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CHAPTER XIII
HEALTH AND PHYSIQUE OF SCHOOL CHILDREN

By James Frederick Rogers,
Chief of Division of Physical Education and Hehool Hygiene

Content."?.—School housing—Playgrounds—Medical inspection—Dental work—Nutrition—■ Open-air schools and open-window rooms—The summer rump—Other special schools and classes—Health education—Physical training—Safety and first uid—Preschool work—College health—Health of teachers—Teacher training—Parent-teacher organizations—Legislation—School health agencies

SCHOOL HOUSING

Steady progress in recent years has been made in the safe and healthful housing of school children. From a none too carefully constructed box, poorly lighted, and fitfully warmed by a central stove, which failed in making comfortable the wind-chilled floors, furnished with unsuitable benches and with blackboards which belied the name, and provided externally with toilets which were often striking examples of what such appointments should not be, we have come, in a half century or so, to single or consolidated schools having suitable heating apparatus in the basement, the latest toilet and lavatory arrangements under the same roof, a well-equipped lunchroom, blackboards that are black, abundant illumination, suitable seats, some special features for the comfort of the teacher, and, in a word, all necessary facilities (so far as we can now see them) for the health of all concerned. Many schools have gone still further and have supplied special rooms and equipment for the stud}7 of home economics, and have provided materially for the physical development of the child by furnishing gymnasiums, baths, and swimming pools.

In some respects we may have gone too far in the use of creature comforts. We have made use of playrooms and gymnasiums in seasons when the playground would have been far more appropriate, and it has been discovered that frequently the schoolrooms have been kept at such a high temperature as to interfere with the loss of body heat and to cause coincident interference with mental activity.

Perennial reports continue from many quarters of overcrowding and double sessions, and the picture of the safe, sanitary, and wellequipped school does not hold universally. In many parts of the country deplorable conditions still exist. According to a ParentTeacher Association survey of the schools of Delaware, "two-thirds of the buildings now in use are violating practically all of the health standards which it is one of the supreme tasks of the school to teach to the children."

The water supply of schools is not always chosen with the care lhat one would expect. An examination of the supplies of 97 of its rural schools by the State department of health in Connecticut was recently made; of these only 24 were considered satisfactory, and 1G were pronounced unsafe.

PLAYGROUNDS

Toward the middle of the nineteenth century the educator, intent on adding new subjects to the curriculum and zealous to increase the intellectuality of his pupils at all costs, lost sight of the importance of the playground and often begrudged the child his two blissful respites, the traditional recess periods. Old school grounds were encroached upon, and with the rising cost of city lots new school sites were limited to little more than a mere space for the building. However, in the last quarter of the past century an effort at rescue of the playground was begun, and with the efficient assistance of the Playground and Recreation Association of America not only is more adequate room for play now included in the newer school-building programs but opportunity is supplied elsewhere and trained organizers and directors of play are widely employed. In many cities the municipal playgrounds are under the control of the board of education and are directed by employees of that department throughout the summer as well as at other seasons. It is the opinion of the superintendents of schools in 91 out of 136 large cities that all playgrounds should be under the supervision of the department of education.

Out of 164 cities affording information on the subject 143 stated that playgrounds are provided for every new school building. Doubtless in many instances there is much to be desired in the size of these grounds, but in at least one State a minimum standard has been set of 2 acres for every one-teacher school, 3 acres for every twoteacher school, 4 acres for every three-teacher school, and 5 acres for every larger elementary school. Ten acres has been set as the minimum for high schools. These dimensions have been greatly exceeded by many schools in more than one State.

Besides furnishing playgrounds, some effort is made to put the grounds in condition for use on as many days of the year as possible and to make use of them under special or regular teacher supervision not only during the school session but after school and on Saturday. There is no time in the regular curriculum, unless it should undergo radical revision, for an adequate program of physical training, and it is to wisely supervised after-school and vacation activities that we must look for full value in this kind of work.

MEDICAL INSPECTION

Medical inspection, or health examination (to use a better term), began a half century or so ago in Europe with the examination of the vision of pupils. In many sections of this country it has not in practice advanced beyond this stage of development, and, although 42 States have laws requiring or permitting medical inspection, it is estimated that half of the children of the country have never so much as had their vision tested. The examination of vision was an acknowledgment that the eye is an essential intellectual tool with which the pupil works and with which he works best when it is most nearly perfect. This idea has not, however, as yet penetrated through the dense layer of materialistic tradition with which all our minds are still incrusted; for many a teacher wastes time and effort year after year working not only with pupils handicapped with defective vision, but with children who are dull because deaf, and stupid because of badly fueled brains.

