai4 ,retire regularly at a fixed hour1 making up for irregularity by an earlier hour next night4 #bj1 #ba1 #bb4 ,repeat #d1 #f1 #h4 #bc4 ,turn underclothes wrong side out for ventilation4 #bd4 ,open windows4 #be4 ,relax mind and body and go to sleep4 ,no man chronically neglects any one of the above rules without reducing his industrial efficiency4 ,no man chronically neglects all of them without becoming1 sooner or later1 a health bankrupt4 ,in addition to this daily routine1 there are certain other acts that should become habitual3 #a4 ,bathing less frequently than once a week is almost as dangerous to health as it is to attractiveness4 #b4 ,distaste for unclean linen or undergarments and for acts or foods that interfere with vitality should become instinctive4 #c4 ,excesses in eating or playing should be automatically corrected the next day and the next4 ,parties we shall continue to have4 ,it will be some time before reasonable hours and reasonable refreshments will prevail4 ,meanwhile it is probably better for an individual to sacrifice somewhat his own vitality for the sake of the union1 the class1 or the church4 ,while trying to improve group habits1 one can acquire the habit of not eating three meals in one1 of eating less next day1 of sleeping longer next night1 of being particularly careful to have plenty of outdoor air4 #d4 ,visits to the dentist twice a year at least1 and whenever a cavity appears1 even if only a week after the dentist has failed to find one2 whenever the gums begin to recede2 and whenever anything seems to be wrong with the teeth4 #e4 ,periodic physical examination by a physician4 #f4 ,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 routine4 ,health habits do not become instinctive until a continued1 conscious effort is made to accustom the body to them4 ,when this is once done1 however1 the body not only attends to its primary health needs automatically1 but it rebels at their omission1 as surely as does the stomach at the omission of dinner4 ,witness the discomfort of the consumptive1 trained to fresh air at a sanatorium1 when he returns to his overheated and underventilated home1 or the actual pain experienced in readjusting our own healthy bodies to the stuffy workroom or schoolroom after a summer vacation out of doors4 ,i heard a consumptive say that he left a sanatorium for a day class after trying for three nights to sleep in an unventilated ward4 ,for many people the regular morning bath is at first a trial1 then a pleasure1 and finally a need2 if omitted1 the body feels thirsty and dissatisfied1 the eyes sleepy1 and the spirit flags early in the day4 ,illustration3 ,,improvised ,,seaside ,,hospital ,,for ,,nonpulmonary ,,tuberculosis ,,at ,,sea ,,breeze ,,teaches ,,passers-,,by ,,the ,,fresh-,,air ,,gospel ,cold baths are not essential or even good for everybody4 ,the same diet or the same amount of food or time for eating is not of equal value for all4 ,the temperature of bath water1 the kind and quality of food1 are influenced by one's work and one's cook4 ,set rules about these things do more harm than good4 ,such questions must be decided for each individual1--by his experience or by the advice of a physician1--but they must be decided and the decisions converted into health habits if he would attain the highest efficiency of which he is capable4 ,here again our old contrast between doing things and getting things done applies4 ,get your body to attend to the essential needs for you1 and get it to remind you when you let the exigencies of life interfere4 ,don't burden your mind every day with work that your body will do for you if properly trained4 ,illustration3 ,,crippled ,,children ,,leaving ,,sea ,,breeze ,,hospital ,,for ,,bone ,,tuberculosis ,,find ,,stale ,,air ,,offensive ,,by ,,night ,,or ,,by ,,day ,obstacles to habits of health are numerous2 therefore the importance of correcting those habits of factory1 family1 trade1 city1 or nation that make health habits impracticable4 ,we must change others' prejudices before we can breathe clean air on street cars without riding outside4 ,when one's co-workers are afraid of fresh air1 ventilation of shop1 store1 and office is impossible4 ,so long as parents fear night air1 children cannot follow advice to sleep with windows open4 ,unless the family coperates in making definite plans for the use of toilet and bath for each member1 constipation and bad circulation are sure to result4 ,indigestion is inevitable if employees are not given lunch periods and closing hours that permit of regular1 unhurried meals4 ,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 baths4 ,a temperate subsistence on adulterated1 poisonous1 or drugged foods might be better for one's health than gormandizing on pure foods4 ,no recipe has ever been found for bringing up a healthy baby on unclean1 infected milk2 for avoiding tuberculosis among people who are compelled to work with careless consumptives in unclean air2 or for making a five-story leap as safe as a fire escape4 ,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 city1 county1 state1 and national authorities4 ,illustration3 ,,at ,,junior ,,sea ,,breeze1 ,,teaching ,,mothers ,,the ,,health ,,routine ,,for ,,babies ,the municipalization or public subsidy of health habits is indispensable to protecting industrial efficiency4 ,public lavatories1 above or below ground1 have done much to reduce inefficiency due to alcoholism1 constipation of the bowels1 and congestion of the kidneys4 ,theaters1 churches1 and assembly rooms could be built so as to drill audiences in habits of health instead of fixing habits of uncleanly breathing4 ,street flushing1 drinking fountains1 parks and breathing spaces1 playgrounds and outdoor gymnasiums1 milk1 food1 and drug inspection1 tenement1 factory1 and shop supervision1 enforcement of anti-spitting penalties1 restriction of hours of labor1 prohibition of child labor1--these inculcate community habits of health that promote community efficiency4 ,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 habits1 so far as the evils of neglect become apparent to health authorities4 ,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 health1 and the industrial and community losses that result from habits of unhealthy living4 ,,footnotes3 #ab ,serviceable guides to personal habits of health are ,aristocracy of ,health by ,mary ,foote ,henderson1 and ,efficient ,life by ,dr4 ,luther ,h4 ,gulick4 ,,chapter ,,xxiii ,,industrial ,,hygiene ,to call the movement for better factory conditions the humanizing of industry implies that modern industry not influenced by that movement is brutalized4 ,the brutalizing of industry was due chiefly to a general ignorance of health laws1--an ignorance that registers itself clearly and promptly in factory and mine4 ,it is not that a man is expected to do too much1 but that too little is expected of the human body4 ,the present recognition of the body's right to vitality is not because the employer's heart is growing warmer1 or because competition is less vicious1 but because the precepts of hygiene are found to be practical4 ,where better ventilation used to mean more windows and repair bills1 it now means greater output4 ,where formerly a comfortable place in which to eat lunch meant giving up a workroom and its profits1 it now means #be per cent more work done in all workrooms during the afternoon4 ,the general enlightenment as to industrial hygiene has been accelerated by the awakening that always follows industrial catastrophes1 by the splendid crusade against tuberculosis1 and by compulsory notification and treatment of communicable diseases4 ,catastrophes1 however1 have dominated the vocabulary that describes factory welfare work4 ,because accidents such as gas in mines1 fire in factories1 fever in towns1 and epidemics of diseases incident to certain trades were beyond the power of the workers themselves to control or prevent1 wage earners have come to be looked upon as helpless victims of the cupidity and inhumanity of their employers4 ,this attitude has weakened the usefulness of many bodies organized to promote industrial hygiene4 ,although the term industrial hygiene is broad enough to include all sanitary and hygienic conditions that surround the worker while at work1 it is restricted by some to the efforts made by altruistic or farsighted employers in the interest of employees2 others think of prohibitions and mandates1 in the name of the state1 that either prevent certain evils or compel certain benefits2 for too few it refers to what the wage earner does for himself4 ,pity for the employee has caused the motive power of the employee to be wastefully allowed to atrophy4 ,yet when a man becomes an employee1 he does not forfeit any right of citizenship1 nor does being an employee relieve him from the duties of citizenship4 ,in too many cases it has been overlooked that a worker's carelessness about habits of health1 as well as about his machinery1 causes accidents and increases industrial diseases4 ,too often the worker himself is responsible for uncleanliness and lack of ventilation and his own consequent lack of vitality4 ,a study into the conditions of ventilation and cleanliness of workers' homes will prove this4 ,knowing that a light1 well-aired1 clean1 safe factory would not of itself insure healthy men1 many employers have built and supplied houses for their workmen at low rents4 ,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 hygiene1 so the employee has failed to see that he is a part of the public that passes laws and determines the efficiency of factory inspection4 ,the enforcement of state legislation for working hours1 proper water and milk supply1 proper teaching of children1 proper tenement conditions1 efficient health administration1 is dependent upon the interest and activity of the public1 of which the working class is no small or uninfluential part4 ,illustration3 ,,country ,,club ,,house ,,for ,,new ,,york ,,social ,,workers ,given by the founder of ,caroline ,rest ,educational ,fund ,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 them4 ,men still throw out their chests when talking of their rights4 ,the posting of the game laws in a club last summer1 and the instruction of all the natives of the countryside in regard to their rights as against those of outsiders1 meant that for the first time in their history the game laws were enforced4 ,all the natives1 instead of poaching as has been their wont1 joined together in protecting club property from intruding outside sportsmen4 ,poachers were caught and served with the full penalties of the law4 ,over winter fires these people's heroism will grow1 but their respect for law will grow also1 and it is doubtful if the game laws can be violated in that section so long as the tradition of this summer's work lives4 ,and so it would be in a factory1 if employees once realized that by uniting they could1 as citizens1 enforce health rights in the factory4 ,the hygiene of the workshop is not the same problem as the hygiene of the home and schoolhouse1 because there are by-products of factory work that contaminate the air1 overheat the room1 and complicate the ordinary problems of ventilation4 ,certain trades are recognized as dangerous trades4 ,the problem of adequate government control of factories is one for a sanitary engineer4 ,it has to do with disease-bearing raw material that comes to a factory1 disease-producing processes of manufacture4 ,there is need for revision of the dangerous-trade list4 ,many of the industries not so classed should be2 many of the so-called dangerous trades can be made comparatively harmless by devices for exhausting harmful by-products4 ,industrial diseases should be made notifiable1 so that they can be controlled by the factory or health department4 ,it is those trades that are dangerous because of remediable unsanitary and unhygienic conditions which demand the employer's attention4 ,complaints should be made by individuals when carelessness or danger becomes commonplace4 ,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 children4 ,here1 as there1 is the difference between doing things and getting things done4 ,here more than there is the tendency to exaggerate legislation and to neglect enforcement of law4 ,instead of harnessing the whole army of workingmen to the crusade and strengthening civic agencies such as factory1 health1 and tenement departments1 houses are built and given to men1 clubs are formed to amuse factory girls1 amateur theatricals are organized4 ,all this is called welfare work4 ,what is welfare work8 reads the pamphlet of a large national association4 ,it is especial consideration on the part of the employer for the welfare of his employees4 ,in the words of this pamphlet1 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 progress4 ,the membership is drawn from practical men of affairs1 whose acknowledged leadership in thought and business makes them typical representatives of business elements that voluntarily work together for the general good4 ,as defined by this organization1 welfare work is something given to the employee by the employer for the welfare of both4 ,it is not something the employee himself does to improve his own working conditions4 ,we are told that employees should assume the management of welfare work4 ,should they install sanitary conveniences8 ,of course not4 ,would they know the need of a wash room in a factory if they never had had one8 ,no4 ,should they manage lunch rooms8 ,a few employers have attempted unsuccessfully to turn over the management of the lunch rooms to the employees1 the result being that one self-sacrificing subofficial in each concern would find the burden entirely on his shoulders before working hours1 during working hours1 and after working hours4 ,employees cannot attend committee meetings during working hours1 and they are unwilling to do so afterwards1 for they generally have outside engagements4 ,furthermore1 the employees know nothing about the restaurant business4 ,if they did1 they would probably be engaged in it instead of in their different trades4 ,all experiments along this line of which we have heard have failed4 ,the so-called democratic idea1 purely a fad1 never has been successfully operated4 ,many employers would introduce welfare work into their establishments were it not for the time and trouble needed for its organization4 ,the employment of a welfare director removes this obstacle4 ,successful prosecution of welfare work requires concentration of responsibility4 ,all of its branches must be under the supervision of one person1 or efforts in different directions may conflict1 or special and perhaps pressing needs may escape attention4 ,pressure of daily business routine usually relegates welfare work to the last consideration1 but the average employer is interested in his men and is willing to improve their condition if only their needs are brought to his attention4 ,illustration3 ,,first ,,lessons ,,in ,,industrial ,,hygiene ---------------------------------------- ---------------------------- ,consumption ,is chiefly caused by the ,filthy ,habit of ,,spitting ,,take ,,this ,,card ,,home ,and show it to your family1 friends1 and neighbors ,consumption is a disease of the lungs1 which is taken from others1 and is not simply caused by colds1 although a cold may make it easier to take the disease4 ,the matter coughed up and sneezed out by consumptives is full of living germs or tubercle bacilli too small to be seen4 ,these germs are the cause of consumption1 and when they are breathed into the lungs they set up the disease4 ,,don',t ,,get ,,consumption ,,yourself ,keep as well as possible1 for the healthier your body1 the harder for the germs of consumption to gain a foothold4 ,every person should observe the following rules3 ,,don',t live1 study1 or sleep in rooms where there is no fresh air4 ,fresh air and sunlight kill the consumption germs and other germs causing other diseases2 therefore have as much of both in your room as possible4 ,,don',t live in dusty air2 keep rooms clean2 get rid of dust by cleaning with damp cloths and mops4 ,,don',t sweep with a dry broom4 ,,keep one window partly open in your bedroom at night1 and air the room two or three times a day4 ,,don',t eat with soiled hands4 ,wash them first4 ,,don',t put hands or pencils in the mouth1 or any candy or chewing gum other persons have used4 ,,don',t keep soiled handkerchiefs in your pockets4 ,,take a warm bath at least once a week4 ,,don',t neglect a cold or a cough1 but go to a doctor or dispensary4 ---------------------------------------- ---------------------------- ,illustration3 ,,welfare ,,work ,,that ,,counts ---------------------------------------- --------------------------- ,,how ,,to ,,get ,,well ,,if ,,you ,,have ,,consumption ,if you or any one in your family have consumption1 you must obey the following rules if you wish to get well3 ,,don',t waste your money on patent medicines or advertised cures for consumption1 but go to a doctor or dispensary 7see last page74 ,if you go in time1 you can be cured2 if you wait1 it may be too late4 ,,don',t drink whisky or other forms of liquor4 ,,don',t sleep in the same bed with any one else1 and1 if possible1 not in the same room4 ,good food1 fresh air1 and rest are the best cures4 ,keep out in the fresh air and in the sunlight as much as possible4 ,,keep your windows open winter and summer1 day and night4 ,,if properly wrapped up you will not catch cold4 ,,go to a sanatorium while you can and before it is too late4 ,the careful and clean consumptive is not dangerous to those with whom he lives and works4 ,don't give consumption to others4 ,many grown people and children have consumption without knowing it1 and can give it to others4 ,therefore every person1 even if healthy1 should observe the following rules3 ,,don',t ,,spit on the sidewalks1 playgrounds1 or on the floors or hallways of your home or school4 ,it spreads disease1 and is dangerous1 indecent1 and unlawful4 ,,when ,,you ,,must ,,spit1 spit in the gutters or into a spittoon half filled with water4 ,,don',t ,,cough ,,or ,,sneeze without holding a handkerchief or your hand over your mouth or nose4 ---------------------------------------- --------------------------- _/ ,this method of promoting the welfare of the worker may have been a necessary step in the development of industrial hygiene4 ,undoubtedly it has succeeded1 in many cases1 in bringing to an employer's consciousness the needs of his workmen1 in accustoming employees to higher sanitary standards1 and in teaching them to demand health rights from their employers4 ,in many cases1 however1 welfare work has miseducated both employer and employee4 ,the fact that the so-called democratic idea1 purely a fad1 has never been successfully operated1 is due to the interpretation given to democratic idea4 ,the two alternatives in the paragraph above quoted are lunch rooms1 wash rooms1 as gifts from employers to employees1 or lunch rooms and wash rooms to be furnished by employees at their own expense4 ,the true democratic idea1 however1 is that factory conditions detrimental to health shall be prohibited by factory legislation1 and this legislation enforced by efficient factory inspectors1 regardless of what may be given to employees above the requirement of hygiene4 ,until employees are more active as citizens and more sensitive to hygienic rights1 it is desirable that welfare directors be employed in factories to arbitrate between employer and employee1 to raise the moral standard of a factory settlement1 to organize amusements4 ,welfare work at its best is a method of dividing business profits among all who participate in making these profits4 ,too often welfare secretaries teach employees how to be happy in the director's way1 rather than in their own way4 ,this adventitious position increases suspicion on both sides1 disturbs the discipline of the foreman1 weakens rather than strengthens the worker's efficiency1 because it depends upon other things than work well done and the relation of health to efficiency4 ,in a small factory town the owner of a large cotton mill has recognized the financial benefit of physically strong workers1 and is trying the experiment of a welfare director4 ,the man himself works with his sleeves up4 ,the social worker has an office in the factory4 ,a clubhouse is fitted up for the mill hands to make merry in4 ,a room in the factory is reserved for a lunch room1 with plants1 tables1 and chairs for the comfort of the women4 ,parties are given by the employer to the employees1 which he himself attends4 ,he has thrown himself into whatever schemes his director has suggested4 ,the director complained that the reason the new lunch room was not more popular was because a piano was needed4 ,a second-hand one would not do1 for that would cultivate bad taste in music4 ,this showed the employer that soon everything would be expected from the big house on the hill4 ,an event which happened at the time when the pressure was greatest on him for the piano1 convinced him that his employees could supply their real needs without any trouble or delay4 ,the assistant manager was about to leave1 and in less than a week five hundred dollars was raised among the workers for his farewell gift4 ,walking home that night late from his office the owner was attracted by the sound of jollity1 and saw a little room jammed full of mill people enjoying the improvised music of a mouth organ played to the accompaniment of heels4 ,he resolved henceforth to train his employees to do his work well and to earn more pay1--and to let them amuse themselves4 ,from that time on he refused to be looked upon as the deus ex machina of the town4 ,he decided that the best way to give ,english lessons to foreigners was to improve the school4 ,his beneficence in supplying them with pure water at the mill did not prevent a ravaging typhoid epidemic because the town water was not watched4 ,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 rights4 ,emergency hospitals and ,y4,m4,c4,a4 buildings are sad substitutes for safety devices and automatic couplers4 ,christmas shopping in ,november is less kind than prevention of overwork in ,december4 ,night school and gymnastic classes are a poor penance for child labor and for work unsuited to the body4 ,the left hand cannot dole favors enough to offset the evils of underpay1 of unsanitary conditions1 of inefficient enforcement of health laws tolerated by the right hand4 ,just because a man is taking wages for work done1 is no reason why he should forfeit his rights as a citizen1 or allow his children1 sisters1 neighbors1 to work in conditions which decrease their efficiency and earning power4 ,what the employee can do for himself as a citizen1 having equal health rights with employers1 he has never been taught to see4 ,factory legislation is state direction of industries so far as relates to the safety1 health1 and moral condition of the people1--and which embraces to-day1 more than in any other epoch1 the opinion of the workers themselves4 ,no government1 however strong1 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 necessary4 ,until schools insist upon a better ventilation than the worst factories1 how can we expect to find children of working age sensitive to impure air8 ,where work benches are more comfortable than school desks1 where drinking water is cleaner and towels more sanitary1 however unsanitary they may be1 than those found in the schoolhouse1 the worker does not realize that they menace his right to earn a living wage as much as does a temporary shut-down4 ,employers are by no means solely to blame for unhealthy working conditions4 ,a shortsighted employee is as anxious to work overtime for double pay as a shortsighted employer is to have him4 ,among those who are agitating for an eight-hour day are many who1 from self-interest or interest in the cause1 work regularly from ten to sixteen hours4 ,would it help to punish employees for working in unhealthy places8 ,the highest service that can be rendered industrial hygiene is to educate the industrial classes to recognize hygienic evils and to coperate with other citizens in securing the enforcement of health rights4 ,,chapter ,,xxiv ,,the ,,last ,,days ,,of ,,tuberculosis ,if the historian ,lecky was right in saying that the greatest triumphs of the nineteenth century were its sanitary achievements1 the ,lecky of the twenty-first century will probably honor our generation not for its electricity1 its trusts1 and its scientific research1 but for its crusade against the white plague and for its recognition of health rights4 ,thanks to committees for the prevention of tuberculosis1--local1 state1 national1 international1--we are fast approaching the time when every parent1 teacher1 employer1 landlord1 worker1 will see in tuberculosis a personal enemy1--a menace to his fireside1 his income1 and his freedom4 ,just as this nation could not exist half slave1 half free1 we of one mind now affirm that equal opportunity cannot exist where one death in ten is from a single preventable disease4#ac ,of no obstacle to efficient living is it more true than of tuberculosis1 that the remedy depends upon enforcing rather than upon making law1 upon practice rather than upon precept1 upon health habits rather than upon medical remedies1 upon coperation of lay citizens rather than upon medical science or isolated individual effort4 ,without learning another fact about tuberculosis1 we can stamp it out if we will but apply1 and see that officers of health apply1 lessons of cleanliness and natural living already known to us4 ,illustration3 ,,dr4 ,,trudeau',s ,,little ,,red ,,cottage ,,at ,,saranac--,,birthplace ,,of ,,out-,,of-,,door ,,treatment ,,in ,,america ,perhaps the most striking results yet obtained in combating tuberculosis are those of the ,massachusetts ,general ,hospital in ,boston4 ,to visit its tuberculosis classes reminds one more of the sociable than the clinic4 ,in fact1 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 cures4 ,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 week4 ,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 minutes4 ,it was then suggested that twenty hours a day would be enough for any one to stay out of doors1 and that plenty of time should be taken for meals with the family and for cold baths1 keeping clean1 etc4 ,interesting facts gathered by personal interviews of two physicians with individual patients are explained to the whole class4 ,next to the number of hours out of doors1 the most interesting fact is the number of hours of exercise permitted4 ,a man of forty1 the head of a family1 beamed like a school child when told that1 after nearly a year of absolute rest1 he might during the next week exercise ten minutes a day4 ,a graduate drops in1 the very picture of health1 weighing two hundred pounds4 ,an apparently hopeless case would brighten up and have confidence when told that this strong1 handsome man has gained fifty pounds by rest1 good cheer1 fresh air1 all on his own porch4 ,one young man1 just back from a ,california sanatorium where he progressively lost strength in spite of change of climate1 is now returning to work and is back at normal weight4 ,illustration3 ,,outdoor ,,life ,,chart4 ,illustration3 ,,fighting ,,tuberculosis ,,in ,,the ,,mountains--,,saranac ,every patient keeps a daily record1 called for by the following instructions3 ,make notes of temperature and pulse at #h1 #ab1 #d1 and #h o'clock1 daily2 movements of bowels2 hours in open air2 all food taken2 total amount of milk2 total amount of oil and butter2 appetite2 digestion2 spirits2 cough 7amount1 chief time72 expectoration 7amount in #bd hours1 color1 nature72 exercise 7if allowed71 with temperature and pulse #ae minutes after exercise2 sweats2 visitors4 ,the following simple instructions can be followed in any home1 even where open windows must take the place of porches3 ,rest out of doors is the medicine that cures consumption4 ,absolute rest for mind and body brings speedy improvement4 ,it stops the cough and promotes the appetite4 ,the lungs heal more quickly when the body is at rest4 ,lie with the chest low1 so the blood flow in the lungs will aid to the uttermost the work of healing4 ,the rest habit is soon acquired4 ,each day of rest makes the next day of rest easier1 and shortens the time necessary to regain health4 ,the more time spent in bed out of doors the better4 ,do not dress if the temperature is above #ii degrees1 or if there is blood in the sputum4 ,it is life in the open air1 not exercise1 that brings health and strength4 ,just a few minutes daily exercise during the active stage of the disease may delay recovery weeks or months4 ,rest favors digestion1 exercise frequently disturbs digestion4 ,when possible have meals served in bed4 ,never think the rest treatment can be taken in a rocking-chair4 ,if tired of the cot1 shift to the reclining chair1 but sit with head low and feet elevated4 ,do not write letters4 ,dictate to a friend4 ,do not read much and do not hold heavy books4 ,while reading remain in the recumbent posture4 ,illustration3 ,,fighting ,,tuberculosis ,,in ,,day ,,camps--,,boston ,once having learned the simple facts that must be noted and the simple laws that must be followed1 once having placed oneself in a position to secure the rest1 the fresh air1 and the health diet1 no better next steps can be taken than to observe the closing injunction in the rules for rest3 ,there are few medicines better than clouds1 and you have not to swallow them or wear them as plasters1--only to watch them4 ,keeping your eyes aloft1 your thoughts will shortly clamber after them1 or1 if they don't do that1 the sun gets into them1 and the bad ones go a-dozing like bats and owls4 ,illustration3 ,,the ,,back ,,of ,a ,,street-,,car ,,transfer1 ,,sundays1 ,,new ,,york ,,city ---------------------------------------- ---------------------------- ,,consumption ,,in ,,early ,,stages ,,can ,,be ,,cured ,take your case in time to a good physician or to a dispensary and you may be cured--,,do ,,not ,,wait4 ,consumption is caught mainly through the spit of consumptives4 ,friends of ,consumption--,dampness1 ,dirt1 ,darkness1 ,drink4 ,enemies of ,consumption--,sun1 ,air1 ,good ,food1 ,cleanliness4 ,if you have tuberculosis do not give it to others by spitting2 even if you have not1 set a good example by refraining from a habit always dirty and often dangerous4 ,the ,committee on the ,prevention of ,tuberculosis ,of the ,charity ,organization ,society 7,by ,courtesy of ,siegel ,cooper ,co47 ---------------------------------------- ---------------------------- ,important as are sanatoriums in mountain and desert1 day or night camps within and near cities1 milk and egg clinics1 home visiting1 change of air and rest for those who are known to be tuberculous1 their importance is infinitesimal compared with the protection that comes from clean1 healthy environment and natural living for those not known to be tuberculous4 ,this great fact has been recognized by the various bodies now engaged in popularizing the truth about tuberculosis by means of stationary and traveling exhibits1 illustrated lectures1 street-car transfers1 advertisements1 farmers' institutes1 anti-spitting signs in public vehicles and public buildings1 board of health instructions in many languages1 magazine stories1 and press reports of conferences4 ,this brilliant campaign of education shows what can be done by national1 state1 and county superintendents of schools1 if they will make the most of school hygiene and civics4 ,illustration3 ,,an ,,example ,,in ,,co,,peration ,,that ,,anti-,,tuberculosis ,,crusaders ,,should ,,follow ---------------------------------------- --------------------------- ,,circular ,,issued ,,by ,the ,committee of ,sanitation of the ,central ,federated ,union of ,new ,york ,the ,committee on the ,prevention of ,tuberculosis of the ,charity ,organization ,society #aje ,east #bb;d ,street1 ,new ,york ,city 99 99 99 99 99 ,don't ,give ,consumption to ,others ,don't ,let ,others ,give ,it to ,you 99 99 99 99 99 ,how to ,prevent ,consumption ,the spit and the small particles coughed up and sneezed out by consumptives1 and by many who do not know that they have consumption1 are full of living germs too small to be seen4 ,,these ,,germs ,,are ,,the ,,cause ,,of ,,consumption4 ,,don',t ,,spit on the sidewalks--it spreads disease1 and it is against the law4 ,,don',t ,,spit on the floors of your rooms or hallways4 ,,don',t ,,spit on the floors of your shop4 ,,when ,,you ,,spit1 spit in the gutters or into a spittoon4 ,have your own spittoons half full of water1 and clean them out at least once a day with hot water4 ,,don',t cough without holding a handkerchief or your hand over your mouth4 ,,don',t live in rooms where there is no fresh air4 ,,don',t work in rooms where there is no fresh air4 ,,don',t sleep in rooms where there is no fresh air4 ,keep at least one window open in your bedroom day and night4 ,fresh air helps to kill the consumption germ4 ,fresh air helps to keep you strong and healthy4 ,,don',t eat with soiled hands--wash them first4 ,,don',t ,,neglect ,a ,,cold or a cough4 ,how to ,cure ,consumption ,,don',t ,,waste ,,your ,,money on patent medicines or advertised cures for consumption1 but go to a doctor or a dispensary4 ,if you go in time ,,you ,,can ,,be ,,cured2 if you wait until you are so sick that you cannot work any longer1 or until you are very weak1 it may be too late2 at any rate it will in the end mean more time out of work and more wages lost than if you had taken care of yourself at the start4 ,,don',t ,,drink ,,whisky1 beer1 or other intoxicating drinks2 they will do you no good1 but will make it harder for you to get well4 ,,don',t ,,sleep ,,in ,,the ,,same ,,bed with any one else1 and1 if possible1 not in the same room4 ,,good ,,food1 ,,fresh ,,air1 ,,and ,,rest are the best cures4 ,keep in the sunshine as much as possible1 and ,,keep ,,your ,,windows ,,open1 winter and summer1 night and day4 ,fresh air1 night and day1 is good for you4 ,,go ,,to ,a ,,hospital ,,while ,,you ,,can ,,and ,,before ,,it ,,is ,,too ,,late4 ,there you can get the best treatment1 all the rest1 all the fresh air1 and all the food which you need4 ,,the ,,careful ,,and ,,clean ,,consumptive ,,is ,,not ,,dangerous ,,to ,,those ,,with ,,whom ,,he ,,lives ,,and ,,works ---------------------------------------- --------------------------- ,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 hospitals8 ,most of the local secretaries are men whose inspiration came from contact with the non-medical relief of the poor in city tenements4 ,the secretary of the national association is a university professor of anthropology1 who has also a medical degree4 ,the child victim's plea--,little ,jo's ,smile--was nationalized by an association of laymen1 aided by the advertising managers of forty magazines4 ,the smaller cities of ,new ,york state are being aroused by a state voluntary association that for years has visited almshouses1 insane asylums1 and hospitals4 ,these facts ,i emphasize1 for they illustrate the opportunity and the duty of the lay educator1 whether parent1 teacher1 labor leader1 or trustee of hospital1 orphanage1 or relief society4 ,three fundamental rules of action should be established as firmly as religious principles3 #a4 ,the public health authorities should be told of every known and every suspected case of tuberculosis4 #b4 ,for each case proved by examination of sputum to be tuberculous1 the public-health officers should know that the germs are destroyed before being allowed to contaminate air or food4 #c4 ,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 vacuum4 ,illustration3 ,,fighting ,,tuberculosis ,,with ,a ,,national ,,organization ,all laws1 customs1 and environmental conditions opposed to the enforcement of these three principles must be modified or abolished4 ,if the teachers of ,america will list for educational use in their own communities the local obstacles to these rules of action1 they will see exactly where their local problem lies4 ,the illustrations that are given in this book show in how many ways these rules of action are now being universalized4 ,three or four important steps deserve especial comment3 #a4 ,compulsory notification of all tuberculous cases4 #b4 ,compulsory removal to hospital of those not able at home to destroy the bacilli1 or compulsory supervision of home care4 #c4 ,examination of all members of a family where one member is discovered to be tuberculous4 #d4 ,special provision for tuberculous teachers4 #e4 ,protection of children about to enter industry but predisposed to tuberculosis4 #f4 ,prohibition of dry cleaning of schools1 offices1 and streets4 #g4 ,tax provision for educational and preventive work4 ,compulsory notification was introduced first in ,new ,york ,city by ,hermann ,m4 ,biggs1 ,m4,d41 chief medical officer3 #ahic1 partially voluntary1 partially compulsory2 #ahig1 compulsory for all4 ,physicians who now hail ,dr4 ,biggs as a statesman called him persecutor1 autocrat1 and violator of personal freedom fifteen years ago4 ,foreign sanitarians vied with ,american colleagues in upbraiding him for his exaggeration of the transmissibility of consumption and for his injustice to its victims4 ,as late as #ahii one ,british expert particularly resented the rejection of tuberculous immigrants at ,ellis ,island1 and said to me1 ,perhaps if you should open a man's mouth and pour in tubercle bacilli he might get phthisis1 but compulsory notification is preposterous4 ,in #aijf 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 borders2 in #aijf more than twenty thousand individual cases were reported1 ten thousand of these being reported more than once4 ,to know the nature and location of twenty thousand germ factories is a long step toward judging their strength and their probable product4 ,to compulsory notification in ,new ,york ,city is largely due the educational movements of the last decade against the white plague1 more particularly the growing ability among physicians to recognize and to treat conditions predisposing to the disease4 ,as in ,new ,york ,city1 the public should provide free of cost bacteriological analysis of sputum to learn positively whether tuberculosis is present4 ,simpler still is the tuberculin test of the eyes1 with which experiments are now being made on a large scale in ,new ,york ,city1 and which bids fair to become cheap enough to be generally used wherever physical examinations are made4 ,this test is known as ,calmette's ,eye ,test4 ,inside the eyelid is placed a drop of a solution--#ie per cent alcohol and tuberculin4 ,if conjunctivitis develops in twenty-four hours1 the patient is proved to have tuberculosis4 ,some physicians still fear to use this test4 ,others question its proof4 ,the skin test is also being thoroughly tried in several ,american cities and1 if finally found trustworthy1 will greatly simplify examination for tuberculosis4 ,dr4 ,john ,w4 ,brannan1 president of ,bellevue and ,allied ,hospitals1 ,new ,york ,city1 is to report on skin and eye tuberculin tests for children at the ,international ,congress on ,tuberculosis1 mentioned later4 ,illustration3 ,,fighting ,,tuberculosis ,,by ,,organized ,,co,,perative ,,dispensary ,,work ,illustration3 ,,fighting ,,bone ,,tuberculosis ,,at ,,sea ,,breeze1 ,,where ,,eye ,,and ,,skin ,,tuberculin ,,tests ,,are ,,being ,,made ,compulsory removal of careless consumptives is yet rare4 ,one obstacle is the lack of hospitals4 ,in ,new ,york ten thousand die annually from tuberculosis and fifty thousand are known to have it1 yet there are only about two thousand beds available4 ,so long as the patients anxious for hospital care exceed the number of beds1 it does not seem fair to give a bed to some one who does not want it4 ,on the other hand1 it should not be forgotten that patients are taken forcibly to smallpox and scarlet-fever hospitals1 not for their own good1 but for the protection of others4 ,the last person who should be permitted to stay at home is the tuberculous person who is unable1 unwilling1 or too ignorant to take the necessary precautions for others' protection4 ,a rigid educational test should be applied as a condition of remaining at home without supervision4 ,the objections to compulsory removal are two3 7#a7 it is desired to make sanatorium care so attractive that patients will go at the earliest stage of the disease2 7#b7 an unwilling patient can defeat the sanitarian's effort to help him and others4 ,the alternative for compulsory removal is gratuitous1 and1 if need be1 compulsory1 supervision of home care1 such as is now given in ,new ,york ,city4 ,in ,brighton1 ,england1 ,dr4 ,newsholme treats his municipal sanatorium as a vacation school1 giving each patient one month only4 ,thus one bed helps twelve patients each year4 ,almost any worker can spare one month and in that time can be made into a missionary of healthy living4 ,family examining parties were begun in ,new ,york by ,dr4 ,linsly ,r4 ,williams1 for the relief agency that started the seaside treatment of bone tuberculosis4 ,many of the crippled children at ,sea ,breeze were found to have consumptive fathers or mothers4 ,in one instance the father had died before ,charlie had hip trouble4 ,long after we had known ,charlie his mother began to fail4 ,she too had consumption4 ,family parties were planned for #bij families4 ,weights were taken and careful examination made1 the physician explaining that predisposition means defective lung capacity or deficient vitality4 ,of #cgi members1 supposedly free from tuberculosis1 sixteen were found to have well-marked cases4 7,of twenty ,boston children whose parents were in a tuberculosis class1 four had tuberculosis47 ,in one instance the father was astonished to learn not only that he was tuberculous1 but that he had probably given the disease to the mother1 for whom he was tenderly concerned4 ,of special benefit were the talks about teeth and nourishment1 and about fresh air and water as germ killers4 ,one examination of this kind will organize a family crusade against carelessness4 ,illustration3 ,,fighting ,,tuberculosis ,,in ,,small ,,cities ,new ,york ,state ,charities ,aid ,association ,tuberculous teachers ought to be excluded from schoolrooms not merely because they may spread tuberculosis1 but because they cannot do justice to school work without sacrifices that society ought not to accept4 ,a tuberculous teacher ought to be generous enough to permit public hospitals to restore her strength or enterprising enough to join tuberculosis classes4 ,it is selfish to demand independence at the price which is paid by schools that employ tuberculous teachers4 ,illustration3 ,,fighting ,,bone ,,tuberculosis ,,with ,,salt ,,water ,,and ,,salt ,,air ,predisposition to tuberculosis should be understood by every child before he is accepted as an industrial soldier4 ,many trades now dangerous would be made safe if workers knew the risk they run1 and if society forbade such trades needlessly to exhaust their employees4 ,a perfectly sound man is predisposed to tuberculosis if he elects to work in stale1 dust-laden air4 ,ill-ventilated rooms1 cramped positions1 lack of exercise in the open air1 prepare lungs to give a cordial reception to tubercle bacilli4 ,rooms as well as persons become infected4 ,fortunately1 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 vitality4 ,destruction of germs in the air1 in carpets1 on walls1 on streets1 is quite as important as destruction of germs in lungs4 ,why should not tenants and workers require health certificates stating that neither house nor working place is infected with tubercle bacilli8 ,some cities now compel the disinfection of premises occupied by tuberculous persons after their removal4 ,landlords1 employers1 tenants1 and employees can easily be taught to see the advantage of disinfecting premises occupied by tuberculous cases before detection4 ,illustration3 ,,fighting ,,feather ,,dusters ,,is ,,one ,,object ,,of ,,sea-,,air ,,hospitals ,,for ,,bone ,,tuberculosis ,dry cleaning1 feather dusters1 dust-laden air1 will disappear from schoolrooms within twenty-four hours after school-teachers declare that they shall disappear4 ,we have no right to expect street cleaners1 tenement and shop janitors1 or overworked mothers to be more careful than school-teachers4 ,last year ,i said to a janitress1 ,don't you realize that you may get consumption if you use that feather duster8 ,her reply caused us to realize our carelessness3 ,i don't want any more than ,i've got now4 ,shall we some day have compulsory examination and instruction of all cleaners1 starting with school cleaners8 ,illustration3 ,,fighting ,,tuberculosis ,,in ,,open ,,tents ,taxing is swift to follow teaching in matters of health4 ,teachers can easily compute what their community loses from tuberculosis4 ,the totals will for some time prove a convincing argument for cleanliness of air1 of body1 and of building wherever the community is responsible for air1 building1 and body4 ,the annual cost of tuberculosis to ,new ,york ,city is estimated at #bc1jjj1jjj and to the ,united ,states at #ccj1jjj1jjj4 ,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 year1 and whose habits they can determine4 ,the first meeting in ,america of the ,international ,congress on ,tuberculosis was held at ,washington1 ,d4,c41 ,september #ba to ,october #ab1 #aijh4 ,for many years the proceedings of this congress will undoubtedly be the chief reference book on the conquest of tuberculosis4#ad ,how many aspects there are to this problem1 and how many kinds of people may be enlisted1 may be seen from the seven section names3 ,i4 ,pathology and ,bacteriology2 ,,ii4 ,sanatoriums1 ,hospitals1 and ,dispensaries2 ,,iii4 ,surgery and ,orthopedics2 ,,iv4 ,tuberculosis in ,children--,etiology1 ,prevention1 and ,treatment2 ,v4 ,hygienic1 ,social1 ,industrial1 and ,economic ,aspects2 ,,vi4 ,state and ,municipal ,control of ,tuberculosis2 ,,vii4 ,tuberculosis in ,animals and ,its ,relation to ,man4 ,illustration3 ,,fighting ,,tuberculosis ,,in ,,cheap ,,shacks1 #abe ,,per ,,bed1 ,,otisville1 ,,new ,,york ,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 ,v4 ,these topics suggest an interesting and instructive year's study for clubs of women1 mothers1 or teachers1 or for advanced pupils4 ,i4 ,,economic ,,aspects ,,of ,,tuberculosis #a4 ,the burdens entailed by tuberculosis3 a4 ,on individuals and families4 b4 ,on the medical profession4 c4 ,on industry4 d4 ,on relief agencies4 e4 ,on the community4 f4 ,on social progress4 #b4 ,the cost of securing effective control of tuberculosis3 a4 ,in large cities4 b4 ,in smaller towns4 c4 ,in rural communities4 ,,ii4 ,,adverse ,,industrial ,,conditions #a4 ,incidence of tuberculosis according to occupation4 #b4 ,overwork and nervous strain as factors in tuberculosis4 #c4 ,effect of improvements in factory conditions on the health of employees4 #d4 ,legitimate exercise of police power in protecting the life and health of employees4 ,,iii4 ,,the ,,social ,,control ,,of ,,tuberculosis #a4 ,outline of a comprehensive programme for3 a4 ,national1 state1 and municipal governments4 b4 ,departments of health and departments of public relief4 c4 ,private endowments4 d4 ,voluntary associations for educational propaganda4 e4 ,institutions1 such as schools and relief agencies1 which exist primarily for other purposes4 #b4 ,a symposium on the relative value of each of the features in an aggressive campaign against tuberculosis3 a4 ,compulsory registration4 b4 ,free sputum examination4 c4 ,compulsory removal of unteachable and dangerous cases4 d4 ,laboratory research4 e4 ,hospital4 f4 ,sanatorium4 g4 ,dispensary4 h4 ,the tuberculosis class4 i4 ,day camp4 j4 ,private physician4 k4 ,visiting nurse4 l4 ,after-care of arrested cases4 m4 ,relief fund4 n4 ,climate4 o4 ,hygienic instruction1--personal and in class4 p4 ,inspection of schools and factories4 q4 ,educational propaganda4 ,,iv4 ,,early ,,recognition ,,and ,,prevention #a4 ,importance of discovering the persons who have tuberculosis before the disease has passed the incipient stage4 #b4 ,examination of persons known to have been exposed or presumably predisposed4 #c4 ,systematic examination of school children during their course and on leaving school to go to work4 #d4 ,professional advice as to choice of occupation in cases where there is apparent predisposition to disease4 ,v4 ,,after-,,care ,,of ,,arrested ,,cases #a4 ,instruction in healthful trades in the sanatorium4 #b4 ,training for professional nursing in institutions for the care of tuberculous patients4 #c4 ,farm colonies4 #d4 ,convalescent homes or cottages4 #e4 ,aid in securing suitable employment on leaving the sanatorium4 #f4 ,how to deal with the danger of a return to unfavorable home conditions4 ,,vi4 ,,educational ,,methods ,,and ,,agencies #a4 ,special literature for general distribution4 #b4 ,exhibits and lectures4 #c4 ,the press4 #d4 ,educational work of the nurse4 #e4 ,labor organizations4 #f4 ,instruction in schools of all grades4 #g4 ,presentation and discussion of leaflets awarded prizes by the congress4 ,,vii4 ,,promotion ,,of ,,immunity #a4 ,development of the conception of physical well-being4 #b4 ,measures for increasing resistance to disease3 a4 ,parks and playgrounds4 b4 ,outdoor sports4 c4 ,physical education4 d4 ,raising the standards of living3 housing1 diet1 cleanliness4 #c4 ,individual immunity and social conditions favorable to general immunity4 ,,viii4 ,,responsibility ,,of ,,society ,,for ,,tuberculosis #a4 ,a symposium of representative a4 ,citizens4 b4 ,social workers4 c4 ,employers4 d4 ,employees4 e4 ,physicians4 f4 ,nurses4 g4 ,educators4 h4 ,others4 ,cash prizes of one thousand dollars each are offered3 7#a7 for the best evidence of effective work in the prevention or relief of tuberculosis by any voluntary association since #aije2 7#b7 for the best exhibit of a sanatorium for working classes2 7#c7 for the best exhibit of a furnished home for the poor1 designed primarily to prevent1 but also to permit the cure of tuberculosis4 ,illustration3 ,,boston ,,fights ,,tuberculosis ,,with ,a ,,comprehensive ,,plan ,a-,d1 ,f1 ,h-,j1 private hospitals and agencies reporting cases to the official center2 ,e1 home care2 ,k1 ,l1 ,m1 day camp and hospitals for incipient and advanced cases ,a white-plague scrapbook containing news items1 articles1 and photographs will prove an interesting aid to self-education or to instruction of children1 working girls' clubs1 or mothers' meetings4 ,everybody ought to enlist in this war1 for the fight against tuberculosis is a fight for cleanliness and for vitality1 for a fair chance against environmental conditions prejudicial to efficient citizenship4 ,so sure is the result and so immediate the duty of every citizen that ,dr4 ,biggs wrote in #aijg3 ,in no other direction can such large results be achieved so certainly and at such relatively small cost4 ,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 interests4 ,,footnotes3 #ac ,the best literature on tuberculosis is in current magazines and reports of anti-tuberculosis crusaders4 ,for a scientific1 comprehensive treatment1 libraries and students should have ,the ,prevention of ,tuberculosis 7#aijh7 by ,arthur ,newsholme1 ,m4,d4 ,a popular book is ,the ,crusade against ,tuberculosis1 by ,lawrence ,f4 ,flick1 of the ,henry ,phipps ,institute for the ,study1 ,treatment1 and ,prevention of ,tuberculosis4 #ad ,those desiring copies this year or hereafter will do well to write to ,the ,national ,association for the ,study and ,prevention of ,tuberculosis1 #aje ,east #bb;d ,st41 ,new ,york ,city4 ,the congress is under the control of the ,national ,association and is managed by a special committee appointed by it4 ,even after a national board of health is established1 the ,national ,association for the ,study and ,prevention of ,tuberculosis will continue to be a center for private interest in public protection against tuberculosis4 ,one of its chief functions is the preparation and distribution of literature to those who desire it4 ,,chapter ,,xxv ,,the ,,fight ,,for ,,clean ,,milk ,with the approval of the ,president and with the coperation of the ,department of ,agriculture1#ae 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 health4 ,this promise of the ,united ,states ,treasury insures national attention to the evils of unclean milk and to the sanitary standards of farmer and consumer4 ,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 babies4 ,when two national bureaus study1 learn1 and report1 newspapers will print their stories on the first page1 magazines will herald the conclusions1 physicians will open their minds to new truths1 state health secretaries will carry on the propaganda1 demagogues and quacks will become less certain of their short-cut remedies1 and everybody will be made to think4 ,the evolution of this newly awakened national interest in clean milk follows the seven stages and illustrates the seven health motives presented in ,chapter ,,ii4 ,i give the story of ,robert ,m4 ,hartley because he began and prosecuted his pure-milk crusade in a way that can be duplicated in any country town or small city4 ,robert ,m4 ,hartley was a strong-bodied1 strong-minded1 country-bred man1 who started church work in ,new ,york ,city almost as soon as he arrived4 ,he distributed religious tracts among the alleys and hovels that characterized lower ,new ,york in #ahbe4 ,meeting drunken men and women one after another1 he first wondered whether they were helped by tracts1 and then decided that the mind befogged with alcohol was unfit to receive the gospel message4 ,then for fifteen years he threw himself into a total-abstinence crusade1 distributing thousands of pamphlets1 calling in one year at over four thousand homes to teach the industrial and moral reasons for total abstinence4 ,finally1 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-control4 ,so in #ahdc he organized the ,new ,york ,association for ,improving the ,condition of the ,poor1 which ever since has remembered how ,hartley found alcoholism back of irreligion1 and how back of alcoholism and poverty and ignorant indifference he found indecent housing1 unsanitary streets1 unwholesome working conditions1 and impure food4 ,illustration3 ,,fighting ,,infant ,,mortality ,,by ,a ,,school ,,for ,,mothers ,,in ,,the ,,heart ,,of ,,new ,,york ,,city1--,,junior ,,sea ,,breeze ,illustration3 ,,providing ,,against ,,germ ,,growth ,,and ,,adapting ,,milk ,,to ,,the ,,individual ,,baby',s ,,need1--,,rochester',s ,,model ,,dairy ,hartley's instinct started the first great pure-milk agitation in this country4 ,while visiting a distillery for the purpose of trying to persuade the owner to invest his money in another business1 he noticed that slops smoking hot from the stills were being carried to cow stables4 ,he followed and was nauseated by the sights and odors4 ,several hundred uncleaned cows in low1 suffocating1 filthy stables were being fed on this disgusting1 unnatural food4 ,similar disgust has in many other ,american cities caused the first effort to better dairy conditions4 ,hartley could never again enjoy milk from distillery cows4 ,furthermore1 his story of #ahda made it impossible for any readers of newspapers in ,new ,york to enjoy milk until assured that it was not produced by distillery slops4 ,the instinctive loathing and the discomfort of buyers awakened the commerce motives of milk dealers1 who covered their wagons with signs declaring that they no longer or never fed cows on distillery refuse4 ,but ,hartley could not stop when the anti-nuisance stage was reached4 ,he did not let up on his fight against impure or adulterated milk until the state legislature declared in #ahfd that every baby1 city born or country born1 no matter how humble its home1 has the right to pure milk4 ---------------------------------------- --------------------------- ,clean ,milk for ,new ,york ,city ,,conference ,,room #dd1 ,n4,y4 ,,academy ,,of ,,medicine ,no4 #ag ,,west #dc;,d ,,street ,november #bjth1 #aijf1 ,tuesday #c p4m4 and #h p4m4 ,,essential ,,facts ,,as ,,to ,,new ,,york ,,city ,manhattan's ,infant ,mortality 7,,under #e ,,yrs47 ,june to ,september1 #aijd1 #ddbh ,june to ,september1 #aije1 #dfhg ,june to ,september1 #aijf1 #ddbh ,daily ,consumption of ,milk #a1fjj1jjj qts4 in quart bottles in #dj-quart cans ,certified1 #aj1jjj quarts ,inspected1 #c1jjj quarts #bd to #dh hours old on arrival ,comes from #cj1jjj dairies1 #dj to #djj miles distant #fjj creameries--#aje proprietors #aj city railroad depots ,sold in #ab1jjj places1 mostly from cans ,sale of skim milk prohibited ,milk ,law ,violations1 #aije ,destroyed1 #ci1fah quarts ,arrests1 #hjf ,fines1 #af1dce ,new ,york ,city ,inspectors #ad in country since ,july2 might make rounds not oftener than once a year 7,for #c yrs4 before1 only #b2 previously none7 #af in city1 might make rounds in #cj to #dj days 7,before ,july1 #ad7 ,,points ,,of ,,agreement ,cleanliness is the supreme requisite1 from cow to consumer ,cows must be healthy1 persons free from contagious diseases1 premises clean1 water pure1 utensils clean1 cans and bottles sterile1 shops sanitary ,temperature is second essential #ej ,f4 or lower at dairy #de ,f4 at creamery #de ,f4 or less during transportation ,not above #ej when sold to the consumer ,as to ,pasteurization ,not necessary for absolutely clean milk ,destroys benign as well as harmful germs ,disease germs develop more rapidly than in pure raw milk ,true1 #aee for #cj minutes to #afg for #bj minutes ,cost per quart1 estimated1 to ct4 ,commercial1 #afe for #ae seconds ,cost per quart1 negligible ,as to ,inspection ,some inspection needed within the city ,some inspection needed of dairy and creamery ,,what ,,next ,,steps ,,should ,,new ,,york ,,take8 ,skim ,milk ,should its sale be permitted8 ,under what conditions8 ,how would this affect price of whole milk8 ,pasteurization ,should pasteurization be made compulsory8 ,for what portion of the supply8 ,at whose expense8 ,would it increase price of milk8 ,does it render inspection unnecessary8 ,does it reduce need for inspection8 ,should sale of repasteurized milk or cream be permitted8 ,should bottles show whether true or commercial pasteurization is used8 ,infants' ,milk ,depots ,should they use pasteurized or clean milk8 ,are municipal depots desirable8 ,should private philanthropy support depots8 ,how many depots would be required in ,new ,york ,city8 ,is ,rochester experience applicable to ,new ,york ,city8 ,what educational work is possible in connection with milk depots8 ,model ,milk ,shops ,what may safely be sold in connection with milk8 ,should law discourage other than model shops8 ,are present sanitary laws rigid enough8 ,should private capital be encouraged to establish shops8 ,is it practicable to prohibit use of cans8 ,what provision can be demanded for proper refrigeration8 ,what for receiving milk before business hours when delivered from stations8 ,what for sterilization of utensils and bottles8 ,what for attendants' dress and care of person8 ,would such restrictions increase price8 ,inspection ,is it practicable by inspection alone to secure a clean milk supply8 ,will it protect against more dangerous forms of infection8 ,how many inspectors does ,new ,york ,city need8 ,within the city8 ,among country dairies and creameries8 ,how many inspectors should the state employ8 ,legislation ,what needed as to diseased cattle8 ,what as to diseases of persons producing or handling milk8 ,is present sanitary code sufficient8 ,shall law require sterilization of all milk cans and bottles by milk company or creamery before returned to farms or refilled8 ,shall sealing cans at creameries be required8 ,shall transferring from one can to another or from can to bottle in open street be made a misdemeanor8 ,shall pollution of milk cans and bottles be made a misdemeanor8 ,shall bacterial standard be established8 ,is state supervision now adequate8 ,what further legislation is needed8 ,does present law prescribe adequate penalties8 ,education ,should state system of lectures before agricultural institutes be extended8 ,should ,maryland plan of traveling school be adopted as means of reaching producer8 ,what can be done to assist ,teachers ,college in its plan for milk exhibit8 ,what can be done to teach mothers to detect unclean milk and to care properly for milk purchased8 ,how can tenement mothers keep milk at proper temperature8 ,can nothing be done to increase the supply and cheapen the price of ice8 ,is it desirable that a local committee be formed to coperate with the ,department of ,health and ,county ,medical ,society8 ---------------------------------------- --------------------------- ,unfortunately ,hartley and his contemporaries had never heard of disease germs that are carried by unclean milk into the human stomach4 ,science had not yet proved that many forms of barnyard filth could do quite as much harm as distillery refuse4 ,commerce had not invented milk bottles of glass or paper4 ,the law of #ahfd failed in two particulars3 7#a7 it did not demand cleanliness from cow to consumer2 7#b7 it did not provide means for its own enforcement1 for learning whether everything and everybody that had to do with milk was clean4 ,not knowing of germs and their love for a warm climate and warm food1 they naturally did not prohibit a temperature above fifty degrees from the time of milking to the time of sale4 ,how much has been left for our generation to do to secure pure milk is illustrated by the opening sentence of this chapter1 and more specifically by the programme of a milk conference held in ,new ,york in ,november1 #aijf1 the board of health joining in the call4 ,the four-page folder is reproduced in facsimile 7excepting the names on the fourth page71 because it states the universal problem1 and also because it suggests an effective way to stimulate relevant discussion and to discourage the long speeches that spoil many conferences4 ,this conference led to the formation of a milk committee under the auspices of the association founded by ,hartley4 ,business men1 children's specialists1 journalists1 clergymen1 consented to serve because they realized the need for a continuing public interest and a persisting watchfulness4 ,such committees are needed in other cities and in states1 either as independent committees or as subcommittees of general organizations1 such as women's clubs1 sanitary leagues1 county and state medical societies4 ,teachers' associations might well be added1 especially for rural and suburban districts where they are more apt than any other organized body to see the evils that result from unclean milk4 ,the ,new ,york ,milk ,committee set a good example in paying a secretary to give his entire time to its educational programme1--a paid secretary can keep more volunteers and consultants busy than could a dozen volunteers giving what time they can spare4 ,thanks chiefly to the conference and the ,milk ,committee's work1 several important results have been effected4 ,the general public has realized as never before that two indispensable adjectives belong to safe milk1--clean and cool4 ,additional inspectors have been sent to country dairies2 refrigeration1 cans1 and milk have been inspected upon arrival at night2 score cards have been introduced1 thanks to the convincing explanations of their effectiveness by the representatives of the ,bureau of ,animal ,industry of the national ,department of ,agriculture2 #hfdj milch cows were inspected by veterinary practitioners 7#aije-aijg71 to learn the prevalence of bovine tuberculosis 7of these thirty-six per cent reacted to the tuberculin test72 state societies and state departments have been aroused to demand an efficient live-stock sanitary board2 magistrates have fined and imprisoned offenders against the milk laws1 where formerly they warned2 popular illustrated milk lectures were added to the public school courses2 illustrated cards were distributed by the thousand1 telling how to keep the baby well2 finally1 private educational and relief societies1 dispensaries1 settlements1 have been increasingly active in teaching mothers at home how to prepare baby's milk4 ,in #aijh a ,conference on ,summer ,care of ,babies was organized representing the departments of health and education1 and fifty private agencies for the care of sick babies and the instruction of mothers4 ,the superintendent of schools instructed teachers to begin the campaign by talks to children and by giving out illustrated cards4 ,similar instructions were sent to parochial schools by the archbishop4 ,illustration3 ,,night ,,inspection ,,of ,,country ,,milk ,,upon ,,arrival ,,in ,,new ,,york ,,city ,as elsewhere1 there are two schools of pure-milk crusaders3 7#a7 those who want cities to do things1 to pasteurize all milk1 start milk farms1 milk shops1 or pure-milk dispensaries2 and 7#b7 those who want cities and states to get things done4 ,so far the ,new ,york ,milk ,committee has led the second school and has opposed efforts to municipalize the milk business4 ,the leader of the other school is the noted philanthropist1 ,nathan ,strauss1 who has established pasteurization plants in several ,american and ,european cities4 ,the discussion of the two schools1 similar in aim but different in method1 is made more difficult1 because to question philanthropy's method always seems to philanthropy itself and to most bystanders an ungracious1 ungrateful act4 ,as the issue1 however1 is clean milk1 not personal motive1 it is important that educators and parents in all communities benefit from the effective propaganda of both schools1 using what is agreed upon as the basis for local pure-milk crusades1 reserving that which is controversial for final settlement by research over large fields that involve hundreds of thousands of tests4 ,illustration3 ,a ,,new ,,york ,,milk ,,committee',s ,,infant ,,depot ,,and ,,school ,,for ,,mothers ,pasteurization1 municipal dairies1 municipal milk shops1 municipal infant-milk depots1 are the four chief remedies of the doing things school4 ,european experience is cited in support of each4 ,we are told that cow's milk1 intended by nature for an infant cow with four stomachs1 is not suited1 even when absolutely pure1 to the human infant's single stomach4 ,cow's milk should be modified1 weakened1 diluted1 to fit the digestive powers of the individual infant2 hence the municipal depot or milk dispensary that provides exactly the right milk for each baby1 prescribed by municipal physicians and nurses who know4 ,that the well-to-do and the just-past-infancy may have milk as safe as babies receive at the depot1 municipalization of farm and milk shop is advocated4 ,some want the city to run only enough farms and milk shops to set a standard for private farmers1 as has been done in ,rochester4 ,this is city ownership and operation for educational purposes only4 ,finally1 because raw milk even from clean dairies may contain germs of typhoid1 scarlet fever1 or tuberculosis1 pasteurization is demanded to kill every germ4 ,there are advocates of pasteurization that deprecate the practice and deny that raw milk is necessarily dangerous2 they favor it for the time being until farms and shops have acquired habits of cleanliness4 ,likewise many would prefer private pasteurization or laws compelling pasteurization of all milk offered for sale2 but they despair of obtaining safe milk unless city officials are held responsible for safety4 ,why wait to discuss political theories about the proper sphere for government1 when1 by acting1 hundreds of thousands of lives can be saved annually8 ,these methods of doing things will not add to the price of milk2 it is1 in fact1 probable that the reduction in the cost of caring for the sick and for inspecting farms and shops will offset the net cost of depots1 farms1 and dairies4 ,illustration3 ,,one ,,of ,,rochester',s ,,schools ,,in ,,cleanliness ,illustration3 ,,rochester',s ,,model ,,dairy ,,farm ,as to pasteurization1 its cost is negligible1 while the cost of cleanliness is two1 four1 or ten cents a quart4 ,whether ideally clean milk is safe or not1 raw milk that is not clean is unfit for human consumption4 ,all cities should compel evidence of pasteurization as a condition of sale4 ,large cities should have their own pasteurizing plants1 just as many cities now have their own vaccine farms and antitoxin laboratories4 ,parents in small towns and in the country should be taught to pasteurize all milk4 ,the getting things done school admits the need for modified milk of strength suited to the infant's stomach2 affirms the danger of milk that contains harmful germs2 demands educational work by city1 state1 and nation2 confesses that talk about cleanliness will not make milk safe4 ,on the other hand1 it denies that raw milk is necessarily dangerous2 that properly modified1 clean1 raw milk is any safer when pasteurized2 that talking about germ-proof milk insures germ extinction4 ,it maintains that pasteurization kills benign germs essential to the life of milk1 and that after benign germs are killed1 pasteurized milk1 if exposed to infection1 is more dangerous than raw milk1 for the rapid growth of harmful germs is no longer contested by benign germs fighting for supremacy4 ,while it is admitted that raw milk produced under ideal conditions may become infected by some person ignorant of his condition1 and before detection may cause typhoid1 scarlet fever1 or consumption1 it has not been proved that such instances are frequent or that the aggregate of harm done equals that which pasteurized milk may do4 ,pasteurization does not remove chemical impurities2 boiling dirt does not render it harmless4 ,the remedy for germ-infected milk is to keep germs out of milk4 ,the remedy for unclean milk is cleanliness of cow1 cow barn1 cowyard1 milker1 milk can1 creamery1 milk shop1 bottle1 nipple4 ,if the sale of unclean milk is prevented1 farmers will1 as a matter of course1 supply clean milk4 ,by teaching farmers and milk retailers the economic advantages of cleanliness they will cultivate habits that guarantee a clean milk supply4 ,by punishing railroads and milk companies that transport milk at a temperature which encourages germ growth1 and by dumping in the gutter milk that is offered for sale above #ej degrees1 the refrigerating of milk will be made the rule4 ,purging magistrates' courts of their leniency toward dealers in impure1 dangerous milk is better than purging milk of germs4 ,boiling milk receptacles will save more babies than boiling milk4 ,teaching mothers about the care of babies will bring better results than giving them a false sense of safety1 because only one of many dangers has been removed by pasteurization4 ,educating consumers to demand clean milk and to support aggressive work by health departments leaves fewer evils unchecked than covering up uncleanliness by pasteurization4 ,illustration3 ,,new ,,york ,,milk ,,committee',s ,,graphic ,,method ,,of ,,showing ,,babies' ,,progress ,illustration3 ,,producing ,,winter ,,conditions ,,in ,,midsummer ,,by ,,proper ,,refrigeration ,,for ,,milk ,,in ,,freight ,,cars ,when doctors disagree what are we laymen to do8 ,we can take an intelligent interest in the inquiries that are now being made by city1 state1 and national governments4 ,because everybody believes that clean milk is safer than unclean milk1 that milk at #ej degrees will not breed harmful germs1 we can demand milk inspection that will tell our health officers and ourselves which dealers sell only clean milk at #ej degrees and never more than #fj degrees1 that never shows over #ajj1jjj colonies to the cubic centimeter4 ,we can get our health departments to publish the results of their scoring of dairies and milk shops in the papers1 as has been done in ,montclair4 ,we can tell our health officers that the best results in fighting infant mortality are at ,rochester1 which city1 winter and summer1 by inspection1 correspondence1 and punishment1 educates farmers and dealers in cleanliness1 not only censuring when dirty or careless1 but explaining how to make more money by being clean4 ,finally1 mothers can be taught at home how to cleanse the bottles1 the nipples1 all milk receptacles1 and all things in rooms where milk is kept4 ,absolutely clean milk of proper temperature at the shop may not safely be given to a baby in a dirty bottle4 ,infant milk depots1 pasteurization1 the best medical and hospital care1 breast feeding itself1 cannot prevent high baby mortality if mothers are not clean4 ,the most effective volunteer effort for pure milk is that which first makes the health machinery do its part and then teaches1 teaches1 teaches mothers and all who have to do with babies4 ,illustration3 ,,neither ,,pasteurization ,,nor ,,inspection ,,can ,,make ,,it ,,safe ,,to ,,sell ,,dip ,,milk ,,under ,,such ,,unclean ,,conditions ,clean air1 clean babies1 clean milk1 has been the slogan of ,junior ,sea ,breeze1--a school for mothers right in the heart of ,new ,york's upper ,east ,side4 ,in the summer of #aijg twenty nurses went from house to house telling #ajb1jjj mothers how to keep the baby well4 ,this was the only district that had fewer baby deaths than for #aijf4 ,had other parts of the city shown the same gain1 there would have been a saving of #aajj babies4 ,the following winter a similar work was conducted by nurses from the recently founded ,caroline ,rest1 which has an educational fund for instruction of mothers in the care of babies1 especially babies not yet born and just born4 ,heretofore the baby has been expected to cry and to have summer complaint before anybody worried about the treatment it received4 ,if the baby lived through its second summer1 it was considered great good fortune4 ,junior ,sea ,breeze and ,caroline ,rest start their educational work before the baby is sick1 in fact1 before it is born4 ,their results have been so notable that several well-to-do mothers declare that they wish they too might have a school4 ,dispensaries and diet kitchens and more particularly maternity wards of hospitals1 family physicians1 nurses1 and midwives1 should be required to know how to teach mothers to feed babies regularly1 the right quantities1 under conditions that insure cleanliness whether the breast or the bottle is used4 ,perhaps some day no girl will be given a graduating certificate1 or a license for work1 teaching1 or marriage1 until she has demonstrated her ability to give some mother's baby clean air1 clean body1 clean milk4 ,,footnotes3 #ae ,libraries should obtain all reports on milk1 ,bureau of ,animal ,industry1 ,washington1 ,d4,c4 ,,chapter ,,xxvi ,,preventive ,,humanized ,,medicine3 ,,physician ,,and ,,teacher ,no profession1 excepting possibly the ministry1 is regarded with greater deference than the medical profession4 ,our ancestors listened with awe and obedience to the warnings and behests of the medicine man1 bloodletter1 bonesetter1 family doctor4 ,in modern times doctors have disagreed with each other often enough to warrant laymen in questioning the infallibility of any individual healer or any sect1 whether homeopath1 allopath1 eclectic1 osteopath1 or scientist4 ,yet to this day most of us surround the medical profession or the healing art with an atmosphere of necromancy4 ,even after we have given up faith in drugs or after belief is denied in the reality of disease and pain1 we revere the calling that concerns itself1 whether gratuitously or for pay1 with conquering bodily ills4 ,self-laudation continues this hold of the medical profession upon the lay imagination4 ,one physician may challenge another's faults1 ridicule his remedies1 call his antitoxin dangerous poison1 but their common profession he proudly styles the most exalted form of altruism4 ,young men and women beginning the study or the practice of medicine are exhorted to continue its traditions of self-denial1 and in their very souls to place human welfare before personal or pecuniary advancement4 ,newspapers repeat exhortation and laudation4 ,we laymen pass on the story that we know is not universally true1--physicians know1 physicians apply what they know without consciousness of error1 physicians must be implicitly trusted4 ,for a physician to give poison when he means to give food is worse1 not better1 than for a layman to make the same mistake4 ,neither the moral code nor the law of self-preservation enjoins a tuberculous mother to take alcohol or to sleep in an unventilated room1 even if an uninformed physician prescribes it4 ,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 physicians4 ,a family doctor who gives cod-liver oil for anmia due to adenoids may do a child as much harm as a nurse who drugs the baby to make it sleep4 ,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 train4 ,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 teachers4 ,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 cure4 ,for its sins of omission1 as for its sins of commission1 the medical profession shares responsibility with laymen4 ,for years leading educators1 business men1 hospital directors1 public officials1 have known that communicable diseases could be stamped out4 ,the methods have been demonstrated4 ,there is absolutely no excuse to-day for epidemics of typhoid in ,trenton1 ,pittsburg1 or ,scranton1 for epidemics of scarlet fever in the small towns of ,minnesota1 for uninterrupted epidemics of tuberculosis everywhere4 ,had either laymen1 physicians1 or school-teachers made proper use of the knowledge that has been in text-books for a generation1 this country would be saving thousands of lives and millions of dollars every year4 ,our doing and getting done have lagged behind our knowing4 ,the failure of physicians to socialize or humanize their knowledge is due to two causes3 7#a7 no one has been applying result tests to the profession as a whole and to the state in its capacity as doctor1 testing carefully the sickness rate1 the death rate1 and the expense rate of preventable diseases2 7#b7 physicians themselves have not needed to know1 either at college or in practice1 the tax levied upon their communities by preventable sickness4 ,public schools can do much to secure result tests for individual physicians1 for the profession as a whole1 and for boards of health4 ,schooling in preventive medicine1 or1 better named1 schooling in preventive hygiene1 will fit physicians to do their part in eradicating preventable disease4 ,preventive hygiene is not an essential part of the training of ,american physicians or nurses to-day4 ,not only are there no colleges of preventive hygiene1 but medical schools have not provided individual courses4 ,it is possible for a man to graduate with honors from our leading medical colleges without knowing what vital statistics means4 ,even boards of health1 their duties and their educational opportunities1 are not understood by graduates2 it is an accident if the social and economic aspects of medical practice1 statistical fallacies1 hospital administration1 infant mortality1 are familiar terms4 ,it is for this reason1 rather than because physicians are selfish1 that indispensable and beneficent legislation is so generally opposed by them when the prerogatives of their profession seem in danger4 ,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 need4 ,physicians bitterly attacked compulsory vaccination1 medical inspection of schools1 compulsory notification of communicable diseases4 ,what is perhaps more significant of the physician's indifference to preventive hygiene is the fact that most of the sanitary movements that have revolutionized hygienic conditions in ,america owe their inception and their success to laymen1 for example1 tenement-house reform1 anti-child labor and anti-tuberculosis crusades1 welfare work in factories1 campaigns for safety appliances1 movement for a national board of health1 prison1 almshouse1 and insane-asylum reform1 schools for mothers1 and milk committees4 ,the first hospital for infectious diseases1 the first board of health1 the first out-of-door sea-air treatment of bone tuberculosis in the ,united ,states1 were the result of lay initiative4 ,dr4 ,hermann ,m4 ,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 sickness4 ,a physician without knowledge of preventive hygiene is simply doing a general repair business4 ,for a few months in #aijg ,new ,york ,city had a highly efficient commissioner of street cleaning1 who1 in spite of the unanimous protests and appeals of the press1 refused to give up the practice of medicine4 ,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 preventives4 ,statesmanship as well as professional ability is expected of physicians in the leading ,european cities1 more particularly of those connected with health departments4 ,there it is not felt that a medical degree is of itself a qualification for sanitary or health work4 ,after the professional course1 physicians must take courses in preventive hygiene and in health administration4 ,medical courses include such subjects as vital statistics1 duties of medical officers of health1 sanitary legislation1 state medicine4 ,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 country4 ,that city alone sacrifices twenty-eight thousand lives annually to diseases that are officially called preventable4 ,the yearly burial cost of these victims of professional and community neglect is more than a million dollars4 ,when to the doctor bills1 wages lost1 burial cost of those who die are added the total doctor bills1 wages lost1 and other expenses of the sick who do not die1 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 health4 ,many diseases and much sickness are preventable that are not communicable4 ,indigestion due to bad teeth is not itself communicable1 but it can be prevented4 ,one's vitality may be sapped by irregular eating or too little sleep2 others will not catch the trouble1 although too often they imitate the harmful habits4 ,adenoids and defective vision are preventable1 but not contagious4 ,spinal curvature and flat foot are unnecessary1 but others cannot catch them4 ,preventive hygiene1 however1 should teach the physician's duty to educate his patient and his community regarding all controllable conditions that injure or promote the health4 ,in the absence of special attention to preventive medicine new truth is forced to fight its way1 sometimes for generations1 before it is accepted by the medical profession4 ,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 patients1 that the forces of honorable medical practice tend to discourage research and invention4 ,the man who discovers a surgical appliance is forced by the ethics of his profession either to commercialize it and lose his professional standing1 or to abide the convenience of his colleagues and their learned organizations in testing it4 ,rather than be branded a quack1 charlatan1 or crank1 the physician keeps silent as to convictions which do not conform to the text-books4 ,many a life-saving1 health-promoting discovery which ought to be taken up and incorporated into general practice from one end of the country to the other1 and which should be made a part of the minimum standard of medical practice and medical agreement1 must wait twenty-five or fifty years for recognition4 ,illustration3 ,,the ,,disciple ,,of ,,fresh ,,air ,,and ,,home ,,instruction ,,is ,,still ,,an ,,outcast ,,in ,,scores ,,of ,,hospitals ,for want of a school of preventive medicine to emphasize universally every new truth1 the medical colleges are permitted to remain twenty-five or fifty years behind absolutely demonstrated facts as to medical truth and medical practice4 ,in #agfa a ,german physician1 ,avenbruger1 after discovering that different sounds revealed diseased tissue1 used chest tapping in the diagnosis of lung trouble4 ,in #ahae ,lannec discovered that sound from the chest was more distinct through a paper horn4 ,on that principle the modern stethoscope is built4 ,he made an accurate diagnosis of tuberculosis1 and while suffering from that disease treated himself as a living clinical study4 ,in #aheg ,pasteur proved the presence of germs without which no putrefaction1 no fermentation1 no decay of tissue takes place4 ,in #ahhd ,trudeau started the first out-of-door care of pulmonary tuberculosis in ,america4 ,in #ahib ,biggs secured the compulsory notification of pulmonary tuberculosis4 ,in #aijd began our first out-of-door sea-air treatment for bone tuberculosis4 ,yet there are thousands of physicians to-day who sincerely believe that they are earning their fees1 who1 from houses shut up like ovens1 give advice to patients for treatment of tuberculosis1 who prescribe alcohol and drugs1 who diagnose the disease as malaria for fear patients will be scared1 who oppose compulsory registration1 and who never look for the tuberculous origin of crippled children4 ,just think of its being possible1 in #aijh1 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 day6 ,in #agff ,america's first dentist came to the ,united ,states4 ,by #aghe itinerant dentists had built up a lucrative practice4 ,in #ahbe a course of lectures on dentistry was delivered before the medical class at the ,university of ,maryland4 ,as early as #agdb treatises were written ,upon ,dentition and the ,breeding of ,teeth in ,children4 ,in #ahjc the possibility of correcting irregularities was pointed out1 as was the pernicious effect of tartar on the teeth in #ahbg4 ,in #ahch attempts were made to abolish1 in all common cases1 the pernicious habit of tooth drawing4 ,in #ahda treatises were written on the importance of regulating the teeth of children before the fourteenth year and on the importance of preserving the first teeth4 ,yet in #aijh it is necessary to write the chapter on ,dental ,sanitation4 ,few physicians1 whether in private practice or hospitals or just out of medical college1 consider it necessary to know the conditions of the mouth before prescribing drugs for physical illness4 ,osteopathy furnishes an up-to-date illustration4 ,discredited by the medical profession1 by medical journals and medical schools1 it has in fifteen years built up a practice of eight thousand men1 having from one to three years' training1 including over one hundred physicians with full medical training plus a course in osteopathy4 ,there were means of learning fifteen years ago what was truth and what was quackery about the practice of osteopathy4 ,by refusing to look for its truth and by concentrating attention upon its quackery the medical profession has lost fifteen years4 ,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 physician1 a position has been reached where alleged quackery seems in several important points to be discrediting the sincerity1 the intelligence1 and the efficiency of orthodox medicine4 ,no appeal to the natural can be stronger1 no justification of schools of preventive medicine more complete1 than the following paragraph from an osteopathic physician who is among the small number who1 having both the medical and osteopathic degrees1 see both the possibilities and limitations of manual surgery and demand the inclusion of this new science in the medical curriculum4 ,the physical method of treating disease presents a tremendous and significant departure from the empiricism of medicine and the experimentation of dietetics1 the restricted fields of electricity1 suggestion1 water cures1 and massage4 ,the patient as an individual is not treated2 the disease as a disease is not treated2 the symptoms are not treated2 but the entire physical organism1 with its many parts and diverse functions1 is exhaustively examined until each and every abnormal condition1 whether of structure or of function1 causing disease and maintaining symptoms1 is found and administered to with the skill of a definite art1 based upon the data of an exact science4 ,likewise the truths underlying ,christian ,science have been disdained by medical schools and medical experts1 just as its spiritual truth has been disdained by religious leaders1 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 medicine4 ,in ,may1 #aijg1 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 science4 ,daily papers and magazines are giving a great deal of space to this experiment in psychotherapy1 which is discussed in the chapter on ,mental ,hygiene4 ,schools and chairs in preventive hygiene would soon give to the medical profession a point of view that would welcome every new truth1 such as the alliance of religion and medicine1 and estimate its full worth promptly4 ,truth seeking would be not only encouraged but made a condition of professional standing4 ,just what attitude any particular physician takes can be learned by the teacher or parents whose children he treats4 ,if he pooh-poohs or resents board of health regulations as to isolation of scarlet-fever patients1 he is a dangerous man1 no matter how noble his personal character4 ,if he says cross-eyes will straighten1 weak eyes will strengthen1 or nose-stopping adenoids absorb1 he is bound to do harm4 ,if he says tuberculosis is incurable1 noncommunicable1 hereditary1 or curable by drugs1 or if he tries to cure cancer by osteopathy1 he can do more injury than an insane criminal4 ,if he fails to teach a mother how to bathe1 feed1 and clothe the baby1 how to ventilate a room for the sick or the well1 he is an expensive luxury for family or for school1 and belongs to an age that knew neither school nor preventive hygiene4 ,if he takes no interest in health administration2 if he overlooks unclean milk or unclean streets1 open sewers1 and unsanitary school buildings1 street cars1 churches1 and theaters2 if he does not help the health board1 the public hospitals1 the schools1 the factory1 and tenement departments enforce sanitary laws1 he is derelict as a citizen and as a member of an exalted profession4 ,if he sees only the patients he himself treats or one particular malady1 he is derelict as a teacher1 no matter how charming his personality or how skilled in his specialty4 ,if a school physician is slovenly in his work1 if he spends fifteen minutes when he is paid for an hour1 should the efficient school-teacher conceal the fact from her superiors because he is a physician8 ,if private hospitals misrepresent facts or compromise with political evils for the sake of a gift of public money1 their offense is more heinous because of their exalted purpose4 ,the test of a physician's worth to his patients and to his community is not what he is or what he has learned1 and not what his profession might be1 but what happens to patient and to community4 ,human welfare demands that the medical profession be judged by what it does1 not by what it might do if it made the best possible use of its knowledge or its opportunity4 ,illustration3 ,,too ,,many ,,physicians ,,and ,,even ,,maternity ,,hospitals ,,fail ,,to ,,teach ,,mothers1 ,,either ,,before ,,or ,,after ,,babies ,,are ,,born ,caroline ,rest ,educational ,fund was given to show the value of such teaching ,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 straps4 ,unless physicians test themselves and their profession by results1 we shall be compelled to municipalize the medical man4 ,preventable sickness costs too much1 causes too much wretchedness1 and hampers too many modern educational and industrial activities to be neglected4 ,if the medical profession does not fit itself to serve general interests1 then cities1 counties1 and states will take to themselves the cure as well as the prevention of communicable and other preventable sickness4 ,human life and public health are more precious than the medical profession1 more important even than theories and traditions against public interference in private matters4 ,the unreasoning opposition of medical men to government protection of health1 their concentration on cure1 and their tardy emphasis on prevention have forced many communities to stumble into the evil practices mentioned in ,chapter ,,xvi4 ,incidentally1 the best physicians have learned that the prosperity of their profession increases with every increase in the general standard of living4 ,it is the man in the ten-room house not the man in one room who supports physicians in luxury4 ,it is the healthy man and the healthy community that value efficient medical service4 ,many ,american cities maintain dispensaries and hospitals for the poor4 ,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 do4 ,the state already says when a physician's training fits him to practice4 ,it will soon expect him to pass rigid examinations in the social and economic aspects of his profession1--its educational opportunity1 vital statistics1 sick and death rates4 ,will it need to municipalize him in order to protect itself8 ,obviously the teacher or parent should not begin cooperation with physicians by lecturing them or by assuming that they are selfish and unwilling to teach4 ,the best first step is to ask questions that they should be able to answer3 ,what causes cholera morbus or summer complaint8 ,when does milk harm the baby8 ,how can unclean milk be made safe8 ,whose fault is it that the milk is sold unclean and too warm8 ,what agencies help sick babies8 ,what is the health board doing to teach mothers8 ,or1 if a school physician1 the teacher can ask3 ,why not remove these adenoids8 ,what causes them8 ,when will they disappear by absorption8 ,what harm can they do in the meantime8 ,how long would an operation take8 ,would it hurt very much8 ,what would be the immediate effects8 ,why not act at once8 ,what provisions are there in town for such operations8 ,why have the physicians paid so little attention to breathing troubles8 ,what could your state do to interest physicians in school hygiene8 ,will the school physician talk to a mothers' meeting8 ,what agencies will give outings to sick children8 ,what dispensaries are accessible8 ,who is the proper person to organize a public health league8 ,physicians love to teach4 ,if teachers and parents will love to learn and will ask the right questions1 all physicians can be converted into hygiene missionaries1 heralds of a statesmanship that guarantees health rights to all4 ,,licensing ,,the ,,practitioner ,three parties are interested in setting a high standard for physicians1 dentists1 druggists1 nurses1 and veterinary surgeons--the profession itself1 the schools that educate1 and the general public on whom the arts are practiced4 ,the schools and the practitioners are1 for the most part1 primarily interested in protecting a monopoly of skill4 ,their interest in restrictive legislation is analogous to that of the labor union which limits the number of apprentices4 ,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 public4 ,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 clients4 ,it is almost impossible to get such laws through unless the original law exempts all persons by whatever name1 who are practicing the art in question at the time the law is passed4 ,whether we are speaking of medicine1 law1 dentistry1 accountancy1 osteopathy1 or barbering1 this has been the history of compulsory restriction and of state examinations4 ,as with regard to most other legislation1 the enforcement of the law lags behind its definition4 ,moreover nothing is done after a man has passed a certain examination to see that he remains fit and safe to treat the public4 ,because no supervision is provided except on the day of examination1 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 will1 in all probability1 be asked4 ,forever after1 the public is left to protect itself4 ,out of this condition have arisen the evil1 unethical1 and unprofessional practices represented particularly by painless dentists1 by ignorant or dishonest physicians1 and by osteopaths and careless nurses4 ,the machinery for preventing these evils is discussed in ,chapter ,,xxix4 ,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 evils1 and for further tests by which the public can learn from time to time which1 among those professional men who are protected by the public against competition1 continue to be safe4 ,finally1 if1 as will be clearly seen1 it is desirable that what we call professional ethics persist and that self-advertisement be discouraged1 society must1 for its own protection1 adopt some other means than epithets to correct the evils of self-advertisement and quackery4 ,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 window1 it must be seen that we cannot hold responsible for their choice men and women who receive through newspapers1 magazines1 or circulars convincing notices that ,dr4 ,so-and-,so or the ,integrity ,company or the ,peerless ,dental ,parlor will place at their disposal1 at prices within their reach1 skill and devotion absolutely beyond their reach at the office of an efficient private practitioner4 ,some way must be found by which departments of health will currently impose tests of methods and results upon physicians1 opticians1 pharmacists1 manufacturers of medicine1 and dentists4 ,as laymen become more intelligent regarding their own bodies and healthy living1 it grows harder and harder for quacks and incompetents to mislead and exploit them4 ,better than any possible outside safeguard is hygienic living4 ,fortunately1 we can all learn the simple tests of environment and of living necessary to the selection of physicians1 dentists1 and opticians1 or other architects of health whose efficiency and integrity are beyond question4 ,,part ,,iv4 ,,official ,,machinery ,,for ,,enforcing ,,health ,,rights ,,chapter ,,xxvii ,,departments ,,of ,,school ,,hygiene ,the term school hygiene generally suggests no other school than the public school4 ,state laws say nothing about compulsory hygiene in military academies1 ladies' seminaries1 or other preparatory and finishing schools4 ,yet when one thinks of it1 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 expense4 ,there is a better way to check swollen fortunes than by ruining the health of fortune's children4 ,the waste and danger of slow-minded1 noticeably inefficient children are no less when parents are rich than when parents are poor4 ,there is no justification for neglecting the health of children in parochial schools1 in private schools for the well-to-do or rich1 or in commercial schools for the ambitious youth of lower income strata4 ,nor has the commercial1 parochial1 private school1 or college1 any clearer right than the public school to injure or to fail to promote pupils' health4 ,so far as school hygiene is advisable1 so far as it is right to make hygiene compulsory1 its personal and social benefits should be shared by children of school age without regard to income1 and its laws should be enforced by all teachers1 principals1 and officers that have to do with school4 ,in presenting a programme for school hygiene this chapter refers to the hygiene taught1 the hygiene practiced1 the hygiene not taught1 and the hygiene not practiced in buildings and on grounds where children and youth are at school1 whether these children are in kindergarten or high school1 in reformatory or military academy1 in charitable school1 or in finishing and preparing center for society's juniors4 ,the question of the local1 state1 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 hygiene4 #a4 ,thorough physical examination of all candidates for teachers' positions and periodic rexamination of accepted teachers4 ,teachers would be grateful to be told in time their own physical needs and the relations of their vitality to the vitality of their pupils4 ,are your teachers examined8 ,do they know the laws of health and the signs of child health8 ,are they permitted to continue in schoolrooms after tuberculosis is discovered8 ,are normal graduates given physical tests before being permitted to teach and before being permitted to give four years to preparation for teaching8 #b4 ,thorough physical examination of every single child in every single school upon entering and periodically during school life4 ,we believe a vast number of things that ain't so about the health of country children as compared with city children1 of private-school children as compared with public-school children4 ,where do we find more degenerate men1 physically and morally1 than in so-called ,american settlements1 where1 for generations1 children have had all outdoors to play in1 except when in homes and schoolhouses that are seldom cleansed and seldom ventilated8 ,open mouths and closed minds clog the little red schoolhouse2 there headaches do not suggest eye strain2 there deafness and running ears are frankly attributed to scarlet fever which everybody must have with all the other catching diseases1 the earlier the better2 there colds begin in ,december and run until ,march1 to the serious injury of attendance and promotion records2 there bone tuberculosis is called knee trouble or spine trouble in the family2 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 minutes4 ,the index to community life and community living conditions should be read in the country1 not only for the country's sake1 but also for the sake of the city whose milk and water1 poisoned in the country1 cause thousands of deaths annually1 besides annual sick bills exceeding many times over the ,russell ,sage and ,carnegie ,foundations1 which we rightly call munificent4 ,reading the index of private schools and colleges is important for their children and youth1 but still more important for the community upon which unbridled passion1 inability to work or to spend properly1 inconsequential thinking1 medival ideals of caste1 etc41 can inflict greater injuries than can typhoid fever or cholera4 ,the physical record of each child should be kept from date of entrance to date of leaving school1 showing condition at successive examinations1 absence because of illness1 etc4 #c4 ,thorough physical examination of children when leaving school1 or when passing compulsory school age1 as a condition to working papers and to coming out4 ,to give working papers to children seriously handicapped by physical defects is to buy future industrial trouble1 hospital and poorhouse bills4 ,a boy with adenoids1 a girl with eye trouble1 should not be permitted to begin the fight for self-support without at least being clearly shown that the correction of these defects will increase their earning power4 ,at present a schoolgirl with incipient tuberculosis1 or predisposed to that disease1 can get working papers1 go to a hammock or tobacco factory1 work long hours1 breathe bushels of dust1 deplete her vitality1 spread tuberculosis among her co-workers and home associates1 infect a tenement1--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 center4 ,we may disagree about society's right to control a child's act after the defects are discovered1 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 society8 #d4 ,supervision by physicians of hygiene practiced in schoolrooms and on playgrounds4 ,superintendent ,maxwell1 of ,new ,york ,city1 and other educational leaders urge teachers to do their utmost to learn the physical conditions and home environment of the individual child1 and to fit school treatment to the individual possibilities and handicaps4 ,but experience proves conclusively that try as they will1 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 children4 ,physicians and nurses are needed1 not so much for treating children1 as for teaching children1 parents1 teachers1 family and dispensary physicians4 ,private schools have visiting physicians who may be consulted2 they need physicians to supervise1 with power to examine or to require certificates of examination4 ,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 coperation of parents1 teachers1 family physicians1 dispensaries1 school boards1 and charitable societies4 ,the ,hawthorne ,club's school secretary has been similarly successful in ,boston1 as have those of ,hartley ,house1 ,greenwich ,house1 and the ,public ,education ,association in ,new ,york4 #e4 ,restriction of study hours at school and at home to limits compatible with health4 ,whether the hours of study at school and at home are excessive cannot be learned from treatises on pedagogics or physiology4 ,because children differ in vitality as in ability to learn1 the maximum limit for study hours should be determined by the individual child's physical condition4 ,when the ,japanese went to war with ,russia the highest authority in the field was the army surgeon4 ,to this fact was largely due the astonishingly small amount of sickness and the high fighting capacity and endurance of the ,japanese1 working under unfavorable conditions4 ,no board of school superintendents or board of directors1 no state superintendent of schools or college professor1 has the right to compel or to allow study hours beyond the maximum compatible with the individual student's physical condition and endurance4 ,the physician responsible for school hygiene should have an absolute veto upon any educational policy1 method1 or environment demonstrably detrimental to children's vitality4 #f4 ,establishment of a follow-up plan to insure action by parents to correct physical defects and to attend to physical needs4 ,the advantages of getting things done over doing things have been repeatedly emphasized4 ,in smaller cities and in rural districts it is particularly important for schools to get things done better by existing local agencies1 such as churches1 health and street-cleaning departments1 hospitals1 clinics1 medical and sanitary societies1 trade unions1 young people's societies1 and women's clubs4 ,where parents who have been followed up and taught1 obstinately or ignorantly refuse to attend to their children's needs1 the segregation of the physically defective or needy will encourage the coperation of children themselves in persuading parents to act intelligently for the child's sake4 ,no child wants to remain queer or dopey or behind his peers4 ,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 steps1 within their power1 to remove physical defects discovered at school4 ,illustration3 ,,teaching ,a ,,mother ,,to ,,care ,,for ,,one ,,child ,,insures ,,better ,,care ,,for ,,all ,,her ,,children #g4 ,physiological age should influence school classification and school curriculum4 ,on this subject the studies of ,dr4 ,c4 ,ward ,crampton1 referred to in the chapter on ,vitality ,tests1 are invaluable and as convincing as they are revolutionary4 ,scientists accept his proof that our present high school curriculum is ill adapted to a large proportion of children2 the physiologically too young drop out2 only the physiologically mature succeed4 ,the two physiological ages should be given different work4 ,children whose bodies yearn for pictures1 muscular and sense expression1 should be given a chance in school for normal development4 ,analysis should wait for action4 ,organized play and physical training antedated physical examination in our schools4 ,like the curriculum they often disregard physiological age1 doing harm instead of good4 ,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 supervision4 ,only good would result from adopting ,leipsic's plan of having school children examined without clothing1 in the presence of parents if parents desire4 ,expensive8 ,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 remain4 #h4 ,construction of school building and of curriculum so that1 when properly conducted1 they shall neither produce nor aggravate physical defects4 ,when the state for its own protection compels a child to go to school1 it pledges itself not to injure itself by injuring the child4 ,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 indignation4 ,two illuminating studies of school buildings in ,new ,york ,city were made last year by the ,committee on the ,physical ,welfare of ,school ,children1 and later by the ,board of ,education4 ,similar studies should be made of every schoolroom4 ,whereas our discussions of buildings and curriculum have hitherto proceeded largely from abstract principles of light1 ventilation1 heating1 and pedagogics1 these two reports deal with rooms1 equipment1 courses of study1 and school habits as they are1 with obvious detrimental effects on child victims4 ,numerous questions that it is practicable to answer are given in ,chapter ,,xiv4 ,what and when to build can be better determined after we have learned the what and the where of present equipment4 ,in passing it is worth while to note that in large cities teachers are frequently forced to choose between bad ventilation and street noises4 ,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 fields1 transporting1 and1 if necessary1 feeding children at public expense4 ,while it is true that the public funds now spent in attempting to cure physical and moral ills would purchase ample country reservations1 the practical next step seems to be to provide ample play space and breathing space within the city for every school building already erected1 and without fail for all buildings to be erected hereafter4 #i4 ,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 efficiency4 ,social rather than personal1 public rather than private1 health needs emphasis4 ,children can be shown how their health affects their neighbor2 why money spent for health boards is a better investment than money given to corrupt politicians2 that the cost of accepting ,thanksgiving turkey or a park picnic from a political leader who encourages inefficient government is sickness1 misery1 deficient schooling1 lifelong handicap2 that children and adults have health rights in school and factory1 on street and playground1 which the law will protect if only they know when these rights are infringed4 #aj4 ,central supervision of school hygiene4 ,in private and public1 boarding and day1 country and city1 reformatory and military1 commercial and high schools1 the index--physical welfare of school children--should be read and interpreted4 ,headquarters should learn whether or not physical examinations are made and whether harmful conditions are corrected4 ,so far as public schools are concerned1 headquarters means for cities the fact center that informs city superintendent or school board2 for rural schools1 it means the county superintendent's office4 ,whether city or county headquarters have the facts and act accordingly should be known by state superintendents4 ,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 world4 ,some people think the state health board should be responsible1 others the state educational authority4 ,the important thing is to make some one officer responsible4 ,methods can be easily worked out if the need is conceded4 ,legislatures will gladly confer the powers necessary to reading the index of all public schools4 ,as for parochial and private schools1 they may resent for a time public supervision of their hygiene teaching and practice4 ,however1 the case could be so presented that they would ask for it1 because it would help not only their pupils and society but the schools themselves4 ,no religious belief or private investment can afford to admit that it disregards child health2 state supervision would require nothing more than evidence of adequate school hygiene4 #aa4 ,information gained at school regarding conditions prejudicial to community health should be published and made the basis of an aggressive campaign for the enforcement of sanitary laws4 ,ten thousand uses can be made of the information gained at school1 ten thousand forces can be made to do educational work1 but only a few kinds of work can be done effectively at school4 ,franklin ,ford has said3 ,you can relate school to all life1 but you cannot bring all life under the school roof4 ,as ,chapters ,,xvi-,,xviii make clear1 to socialize the point of view of dispensaries and hospitals is more effective than to put clinics in school buildings4 ,to do for or give to people who can help themselves is to give up and