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Chicago carries on an extensive outing work. Medical inspection of the children often eliminates from the joys of a vacation in the country children who are predisposed to tuberculosis, who are running temperatures, and whose physical condition is such that they cannot safely romp and play with other children. Furthermore, our work calls us into homes where tuberculosis has laid low the supporter of the family. Chicago is still losing 4,000 people a year from tuberculosis. Our Tuberculosis Institute has found that from 25 per cent to 30 per cent of the children in such families are infected. The heaviest toll laid upon the resources of the United Charities of Chicago by any one cause is that occasioned by tuberculosis.

We know the three-room home, the family trying to live on six dollars a week. We see the children as babes, as little boys and girls; later, we deal with the same boys and girls who come out of school and try to find employment. We witness their disappointment when they fail because of health. We deal with grown people, failures because they have not the physique to stand up and take their place in the world. We see the finished dependent become chargeable for life upon the community because of failure of health or moral delinquency that arises thru inability to earn. We realize that it is hopeless to deal with trouble after it happens; that prevention is necessary; that it must be brought about thru education and the spread of right knowledge of living; that the hope is with the children of the country.

Professor Irving Fisher states that there are 138,000 deaths in a year in this country from tuberculosis, and estimates that unless something is done, of people now living 5,000,000 are destined to die from this preventable disease. It levies its greatest toll between the ages of twenty and thirty years. Saying nothing about affection, human values, and happiness, Professor Fisher states that the money loss alone is $1,100,000,000 a year.

Another authority has recently shown that in the state of Illinois alone $1,187,000 a year has been spent in the work of educating children who died before reaching their twentieth year.

The discovery of health needs has come from another angle and almost simultaneously. Medical inspection of schools began in Brussels in 1904, and is now national in scope in England, France, Belgium, Sweden, Switzerland, Bulgaria, Japan, the Argentine Republic, and practically so in Germany. In the United States, Boston began in 1894. Now all Massachusetts towns and cities and seventy cities in this country outside of that state have medical inspection. The data are not very accurate, but it is the universal experience that physical defects are found in a large percentage of the children. We are now speaking of all kinds of defectsnot tuberculosis only. In Minneapolis, in 1908, 65 per cent of the children examined were found defective; in New York, in 1906, 71 per cent. As a rule this inspection is yet crude, and only the more patent defects are discovered, because the examinations are not detailed or thoro; however, imperfect as is this machinery of discovery, it is much more complete than that for remedying defects when discovered. For instance, in Cleveland in 1907, only 22 per cent of the defective children discovered secured attention and correction; in New York, 25 per cent; in Somerville, Mass., 15 per cent.

This seems to indicate need of further interest and action by both teachers and the general public. It is of little value to know that 100 children have defects if only 25 receive treatment. It has not profited the other 75 much that somebody knows there is something the matter.

The particular form of relief which we are discussing this morning is that of anaemic children, those predisposed to tuberculosis. In Sweden there have been some very careful investigations. In Stockholm, this thoro work revealed the fact that 1.61 per cent of all the children under 15 showed pronounced tubercular infection. If this percentage were applied to the United States, and it is believed by many authorities to be a conservative estimate of children similarly affected in this country, it would mean that we have 230,000 such children.

It is commonly agreed that the usual school régime is not adapted to the needs of children of such pronounced physical handicap. The openair schools that receive these children are essentially ungraded schools, and perhaps 25 would be the right number for each room or teacher. If this were the case, there ought to be in the United States 9,200 such schools instead of 27 as there are at present. It would mean 85 in the city of Chicago instead of two.

What then is the open-air school ? How did it come about? Charlottenburg, a suburb of Berlin, led the way. With German thoroness, their people discovered the needs of these children first. They were also first in the field with sanatorium and scientific treatment. They discovered two things:

1. That the ordinary school régime did positive physical injury to such children.

2. That if they sent them to the sanatorium, while they improved in health, they lost their chance for an education or fell behind; hence the Wald Schule was the happy middle ground.

