204 Insanitary State of Schools. CHAPTER XIX. SCHOOL HYGIENE. No inconsiderable proportion of the life of the inhabitants of civilized countries is expended in schools and colleges; the hygienic condition of these places, and the physical culture of the bodies of those who spend their time in them, are matters of great importance to the community. A large number of educational institutions exist on very unhealthy sites; and in too many of them there is a serious deficiency in the arrangements for ventilation. They are also frequently supplied with water of bad quality, and in numerous instances their sewerage system is out of order. I have lately inspected the sanitary condition of several public schools, and in each I found the most serious hygienic defects. The case of Mercer's endowed school for girls at Ashtown, in the County of Dublin, will serve as an illustration. In this institution, which is situated in the open country, the girls were extremely well fed and comfortably clothed; they were provided with ample play-ground, and they slept in well-ventilated dormitories. Notwithstanding these advantages their health was not nearly so good as that of the inmates of another school under the same management, who were not supplied with equally good food, and who lived in one of the most densely populated parts of the city of Dublin. On examining the state of Mercer's school, I found quite sufficient to account for the delicacy of some of its inmates. The main sewer was choked, and an untrapped opening in the bath allowed the sewage gases to enter in to the bath room, and from thence to diffuse themselves throughout the house. The well water, too, was impregnated with sewage, which escaped from the blocked-up sewer. It contained 56-56 grains of solid matter per imperial gallon (70,000 grains weight), of which 22.6 grains consisted of organic and volatile matters. There were large quantities of free ammonia, albuminoid nitrogen, nitrous acid, and nitric acid in it. In this case the school authorities (one of whom is the Most Rev. Dr. Trench, Archbishop of Dublin, and who for nearly three hours was present at one of my examinations) did their duty in making a thorough investigation into the cause of the unhealthiness of the institution; but I fear that in but too many instances those in whom the management of scholastic and eleemosynary institutions is vested never think of ascertaining whether or not their sanitary condition is satisfactory. The recent removal of the London Charter House, and others of the large endowed schools, from towns to suburban or rural districts is literally a move in the right direction, which we hope will ere long become general. Could there be a more unhealthy site, for example, than that of the Dublin Marine School, situated as it is on the banks of a river into which the sewage of a city of a quarter of a million inhabitants is discharged, and supplied with air contaminated with the exhalations of chemical, ammonia, coke, tar, gas, and artificial manure works? Children are less able to resist the effects of excess of cold or heat, and of deficiency of food, than adults; they also are more seriously affected by an impure atmosphere. A young man may endure without permanent injury a few years' exposure to insanitary influences; but if the period between infancy and adolescency be passed under conditions unfavourable to the vigorous development of the body, then, indeed, it is rarely that the child attains to a strong and healthy manhood. The malign influence which schools exercise on the health of children attracted attention many years ago. Carmichael, in his work on scrofula, published in 1810, proved that the excessive amount of phthisis which he found in many of the Dublin schools was caused by defective ventilation, and not by insufficient nutrition. In the children's department of the House of Industry, the cases of scrofula were so numerous that the disease was believed to be present in a contagious form. In one of the wards, 60 feet long by 18 feet broad, there were no fewer than 38 beds, each containing four children! The amount of square feet allowed to each child was, therefore, only 63. The height of the ward is not given in Carmichael's work; but assuming it to have been 15 feet, that would have given to each child 102 cubic feet. Neil Arnott and other authorities have placed on record cases of defective ventilation in schools almost as bad as those discovered by Carmichael; and if a careful inquiry were instituted at the present time, I have no doubt but that, even in the matter of ventilation, a large proportion of our schools would be found in a bad condition. The amount of carbonic acid gas in pure air is 0.04 per cent. When this proportion is doubled the state of the atmosphere is unsatisfactory. Roscoe found in the air of a school-room containing 22,141 cubic feet, and in which 164 boys were studying for two and a half hours, 0.2371 per cent. of carbonic acid; and in another school-room he found 0.31 per cent. of this gas. Luna found in a room of a girls' school, at Madrid, 0723 per cent. of carbonic acid, or eighteen times the normal proportion of that gas. In two schools in Dublin I found the carbonic acid to amount to 0.14 and 0.12 per cent. respectively; but in others the air was tolerably pure. Dr. Endemann found the amount of carbonic acid in the air of 17 schools to vary from 097 to 357 per cent. I conceive that it is a part of the duty of the Medical Officer of Health Da 1 The Lancet, in one of its reports on the condition of the English public schools, has shown the depressing influence on the health of the boys of London schools which the air of a large town exercises.-Lancet, May 14, 1870. 206 Chadwick on Schools. to inspect the schools, public and private, in his district, and to ascertain whether or not they are so over-crowded as to be injurious to health. Physical exercise is now a feature of school and college life, and more especially so in these countries. A friendly emulation amongst the scholars of the same educational institution, and between rival schools and universities, in the performance of rowing, cricket, and other robust games, does much for the improvement of the physique of the rising generation. And it is in favour of these competitions that they have not a brutalizing tendency, like some of the pastimes of our forefathers. The drawback to the system of competition in athletic exercises is the undue strain which it so often imposes upon the muscular system, and which sometimes occasions permanent injuries, and even fatal lesions. Cricket is, perhaps, the game which is most unlikely to do violence to the important muscles; whilst it has the advantage of being, at least, a semi-intellectual pastime. During inclement weather children should be provided with a large empty room as a substitute for the out-of-door play-ground. With respect to the ordinary gymnastics in boys' schools, they are, on the whole, well contrived to produce a healthy development