do up power of self-help4 ,machinery that must some day exist for the execution of this programme will be approximately the following3 ,i4 ,,national ,,machinery #a4 ,clearing house for facts regarding school hygiene as taught and practiced in all schools under the ,stars and ,stripes2 this to be a part of the ,national ,bureau of ,education4 #b4 ,scientific research to be conducted by the ,national ,bureau of ,education or by the future ,national ,board of ,health4 ,,ii4 ,,state ,,machinery #a4 ,clearing house for facts regarding school hygiene taught and practiced in all schools within state limits2 this to be maintained by the state educational authorities4 #b4 ,agents to make special inquiries as to practice and teaching of school hygiene4 #c4 ,agents to inspect and to instruct county superintendents1 county physicians1 teachers1 normal schools1 etc4 #d4 ,a bureau of experts--architect1 sanitarian1 teacher--whose approval must be obtained before any school building can be erected4 7,a plan which brought excellent results when applied by state boards to charitable institutions1 hospitals for the insane1 etc47 #e4 ,standard making by normal schools1 state universities1 hospitals1 or other educational and correctional institutes under direct state management4 ,,iii4 ,,county ,,machinery #a4 ,clearing house for facts regarding school hygiene taught and practiced in all schools within county limits2 this to be maintained by the county superintendent of schools4 #b4 ,physician and nurse to organize inspection and instruction for rural schools1 to give lessons and make demonstrations at county institutes1 to show teachers how to interest physicians1 dentists1 health officers1 and parents in the physical welfare of school children4 ,,iv4 ,,town ,,and ,,township ,,machinery #a4 ,teachers intelligent as to physical needs1 as to sanitation of buildings1 etc4 #b4 ,an examining physician1 to be salaried where the population justifies2 elsewhere to work as a volunteer in coperation with teacher and with county physician4 #c4 ,physical history of each child from date of entrance to date of leaving school1 to be kept up to date by teacher4 ,v4 ,,city ,,machinery #a4 ,a division to be known as the ,department of ,school ,hygiene1 headed by an officer who gives his entire time to that department4 #b4 ,a subcommittee of the ,board of ,education4 #c4 ,clearing house for facts regarding school hygiene taught and practiced in all schools within city limits4 #d4 ,specialists to examine applicants for teaching positions1 and to rexamine teachers to determine fitness for continuance1 for promotion1 and for special assignments4 #e4 ,a bureau for inspection and control of all hygiene of school buildings1 old and new1 with power to compel repairs or to reject plans that do not make adequate sanitary provision4 #f4 ,similar supervision of curriculum and of study hours prescribed4 #g4 ,a bureau for the inspection and control of curriculum1 required home study1 exercise1 physical training1 etc41 so far as relates to the health of pupils1 and to the physical ability of children to be in certain grades or to be promoted4 ,this will decide the duration of lessons1 frequency of intermissions1 sequence of subjects1 time and method of recess throughout the various grades4 #h4 ,supervision of indoor and outdoor playgrounds1 roof gardens1 indoor and outdoor gymnasiums1 swimming pools1 etc4 #i4 ,supervision of instruction in school hygiene4 #aj4 ,a staff of inspectors for communicable diseases of pupils and teachers1 to be subject to the board of education or the board of health4 #aa4 ,a staff of examiners adequate to examine all children and teachers at least once a year for defects of eye1 ear1 teeth1 nose1 throat1 lungs1 spine1 bones1 glands1 etc41 and for weight and height to be under the control of the board of education or the board of health4 ,the expense would not be as great as the penalty paid for omitting such examination4 #ab4 ,a staff of nurses to assist medical examiners to give children practical demonstrations in cleanliness1 to teach mothers the care of children both at their homes and in mothers' meetings1 to enlist the coperation of family physician and neighborhood facilities1 such as hospitals1 dispensaries and relief agencies1 magistrates' courts and probation officers1--all to be under the control of the board of education or the board of health4 ,whether inspectors1 examiners1 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 conditions4 ,so far as state and county organizations are concerned1 it is clear that whatever the boards of health may do1 it will be necessary for state and county superintendents of education to equip themselves with the machinery above recommended4 ,in cities it is quite clear that a board of education should be responsible for all of the machinery suggested1 excepting the three divisions that have to do with work hitherto considered as protection against transmissible diseases1 namely1 inspection1 examination1 district visiting4 ,in ,cleveland these are school duties4 ,in ,new ,york they are duties of the health department4 ,boston has school nurses and health department physicians4 ,the state law of ,massachusetts provides that where health boards do not examine school children1 school boards may spend money for the purpose4 ,as to inspection for transmissible diseases1 it seems quite clear that health boards should not delegate their authority or responsibility to any other body1 for they alone are accountable to their communities for protection against contagion4 ,it is clear1 too1 that in the interest of community health1 departments of health are justified in pointing out in advance of contagion those children most likely to become a menace4 ,similar grounds of public interest justify the health boards in sending nurses and physicians to the home as a means of getting things done4 ,dr4 ,biggs feels that responsibility for the physical welfare of school children will strengthen health work in all cities1 and1 given proper interest on the part of school officials1 should make possible universal coperation in a constructive programme4 ,on the other hand1 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 programme4 ,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 board4 ,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-teacher4 ,because the follow-up work in the homes incident to successful use of knowledge gained at school involves so many sanitary remedies1 it is theoretically better organization to hold the health authority responsible4 ,,chapter ,,xxviii ,,present ,,organization ,,of ,,school ,,hygiene ,,in ,,new ,,york ,,city ,many of the elements of the machinery outlined in the preceding chapter already exist in ,new ,york ,city4 ,all of them brought together1 either by amalgamation or by proper cordination1 would present a very strong front4 ,unfortunately1 however1 there is not only unsatisfactory team work1 but the efficiency of individual parts is seriously questioned by the heads of the health and school departments4 ,the inspection for contagious diseases1 the examination for physical defects1 the follow-up work by nurses and physicians1 are in charge of the department of health4 ,physical training and athletics for elementary and high schools1 winter recreation centers1 and vacation playgrounds are under directors and assistants employed by the board of education4 ,heretofore inadequate powers and inadequate assistance for training or for research have been given to the physical director4 ,the city superintendent of schools1 in his report for the year #aijg1 presented to the board of education in ,january1 #aijh1 declares that the present arrangements have been inadequate4444 ,in only #bdh schools--less than half the total number--were any examinations for possible diseases made4 ,in these #bdh schools not more than one third of the pupils were examined4 ,it is only a few months since any examinations for physical defects were made outside of the boroughs of ,manhattan and ,the ,bronx1 and then only on account of the ,new ,york ,committee on the ,physical ,welfare of ,school ,children4 ,as is so often the case1 it is difficult to decide the merits of a method that has not been efficiently executed4 ,the department of health has not hitherto done its best in its school relations4 ,the commissioner of health1 in a public interview1 expresses resentment at the strictures by the school authorities4 ,yet in #aijg he permitted to accumulate an unexpended balance of #cc1jjj specifically voted for school inspectors1 and repeatedly tried to have this amount transferred to other purposes4 ,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 publicity1 preserved this particular fund4 ,moreover1 the discussion that prevented its diversion from physical examinations strengthened the health department's interest in this important responsibility4 ,neither physicians nor nurses have been adequately supervised4 ,instead of seeing that defects were removed1 the department of health sent out postal cards like the following3 ,illustration3 7,notice ,example7 ---------------------------------------- ------------------------------- ,this ,notice ,does ,,not ,exclude ,this ,child ,from ,school ,,department ,,of ,,health ,,the ,,city ,,of ,,new ,,york ,oct4 #b1 #aijf ,the parent or guardian of ofattending ,p4,s4#ea is hereby informed that a physical examination of this child seems to show an abnormal condition of the ,eyes1 ,nose1 ,throat and ,teeth ,remarks,is ,anaemic ,take this child to your family physician for treatment and advice4 ,take this card with you to the family physician4 ,,thomas ,,darlington1 ,m4,d41 ,commissioner of ,health4 ,,hermann ,m4 ,,biggs1 ,m4,d41 ,general ,medical ,officer ---------------------------------------- ------------------------------- ,from #aah1jjj such notices sent out only #ifjj replies were received1 of which only one in twenty stated that attention had actually been given the needy child4 ,the department had been satisfied with evidence that family physicians had advised parents properly1 as in the case of the child above reported3 ,illustration3 7,card example7 ---------------------------------------- ------------------------------ ,,take ,,this ,,card ,,to ,,your ,,physician ,the ,physician in charge is requested to fill out and forward this postal after he has examined this child4 ,i have this day examined of ,p4,s4 #ea and find the following condition3 ,as reported1 ,also enlarged 7unclear7 glands and advised as follows3operation for adenoids and tonsils ,dental treatment at ,cornell4 ,fresh air outing at ,sea ,breeze ,eyes wait4 ,respectfully yours1 ,p4,l4 ,,ob ,date ,oct4 #i1 #aijf ---------------------------------------- ------------------------------ ,for a candid1 complete criticism of the medical examination work up to ,june1 #aijh1 consult the report of the ,bureau of ,municipal ,research1 presented to the ,washington ,congress of ,public ,education ,associations in ,october1 #aijh1 by ,commissioner of ,health1 ,dr4 ,darlington4 ,the bureau's study is entitled ,a ,bureau of ,child ,hygiene1 and1 in addition to the story of medical examination in ,new ,york ,city schools1 gives the blank forms adopted for use in ,september1 #aijh4 ,important as are the facts given in this study1 its greatest value1 its authors declare1 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 needs4 ,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 defects1 or to deficient administration of power and inclination by health officials4 ,coperating with school physicians and nurses in three schools1 #addb children were examined1 of whom #acde1 or #ic4b per cent1 had #cdeh defects that needed treatment4 ,the postal-card notice was followed by an interview with the parent either at school or at home4 ,only #d4b per cent of the total number of parents refused to act1 #ha per cent secured or permitted treatment for one or more defects1 while #ae per cent promised to take the proper steps at the earliest possible date4 ,three fourths of the parents acted after one personal interview4 ,the net average result of a day's work by a nurse was the actual treatment of over five children1 three of them completely1 and two of them for one or more defects1--sixty cents per child6 ,illustration3 ,a ,,photograph ,,of ,,mouth ,,breathing ,,may ,,make ,,compulsion ,,unnecessary ,having established the willingness--even eagerness--of parents to do all in their power to remove defects that handicapped their children1 it was obviously the duty of the health department so to organize its work that it could insure the education of parents4 ,the new ,bureau of ,child ,hygiene gives foremost place to instruction of parents in care of babies1 in needs of school children1 and in the importance of physical examination when enlisting in the industrial army4 ,whether this work is well done is learned by result tests applied at headquarters1 where work done and results are reported daily and summarized weekly4 ,no longer will it be possible1 without detection1 for one physician to find only eye trouble and to neglect all other defects2 for two inspectors examining different children in the same school to report results differing by #ajj per cent2 for physicians in different schools to find one #ah per cent1 another #ajj per cent with defects2 for two inspectors examining identical children to agree on #ea out of #aja cases of vision1 on #di out of #if cases of adenoids1 or #c out of #aj cases of skin disease4 ,so conclusive were the results of follow-up work efficiently supervised by the department of health1 that school officials are1 for the present1 inclined to waive the demand for the transfer of physicians and nurses to the board of education1 and to substitute education for compulsion with parents who obstinately refuse to take proper remedial measures for their children when reported defective4 ,this present plan requires the entire working time of inspectors and nurses for school work4 ,thus ,new ,york has for the present definitely abandoned the plan of having the district inspection for contagious diseases done by school physicians4 ,the purpose of the change is not to reduce danger of infection1 which was negligible1 but to increase the probability of scientific attention to school children4 ,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 them4 ,it is conceivable that one physician working from nine to five would accomplish more than six physicians working the alleged three hours a day4 ,so imperative are the demands of school hygiene that it seems probable that in ,new ,york and in other large cities school physicians1 whether paid by the board of health or the board of education1 must be expected to be at the service of school children1 subject to the call of school officers1 during as many hours of the day as teachers themselves must give4 ,it is even conceivable that effective use of the knowledge gained by physical examinations of school children1 and by those responsible for school hygiene1 will require evening office hours or evening visits to homes1 and regular ,saturday office hours and ,saturday visits by school physicians and nurses4 ,finally1 it must be expected that the programme for school hygiene will need the special attention of physicians and nurses during the summer months1 and other vacation periods when children and parents alike have time to receive and to carry out their instructions4 ,one danger in ,new ,york ,city is that the board of education1 like the board of health1 when compelled to choose between so-called standard1 necessary1 traditional duty and school hygiene1 will sacrifice the latter4 ,the school authorities1 without any more funds and without physicians and nurses1 could already have made1 had they desired1 eye tests and breathing tests sufficiently accurate to detect the majority of children needing attention4 ,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 welfare1 and to increase the attention given by both to the physical condition of the child when he presents himself for registration as a wage earner4 ,,chapter ,,xxix ,,official ,,machinery ,,for ,,enforcing ,,health ,,rights ,the argument for getting things done presumes adequate active machinery1 official and private1 for doing things that schools are being urged to do4 ,the chapter on ,departments of ,school ,hygiene suggests local1 county1 state1 and national machinery necessary 7#a7 to protect the child from injuries due to school environment1 school methods1 and school curriculum2 7#b7 to getting those things done for the child at home and on the street1 need for which is disclosed by physical and vitality tests at school4 ,it is unreasonable to confine the school to the activities above outlined unless health machinery1 adequate to the demands placed upon it by school and other community needs1 is devised and kept in order4 ,generally speaking1 adequate health machinery is already provided for by city charters and by the state laws under which villages1 townships1 and counties are organized4 ,quite as generally1 however1 machinery and methods of adequate administration are undeveloped4 ,how much machinery has already been set to work by ,new ,york ,city is shown by the accompanying chart4 ,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 locality1 county1 and state4 ,even for ,new ,york it should be remembered that this chart does not include national quarantine1 the state protection of the port1 the state dairy and health commissions1 or the state and national food inspection4 ,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 health4 ,the building bureau1 tenement-house department1 board of water supply1 sewage commission1 street cleaning1 public baths and comfort stations1 the department of water1 gas1 and electricity1 and finally the department of hygiene and physical training in the public schools4 ,illustration3 ,,chart ,,showing ,,how ,,new ,,york ,,city',s ,,department ,,of ,,health ,,exercises ,,it',s ,,authority ,courtesy of ,bureau of ,municipal ,research ,five elements of adequate machinery are generally lost sight of3 #a4 ,the voter4 #b4 ,the nonvoter1 subject to health laws and often apt to violate them4 #c4 ,the mayor1 governor1 or president who appoints health officers4 #d4 ,the council1 board of aldermen1 legislature1 or congress that enacts health laws4 #e4 ,the police courts and the judiciary--police1 circuit and supreme--that decide whether society has suffered from violation of law and what penalties should be inflicted for such violation4 ,legislative bodies have hitherto slighted their responsibilities toward public health4 ,the chairman of a committee on public health of a state legislature was heard to remark1 ,i asked for that committee because there isn't a blooming thing to do4 ,if voters1 nonvoters1 and health officials will follow the suggestion of this book to secure school and health reports that will disclose community and health needs1 it will be increasingly difficult for legislators to refuse funds necessary to efficient health administration4 ,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 laws4 ,yet nothing is more obstructive of sanitary progress than the failure of magistrates to enforce adequate penalties for truancy1 adulteration of milk1 maintaining a public nuisance1 defiling the air with black smoke1 offering putrid meats for sale1 running an unclean lodging house1 defying tenement-house or factory regulations1 working children under age and overtime1 spitting in public places1 or failing to register transmissible diseases4#af ,the appointing officer cannot1 of course1 be held responsible unless voters and nonvoters know in how far his appointees are inefficient1 and in how far he himself has failed to do his utmost to secure funds necessary to efficiency4 ,too frequently appointments to health positions have been made on political grounds1 and catastrophes have been met by blundering incapacity4 ,the political appointee has been made the scapegoat1 and the appointing officer1 whether mayor1 governor1 or president1 has regained public confidence by replacing an old with a new incompetent4 ,in order to have health machinery work properly1 the appointing officer should not be allowed to shift responsibility for failure to his subordinates4 ,for example1 it was recently found in ,new ,york ,city that while the tenement-house commissioner was being condemned for failing to enforce the law1 he had turned over to the corporation counsel1 also appointed by the mayor1 for prosecution ten thousand violations to which no attention whatever had been paid6 ,the voter1 nonvoter1 appointing officer1 legislative officer1 and judicial officer determine the character and purpose of machinery and are analogous to the surveyors1 stock-holders1 directors1 and constructors who provide railroads with tracks and with running stock4 ,the actual running force of health department or railroad is what is meant by its official machinery4 ,what this machinery should be depends1 of course1 upon the amount of business to be done1 and differs with the size of the district and the character of population to be served4 ,illustration3 ,,for ,,push-,,cart ,,food1 ,,inspection ,,is ,,particularly ,,needful ,local health machinery should guarantee protection against the evils mentioned in preceding chapters4 ,in general1 one man is better than three to execute1 although three may be better than one to legislate4 ,where small communities do not wish to have the entire state sanitary code rigidly administered1 they can adopt ,new ,york's method of a legislative board of three members1 headed by an executive1 whose business it is to act1 not talk2 to watch subordinates1 and to enforce rigidly and continuously ordinances passed by the board4 ,the ,national ,bureau of ,census places under the general heading ,health and ,sanitation the following activities3 health administration1 street cleaning and refuse disposal1 sewers and sewage disposal4 ,sanitarians generally emphasize also the health significance of efficient water service4 ,a community's health programme should be clearly outlined in the annual budget4 ,where health work is given funds without specification of the kinds of work to be done1 serious evils may be overlooked and lesser evils permitted to monopolize the energies of health officers4 ,again1 after money has been voted to prevent an evil1 records should be made of work done when done1 and of money spent when spent1 so that any diversion will be promptly made known4 ,the best present guides to budget making1 to educational health reports1 and to records that show efficiency or inefficiency of health administrators are the budget and report of the department of health for ,new ,york ,city1 and the story of their evolution told in ,making a ,municipal ,budget1 by the ,bureau of ,municipal ,research4 ,to find out whether local machinery is adequate1 the reader must enumerate the things that need to be done in his community1 remembering that in all parts of the ,united ,states to-day there are sanitary laws offering protection against dangers to health1 excepting some dangers not understood until recently1 such as child labor1 dangerous trades1 lack of safety devices4 ,adequate local protection1 however1 will not become permanent until adequate state machinery is secured4 ,state health machinery should be of two kinds1--fact-gathering and executive supervision through inspection4 ,the greatest service of state boards of health is to educate localities as to their own needs1 using the experience of all communities to teach each community in how far its health administration menaces itself and its neighbors4 ,in addition to registration of contagious diseases1 facts as to deaths and births should be registered4 ,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 health4 ,when communities persist in maintaining a public nuisance and in failing to enforce health laws1 state health machinery should be made to accomplish by force what it has failed to accomplish by education4 ,illustration3 ,,national ,,machinery ,,has ,,stimulated ,,local ,,milk ,,inspection ,,and ,,state ,,dairy ,,inspection ,states alone can cope adequately with dangers to milk and water sources and to food4 ,the economic motive of farmers has developed strong veterinary boards for the protection of cattle4 ,similar executive precaution must soon be taken by cities for the protection of babies and adults of the human species4 ,it is far more economical to insure clean dairies1 clean water sources1 and wholesome manufactured foods by state inspectors than by local inspectors4 ,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 foods4 ,once tested1 it would be very easy to prove that properly supported state health authorities will save many times the cost of their health work in addition to thousands of lives4 ,county or district machinery is little known in ,america4 ,for that reason rural sanitary administration is neglected and rural hospitals are lacking4 ,in the ,british ,isles rural districts are given almost as careful inspection as are cities4 ,houses may not be built below a certain standard of lighting1 ventilation1 and conveniences4 ,outbuildings must be a safe distance from wells4 ,dairies must be kept clean4 ,patients suffering from transmissible diseases may be removed by force to hospitals4 ,what is more to the point1 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 home1 while less likely to pollute water and milk sources or otherwise to endanger health4 ,with national machinery the chapter on ,vital ,statistics has already dealt4 ,we shall undoubtedly soon have a national board of health4 ,like the state boards1 its first function should be educative4 ,in addition1 however1 there are certain administrative functions where inefficiency may result in serious losses to nation1 state1 and locality4 ,national quarantine1 national inspection of meats1 foods1 and drugs are administrative functions of vital consequence to every citizen4 ,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 life4 ,in the ,spanish ,american ,war #ad soldiers died of disease for #a killed in battle2 in the ,civil ,war #b died of disease to #a killed in battle2 during the wars of the last #bjj years #d have died of disease for #a killed in battle4 ,yet ,japan in her war with ,russia1 by using means known to the ,united ,states ,army in #ahfj1 gave health precedence over everything else and lost but #a man to disease for #d killed in battle4 ,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 ,panama4 ,the ,japanese invented nothing and had no peculiar knowledge or skill2 they merely took occidental science and used it4 ,the remarkable thing is not what they did1 but that they were allowed to do it4 ,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 means1 in case our army should have anything to do1 not only the utterly needless and useless loss of thousands of lives1 but an enormous decrease of military efficiency1 and might1 conceivably1 make all the difference between victory and defeat4 ,,footnotes3 #af ,the technic and principles of municipal engineering have been treated in detail in ,principles of ,sanitary ,science and the ,public ,health1 by ,william ,t4 ,sedgwick1 and in ,municipal ,sanitation in the ,united ,states1 by ,charles ,n4 ,chapin1 ,m4,d4 ,,chapter ,,xxx ,,school ,,and ,,health ,,reports ,for every school-teacher or school physician responsible for the welfare of children at school1 there are fifty or more parents responsible for the physical welfare of children at home4 ,therefore it is all important for parents to know how to read the index for their own children1 for their children's associates1 and for their community4 ,school reports and health reports should tell clearly and completely the story of the school child's physical needs4 ,illustration3 ,,necessary ,,to ,,efficient ,,democracy ,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 boards1 for1 with few exceptions1 little effort is made to write these reports so that they will interest the parent4 ,fortunately1 a small number of persons wishing to be intelligent can compel public officials to ascertain the necessary facts and to give them to the public4 ,so backward is the reporting of public business 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 boards4 ,generally speaking1 these published reports fail to interest the citizen1 not because officials wish to conceal1 but because officials do not believe that the public is interested4 ,a mayor of ,philadelphia once furnished a notable exception4 ,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 business4 ,a sanitary inspector who was in the room asked if ,philadelphia's business was more important than the health of ,philadelphia's citizens4 ,as a result of her impertinence the inspector was removed4 ,that same year an epidemic of smallpox spread through all the rural districts and cities of ,pennsylvania1 because physicians thought it would be kinder to the patients not to make known to their neighbors the presence of so disagreeable a disease4 ,almost all health and school authorities1 however1 can be made to see the advantage of taking the public into their confidence1 because public confidence means both public recognition and greater success in obtaining funds4 ,with more funds comes the power to do more work4 ,other details with regard to health reports will be found in the chapter on ,vital ,statistics4 ,as to school reports1 little thought has been given in the past to their educational possibilities4 ,a book was recently published--,school ,reports and ,school ,efficiency--by the ,committee on the ,physical ,welfare of ,school ,children1 which tells the origins of school reports2 contains samples of reports from one hundred cities2 gives lists of questions frequently answered1 occasionally answered1 and never answered2 and shows how to study a particular report so as to learn whether or not important questions are answered4 ,the ,united ,states commissioner of education has organized among state and city superintendents special committees on uniform and adequate reporting4 ,his aggressive leadership is welcomed by school men generally1 and promises vast benefits4 ,just because the physical welfare of the school child is an index to health needs1 the school report can put into one statement for a city or a state the story told by the index4 ,the accompanying card tells facts that the individual teacher and individual parent want to know about a child1 what a superintendent wants to know about all children1 and what a community wants to know about all children4 ,a modification of this card will soon be adopted in ,new ,york ,city4 ,it is both a card index and a card biography of the individual boy or girl4 ,it is expected to follow the child from class to class1 each teacher telling the story of his physical welfare and his progress4 ,when the boy goes to a new school or new grade1 his new teacher can see at a glance not only what subjects have given him trouble1 but what diseases or physical defects have kept him out of school or otherwise retarded his progress4 ,with this card it is easy to take a hundred children of the same age and the same grade1 to put down in one column those who have eye defects1 and in another those who have no eye defects1 for every school1 every district1 and for the schools as a whole4 ,schools that use these record cards are enabled1 by thus classifying the total1 to learn where the defects of children are1 how serious the problem is1 how many days children lose from school because of preventable defects1 and in what section of the city the defects are most prevalent4 ,the mere reporting of facts will stimulate teachers1 principals1 and parents to give attention4 ,for example1 assume a table3 ,,field ,,of ,,inspection ,total number of public schools #g ,public schools under inspection #c ,public schools not under inspection #d ,the reader wonders why four schools are neglected and which particular schools they are4 ,let the next table read3 ,,examination ,total registration in all schools #aejj ,number of children examined #ejj ,number of children not examined #ajjj ,parents begin to wonder whether or not their children were examined1 and why the taxes spent for school examination of all children go to one third of the children4 ,the next table arrests attention3 ,,treatment ,number needing treatment #bjj ,number known to have been treated #ej ,number not known to have been treated #aej ,we ask1 at once1 if examination is worth while1 and if treatment really corrects the defects1 saves the pupil's time and teacher's time1 discovers many defects2 and we want to find out whether the one hundred and fifty reported not treated have since been attended to4 ,illustration3 ,,pupil',s ,,record ,illustration3 ,,department ,,of ,,health ,,city ,,of ,,new ,,york ,,report ,again1 if three out of five of those examined need treatment1 people will wonder whether among the thousand not examined there is the same proportion--three out of five1 or six hundred--who have some trouble that needs attention4 ,having begun to wonder1 they will ask questions1 and will expect the board of health or the school physicians to see that the questions are answered4 ,as has been proved in ,new ,york1 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 policies4 ,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 health3 ,,table ,,xii ,,prevalence ,,of ,,contagious ,,diseases ,,in ,,school ,,children 7,case rate schools7 ,,key3 ,a3 ,in ,school ,b3 ,among ,absentee ,,communicable ,,general ,,communicable ,,diseases#a ,,diseases ,,of ,,eye ,,school ,,and ,,skin#b ---------------------------------------- --------------------- ,,number -------------------------- ,number per ,number ,found by ,reported #ajjj ,number per #ajjj ,inspectors by ,registeredfound by ,registered --------- ,attending in ,schools,inspectorsin ,schools ,a ,b ,physician ,total ,inspected and ,nurses,inspected ---------------------------------------- -------------------------- ,a ,b ,c #a ,smallpox1 diphtheria1 scarlet fever1 measles1 chicken pox1 mumps1 and whooping cough2 excluded when found4 #b ,trachoma and other contagious eye diseases1 ringworm1 impetigo1 scabies1 favus1 and pediculosis2 excluded only for persistent nontreatment4 ,another table shows the following facts for each disease3 ,,table ,,xiii ,,contagious ,,diseases ,,found ,,in ,,schools ,,by ,,inspectors ,,and ,,nurses 7,number and disposition of cases7 ,,key3 ,a3 ,diphtheria ,j3 ,other ,b3 ,scarlet fever ,k3 ,ringworm ,c3 ,measles ,l3 ,impetigo ,d3 ,smallpox ,m3 ,scabies ,e3 ,chicken pox ,n3 ,favus ,f3 ,whooping cough ,o3 ,pediculosis ,g3 ,mumps ,p3 ,miscellaneous ,h3 ,total ,q3 ,total ,i3 ,trachoma ,,general ,,communicable ,,diseases ,,communicable ,,of ,,eye ,,and ,,skin ,,diseases -------------------------- ,,eye ,,skin ----------------------------------- ,a ,b ,c ,d ,e ,f ,g ,h ,i ,j ,k ,l ,m ,n ,o ,p ,q ---------------------------------------- -------------- ,cases found in school ,cases excluded from school ,cases treated in school ,cases instructed in school or evidence of treatment furnished ,number of treatments ,number of instructions ,the story of noncontagious physical defects found and treated is set forth in the following table3 ,,table ,,xiv ,,medical ,,examination ,,of ,,school ,,children3 ,,noncontagious ,,physical ,,defects ,,found ,,and ,,treated1 #aijf ,,school ,a ,,school ,b ---------------------------------------- ---------------- ,found ,reported ,found ,reported ,treated ,treated ---------------------------------------- ------------ ,,defects ,no4 of ,no4 of ,no4 of ,no4 of ,total ,defects ,total ,defects ,defects ,found ,defects ,found ,found ,found ---------------------------------------- -------------------------- ,adenoids ,nasal breathing ,hyper-trophied tonsils ,defective palate ,defective hearing ,defective vision ,defective teeth ,bad nutrition ,diseased anterior cervical glands ,diseased posterior cervical glands ,heart disease ,chorea ,pulmonary disease ,skin disease ,deformity of spine ,deformity of chest ,deformity of extremities ,defective mentality ,total ,,school ,c ---------------------------- ,found ,reported ,treated -------------------------- ,,defects ,no4 of ,no4 of ,total ,defects ,defects ,found ,found ---------------------------------------- ,adenoids ,nasal breathing ,hyper-trophied tonsils ,defective palate ,defective hearing ,defective vision ,defective teeth ,bad nutrition ,diseased anterior cervical glands ,diseased posterior cervical glands ,heart disease ,chorea ,pulmonary disease ,skin disease ,deformity of spine ,deformity of chest ,deformity of extremities ,defective mentality ,total ,the effect of a report telling what schools have enough seats1 proper ventilation1 adequate medical inspection1 safe drinking water1 ample play space1 and what schools are without these necessities is to cause the reader to rank the particular school that he happens to know2 i4e4 he says1 ,school ,a is better equipped than ,school ,b2 or1 ,school ,c is neglected4 ,county and state superintendents in many states have acquired the habit of ranking schools according to the number of children who pass in arithmetic1 algebra1 etc4 ,it would greatly further the cause of public health and1 at the same time1 advance the