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use of a diet which will furnish from their prenatal beginning the right materials for the making and maintenance of the teeth.
For nearly a century and a half it has been found advisable in European States to furnish meals for poorly fed pupils, but otherwise the most fundamental subject in hygiene, namely, nutrition, has until very recently been nearly neglected. The efforts at improving the daily food habits of the child constitute the most important movement in health work of the age and give promise of the most farreaching results not only healthwise but economically. We have hitherto been too much inclined to take it for granted that a child is “well fed if he does not starve” or that any kind of food will do for him. We are much concerned about the kind and amount of gasoline and oil which we put in an automobile, but it has not entered our heads that the amount and character of work of the school child is at all connected with what he has had for dinner, or, as was long ago pointed out by Voltaire, that his disposition depends on his digestion.
In the efforts at improving the nutrition of the more evidently malnourished children, whether selected by crude measure of relative weight for age and height or by the more trustworthy method of a general examination for all the signs of this condition, special classes have been organized and even open-air treatment has been afforded them. The tendency is, however, except in the most serious cases, to go direct to the root of the matter and secure the right feeding and other conditions affecting nutrition for all children in the home, if possible, and give supplemental feeding in the school only where this is deemed necessary for the time being.
Certainly where children have not sufficient time, or where the distance from home is too great for them to return home at noon, a suitable noon lunch, planned and superintended by the teacher of domestic science, is now deemed essential, and this function is made use of not only for mere feeding but as an objective part of the teaching of hygiene. About one-third of all cities are now furnishing this lunch. In rural schools, where suitable provisions for the noon meal are of especial importance, the serving of hot chocolate or soup with the food brought by the child is arranged for, while suggestions to parents and the distribution of such publications on the subject as those issued by the Bureau of Education have made an improvement in the contents of the lunch basket.
OPEN-AIR SCHOOLS AND OPEN-WINDOW ROOMS Open-air schools and open-window classes are a part of the special equipment in about 25 per cent of cities having a population of 30,000 and more and in about 10 per cent of those from 10,000 to 30,000. The proportion has not increased much in a decade. The success of these schools, which grew out of methods employed in sanitoria for the tuberculous, has, of course, depended on much more than pure or cool air; for extra feeding, rest periods, and a kympathetic atmosphere have been as important factors in the results obtained.
Open-window classes have been used for the same type of pupils where no open-air schools exist or for presumably nontuberculous cases of malnutrition.
As Newmayer says, open-window classes were a “confession that only malnutrition cases shall receive fresh air, and this to be given at times at uncomfortable temperature." It is the duty of educators to furnish such a necessity as pure air at a comfortable temperature to every child in every class. “The lack of fresh air in our schools is an indictment against the designers and builders of our school plants." Even if we furnish a pure and not superheated atmosphere to only our tuberculous children, we shall have to make such conditions for a very large per cent of them.
Children who are suffering from active tuberculosis or other serious chronic diseases have no place even in an open-air school. Their physical care is paramount, and they should be placed in a preventorium or sanitorium, where they can have for 24 hours a day the best conditions for healing and recovery. Even in cases of serious malnutrition (which may often be due to tuberculosis) as much progress will be made if the mental work be made clecidedly secondary to physical welfare.
The rulings made in New York City as to cases suitable for openair schools are as follows:
1. Those who show tuberculous infection but have no sign of active disease.
2. Children exposed to active tuberculosis, particularly those of a marked degree of malnutrition.
3. All definitely arrested cases of pulmonary or other forms of tuberculosis.
1. Marked cases of malnutrition.
Besides learning that pure air and comfortable temperature are essential for body-mind activities, we need to be reminded by the more recent studies of nutrition that “the human flower is, of all flowers, the one which has most need of sunlight.” In this connection we may well spend some time in informing ourselves as to the work of Doctor Rollier, of Switzerland, who gives his pupils not only pure air but abundant light and bodily movement. His inethods are having an influence in schools in other European countries.
THE SUMMER CAMP
The summer-camp idea dates back some centuries, but in practice it has only lately had its phenomenal development. Like other schools, it began and chiefly remains a private institution, but it is made use of to an increasing degree as an adjunct of the school for the treatment of tuberculous or malnourished children. In the camp the child, during a season when he is often left too much to his own ill-considered ways, can be placed without thought that he is being schooled, under an ideal régime for health in which every condition from the foundations of diet and rest, up, can be supervised while he is brought into that intimacy with nature, too much lacking in our modern life. This deserves to become a part of the experience not only of the ailing child or the child with well-to-do parents but of every child and at public if not private expense. The cost might be considerable, but the results would be worth it. In 83 cities the camp has established itself as a part of the recreational system, and it only needs to be absorbed by the schools.