They took a group of anaemic children predisposed to tuberculosis to an open-air school in a forest near by, and the thrilling results started a chain of schools around the world.

In the open-air school, the health of the child is made first consideration, and the school work fits in according as physical needs will warrant. There is much more freedom and informality in such schools than in the usual school. Medical inspection, weighing, taking of temperatures, care and supervision by a nurse, knowledge of home conditions form an important part. Usually the day is something as follows:

Arrive at school, temperature taken, and inspection by nurse, 8:00 to 8:30.
Bath followed by lunch, 8:30 to 9:00.

In school, 9:00 to 10:15.
Recess, 10:15 to 10:30.
In school, 10:30 to 11:45.
Preparation for dinner, and dinner, 11:45 to 12:45.

Period of rest of one section of the school alternating with the second section which goes through the same régime, 12:45 to 3:15.

Then play, gymnastics, temperature, and lunch, return home and to bed at eight o'clock.

The school régime includes not only the medical inspection but care and attention of the nurse all the time and careful and thoro knowledge of the home conditions of each child and a conscious, definite effort made thru the doctor, the nurse, and the social worker if need be to reach the home conditions and render them suitable to the needs of the child. This means diet, ventilation of sleeping-rooms, cleanly habits, good cooking, and all the rest. It often meant putting relief in the home, because the home conditions of most of the 49 children who came to the Elizabeth McCormick Open-Air School was such that it needed not only the advice and help of the nurse but often relief from charitable agencies.

In the distinctly open-air school as conducted in this country, children of pronounced predisposition or infection are selected. In the New York and Boston open-air schools, cases of open tuberculosis are admitted. These schools have been conducted in all kinds of places-schoolrooms, roofs, ferry boats, balconies, tents, unused school buildings, dwellinghouses, municipal bath buildings, park refectories, and specially designed rooms.

Growing out of the experiments with these children who showed tuberculous infection, the open-window room with its particular régime is evolying. These rooms are designed for anaemic children and those with less pronounced physical difficulties.

The expense in the open-air schools incurred on account of food, clothing, special attendants, and usually the building is borne by some private agency. The average cost for such schools, exclusive of the original equipment, is from twenty to twenty-five cents per school day per child. In the open-window rooms any extra expense for food, clothing, attendants, cost of special equipment is also borne by some private agency. The school board, I think, in every instance has supplied the teacher and all school equipment and supervision.

The régime for the open-window room, at least in Chicago, has not been fully standardized as yet, but I think that all will agree that there should be careful medical inspection in selecting the children, that they should be weighed periodically, temperatures taken, home conditions known and made suitable if possible, and that the services of a nurse or attendant to supplement the teacher's work by taking care of feeding, wrapping the children up when they are lying down, helping to remove wet clothing, etc., should be a part of the scheme. Chicago is planning

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also to have three or four rooms where it is hoped that the only addition to the usual school régime will be more careful and detailed medical supervision. These will probably be known as low-temperature rooms, but it it is to be distinctly understood that low temperature in this sense is synonymous with fresh air. No one wants to make the mistake of assuming that cold air is necessarily fresh air. The great point to be achieved in all this work is that the whole 19,000,000 children should get their share of the fresh air of which the Good Lord has made plenty for all. If they are educated to the right feeling for fresh air and for health needs and health rights, the problems of smoke nuisance, bad air in theaters, churches, street cars, and trains will be on the high road to solution. It only needs the right attitude on the part of the public to obtain its rights in this respect, for the fresh air is present everywhere, only waiting to be let in, and certainly the intelligence of the American people will find a way.

Now as to the results. The universal testimony is that the children gain in weight, that temperatures are reduced, that listless children become alert and attentive, and that there is a marked change in the mental grasp. In the Elizabeth McCormick Open-Air School, there was an average gain of something over four pounds. Altho there was one-third less time spent on the school work, no child failed to make his grade, three of them made two grades, and one made three.