interest of education if state superintendents would rank individual schools1 and if county superintendents would rank individual schools1 according to the number of children found to have physical defects1 the number afflicted with contagious diseases1 and the number properly treated4 ,it is difficult to compare one school with another1 because it is necessary to make subtractions and divisions and to reduce to percentages4 ,it would not be so serious for a school of a thousand pupils as for a school of two hundred1 to report #ajj for adenoids4 ,to make it possible to compare school with school without judging either unfairly1 the state superintendent of schools for ,connecticut has made tables in which cities are ranked according to the number of pupils1 average attendance1 per capita cost1 etc4 ,as to each of these headings1 cities are grouped in a manner corresponding to the line up of a battalion1 according to height4 ,a general table is then shown1 which gives the ranking of each city with respect to each important item4 ,applied to schools1 this would work out as follows3 ,,table ,,xv ,,table ,,of ,,ranking-,,schools ,,arranged ,,alphabetically ,,school ,,rank ,,in ---------------------------------------- ---------------- ,register ,defects ,children ,children ,children ,found ,needing ,treated not ,treatment ,treated ---------------------------------------- ---------------- ,a #aj #aa #aa #ab #f ,b #bj #bb #bb #bd #ab ,c #cj #cc #cj #cf #ah ,such a table fails to convey its significance unless the reader is reminded that rank #ah in children not treated is as good a record for a school that ranks #cj in register as is rank #f for a school that ranks #aj in register4 ,the ,connecticut report makes a serious mistake in failing to arrange schools according to population4 ,if this were done1 schools of a size would be side by side and comparison would be fair4 ,when1 as in the above table1 schools are arranged alphabetically1 a school with four thousand pupils may follow or precede a school with four hundred pupils1 and comparison will be unfair and futile4 ,where1 on the other hand1 schools are arranged in order of register1 a table will show whether schools confronted with practically the same problems1 the same number of defects1 the same number of children needing treatment1 are equally successful1 or perhaps equally inactive1 in correcting these defects4 ,the following table brings out clearly marked unequal achievement in the face of relatively equal need4 ,,table ,,xvi ,,table ,,of ,,ranking-,,schools ,,arranged ,,according ,,to ,,register1 ,,not ,,alphabetically ,,rank ,,in ,,school ---------------------------------------- --------- ,register ,defects ,children ,children ,children ,found ,needing ,treated not ,treatment ,treated ---------------------------------------- ---------------- ,a #i #i #i #i #i ,x #aj #aj #aj #ad #f ,h #aa #aa #aa #ag #c ,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 school1 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 interested4 ,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 are1 what penalties are paid for want of them1 and what benefits would result from obtaining them4 ,if health needs of school children were placed side by side with mental results1 the relation would come out so clearly that parents1 school boards1 and taxpayers would realize how inextricably they are bound together and would see that health needs are satisfied4 ,to this end superintendents should require teachers to keep daily reports of school conditions4 ,,table ,,xvii ,,weekly ,,class-,,room ,,schedule ,temperature ,cleaning ,exercise ---------------------------------------- ---------- ,in ,out of #aj4cjab4jj #b4jj ,dry ,wet ,disinfecting ,room ,room ---------------------------------------- -------------------- ,monday ,tuesday ,wednesday ,thursday ,friday ,the teacher's daily report of the temperature of a schoolroom1 taken three times a day1 tells the parent exactly what is the efficiency of the ventilating and heating apparatus in the particular school in which he is interested2 whereas the report of the department of buildings gives only the number of schools which have an approved system of ventilation and steam heat4 ,school authorities may or may not know that this system of ventilation is out of order1 that the thermometer in the indoor playground of ,school ,a stood at forty degrees for many days in winter4 ,but they must know it when the principal of ,school ,a sends in a daily record2 the school board1 the parents1 or the press will then see that the condition is remedied4 ,if the condition is due to lack of funds1 funds will never be forthcoming so long as the condition is concealed4 ,similar results will follow publicity of overcrowding1 too little play space1 dry cleaning of school buildings1 etc4 ,the intent of such reporting is not to keep tabs on the school-teacher1 the school child1 the janitor1 the principal1 superintendent1 or board1 but to insure favorable conditions and to correct bad conditions4 ,this is done best by giving everybody the facts4 ,the objective test of the efficiency of a method throws emphasis on the method1 not on the motive of those operating it4 ,the blackboard method of publishing facts concentrates attention upon the importance of those facts and enlists aid in the attainment of the end sought4 ,,chapter ,,xxxi ,,the ,,press ,the president of ,princeton ,university declares that for several decades we have given education that does not instruct and instruction that does not educate4 ,others tell us that because we read daily papers and magazines our minds become superficial1 that our power to concentrate or memorize is weakened1--that we read so much of everything that we learn little of anything4 ,as the habit of reading magazines and newspapers is constantly increasing1 ,i think we must assume that it has come to stay4 ,if we cannot check it1 we can at least turn it to good advantage1 systematize it1 and discipline ourselves4 ,among the subjects continually described in newspapers and magazines1 and even on billboards and in street-car advertising1 is the subject of hygiene4 ,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 health1 to separate misinformation from information1 and to apply the lessons learned to personal and public hygiene4 ,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 health1 and then to classify these under the subject-matter treated4 ,a teacher1 parent1 or club leader might practice by using the classification of subjects outlined in the ,contents of this book4 ,it is surprising how rapidly one builds up a valuable collection serviceable for talks or papers1 but more particularly for giving one a vital and intelligent interest in practical health topics4 ,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 circulation1 ,i made during one week thirty-eight clippings from the three-cent paper and ninety-five from the penny paper4 ,the high-priced paper had no editorial comment within the field of health1 whereas the penny paper had three columns1 in which were discussed among other things3 ,the ,economics of ,bad ,teeth2 ,need for ,individual ,efficiency2 ,good ,fellows ,lower ,standard of ,living by ,neglecting their ,families4 ,the penny paper advertised fifty-two foods1 garments1 whiskies1 patent medicines1 or beautifiers urged upon health grounds4 ,in the three-cent paper twenty-six out of thirty-eight items advertised food1 clothing1 patent medicine1 or whisky4 ,one issue of a monthly magazine devoted to woman's interests contained twenty-eight articles and editorials and fifty-five advertisements that concern health1--thirty-seven per cent of total reading matter and thirty-seven per cent of total advertisement4 ,excellent discipline is afforded by this clipping work4 ,it is astonishing how few men and women1 even from our better colleges1 know how to organize notes1 clippings1 or other data1 so that they can be used a few weeks later4 ,there is a satisfaction in seeing one's material grow1 as is remembered by all of us1 in making picture scrapbooks or collections of picture postal cards and stamps4 ,collections have generally failed for want of classification1--putting things of a kind together4 ,chronological arrangement is uninteresting because unprofitable4 ,one never knows where to find a picture1 or a stamp1 or a health clipping4 ,clippings1 like libraries1 will be little used if not properly catalogued so that use is easy4 ,if a health-clipping collection is attempted1 there are four essentials3 7#a7 arrangement by topic2 7#b7 inclusion of advertisements2 7#c7 inclusion of items from magazines2 7#d7 cross references4 ,for classification1 envelopes can be used or manila cards #ajab inches4 ,the teacher1 parent1 or advanced student will probably think the envelope most useful because most easily carried and filed1--most likely to be used4 ,but clippings should be bound together in orderly appearance1 or else it will be disagreeable working with them4 ,children1 however1 will like the pasting on sheets1 which show clearly the growth of each topic4 ,envelopes or cards should not have clippings that deal with only one health topic4 ,unless a test is made to see how many health references there are in a given period1 it should be made a rule not to clip any item that does not contain something new1--some addition to the knowledge already collected4 ,advertisements will prove interesting and educative4 ,when newspapers and magazines announce some new truth1 the commercial motive of manufacturer or dealer sees profit in telling over and over again how certain goods will meet the new need4 ,children will soon notice that the worst advertisements appear in the papers that talk most of popular rights1 justice1 and morality4 ,they will be shocked to see that the popular papers accept money to tell falsehoods about fake cures4 ,they will be pleased that the best monthly magazines contain no such advertisements4 ,they will challenge paper or magazine1 and thus will be enlisted while young in the fight against health advertisements that injure health4 ,to clip articles from magazines will seem almost irreverent at first4 ,but the reverence for magazines and books is less valuable to education than the knowledge concealed in them4 ,except where families preserve all magazines1 clippings will add greatly to their serviceability4 ,the art of cross-referencing is invaluable to the organized mind4 ,the purpose of classifying one's information is not to show how much there is1 but to answer questions quickly and to guide constructive thinking4 ,a clipping that deals with alcoholism1 patent medicine1 and tuberculosis must be posted in three places1 or cross-referenced2 otherwise it will be used to answer but one question when it might answer three4 ,if magazines may not be cut1 it will be easy to record the fact of a useful article by writing the title1 page1 and date on the appropriate index card1 or inclosing a slip so marked in the proper envelope4 ,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 it1 there are a number of health journals that one can profitably subscribe for4 ,in fact1 it is often true that the significant discoveries in scientific fields1 or the latest public improvements1 such as parks1 bridges1 model tenements1 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 conditions4 ,the physician and nurse in their educational work for hospitals are distributors of health propaganda4 ,wherever there is a local journal devoted to health1 parents1 teachers1 educators1 and club leaders would do well to subscribe and to hold this journal up to a high standard by quoting1 thanking1 criticising it4 ,in ,new ,jersey1 for example1 is a monthly called the ,new ,jersey ,review of ,charities and ,corrections that deals with every manner of subject having to do with public health as well as with private and public morality and education4 ,a similar journal1 intended for national instruction1 is ,the ,survey1 whose topical index for last year enumerates two hundred and thirty-two articles dealing with subjects directly connected with public hygiene1 e4g43 ,schools1 #f2 school inspection1 #c2 eyes1--school children1 #a2 sex instruction in the schools1 #b2 psychiatric clinic1 special children1 #b2 industrial education1 #e2 child labor1 #ah2 playgrounds1 #bf2 alley1 crap1 playing in streets1 #c2 labor conditions1 #ah2 industrial accidents1 #aj2 wage-earner's insurance1 #d2 factory inspection1 #a2 consumer's league1 #c2 women's work1 #f2 tuberculosis1 #bc2 hospitals1 dispensaries 7social71 #e2 tenement reform1 #aj2 living conditions1 #b2 baths1 #a2 public comfort stations1 #b2 lodging houses1 #a2 clean streets1 #f2 clean milk1 #f2 smoke1 #a2 noises1 #a2 parks1 #a2 patent medicines1 #b2 sanitary code1 #a2 mortality statistics1 #b2 social settlements and public health1 #a2 midwives1 #a2 children's bureau1 #a2 juvenile and adult delinquent1 #be2 dependent1 defective1 and insane1 #g2 blind1 #e2 cripples1 #a2 homes for aged1 #a2 inebriates1 #c2 ,traveler's ,aid ,committee1 #a2 infant mortality1 #b2 social diseases1 #b4 99 99 99 99 99 ,the ,national ,hospital ,record1 the ,dietetic and ,hygienic ,gazette1 the ,journal of ,nursing1 are three other magazines primarily intended for nurses and physicians1 but full of suggestive material for unprofessional readers4 ,national magazines concerned with health1 but seeking popular circulation1 are ,good ,health and ,physical ,culture4 ,in ,england there is a special magazine called ,children's ,diseases1 which could be of great help to a school library for special reference4 ,the same can be said of the ,psychological ,clinic1 ,pediatrics1 and other technical journals published in this country4 ,for many persons1 to make the best use of any one copy of these magazines1 clipping is of course impossible1 but noting on a card or envelope is practicable4 ,of late many of the national popular magazines have several columns devoted to health4 ,we have not appreciated the educational possibilities of these columns4 ,in most large cities there are monthly book reviews which may be profitably consulted in learning the new thought in the health field4 ,if teachers would either write their experience or ask questions1 if children knew that in a certain magazine or newspaper questions as to ventilation1 bathing1 exercise1 would be answered1 they would take a keen interest in the progress of discussions4 ,the large daily papers make a great feature of their health hints4 ,it is not their fault if questioners care more about cosmetics and hair bleaches than about the fresh-air cure of headaches4 ,they will coperate with teachers and parents in securing more general discussion of other problems than beauty doctoring4 ,finally1 persons wanting not only to have intelligence as to matters promoting health1 but actually to exert a helpful influence in their community1 ought to want the published reports of the mayor1 health department1 the public schools1 and other institutions1 noting carefully all that is said about conditions relating to health and about efforts made to correct all unfavorable conditions4 ,the best literature of our day1 with regard to social needs1 appears in the reports of our public and private institutions and societies4 ,of increasing value are the publications of the national government printing office4 ,because it is no one's business to find out what valuable material is contained in such reports1 and because no educational museum is comparing report with report1 those who live nearest to our health problems and who see most clearly the health remedies1 are not stimulated to give to the public their special knowledge in an interesting1 convincing way4 ,teaching children how to find health lessons in public documents will advance the cause of public ethics as well as of public health4 ,at the ,new ,york ,state ,conference of ,charities1 of #aijg1 one official complained that the physicians made no educational use of their valuable experience for public education4 ,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 service4 ,this state of affairs is even more exaggerated in strictly educational institutions4 ,columbia ,university has recently instituted a series of lectures to be given by its professors to its professors1 so that they may have a general knowledge of the work being done in other fields besides their own at their own university4 ,this is equally important for teachers and heads of departments in elementary schools4 ,it is now admitted by most educators that elementary schools and young children present more pedagogical difficulties and pressing biological problems than higher schools4 ,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 teachers1 their spirit of coperation would soon be reflected in school journals1 popular magazines1 and daily newspapers4 ,,part ,v4 ,,alliance ,,of ,,hygiene1 ,,patriotism1 ,,and ,,religion ,,chapter ,,xxxii ,,do-,,nothing ,,ailments ,men have died1 from time to time1 and worms have eaten them1 but not for love--nor for work4 ,work of itself never killed anybody nor made anybody sick4 ,work has caused worry1 mental strain1 and physical breakdown1 only when men while working have been deprived of air1 sun1 light1 exercise1 sleep1 proper food at the proper time1 opportunity to live and work hygienically4 ,fortunately for human progress1 doing nothing brings ailments of its own and has none of the compensations of work4 ,as the stomach deprived of substantial food craves unnatural food1--sweets1 stimulants1--so the mind deprived of substantial1 regular diet of wholesome work turns to unwholesome1 petty1 fantastic1 suspicious1 unhappy thoughts4 ,this state of mind1 combined with the lack of bodily exercise that generally accompanies it1 reacts unfavorably on physical health4 ,an editor has aptly termed the do-nothing condition as a self-inflicted confinement3 ,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 jail4 ,they have nothing to do but eat1 drink1 and enjoy themselves1 and they cannot understand why their lives are dull4 ,we have had the owner of a great railroad system pathetically telling the public that he is unhappy4 ,that is undoubtedly true1 because with all his race horses1 and his yachts1 and all the things that he imagines to be pleasures1 he is not really doing anything4 ,if he were running one little railroad station up the road1 handling the freight1 fussing about dispatches1 living above the railroad station in two rooms1 and buying shoes in a neighboring village for fifteen children he would be busy and happy4 ,but he cannot be happy because he is in prison1--in a prison of money1 a prison that is honorable because it gives him everything that he wants1 and he wants nothing4 ,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 ,jim1 the richest dog in the world4 ,dandy ,jim's mistress left him a ten-thousand-dollar legacy4 ,during his lifetime he wore diamonds4 ,every day he ate candy that cost eighty cents a pound4 ,the coachman took him driving in the park sunny afternoons4 ,he had no cares and nothing to work for4 ,his food came without effort4 ,he had fatty degeneration of the vital organs4 ,he was pampered1 coddled1 and killed thereby4 ,thousands of men and women drag out lives of unhappiness for themselves and others because1 like ,dandy ,jim1 they have nothing to work for1 are pampered1 coddled victims of fatty degeneration4 ,when ,president ,butler of ,columbia ,university finds it necessary to censure the folly and indifference of the fathers1 vanity and thoughtless pride of the mothers who encourage do-nothing ailments2 and when the editor of the ,psychological ,clinic protests that the fashionable private schools and the private tutor share with rich fathers and mothers responsibility for life failures1--it is time that educators teach children themselves the physical and moral ailments and disillusions that come from doing nothing4 ,ten years ago a stenographer inherited two hundred and fifty thousand dollars4 ,her dream of nothing to do was realized4 ,she gave up her strenuous business life4 ,possessions formerly coveted soon clogged her powers of enjoyment4 ,she imagined herself suffering from various diseases1 shut herself up in her house1 and refused to see any one4 ,she grew morbid and was sure that every person who approached her had some sneaking1 personal1 hostile motive4 ,though always busy1 she accomplished little4 ,desultory work1 procrastination1 and self-indulgence destroyed her power of concentration4 ,she could not think long enough on one subject to think it out straight1 therefore she was constantly deceived in her friends and interests4 ,she first trusted everybody1 then mistrusted everybody4 ,infatuation with every new acquaintance was quickly followed by suspicion4 ,for years she was a very sick woman1 a victim of do-nothing ailments4 ,doing nothing has of late been seriously recommended to ,american business men4 ,they are advised to retire from active work as soon as their savings produce reasonable income4 ,it is true1 this suggestion has been made as an antidote to greed rather than for the happiness of the business man4 ,what retiring from business is apt to mean1 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 life4 ,he became restless and very miserable4 ,he threw himself violently into one thing after another2 in less than a year he became an ill1 broken old man1 after trying vainly to buy back his business4 ,both mind and body were made to work4 ,the function of the brain is to think to a purpose1 just as the function of the heart is to pump blood4 ,the habit of doing nothing is very easily formed4 ,the out-of-work soon become the work-shy4 ,having too little to do is worse for the body and mind than having too little to eat4 ,social reformers emphasize the bad effect on society of vagrancy4 ,evils of indiscriminate relief to the poor are vividly described year after year4 ,the philanthropist is condemned1 who1 by his gifts1 encourages an employee's family to spend what they do not earn1 and to shun work4 ,yet the idleness of the tramp1 street loafer1 and professional mendicant is a negligible evil compared with the hindrance to human progress caused by the idleness of the well-to-do1 the rich1 the educated1 the refined1 the best people4 ,it is as much a wrong to bring up children in an atmosphere of do-nothingism1 as to refuse to have their teeth attended to or to have glasses fitted to weak eyes4 ,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 charge4 ,not only has society a right to expect more from rich children in return for the greater benefits they enjoy1 but so long as rich children control the expenditure of money1 they control also the health and happiness of other human beings4 ,unless taught the value and joy of wholesome work they cannot themselves think straight1 nor are they likely to want to understand how they can use their wealth for the benefit of mankind4 ,to quote ,president ,butler again3 ,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 account1 just as now by the neglect1 or worse1 of his parents the very rich boy is apt to be relegated to the limbo of curiosities1 and too often of decadence4 ,nervous invalids make life miserable for themselves and for others1 when often their sole malady is lack of the right kind of work to do4 ,suiting work to interest and interest to work is an economy that should not be overlooked4 ,the energy spent in forcing oneself to do a distasteful task can be turned to productive channels when work is made pleasurable4 ,the fact is frequently deplored that whereas formerly a man became a full-fledged craftsman1 able to perform any branch of his trade1 he is now confined to doing special acts because neither his interest nor his mind is called into play4 ,work seems to react unfavorably on his health4 ,he has not the pride of the artisan in the finished product1 for he seldom sees it4 ,he does a task4 ,his employer is a taskmaster4 ,he decides that work is not good for him as easily as when a school-boy he grasped the meaning of escape from his lessons4 ,by failing to fit studies to a student's interest1 or by failing to insure a student's interest in his studies1 schools and colleges miseducate young men and young women to look upon all work as tasks1 as discipline1 necessary but irksome1 and to be avoided if possible4 ,just as there is a way of turning all the energy of the play instinct into school work1 so there is a way of interesting the factory and office worker in his job4 ,however mechanical work may be1 there is always the interest in becoming the most efficient worker in a room or a trade4 ,routine--accurate and detailed work--does not mean the stultification of the imagination4 ,it takes more imagination to see the interesting things in statistical or record work than to write a novel4 ,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 part4 ,the other day a father said to me1 ,i want my boys to be as ashamed to do work in which they are not interested as to accept graft4 ,when interest in work and efficiency in work are regarded as of more importance than the immediate returns for work1 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 the ,stars and ,stripes1 do-nothing ailments will be less frequent and less costly4 ,work--that one enjoys--is an invaluable unpatented medicine4 ,it can make the sick well and keep the well from getting sick4 ,it is the chief reliance of mental hygiene4 ,i should have the grippe if ,i had time1 said a business woman to me the other day2 but she did not have time1 hence she did not have the grippe4 ,if you're sick with something chronic1 ,and you think you need a tonic1 ,do something4 ,there is life and health in doing1 ,there is pleasure in pursuing2 ,doing1 then1 is health accruing-- ,do something4 ,and if you're seeking pleasure1 ,or enjoyment in full measure1 ,do something4 ,idleness1 there's nothing in it2 ',twill not pay you for a minute-- ,do something4 ,,chapter ,,xxxiii ,,heredity ,,bugaboos ,,and ,,heredity ,,truths ,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 consumption4 ,for years ,i had known that ,i was a marked victim4 ,silently ,i carried my tragedy1 suspecting each cold and headache to be the telltale messenger that should let others into my secret4 ,he was a veritable emancipator who informed me that heredity did not work from uncle to nephew2 that not more than a predisposition to consumption could pass even from parent to child2 that a predisposition to consumption would come to nothing without the germ of the disease and the environmental conditions which favor its development2 and that if those so predisposed avoid gross infection1 lead a healthy life1 and breathe fresh air they are as safe as though no tuberculous lungs had ever existed in the world4 ,some years later ,i learned to understand the other side of the case2 ,i realized how ,i had been in real danger of contracting consumption in the darkened1 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 boys4 ,there are two distinct things which make each individual life3 the living stuff1 the physical basis of life1 handed down from parent to child2 and the environmental conditions which surround it and play upon it and rouse its reactions and its latent possibilities4 ,it is like the seed and the cultivation4 ,you cannot grow corn from wheat1 but you can grow the best wheat1 or you may let your crop fail through careless handling4 ,it is well that we should think seriously about the part played by heredity1 for the living stuff of the future depends upon our sense of responsibility in this regard4 ,the intelligent citizen would do well to read such a book as ,j4 ,arthur ,thompson's ,heredity 7#aijh71 in which the latest conclusions of science are clearly and soundly set forth4 ,the main problem of to-day1 however1 is to use well the talents that we have4 ,here two things should always be kept in mind3 ,first1 the inherited elements which make up our minds and bodies are complex and diverse4 ,health and strength are inherited as well as disease and weakness2 they have indeed a better chance of survival4 ,in the most unpromising ancestry there are latent potentialities which may be made fruitful by effort4 ,no limit whatever can be set to the possibilities of improvement in any individual4 ,in the second place1 if science has shown anything more clearly than the importance of heredity1 it is the importance of environment4 ,this influence upon human lives is within our control1 and it is a grave error to neglect what lies clearly within our power and to bemoan what does not4 ,science has wrought no benefits greater than those which result from drawing a clear line between heredity bugaboos and heredity truths4 ,an overemphasis on the hereditary factor in development at the expense of the environmental factor1 ,i call a heredity bugaboo2 and it is a tendency which cannot be too strongly condemned4 ,to fight against the sins and penalties of one's grandfather is a forlorn task that quickly discourages4 ,to overcome diseases of environment1 of shop and street1 of house and school1 seems1 on the contrary1 an easy task4 ,heredity bugaboos dishearten1 enervate1 encourage excesses and neglect4 ,heredity truths stimulate remedial and preventive measures4 ,we may well watch with interest the progress of eugenics1 that new science which biologists and sociologists hope will some day remake the very living stuff of the human race4 ,but meanwhile let us take up with hope and courage and enthusiasm the great hemisphere of human fate which lies within our grasp4 ,good food and fresh air1 well-built cities1 enlightened schools and well-ordered industries1 stable and free and expert government1--given these things1 we can transform the world with the means now at our disposal4 ,we can reap1 if we will1 splendid possibilities now going to waste1 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 ours4 ,physical deterioration is a bugaboo that is discovered by some in heredity and by others in modern industrial evils4 ,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 unfit4 ,a ,commission on ,physical ,deterioration was appointed to investigate the cause1 and to learn whether the low physical standard of the would-be ,tommy ,atkins was due to inherited defects4 ,the results of this study were published in a large volume called ,report on ,physical ,deterioration1 #aijd1 in which is set forth a positive programme for obtaining periodically facts as to the physique of the nation4 ,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 teeth4 ,there are happily no grounds for associating dental degeneracy with progressive physical deterioration4 ,the increase in optical defects is attributed not to the deterioration of the eye1 but to greater knowledge1 more treatment1 and better understanding of the connection between optical defects and headache4 ,illustration3 ,testing ,environment--,house ,score ---------------------------------------- ---------------------------- ,,definitions ,,of ,,terms ,,used ,,in ,,house ,,score ,,card ,,light--,light enough to read easily in every part4 ,,gloomy--,not light enough to read easily in every part1 but enough readily to see one's way about when doors are closed4 ,,dark--,too dark to see one's way about easily when doors are closed4 ,,well ,,ventilated--,with window on street or fair-sized yard 7not less than #ab ft4 deep for a five-story tenement house not on a corner71 or on a large1 well-ventilated court open to the sky at the top3 large being for a court entirely open on one side to the street or yard in a five-story tenement1 not less than #f ft4 wide from the wall of the building to the lot line2 for a court inclosed on three sides and the other on the lot line in a five-story tenement1 not less than #abbd ft41 well ventilated meaning either entirely open on one side to the street or yard1 or else having a tunnel at the bottom connecting with the street or yard4 ,,fairly ,,ventilated--,with window opening on a shallow yard or on a narrow court1 open to the sky at the top1 or else with #ec inside window 7#ae ft4 square7 opening on a well-ventilated room in same apartment4 ,,badly ,,ventilated--,with no window on the street1 or on a yard1 or on a court open to the sky1 and with no window1 or a very small window1 opening on an adjoining room4 ,,in ,,good ,,repair--,no torn wall paper1 broken plaster1 broken woodwork or flooring1 nor badly shrunk or warped floor boards or wainscoting1 leaving large cracks4 ,,in ,,fair ,,repair--,slightly torn or loose wall paper1 slightly broken plaster1 warped floor boards and wainscoting4 ,,in ,,bad ,,repair--,very badly torn wall paper or broken plaster over a considerable area1 or badly broken woodwork or flooring4 7,rooms not exactly coinciding with any of the three classes are to be included in the one the description of which comes nearest to the condition47 ,,sinks3 ,,good--,iron1 on iron supports with iron back above to prevent splashing of water on wall surface1 in light location1 used for one family4 ,water direct from city water mains or from a ,,clean roof tank4 ,,bad--,surrounded by wood rims with or without metal flushings1 space beneath inclosed with wood risers2 dark location1 used by more than one family2 water from dirty roof tank4 ,,fair--,midway between above two extremes4 7,sinks not exactly coinciding with any of the three classes are to be included in the one the description of which comes nearest to the condition47 ,,water-,,closet3 ,,good--,indoor closet4 ,in well lighted and ventilated location1 closet fixture entirely open underneath1 abundant water flush4 ,,fair--,indoor closet1 poor condition--badly lighted and ventilated location1 fixture inclosed with wood risers1 or poor flush4 ,,poor--,yard closet--separate water-closet in individual compartment in the yard4 ,,bad--,school sink--sewer-connected privy1 having one continuous vault beneath the row of individual toilet compartments4 ---------------------------------------- ---------------------------- ,the commission hoped that the facts and opinions they have collected will have some effect in allaying the apprehensions of those who1 as it appears1 on insufficient grounds1 have made up their minds that progressive deterioration is to be found among people generally4 ,in regard to the facts which started the fear1 the report says3 7#a7 the evidence adduced in the director general's memorandum was inadequate to prove that physical deterioration had affected the classes referred to2 7#b7 no sufficient material 7statistical or other7 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 times4 ,illustration3 ,,the ,,best ,,inheritance ,,is ,a ,,mother ,,who ,,knows ,,how ,,to ,,keep ,,her ,,baby ,,well ,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 us3 ,i4 ,,as ,,to ,,babies ,training of mothers1 provident societies and maternity funds1 feeding of infants1 milk supply1 milk depots1 sterilization and refrigeration of milk1 effect of mother's employment upon infant mortality1 still births1 cookery1 hygiene and domestic economy1 public nurseries1 crches4 ,,ii4 ,,as ,,to ,,children ,anthropometric measurements1 sickness and open spaces1 medical examination of school children1 teeth1 eyes1 and ears1 games and exercises for school children1 open spaces and gymnastic apparatus1 physical exercise for growing girls and growing boys1 clubs and cadet corps1 feeding of elementary school children1 partial exemption from school1 special schools for retarded children1 special magistrate for juvenile cases1 juvenile smoking1 organization of existing agencies for the welfare of lads and girls1 education1 school attendance in rural districts1 defective children4 ,,iii4 ,,as ,,to ,,living ,,and ,,working ,,conditions ,register of sickness1 medical certificates as to causes of death1 overcrowding1 building and open spaces1 register of owners of buildings1 unsanitary and overcrowded house property1 rural housing1 workshops1 coal mines1 etc41 medical inspection of factories1 employment of women in factories1 labor colonies1 overfatigue1 food and cooking1 cooking grates1 adulteration1 smoke pollution1 alcohol1 syphilis1 insanity4 ,,iv4 ,,as ,,to ,,health ,,machinery ,medical officers of health1 local1 district1 and national boards1 health associations4 ,scientists of the next generation will continue to differ as to heredity truths and heredity bugaboos unless records are kept now1 showing the physical condition of school children and of applicants for work certificates and for civil service and army positions4 ,the ,british investigators declared that anthropometric records are the only accredited tests available1 and1 if collected on a sufficient scale1 they would constitute the supreme criterion of physical deterioration1 or the reverse4444 ,the school population and the classes coming under the administration of the ,factory ,acts offer ready material for the immediate application of such tests4 ,in addition to the physical tests proposed in other chapters1 there is great educational opportunity in the records of private and public hospitals4 ,every nation1 every state1 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 parenthood1 and the environmental deficiencies that can be avoided by efficient health machinery4 ,the greatest of all heredity truths are these3 7#a7 the deficiencies of