of the muscles. In France this kind of physical education has been brought to a high degree of perfection-thanks to the teachings and efforts of A. Thierry, Berard, Colonel Amoros, Beclard, Bouvier, Londe, and Milne-Edwards. That veteran sanitarian, Mr. Edwin Chadwick, C.B., has, in a recent communication to the Journal of the Society of Arts, pointed out the more common defects of the ordinary schools of these countries. He maintains that the chief sanitary defects of our schools are-1. Defective ventilation; 2. Defective warming; 3. Bad drainage and foul latrines; 4. Want of means of maintaining personal cleanliness; 5. Bad lighting; 6. Bad arrangements of desks and seats; 7. Want of proper means of gymnastic exercises; 8. Insufficient and ill-paved play-grounds. He submits that it is important that school boards should require, in the competition for plans, that these evils should be first considered and provided for, and that the architectural designs and elevations be made of secondary consideration. It is painful, he says, to observe the condition of children in the common schools in winter time, going there in cold and wet, in driving sleet and snow, frequently ill-shod, and commonly illelothed; kept in the school during excessively long hours under any conditions for children, with feet and hands painfully cold, fingers often so benumbed as to be scarcely able to hold their slates and pencils; the open fires at one end of the school not freely to be approached, and, when approached, the warming or heating on one side, "roasting in front and freezing behind," so as to give inflammations or colds from the disturbed and unequal circulation. The confinement of children for five or six hours under such conditions, overtasked mentally, and painfully constrained bodily, surely requires active intervention for their relief. In every school-room there should be a thermometer, and the teacher should take care that it does not register less than 60 degs. Fahr. Mr. Chadwick considers that of the modes of warming, those by hot-water pipes and iron surfaces are of inferior, and sometimes, when for high heats, of pernicious effect; besides, they are very expensive. They are apt to warm only the sides of the rooms, or the upper parts of them, and to leave the feet cold, unless an inconvenient and objectionable degree of heat is created over the whole room. It is, moreover, matter of considerable experience that warming by earthenware substances, or stone substances, especially by heat diffused over wide earthenware or concrete surfaces, is more agreeable and more salubrious than any warming by iron surfaces. In Germany attention has been called to the poisoning of the air of school-rooms by carbonic acid and carbonic oxide passing into it through the sides of iron stoves. Dr. Oidtmann, in a pamphlet on this subject, published in 1868, states that chronic poisoning of children by carbonic oxide is very common. I agree, then, with Mr. Chadwick in considering the principle of floorwarming, which he has so long advocated, as the best. In some of the public schools, too, such a plan would prevent the tyranny of the larger boys excluding the weaker and more delicate children from snug places beside the stove or fire-place. In the large institutions, where children are boarded, the effects of progressive sanitary improvement have been distinctly marked. In one, where the death-rate had been about twelve per thousand, the foul air from cesspools and bad drains was excluded, the latrines were mended, and the ventilation was improved, whereupon the death-rate was reduced to eight in a thousand. Next, regular tepid ab'ution, and, in summer time, cold water bathing and careful skin-cleanliness was introduced, and the death-rate was reduced to four in a thousand. Mr. Chadwick advocates the washing of children at schools, for various reasons, hygienic and otherwise. There is, in well-appointed schools in Holland, usually a female attendant on the schoolmistress, who takes the dirtied children into an apartment and washes them, the schoolmistress herself being above such a service. There are, no doubt, few (if any) private schools now in existence on the type of Dotheboy's Hall; but in cheap boarding schools there is no guarantee that the children located in them receive a sufficient quantity of nutritious food and at proper times. I have known many cases where parents were obliged to remove their children from boarding-schools, even of the better class, because of their insufficient dietaries. Notwithstanding the advantages resulting from free trade, the State should take care that competition in boarding-schools does not result in the pupils being insufficiently fed as well as badly instructed. Every school should be managed, as in Prussia, by a person licensed for such a purpose, and should be subject to official visitation. The celebrated Rudolph Virchow, Professor of Medicine in the University of Berlin, has written (in 1869) a valuable treatise on the diseases incidental to schools, which I should be glad to see translated into English, and circulated amongst the school authorities of these countries. Virchow agrees with those orthopedists who maintain that the school is largely to blame for distortions of the spine, and more especially for that form of spinal curvature termed Scoliosis. He quotes several eminent authorities, amongst others Guillaume, who found amongst 731 scholars whom he examined no fewer than 218 with distortion. The great majority of cases of scoliosis are amongst girls. In 72 cases noticed by Knorr, of Munich, there were 60 females. As girls spend less time at school than boys, and fewer girls attend at school, it has been urged that scoliosis is not most frequently induced by bad postures whilst studying. To this objection it may be answered that boys during their hours of play counteract by vigorous exercises, involving the play of nearly all the muscles of the body, the evil influence of the school-room postures. On the other hand, girls, as a rule, do not practise any kind of gymnastics. In almost every school the children in each class, no matter their heights, have to sit at desks of the same size: why could not the desks for each class be made in short lengths, and of different heights, so that no child would be placed at one either too low or too high for him or her? Dr. Guillaume gives a table showing the proper height of desks for children of different heights. Virchow attributes a large proportion of the pulmonary consumption of childhood to over-crowding in school-rooms, to sudden changes of temperature in passing from hot school-rooms into the cold outside air, to the dust of the school-room, and, lastly, to impaired respiratory movement induced by prolonged sitting. Short sight is the commonest disease in Germany. Dr. Cohn found that 60 per cent. of the students of the University of Breslau 1 Ueber gewisse die gesundheit benachtheiligende einflüsse der schulen. 211 Swiss inches equal 13 English inches. |