It is true that the mere removal of defects does not affect the hereditary basis of poor or good intelligence. It is inadvisable, however, to attempt to train children who are mentally hampered by remediable bodily defects; though this is carried on to an incredible extent. There are bright spots, it is true, but the general picture the country over is not what could be wished. In at least one European State every child is thoroughly examined, stripped, by a physician three times in his school life, and oftener if his condition seems to warrant it.

There is no longer need for examination for the mere sake of piling up appalling statistics on the subject of human defects. Whether in city or country, East, West, North, or South, the proportion of physical defects is much the same and is a depressing commentary on the fall of man from physical perfection.

Although the examination by a thoroughly trained physician of each child fully stripped would be the ideal practice, the recent tendency has been to make of the school nurse or the regular teacher at least the preliminary examiner. Even where there are other examiners it is the teacher's business to know the instruments upon which she plays, whether they are at their best and remain at their best. Without the use of any kind of special instrument she should know whether a child is doing good work, whether he shows signs of defective vision, is dull of hearing, can not breathe through his nose, has decayed teeth, is stooped, or shows other evidence of being improvable. As for the detection of communicable disease, the teacher can be the only first-hand observer, and first-hand knowledge of such conditions is the only kind worth while. It needs only a comparatively brief period of instruction and of practice to make the teacher an excellent examiner, and such training promises to be afforded hereafter in her professional education. It has, in fact, been begun in a few teacher-training institutions.

No matter who makes the preliminary examinations, there is need in every school system of a thoroughly trained and well-paid medical inspector and consultant, for the end of such examination is not to find defects but to decide which need to be removed or improved, and to have something done about them.

In the health examination heretofore the persons most concerned and whose cooperation is most needed—the parents—have been ignored. It is notable that in the past few years this method has been undergoing change, and in some cities, where an invitation has been extended, the parents have been present to the extent of 75 per cent. They furnish to the examiner much valuable first-hand information concerning the child's physical history and reduce the labors of the school nurse whose most important business has been the "follow-up " work of home explanation and persuasion after examinations.

It is a high tribute to the usefulness of the school nurse that, although there has been some diminution in the number of full-time school physicians, the number of nurses has increased in both urban and rural regions; and the number of pupils has, in many instances, been reduced to 1,000 per nurse. The employment of school nurses in rural communities is increasing rapidly, and wherever a sufficiently trained and tactful person has been employed she has been found to be indispensable.

A few years ago the administration of medical and dental inspection was about evenly divided between departments of health and departments of education, but there is an increasing balance on the side of educational authority, especially in small cities. In 80 per cent of cities with a population of 10,000 to 100,000 furnishing information on this subject, the administration of medical inspection is under the department of education. This division has bren occasioned by the presence of communicable disease, the management of which always falls within the province of the health officials. As these diseases are stamped out the health work will become more exclusively the field of the. department of education, though the crest of the wave of public-health activity itself has become purely educational.

Half of the children of the country are in the rural schools, and though these are not better off physically than their city cousins, health work, except in spots, is far from adequate. It is particularly

lacking in organization and direction. In most instances it is still waiting on the progress toward better county or district organization in public-health work, if not in education, and these await the approval of the taxpayer.

It is to be regretted that in this country more men broadly interested and qualified for directing the health activities of schools, both urban and rural, can not be given attractive salaries with sufficient time for research, as the opportunities for valuable investigation are unlimited.

DENTAL WORK

There has been a steady development of dental work in schools. In many instances this has been inaugurated by the local dentists, though most satisfactory results are obtained where it has been incorporated as a part of the general health work of the school. Besides the school dentist who attends to fillings, extractions, and alignment, dental hygienists are employed in increasing numbers. In addition to examining and cleaning teeth, these workers assist in the training of the child in the care for the appearance and preservation of these valuable structures.

Mouths which have never been entered by brush or dentifrice may contain the most beautiful teeth, while others which have known the most persistent and approved efforts at artificial cleansing may contain few sound specimens. School work on a large scale has proved conclusively that oral hygiene alone has little effect, at any rate during school life, in reducing the tendencies to decay. On the other hand, recent experiments indicate that the amount of caries is noticeably affected within a few months by the character of the food.

The Children's Bureau, in a study of preschool children in Gary, Ind., found that in those whose diet was almost wholly deficient, or lacked one or more essential food elements, there were 7r>.G per cent, with carious teeth as compared with 52.1 per cent for others; and in experiments on three groups of 7-year-old children, conducted by Mellanby, Pattison, and Pro'ud in a London hospital, the effect of deficient diet on the extent of existing caries, and on the increase in number of decaying teeth, was evident within a few months.

Though proper nutrition is essential for good teeth, efforts at oral cleanliness are worth while, from the point of view of aesthetics if from no other, and preservation by prompt filling of all cavities is of the utmost importance. The trend, however, in dental prophylaxis is at last toward the removal of the causes of caries through the

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