infants are infinitesimal compared with the deficiencies of the world with which we surround them2 7#b7 each of us can have a part in begetting for posterity an environment of health and of opportunity4 ,,chapter ,,xxxiv ,,ineffective ,,and ,,effective ,,ways ,,of ,,combating ,,alcoholism ,wherever the ,stars and ,stripes fly over school buildings it is made compulsory to teach the evils of alcoholism4 ,for nearly a generation the great majority of school children of the ,united ,states have been taught that alcohol1 in however small quantities1 is a poison and a menace to personal and national health and prosperity4 ,yet during this very period the per capita consumption of every kind of alcoholic beverage has increased4 ,whereas #af4di gallons of spirituous liquors were consumed per capita of population in #ahif1 #bb4bg gallons were used in #aijf4 ,obviously the results of methods hitherto in vogue for combating alcoholism are disappointing4 ,why this paradoxical relation of precept to practice8 ,why is this1 the most hygiene-instructed country in the world1 the ,elysium of the patent-medicine and cocaine traffic8 ,if we have only the expected divergence of achievement from ideal1 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 schools4 ,if1 on the other hand1 our disappointment is due to ineffective method1 then the next step is to change our method4 ,the chief purpose of school hygiene has hitherto been not to promote personal and community health1 but to lessen the use of alcohol and tobacco4 ,arguments were required against whisky1 beer1 cigars1 and cigarettes4 ,as the strongest arguments would probably make the most lasting impression upon the school child and the best profits for author and bookseller1 writers vied with one another in the rhetoric and hyperbole of platform agitation4 ,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 water8 ,what is the effect on the mind of a boy or a girl who sees that the family doctor1 the minister1 the teacher1 the judge1 the governor1 the ,president1 and the philanthropist use tobacco and alcoholic beverages1 when taught that boys who use tobacco and alcoholic beverages will find closed in their faces the doors to strength1 good health1 skill in athletics1 good scholarship1 long life1 best companions1 many business positions1 highest success8 ,it is probably true that a boy once drank some whisky from a flask and died within a few hours4 ,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 afterwards1 or that ,george ,washington drank whisky and became the ,father of his ,country4 ,how special pleading has dominated the teaching of school hygiene is illustrated by a recent book which1 for the most part1 successfully breaks away from the narrow point of view and the crude methods hitherto prevailing4 ,it presents the following facts concerning ,new ,york ,city3 ,saloons #aj1hba ,arrests #acc1gdi ,expense of police department #aj1aii1bjf ,police courts1 jails1 workhouses1 reformatories #a1caj1daa ,hospitals1 asylums1 and other charities #d1ged1chj ,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 hospital1 jail1 and charity bills4 ,instead of wipe out she says shrivel4 ,no truth would have been lost by avoiding all misrepresentation4 ,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 alcohol3 ,is not the untruth of these exaggerated statements less dangerous than the untruth of dispassionate1 scientific statement8 ,so long as the child mind takes in only an impression1 is it not better to write this impression indelibly8 ,he sadly but indulgently replied1 ,and in what other studies would you substitute exaggeration for truth8 ,the reaction has already begun against exaggeration in hygiene text-books1 against drawing lessons from accidental or exceptional cases of excessive use of alcohol1 against classing moderate drinking and smoking with drunkenness as sins of equal magnitude1 and against overlooking grave social and industrial evils that threaten children far earlier and more frequently than do tobacco and alcohol4 ,instead of adding an ell to the truth1 text-book writers are now adding only an inch or two at a time4 ,no longer do we favor highly colored charts that picture in purple1 green1 and black the effect of stimulants and narcotics upon the heart and brain1 the stomach1 the liver1 the knee1 and the eardrum1 assuming that all resultant evils are concentrated in one organ4 ,menacing habits1 such as overeating and indulgence in self-pity1 are beginning to receive attention4 ,it is also true that physiology and anatomy are progressively made more interesting4 ,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 laws4 ,a score of improvements in the method of carrying out a small ideal will not take the place of enlarging that ideal4 ,if existing laws stand in the way of broadening the purpose of school hygiene1 let the laws be changed4 ,if text-book publishers stand in the way1 let us induce or compel them to get out of the way4 ,if we fear rumsellers1 their money1 and the insidious political methods that they might employ to bring in undertruth if overtruth is once sacrificed1 let us go to our communities and locate the rumseller's guns1 draw their fire1 tell the truth about their opposition1 and educate the public to overcome it4 ,if1 on the other hand1 misguided teetotalism stands in the way1 then1 as one teetotaler1 ,i suggest that we prove1 as we can1 in our respective communities that there is a better way of inculcating habits of temperance and self-restraint than by telling untruths1 overtruths1 or half truths about alcohol and tobacco4 ,let us prove1 as we can1 that a subject vital to every individual1 to every industry1 and to every government is now prevented from fulfilling its mission not by its enemies but by its friends4 ,we can learn the character of hygiene instruction in our schools and the interest taken in it by teachers1 principals1 and superintendents4 ,we can learn how teachers practice hygiene at school1 and how the children of our communities are affected by the hygiene instruction now given4 ,finally1 we can compel a public discussion of the facts1 and action in accordance with facts4 ,without questioning anybody's avowed motive1 we can learn how big that motive is and how adequate or inadequate is the method of executing it4 ,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 used4 ,hygiene1 on the other hand1 is of constant1 uninterrupted concern4 ,why1 therefore1 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 life8 ,beyond the text-book and schoolroom a thousand influences are at work to teach the social evils1 the waste of energy1 and the unhappiness that always accompany the excessive use--and frequently result from a moderate use--of stimulants and narcotics4 ,of the many reasons for not drinking and smoking1 physiology gives those that least interest and impress the child4 ,the secondary effects1 rather than the immediate effects1 are those that determine a child's action4 ,most of the direct physiological effects are1 in the majority of instances1 less serious in themselves than the effects of overeating1 of combining milk with acids1 of eating irregularly1 of neglecting constipation4 ,were it not for the social and industrial consequences of drunkenness and nicotinism1 it is doubtful if the most lurid picture of fatty degeneration1 alcoholic consumption1 hardened liver1 inactive stomach lining1 would outweigh the pleasing--and deceiving--sensations of alcoholic beverages and cigarettes4 ,the strong appeal to the child or man is the effect these habits have upon his mother1 his employer1 his wife1 his children4 ,the vast majority of us will avoid or stop using anything that makes us offensive to those with whom we are most intimately associated1 and to those upon whom our professional and industrial promotion depends4 ,children will profit from drill in and out of school in the science of avoiding offense and of giving happiness1 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 relations of son1 companion1 employer1 husband1 father1 and citizen1 those who set out to avoid alcohol and tobacco find themselves ill equipped to carry the obligations of a temperate1 law-abiding citizen4 ,things do not happen as described in the early text-book4 ,other things not mentioned hinder progress and happiness4 ,the child at work resents the mis-education received at school and suspects that he has been following false gods4 ,the enemies that cause him trouble come from unexpected sources4 ,he finds it infinitely easier to eschew alcohol and tobacco than to avoid living conditions that insidiously undermine his aversion to stimulants and narcotics4 ,the reasons for avoiding stimulants in the interest of others are more numerous and more cogent than the reasons for avoiding stimulants and narcotics for one's own sake4 ,the altruistic reasons for shunning stimulants and narcotics cannot be implanted in the child unless he sees the evil of excess per se in anything and everything1 and unless he becomes thoroughly grounded in the life relations and health relations to which he must adapt himself4 ,unclean streets1 unclean milk1 congested tenements1 can do more harm than alcohol and tobacco1 because they breed a physique that craves stimulants and drugs4 ,adenoids and defective vision will injure a larger proportion of the afflicted than will alcohol and tobacco1 because they earlier and more certainly substitute discouragement for hope1 handicap for equal chance4 ,failure to enforce health laws is a more serious menace to health and morals than drunkenness or tobacco cancer4 ,if it is true that we must attack the problem of alcohol from the standpoint of its social and industrial effects1 we are forced at once to consider the machinery by which cities and governments control the manufacture and sale of alcohol4 ,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 respiration4 ,if ,sunday closing of saloons1 local option1 high license1 and prohibition have failed1 there is no evidence that the failure is due to the principles underlying any one of these methods4 ,until more earnest effort is made to study the effects of these methods1 the results of their enforcement and the causes of their nonenforcement1 no one is justified in declaring that either policy is successful or unsuccessful4 ,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 drunkenness4 ,the consequence is that the movements to control1 restrict1 or prohibit the use of alcohol are emotional1 not rational4 ,it is impossible to keep emotion1 sensation1 sentiment1 at white heat4 ,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 before4 ,no new fuel is added to the anti-saloon fire1 which gradually cools and dies down4 ,not so1 however1 with those who make money by the sale of intoxicants4 ,the greater the opposition1 the more brains1 the more effort1 the more money they put into overcoming or circumventing that opposition4 ,fuel is piled on and the bonfire is fed freely4 ,every day the anti-restriction bonfire becomes larger and larger1 and the anti-saloon bonfire becomes smaller and smaller4 ,by carefully selecting their facts1 by counting the number of arrests for drunkenness and the number of saloons open on ,sunday1 by reiteration of their story the pro-saloonists gradually win recruits from the opposition1 and1 when the next election comes1 their friends outnumber their enemies and the dry policy of a city1 county1 or state is reversed4 ,the failures attributed to prohibitive or restrictive measures are probably no more numerous than the failures of government in other respects4 ,the present ambassador from ,england1 ,james ,bryce1 writing his ,american ,commonwealth1 declared that municipal government was ,america's most conspicuous failure4 ,the mayor of ,toledo1 writing in #aijg1 says1 ,there has been a pessimism1 almost enthusiastic1 about the city4 ,these failures are due not to any lack of desire for good government1 not to any fundamental evils of cities1 but to the fact that municipal reform1 like the crusade against alcohol1 has been based upon emotionalism1 not upon definite proof4 ,reformers have been unable to lead in the right direction1 because they have looked at their lantern instead of their road4 ,not having cumulative information as to government acts1 they have been unable to keep their fires burning4 ,to illustrate3 in ,november1 #aijg1 the governor of ,new ,york state1 the mayor of ,new ,york ,city1 and reformers of national reputation eulogized the tenement-house department2 yet this department1 whose founding was regarded as a national benefaction1 was the only department of the city government that did not receive an increase for #aijh4 ,it is in the position of temperance legislation1 the facts of whose enforcement or nonenforcement are not promptly and continuously made public4 ,fear of the negro victim of alcoholism1 social evils of intemperance1 whether among white or black1 industrial uncertainty and waste due to alcoholism1 are the three chief motives that have swept alcohol traffic out of the greater part of the ,south4 ,knowledge of physiological evils has had little influence1 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 beverage4 ,religious revivals1 street parades by day and by night1 illustrated banners1 personal intercession1 lines of women and children at the polls1 made it necessary for voters to make known their intention1 and made it extremely difficult for respectable men1 engaged in respectable business1 to vote for saloons4 ,some states have gone so far as to prohibit the manufacture of alcoholic stimulants1 even though not offered for sale within state limits4 ,in ,georgia wine cannot be used at the communion service1 nor can druggists sell any form of liquor except pure alcohol4 ,in ,louisiana it is illegal for representatives of wet districts to solicit orders for liquor in any of the dry districts4 ,in ,texas the sale of liquor in dining cars is forbidden1 and the traveler may not even drink from his own flask4 ,congress is being urged by senators and congressmen1 as well as by anti-saloon advocates1 to pass laws prohibiting common carriers from delivering alcoholics to any dry community4 ,the more optimistic anti-saloon workers believe it is but a matter of a short time when ,congress will pass laws prohibiting the manufacture or sale of alcoholic beverages within any limits protected by the ,united ,states ,constitution4 ,southern states have been warned that they could not afford the depreciation of real estate values1 of rents1 and of business that would surely follow the confiscation of capital and interference with personal liberty4 ,this warning has been met by plausible arguments that the buyers of legitimate and nonpoisonous commodities could pay better rents1 better profits on business and on real estate1 if freed from the uneven fight against temptation to drink4 ,the argument that schools and streets and health must suffer if the license money was withdrawn1 has been met by the plausible argument that the ultimate taxpayer--the family that wants clothing1 food1 and shelter--will save enough money to be able to spend still larger sums than heretofore upon education1 health1 and public safety4 ,for the first time dealers in alcohol recognize the possibility of a great national movement and of national prohibition4 ,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 7#aijg7 of the ,transactions of the ,american ,brewing ,institute4 ,under the title1 ,social ,order and the ,saloon--the ,measure of the ,brewer's ,responsibility1 ,mr4 ,hugh ,f4 ,fox1 known throughout the ,union as a defender of child rights1 advocate of probation and children's courts1 promoter of health and education1 outlined a plan for research that is indispensable to the proper settling of this great question4 ,whether brewer or anti-saloon leaguist1 total abstainer or moderate drinker1 employer or trade unionist1 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 paper1 whose thoroughness and whose social point of view would do credit to a church conference4 ,the address is 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 evidence4 ,the regulation of the liquor business involves fundamental questions of the function and scope of government1 and there is hardly any department of organized human activity that has been the subject of so much experiment and futile tinkering4444 ,the only people who are perfectly consistent are the prohibitionists1 whose policy is abolition4 ,let us1 however1 try to detach ourselves from any personal interest that we may have in the subject1 and consider it impartially as a matter of public concern4 ,what the brewer as an individual cannot do1 the brewers as an organization have done successfully in many places in spite sometimes of official negligence1 corruption1 or incapacity4 ,the ,texas ,brewers' ,association is reported as having successfully prosecuted two thousand cases against keepers of disreputable resorts during the past three years4 ,the object of their campaign was to purify the retail liquor trade from unclean and law-defying elements4 ,the greatest gain that has come to society1 as distinguished from the individual1 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 problem2 and as a secondary result of such agitation1 ,i should cite the growing sensitiveness of all persons in the business to the power of public opinion4 ,the recognition by brewers of the force of public opinion is a recent affair4 ,in former years they were totally indifferent to it1 if indeed they did not openly flout it4 ,even now their appeal to public sentiment is mainly a special plea for defensive purposes1 and has little or no educational value4 ,brewers have opposed practically every effort to effect a change in excise laws1 often without any convincing reason1 but simply because the proposed change involved temporary inconvenience and uncertainty1 and perhaps a temporary loss4 ,the brewing trade has utterly failed to develop a constructive programme in connection with the public regulation of its affairs4 ,it does not seem to have any fixed principles or positive convictions as to excise methods and liquor laws4 ,its policy has been that of an opportunist1 at the best1--or an obstructionist1 at the worst4 ,as in all other industries which affect the welfare of the people1 reforms have been forced from the outside1 with no help from within4 ,of course this is equally true of insurance and railroad corporations1 of food purveyors1 mine owners1 cotton merchants1 and a score of other interests4 ,it is due not merely to human selfishness but to shortsightedness2 in other words1 to a lack of statesmanship4 ,to call your opponents hypocrites1 cranks1 fakirs1 and fanatics may relieve your feelings1 but it doesn't convince anybody1 and only hurts a just cause4 ,it is foolish to question the motives of men who1 without thought of personal gain1 are trying to remedy the evils of inebriety4 ,the church is perfectly right in urging total abstinence upon the individual4 ,the only path of safety lies in abstinence for some individuals4444 ,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 all6 ,to make the discussion of this subject as fruitful as possible1 ,i venture to submit the following questions for your consideration4 ,none of them involve any direct moral issue1 but there is an honest difference of opinion about each one of them1 and they are certainly of vital importance in determining the course of wise and just administration4 ,what has been the effect of high license8 ,how much public revenue should the traffic yield8 ,does high license stimulate unlawful trade8 ,how much license tax should be imposed upon local bottlers and grocers8 ,should they be allowed to peddle beer or to sell it in single bottles8 ,should the place or the individual be licensed8 ,should the licensing authorities be appointive or elective8 ,by whom should they be appointed1 and for what term of office8 ,have the courts made good or bad licensing authorities8 ,where the courts issue licenses1 what has been the effect on the court8 ,should the licensing authority alone have the power to revoke a license1 and discretion to withhold a license8 ,how can the licensing authority enforce the law8 ,should it not be independent of the police8 ,what should be the penalty for breach of the law8 ,do not severe penalties miscarry8 ,on what plea1 and under what conditions1 should licenses be transferred8 ,what has been the effect of limiting the number of saloons8 ,should limitation be according to area or to population8 ,is there any relation between the number of saloons and the volume of consumption8 ,what should be the limit to the hours of selling8 ,should saloons be allowed to become places of entertainment8 ,how can the sale of liquor by druggists be controlled8 ,how can spurious drinking clubs be prevented or controlled8 ,how can the operation of disreputable hotels be prevented8 ,what should be the definition of a hotel8 ,who should define it8 ,by whom should it be licensed8 ,what special privileges should be given to it8 ,how can the back-room evil be stopped8 ,is it legal 7i4e4 constitutional7 to prohibit the sale or serving of liquor to women8 ,has the removal of screens reduced the volume of consumption8 ,has it improved the character of saloons8 ,has it solved the problem of ,sunday prohibition for any length of time8 ,what has been the general effect of it in the tenement districts8 ,should the state undertake to regulate the liquor business or to enforce liquor laws8 ,is it possible to devise any working plan which will apply with equal effectiveness and equity in communities of compact and of scattered population8 ,should1 or should not1 the principle of self-government be carefully preserved in the whole scheme of legislation to regulate the liquor business8 ,whether the present prohibition wave shall wash away the legalized saloon1 as ocean waves have from time to time engulfed peninsulas1 islands1 and whole continents1 depends upon the power of ,american educators and ,american officials to answer right such questions as the foregoing4 ,the great danger is that we shall1 as usual1 over-emphasize lawmaking1 underemphasize lawbreaking1 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 enforced4 ,unless exactly the same principles of law enforcement are applied in dry districts as we have urged for eradication of smallpox1 typhoid1 scarlet fever1 and adenoids1 local and city prohibition are doomed to failure4 ,there must be3 #a4 ,inspection to discover disease centers--blind pigs1 blind tigers1 etc4 #b4 ,compulsory notification by parents and landlords1 and by police and other officials4 #c4 ,prompt investigation upon complaint from private citizens4 #d4 ,prompt removal of the disease and disinfection of the center4 #e4 ,segregation of individual units that disseminate disease1 whether bartender1 saloon keeper1 owner of premises1 or respectable wholesaler1 none of whom should be permitted to shift to another the responsibility for violating liquor laws4 #f4 ,persistent publicity as to the facts regarding enforcement and violation1 so that no one1 whether saloon leaguist or anti-saloon leaguist1 shall be uninformed as to the current results of dry laws4 ,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 laws1 just as the improvement of other ills of municipal government require the constant attention of trained investigators4 ,cogent arguments for such funds have recently appeared in the ,new ,york ,evening ,post's symposium on ,how to ,give ,wisely1 by ,mrs4 ,emma ,garrett ,boyd1 of ,atlanta1 and ,miss ,salmon1 of ,vassar ,college4 ,if the saloon is here to stay1 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 control4 ,on the other hand1 if the saloon is destined to be abolished as a public nuisance and a private wrong1 as a menace to industry and social order1 is it not a frightful1 unforgivable waste of energy to permit prohibition laws to fail1 and thus to discredit the principle of prohibition8 ,philanthropists have provided millions for scientific research1 for medical research1 for the study of tuberculosis1 and for the study of living conditions4 ,it is to be hoped that a large benefaction1 or that an aggregation of small benefactions1 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 alcoholism4 ,,chapter ,,xxxv ,,is ,,it ,,practicable ,,in ,,presenting ,,to ,,children ,,the ,,evils ,,of ,,alcoholism ,,to ,,tell ,,the ,,truth1 ,,the ,,whole ,,truth1 ,,and ,,nothing ,,but ,,the ,,truth8 ,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 enforcement2 if children are taught that the strongest reasons for total abstinence are social1 economic1 and industrial rather than individual and physiological1--there is much to be gained and little to lose from telling them the truth1 the whole truth1 and nothing but the truth about alcohol4 ,to stimulate a child's imagination by untruths about alcohol is as vicious as to stimulate his body with alcohol4 ,whisky drinking does not always lead to drunkenness1 to physical incapacity1 to short life1 or to obvious loss of vitality4 ,beer drinking is not always objected to by employers4 ,neither crime1 poverty1 immorality1 lack of ambition1 nor ignorance can always be traced to alcohol4 ,on the contrary1 it is unquestionably true that the majority of the nation's heroes have used alcoholics moderately or excessively for the greater part of their lives4 ,it is probably true that among the hundred most eminent officials1 pastors1 merchants1 professors1 and scientists of to-day1 the great majority of each class are moderate users of one or more forms of alcoholics4 ,overeating of potatoes or cake or meat1 sleeping or working in ill-ventilated rooms1 neglect of constipation1 may occasion physiological and industrial injuries that are not only as grave in themselves as the evils of moderate drinking1 but1 in addition1 actually tempt to moderate drinking4 ,all of this can be safely admitted1 because whether parents and teachers admit it or deny it1 children by observation and by reading will become convinced that up to the year #aijh the noblest and the most successful men of ,america1 as well as the most depraved and least successful1 have used alcoholics4 ,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 arguments1 based upon social and industrial as well as physiological grounds1 against running the risks that are inevitably incurred by even the moderate use of alcohol4 ,other things being equal1 the same man will do better work without alcohol than with alcohol2 the same athlete will be stronger and more alert without alcohol than with alcohol2 the clerk or lawyer or teacher will win promotion earlier without alcohol than with alcohol2 man or woman will grow old quicker with than without alcohol4 ,other things being equal1 a man of fifty will have greater confidence in a total abstainer than in a man of identical capacity who uses alcohol moderately2 a mother will give better vitality and better care to her children without than with alcohol2 a policeman or fireman or stenographer is more apt to win promotion without than with alcohol4 ,whatever the physical ailment1 there is in every instance a better remedy for an acute trouble1 and infinitely better remedies for deep-seated troubles1 than alcoholics4 ,the percentage of failure to use alcoholics moderately is so high1 the uncertainty as to a particular individual's ability to drink moderately is so great1 as to lead certain insurance companies1 first1 to give preference to men who never use alcoholics1 and later1 to refuse to insure moderate drinkers4 ,life insurance companies have the general rule that habitual drinkers are bad risks1 as the alcohol habit is prejudicial to health and longevity2 but they have no means of studying the risk of moderate drinkers1 because1 except where alcohol has already left a permanent impression upon the system1 the indications are by no means such as to enable the medical examiner to trace its existence with certainty4 ,for this reason the life insurance companies have little effect in preventing alcoholism4 ,though they are agreed that habitual drinkers ought to be declined altogether1 only a few companies have taken the decided stand of declining them4 ,habitual drinkers1 if not too excessive1 are admitted into the general class where the expected mortality1 according to the experience of the ,pennsylvania ,mutual ,life ,insurance ,company1 is #hj per cent1 as against #ef per cent for the temperate class4 ,though it is only necessary to look over the death losses presented each day to see that intemperance in the use of liquors1 as shown by cirrhosis of the liver1 ,bright's disease1 diseases of the heart1 brain1 and nervous system1 is the cause of a large proportion of the deaths1 these companies prefer to grade the premiums accordingly rather than to decline habitual drinkers altogether4 ,while this is partly due to the difficulty and expense of diagnosis1 it is more probably due to an objection to take a definite stand on the temperance question4 ,thus the insurance companies' rules touch only the confirmed drinker1 whose physique is often irreparably injured4 ,one company writes3 ,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 cure1 and only when it can be conclusively shown that during the whole period they have refrained entirely from the use of alcoholic liquor1 and that their former excesses have not in any way impaired the physical risk4 ,thus far ,american insurance companies are doing little preventive and educational work on the alcohol question1 though they have the very best means at their command for so doing4 ,according to the ,metropolitan ,life ,insurance ,company nine tenths of the school children in ,new ,york ,city are insured by them1 and an even greater proportion of workingmen4 ,even though this is done at twice the normal cost1 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 power1 or in the evils of the alcohol and the smoking habits4 ,naturally the moderate drinker is first rejected for positions where an occasional overindulgence would be most noticeable and most serious4 ,the manager of a large factory tells his men3 ,you cannot work here unless you are sober4 ,if you must drink at parties1 stay at home if necessary until #ab o'clock the next day and sleep it off1 but don't come here till you are straight4 ,we cannot afford it4 ,occasionally his men stay at home and not a word is said1 but the minute they are found at work in an unsteady condition they are summarily discharged4 ,from this position it is but a step to that of an upholsterer in ,new ,york ,city1 who prints on his order blanks1 ,no drinking man employed4 ,his company recently discharged a man after twenty years of service because a customer for whom this man was working detected a whisky breath4 ,men reported to trade unions for frequent intoxication are blacklisted4 ,a certain financial corporation permits no liquor on its grounds or in its lunch rooms4 ,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 drinking1 even though he had previously worked faithfully for years4 ,rejection of moderate drinkers by business houses is not done on moral grounds alone1 but because experience has proved the danger of employing men who have not their faculties fully under control all the time they are at work4 ,the rules are especially strict for men working for a railroad or street railway company4 ,the ,pennsylvania ,railroad ,company replied to my inquiry as to their custom of discriminating against drinking men in these words3 ,we have no printed rules in regard to this except in a general way1--that no employee is allowed to go into a saloon during his hours of work or wearing the company's uniform4 ,of course the men are promptly discharged or disciplined if they show the effects of liquor while on duty1 and the whole tendency of the administration of the rules is to get rid of any men who are habitual drinkers1 but the administration of the rules and discipline is left to the superintendent of each division4 ,the ,interborough ,rapid ,transit ,company of ,new ,york has these printed rules for the physical standard required for applicants for employment3 #a4 ,examination of heart and arteries4 ,rejection of candidates showing excessive or long-continued use of tobacco and alcohol1 with explanation of condition1 causes1 and dangers of continued use4 ,warning to chiefs of departments regarding those accepted who show tendency to drink at times1 but whose physical examination does not disclose sufficient evidence to warrant their disqualifications4 ,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 all4 #b4 ,on rexamination of employees4 ,warning to or rejection of those showing1 on physical examination1 indulgence to excess of alcohol1 tobacco1 or drugs4 ,warning to chief of department of evidence of such habits on part of any employee examined for any reason1 but retained in service of the company with injunction to chief of department to speak with such employee and have him under proper supervision4 ,the blacklisting of habitual drinkers by their union1 and the growing tendency on the part of large corporations1 factories1 and business houses to take a decided stand against drinking1 are having a marked effect in reducing drunkenness where it does most harm4 ,this practice has been declared by ,john ,bach ,mc,masters1 the noted ,american historian1 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 #aijg4 ,the school1 by instructing children how the alcohol habit will affect their chances of business success1 future usefulness as citizens1 and enjoyment of life1 will inevitably reduce the evils of alcohol4 ,by teaching based on facts that intimately concern the life of the child1 as well as by caring for his health and his environment1 the schools can help supplant the desire for alcohol with other more healthy desires4 ,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 sanitation1 too long hours of work1 food that fails to nourish1 lack of exercise1 rest1 and fresh air4 ,conditions that produce bounding vitality and offer freedom for its expression at work and at play will supplant the craving for stimulants4 ,finally1 the great truth contained in the last chapter must be taught1 that success in coping with alcoholism is a community task requiring efficient government above all else4 ,,chapter ,,xxxvi ,,fighting ,,tobacco ,,evils ,it is not necessarily vicious or harmful to soothe excited nerves4 ,this editorial comment explains1 even if it condemns while trying to justify1 the tobacco habit4 ,to soothe excited nerves by lying to them about their condition and by weakening where we promise to nourish1 is vicious and harmful just as other lying and robbery are vicious and harmful4 ,yet two essential facts in dealing with tobacco evils must be considered3 tobacco does soothe excited nerves1 and the harm done to the majority of smokers seems to them to be negligible4 ,for these two reasons the tobacco user1 unless frightened by effects already visible1 refuses to listen to physiological arguments against his amiable self-indulgence4 ,cheerfully he admits the theoretical possibility that by its method of soothing nerves tobacco kills nerve energy4 ,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 tea1 candy or lobster1 overeating or undersleeping4 ,therefore the physician1 the bishop1 the school superintendent1 candidly run the necessary risk for the sake of nerve soothing and sociability4 ,less harm would be done by tobacco if it were more harmful4 ,like so many other food poisons1 its use in small quantities does not produce the prompt1 vivid1 unequivocal results that remove all doubt as to the user's injuries and intemperance4 ,as inability to see the physiological effect upon himself encourages the tobacco user to continue smoking or chewing1 so failure to identify evil physiological effects upon the smoker encourages the nonuser to begin smoking or chewing4 ,a very few smokers give up the habit because they fear its results1 but too often the man who can see the evil results would rather give up almost anything else4 ,the one motive that most frequently stops inveterate smoking--fear--is the least effective motive in dissuading those who have not yet acquired the habit2 every young man1 unless already suffering from known heart trouble1 thinks he will smoke moderately and without harm4 ,unfortunately1 every boy who begins to smoke succeeds in picturing to himself the adult who shows no surface sign of injury from tobacco1 rather than some other boy who has been stunted physically1 mentally1 and morally by cigarettes4 ,for adult and child1 therefore1 it behooves us to find some other weapons against tobacco evils in addition to fear of physiological injuries4 ,among these weapons are3 #a4 ,enforcement of existing laws that make it an offense against society for dealer1 parent1 or other person to furnish children under sixteen with tobacco in any form2 and raising the age limit to twenty-one1 or at least to eighteen4 #b4 ,enforcement of restrictions as to place and time when smoking is permitted4 #c4 ,agitation against tobacco as a private and public nuisance4 #d4 ,explanation of commercial advantages of abstinence4 ,because the childish body quickly shows the injurious effects of what in adults would be