OTHER SPECIAL SCHOOLS AND CLASSES
Besides the open-air schools and classes for those crippled constitutionally by bad feeding or chronic bacterial disease, there has been much progress toward special assistance for those locally crippled in eye, ear, heart, or limb. “Sight saving” or “sight conservation” classes are being established in increasing numbers for children with corneal opacities, pronounced or progressive near sight, or other causes which greatly impair the vision. These classes are given an especially good light; extra large print is used ; and the methods of training are especially adapted to these half-blind children.
The number of children who are hard-of-hearing is large, and classes with appropriately adapted methods have been organized in many cities for those children who, because of this defect, can not profit as they should by the regular school activities. A study of best methods of selecting and training such children has recently been undertaken by the American Federation of Organizations for the Hard of Hearing in cooperation with the Bureau of Education.
Children with speech defects are given more attention chiefly through special teachers who work with the children individually or in small classes at special periods in the school day. They help also indirectly by advising the regular teacher as to general methods of handling these children so that they may not suffer from consciousness of their distressing ailments. In the city of Philadelphia 10 of these special teachers are employed.
Children with damaged hearts are given special attention in some of our larger cities by the establishment of special heart clinics and by placing the children in special classes where their exercise and nutrition can be supervised.
Training in the practice as well as in the theory of hygiene (or health education, as it has been called) is widely adopted in the school program, and excellent progress has been made in the perfection of methods for arousing interest and for securing results. This development has been powerfully stimulated by the efforts of the American Child Health Association, the joint committee of the National Education Association and the American Medical Association, the American Red Cross, the National Tuberculosis Association, the National Child Welfare Association, and other private agencies. Such work hinges on the attitude and degree of cooperation of the home, and this fact is still too much ignored. The work of health education has its objective beginning in the first physical examination of the child, and the presence on that occasion of one or both parents should start the welding of a link of mutual understanding as to what the school is driving at when it attempts to improve the child's daily habits. Periodic weighing and measuring of the child serves as a concrete reminder of his bodily being and as a peg on which to hang health lessons that endure.
This work is placed, in many school systems, under the supervision and direction of a special health teacher or of a physical director or nurse well grounded in these methods, and preparation in this subject has been introduced in teacher-training institutions.
Besides the helps for teachers in the practical teaching of hygiene issued by this bureau, we would mention the reports of the conferences on health education held by the American Child Health Association and the report of the joint committee on health problems in education, issued in 1924, and entitled “Health Education."
There has beʼn increasing improvement in the methods of teaching and in the textbooks used in the elementary school. In high schools, however, except incidentally in connection with general science, biology, or civics (none of which subjects are always required of all pupils), the matters of health are too much neglected for subjects of less moment save for obtaining entrance to college.
There is a steady increase in the number of schools making some effort at presenting the facts connected with sex; and, though progress in this direction seems painfully slow, there is promise that schoolmen are coming to the opinion that this subject is of importance and that they can transmit information on human origin with as much success as those to whom the precious task has hitherto been so generously confided.
The teaching of practical home hygiene, the care of children and of the sick, has found a foothold in many schools to the great benefit of all concerned. This work has been furthered in many quarters through the activity of the American Red Cross.
There is a most unfortunate confusion of terms and of understanding as to what is meant by physical education. Whereas in some school systems the words are still applied in their former broad meaning as covering all activities having to do principally with bodily development, health, and efficiency; in others they are applied in a limited sense to those more primitive (but none the less essential) body-mind activities in which the larger muscles are brought into play with coincident exercise of underlying functions.
Taking this subject in its narrower meaning, there has been a decided widening of interest in physical education in the past decade, brought about particularly by the war.
The movement for physical training of children in public schools, which arose in Europe in the early years of the nineteenth century, reached this country in due season. The systems adopted from Sweden and Germany were admirably adapted to fit into the routine order of classroom work. It was asserted and hoped that these exercises would counteract the effects of long sitting and of unavoidable bad posture. It was not likely, however, that gymnastics (arried on for a few minutes a day could have much developmental or recreative effect or any great mental or moral influence. In fact, the time element in itsell (seldom more than 15 minutes a day) negativeul any notable influence on physical development. Nevertheless, gymnastic exercises did much good, and were worth all the scant time and effort bestowed on them.
Interschool athletics were pursued in many schools with considerable outlay for coaching and for outfits, but this interest was bestowed where it was least needed from a purely physical standpoint.
The trend has been in late years, so far as the school curriculum and facilities will permit, to add to the formal gymnastic exercises the more natural training afforded by clancing, games, and a general participation in athleties. Methods of classifying elementary and secondary pupils for participation in sports are sought, and rewards of excellence in the way of badges or letters are employed to stimullate interest.
Thirty-three States have passed laws making physical education a part of the school curriculum, and in all but two instances the law is, in effect, mandatory. Fourteen States have appointed State directors, and the preparation of teachers in this subject, as well as