What do the teachers think about this work? Here are testimonials from those who have been engaged in this work in places scattered all over the country.

TESTIMONY OF TEACHERS WHO HAVE TRIED THE WORK

“I would not care to return to the closed room. My pleasure in my work makes me wish that for the sake of the teacher as well as the pupil every room might be an open-air room.”—Marie E. Powers, teacher in the Providence Open-Air School.

“As I am an arrested case of tuberculosis, I could never have stood work in any place but an open-air school. I never wish to go back to the usual poorly ventilated school building.”—H. L. Birdsall, teacher in the Brooklyn Open-Air School.

“For a score or more years my experience as a teacher has been gained in the public schools of this country, in good old New England, California, and the Middle West. Our teachers today are victims of nervousness, irritability, and so-called overwork. Those who have tried the outdoor work have been capable of more prolonged labor with far less fatigue. This is my own experience and nearly all teachers who have given it a fair trial feel that there is no place for them like the open-air school.”—Helen M. Mead, formerly teacher in Franklin Park School, Boston.

“The work is heavier in an open-air class, but I feel much more able to accomplish it. After a day's work I now return home fresh and do not suffer from the usual headache and dryness of throat that follow teaching in the ordinary room.”—Katherine Nolan, teacher in open-air room, Public School No. 21, New York City.

“My color has improved and my weight increased. At 3:15 I do not feel the fatigue I formerly felt at 10:30. I am comfortable in a lower temperature than before. Trifles which had assumed the proportions of mountains affect me less.”—Effie Hoerner, teacher in open-window room, Graham School, Chicago.

“Fresh air has done wonders for me. I am strong and fat and have gained ten pounds since last year in spite of seven weeks' work in the summer. My complexion has undergone a complete change. Instead of being a sallow, dead, dry-skinned person, my skin is fresh, full of life and rosy.”—Henriette Roos, teacher in open-window room, Graham School, Chicago.

“I have never in my life been so free from backache and extreme fatigue as I hav been since I took the open-air school. 'How do you keep so fresh?' asked another teacher last night. 'I am always nervously exhausted after a dark, rainy day like this.' I told her, truthfully, that I had ceased to dread such days. Not even rain can dispel the sunshine in the open-air school.”—Anna Bunker, teacher in the Elizabeth McCormick OpenAir School, Chicago.

Boston has already voted to have at least one room in each new school building constructed with the intention of being used for open-air work. New York has remodeled rooms in several buildings so that roofs can be utilized and windows opened clear out. A school principal in San Diego, Calfornia, writes:

My building here in this city is so crowded that the board are talking of erecting a new building. I am trying to persuade the superintendent to give me a thoroughly typical southern California schoolhouse, all on the ground floor, if need be, with one side of the room so constructed of glass folding doors that the entire side can be thrown open to the air. There are not more than ten or a dozen days during our school year when we could not have that side open.

The Elizabeth McCormick School was started and maintained by a fund given in memory of a most unusual child. In her few brief years, she had given indication of a life of altruism and great usefulness. A child herself, her interest was peculiarly in children, in surrounding their lives with possibilities of happiness. Thru this fund in her memory was discovered Julia, the little girl whose picture graces the cover of the book, Open-Air Crusaders. Both of these children have had a part in carrying this message one who gave, and one who, in receiving, also gave.

B. THE TRAINING OF THE MENTALLY AND PHYSICALLY

UNFORTUNATE

LEONARD P. AYRES, RUSSELL SAGE FOUNDATION, NEW YORK CITY

DEVELOPMENTS OF THE PAST DECADE

Eleven years ago the school superintendents of America, assembled in convention in Chicago, discussed the problems then foremost in educational thought and action. Diligent search thru the printed report of that meeting discloses no single mention of child health, no word about school hygiene, no address devoted to the conservation or development of the physical vigor of youth.

At that time eight cities in America had systems of medical inspection in their public schools. Today the number of such systems is over four hundred. This development is without parallel in the history of education.

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