called moderate smoking1 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 community4 ,even the scientists who claim that in some cases tobacco aids digestion1 or that tobacco may be used without bad effects when used moderately by people who are in condition to use it1 declare emphatically that tobacco must not be used in any form by growing children or youths4 ,prohibitive laws can be rigidly enforced if a small amount of attention is given to organizing the strong public sentiment that exists against demoralizing children by tobacco4 ,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 parent1 teacher1 and society4 ,one effective weapon is the sign on a ferryboat or street car3 ,no smoking allowed on this side1 or ,smoking allowed on three rear seats only4 ,public halls and vehicles in increasing numbers either prohibit smoking altogether or put smokers to some considerable inconvenience4 ,the trouble involved in going to places where smoking is permitted tends gradually to irritate the nerves beyond the power of tobacco to soothe4 ,again1 many men would rather not soothe their excited nerves after five1 than have their nerves excited all day waiting for freedom to smoke4 ,restrictions as to time or place make possible and expedite still further restrictions4 ,thus gradually the army of occasional smokers or nonsmokers is being recruited from the army of regular smokers4 ,the anti-nuisance motive follows closely upon the drawing of sharp lines of time and place for the use of tobacco4 ,like treason1 smoking in the presence of nonsmokers can be considered respectable only when the numbers who profess and practice it are numerous4 ,if the two first-mentioned weapons are effectively used1 there will be an increasing proportion of nonsmokers and not-yet-smokers who will give attentive ear to proof that nicotinism is a nuisance4 ,the physical evidences of the cigarette habit can easily be made distasteful to all nonsmokers if frankly pointed out1--the yellow fingers1 the yellow teeth1 the nasty breath1 the offensive excretions from the pores that saturate the garments of all who cannot afford a daily change of underwear4 ,the anti-nuisance argument is always insidious and abiding4 ,in the presence of nonsmokers accustomed to regard tobacco using as a nuisance1 smokers become self-conscious and sensitive4 ,men and women alike would prefer a reputation for cleanliness to the pleasures of tobacco4 ,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 restaurants4 ,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 appearance4 ,cigarette smoking stains a woman's fingers and discolors her teeth4 ,it also tends to make her complexion sallow and to detract from the rubiness of her lips4 ,it bedims the sparkle of her eyes4 ,it makes her less attractive mornings4 ,chewing has practically disappeared1 not because it ceased to soothe excited nerves but because it was seen to be a nasty nuisance4 ,finally1 the selfishness of the smoker is a nuisance that continues only because it has not been called by its right name4 ,do you mind if ,i smoke8 was a polite question two hundred years ago when tobacco was rare enough to make smoking a distinction1 or fifty years ago when everybody smoked at home and in public4 ,but it is effrontery to-day when people do mind1 when smoking pollutes the air of drawing room and office1 and while soothing the excited nerves of the smoker lowers the vitality of nonsmokers compelled to breathe smoke-laden air4 ,it is selfish to intrude upon others a personal weakness or a personal appetite4 ,it is selfish to divert from family purposes to soothing excited nerves even the small amounts necessary to maintain the cigar or cigarette habit4 ,it is selfish to run the risk of shortening one's life1 of reducing one's earning capacity4 ,because the tobacco habit is selfish it is anti-social and a nuisance1 and should be fought by social as well as personal weapons1 as are other recognized nuisances1 such as spitting in public or offensive manners4 ,the economic motive for avoiding and for eliminating tobacco is gaining in strength4 ,the soothing qualities of all drugs are found to be expensive to physical and business energy if enjoyed during business hours4 ,strangely enough1 employers who smoke are quite as apt as are nonsmokers1 to forbid the use of tobacco by employees at work4 ,some of this seeming inconsistency is due to a dislike for cheaper tobacco or for mixed brands in one atmosphere2 some of it is due to the smoker's knowledge that soothing nerves and sustained attention do not go hand in hand1 while pipe dreams and unproductive meditation are fast companions2 finally no little of the opposition to tobacco in business is due to fear of fire4 ,these various motives1 combining with the anti-nuisance motive among nonsmokers1 have led many business enterprises to prohibit the use of tobacco in any form on their premises or during business hours1 even when on the premises of others4 ,notable examples are railroads that permit no passenger trainman to use tobacco while on duty4 7,freight trainmen are restricted more tardily because the risk of damages is less and the anti-nuisance objection is wanting47 ,from penalizing excessive use and prohibiting moderate use in business hours1 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 evidences4 ,no young man expects to obtain a favorable hearing if he offers himself for employment while smoking or chewing tobacco4 ,business men dislike to receive tobacco-scented messengers4 ,cars and elevators contain signs prohibiting lighted cigars or cigarettes4 ,insurance companies reject men who show signs of excessive use of tobacco4 ,why8 ,because they are apt to die before their time4 ,the ,interborough ,rapid ,transit ,company of ,new ,york ,city rejects applicants for motormen and conductors for excessive or long-continued use of tobacco4 ,why8 ,because1 other things being equal1 such men are more apt to lose their nerve in an emergency and to fail to read signals or instructions correctly4 ,armed with these weapons against tobacco1 parents and teachers can effectively introduce physiological arguments against excessive use1 against use by those who suffer from nervous or heart trouble1 and against any use whatever by those who have not reached physical maturity4 ,by avoiding physiological arguments that children will not--cannot--believe contrary to their own eyes1 parents and teachers are able to speak dogmatically of that which children will believe1--injuries to children1 evils of excess1 restrictions as to time and place1 and offensiveness to nonsmokers4 ,but even here it is wrong1 as it is inexpedient1 to leave the physical strength of the next generation to the persuasive power of parents and teachers or to the faith and knowledge of minors4 ,society should protect all minors against their own ignorance1 their own desires1 the ignorance of parents and associates1 and against the economic motive of tobacco sellers by machinery that enforces the law4 ,,chapter ,,xxxvii ,,the ,,patent-,,medicine ,,evil ,dhrugs1 says ,dock ,o',leary1 are a little iv a pizen that a little more iv wud kill ye4 ,ye can't stop people fr'm takin' dhrugs1 an' ye might as well give thim somethin' that will look important enough to be inthrojuced to their important and fatal cold in th' head4 ,if ye don't1 they'll leap f'r th' patent medicines4 ,mind ye1 ,i haven't got annything to say agin' patent medicines4 ,if a man wud rather take them thin dhrink at a bar or go down to ,hop ,lung's f'r a long dhraw1 he's within his rights4 ,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' ,dr4 ,wheezo's ,consumption ,cure4 ,the ,dock says th' more he practices medicine th' more he becomes a janitor with a knowledge iv cookin'4 ,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 pollyticks4 ,thus ,mr4 ,dooley with his usual wit and insight tells the ,american people why they spend over two hundred million dollars annually on patent medicines4 ,americans consume more drugs and use more patent medicines than the people of any other country on the civilized globe4 ,self-medication has grown to tremendous proportions4 ,everywhere--in cars1 on transfers1 on billboards1 in magazines1 in newspapers1 in the mails--are advertised medicines to cure disease and devices to promote health4 ,when we consider that electric cars contain from thirty-two to fifty-two advertisements each1 three fourths of which are directly or indirectly concerned with health2 when we multiply these by the number of cars actually in use in ,american cities2 when we consider the number of advertisements in magazines and daily papers1 and the enormous circulation of these papers and magazines2 when we consider that an increasingly large proportion of advertising space is devoted to health1--we begin to realize the cumulative power for good or for evil that health advertisements must have4 ,to illustrate advertisements devoted to health to-day1 ,i have kept clippings for one week of news items1 editorials1 and advertisements in a penny and a three-cent paper1 and had them classified according to the subjects treated3 ,,penny ,,paper ,,three-,,cent ,,paper ---------------------------------------- ----- ,news ,editorial ,adver- ,news,editorial ,adver- ,item tisement ,item tisement ---------------------------------------- ------------------------ ,milk #c -- #b #c -- #b ,teeth -- #a #b -- -- #a ,shoes -- -- #d -- -- #a ,food #a -- -- #a -- #d ,alcohol #a -- #e #c -- #g ,tuberculosis -- -- #a #a -- -- ,patent medicine -- -- #ag -- -- -- ,constipation cures -- -- #d -- -- #e ,eyes #c -- #e #a -- -- ,beauty #b #e #h -- -- #f ,general #h #c #c #e -- -- ---------------------------------------- ------------------------ ,total #ah #i #ea #ad -- #bf ,the following list of health topics was treated in the advertisements1 editorials1 and articles of a popular monthly periodical devoted to women3 ,,article ,,editorial ,,advertisement ---------------------------------------- -------------------- ,babies #a -- #aa ,soaps and powders -- -- #e ,beauty #c -- #f ,quack cures -- #b -- ,tooth powders -- -- #d ,household #a -- #e ,food and cooking #a -- #ad ,clothes #ac -- #e ,teaching sex laws #a #b -- ,medicine #d #a -- ---------------------------------------- -------------------- ,total #bd #e #ej ,besides the classic patent medicines1 such as ,lydia ,pinkham's ,vegetable ,compound1 ,castoria1 ,cod ,liver ,oil1 etc41 there are ,colds ,cured in ,one ,day1 ,appendixine1 health foods1 massage vibrators1 violet rays1 ,porosknit underwear1 sanitary tooth washes1 soaps1 vitopathic1 naturopathic1 and faith cures4 ,new ones appear every day1--enough to make a really sick person dizzy1 let alone a person suffering from imaginary ailments4 ,all seem to outline my particular symptoms4 ,after they have flamed at me in red letters in the surface cars1 pursued me in the elevated and underground1 accompanied me out into the country and back again to the city1 greeted me each morning in the daily paper and in my daily mail1 each week or each month in the periodical1 the coincidence of a familiar package on a drug-store counter seems to be providential and therefore irresistible4 ,i know that ,i ought to be examined by a physician1 but ,i am busy and not unwilling to gamble for my health2 it cannot kill me and there is a chance that it will cure me4 ,if there is nothing the matter with us1 we may be cured by our faith4 ,if we are taking a cure for consumption1 the morphine in it may lull us into thinking we feel better4 ,if we are taking a tonic for spring fever1 the cheap alcohol may excite us into thinking our vitality has been heightened4 ,soothing sirup soothes the baby1 often doping its spirit for life1 or soothing it into a sleep from which it never wakes4 ,in spite of the fact that the ,great ,american ,fraud has been exposed repeatedly in newspapers and magazines of wide circulation1 the appeal of the quack still catches men and women of intelligence4 ,the other night a friend went out to a dinner and conference with a lawyer in the employ of the national government4 ,annoyed by a nagging headache1 he made for the nearest drug store and ordered a headache powder4 ,he admitted that it was an awful dose1 but he had been told that it always did the business4 ,he knew the principle was bad1 confessed to a scorn for friends of his whom he knew to be bromo-seltzer fiends1 but he had the headache and the work to do--a sure cure and a quick one seemed imperative4 ,the headache was due to overwork1 indigestion1 constipation4 ,plain food and quiet sleep was what he needed most4 ,but the dinner conference plus the headache was the unanswerable argument for a dose with an immediate result4 ,last winter an ,irish maid slowly lost her rosy cheeks and grew hollow-eyed and thin4 ,she was taken to a specialist who discovered a rapidly advancing case of consumption4 ,he said that owing to the girl's ignorance1 stupidity1 and homesickness1 her only chance of recovery was to return to the auld countrie at once4 ,the girl agreed to go1 but insisted on a few days to talk it over with her cousins in ,new ,york4 ,after two weeks had elapsed she was found in a stuffy1 overcrowded ,new ,york tenement4 ,she had found a doctor who had given her a little bottle of medicine for two dollars1 which would cure her in the city4 ,it was futile to protest4 ,days in the unventilated tenement and nights in a dark room meant that she would never live to finish the bottle4 ,for a year ,miss ,h4 took a patent preparation for chronic catarrh4 ,it seemed to set her up2 but it so undermined her strength1 through its artificial nerve spur1 that chronic catarrh was followed by consumption4 ,it later transpired that the cure's chief ingredient was whisky1 and cheap whisky4 ,a good grandmother1 herself a vigorous temperance agitator and teetotaler1 offered to pay for it as long as my friend would take it faithfully4 ,the irony of it makes one wonder how many earnest advocates of total abstinence are in reality addicted to the liquor habit4 ,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 women4 ,a baby lay on the bed gasping and rolling its eyes up into the top of its head4 ,the nurse asked the frightened mother what she had been giving it4 ,nothing at all1 said the woman4 ,but a telltale bottle of soothing sirup showed that the child was dying from morphine poisoning4 ,happily the nurse came in time to save it4 ,is it not pitiful1 this grasping for a poison in an extremity2 this seizing of a defective rope to escape the fire8 ,illustration3 ,,learning ,,how ,,to ,,keep ,,baby ,,well ,,without ,,patent ,,medicines ,recreation ,pier1 ,new ,york ,city1 ,summer1 #aijh ,the patent-medicine evil cannot be cured by occasional exposure or by overexposure4 ,nor can it be cured by legislation1 legislation1 legislation1 unless laws are rigidly enforced4 ,occasional exposure is no better than occasional advertising of good things4 ,the patent-medicine business thrives on constant1 not occasional1 advertising4 ,leading advertisers expect so little from the first notice that they would not take the trouble to write out a single advertisement4 ,that is the reason merchants charge advertising in the programmes of church1 festival1 and glee-club concert to charity1 not to business4 ,warning people once does no more lasting good than sending a child to school once a month4 ,the exposure of patent-medicine evils must be as constant as efforts to sell the medicines4 ,overexposure is ineffective4 ,it is the evils of patent medicines that do harm1 not their name and not their patents4 ,the medical profession has in vain protested against proprietary medicines4 ,ethical barriers cannot be erected by resolution4 ,calling things unethical does not make them unethical4 ,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 safe4 ,physicians who would not themselves patent a drug will use certain patented drugs whose ingredients are known to be safe and uniform4 ,true exposure of patent-medicine evils will enable the average physician and the average layman to distinguish the dangerous from the safe1 the fraud from the genuine1 lies from truths4 ,legislation is needed to crystallize modern knowledge and to establish in courts the right to protection against the evils of patent medicines4 ,the national ,pure ,food ,law1 passed ,january #a1 #aijg1 and now in force throughout the country1 requires on the labels of all proprietary medicines entering into interstate commerce1 a statement of the quantity or proportion of any alcohol1 morphine1 opium1 heroin1 chloroform1 cannabis indica1 chloral hydrate1 or acetanilid1 or any derivative or preparation of any such substance contained therein2 this information must be in type not smaller than eight-point capital letters2 also the label shall embody no statement which shall be false or misleading in any particular4 ,this law does not forbid patent medicines nor the use of alcohol and narcotics in patent medicines2 it merely says1 ,let the label tell1 that all who buy may read4 ,it does not require that all who run may read1 for it does not say that advertisements of a patent medicine shall tell the truth about its ingredients or its action on the human body2 only that the label on the bottle shall tell4 ,the object of this law is to explain to the consumer the exact nature of the medicine4 ,but to the majority of people the word acetphenitidin on the label of a headache medicine does not explain4 ,the new order that requires manufacturers to substitute acetanilid for acetphenitidin does no more than replace fog with mist4 ,protection requires legislation that cannot be evaded by technical terms4 ,the present law requires that packages must be properly labeled on entering the state4 ,to carry out the national law1 state laws should make it an offense for dealers to have in their possession proprietary medicines without explanatory labels that explain4 ,where state laws to this effect do not exist1 the packages once in the state may be deprived of their labels and sold as secret remedies1 thus nullifying the whole effect of the national law4 ,enforcement must be insured4 ,impure drugs may do as much harm as patent medicines containing harmful drugs4 ,in ,new ,york a vigorous campaign was recently inaugurated by the department of health to drive out impure drugs4 ,drugs are dangerous enough at their best4 ,when they are not what they pretend to be1 whether patented or not1 they may take life4 ,one extreme case where a patient's heart was weakened when it ought to have been strengthened1 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 used4 ,yesterday four lives and several million dollars were lost in a ,new ,york fire because the hose was rotten or weak4 ,as inspection and testing were needed to insure hose equal to emergency pressure1 so inspection and testing of patent medicines and drugs are needed to make legislation effectual4 ,legislation and enforcement should reach the newspaper1 magazine1 billboard1 street car1 that advertises a falsehood or less than the essential truth regarding drugs1 foods1 and patent medicines4 ,public sentiment condemns the advertising of many opportunities to commit crime or to be disorderly or indecent or to injure one's neighbor4 ,the facts about hundreds of nostrums can be absolutely determined4 ,the advertising agency1 whether secular or religious1 that carries misrepresentation of drugs and foods should be forbidden circulation through the mails4 ,the existence of such advertisements should be made evidence of complicity in a public offense and punished accordingly4 ,treat them as we treated the ,louisiana lottery4 ,boards of health1 instead of furnishing names to druggists and manufacturers who want to sell patent foods and medicines1 should print circulars exposing frauds1 and punish so far as the law permits4 ,while trying to secure adequate legislation and efficient administration of the above-mentioned standards1 there is much that can be done by individuals and clubs4 ,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 harmful4 ,we can refuse to have in the house a paper or journal which prints notices that lie or that conceal the truth4 ,if this drastic measure would cut us off entirely from daily papers1 we could choose the least offensive and petition it to exclude specific lying methods4 ,when it preaches health1 honesty1 and philanthropy1 we can cut out of one issue the noble editorial and the exploiting advertisements and send them to the editor with our protest4 ,knowledge of the ingredients and dangers of patent medicines should be a prerequisite for the practice of medicine or pharmacy4 ,we can help bring about such conditions1 and we can patronize physicians who send patients to drug stores that cater to intelligence rather than to ignorance4 ,fighting patent-medicine evils is a civic duty to be accomplished by civic coperation1 not private effort4 ,it is impossible to organize unofficial educational agencies that can offset the cumulative1 lying advertisement4 ,personal opposition is but the beginning4 ,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 faith4 ,,chapter ,,xxxviii ,,health ,,advertisements ,,that ,,promote ,,health ,it is usually considered futile to attempt to defeat the devil with his own methods1 because he knows so much better how to use them4 ,but abuse does not do away with use1 and the success of quacks in reaching the people demands our respect4 ,there is no reason why their methods1 based on a knowledge of human nature and human psychology1 should not be employed to appeal to needs rather than to weaknesses4 ,a good thing may lie unused because of lack of advertisement4 ,vitality is coming to be the passion of the ,american people4 ,it is on this sincere passion that fakirs have so long traded4 ,there can be no doubt that advertisements of health-promoting goods are quite as profitable as health advertisements that injure health1 when equally effective methods are used to make them reach the public4 ,the tradition has been repeatedly mentioned in this book that the better the doctor1 the less he advertises himself1 except in medical and scientific journals that notoriously fail to reach the people4 ,the same is too often true of reputable remedies and goods4 ,the theory that these things stand or fall on their merits is not borne out by practical experience1--conspicuously in the case of fake remedies4 ,purely philanthropic undertakings for the advancement of health fail1 if not placed before the people whom they aim to help in an attractive1 convincing form4 ,failure to advertise a worthy cause limits its usefulness1 and is therefore unjustifiable1 whether we speak of medicine1 legal aid1 or dental clinics4 ,an intensive study of the methods used to advertise patent medicines will suggest means of extending the usefulness of health-promoting goods4 ,aside from clever methods of suggestion that lead many people to take medicine for imaginary ailments1 especially seasonal ailments1 patent-remedy advertisers have employed 7as an argument for the efficiency of their cures7 scientific theory1 bacterial origin of diseases1 recent medical or physiological discoveries1 and state and national movements for promoting health4 ,in fact1 they have turned to their own uses the very law that seeks to control them and the exposures that seek to exterminate them4 ,whatever may be the merits of ,castoria1 the ,don't ,poison ,baby advertisement on the following page1 printed just after the accompanying ,babies ,killed by ,patent ,medicines1 which appeared in a home journal1 was surely a clever bit of advertising4 ,upon an editorial in a daily paper on the relation of eyeglasses to headache and indigestion1 an optician based a promise of immediate relief for these ailments if he himself were patronized4 ,the recent investigations of the ,department of ,agriculture1 and of ,professors ,chittenden and ,fisher1 in regard to foodstuffs1 are proving helpful to food quacks and advertisers of pills for constipation and indigestion4 ,since the passage of the ,pure ,food ,law one health food is advertised in a column headed ,pure ,food4 ,when the season for pneumonia comes around numerous medicines are sure cures for grippe and pneumonia4 ,rosy teachers look better in the schoolroom than the sallow sort1 is surely a good introduction to a new food4 ,woman's vanity sells many a remedy advertised to counteract the vandal hand of disease1 which robs her of her beauty1 yellows and muddies her complexion1 lines her face1 pales cheek and lip1 dulls the brilliancy of her eye1 which it disfigures with dark circles1 aging her before her time4 ,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 those standing near them turn their heads away in disgust8 ,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 headline1 ,medical ,supervision ,needed to ,prevent the ,spread of ,consumption in the ,schools4 ,thus grafting itself on the successful results of the medical examination in the ,massachusetts schools1 it enlists the aid of teachers1 trades on the fear of tuberculosis1 even indorses the fresh-air treatment4 ,so convincing was this appeal that it was reprinted in the news columns of a daily paper in ,new ,york as official advice to school children4 ,illustration3 ,don't ,poison ,baby4 ,so clever are these methods of advertising and so successful are they in reaching great numbers of people1 that if reputable physicians would take lessons of them1 they might conduct a health crusade that would exterminate tuberculosis1 diminish the use of alcohol and tobacco1 and save thousands of babies that die unnecessarily4 ,the theory of patent-medicine advertising is sound4 ,it emphasizes the joys of health1 the beauty of health1 the earning power of health4 ,it adapts its message to season1 event1 and need4 ,it offers testimonials of real persons cured4 ,it is all-appealing1 promising1 convincing1--a fearful menace to health when the remedies offered are dishonest1 a universal opportunity for promoting health if the cure is genuine4 ,a classic example of health advertising that promotes health is ,sapolio4 ,the various hygiene lessons that have promoted ,sapolio have done much to raise the standard of living in the ,united ,states4 ,few eminent physicians have done so much for public health as the ,poor ,m4,d4 of ,spotless ,town who scoured the country for miles around1 but the only case he could find was a case of ,sapolio4 ,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 adjusted4 ,in spite of the long mis-education by makers of corsets1 the persistent advertising of good health and common-sense waists has gained an increasing number of recruits from the ranks of the self-persecuting4 ,it is only a matter of time when the term stylish will be transferred to the advocates of health1 because advertisers who tell the truth will1 if persistent1 gain a larger patronage than advertisers of falsehoods2 there is profit in retaining old customers4 ,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 kill4 ,a man deserves profit who sends this message to millions of readers3 ,there are three kinds of cleanliness3 ,first1 the ordinary soap-and-water cleanliness4 ,second1 the so-called beauty cleanliness4 ,third1 prophylactic cleanliness1 or the cleanliness that guards against disease4 ,but the man who sells soap ought to be the one to use this advertisement1 not a man who sells toothwash that1 when pure1 is little better than water1 that is seldom pure1 and that always hurts the teeth4 ,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 foot4 ,millions would never know how to discover the evil effects upon themselves of coffee and alcohol except for money-making advertisements4 ,little ,jo's ,smile taught a nation that the majority of crippled children are victims of neglect on the part of adult consumptives4 ,certain it is that advertising is an art promoted by the severest competition of the cleverest brains4 ,it is a force which we cannot afford to ignore4 ,if we can harness it to the promotion of aids to health1 it will do more good than all the hygiene books ever written4 ,to this end we must educate ourselves to distinguish between goods which do what they profess to do and those which do not4 ,a good eye opener would be to keep for a week clippings from a high-priced daily paper1 a penny daily paper1 and one or two representative magazines1 including a religious paper4 ,teachers and parents can very easily interest children in such clippings4 ,moreover1 they can use the bulletin method1 the stereopticon exhibit1 the cumulative illustration of a fact1 which is the essence of successful advertising4 ,boards of health can use all the typographical aids to clear understanding1--cuts1 diagrams1 interesting anecdotes4 ,in ,new ,york both the health board and the school board have issued circulars and given illustrated lectures1 some of them being in school and some on public squares4 ,medical and sanitary societies and other educators can be induced to follow what a successful business man has called the three cardinal rules of advertising3 ,first1 put your advertisement where it will be seen4 7,tell your story where it will be heard47 ,second1 write it so that people will read it4 7,tell it so that people will understand it47 ,third1 tell the truth1 so that people will believe it4 ,,chapter ,,xxxix ,,is ,,class ,,instruction ,,in ,,sex ,,hygiene ,,practicable8 ,among remedies for preventable disease and preventable poverty1 the following was urged at a national conference for the betterment of social conditions3 ,we have been too prudish4 ,because we have been unwilling to teach school children the evils of violating sex hygiene1 we have been unsuccessful in combating evils justly attributable to ignorance on the part of girls as to the duties and dangers of motherhood4 ,this point of view is shared by so many men and women that a national body was organized in #aije to promote the teaching of sex hygiene1--the ,society for ,sanitary and ,moral ,prophylaxis4 ,this society has its headquarters in ,new ,york1 and distributes at cost lectures and essays4 ,the second of its educational pamphlets is addressed to teachers1 and is entitled ,instruction in the ,physiology and ,hygiene of ,sex4 ,the introduction asks eleven questions of the teachers as follows3 #a4 ,do you wish a pamphlet on sex subjects to hand to your pupils8 ,why8 #b4 ,do you wish separate pamphlets for boys and girls8 #c4 ,for what age limits and social conditions do you wish them8 #d4 ,what topics do you wish the pamphlets for boys to handle8 #e4 ,what topic do you wish the pamphlet for girls to handle8 #f4 ,if you think one pamphlet sufficient for both sexes1 what should it consider8 #g4 ,how far do you go in teaching sexual hygiene or reproduction8 ,by what method8 #h4 ,what special difficulties do you find in teaching it8 #i4 ,what special need of teaching it have you found8 #aj4 ,what special benefits 7or otherwise7 have you noticed from teaching it8 #aa4 ,what criticisms 7favorable or otherwise7 do you encounter8 ,the difficulty of introducing formal instruction in sex hygiene1 even in the upper grades of public and private schools1 is hinted at in the pamphlet4 ,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 evil4 ,although sex hygiene does not begin with sex immorality1 almost every text-book on sex hygiene1 and almost every pamphlet urging class instruction in sex hygiene1 begins with sex immorality4 ,yet only the exceptional school child is in danger of violating sex morals1 while every school child needs instruction in sex hygiene4 ,instruction in sex hygiene1 whether at school or at home1 should deal with sex normality1 sex health1 sex temperance4 ,instruction in sex immorality is objectionable1 not merely because it offends prudists1 not because it is difficult1 but because it can be shown by experience to be less efficacious than training in sex health4 ,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 law4 ,for centuries man failed in attempts to fit the punishment to the crime4 ,to deter men from committing crime by holding up a threat of prolonged and dreadful punishment has been found futile4 ,individuals take the risk because they think they will escape detection4 ,it is an axiom of criminal procedure that a would-be offender is deterred by the certainty1 not by the severity1 of punishment4 ,the modern theory of probation is1 that children and adults may be best led away from evil practices by crowding out old influences with newer and stronger interests4 ,occupations that are wholesome are made to rival diversions or occupations that are harmful and criminal4 ,illustration3 ,,object ,,lessons ,,for ,,instruction ,,in ,,sex ,,health ,note the uncomfortable1 unhealthy overdressing ,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 environment4 ,cure and prevention require two kinds of treatment within reach of parents and teachers3 7#a7 build up the child's physical condition2 and 7#b7 give him other interests4 ,proper physical care1 and work adjusted to body and mind1 may be relied upon to do infinitely more to promote sex hygiene than instruction1 either at home or at school1 in immoral sex diseases4 ,that sex morality is weak and untrustworthy which is based upon fear of sex diseases4 ,like alcoholism and nicotinism1 the saddest results of sex diseases are social and economic4 ,the strongest reasons against such diseases are economic and social1 not physiological4 ,illustration3 ,,the ,,study ,,of ,,infant ,,health ,,is ,,conducive ,,to ,,pure-,,mindedness ,note the simple1 comfortable1 hygienic dress ,once having made up our minds to concentrate the teaching of sex hygiene upon sex health rather than upon sex immorality1 upon sex functions rather than upon sex diseases1 the chief objection to school instruction and to instruction in class will disappear4 ,our school text-books in history1 literature1 and biology abound in references to sex distinctions1 sex functions1 and sex health4 ,in enumerating the daily routine of health habits ,i mentioned daily bathing of the armpits and crotch4 ,there is nothing in this injunction to offend or injure a boy or girl4 ,if studies and physical training are to be adapted to physiological age1 and if children are to know why they are graded according to physiological age as well as mental brightness1 we shall soon be talking of mature1 maturing and not-yet-maturing girls and boys1 so that everybody will be instructed in sex hygiene without offense4 ,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 birth1 why breast-fed babies are more apt to live than bottle-fed babies1 why it is as important for the mother to keep a nursing breast absolutely clean as to clean the nipple of a nursing bottle4 ,words whispered by children1 or marked in dictionaries1 to be stealthily and repeatedly looked upon and talked over with other children1 lose all their glamour when pronounced by a teacher4 ,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 blunt1 candid discussion of sex facts can make harmless4 ,children now learn1 whether in fashionable private schools or crowded slums1 practically all that is lascivious and unwholesome about sex4 ,for teachers to explain that which is wholesome and pure will disinfect the minds of most children and protect them against miseducation4 ,class instruction in hygiene is practicable for all matters pertaining to normal sex health4 ,girls of thirteen should be taught in classes the fact and meaning of menstruation1 and its grave importance to the health1 in order that they may care for themselves not only before1 during1 and immediately after the menstrual period1 but throughout the month1 in order that menstruation itself shall not be unnecessarily painful1 enervating1 and harmful to efficiency4 ,it is not yet advisable to discuss dangers peculiar to girls or dangers peculiar to boys in mixed classes4 ,generally speaking1 it is undesirable that men teachers discuss girls' troubles with girl pupils4 ,but why should it not become possible for women teachers to explain health dangers peculiar to girls to classes of boys8 ,individual instruction in sex matters should be reserved for the diseased mind1 for the boy or girl who has already been morbidly instructed4 ,discussion of immoral sex diseases should be confined to individual talk4 ,this field teachers have already entered4 ,repeated physical examination of children will detect symptoms of sex abnormality4 ,when detected1 the fact and the meaning should be explained to the individual by school physician1 school nurse1 or school-teacher4 ,while much can be done through mothers' meetings and through individual instruction of parents1 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 school4 ,armed with the ,a ,b ,c's of sex hygiene at school1 boys and girls will be prepared to select employment1 associates1 and newspapers that will permit normal1 healthy sex development4 ,men and women who are leading normal lives1 who have plenty of work1 sleep1 fresh air1 nourishing food1 amusement1 and exercise are unlikely to be sexually abnormal4 ,after all1 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 health4 ,the woman who does not know how to take care of her own sex health1 the man who is ignorant of a woman's special needs1 cannot do justice to the requirements of arithmetic1 language1 and discipline4 ,whether men and women teachers are mentally1 physically1 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 questions4 ,whether an instructor's personality will enable him to fill the minds of children with interests more wholesome1 more absorbing than obscene stories or morbid sex curiosity can also be learned4 ,when school-teachers are prepared to teach the social and economic aspects of general health they will quickly solve the problem of instruction in sex health4 ,just one word about country morality4 ,it is customary to deplore the influence of large cities on the young4 ,of late1 however1 there has been a tendency to question whether1 after all1 sex morality is apt to be higher in the country than in the city4 ,parents and teachers in small towns and in rural districts will do well to take an inventory of the influences surrounding their children4 ,it will always be impossible to give country children city diversions4 ,one great disadvantage of country children frequently counter-acts the beneficial influence of out-of-door living2 namely1 isolation4 ,the city child is practically always in or about to be in the sight of1 if not in the presence of1 other people4 ,numbers and close contact with people1 though they be strangers1 mean restraint and pervading social conscience4 ,city children find it difficult to have good times in pairs4 ,no amount of instruction of rural pupils in sex hygiene will take the place of amusements and entertainments for groups of children1 forming thus a special antidote for two's company1 three's a crowd4 ,liberating and standardizing normal intersex relations and discouraging cramped social intersex relations are more urgent needs than instruction in sex diseases4 ,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 prophylaxis4 ,,chapter ,,xl ,,the ,,element ,,of ,,truth ,,in ,,quackery2 ,,hygiene ,,of ,,the ,,mind ,patent medicines and other forms of quackery could not pay such enormous dividends unless there was some truth in their claims2 unless their victim found some beneficial return for his money4 ,they win confidence because they raise hopes and combat fear4 ,they do cure thousands of people of fear and of ingrowing thoughts4 ,in so doing they remove the sole cause of much disability4#ag ,in so doing they are merely applying by wholesale principles of mental hygiene that are legitimately used by physicians1 tradesmen1 teachers1 and parents who deal successfully with nervousness4 ,quackery makes cures and makes money because of the undoubted influence of mind in causing and in removing those ailments that originate in fear1 imagination1 or morbid introspection4 ,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 around4 ,miraculous cures were heralded broadcast4 ,life-long cripples left wagon loads of crutches and braces to decorate the little church with the enchanted transom4 ,people who had not walked for years returned to their homes cured4 ,the marvels of famous shrines were fast being duplicated when the church authorities at ,st4 ,paul issued an explanation of the alleged miraculous appearance of biblical figures in the transom of the new church4 ,the outlines of a mother carrying a baby had been vaguely impressed in the transom glass when molten4 ,when the mystery was explained the excursions and the cures stopped4 ,nearly every physician and practically every medical charlatan can count scores of cures of ailments that had previously defied the skill of eminent physicians4 ,a child's bumps actually stop aching after the mother or nurse kisses the abused spot4 ,invalids forget their limitations under stress of some great excitement or some intense desire for pleasures incompatible with invalidism4 ,many a physician of reputation owes his success in great part to the discriminating use of the placebo1--a bread pill designed to supplant the patient's fear with confidence4 ,hypnotism and suggestion have been successfully used to cure alcoholism and to fill patients' minds with conviction stronger than the fear that produced the sickness4 ,a well-known writer and preacher cures insomnia by auto-suggestion1 telling himself he is sleepy1 is very sleepy1 is going to sleep1 is almost asleep1 is fast asleep4 ,treatment by osteopathy has been followed by disappearance of diseases that cannot possibly be cured by osteopathy4 ,christian ,science has restored to health and happy usefulness hundreds of thousands of chronic invalids4 ,verily is hygiene of the mind an important factor in the civics of health4 ,fear can originate with mind4 ,fear produces fear4 ,fear disarranges circulation of the blood and the nourishment of muscle and nerve4 ,fear can produce many bodily disorders which in turn feed fear4 ,fear cannot last unless bodily symptoms exist or arise to justify and feed it4 ,fear can be cured and removed in two ways3 7#a7 by driving away fear and releasing bodily disorders from its thraldom2 7#b7 by removing the disorders and making fear impossible to the logical mind4 ,an enforced sea voyage begins with the disorder2 a clever1 buoyant physician begins with the fear4 ,patent-medicine proprietors1 quacks1 and fakes of every kind begin by displacing the fear with hope or cheer2 the physical disorders frequently vanish by the same window as fear4 ,for fear write self-pity1 morbid self-consciousness1 hypertrophied submission2 to hope and cheer add smile1 relaxation1 and zest2 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 quacks4 ,the social aspects of mental hygiene are particularly important4 ,once admitting the power of the mind to decrease vitality1 we recognize the duty of seeming happy1 buoyant1 cheerful1 vital1 at least when with others1 for the sake of others' minds and bodies4 ,secondly1 we find the duty to refrain from commenting on others' appearance in a way that will start ingrowing thoughts4 ,a grouchy foreman can give blues and indigestion to a roomful of factory girls4 ,a self-pitying teacher can check the heart beats of her class1 cause arteries and lungs to contract1 and deprive the brain of fresh blood4 ,an oversympathetic neighbor can put a strong man to bed by discovering signs of nervous disintegration4 ,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 away8 ,is the time coming when boards of health will accompany infection leaflets with messages such as this from ,james ,whitcomb ,riley3 ,talk health4 ,the dreary1 never-changing tale ,of mortal maladies is worn and stale4 ,you cannot charm or interest or please ,by harping on that minor chord1 disease4 ,whatever the weather may be1 says he1 ,whatever the weather may be1 ,it's the songs ye sing1 and the smiles ye wear1 ,that's a-making the sun shine everywhere4 ,mental hygiene has hitherto enjoyed an evil reputation and has been condemned to generally evil associations1 because the rank and file have been ignorant of hygiene of every kind4 ,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 quackery4 ,quacks often get social and economic results more agreeable to the patient and more helpful to society than orthodox medicine4 ,when traitors become numerous enough treason becomes respectable4 ,so when mental hygiene succeeds1 it becomes science for the case in question1 and for that case orthodox medicine loses its respectability4 ,for the layman there is no safety except in having intelligence enough to know whether his trouble has defied the sincere application of mental treatment1 auto-suggestion1 and loyalty to the health ideal4 ,mental hygiene admits the existence of dental cavities1 scarlet fever germs1 adenoids1 cross-eyes1 uncleanliness1 broken legs1 inflamed eyes1 overeating4 ,the organic1 structural defects which are to be sought by physical examination are all admitted by mental hygienists4 ,they work for an orderly1 daily routine and affirm the penalties of its violation4 ,they would even favor going periodically to a physician1 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 relief4 ,unhygienic living and mind cure cannot go together4 ,the mind that tries to deceive itself cannot cure either mind or body4 ,the man who violates the habits of health cannot patch his injuries or conceal the ravages of dissipation by mental hygiene4 ,here is the great advantage of knowing how to live hygienically1 of observing habits of health1 and then concerning ourselves not with ourselves1 but with conditions of living for all those whose health can be affected by our health1 or can affect our health and efficiency4 ,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 ,boston4 ,this clinic represents the union of three forces1--religion1 medical diagnosis1 mental hygiene4 ,as a result of this alliance it is anticipated that both religion and medicine will be humanized1 socialized1 vitalized1 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 impulse4 ,no person is treated at this moral clinic whose trouble is organic or structural4 ,in determining whether the case belongs to this clinic1 expert medical diagnosis is relied upon rather than the credulity of the patient or the zeal of the clergyman4 ,medical scientists of highest repute can consistently coperate1 because they recognize two scientific facts3 first1 that many troubles are due primarily to mental disorder2 and1 second1 the greatest asset of the human mind is that something called religion1 which is no less real and potent because peculiar to each individual4 ,whatever may be that deepest current of thought and feeling1 whatever that synthetic philosophy1 that explanation of being1 which guides my life1 it can be of inestimable aid if enlisted in an effort to secure normal vitality of mind and body4 ,the controlling motive of the moral clinic has proved infectious4 ,there is reason to believe that the alliance of medicine and religion has come to stay1 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 disease4 ,unwholesome1 morbid1 self-centered thought is driven out4 ,a recognition of others' claims takes its place4 ,hypnotism1 suggestion1 and group enthusiasm are used to their utmost possibilities4 ,the success of the ,boston moral clinic is due to establishing in the mind of the neurasthenic1 the alcoholic1 the world-weary1 and the purposeless a truer conception of the pleasures that result from vitality and from altruistic effort4 ,it is too early to classify by kind of functional disorder the patients treated4 ,results from one patient have been described in newspapers as follows3 ,a school-teacher1 as a result of nervous collapse1 had lost control1 began to fear the children under her care1 and thought of relinquishing her profession4 ,she was instructed in the art of self-control and the control of others2 the notion of fear was dislodged and a sentiment of love for her little charges took its place4 ,in the course of a few weeks this conscientious and experienced teacher regained her poise and found herself performing her duties better than ever before4 ,many alcoholics have for months given evidences of complete cure4 ,stories almost incredible are quickening pastor and physician alike throughout the country4 ,after individual treatments are given1 after religious motive is appealed to1 and the soul stirred to heed the lessons of religion1 medicine1 and sociology1 patients are given the work cure4 ,thus a branch of social service is established1 where after-treatment is given to the patient whose thoughts have been turned from himself to others4 ,all of a sudden the church finds itself in need of definite knowledge as to opportunities for altruistic work1 as to definite community needs not met1 as to people in distress who can be relieved by volunteers1 as to agencies which can be called upon to coperate both in treating the individual and in utilizing his energies for others' benefits4 ,because a relatively small percentage of men and women are neurasthenic1 melancholy1 morbid1 alcoholic1 the lesson of the moral clinic is most serviceable when extended for the benefit of the not yet alcoholic and the not quite neurasthenic4 ,in other words1 individuals in thinking of themselves must learn the health value and soul value of purpose that centers in others' happiness4 ,that thing which we have called tact in personality1 and which in the past was discovered by induction1 namely1 the law of mental hygiene and the control it gives over others' health1 must be taught in schools to children by wholesale1 must be taught in medical and theological schools1 to all physicians and all pastors4 ,this alliance of medicine and religion1 which is at present confined to one or two moral clinics1 should be incorporated into education1 into social work1 into church work1 becoming thus a part of civilization's normal point of view4 ,mental hygiene cannot survive conscious violation of the fundamental laws of medicine and religion4 ,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 love4 ,self-centered religion1 like self-centered medicine1 destroys both body and soul4 ,,footnotes3 #ag ,the alliance of mental hygiene1 medicine1 and religion is discussed in the ,emmanuel ,church book1 ,religion and ,medicine2 the ,moral ,control of ,nervous ,disorders2 also in its bulletins1 ,religion and ,medicine4 ,,chapter ,,xli ,a ,,natural ,,law ,,is ,,as ,,sacred ,,as ,a ,,moral ,,principle ,when a grammar-school boy ,i learned from the game ,quotations that ,louis ,agassiz1 scientist1 had written the sentence with which ,i introduce a final appeal for living that will permit physical and civic efficiency4 ,agassiz has been called ,america's greatest educator1 and again the finest specimen yet discovered of the genus homo1 of the species intelligens4 ,the story of his long life as teacher of teachers reads like a romance4 ,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 principle4 ,all who remember this beatitude will be helped to solve many perplexing problems of dress1 diet1 play1 education1 philanthropy1 morals1 and civics4 ,reverence for the natural carries with it a distaste for the unnatural4 ,those who obey natural law soon come to regard its violation as a nuisance when not immoral4 ,on the other hand1 compromise with the unnatural1 like compromise with vice1 quickly leads first to toleration and thence to interest and practice4 ,therefore the importance of giving children ,agassiz's conception of the sacredness of the laws that govern the human body4 ,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 sense4 ,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 life1 back to nature1 and back to the land4 ,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 nature4 ,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 part4 ,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 him4 ,natural living according to natural law must be something sounder1 more beautiful1 and more progressive than can be read into or out of mountains1 trees1 brooks1 and sky1 or primitive society4 ,natural law points to a ,nature ,fore as well as a ,nature ,back1 to a ,nature ,up and ,beyond as well as a ,nature ,down and ,behind4 ,the ,nature that was yesterday will not do for to-morrow1 any more than a man is willing to give up his nature aspirations for the careless1 animal ways of romping childhood4 ,civilization is constantly urged at each step to repeat the prayer of ,holmes's old man who dreams for the ,autocrat of the ,breakfast ,table3 ,oh for one hour of youthful joy6 ,give back my twentieth spring6 ,i'd rather laugh a bright-haired boy ,than reign a gray-beard king6 ,off with the wrinkled spoils of age6 ,away with learning's crown6 ,tear out life's wisdom-written page1 ,and dash its trophies down6 ,one moment let my life blood stream ,from boyhood's fount of flame6 ,give me one giddy1 reeling dream ,of life all love and fame6 ,but every experiment in turning back exalts the present and the future4 ,gifts as well as problems are seen to come with complexity1 and civilization flatly refuses to relinquish these gifts4 ,sound maturity is better than youth or age3 ,the smiling angel dropped his pen1-- ,why1 this will never do2 ,the man would be a boy again1 ,and be a father too6 ,problems of health and of civics can never be solved by appealing to ,nature ,back1 when only the few could be healthy1 when one baby in three died in infancy1 when old age was toothless and childish1 when infection ravished nations1 when the average life was twenty years shorter than now1 and when unspeakable filth was tolerated in air1 street1 and house4 ,they can all be solved by appeals to ,nature ,fore1 which holds up an ideal of mankind physically able to enjoy all the benefits and to conquer all the dangers of civilization4 ,it is not looking back1 but looking in and forward that reveals what natural law promises to those who obey it4 ,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 playing4 ,health for health's sake has nowhere been urged4 ,on the contrary1 healthful living has been frankly valued for its aid to efficient living by individual and by community2 wherefore the emphasis upon others' health and upon the civic aspects of our own health4 ,tests furnish us with the technic necessary to efficient living2 civics1 with the larger reason2 natural law1 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 determined4 ,fashions1 tastes1 mannerisms1 personal indulgences1 have been left for ,agassiz to deal with4 ,generally speaking1 we all know of numerous acts committed and numerous acts omitted in our daily routine that convict us of not living up to our knowledge of physiology and hygiene1--wearing tight shoes or tight corsets1 drinking strong coffee1 smoking1 reading while reclining1 failing to insure clean air and clean bodies4 ,then there are other acts whose omission or commission violate no physical law so far as we can see1 but whose unnaturalness we concede1--putting chalk on the eyebrows1 wearing false hair or curious puffs1 putting perfumery in the bath or on handkerchiefs1 assuming artificial poses of body or mouth4 ,these violations of natural law are forced upon us by style or custom or family convenience4 ,when we come to choose between following fashions and disobeying them1 we generally decide that it is better to do a foolish or slightly harmful thing than to occasion criticism1 mirth1 or even special notice by our dress or our abstemiousness4 ,last night ,i went to a dinner party at eight4 ,i ate and ate a great variety of palatable foods that ,nature ,back never knew4 ,after two hours of eating ,i imbibed for two hours the tobacco smoke of the gentlemen who made up the party4 ,i knew that eight o'clock was too late for me to begin eating1 that two hours was too long to eat1 that the tobacco of others was bad for my health and for to-day's efficiency4 ,all this ,i knew when ,i accepted the invitation to dinner4 ,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 day4 ,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 meeting4 ,natural law was abated in part4 ,but ,i declined certain dishes that would not agree with me1 helped myself sparingly of many dishes1 avoided tobacco and wines1 and by a three-mile walk in the open air1 a bath1 and a good long night's sleep have almost recovered my right to talk of the sacredness of natural law4 ,nature ,back says ,i should not have gone to this dinner4 ,but ,i was compelled to go4 ,i know ,i am going to others4 ,i cannot do my work unless ,i overdraw my current health account4 ,nature ,fore tells me that effective coperation with others will frequently require me to eat at the dinner hour of others1 to retire at others' sleeping time1 to wear what others will approve1 to violate natural law4 ,but ,nature ,fore also tells me how to build up a health reserve so that ,i can meet these emergencies without endangering my health credit4 ,nature ,back demands dress reform4 ,nature ,fore tells me that ,i can march in step with my contemporaries without either attracting attention or discrediting and affronting natural law4 ,passion for the natural has effected numerous reforms in dress1 diet1 and social habits1 until commerce provides a natural adaptation of practically every fashion4 ,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 sake4 ,we may wear what we will1 eat what we prefer1 decline what is unnatural for us1 without inviting censure4 ,the debauches of those unfortunate people who live an unnatural1 purposeless existence1 affect such a small number that their laws need not be considered here4 ,natural law makes obedience to itself attractive2 hence commerce is rapidly learning to cater to distaste for the unnatural4 ,with few exceptions1 only temporary concessions to unnatural living are required in order to dress and act conventionally4 ,nature ,back throws little light upon conditions necessary for modern labor4 ,it can do nothing but demand the abolition of the factory1 the big store1 the tenement1 the school4 ,nature ,fore says we cannot abolish the means of working out the highest forms of coperation4 ,but we can make them compatible with natural living4 ,we can modify conditions so that earning a livelihood will not compel workers to violate natural law at any or all times4 ,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 children4 ,parents and teachers must live the natural before they can make children love the natural4 ,parents and teachers cannot possibly be natural in this day1 cannot live or love natural law unless they know the machinery by which their communities are combating conditions prejudicial to health1 morals1 and civic efficiency4 ,,index ,adenoids4 ,see ,mouth breathing ,administration1 health3 steps in evolution1 #aa-bb2 knowledge of needs1 #bbj2 machinery1 #cjb-cji2 in combating alcoholism1 #cfb2 departments of health3 7#a7 ,new ,york ,city1 #bf1 #bg1 #dg1 #dh1 #fa1 #ga1 #hd1 #bif-bih1 #cjb2 7#b7 general1 #bfe1 #bha ,advertisements3 motives for1 #h2 for dental parlors1 #ajj2 for consumptives1 #bcd2 by physicians1 #bha2 educational1 in newspapers and magazines1 #cbc2 no smoking signs1 #cfe2 of patent medicines1 #cfi2 that promote health1 #cgh-chc ,agassiz1 ,louis1 #cih1 #djj ,air1 night1 #baf4 ,see ,fresh air ,alcoholism1 #cdc-cfb2 compulsory instruction in1 #c2 insurance companies against1 #g2 disqualifies for railroad service1 #aic2 depletes vitality1 #bja2 results1 #bji2 ,hartley's fight against1 #bec2 injures the tuberculous1 #bgd2 ineffective ways of combating1 #cdc2 incited by bad living conditions1 #cdh2 injury to negroes1 #cej2 so-called moderate use1 #ceh2 labor unions blacklist drunkards1 #cfa2 social dangers1 #chf2 mental hygiene1 #cib1 #cif ,animal sanitation1 #beb1 #bfj1 #cjg ,association for ,improving the ,condition of the ,poor1 ,new ,york1 #agg1 #bcf1 #bec ,babies4 ,see ,milk ,bathing3 motives for1 #h1 #ac2 a social requirement1 #ad2 cold-water1 #bad ,beauty1 reason for health1 #ae ,bibliography3 ,a ,bureau of ,child ,hygiene 7,bureau of ,municipal ,research71 #bih2 ,annals of a ,quiet ,neighborhood 7,mac,donald71 #aaj2 ,aristocracy of ,health 7,henderson71 #bjh2 ,bitter ,cry of the ,children 7,spargo71 #cc1 #afg2 ,bulletins of ,emmanuel ,church1 #cia2 ,bureau of ,municipal ,research1 publications1 #bih2 ,care of ,dependent1 ,defective1 and ,delinquent ,children 7,folks71 #agd2 ,charities and the ,commons1 #cbe2 ,child ,growth 7,newsholme71 #abj2 ,children of the ,nation 7,gorst71 #cc2 ,children's ,diseases1 #cbf2 ,clean ,milk for ,new ,york ,city1 #bee2 clippings1 #cgj1 #chb2 white-plague scrapbook1 #bej2 ,committee on ,physical ,welfare of ,school ,children1 programme1 #aff1 three studies1 #afh2 ,crusade against ,tuberculosis 7,flick71 #bbi2 ,dangerous ,trades 7,oliver71 #bjc2 ,dental ,catechism1 #id2 ,dentistry1 lectures and treatises1 #bgd2 ,deterioration1 ,physical1 report on1 #cci2 ,development of the ,child 7,oppenheimer71 #aaj2 ,dietetic and ,hygienic ,gazette1 #cbf2 ,efficient ,life 7,gulick71 #bjh2 ,environment of ,child at ,school 7,north71 #adb2 ,pure ,food 7,u4,s4 ,department of ,agriculture71 #cgi2 ,good ,health1 #cbf2 ,health of the ,school ,child 7,mackenzie71 #acb2 ,heredity 7,thompson71 #ccf2 ,how to ,give ,wisely1 #cee2 ,international ,congress1 ,tuberculosis1 programme1 #bdf-bdi2 ,journal of ,nursing1 #cbf2 ,making a ,municipal ,budget 7,bureau of ,municipal ,research71 #cjf2 ,milk ,industry1 #beb2 ,municipal ,sanitation in the ,united ,states 7,chapin71 #cjd2 ,national ,hospital ,record1 #cbf2 ,new ,basis of ,civilization 7,patten71 #cc2 ,new ,jersey ,review of ,charities and ,corrections1 #cbe2 ,pediatrics1 #cbf2 ,physical ,culture1 #cbf2 ,poverty 7,hunter71 #afg2 press and magazines1 #cbb-cbh2 ,prevention of ,tuberculosis 7,newsholme71 #bbi2 ,principles of ,relief 7,devine71 #agd2 ,principles of ,sanitary ,science and the ,public ,health 7,sedgwick71 #cjd2 ,psychological ,clinic1 #ajf1 #cbf1 #ccj2 ,real ,triumph of ,japan 7,seaman71 #bc2 ,religion and ,medicine 7,emmanuel ,church71 #cia2 reports of schools1 #aff2 reports of schools and health1 #caj-cba2 reports of institutions and societies1 #cbg2 reports of state and national conferences of charities and corrections1 #cbg2 reports of ,united ,states bureau of labor1 #bjc2 ,sanitation of ,public ,buildings 7,gerhard71 #aci2 ,school ,reports and ,school ,efficiency 7,snedden and ,allen71 #caa2 ,social ,order and the ,saloon 7,fox71 #cea2 ,study of ,children and their ,school ,training 7,warner71 #aaj2 ,study of ,school ,buildings in ,new ,york ,city1 #bhi2 ,teeth and their ,care 7,hyatt71 #id2 ,training of the ,human ,plant 7,burbank71 #abj2 ,typhoid ,fever 7,whipple71 #ac1 #af2 ,uncommercial ,traveller 7,dickens71 #df2 ,unconscious ,mind 7,schofield71 #aaj2 ,vital ,statistics 7,newsholme71 #aca ,biggs1 ,hermann ,m41 ,m4,d41 #bcg1 #bea1 #bga1 #bgd1 #bie ,boston1 #cd1 #aee1 #afa1 #bda1 #bej1 #bij1 #cie ,boston ,society for the ,relief and ,study of ,tuberculosis1 #aee ,boyd1 ,emma ,garrett1 #cee ,brannan1 ,john ,winters1 ,m4,d41 #bdj ,breath1 bad1 #cfj1 #cgi ,brightness1 abnormal1 #ajd-ajf ,bronchitis1 #fg ,brookline1 #cd ,budget3 should provide for cleansing1 #fa2 and tuberculosis1 #bcg2 annual health programme1 #cjf2 reforms in ,new ,york ,city1 #cej ,burbank1 ,luther1 #abj ,bureau of ,municipal ,research1 #bih1 #cjf ,butler1 ,nicholas ,murray1 ,,ll4,d41 #ccj1 #ccb ,cabot1 ,richard ,c41 ,m4,d41 #aha ,calmette's ,eye ,test1 #bch ,carnegie ,foundation1 #bhe ,caroline ,rest1 #gj1 #bfg ,catching diseases3 cost of1 #af2 unenforced laws1 #cj2 steps in eradicating1 #ca2 germ sociology1 #eg1 #ga2 favorable soil at school1 #eh2 instruction concerning1 #fb2 mouth a breeding ground for1 #fc2 information for bathers1 #fd2 dangers of1 #aca2 reasons for national board of health1 #ace2 cost of1 in ,new ,york ,city1 #bgb2 remedies urged1 #chd ,charity ,organization ,society1 ,new ,york1 #bcf1 #bci ,chicago1 #cd ,chicken-pox1 #fd ,child ,hygiene1 ,bureau of3 working-paper tests1 #aib2 established1 ,new ,york ,city1 #bih2 programme1 #bii ,child labor3 compulsory school attendance1 #adj2 welfare or age test1 #adb2 movement's limitations1 #ahe2 national and local committees1 #cc1 #aib2 physical-fitness tests1 #aid ,children's ,aid ,society1 ,new ,york1 #ef1 #ic ,child-saving agencies3 coperation with schools1 #agd-ahc2 do-nothingism in1 #ccb ,chorea4 ,see ,nervousness ,christian ,science1 #bgf1 #cib ,christmas shopping1 #bbg ,cigarettes4 ,see ,tobacco ,cincinnati1 #aah ,cleanliness3 acquired taste1 #ad2 beauty of1 #if2 personal uncleanliness1 #baj2 cost of1 #baf2 dry cleaning dangerous1 #bdd2 in fighting tuberculosis1 #bej ,cleveland1 ,ohio1 #bid ,clippings3 scrapbook1 #bej2 envelope method1 #cbd2 advertisements1 #chb ,coffee1 strong1 #dja ,colds1 #fc-fi ,college1 physical tests1 #ci ,committee on ,physical ,welfare of ,school ,children1 ,new ,york1 #ci-da1 #aff1 #afh1 #agh1 #bhf1 #bij1 #caa ,compulsory laws3 school hygiene1 #c2 purpose of1 #cc2 registration of catching diseases1 #eg2 removal of tuberculosis cases1 #bcg2 notification of tuberculosis1 #bcg1 #bgd2 hygiene1 for private schools1 #bhc2 to remove physical defects1 #bhh2 restricting alcoholism1 #cdc ,conference on ,summer ,care of ,babies1 ,new ,york1 #bfj ,congestion3 evils avoided1 #bij2 and alcoholism1 #cdh ,conjunctivitis1 #ga4 ,see ,eyes ,connecticut's school reports1 #cah ,constipation1 #baj1 #baf1 #cdg1 #ceg ,consumption4 ,see ,tuberculosis ,corsets1 #cha1 #dja ,cost3 of preventable diseases1 #af2 of bad breath1 #ih2 of diseases to nation1 #ace2 of tuberculosis1 #bde ,crampton1 ,c4 ,ward1 ,m4,d41 #abi1 #bhi ,dangerous trades1 #aia ,darlington1 ,thomas1 ,m4,d41 #big ,death rates3 of bronchitis1 #fg2 of pneumonia1 #fg2 how to reduce1 #aca ,defects1 physical3 index of community needs1 #cc-dd2 removable1 of children1 #bb2 schools manufacture1 #aci2 income distribution1 #afi ,delinquency1 and mouth breathing1 #dg ,dental ,hygiene ,council1 #ie ,dental sanitation1 #hi-ajc2 surface for breeding germs1 #fc2 dentists1 #ic2 state organizations1 #ie2 clinics needed1 #aga2 insurance companies treat teeth1 #bjd2 family instruction1 #bde2 indigestion1 #bgb2 early treatises1 #bgd2 advertising parlors1 #bha ,devine1 ,professor ,edward ,t41 #agd ,diet3 cooking lessons at home1 #ahj2 overeating1 #bja1 #cdg2 improper1 #baj2 proper and regular1 #bab2 adapted to need1 #bad1 #dja2 kitchens1 #bfg2 irregular eating1 #bgb1 #cdg ,diet kitchens1 #bfg ,diphtheria1 #ah1 #fe ,dispensaries and hospitals3 dental supervision1 #ajb2 coperate with schools1 #agd-ahc1 #ahe2 welfare nurse1 #ahh2 emergency1 #bbg2 to prevent duplication1 #bci2 lack of1 #bdj2 teach baby feeding1 #bfa2 inefficient1 #bgh2 social interest of1 #bib ,doing things at school1 #aei-afe2 free meals1 #dd1 #afa1 #aga2 may hurt1 #aha2 cripple social agencies1 #ahe1 #ahi2 danger of malpractice1 #ahd1 #ahi2 analogous to model tenements1 #ahf ,do-nothing ailments1 #cbi-ccd ,ear trouble1 #hc-he2 periodic tests for1 #bja1 #bjg ,edinburgh1 #gj ,ellis ,island1 #bch ,environment3 health problem1 #i2 tests1 #abj1 #cbj2 injurious school1 #aci-aej2 effect on physique1 #bjc2 and tuberculosis1 #bbi-bea2 do-nothing ailments1 #cbi2 within our control1 #ccf2 in combating liquor1 #cfb ,epidemics1 #ah1 #ch ,epilepsy1 #dg1 #di ,ergograph1 #abe-abg ,erysipelas1 #fe ,ethics1 professional1 #ha1 #aja1 #bha ,eugenics1 and heredity1 #ccf ,european remedies1 #aei-afe ,eye trouble1 #gb-hb2 in high school1 #dj2 catching diseases1 #fi-ga2 caused by bad teeth1 #hi2 eyeglasses1 free1 #afa1 #afd1 #aga1 #ahd2 in business1 #aic2 examination for adults1 #bja2 tuberculin test1 #bch2 inefficient inspection of1 #cjj2 teachers' test1 #cja ,examination1 physical3 of school children1 #cc-ach2 best test of health needs1 #cc-dd2 individual record of1 #ce1 #cab2 ,snellen test1 #gc1 #gg2 of teachers1 #aec2 for work certificates1 #aij-bjj1 #bcg1 #cja2 by railroads1 #aic2 at ,west ,point1 #aii2 periodic after school1 #bja-bjg1 #bah1 #bbh2 semi-annual1 #bjb2 tuberculin tests1 #bdj2 stripped1 at ,leipsic1 #bhi2 follow-up work1 #bie-cjj2 of teachers and sex hygiene1 #chi ,family3 unit of social treatment1 #agd2 examining parties1 #bcg1 #bda2 tuberculosis histories1 #bda ,fear and bodily disorders1 #cib ,flick1 ,lawrence ,f41 ,m4,d41 #bbi ,follow-up work1 #bie-cja ,fox1 ,hugh ,f41 #cea ,fresh air3 others' standards of1 #i2 fiends1 #ff2 outings1 #agf1 #agh2 economic value of1 #aie2 ventilation at school1 #adb2 ventilation at home1 #baj2 ventilation at work1 #bab2 ventilation at sanatoriums1 #bad2 ventilation at churches and theaters1 #bag4 ,see ,air ,georgia1 #cej ,germany1 #afj1 #bjd ,germs1 disease3 in milk bottles1 #ad2 isolation1 #ca2 germ sociology1 #eg-ga2 dental sanitation1 #hi-ajc2 locating germ factories1 #bch2 tuberculosis1 #bcd ,getting things done1 #aff-agc2 doing of highest kind1 #ahc2 study underlying causes1 #ahi2 by local agencies1 #bhg ,glands1 #hh ,goler1 ,george ,w41 ,m4,d41 #aif ,gorgas1 ,william 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,york state1 #ab1 #bd ,new ,york ,state ,charities ,aid ,association1 #bcf1 #bdb ,nicotinism4 ,see ,tobacco ,normal schools1 #aaj ,north1 ,professor ,lila ,v41 #adb ,notification of diseases1 #ca1 #da ,nuisances1 #ag1 #ah1 #bc1 #cff ,nurses at school1 #bcj1 #bhf1 #bic1 #cjj4 ,see ,milk ,oliver1 ,thomas1 #bjc ,orthopedics4 ,see ,tuberculosis ,ophthalmia1 #fe ,oppenheimer1 ,nathan1 ,m4,d41 #aaj ,osteopathy1 #bge ,panama1 #ei ,parents3 and school hygiene1 #c2 interested by examinations1 #da2 should coperate with physician1 #bgi2 interested in school examinations1 #big2 need health reports1 #caj2 heredity1 #cce-cdb2 nicotinism1 #cfh ,parks and playgrounds1 #g1 #cb1 #aah1 #abb1 #adb1 #ahf1 #bij1 #bid ,parochial schools1 #ahi1 #aih ,patent medicines3 evils of1 #cfi-cgg2 advertisements1 #chj ,patten1 ,professor ,simon ,n41 #i1 #ad1 #cc1 #afe ,pediculosis1 #fi-ga ,pennsylvania1 #caa ,philadelphia1 #cd ,phthisis4 ,see ,tuberculosis ,physical training1 #aae-aag2 in ,new ,york ,city1 #bif2 and 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,ringworm1 #fe ,rochester1 ,n4,y41 #bfb1 #bff ,rome1 #ae ,roosevelt1 ,theodore1 #fj1 #aah ,rural districts3 encourage disease1 #ac2 compared1 #cb2 physical defects1 #gd2 schools unsanitary1 #ada2 hygiene in ,great ,britain1 #cjh ,russia1 #ajh ,sage ,foundation1 #bhe ,st4 ,vitus's dance1 #aaa ,salmon1 ,professor ,lucy ,m41 #cee ,scabies1 #fe4 ,see ,itch ,scarlatina1 #fe ,scarlet fever3 thrives in slums1 #ah2 signs and method of infection1 #fe2 peeling1 #acb2 compulsory removal of cases1 #bdj2 germ carried in milk1 #bfd ,school hygiene3 and employers1 #c2 instruction compulsory1 #c-aj2 practice of1 #e1 #ah2 biological engineering1 #aci1 #bjc1 #cci2 departments of1 #bhc-bic2 in ,new ,york ,city1 #bid1 #bif-cja ,score cards1 #bg1 #bi1 #bei1 #ccg ,scranton1 #bfi ,sea ,breeze fresh-air home1 #agf ,sea ,breeze seaside hospital1 #i1 #bdj ,seaman1 ,l4,l41 ,m4,d41 #bc ,seattle1 #afa ,sedgwick1 ,professor ,william ,t41 #cjd ,sex hygiene1 #chd-chi ,sexual deviates1 #ahb ,shoes1 tight1 #dja ,sickness1 preventable1 cost of1 #bgh ,sleep and vitality1 #bja1 #bgb ,slum1 a menace1 #ac1 #bj ,smallpox3 epidemics great teachers1 #f2 conquered by vaccination1 #g2 neglected in rural ,pennsylvania1 #ah2 comes rarely to cities1 #ca2 compulsory removal of cases1 #bdj ,snedden1 ,professor ,david ,s41 #cc1 #afe1 #caa ,snellen eye test1 #gc1 #gg ,society for ,sanitary and ,moral ,prophylaxis1 #chd ,southern states1 #cea ,spargo1 ,john1 #cc1 #afg ,spitting1 #bbc1 #bce ,state activity1 #d1 #gc1 #aba1 #bcf1 #bib1 #cjf ,statistics1 object of1 #aca1 #acd1 #ccc ,strauss1 ,nathan1 #bfj ,streets1 #ae1 #abb1 #bag1 #bed1 #cdh ,study hours1 too long1 #bhg ,sweating1 #aeb1 #baa ,taxes1 taxpayers4 ,see ,budget ,teacher's health3 tests of1 #aeb-aeh ,teachers3 social work1 #agb2 health passport1 #bjb2 for tuberculous pupils1 #bcg2 excluded when tuberculous1 #bdb2 and physicians1 #bgi2 physical examination of1 #bhd2 use of alcohol1 #ceh2 cigarettes1 #cfh2 use clippings1 #chb ,teeth4 ,see ,dental ,sanitation ,temperance4 ,see ,alcoholism ,tenement reforms1 #bj1 #ahf1 #bji1 #cjd1 #djc ,thompson1 ,j4 ,arthur1 #ccf ,tobacco3 instruction at school1 #c2 economic injuries of1 #bja2 forbidden to employees1 #baj2 evils of nicotinism1 #cfc-cfh1 #chf ,tonsils1 hypertrophied1 #dd ,trachoma1 #fi-ga ,trudeau1 ,e4,l41 ,m4,d41 #bgd ,tuberculosis3 pupils excluded from school because of1 #fe2 aggravated by colds1 #fh2 bone tuberculosis1 #hg1 #hh1 #bcf2 and bad teeth1 #ij1 #ii2 in teachers1 #aec2 examination for working papers1 #aia2 periodical examination for1 #bja2 last days of1 #bbi-bea2 eye and skin tests for1 #bdj2 tests of cows1 #bfj2 carried in milk1 #bfd2 out-of-door treatment1 #bgd2 only predisposition to1 inherited1 #cce ,typhoid3 a rural disease1 #ac2 carried in milk1 #bfd ,university ,extension ,society1 #agh ,vacation schools1 playgrounds1 #aji1 #bif ,veiller1 ,lawrence1 #i ,vitality tests and statistics1 #abd-ach ,water1 drinking3 reason for works1 #ae2 factories pollute1 #ag2 fountains1 #bag2 public responsibility for1 #bbf2 protecting sources1 #cjg ,welfare work1 #g1 #bba-bbe ,west ,point1 #aii ,wheeler1 ,herbert ,l41 ,d4,d4,s41 #ic ,whipple1 ,george ,c41 ,ph4 ,d41 #ac1 #af ,white plague4 ,see ,tuberculosis ,whooping cough1 #fd ,williams1 ,alida ,s41 #gb1 #abb ,williams1 ,linsly ,r41 ,m4,d41 #bda ,work3 physical examination for working papers1 #aij-bjj1 #bhe2 healthful habits1 #bjh-bag2 unpatented medicine1 #ccd4 ,see ,industrial ,hygiene ,young ,men's ,christian ,association1 #bbg 99 99 99 99 99 ---------------------------------------- ------------------- ,typographical errors corrected in text3 ,page #fj3 heath replaced with health ,text moved to avoid splitting paragraphs with tables3 ,first half of last paragraph on page #be1 moved to page #bi1 following ,table ,,iii and ,table ,,iv on pages #bf to #bh4 ,first half of last paragraph on page #fc1 moved to page #ff1 following ,table ,,viii on pages #fd to #fe4 ,first half of last paragraph on page #aha1 moved to page #ahc1 following ,illustration on page #ahb4 ,continuation of paragraph begun on page #bbb1 moved from page #bbe to the end of the paragraph on page #bbb1 to precede text ads_/,illustrations on pages #bbc and #bbd4 ,continuation of paragraph begun on page #bed1 moved from page #beh to the end of the paragraph on page #bed1 to precede ,conference information on pages #bee to #beg4 ,first half of last paragraph on page #ccg1 moved to page #cdj1 following ,score ,cards on pages #cch and #cci4 ---------------------------------------- ------------------- 99 99 99 99 99